Knee Joint Disorders Research Articles

Retraction Note: Security-enhanced machine learning model for diagnosis of knee joint disorders using vibroarthrographic signals

Retraction Note: Security-enhanced machine learning model for diagnosis of knee joint disorders using vibroarthrographic signals

Numerical investigation of knee prosthesis stresses in daily activities: Insight into knee rehabilitation and Creation of a new optimal model

Total knee arthroplasty (TKA) is a cornerstone in addressing knee joint disorders, significantly enhancing patients' quality of life. However, despite technological advancements, a comprehensive understanding of the dynamic stresses experienced by knee prostheses during daily activities, particularly under rehabilitation interventions, remains elusive. This study aims to bridge this gap by employing numerical simulations and finite element analysis to elucidate these dynamic stresses and their interaction with rehabilitation protocols.A real-life knee replacement prosthesis model was meticulously constructed through coordinate measuring and 3D scanning, facilitating detailed finite element analysis in ANSYS Workbench version 17.1. Two distinct boundary conditions and loading scenarios were applied, with comparisons made between linear and nonlinear material assumptions. The simulation results using these different boundary condition methods revealed minimal differences. Specifically, at a knee angle of 0°, the relative stress error rate between the two boundary condition types was approximately 1 % (1.11 MPa and 1.099 MPa, respectively). At 15° and 90°, the error rates were 1.9 % and 0.56 %, respectively (10.275 MPa and 10.078 MPa at 15°; 10.275 MPa and 10.078 MPa at 90°). Given these minimal differences, the first type of boundary condition was adopted for the subsequent scenarios to enhance convergence efficiency in the analysis.Moreover, comparative analyses between linear and nonlinear material behaviors demonstrated acceptable agreement, offering insights into potential efficiency gains in simulation methodologies. Building on this foundation, an optimized tibial model was proposed, incorporating geometric alterations to the tray. Quantitative assessments revealed significant reductions, with von Mises stress decreasing by 23.35 % and equivalent strain by 17 % at a knee angle of 140°. Further evaluations at varying angles, including 60°, consistently showed positive influences on stress and strain. These quantitative findings not only contribute valuable insights into the mechanical behavior of knee prostheses but also provide tangible evidence for the efficacy of linear material behavior assumptions. The proposed optimized model exhibits promising potential for enhancing the design and performance of knee prostheses, particularly under critical loading conditions.In conclusion, these results underscore the importance of a nuanced understanding of knee prosthesis behavior during rehabilitation, offering a quantitative foundation for refining existing designs and informing the development of next-generation prostheses.

Accuracy of an image matching technique for assessing knee alignment during the stance phase of gait using single-plane anteroposterior radiography.

Accurate measurement of bone alignment of the knee during walking provides ideal clinical information for diagnosis and treatment of knee joint disorders. To bring this ideal closer to clinical reality, we developed an image matching technique to measure the three-dimensional (3D) position of bones using anteroposterior radiography during the stance phase of treadmill walking. To develop and validate an image matching method for evaluation of 3D knee alignment using anteroposterior radiography of artificial femoral and tibial bones. The 3D position of each bone was recovered by minimizing the difference between the projected outline and the contour of the bone in the anteroposterior radiograph. The true value of the position was measured using a 3D coordinate measuring machine. The mean values ± standard deviation and root mean squares (RMS) of translation errors were within -1.6 ± 2.1 mm and 2.6 mm, respectively, for femur, and 2.1 ± 1.9 mm and 2.8 mm for tibia. The mean values ± standard deviation and RMS of errors in rotation were within 0.3 ± 0.7° and 0.7°, respectively, for femur, and -0.3 ± 0.9° and 0.9°, respectively, for tibia. Our method is suitable for evaluating 3D knee alignment on anteroposterior radiography.

Adductor Canal Block Versus Femoral Nerve Block for Postoperative Pain Management in Anterior Cruciate Ligament Reconstruction: A Prospective Interventional Study.

