Knee Effusion Research Articles

Vascular endothelial growth factor and colour Doppler ultrasonography in knee osteoarthritis: Relation to pain and physical function

Aim of the workTo investigate the vascular endothelial growth factor (VEGF) levels in serum and synovial fluid of patients with knee osteoarthritis (KOA) and to determine the relationship of VEGF levels with clinical manifestation, physical function, radiographic grading and ultrasonography (US) findings. Patients and methods45 patients with KOA and 15 matched control subjects were enrolled. Western Ontario McMaster Osteoarthritis index (WOMAC) was scored, knee X-rays assessed using Kellgren and Lawrence (KL) scale and superficial gray scale and colour Doppler US were done. Serum and synovial VEGF levels were analyzed. ResultsThe 45 patients mean age was 56.5 ± 11.2 years; 39 females and 6 males (F:M 6.5:1). 30 (66.7%) patients had bilateral symptomatic KOA. Knee effusion was mild in 4, moderate in 26 and severe in 21. The mean WOMAC score was 70.9 ± 10.7; pain (14.7 ± 3.4); stiffness (6.2 ± 1.4) and disability (49.2 ± 12.4). The serum VEGF level was 0.29 ± 1.02 pg/ml and the synovial 0.48 ± 0.1 pg/ml both significantly increased compared to the control (0.14 ± 0.7 pg/ml and 0.33 ± 0.1 respectively, p < 0.0001). Levels in grade 3 KL were significantly increased compared to those with grades 1 or 2 (p < 0.0001) and between colour Doppler US grades 1 and 2 (p < 0.0001). A strong correlation was present between serum and synovial VEGF with X-ray and colour Doppler US grading as well as the WOMAC index (p < 0.0001). ConclusionSerum and synovial VEGF correlated with clinical, functional, radiographic and US severity in KOA patients. Both VEGF and musculoskeletal ultrasound may serve as promising potential tools for evaluating disease severity in KOA.

Traumatic knee injury: correlation of radiographic effusion size with the presence of internal derangement on magnetic resonance imaging.

Traumatic knee injury is a common clinical presentation. However, knee internal derangement often goes undiagnosed on physical exam. The authors hypothesize that patients with suprapatellar joint effusion greater than 10mm anteroposterior diameter on lateral radiograph have a high likelihood of knee internal derangement on magnetic resonance imaging. A retrospective review of knee radiographs and magnetic resonance imaging in 198 patients age 18-40years with acute knee injury was performed. Suprapatellar effusion diameter on lateral radiography was correlated to the presence of internal derangement on magnetic resonance imaging. Magnetic resonance imaging anteroposterior effusion size at four locations was correlated to radiographic suprapatellar effusion measurements. Logistic regression showed a positive correlation between radiographic effusion size and the presence of internal derangement on magnetic resonance exams (p value < 0.001). Radiographic effusion > 10mm was established as a positive test, yielding test sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 55, 96, 93, 71, and 77%, respectively. Statistical analysis showed the radiographic anteroposterior effusion diameter most closely approximated the magnetic resonance effusion diameter at the lateral patellofemoral recess. This study shows that knee radiography is a highly specific screening test for internal derangement in patients less than 40years old with acute knee injury. In this patient population, knee effusion > 10mm on lateral radiograph should prompt consideration for knee magnetic resonance examination. Adopting this approach as a clinical guideline has the potential to decrease delayed diagnosis, improve patient outcomes, and decrease cost-associated disability.

Bilateral lipoma arborescens –A proliferative case demonstrating progression in an adolescent male

CaseWe describe a case of extensive symptomatic bilateral lipoma arborescens of the knee in a 19-year-old man who suffered from recurrent knee effusions for many years. This patient had MRI evidence of progression of disease prior to arthroscopic intervention. He was treated with bilateral complete arthroscopic synovectomies, demonstrating no evidence of cartilage wear. ConclusionLipoma arborescens is a progressive disease. Timely diagnosis and treatment may prevent disease evolution and sequela.

