Knee In Women Research Articles

Effects of three-dimensional femur and tibia postures on the parameters of standing long-leg radiographs for osteoarthritic knees in elderly female subjects

BackgroundLong-leg frontal radiographs of the lower extremities are used to assess knee osteoarthritis. Given the three-dimensional (3D) nature of alignment changes in osteoarthritis, postural alterations in the femur and tibia extend beyond the coronal plane (in-plane) to include the transverse and sagittal planes (out-of-plane). This study investigates the impact of these out-of-plane factors on in-plane knee alignment parameters observed in frontal radiographs. MethodsA total of 97 osteoarthritic knees in women were examined. Using a 3D-to-two-dimensional (2D) image matching technique, we evaluated the 3D postures of the femur and tibia in the standing position as viewed from frontal radiographs in the world coordinate system. Statistical analyses were conducted to explore associations between these 3D postures and 2D alignment parameters obtained from frontal radiographs under identical conditions. FindingsThe femur exhibited a medial inclination of 2.7°, a posterior inclination of 3.9°, and an internal rotation of 4.2°, whereas the tibia showed a lateral inclination of 6.4°, an anterior inclination of 6.7°, and an internal rotation of 6.7°. Both coronal and rotational postures of femur and tibia influenced the hip-knee-ankle angle, mechanical axis percentage, and medial proximal tibial angle. However, only coronal factors of tibia impacted tibial joint line obliquity relative to the floor. InterpretationAttention should be paid to the potential impact of the out-of-plane postures of the femur and tibia on parameters assessed in plain frontal radiographs of the lower extremities.

Prognostic Factors in Intra-articular Platelet-Rich Plasma Treatment for Knee Osteoarthritis: A Comparative Analysis of Responders and Nonresponders.

Knee osteoarthritis (KOA) is a chronic joint disease affecting activities of daily living (ADL) and quality of life due to pain and limited range of motion, afflicting a large number of patients worldwide. However, it is difficult to prevent the progression of the disease. Therapeutic strategies for KOA aim to maintain ADL and QOL by alleviating pain or managing locomotive function. Recently, intra-articular injection of platelet-rich plasma (PRP) has been gaining attention. In this study, the clinical results of PRP treatment in our institution were reported and compared between responders and non-responders using patient characteristics and imaging data assessed from plain X-rays and magnetic resonance imaging (MRI). Participants in the study were KOA patients with varus deformity assessed as grade 2 or higher in the Kellgren-Lawrence classification who received PRP treatment from January 2022 to November 2023 and were followed up for at least three months. PRP was prepared with 27 mL of blood collected from the patient, and 2.7 mL of PRP was prepared using the PEAK©︎PRP System from DePuy Synthes (Raynham, MA). Intra-articular injections of PRP were performed under echo-guided procedures, and responders or non-responders were determined using the Osteoarthritis Research Society International Standing Committee for Clinical Trials Response Criteria Initiative (OMERACT-OARSI) criteria evaluated by the Japanese Knee Injury and Osteoarthritis Outcome Score (J-KOOS) at three months after PRP injection. The clinical efficacy of PRP treatment for KOA was assessed in this study, and a dichotomous analysis was performed comparing the responder group and the non-responder group using patient characteristics and assessed data from plain X-ray images and MRI to determine prognostic factors for PRP treatment. The study population included 36 knees with a mean age of 70.6. ± 9.2 years, comprising six knees in men and 30 knees in women. The responder group consisted of16 knees (44.4%), and the non-responder group consisted of 20 knees (55.6%).J-KOOS subscores at pre-treatment elicited that each subscale in the R group was significantly lower than that in the NR group at pretreatment. A dichotomous analysis for the two groups revealed the distribution of sex and past medical history of hyperlipidemia to be significantly different between the two groups. Multivariable logistic regression analysis showed that the coexistence of hyperlipidemia was the main prognostic factor for the efficacy of PRP therapy. In this study, comparisons were conducted between responders and non-responders to estimate prognostic factors for the efficacy of PRP therapy. Surprisingly, responders to the treatment tended to show lower J-KOOS scores and to have hyperlipidemia. A literature review revealed conflicting reports on prognostic factors for PRP therapy in KOA, highlighting the need for further research.