Background A common knee joint disorder is injury to the anterior cruciate ligament (ACL), which often requires surgery. Proper pain control after the surgery facilitates fast recovery and prevents chronic pain. To provide analgesia for knee procedures, the use of opioids, non-steroidal anti-inflammatory medications, and regional techniques arecommonly employed. This study aims to evaluate the efficacy of adductor canal block (ACB) and femoral nerve block (FNB) for postoperative pain management after anterior cruciate ligament reconstructions (ACLRs). Methodology This prospective interventional study included 30 participants scheduled for patellar graft ACLR. They were assigned into groups, i.e., ACB and FNB, with 15 patients each. The evaluation occurred one day before the operation, and all surgical procedures were performed using spinal anesthesia. During the postoperative period, a 10-point visual analog scale (VAS) was utilized to quantify pain intensity at the end of the surgery and at various intervals after the surgery. Patients with a VAS score greater than 4 received either FNB or ACB using bupivacaine 0.125%. Duration of analgesia time, power of quadriceps muscle, and neurologic complications were documented. Results No statistically significant value was observed in the mean duration of analgesia between the patients in ACB (348.33 minutes) and the patients in FNB (363.06 minutes). No motor block was observed in 12 patients who received ACB, while only four patients had a motor-sparing effect among those who received FNB. No neurological adverse effects were observed in the study participants. Conclusions ACB provides an equal duration of analgesia similar to FNB, and ACB significantly spares motor strength and maintains higher quadriceps power than FNB.

Mesenchymal Stem Cell-Enriched Hydrogels for the Treatment of Knee Joint Disorders: A Systematic Review

Mesenchymal Stem Cell-Enriched Hydrogels for the Treatment of Knee Joint Disorders: A Systematic Review

Validation of a patient-reported knee-specific outcome questionnaire specifically intended to assess pain, stiffness, and functional activities in Indians with osteoarthritis knees: an observational cross-sectional study

Background: Patient-reported outcome measurement assessments that are frequently used for knee joint disorders have ceiling effect. This restriction is allegedly not there in New Hindi score. Purpose of this study is to validate New Hindi Score in patients with osteoarthritis knee. Methods: Level II Prospective cohort study was conducted. In pilot study, 20 patients had their comprehension of New Hindi Score assessed. A prospective cohort study involving 200 individuals with osteoarthritis knee Kl grade 2 and 3 was conducted in AIIMS, Rishikesh, Uttarakhand. Patients' overall age 57.76±8.63 years, both mean and SD. There were 125 females & 75 males. Men's mean & SD were 59.52±9.39 while women's 56.70±8.00. All patients were requested to complete WOMAC, KOOS, OKS & New Hindi Score questionnaires. Validity, reliability, repeatability of New Hindi Score for knee function in KOA patients were evaluated. There's no floor ceiling effect. New Hindi Score's validity, responsiveness, and floor ceiling effect were assessed. Validity was measured using the Pearson correlation coefficient. Results: In pilot study participants answered all question accurately. New Hindi Score shows moderate correlation with WOMAC & weak correlation with OKS and KOOS (Pearson coefficients of 0.45, 0.21, and 0.28, respectively) with 95% confidence interval, indicating strong construct validity in primary study. There was no floor or ceiling effect seen. Conclusions: For KOA patients, New Hindi Score exhibits strong levels of validity, reliability, and reliability. As result, it can be effectively applied to research knee function in Indian population.

Hydrogels Loaded with Mesenchymal Stem Cells Extracellular Vesicles for Treating Knee Joint Disorders: A Systematic Review

Hydrogels Loaded with Mesenchymal Stem Cells Extracellular Vesicles for Treating Knee Joint Disorders: A Systematic Review

Deep Learning-based Automated Knee Joint Localization in Radiographic Images Using Faster R-CNN.