Knee Pain - Football, Basketball

HISTORY: 16 year-old high school football and basketball athlete was referred to Sports Medicine. He could not recall a specific injury, but had 2 months of recurrent pain and swelling with high-impact activities. No neuropathic, mechanical, nor instability symptoms. No prior knee orthopedic history. PHYSICAL EXAMINATION: Inspection showed slight genu valgum and small right knee effusion. No pain with palpation of all bony and soft tissue landmarks of the knee. Active range of motion was pain free and symmetric for knee flexion and extension. Strength was intact at 5/5 hip flexion, knee extension and knee flexion. Provocative maneuvers showed no pain with bounce and McMurrays, firm 1+ endpoint with Lachmans, anterior drawer, and posterior drawer. He was stable and symmetric with no laxity or pain during varus and valgus stressing of the knee at 0 and 30 degrees of flexion. No pain with patellar compression and negative dial testing. DIFFERENTIAL DIAGNOSIS: Includes meniscus pathology, plica syndrome, patellofemoral pain, osteochondritis dissecans (OCD), stress injury TESTS AND RESULTS: 1. Standing knee xrays showed medial femoral condyle OCD with knee effusion and loose body in suprapatellar space. 2. MRI of right knee showed 1.7 x 1.3 cm osteochondral defect at the central weight-bearing surface of the medial femoral condyle with displaced osteochondral fragment in the suprapatellar bursa. FINAL WORKING DIAGNOSIS: Grade IV osteochondritis dissecans lesion TREATMENT AND OUTCOMES: 1. Recommended non-weight bearing and medial unloader brace requested while physical therapy initiated. 2. Diagnostic arthroscopy for loose body removal and biopsy for matrix-induced chondrocyte implantation. 3. Low impact activities only, physical therapy and medial unloader brace with ambulation until harvested cells ready for implantation. 4. Matrix-induced autologous chondrocyte implantation was performed after 6 weeks of cell culturing. 5. Athlete treated with post-operative rehabilitation protocol. 6. MRI at 6 months demonstrated interval progression of healing medial femoral condyle OCD. 7. Athlete will continue post-operative rehabilitation protocol and will be assessed for readiness for sport progression at 12 and 18 months.

Right Distal Thigh Pain - Water Polo

HISTORY: A 15 year old male experienced spontaneous onset of distal lateral thigh pain during his water polo season without preceding event. Symptoms, including an ache and hypersensitivity, responded to activity modification but recurred immediately upon activity resumption, with knee extension even against gravity. He noted no mechanical symptoms, swelling or discoloration. Patient had been receiving physical therapy for presumed distal quadriceps tendinosis but was soon unable to tolerate even topical treatments to the region. PHYSICAL EXAMINATION: Exam revealed tenderness localized to the superior pole of the patella and the vastus lateralis-retinacular interface without nodularity. No knee effusion was present, and all provocative maneuvers of the knee were negative. Give-way weakness of the right quadriceps was present as was skin hypersensitivity. DIFFERENTIAL DIAGNOSIS: 1. Proliferative synovial disorder 2. Vascular malformation 3. Chronic musculotendinous strain of the vastus lateralis-retinacular region 4. Malignancy TEST AND RESULTS: Femur radiographs were negative but contrast MRI of the distal thigh revealed a T2 hyperintense lobulated mass deep to the vastus lateralis and quadriceps tendon, separate from the suprapatellar recess. CT guided biopsy showed benign fibrovascular tissue consistent with an arteriovenous malformation (AVM). FINAL WORKING DIAGNOSIS: Slow flow arteriovenous malformation TREATMENT AND OUTCOMES: The patient underwent percutaneous sclerotherapy with 2cc of absolute alcohol. He reported complete resolution of pain within 1-2 weeks and returned to all previous competitive activity.Figure

Investigation on the prevalence of hyperuricemia among young students

Objective: To investigate the prevalence of hyperuricemia and the distribution of serum uric acid in young students. Methods: Determination of 14 214 cases of freshmen, 3 072 cases of the graduate and 6 804 cases of school staff in 2015-2016 from one University of Beijing with uric acid (UA) enzymatic method, hyperuricemia criteria for male UA >420 μmol/L, female UA >357 μmol/L, were grouped according to age. From freshmen in 2016 randomly selected 1 782 cases men and 1 175 cases women through the questionnaire to investigate the prevalence of gout. Results: The prevalence of hyperuricemia in male and female freshmen were 34.47% (1 958/5 681) and 11.64% (993/8 533) respectively. The prevalence of hyperuricemia in male and female graduates were 32.73% (381/1 164) and 10.06% (192/1 908) respectively. In the same period, the prevalence of hyperuricemia was 14.42% (480/2 844) among male workers and 9.92% (393/3 960) among female workers. The blood uric acid level was analyzed among the freshmen in 2015-2016 and the graduates in 2015, most freshmen were 420-480 μmol/L in males and 357-480 μmol/L in females. The prevalence of gout was 0.34% (6/1 782) in males and 0.26% (3/1 175) in females respectively (which had at least one attack of the first metatarsophalangeal joint and non-traumatic articular pain and swelling of the knee). In addition, there was no significant difference in the prevalence of hyperuricemia in coastal and inland areas (P>0.05). There was significant difference in the proportion of BMI in male and female newborns with hyperuricemia (P<0.05). Conclusion: The young men of high uric acid hematic disease prevalence showed a trend of increased significantly, male and female serum UA value most in mild-to-moderate elevated levels, and a lower incidence of gout. Compared with the general population, BMI of the freshmen with hyperuricemia increased significantly.