Impact of Elderly Women's Knee Osteoarthritis Pain on Daily Living Activity at Northern Upper Egypt

Background: The most common cause of discomfort in old age is osteoarthritis. The age range between 55 and 64 years old has the largest annual incidence of knee osteoarthritis. 65 and younger make up more than half of those with symptomatic knee OA. Women make up 62% of those with osteoarthritis. Aim: The current study’s objective is to determine the effect of osteoarthritis pain in the knees of older women on their ability to carry out everyday activities in Northern Upper Egypt. Setting: The investigation was conducted in the orthopaedics outpatient clinic and the physiotherapy unit at Beni-Suef University Hospital. Subjects: In the current study, 300 studied women were recruited using a non-probability consecutive sampling technique. Tools: Katz scale, interview questionnaire, and Visual Analog Scale (VAS). Results: showed that more than one-third (40%) of the elderly women in the study had knee joint problems from less than five years ago and 70% of them experienced severe pain. Additionally, 30% of the women in the study required supervision, guidance, personal assistance, or complete care when getting dressed, and 90% reported fatigue, 71.3% anxiety, and 70% limited social participation. Conclusion: The pain of osteoarthritis in older women has an impact on their social, psychological, and physical health. Recommendations: Through targeted programs to people in the community, raise public awareness of osteoarthritis pain and complications.

Assessment of the deformation model of the proximal tibia in the course of degenerative disease: analysis of the 3-dimensional mathematical model

BackgroundThe high tibial osteotomy (HTO) is an effective knee-saving procedure, which relieves arthritis symptoms and prolongs the life of the knee joint. This procedure requires detailed preoperative planning. Usually, the contralateral side is used as a template for this purpose. Some intra-operative complications made us thinking how exactly the degenerative disease alter the epiphysis if the tibia. Our study aimed to assess morphological differences between healthy knees and degenerative knees using a three-dimensional mathematical model.MethodsTwenty-three computed tomography (CT) examinations were collected out of 237 individuals screened for inclusion/exclusion. The inclusion criteria were: age between 40 and 69 years, degenerative knees with visible varus deformation, and signs of radiological osteoarthritis (OA) in the knee joint (such as joint space narrowing, subchondral sclerosis, subchondral cyst formation, and osteophytes. The average age of the included patients was 56.2 years. Nine men’s and 14 women’s knee joints were used for the calculation and comparisons.ResultsFemale varus knees showed much more significant variability in tibial plateau dimensions according to sides of the body than male ones. These differences were statistically significant (P=0.03). In comparison between the basal bone and bones with OA, variability in 3D dimensions was statistically significant only for lateral condyles in males’ right knees (P=0.025). Compared to the degenerative knees to the most average, healthy knees, there were significant differences in the measured surface area of males’ right knees for both condyles: for the medial P=0.0046, for lateral P=0.005. Male varus knees had a statistically more considerable (P=0.028) surface area for all measured condyles. Angles of inclination differ significantly between knees with OA and healthy knees in the male population for the medial condyle plateau in the left knees. The female population for the lateral condyle in left knees and the medial condyle in right knees.ConclusionsThe proximal tibial plateau deformation showed high variability in the two-dimensional and three-dimensional analysis in the designed mathematical models. This finding must be considered during preoperative planning.

Lower-limb work during low- and high-impact tasks in hip-related pain: Associations with sex and symptoms