Osteoarthritis is a condition that poses a risk to the knee joint, resulting in pain and impaired function. However, traditional knee X-ray evaluations using the Kellgren-Lawrence grading system have proven to be inefficient. These evaluations are subjective, time-consuming, and labor-intensive, particularly in busy hospital settings. The objective of this research was to present a deep learning-based approach that can detect knee joint regions in medical images. By addressing the limitations of traditional methods, the aim was to develop a more efficient and automated approach for knee joint analysis. The proposed method utilizes the Faster R-CNN model, which consists of a region proposal network (RPN) and Fast R-CNN. The RPN generates region proposals that potentially contain knee joint regions, while the Fast R-CNN network categorizes and extracts features from these proposals. To train the model, a dataset of knee joint images was employed. The performance of the model was evaluated using metrics, such as accuracy, precision, recall, F1-score, and mean IoU (Intersection Over Union). The results demonstrated the high accuracy of the proposed method in detecting knee joint regions. The model achieved a mean IoU of 94.5, indicating a strong overlap between the predicted and ground truth regions. These findings highlight the potential of deep learning-based approaches in automating medical image analysis, specifically in the diagnosis and management of knee joint disorders. This study emphasizes the significance of leveraging advanced technologies, such as deep learning, in medical imaging. By developing more efficient and accurate methods for identifying knee joint regions in medical images, it becomes feasible to enhance patient outcomes and healthcare delivery. The proposed deep learning-based approach showcases promising results, paving the way for further advancements in the field of medical image analysis and contributing to improved diagnostic capabilities for knee joint disorders.

Ultrasonography as a diagnostic tool for posteromedial corner pathologies: a pictorial essay.

The posteromedial corner (PMC) is a common location for knee joint pain, and accurate diagnosis is essential for appropriate treatment. The frequent causes of pain in the PMC include pathologies of the posterior part of the medial meniscus, damage to articular cartilage, popliteal cysts and the semimembranosus tendinopathy.Currently, magnetic resonance imaging is the gold standard for assessing knee joint disorders, but its availability and cost can limit its use in some cases. In this pictorial essay, we presented the use of ultrasonography as an alternative method for assessing PMC.We present a series of images to demonstrate the value of ultrasonography and describe the methods used for assessing PMC with a particular focus on semimembranosus tendinopathy.

Combined Knee Arthroscopy with Medial Open Wedge High Tibial Osteotomy in Management of Medial Knee Joint Disorder of Adults Varus Knee

Combined Knee Arthroscopy with Medial Open Wedge High Tibial Osteotomy in Management of Medial Knee Joint Disorder of Adults Varus Knee

RETRACTED ARTICLE: Security-enhanced machine learning model for diagnosis of knee joint disorders using vibroarthrographic signals

RETRACTED ARTICLE: Security-enhanced machine learning model for diagnosis of knee joint disorders using vibroarthrographic signals

Magnetic Resonance Imaging of Internal Derangements and Other Knee Pathologies in Adult Nigerians.

Knee joint pathologies/injuries are one of the most common musculoskeletal complaints in adults worldwide. The aetiologies of knee joint disorders are diverse. Magnetic resonance imaging (MRI) is a sophisticated method of detecting and characterizing knee pathologies. This study was conducted to document the clinical presentation and MRI patterns of knee joint abnormalities in a group of adults in Lagos, Nigeria, and to juxtapose it with reports from other climes. A retrospective hospital-based analysis of the knee MRI of 158 adult Nigerians was conducted in a single health facility. The clinical history and knee MRI findings were extracted, analyzed, and documented. Statistical significance was established at P≤0.05. There were 158 participants comprising 92 males (58.2%) and 66 females (41.8%) between the ages of 18 and 79. The mean age of the males was 44.75 ± 14.41 years, while that of the females was 47.76 ± 13.72 years (P = 0.19). A history of previous trauma was elicited in 135 (85.4%) participants. Eighty-two right knees (51.9%) and 76 left knees (48.1%) were examined. The dominant joint pathologies detected include effusion (77.2%), medial meniscopathy (48.1%), tibial abnormalities (46.2%), femoral abnormalities (46.2%), patella abnormalities (46.2%), anterior cruciate ligament disorders (37.3%), lateral meniscopathy (27.2%), medial collateral ligament disorders (22.2%), and popliteal (Baker's) cysts (15.8%). ACL abnormalities were significantly more prevalent in male subjects. Knees with ruptured sACL had significantly more joint effusion and injuries to the medial meniscus, lateral meniscus, posterior cruciate ligament (PCL), medial retinacular ligament (MRL), femur, tibia, and fibula. There was no significant difference in the frequency of abnormalities between the right and left knees. Joint effusion, medial meniscopathy, osseous abnormalities (tibia, femur, patella), ACL abnormalities, lateral meniscopathy, and MCL abnormalities, in decreasing order, were the most frequent pathologies in the knee joints evaluated.