Association between objectively assessed physical activity measures and longitudinal knee structural damage

Purpose: The relation between physical activity (PA) and the development of knee osteoarthritis (OA) is an important clinical and public health issue. Studies conducted thus far have shown conflicting results. This is most likely due to the small study samples, semi-quantitative assessment of PA and a lack of objective longitudinal data including intensity of PA. The purpose of the study was to describe the predictors and the longitudinal association between PA level and global knee structural progression. Methods: 864 participants [mean age = 65 (48–84), female % = 58] were included in this study who had valid PA data and right knee MRI data from 48 month and 72 month visits of the Osteoarthritis Initiative (OAI) study. Physical activity was monitored using ActiGraph GT1M uniaxial accelerometers (ActiGraph; Pensacola, FL). PA was categorized into time spent doing light, moderate, moderate to vigorous (MVPA) and vigorous activity depending on the activity counts/minute as described on the OAI website. PA intensity was further categorized into bouts of MVPA and vigorous activity as already describe don the OAI website. PA was further categorized to assess whether the participants met the weekly PA level prescribed American College of Sports Medicine (ACSM) and Department of Health and Human Services (DHHS). MRI data was scored using the modified Whole Organ MRI Score (WORMS). All multivariable analyses were adjusted for age, sex, BMI, radiographic OA and history of knee injury/surgery. Results: 1. Change in total modified WORMS – Baseline predictors Higher number of minutes spent doing light activity independently predicted significant worsening of total modified WORMS (β (per activity count) = +0.99 (+0.51, +1.48)). On the other hand higher number of minutes spent doing vigorous activity (β = −0.17 (−0.33, −0.01)) and more intense (β (per activity bout) = −0.14 (−0.26, −0.01)) PA were associated with a decrease in severity of WORMS over two years. – Longitudinal associations Neither changes in minutes spent in any of the four PA categories nor changes in intensity of PA over two years were significantly associated with total modified WORMS. 2. Changes in individual knee structures on MRI (i) Cartilage defects: – Baseline predictors More minutes spent doing light and moderate PA at baseline were independently associated with a significant worsening of cartilage defects over two years. – Longitudinal associations Increase in the number of minutes spent doing light activity over two years was associated with worsening cartilage defects, however increase in the minutes spent doing vigorous PA was associated with improvement in cartilage defects score. (ii) Bone marrow edema (BME): – Baseline predictors None of the baseline PA categories independently predicted change in BME over 2 years – Longitudinal associations Increase in minutes spent doing light activity was independently associated (β = 3.78 (1.42, 6.19)) with worsening BME over two years, however increase in vigorous activity minutes and intensity was associated with significant improvement in BME lesions. (iii) Meniscal pathologies – Baseline predictors More minutes spent doing light activity were associated with worsening meniscal tears over two whereas vigorous activity and higher intensity were associated with improvement in meniscal score. – Longitudinal associations Increase in time spent doing light to moderate activities was associated with improvement in meniscal scores but remained stable with vigorous PA (iv) Effusion – Baseline predictors Light activity at baseline was associated with significant improvement in severity of effusion whereas vigorous and more intense PA independently predicted worsening effusion grade. Longitudinal associations Increasing time spent doing more vigorous PA was associated with progressively worsening knee effusion. A similar trend was observed with increasing intensity of PA. Increase in PA level from baseline to meet ACSM and DHHS guidelines was generally associated with improvement in knee structural pathology grades. Conclusions: Increases in time spent doing vigorous activity and increase in intensity of PA is generally associated with a protective effect on the knee joint except for knee joint effusion that worsened with increasing level of PA.

