Knee Joint Space Research Articles

The effect of a simulated knee joint effusion on postural control in healthy subjects

Palmieri RM, Ingersoll CD, Cordova ML, Kinzey SJ, Stone MB, Krause BA. The effect of a simulated knee joint effusion on postural control in healthy subjects. Arch Phys Med Rehabil 2003;84:1076-9. Objective:To determine the effects of a simulated knee joint effusion on center of pressure (COP) path and mean power frequency (MPF) during standing. Design:Quasi-experimental design. Setting:Sports injury research laboratory in a university setting. Participants:Twenty healthy volunteers, 10 of whom (age, 20.1±2.4y; height, 168.0±8.1cm; weight, 70.4±13.3kg) were assigned to an effusion group and 10 of whom (age, 25±3.8y; height, 169.4±8.9cm; weight, 74.7±7.7kg) were assigned to a control group. Interventions:COP data were collected before and after a 60-mL injection of sterile saline into the knee joint space. Main Outcome Measures:COP path and mediolateral and anteroposterior MPF. Results:COP path decreased after the effusion (pre-effusion mean, 92.2±21.9cm; posteffusion mean, 77.27±23.0cm). No change was found within the control group for COP path (P>.05). No differences were detected before or after joint effusion when the MPF was examined (P>.05). Conclusions:Possible explanations for the improved postural control after the effusion include additional somatosensory feedback, an augmented neural drive to the soleus, and/or increased capsular tension.

Myotrophic changes in the thigh following primary suture of the anterior cruciate ligament

During a period of three years, 20 patients underwent diagnostic arthroscopy followed by a poly-para-dioxanone augmented primary suture of the anterior cruciate ligament. Besides the clinical diagnostic measures, comparative electromyography and magnetic resonance imaging of the lower extremities were carried out. The control group consisted of ten test persons with healthy knees. The circumference measurement confirmed general experience that legs with an identical circumference immediately after injury show a reduction in circumference of the injured leg in comparison to the uninjured leg during the rehabilitation phase, which is still detectable at the time of the follow-up examination in spite of adequate physiotherapy. The differences were greatest at 20 cm above the medial knee joint space. The difference was the result not only of the reduction in the injured leg but also of a marked increase in the circumference of the uninjured leg. These findings were confirmed by magnetic resonance imaging. The greatest differences and standard deviations in circumference between the two legs of the patients were found for the vastus medialis. However, at the time of follow-up this was the only muscle which had regained its preoperative cross-sectional area. The femoral flexor muscles were affected by these atrophic changes only to a small extent. Electromyography of the vastus medialis, vastus lateralis, semimembranosus and biceps femoris showed that the muscles of the injured leg were less activated immediately after the injury than those of the other leg. The biceps femoris was less affected by this hypoinnervation than the other muscles. However, no injury-specific changes could be found in the EMG pattern of the patients in this study. The difference between the two legs remained detectable as a persisting neuromuscular dysbalance up to the time of follow-up examination and the greatest differences were found in the vastus medialis and semimembranosus muscles.

Embryonic stem cells injected into the mouse knee joint form teratomas and subsequently destroy the joint

To determine whether the joint space is a suitable environment for embryonic stem (ES) cells to grow and form cartilage. We transplanted ES cells into the knee joint and a subcutaneous space of mice with severe combined immunodeficiency. Teratomas formed in both areas. Those in the joints grew and destroyed the joints. The incidence of cartilage formation was the same in the knee joint and subcutaneous space, but the ratio of cartilage to teratoma was higher in the knee joint than in the subcutaneous space. The teratomas were proved to have been derived from the transplanted ES cells by detection of the neomycin-resistance gene that had been transfected into the ES cells. It is currently not possible to use ES cells to repair joint tissues. Further optimization of donor ES cells to differentiate as well as inhibit tumour growth may help to meet these challenges.

Scanning electron microscopic examinations on retarded bone defect healing in spontaneously diabetic BB/O(ttawa)K(arlsburg) rats.