THE KNEE JOINT IS THE ACHILLES' HEEL OF A CHILD'S BODY

The study objective was to draw practicing physicians’ attention to the risk of knee joint disorders in children during intensive growth to ensure timely detection and treatment. Materials and Methods. We analyzed the results of studies on the diseases of the knee joint carried out by modern scientists over the past ten years. We also took into account the clinical observations of children receiving inpatient treatment at the regional children's hospital. The examination methods were radiography, computer tomography, magnetic resonance imaging, and ultrasound. Results and Discussion. During growth, a child's knee joint is subjected to enormous loads and is sensitive to external and internal factors. The knee joint plays a dominant role in the limb’s longitudinal growth; the growth zones grow so intensively that they can be compared to the work of a "bone nuclear reactor." The bones of the skeleton grow unevenly and intermittently. The peak height velocity is observed at 10–14 years in girls and at 13–18 years in boys; then, height velocity slows down, and after 19 years, height growth almost stops. During the period of intensive growth, bones are very sensitive to internal and external factors of shape formation (growth hormones, physiological loads, radiation, vibration, injuries, hypothermia, metabolic disorders, etc. Therefore, this part is most sensitive to various endogenous and exogenous factors, which is manifested by various dysplastic changes and diseases. Conclusions. During the intensive growth of the child, the knee joint is most vulnerable to various endogenous and exogenous negative factors, which is manifested by various diseases. Osteogenic sarcoma, fibrous cortical defect, and juvenile osteocartilaginous exostoses most often affect the weakest place of the knee joint – the metaphyses of the femur and tibia (Achilles’ heel).

A survey on classification methodologies utilized for classifying the knee joint disorder levels using vibroarthrographic signals

The largest as well as complicated joint in the human body is knee joint. A minor pathology in human knee can lead to major discomfort to a person. The pathology may be from a simple stress in knee joints to the higher effective levels of pathology that includes osteoarthritis (OA), chondromalacia patella (CMP) and so on. Hence prediction as well as classification of knee joint pathology plays a vital role for computational medical diagnosis. Pathology identification can be categorized in to two levels invasive and non – invasive methodologies. Invasive are purely medical as well as painful process which are less preferred for predictions. Noninvasive are clinical and computational ones that includes X-Rays, Magnetic Resonance Imaging (MRI), Computed Tomography (CT), Vibroarthography (VAG) etc. This paper compares various classification methodologies utilized by Vibroarthographic (VAG) signal based knee joint disorder level identification and performs a binary classification of data samples as a survey.

Computational biomechanics of human knee joint in stair ascent: Muscle-ligament-contact forces and comparison with level walking.