The effect of knee joint effusion on gait mechanics and muscle activations in individuals with moderate knee osteoarthritis

Purpose: Knee osteoarthritis (OA) is the most common joint disease and is often characterized by pain, stiffness, swelling and limited tolerance to weight-bearing activities. It has been shown to be associated with biological inflammatory processes in the synovium, synovitis, and mechanical insults that lead to the deterioration of the joint structures. Synovitis is usually characterized by knee joint swelling and the mechanical knee joint environment during a loading stimulus can be studied in vivo using state-of-the-art gait analyses. The study objective is to compare knee mechanics and muscle activation patterns during gait in individuals with knee OA who have and do not have knee joint swelling. Methods: 45 patients diagnosed with moderate medial compartment knee OA were recruited. Knee swelling was measured at three locations (mid, medial, lateral) of the supra-patellar recess (SRD) using ultrasound imaging. A maximum depth, regardless of the location was determined. Effusion presence was defined as a SRD depth >4 mm. Knee joint motion was calculated from skin markers and net external moments calculated through inverse dynamics during walking on a dual-belt instrumented treadmill at self-selected speed. Electromyography (EMG) from vastus medialis (VM) and lateralis (VL), medial (MH) and lateral hamstrings (LH), medial (MG) and lateral gastrocnemius (LG) was recorded using standardized procedures. Two-sample unpaired t-tests were used to test for significant differences in sagittal plane knee joint angles, sagittal and frontal external moments, pain, Knee Osteoarthritis Outcome Scores, age, body mass index, stride characteristics, and knee extensor and flexor strength. Principal component analysis (PCA) was performed on the EMG waveforms to capture amplitude and temporal based features. Principal Pattern (PP)-scores were calculated from principal patterns that together explained >90% of the waveform variability. Two-way mixed-model Analysis of Variance models were performed on the PP-scores to identify muscle, group and interaction effects. Bonferroni corrected pairwise post-hoc comparisons were made. A P-value of 0.05 was used to determine statistical significance. Results: Of the 45 participants, 25 had effusion (SRD > 4mm). No significant differences were found between groups in subject demographic and anthropometrics, questionnaire outcomes, and knee strength (P > 0.05). Both groups had a similar radiographic grade distribution. No biomechanical differences existed between both groups, however the effusion group had greater overall amplitudes of VM and VL (PP1-scores) and greater early stance activation of the gastrocnemius muscles (PP2-scores). No other group differences or group by muscle interactions existed. Conclusions: These results, as shown in Figure 1, indicate that specific amplitude knee joint muscle activation patterns are altered in the presence of knee effusion during gait in individuals with knee OA. Greater stance phase amplitudes in the quadriceps and gastrocnemius muscles are consistent with responses aimed at providing neuromuscular knee joint support and increasing early stance active stiffness, respectively, in order to preserve knee function when effusion is present. These muscular adaptations have been previously reported with increased OA severity suggesting a possible link between gait mechanics and knee swelling as knee OA progresses. The 4 mm SRD threshold has previously been linked to a higher risk of knee OA progression, supporting findings of this study. Future studies can investigate different cut-off values for the detection of effusion sonographically to establish whether biomechanical subgroups may exist.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Effectiveness of intraarticular steroids in osteoarthritis of knee

Knee osteoarthritis is a degenerative disease characterized by cartilage destruction which manifests as pain, stiffness and loss of joint motion. With increasing longevity, aging of population and increased incidence of obesity, osteoarthritis remains a potentially major health problem as well as global economic burden. Intraarticular steroids are frequently & effectively used to treat acute and chronic inflammatory conditions of joints, especially during osteoarthritis flare with evidence of inflammation like increasing pain and joint effusion. This reduces acute episodes of pain and increases joint mobility and rehabilitation. This was a prospective hospital based study of 240 Patient with osteoarthritis knee. Average age was about 54±3 years, knee effusion detectable in 80% of patients and radiographic features of osteoarthritis in 91% cases at time of injection. Results showed significant improvement in pain and joint tenderness at 6 weeks after injection. There is consensus now that intraarticular steroids are extremely helpful in acute episodes of arthritic pain and efficacy is almost similar and equal to other modalities of intrarticular injection therapies. Intraarticular steroid injections are reasonably safe, reliable and time tested treatment of arthritic conditions and thus can be used as first line of treatment in flares of osteoarthritis with features of synovial inflammation to reduces crisis of pain and promote rehabilitaional activities and bring back smiles to patients.