Background: Hip-related pain (HRP) is a movement-related condition; however, previous biomechanics research into HRP have concentrated on male-dominated cohorts and focused on people undergoing surgical intervention. As a result, little is known about the biomechanical impairments of women with HRP and those not seeking surgery. Therefore, the aims of this study were threefold: (i) to evaluate the differences in lower-limb joint work between football players with and without HRP, (ii) to explore the relationship between lower-limb work and a person’s burden of HRP, and (iii) to determine whether any potential differences/relationships were sex-dependent. Methods: Football players aged 18-50 years were eligible to participate. For the HRP group, participants were eligible if they presented with a 6-month history of HRP; whereas control players were eligible if they presented with no lower-limb or lower-back pain/injury over the previous six months. A total of 88 players with HRP (23 women) and 30 asymptomatic controls (13 women) participated. Biomechanical data were collected during walking and single-leg drop jumps (SLDJ). HRP burden was quantified using the International Hip Outcome Tool (iHOT33). Between-group differences and relationships between lower-limb work done and a person’s burden of HRP were assessed using linear regressions incorporating sex-based interactions. Results: Walking: No joint work variables were different between footballers with and without HRP independent of sex, nor were any relationships with a person’s burden of HRP evident. SLDJ: A sex-specific interaction was present for the knee’s relative contribution to total lower-limb negative work done, with women with HRP demonstrating a lower contribution compared to their asymptomatic female peers (37.7% vs 42.4%, P=0.04). The iHOT33 was significantly associated with positive (P=0.03 to <0.01) and negative (P=0.02 to <0.01) work done by the hip as well as negative work done by the ankle (P=0.03 to 0.01), independent of sex Discussion: Overall, few differences were observed between players with and without HRP. Only one significant between-group difference was revealed, involving the knee in women only, providing further insight that the relationship between hip pain and biomechanics may be modified by sex. In addition, players with a greater self-reported burden of HRP tended to display lower hip joint work during the SLDJ. Rehabilitation programs for people with HRP should target these impairments and normalize lower-limb work done during high impact tasks. COI statement: Funding was supplied by the NHMRC (GNT:1088683).

Do Sex-Specific Differences Exist in ACL Attachment Location? An MRI-Based 3-Dimensional Topographic Analysis.

Background:Female sex is an independent risk factor for an anterior cruciate ligament (ACL) injury, as the incidence of an ACL rupture is 4- to 6-fold higher in female athletes compared with their male counterparts. The ACL attachment location as a potential risk factor for the increased ACL rupture rate in women has never been reported in the literature.Purpose/HypothesisThe purpose of the present study was to investigate the 3-dimensional topographic anatomy of the ACL bundle attachment in female and male patients, with and without an ACL rupture, and identify potential sex-related differences. We hypothesized that the ACL attachment location would be significantly different between men and women, in both the intact- and ruptured-ACL states.Study Design:Cross-sectional study; Level of evidence, 3.Methods:Magnetic resonance images of the knee from 90 patients (55 men, 35 women) with a ruptured ACL and 90 matched controls (55 men, 35 women), who suffered a noncontact knee injury without ACL rupture, were used to create 3-dimensional models of the femur and tibia. The ACL bundles’ origin and insertion were outlined on each model, and their location was measured using an anatomical coordinate system. A 2-way analysis of variance was used to compare the ACL attachment location between male and female patients, with and without an ACL rupture.Results:No significant differences were found between female and male participants regarding ACL attachment location (femoral origin and tibial insertion). Patients with a ruptured ACL demonstrated a significantly different ACL origin compared with the participants with an intact ACL by an average difference of 8.9% more posterior (P < .05) and 4.0% more proximal (P < .05) in men and 13.0% more posterior (P < .05) and 5.5% more proximal (P < .05) to the flexion-extension axis of the knee in women.Conclusion:The ACL attachment location should not be considered a risk factor for the increased ACL rupture rates in female compared with male athletes. However, a more posterior and proximal location of the femoral ACL origin might be a predisposing factor to an ACL rupture regardless of sex.

Efeitos da prática do treinamento resistido convencional na estabilidade do joelho de mulheres adultas

A qualidade do movimento corporal humano tem sido uma das grandes preocupações da ciência nos últimos anos. Nesse sentido, a articulação do joelho passou a receber atenção especial, pois trata-se de uma estrutura complexa e relativamente instável que recebe sobrecarga frequente. Evidências apontam que a estabilidade dessa articulação é influenciada pela eficiência dos músculos posterolaterais do quadril. O objetivo do estudo foi analisar o padrão de movimento dos joelhos em mulheres praticantes de treinamento resistido convencional, através do teste Descida do degrau (Step down). Com o step ajustado a 10% da estatura, cada participante realizou três repetições em base unipodal com ambos os membros. Aqui, mostramos que 100% das participantes apresentaram algum nível de valgo dinâmico. Portanto, o treinamento resistido convencional, de forma exclusiva, não assegura boa estabilidade para a articulação do joelho.