To date, no detailed knowledge from animal experiments is available on the kind and extent of osseous and mineral metabolic disorders in genetically determined, insulin-dependent Type I diabetes. The purpose of this study was to examine the influence of the diabetic metabolic state in spontaneously diabetic BB/O(ttawa)K(arlsburg) rats on bone defect healing. Eighty spontaneously-diabetic BB/OK rats with a blood-glucose value of 391 +/- 106 mg% (mean +/- SD) at the time of manifestation were used in the study. Based on blood-glucose values at the time of surgery (mg%), postoperative blood-glucose course (mg%) and postoperative insulin requirements (IU/kg), the animals were divided into groups with well-compensated (n = 40, 170 +/- 101 mg%; 221 +/- 120 mg%; 2.1 +/- 1 IU/kg) or poorly compensated (n = 40; 371 +/- 158 mg%; 357 +/- 83 mg%; 5.2 +/- 1.4 IU/kg) metabolic state. Forty LEW.1A rats served as the normoglycemic controls (95 +/- 18 mg%). Using a 1-mm-diameter Kirschner wire, a hole of femoral bone ca. 1 cm proximal to the knee joint space was centrally drilled. Ten animals from each group were killed on postoperative days 7, 14, 24, and 42, and specimens were taken for analysis. Using SEM to measure regions of new bone semiautomatically and quantitatively, also determining the number, area, and circumference of regions not yet filled with new bone. Up to postoperative day 14, very significant differences (p < 0.0001) for all investigated characteristics were found between the spontaneously-diabetic BB/OK rats and the control animals--in favor of the controls--and up to postoperative day 24 within the group of spontaneously-diabetic BB/OK rats, where the well-compensated animals had significantly better results in terms of number and area of regions of bone not yet filled with new bone formations. Forty-two days postoperatively, SEM observations showed no differences between examination groups. The process of bone defect healing in spontaneously-diabetic rats was disturbed only in the early phase and exhibited retardation in its progression. After 42 days, bone defect healing was complete, regardless of the diabetic metabolic state; no differences were detected with the SEM between examination groups at this time point.

Accuracy of needle placement into the intra-articular space of the knee.

To achieve their potential therapeutic benefit, hyaluronic acid derivatives should be injected directly into the knee joint space and not into the anterior fat pad or the subsynovial tissues. In the absence of a knee effusion, reproducible needle placement into the intra-articular space presents a challenge to the clinician. The accuracy of needle placement was assessed in a prospective series of 240 consecutive injections in patients without clinical knee effusion. The injections were performed by one orthopaedic surgeon using a 2.0-in (5.1-cm) 21-gauge needle through three commonly employed knee joint portals: anteromedial, anterolateral, and lateral midpatellar. Accuracy rates for needle placement were confirmed with fluoroscopic imaging to document the dispersion pattern of injected contrast material. Of eighty injections performed through an anterolateral portal, fifty-seven were confirmed to have been placed in the intra-articular space on the first attempt (an accuracy rate of 71%). Sixty of eighty injections performed through an anteromedial approach were intra-articular on the first attempt (75% accuracy rate), as were seventy-four of eighty injections performed through a lateral midpatellar portal (93% accuracy rate). Using real-time fluoroscopic imaging with contrast material, we demonstrated the difficulty of accurately placing a needle into the intra-articular space of the knee when an effusion is not present. This study revealed that a lateral midpatellar injection (an injection into the patellofemoral joint) was intra-articular 93% of the time and was more accurate than injections performed by the same orthopaedic surgeon using either of the other two portals. This study highlights the need for clinicians to refine injection techniques for delivering intra-articular therapeutic substances that are intended to coat the articular surfaces of the knee joint.