Clinical Efficacy of Jump Training Augmented With Body Weight Support After ACL Reconstruction: A Randomized Controlled Trial

Background: Limited knee flexion and increased muscle co-contraction during jump landing are believed to diminish outcomes after anterior cruciate ligament (ACL) reconstruction. The efficacy of jump training to improve patients’ mechanical and neuromuscular deficits is understudied. Hypothesis: Jump training will improve functional, mechanical, and neuromuscular outcomes and higher repetition training augmented by body weight support will result in better retention of gains. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Thirty athletes (18 months after surgery) were screened, and 19 with mechanical deficits and limited clinical outcomes were enrolled in the trial. Testing included the International Knee Documentation Committee (IKDC) questionnaire, leg landing mechanics via motion analysis, knee joint effusion using a stroke test, and a surface electromyography–generated co-contraction index during a single-legged landing. Participants were randomly assigned to 1 of 2 groups: jump training with normal body weight (JTBW) and high-repetition jump training with body weight support (JTBWS). Knee effusion grading throughout training was used to assess joint tolerance. Changes in outcomes over time were analyzed with mixed-effects modeling. Immediate outcomes were compared with retention testing at 8 weeks after training by use of 2-way analyses of variance with effects of time and group. Results: Significant effects of time were found during the training phase for all outcome measures, but no effects of group or sex were found. IKDC score (pooled; mean ± SD) increased from 76 ± 12 to 87 ± 8 (P < .001). Knee flexion during single-legged landing increased from 57° ± 11° to 73° ± 9° (P < .001). Average co-contraction index decreased from 37 ± 15 to 19 ± 6 (P < .001). All measures were retained over the retention period in both groups. The relative risk of knee effusion of the JTBW group versus the JTBWS group was 4.2 (95% CI, 2.25-7.71; P < .001). Conclusion: Jump training mitigated some risk factors for second injury and osteoarthritis in patients after ACL reconstruction. Training made lasting improvements in physical function measures as well as mechanical and neuromuscular coordination deficits. Higher repetitions used with body weight support did not improve retention but substantially reduced risk for effusion. Clinical Relevance: Jump training is an efficacious intervention for athletes with poor outcomes after ACL reconstruction, and training with body weight support lessens the risk for excessive joint stress during practice. Registration: NCT02148172 (ClinicalTrials.gov identifier)

The popliteus tendon provides a safe and reliable location for all-inside meniscal repair device placement.

Repairs of the posterior horn of the lateral meniscus can be technically challenging. In contrast to medial meniscus repairs, the capsule around the posterior segment attachment of the lateral meniscus is quite thin. This study evaluates the clinical results of an arthroscopic all-inside repair technique for unstable, vertical, lateral meniscus tears, using a suture repair placed directly into the popliteus tendon. A retrospective analysis of prospectively collected data from the SANTI database was performed. All patients who had undergone combined ACL reconstruction with lateral meniscus all-inside repair, using sutures placed in the popliteus tendon, between 2011 and 2015, were included. Patients were reviewed clinically at 1 and 2years' follow-up. At final follow-up, all patients were contacted to identify if they underwent further surgery or had knee pain, locking or effusion. Symptomatic patients were recalled for clinical evaluation by a physician and Magnetic Resonance Imaging of the knee. Operative notes for those undergoing further surgery were reviewed and rates and type of re-operation, including for failed lateral meniscal repair were recorded. Two hundred patients (mean age 28.6 ± 10.2years) with a mean follow-up of 45.5 ± 12.8months (range 24.7-75.2) were included. The mean Subjective International Knee Documentation Committee (IKDC) at final follow-up was 85.0 ± 11.3. The post-operative mean side-to-side laxity measured at 1year was 0.6 ± 1.0mm. Twenty-six patients underwent re-operation (13%) at a mean follow-up of 14.8 ± 7.8months. The ACL graft rupture rate was 5.0%. Other causes for re-operation included medial meniscus tear (2.5%), cyclops lesion (1.5%) and septic arthritis (0.5%). The lateral meniscus repair failure rate was 3.5%. No specific complications relating to placement of sutures in the popliteus tendon were identified. Arthroscopic all-inside repair of unstable, vertical, lateral meniscus tears using a suture placed in the popliteus tendon is a safe technique. It is associated with a very low failure rate with no specific complications. Level IV.