Bilateral osteophytes are associated with more severe knee pain in women from an open population

Purpose: Pain is a personal response that is influenced by several factors, for example genetic predisposition, experience and expectations, coping strategies, and sociocultural environment. Therefore, it is difficult to directly link structural osteoarthritis (OA) lesions to pain. Several studies showed that bone marrow lesions (BML) and effusion (inflammation) are associated with pain. Different types of pain have been distinguished within people with osteoarthritis (OA). With the modified painDetect questionnaire (mPD) nociceptive pain, mixed pain and neuropathic-like pain (or predominantly central sensitization) can be distinguished. Little is known about the association between the different types of pain and structural lesions seen on MRI. Therefore, our aim was to explore if there is a difference in structural lesions in the knee in women with different pain types. Methods: In the sub-cohort of 700 women of the Rotterdam Study measurements were performed, including a knee specific questionnaire and MRI of both knees. The knee specific questionnaire included the mPD for knee pain. All MRIs were scored with the MRI OA knee score (MOAKS). The knee was divided in patella and tibiofemoral region. Osteophytes were scored based on size. We defined the presence of a definite osteophytes as a score of 2 or higher. A cartilage lesion was defined as the presence of a cartilage lesion with a score of 1 or higher. Bone marrow lesions (BML) were defined as present if there was a score based on size of 1 or higher. Effusion was defined as present when there was more than a physical amount of fluid seen on the MRI. For each woman we defined if they had no, unilateral of bilateral lesions. The total score of the mPD was calculated and each woman was categorized as no pain (a score of 0), predominantly nociceptive pain (a score <12 on the mPD), mixed pain (a score between 12 and 18 on the mPD), or predominantly central sensitization (a score >18 on the mPD). The number and percentages of unilateral and bilateral osteophytes, cartilage lesions, BML and effusion were calculated. Univariate and multivariate generalized linear models were used to calculated the association between uni- or bilateral MRI features and the categories of the mPD. Results: Of the 700 women, 409 women (59.6%) had no knee pain, 231 women (33.7%) had predominantly nociceptive pain, 40 women (5.7%) had mixed pain, and only six women (0.9%) of this open population had predominantly central sensitization. Due to the low number of women with predominantly central sensitization, we summed the two highest categories of the mPD for further analysis. In table 1 the numbers and percentages of the MRI features are shown per group of women defined by their mPD score. No differences were seen for age per group, while a slightly increasing BMI was seen with each category of the mPD. Bilateral lesions were more likely seen in women with a higher score on the mPD. In table 2 the association between the presence of uni- and bilateral MRI features and the mPD score are shown. Due to high correlation between osteophytes in the patella and osteophytes in the TF joint (r=0.715), and between BML and cartilage lesions in the patella (r=0.664), we discarded the osteophytes and BMLs of the patella from the analysis. Multivariate analysis showed that the presence of osteophytes in the TF (unilateral (OR=1.80 (95%CI 1.1-3.0) p=0.026) and bilateral (OR=3.18 (95% CI 1.7-5.9) p<0.001)) were significantly associated to a higher score on the mPD, independent from age and BMI and the other MRI features. Bilateral effusion (OR=1.63 (95% CI 1.0-2.7) p=0.062) was borderline significantly associated with a higher score on the mPD. A higher BMI (1.055 (1.0-1.1) p=0.009) was also significantly associated to a higher score on the mPD. Conclusions: Women with more OA features seen on MRI, especially those with osteophytes in both knees, are more likely to have mixed pain and predominantly central sensitization (a higher score on the mPD) than women with less OA features. Furthermore, women with mixed pain and predominantly central sensitization had a higher BMI than women with predominantly nociceptive pain and women without pain. Further analysis will be needed to show if women with mixed pain and predominantly central sensitization also have more severe OA features seen on MRI, than women with predominantly nociceptive pain.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Influence of Handgrip Stabilization During Isokinetic Knee Strength Assessment in Older Women.

The present study aimed to evaluate the influence of holding the chair handles during the assessment of older women's knee flexion and extension isokinetic and isometric strength. Of 57 older women (≥60 years) selected from a convenience sample for this research, 23 were randomly chosen to perform the tests twice for reliability analyses. Each participant performed maximal isokinetic knee extension and flexion at 60°/s and 180°/s angular velocities and isometric tests under two conditions: (a) holding the lateral handle of the chair (HOLD) and (b) supporting the hands on the shoulders with the arms crossed (i.e., not holding the handle [NHOLD]). Participants performed significantly better in the HOLD compared with the NHOLD condition. Slightly lower intraclass correlation coefficients (ICC = 0.870-0.956) were noted for the HOLD than for the NHOLD condition (ICC = 0.900-0.981) so that the HOLD performance on Days 1 and 2 was different on some measures. Owing to the higher reliability coefficients in the NHOLD condition, results suggest that, when assessing knee strength in older women, the evaluee should place their hands over their shoulders with arms crossed in front of the chest (NHOLD) to maximize assessment reliability (reproducibility of performance).