Anteroposterior weight-bearing radiography of the knee with both knees in semiflexion, using new equipment

In order to obtain high reproducibility and sensitivity in the evaluation of joint space in osteoarthritic knees, we used new equipment, and established an anteroposterior weight-bearing radiograph with both knees in semiflexion taking into account our investigation of the posterior slope angle. We compared our method with the Rosenberg method, and the coefficient of variation of our method showed higher reproducibility than that of the Rosenberg method. The most essential issue is whether the bilateral leg loading radiograph can show the same sensitivity as the homolateral leg loading radiograph. We compared standing radiographs of the knee in 26° flexion with those of 26° flexion in both knees. We assessed the widths of the narrowest points of the joint spaces in the medial and lateral compartments, the condylar plateau angle, and the femorotibial angle, in 47 knees in 24 patients. The data were analyzed statistically by single regression and each correlation was of statistical significance. Our method has better reproducibility and is more comfortable for the subject than conventional methods.

A 5-year randomized controlled, double-blind study of glycosaminoglycan polysulphuric acid complex (Rumalon®) as a structure modifying therapy in osteoarthritis of the hip and knee

Objective To determine the structure (disease) modifying effect of a glycosaminoglycan polypeptide association complex (GP-C; Rumalon®) in patients with knee and hip osteoarthritis (OA).Methods Double-blind, randomized, placebo-controlled five-year study. Primary assessment criterion was change in radiographic joint space width between baseline and follow-up at 5 years. Secondary outcome criteria included Lequesne algofunctional index (LAI), pain on passive motion and consumption of non-steroidal antiinflammatory drugs (NSAIDs). The patients received 10 courses of injections of placebo or GP-C 2ml intramuscularly in 5 years (two courses each year). Each course included 15 injections administered twice weekly.Results There were 277 patients with knee OA and 117 patients with hip OA. Control and GP-C treated groups were comparable as to sex, age, duration of disease, body weight, X-ray stage and value of LAI at the baseline. Knee joint space at 5 years decreased 0.37±0.08 (mean±standard deviation) mm for GP-C and 0.42±0.08mm for placebo groups (P=0.68). Hip joint space at 5 years decreased 0.21±0.08mm for GP-C and 0.22±0.08mm for placebo groups (P=0.53). In a subset of patients with hip OA, Kellgren–Lawrence≥2 and JSW≥1mm, there was a trend in favor of GPC for lower joint space narrowing in 5 years (P=0.11). In addition, there were no statistical differences between the treatment groups in LAI, pain on passive motion and consumption of NSAIDs. Side-effects after GP-C (14.5%) were rare, mild and not more frequent than in the placebo group (15%).Conclusion We were not able to demonstrate a structure modifying effect of GP-C in OA of the hip or knee. Radiographic progression of OA in both knee and hip OA was lower than expected in both study groups.

Intermittent administration of parathyroid hormone (1-37) improves growth and bone mineral density in uremic rats

Parathyroid hormone (PTH) is secreted in a pulsatile fashion. Continuous infusion of PTH(1-84) resulted in a net decrease in trabecular bone volume. Differential effects have been reported following an intermittent application of PTH. We investigated the effects of a continuous infusion and of an intermittent (2 times daily subcutaneously) administration of PTH(1-37) on growth and bone mineral density (BMD) in healthy and uremic rats. Two-stage subtotal nephrectomy was performed on 130 g female Sprague-Dawley rats. PTH(1-37) or solvent was administered through minipumps in sham-operated and uremic rats (60 microg/kg x day for 2 weeks). The effect of intermittent administration was tested with a subcutaneous injection of solvent: 30 microg/kg PTH(1-37) two times per day, 100 pmol calcitriol (C)/kg two times per day, or both. The length (snout-tailtip) and BMD were measured at the start of uremia and at sacrifice. BMD was measured by peripheral quantitative computer tomography at the proximal tibia, 6 and 12 mm distal of the kneejoint space. Femur bone morphology was assessed by x-rays, and calcium content was measured by atomic absorption spectrophotometry. Length gain was not altered by the continuous infusion of PTH. In contrast, it was significantly increased by intermittent PTH (control solvent 5.35 +/- 0.37 cm vs. control PTH 6.19 +/- 0.47 cm; uremia solvent 4.78 +/- 0.20 cm vs. uremia PTH 6.17 +/- 0.36 cm; P < 0.05). Intermittent PTH but not C increased BMD in uremic rats (Delta total BMD 134 + 13.3 vs. 76.3 +/- 11.5 mg/mL; P < 0.05). X-rays revealed increased bone mass following treatment with PTH but not with C. Uremia decreased bone calcium content (64 +/- 0.3 vs. 73. 3 +/- 2.5 mg/mL), which was normalized by PTH (80 +/- 3.6 mg/mL, P < 0.05) but not by C (69 +/- 1.9 mg/mL). Pulsatile administration of PTH does not adversely affect, but improves longitudinal growth independent of concomitant treatment with C. At the same time PTH increases BMD and the calcium content of bone.