About a third of knee joint disorders originate from the patellofemoral (PF) site that makes stair ascent a difficult activity for patients. A detailed finite element model of the knee joint is coupled to a lower extremity musculoskeletal model to simulate the stance phase of stair ascent. It is driven by the mean of measurements on the hip-knee-ankle moments-angles as well as ground reaction forces reported in healthy individuals. Predicted muscle activities compare well to the recorded electromyography data. Peak forces in quadriceps (3.87 BW, body weight, at 20% instance in our 607 N subject), medial hamstrings (0.77 BW at 20%), and gastrocnemii (1.21 BW at 80%) are estimated. Due to much greater flexion angles-moments in the first half of stance, large PF contact forces (peak of 3.1 BW at 20% stance) and stresses (peak of 4.83 MPa at 20% stance) are estimated that exceed their peaks in level walking by fourfold and twofold, respectively. Compared with level walking, ACL forces diminish in the first half of stance but substantially increase later in the second half (peak of 0.76 BW at 75% stance). Under nearly similar contact forces at 20% of stance, the contact stress on the tibiofemoral (TF) medial plateau reaches a peak (9.68 MPa) twice that on the PF joint suggesting the vulnerability of both joints. Compared with walking, stair ascent increases peak ACL force and both peak TF and PF contact stresses. Reductions in the knee flexion moment and/or angle appear as a viable strategy to mitigate internal loads and pain.

Bone transport in the management of post-osteomyelitis femoral defects in children: A case series with a minimum of 10-year follow-up in Uganda.

Purpose:The aim of this study was to evaluate the long-term outcomes of the bone transport technique in the management of post-infectious segmental femoral bone defects in children in a low-income country.Methods:Eleven children were included in this case series. All had a femoral defect secondary to osteomyelitis managed with the internal bone transport technique using an external fixator alone. Bone and functional results were evaluated and complications recorded after a minimum follow-up period of 10 years (range: 10–16).Results:The mean age of the patients was 7.8 years, and the average size of the bone defect was 10.8 cm. At the latest follow-up, bone results were excellent in three, good in five, and fair in three, while the functional results were excellent in three, good in four, fair in three, and poor in one. Limb length discrepancy was observed in 10 cases while hip and/or knee joint disorder was recorded in six cases. At the last follow-up, only one patient had a recurrence of infection.Conclusion:The bone transport technique has proven to be a valid option for eradicating infection and filling large bone defects in children. However, it is a technically difficult and lengthy procedure that is prone to unique complications.Level of Evidence:IV-Case series

The center of pressure position in combination with ankle dorsiflexion and trunk flexion is useful in predicting the contribution of the knee extensor moment during double-leg squatting

BackgroundSquatting exercises are commonly used in rehabilitation for knee joint disorders; in these exercises, control of knee extensor moment is important to enhance training effects and to avoid adverse effects. Ankle dorsiflexion and trunk flexion are widely used to reduce knee extensor moments during squatting, but the increased load on the low back is a concern. The purpose of this study was to determine whether the anterior–posterior (AP) center-of-pressure (COP) position and the AP-COP position in combination with ankle dorsiflexion and trunk flexion angles can predict the contribution of the knee extensor moment during double-leg squatting.MethodsTwenty-eight healthy individuals (14 female and 14 male participants, age 22.8 ± 1.3 years) performed three sets of five consecutive double-leg squats. Kinematics and kinetics were analyzed using a three-dimensional motion analysis system with force plates. Univariate and multivariate regression analyses were performed to predict the contribution of the knee extensor moment (% total support moment) from AP-COP position, ankle dorsiflexion, and trunk flexion.ResultsThe AP-COP position was a significant predictor of the knee extensor moment contribution (R2 = 0.168, P = 0.030). Multivariate analysis showed that the ankle dorsiflexion angle (ΔR2 = 0.561, β = 0.842) and AP-COP position (ΔR2 = 0.296, β = − 0.499) predicted the knee extensor moment contribution (model R2 = 0.857, P < 0.001). Additionally, the combination of trunk flexion (ΔR2 = 0.429, β = − 0.613) and AP-COP position (ΔR2 = 0.109, β = − 0.332) predicted the knee extensor moment contribution (model R2 = 0.538, P < 0.001). The limb symmetry index of the knee extensor moment was significantly associated with that of the AP-COP position (R2 = 0.493, P < 0.001) but not with that of the ankle dorsiflexion angle (P = 0.057).ConclusionsThe AP-COP position can predict the contribution of the knee extensor moment and improve the prediction when combined with ankle dorsiflexion and trunk flexion. The present findings suggest that intervention focusing on the AP-COP position in combination with ankle dorsiflexion or trunk flexion would be useful to coordinate the contribution of the knee extensor moment during double-leg squatting.