Differences in subchondral bone plate and cartilage thickness between women with anterior cruciate ligament reconstructions and uninjured controls

Anterior cruciate ligament (ACL) tears increase early onset osteoarthritis (OA) risk leading to cartilage and bone degradation. While the contribution of bone in OA development is unclear, evidence suggests that bone changes accompany cartilage degradation. This study aims to assess if regions with differences in subchondral bone plate thickness have differences in cartilage thickness when comparing ACL reconstructed (ACLR) knees of women ≥5 years post-injury to contralateral and controls with uninjured knees. Magnetic resonance imaging (MRI) assessed cartilage and high resolution peripheral quantitative computed tomography (HR-pQCT) assessed subchondral bone in both knees. Multimodal 3D image registration aligned anatomy. Maps of the spatial distribution of thickness on the articular surfaces were generated to compare women with ACL reconstructions to contralateral and controls with uninjured knees. ACLR knees had a thicker subchondral bone plate in the posterior and central lateral femur compared to contralateral knees (10.4% and 4.2% thicker, P=0.032 and 0.032, W=108 and 107, respectively) and in the posterior lateral femur compared to control knees (17.1% thicker, P=0.014, W=177). Cartilage differences were not detected (P>0.05) in these regions. This study demonstrates that subchondral bone plate thickness differences are prominent following knee injury, as measured by HR-pQCT, but no statistically significant differences in cartilage morphology, measured by MRI, were found between ACLR knees compared to contralateral and control knees. These data provide novel insight into post-traumatic knee injuries that may be signs of early OA pathogenesis.

Three-dimensional cortical thickness in femoral diaphysis for ealthy elderly and osteoarthritic knees in women

Three-dimensional cortical thickness in femoral diaphysis for ealthy elderly and osteoarthritic knees in women

Performance of quality of life and functional capacity in women with knee osteoarthritis treated with viscosupplementation and strength training

The viscosupplementation and strength training are interventions accepted in the treatment of knee osteoarthritis. Objective: The study describes the effect of two interventions in quality of life and functional capacity. Method: Thirty women diagnosed with bilateral knee osteoarthritis of grade II and III by radiological criteria of Kellgren & Lawrence, were randomized into three groups with ten patients each: VSTF group submitted to viscosupplementation and strength training, TF group submitted only to strength training and VS group submitted only to viscossuplementation. Moments of the study were defined as pre-procedure (PRE), after 48 hours of VS (POS-VS) after 12 weeks of training (POS T) and after eight weeks of detraining (POS D). Quality of life was assessed by the SF-36 BRAZIL, functional capacity by Lequesne index. Intraarticular infiltrations were carried out with a single dose of 6 ml / 48 mg with 6,000,000 kDa Hylan GF-20 and strength training sessions were held for twelve weeks. Results: Strength training and viscosupplementation were effective in the treatment of knee osteoarthritis. Both interventions promoted improvements in quality of life and in functional capacity (p < 0.001), with advantage to the groups that trained force. Conclusion: Strength training is a possible replacement of viscosupplementation in the treatment of osteoarthritis of women's knees. However, the beneficial effect of viscosupplementation in pain reduction suggests better efficiency in the strength training execution which may be an advantage of the association of both.

Performance of quality of life and functional capacity in women with knee osteoarthritis treated with viscosupplementation and strength training