撮影肢位の相違が立位膝正面Ｘ線像の計測値に与える影響の検討

Standing radiographs are useful for evaluating joint space in knees with osteoarthritis (OA). However, ordinary methods such as hemi-foot standing ar the so-called Rosenberg method have several problems. We therefore developed a new method, in which an anteroposterior radiograph is taken with both knees at about twenty-six-degree flexion.In this study, the joint space angle (JSA) and femorotibial angle (FTA) which were measured by means of the new method were compared with those by ordinary methods. Values of JSA and FTA were more or less the same between the hemi-foot and bilateral feet. Bilateral feet achieved stable lower extremities position compared with the hemi-feet. Radiographs with the knee flexion were more sensitive for evaluating JSA than those in full extension. We concluded that this method is reliable and sensitive in assessing the degree of OA.

Viability of fibroblast-seeded ligament analogs after autogenous implantation.

Fibroblast-seeded collagen scaffolds or ligament analogs are potentially useful for reconstruction of the anterior cruciate ligament of the knee. To provide lasting benefits, the seeded cells must survive implantation within the harsh synovial environment of the knee joint. Our objective was to determine the in vivo fate of autogenous fibroblast-seeded ligament analogs as a function of fibroblast source (anterior cruciate ligament or skin), implantation site (knee joint or subcutaneous space), and time after implantation (1, 2, 4, 6, or 8 weeks). Before implantation, fibroblasts were labeled with PKH26-GL, a fluorescent membrane dye. Immediately after retrieval of the implant, the viability of the labeled seeded cells was assessed under a fluorescent microscope. Viable seeded fibroblasts remained attached to the collagen fibers within the ligament analogs for at least 4 weeks (skin fibroblasts) or 6 weeks (anterior cruciate ligament fibroblasts) after implantation. A larger number of viable seeded cells were consistently observed in the subcutaneous space than in the knee joint. Scaffold resorption prevented observation at the 8-week time period. Fibroblast-seeded ligament analogs remained viable for prolonged periods in the knee joint and therefore have the potential to influence the formation and remodeling of neoligament tissue after reconstruction of the anterior cruciate ligament.

Fifteen-year follow-up of arthroscopic partial meniscectomy

From an original pool of 283 patients, 146 patients who had undergone arthroscopic partial meniscectomy an average of 14.7 years before were followed-up. Lysholm score, Tegner activity level, satisfaction index on a scale of 1 to 10, and standing anteroposterior and flexion weight-bearing radiographs of both knees, were obtained. A physical examination was performed on each knee emphasizing motion, swelling, and ligament evaluation. Radiographs were graded for degenerative changes for each knee. Each knee joint space was also measured in millimeters and compared, operative knee with unoperated knee. The unoperated knee had no injuries or surgeries and was used as a control. Patients were 83% male and 17% female; 78% had undergone medial meniscectomies, 19% lateral, and 3% both. There were 88% good and excellent results in anterior cruciate ligament-stable knees. The radiographic grade side-to-side difference showed the operative knee to be only a 0.23 grade worse than the nonoperative knee. Age at the time of meniscectomy was not found to be a factor. Male patients had better radiographic results than female patients, but not better functional scores. Medial meniscus and lateral meniscus results were not significantly different. Knees with a femoral-tibial anatomic alignment of > 0 degree valgus compared with < or = 0 degree and that had undergone medial meniscectomy had significantly better radiographic results. Patients with anterior cruciate ligament tears and meniscectomy did significantly poorer than stable knees with meniscectomy in regards to radiographic grade change, Lysholm, satisfaction index, Tegner level, and medial joint space narrowing.