3:09 PM Abstract No. 202 Embolization of genicular arteries for chronic hemarthrosis post knee prosthesis

Postoperative hemarthrosis after knee prosthesis can be invalidating due to painful swelling of the knee and diminished mobility. We describe the technique and clinical results of endovascular embolization of genicular arteries performed over a 10-year period. A retrospective review of 31 patients (17 male, 14 female) treated for chronic knee hemarthrosis from 01.2007 until 12.2016 was performed. The mean age was 67y (range, 48-90). A total of 39 embolization procedures were performed (24 single, 6 double and 1 triple), 27 right and 12 left sided. The mean time from surgery to symptoms was 24,4 months (range, 1-64) and to embolization was 27,4 months (range, 1-70). Surgery type was total-knee prosthesis (TKP) in 29 patients, unicondylar (UC) prosthesis in 2. The mean follow-up was 61,9 months (range, 2 - 120). The technical approach was ipsilateral (antegrade femoral) in 34 procedures and contralateral in 5. All embolizations were performed using 4F diagnostic catheters, 2.7F microcatheters and microspheres ranging from 100 - 500μ. The technical endpoint was subtotal devascularization in order to avoid ischemic complications. Clinical endpoint was symptomatic improvement. Technical success was achieved 100%. In all cases, the superior lateral and medial genicular arteries could be embolized. In 12/39 procedures (31%), one or both inferior genicular arteries could not be catheterized due to the superposition of the TKP. Embolization was then performed through collaterals. Symptomatic improvement was achieved in 26/31 patiënts (84%). Symptomatic recidive was more frequent with larger particles (up to 500μ). Postprocedural pain was observed in all patients, treated with paracetamol, resolving inside 24 hours in most. Smaller particles (100μ) resulted in more severe pain. Therefore, particular size of 250μ is preferred. Two complications occurred, one low grade infection and one aseptic necrosis requiring surgical revision. No peripheral emboli were noted. Endovascular embolization of genicular arteries is safe and effective for the treatment of chronic hemarthrosis post knee prosthesis placement. Clinical improvement is seen in most patients. Complications are rare.

PATELLOFEMORAL CHONDRAL DEFECT IN A PREADOLESCENT SKIER: A CASE REPORT IN EARLY SPORT SPECIALIZATION

Early sport specialization (ESS) refers to intense training year round in a specific sport starting at a young age with no or limited participation in other sports. This approach to training is highly controversial; recent literature suggests that this type of specialized training could be a contributing source to overuse injuries in youth athletes. The purpose of this case report was to describe a patellofemoral articular cartilage defect of the knee in a preadolescent skier due to overuse and repetitive microtrauma as a result of ESS. Case Report. A healthy 11-year-old male competitive alpine skier presented with recurrent swelling of his right knee and persistent anterior knee pain while skiing without evidence of any specific history of injury or traumatic event. The patient failed a conservative treatment regimen including rest and formal physical therapy focused on generalized knee strengthening. Magnetic resonance imaging was ordered and revealed an articular cartilage defect of the medial patellar facet. The patient was treated with an arthroscopic debridement of his articular cartilage defect. At 12 weeks postoperatively, the patient presented with a normalized gait pattern, no evidence of knee effusion, full knee range of motion and patellar mobility symmetric to his contralateral limb, and no patellar crepitation or painful palpation on physical exam. The patient was released to begin return to sport progression at 12 weeks, and was cleared for full activities/returned to competitive skiing at 15 weeks postoperatively. At 16 weeks postoperatively, he won an international alpine ski race in Europe for his age group. Cartilage injuries and osteochondral defects are very common in adolescent athletes and often go undiagnosed. Allied healthcare professionals must be educated on the known causes of recurrent knee effusions and how early sport specialization may result in overuse injuries to knee joint cartilage. 4.

Medical image analysis of knee joint lipoma arborescens and arthroscopic treatment

ObjectiveArthroscopy is a minimally invasive surgical procedure on a joint in which examination and treatment of knee damage is performed using a surgical device known as the arthroscope. Lipoma arborescens (LA), an infrequent intra-articular lesion, originates from mature adipose cells under subsynovial tissue. The synovial membrane is pale yellow with large villous projections. It is caused by various underlying factors. We found many patients with LA and processed them appropriately.The research was implemented to investigate therapeutic effect of semi-automated arthroscopic diagnosis and treatment for knee joint. MethodsWe used the Stryker arthroscopic in surgery that is 4 mm in diameter with angle at 30°. Patients were chosen by biomechanical analysis and scanning mode. All of the patients underwent radiographic imaging examination, Magnetic Resonance Imaging (MRI), Lysholm Score and Visual Analogue Scale (VAS). Arthroscopic limited synovectomy was carried out on these patients. ResultsThe wound of all patients healed up. The content of follow-up includes: chief complaints, range of motion of knee joint, Visual Analogue Scale (VAS) and Lysholm score. No swollen nor effusion of the infected knee was found in all patients during the follow-up. The postoperative symptom was markedly alleviated in fourteen patients and partially alleviated in one. All patients were satisfied with the therapeutic effect. ConclusionWe performed biomechanical analysis based on knee slight flexion and extension. Arthroscopy is an endoscope for the diagnosis and treatment of joint diseases. Semi-automated arthroscopic debridement is good for early and mid-term osteoarthritis with Lipoma arborescens.