The Treatment of Baker’s Cyst in The Presence of Knee Joint Effusion

A Baker’s Cyst or popliteal cyst is a fluid-filled sac that forms at the posterior aspect of the knee in the popliteal fossa between the semimembranosus and medial head of the gastrocnemius [1-3]. Adults between the ages of 35 and 70 tend to be affected more; the incidence is between 10% and 41%, while the prevalence is 5% [4, 5]. Women are more affected than men as they are more likely to develop arthritis [2, 6]. Baker’s Cyst is commonly found in association with knee joint disorders such as meniscus tears and osteoarthritis [2, 3, 6]. During its development, a connection between the knee joint and the cyst is formed and a one-way “valve effect” allows for the flow of synovial fluid from the anterior to the posterior aspect of the knee. The valve opens and closes via flexion and extension, respectively; fluid influx occurs during flexion due to negative intra-articular pressure and stops with extension due to positive intra-articular pressure [2, 7]. Common symptoms include a swelling or lump behind the knee; knee/calf pain; fluid accumulation around the knee; and clicking, locking, or buckling of the knee joint [2].

Role of Taila Dhara Therepy in the Management of Various Types of Knee Joint Disorder

Dhara is a part of Keraliya Panchkarma which means pouring liquid medium in a thin, continuous, stream over the body or affected area, when it is done all over the body it is known as Sarvanga Dhara. It comes under Parisheka Swedana. Dhara means pouring liquid medium in a thin, continuous, stream over the body or affected area. In this, fermented liquids are poured over the body in streams for a fixed duration of time as is done in any type of Dhara. It has been truly stated that Dhara is good for almost all diseases. The word Janu refers to knee and Dhara means to pour, mainly medicated oil. It is a very unique procedure mentioned as ‘Snehayukta Swedana’ due to the fact that it comprises both Snehana (therapeutic oleation) and Swedana (sudation therapy). The Taila (oil) used for this procedure does the Snehana and due to the Agni Samyoga in this procedure it has the resulting Swedana effect. Janu Dhara is advised in painful conditions caused mainly by Vata Dosha, usually for degenerative diseases, stiffness associated with bone, joint and or musculoskeletal pains, it relieves swelling and inflammation in the knee joint. At the end of the procedure perspiration is noticed and an increased range of motion can be observed. Previous clinical studies also suggest the efficacy of Janu Dhara in knee joint pain. Janu Dhara helps to tone muscles, provides lubrication and improves the working mobility of the joint.

A Portable Wearable Inertial System for Rehabilitation Monitoring and Evaluation of Patients With Total Knee Replacement.

Knee osteoarthritis is a degenerative disease, which greatly affects the daily life of patients. Total knee replacement (TKR) is the most common method to treat knee joint disorders and relieve knee pain. Postoperative rehabilitation exercise is the key to restore knee joint function. However, there is a lack of a portable equipment for monitoring knee joint activity and a systematic assessment scheme. We have developed a portable rehabilitation monitoring and evaluation system based on the wearable inertial unit to estimate the knee range of motion (ROM). Ten TKR patients and ten healthy adults are recruited for the experiment, then the system performance is verified by professional rehabilitation equipment Baltimore Therapeutic Equipment (BTE) Primus RS. The average absolute difference between the knee ROM and BTE Primus RS of healthy subjects and patients ranges from 0.16° to 4.94°. In addition, the knee ROM of flexion-extension and gait activity between healthy subjects and patients showed significant differences. The proposed system is reliable and effective in monitoring and evaluating the rehabilitation progress of patients. The system proposed in this work is expected to be used for long-term effective supervision of patients in clinical and dwelling environments.