Quantitative radiography in osteoarthritis: Computerized measurement of radiographic knee and hip joint space

Radiographic joint space narrowing is the hallmark of progression in osteoarthritis (OA). An accurate measure of progression for OA requires a precise quantitative method. New techniques have been designed to quantitatively assess knee and hip joint space using computer analysis of digitally stored radiographs. The interobserver coefficient of variation of the technique ranges from 1% to 3.3% and is clearly better than that obtained by the use of dividers and rule. A precise standardization of the radiological procedure as well as use of films of good quality are required for a good reproducibility of the method. The computerized measurement of joint space size from standard radiographs is applicable to monitor progression of hip and knee OA, and appears to be of value in the evaluation of disease-modifying therapies for OA.

Quantitative radiography in osteoarthritis: Computerized measurement of radiographic knee and hip joint space

Quantitative radiography in osteoarthritis: Computerized measurement of radiographic knee and hip joint space

Anti-T cell receptor monoclonal antibody prolongs transgene expression following adenovirus-mediated in vivo gene transfer to mouse synovium.

There are no cures for rheumatoid arthritis (RA) or other inflammatory autoimmune arthropathies. Gene transfer to the synovium would allow administration of anti-inflammatory gene products directly to the articular space where they could exert a local down-regulatory effect on the autoimmune process. Several well-characterized murine models of arthritis closely resemble RA immunologically, genetically, and histopathologically. To determine whether the mouse could serve as a model for gene transfer to the synovium, a methodology was developed to reproducibly inject a 5-microliter volume into the articular space of the mouse knee. Using this approach, Av1LacZ4, an E1a-E3-deleted adenoviral (Ad5) vector expressing the lacZ transgene, was delivered intra-articularly (5 x 10(8) pfu). lacZ expression was observed in the articular synovium for at least 14 days. Biochemical quantitation demonstrated a gradual loss of transgene expression, associated with an early, predominantly neutrophilic, inflammatory response that progressed to a lymphocytic infiltrate, followed by gradual resolution over a 3-week period. Pretreatment with the anti-TCR monoclonal antibody (mAb) H57 resulted in a significant reduction in lymphocytic infiltration and a prolongation of transgene expression. These data demonstrate that transgenes can be delivered to the mouse knee joint space, affording a powerful tool to test the potential of gene therapy as a therapeutic modality for RA. As in other systems, the immune response against recombinant adenoviral vectors may limit the extent and duration of gene expression in the synovium. Anti-T cell mAbs may be useful in inhibiting this immune response.

Examination of joint space by magnetic resonance imaging in anatomically normal knees.

The medical and lateral knee joint spaces of 184 patients who had anatomically normal knees were measured by using magnetic resonance imaging (MRI) method. The findings were compared according to age, sex, height, and body mass index changes of the individuals and the mean values of medial and lateral knee joint spaces were calculated in every group. The results show that in an anatomically normal population, all the individuals have larger lateral knee joint spaces than medial knee joint spaces. The patients lose knee joint space regularly with increasing age. Children have larger knee joint spaces than adults. Men have larger knee joint spaces than women. The knee joint space size of the patients increase regularly with increasing height up to 180 cm. The patients, who are taller than 180 cm do not show any marked difference in joint space size, when compared with the patients whose heights differ in between 171-180 cm. Knee joint space size is not related to the body mass index of the individual.

Knee joint space width measurement: an experimental study of the influence of radiographic procedure and joint positioning.