Inflammation and glucose homeostasis are associated with specific structural features among adults without knee osteoarthritis: a cross-sectional study from the osteoarthritis initiative

BackgroundGreater age and body mass index are strong risk factors for osteoarthritis (OA). Older and overweight individuals may be more susceptible to OA because these factors alter tissue turnover in menisci, articular cartilage, and bone via altered glucose homeostasis and inflammation. Understanding the role of inflammation and glucose homeostasis on structural features of early-stage OA may help identify therapeutic targets to delay or prevent the onset of OA among subsets of adults with these features. We examined if serum concentrations of glucose homeostasis (glucose, glycated serum protein [GSP]) or inflammation (C-reactive protein [CRP]) were associated with prevalent knee bone marrow lesions (BMLs) or effusion among adults without knee OA.MethodsWe conducted a cross-sectional study using baseline data from the Osteoarthritis Initiative. We selected participants who had no radiographic knee OA but were at high risk for knee OA. Blinded staff conducted assays for CRP, GSP, and glucose. Readers segmented BML volume and effusion using semi-automated programs. Our outcomes were prevalent BML (knee with a BML volume > 1 cm3) and effusion (knee with an effusion volume > 7.5 cm3). We used logistic regression models with CRP, GSP, or glucose concentrations as the predictors. We adjusted for age, sex, body mass index (BMI), and Physical Activity Scale for the Elderly (PASE) scores.ResultsWe included 343 participants: mean age = 59 ± 9 years, BMI = 27.9 ± 4.5 kg/m2, PASE score = 171 ± 82, and 64% female. Only CRP was associated with BML prevalence (odds ratio [OR] = 1.43, 95% confidence interval [CI] = 1.09 to 1.87). For effusion, we found an interaction between BMI and CRP: only among adults with a BMI <25 kg/m2 was there a significant trend towards a positive association between CRP and effusion (OR = 1.40, 95% CI = 1.00 to 1.97). We detected a U-shaped relationship between GSP and effusion prevalence. Fasting glucose levels were not significantly associated with the presence of baseline effusion or BML.ConclusionsAmong individuals without knee OA, CRP may be related to the presence of BMLs and effusion among normal weight individuals. Abnormal GSP may be associated with effusion. Future studies should explore whether inflammation and glucose homeostasis are predictive of symptomatic knee OA.

Detection of Non-Traumatic Knee Effusion among Asymptomatic Individual with Different type of Lifestyle and Selected Sociodemographic Factors Using Fluid Shift Test and Ultrasonography

Background history: Non-traumatic knee effusion might be the result of overuse leading to wear and tear processes or systemic diseases. Knee effusion-synovitis was a predictive of some structural abnormalities in the joint suggesting a potential role in early osteoarthritis changes. It is postulated that the active life style with prolonged standing hours predisposed for the increase prevalence of non-traumatic knee effusion even in the young age.Method: Final year medical students and clerical office staffs from Royal college of Medicine Perak were randomly selected. Those who had some kind of physical activities (walking, jogging or any kind of sports) for more than half an hour a day at least three times per week among the students and the clerical office staffs were included in active life style group and the remaining were listed in sedentary life style group. All were assessed for knee effusion by two orthopaedic surgeons clinically and then assessed by ultrasound examination on the same day. All were less than 30 years of age.Results: Data from 46 staffs and 53 students (total 99) were analysed. Number of participants in active life style group was 72 and that in sedentary life style groups was 27. Among the 99 participants, 53 (53.53%) had positive fluid shift test and 46 (46.5%) had effusion on ultrasound examination. The respondents who practice active lifestyle and respondents with BMI more than 25 had more prevalence than non-active respondents and respondents with BMI less than 25 respectively.Conclusion: The persons with active life style had more chance of having knee effusion. The five-point scale method of fluid shift test or stroke test is a reliable test for detection of small amounts of fluid in knee.