We studied the influence of the radiographic procedure and joint positioning on knee joint space width (JSW) in 10 healthy volunteers, and the intrareader reproducibility of JSW measurements on radiographs performed 2 weeks apart using a standardized procedure. Results show that a 5 or 10 downward inclination of the X-ray beam and 15 or 30 of induced external foot rotation significantly reduced JSW. In contrast, knee flexion increased JSW. The mean differences and S.D. in the measurement of JSW between two sets of radiographs taken 2 weeks apart were not statistically significant, ranging from -0.07 mm (S.D. 0.38) to 0.020 mm (S.D. 0.38). Our findings indicate that modifications in knee flexion, foot rotation and X-ray beam inclination influence JSW. Therefore, standardization of joint positioning and of the radiographic procedure is necessary to obtain comparable radiographic images on successive X-rays.

Ossicles anterior to the proximal tibia

Ossicles anterior to the anterior tibia are most usually seen in relation to the tibia] tuberosity. While these are usually taken to represent sequelae of previous Osgood-Schlatter disease, they may, on occasion, represent normal variants in ossification of the tuberosity. Ossicles superior to the tuberosity may have similar origins. Representative examples are presented, as is a very large ossicle separated from the anterior tibia by a prolongation of the knee joint space. Theories of causation of such ossicles are discussed.

Chondroprotective action of salmon calcitonin in experimental arthropathies

To assess whether calcitonin exerts an influence on cartilage, three models of arthropathies in rabbits--representing three different modes of cartilage destruction--were used: (1) corticosteroid administration (endocrinological disturbances model); (2) meniscectomy (mechanical stress model); and (3) immobilization of the hind leg (nutritional disorder model). After 12 weeks of methylprednisolone (MP) administration, the rabbit femur heads displayed cartilage erosions, marked decrease of glycosaminoglycans (GAG) content, and narrowing of joint spaces. Elevation of serum uronic acid, activity of alkaline phosphatase, and calmodulin content was evident. All these changes were minimal--close to normal--in the group treated for 12 weeks with MP + salmon calcitonin (sCT). Partial meniscectomy and hind leg immobilization caused statistically significant loss of GAG from the cartilage and narrowing of the knee joint space during the same experimental period, 12 weeks. In both these models the groups of rabbits treated simultaneously with sCT showed only insignificantly smaller joint spaces and GAG content. These results support our hypothesis of a chondroprotective property of calcitonin. However, the mechanism through which calcitonin influences joint cartilage remains unknown. A direct effect of calcitonin on cultivated chondrocytes, as well as the role of calmodulin, beta-endorphins, calcium, and interleukin-1 in the process are discussed.

関節鏡視下レーザー手術(III)

We applied the laser irradiation on meniscus with the saline filled knee joint in order to prevent the several complication caused by the laser irradiation with the air filled knee joint. The experiment was made in vitro with the pig knee joint, with Ar+UV laser which we have regarded suitable laser for the arthroscopic laser meniscectomy, and with SiO2 glass fiber which can deliver Ar+UV laser light. A pig knee joint was opened and ACL, PCL, MCL, LCL were cut off so as to expand the pig knee joint space. Under arthroscope contact irradiation on meniscus in saline using Ar+UV laser at the power density of 800 W/cm2 was done, and meniscus was perforated in several seconds irradiation. These experiment revealed that contact irradiation in saline using Ar+UV laser is useful for arthroscopic laser meniscectomy.

Idiopathic Chondrolysis of the Hip

Fourteen patients (16 hips) with idiopathic chondrolysis of the hip were retrospectively studied at the Shriners Hospital from 1973 to 1986. Follow up averaged 84 months (range 13-180 months). All 14 patients were female. All but one were premenstrual. Each patient presented with an insidious onset of pain in the hip, thigh, or knee and radiographic symmetrical joint space narrowing. Three of the 16 hips required fusions, and only five regained a full range of motion. Partial restoration of the joint space occurred in eight hips. Essential treatment consists of unloading the hip joint while maintaining motion.