Effectiveness of a low-fat yoghurt supplemented with rooster comb extract on muscle strength in adults with mild knee pain and mechanisms of action on muscle regeneration.

To determine the effects of the intake of low-fat yoghurt supplemented with rooster comb extract (RCE) on muscle strength. 148 subjects, with mild knee pain, participated in a randomized, placebo-controlled, double-blind, and parallel study. Muscle strength, knee effusion, and pain perception were measured. C2C12 myoblasts were used to elucidate the mechanisms of action involved. RCE improved total work and mean power in men, and also peak torque in extension by 10%. RCE reduced synovial effusion by 11.8% and pain perception by 24.6%. Both RCE and HA increased myoblast proliferation by 29%, while RCE reduced myoblast differentiation by 36.2%, suggesting a beneficial role of RCE in muscle regeneration. Low-fat yoghurt supplemented with RCE improved muscle strength. This effect is partially explained by muscle regeneration enhancement, reduced synovial effusion, and reduced pain perception, which could exert a beneficial clinical impact on men affected by mild knee pain.

Chondroblastoma of the Patella: A Case Report

Chondroblastoma is a rare bone tumor of cartilaginous origin representing less than 1% of all the primitive bone tumors. This lesion usually develops in the epiphysis of long bones and occurs during the second decade of life. However, there are rare atypical localizations like the patella. We report an atypical case of chondroblastoma of the patella and discuss the clinical, radiological and therapeutic features of this rare location. A young 20-year-old patient consulted for right knee pain evolving for 2 months with a discreet knee effusion and pain on palpation of the patella. The radiological and CT showed lytic lesion of the distal half of the patella, lobulated, with sclerotic outlines and blowing the internal cortex. The patient underwent surgery with curettage and filling with autologous iliac cancellous bone graft. Histological examination led to the diagnosis of chondroblastoma. At last follow-up, 18 months, the patient had a normal function of his knee with no recurrence for radiological control. The location of chondroblastoma in the patella is exceptional but its radiological features resemble those of usual epiphyseal locations. The most popular treatment is curettage associated with cancellous bone grafting and thus to avoid the functional consequences of a patellectomy.

Effect of colchicine treatment on primary knee osteoarthritic patients

Background and Aim: It was hypothesized that cartilage degradation in osteoarthritis (OA) facilitates monosodium urate crystals nucleation which by its turn contribute to progression of OA. The aim of the current study is to assess the efficacy of oral colchicine treatment in patients having primary Knee OA (KOA). Patients and Methods: This clinical trial included 40 patients with KOA. After baseline evaluation, patients received oral colchicine 0.5 mg twice daily for 16-weeks period. The outcome measures (knee pain and WOMAC scale) and human urinary C-terminal telopeptide of type II collagen (uCTX-II) were evaluated at inclusion and at the end of study. Results: Colchicine had significantly improved frequency of knee effusion (from 62.5% to 40.0%, p=0.044), tenderness score (from 1.9 ± 0.8 to 1.3 ± 0.6, p<0.001), VAS-pain score (from 60.2 ± 11.7 to 48.6 ± 11.5, p<0.001) and the total WOMAC score (from 48.2 ± 6.4 to 42.8 ± 9.2, p=0.003). The uCTX-II was reduced from 447.4 ± 63.4 ng/mmol at baseline evaluation to 428.9 ± 106.7 ng/mmol at the end of treatment but this difference was not significant. Only one patient complained of gastrointestinal side effect in the form of diarrhea. Conclusion: Colchicine appears to be an effective and safe option treatment in primary KOA. Colchicine reduced pain and stiffness and improves functionality with good safety profile

Anatomical variant of the meniscus related to posterior junction: a case report

BackgroundThere are several reports on anatomical differences of the meniscus. However, there are only a few reports on abnormalities in both menisci and anatomical differences in anterior cruciate ligament insertions.Case presentationThis is a case report of a 36-year-old Hispanic man presenting symptoms, including knee pain, locking, and effusion, with an anatomical abnormality of the menisci corresponding to the fusion of the posterior horns of the menisci in tandem with the insertion of the posterior meniscus fibers in the anterior cruciate ligament.ConclusionsThis is the first study describing a meniscus anatomical variant with isolated posterior junction of the posterior horn with an anomalous insertion to the anterior cruciate ligament. The recognition of meniscus variants is important as they can be misinterpreted for more significant pathology on magnetic resonance images.