The viscosupplementation and strength training are interventions accepted in the treatment of knee osteoarthritis. Objective: The study describes the effect of two interventions in quality of life and functional capacity. Method: Thirty women diagnosed with bilateral knee osteoarthritis of grade II and III by radiological criteria of Kellgren &amp; Lawrence, were randomized into three groups with ten patients each: VSTF group submitted to viscosupplementation and strength training, TF group submitted only to strength training and VS group submitted only to viscossuplementation. Moments of the study were defined as pre-procedure (PRE), after 48 hours of VS (POS-VS) after 12 weeks of training (POS T) and after eight weeks of detraining (POS D). Quality of life was assessed by the SF-36 BRAZIL, functional capacity by Lequesne index. Intraarticular infiltrations were carried out with a single dose of 6 ml / 48 mg with 6,000,000 kDa Hylan GF-20 and strength training sessions were held for twelve weeks. Results: Strength training and viscosupplementation were effective in the treatment of knee osteoarthritis. Both interventions promoted improvements in quality of life and in functional capacity (p &lt; 0.001), with advantage to the groups that trained force. Conclusion: Strength training is a possible replacement of viscosupplementation in the treatment of osteoarthritis of women's knees. However, the beneficial effect of viscosupplementation in pain reduction suggests better efficiency in the strength training execution which may be an advantage of the association of both.

Muscle function in women with systemic sclerosis: Association with fatigue and general physical function

BackgroundIndividuals with systemic sclerosis have muscle functions with varying degrees of muscle weakness and atrophy, which in turn can have a negative impact on functional and health-related quality of life. This study aimed to evaluate peripheral muscle performance using isokinetic dynamometry of the knee in women with systemic sclerosis and to correlate peripheral muscle dysfunction with disability levels and general fatigue. MethodsTwenty-six women with systemic sclerosis and a matched control group with an equal number of women underwent knee isokinetic dynamometry at angular speeds of 75°/s and 240°/s, isometric handgrip strength, the Health Assessment Questionnaire Disability Index, the Functional Assessment of Chronic Illness Therapy-Fatigue scale, and the Fatigue Impact Scale. FindingsWomen with systemic sclerosis showed significant reductions in almost all isokinetic parameters for the two angular velocities tested compared with the controls. An agonist/antagonist ratio with values <40% was observed in approximately one-third of the patients. These patients had lower isometric handgrip strength. These patients also performed worse on the two general fatigue scales evaluated. Significant correlations were observed between the isokinetic parameters and the measured isometric handgrip strength, and the Health Assessment Questionnaire Disability Index. InterpretationSystemic sclerosis patients have reduced strength and endurance as well as a muscle imbalance between the quadriceps and hamstrings. In these patients, lower muscle dysfunction of the knee joint is associated with lower handgrip strength and physical incapacity.

AB1165-HPR Relationship between Anterior Knee Pain Severity, Functional Capacity, Frontal Plane Projection Angle, Trunk and Hip Strength in Patellofemoral Pain

BackgroundPatellofemoral Pain Syndrome (PFPS) is characterized by anterior knee pain most commonly on the patella lateral facet. Although the increased Frontal Plane Projection Angle (FPPA), core deficit and hip strength...

Increased fasting serum glucose concentration is associated with adverse knee structural changes in adults with no knee symptoms and diabetes

ObjectiveThere is evidence to suggest that elevated glucose concentration and clinical diabetes are associated with osteoarthritis (OA). However, the association may be confounded by knee symptoms, concomitant treatment for OA or diabetes. We performed a longitudinal cohort study to examine the relationship between serum glucose concentration and knee structure in adults with no knee symptoms or diabetes. Methods179 participants who had fasting serum glucose measurements at 1990–4, with no knee symptoms or diabetes (physician-diagnosed or fasting serum glucose ≥7mmol/L), underwent knee MRI in 2003–4 and 2 years later. Body mass index was measured at 1990–4 and 2003–4. Cartilage volume and bone marrow lesions were determined from MRI at 2003–4 and 2006–7. ResultsFasting serum glucose concentration was positively associated with the rate of tibial cartilage volume loss over 2 years in women (B=44.2mm3, 95% CI 4.6, 83.8) but not in men (B=6.0mm3, 95% CI −68.5, 80.6). Fasting serum glucose concentration was positively associated with incident bone marrow lesions in women (OR=5.76, 95% CI 1.06, 31.21) but not in men (OR=0.11, 95% CI 0.01, 1.79) with significant gender difference (p=0.001 for interaction). ConclusionIncreased fasting serum glucose concentration in a non-diabetic population was associated with adverse structural changes at the knee in women but not in men, suggesting that there may be susceptibility to knee structural change even below the arbitrary “diabetic range” of serum glucose levels. The sex differences warrant further investigation as this may be one mechanism underlying the sex difference in knee OA.

Patterns of compartment involvement in tibiofemoral osteoarthritis in men and women and in whites and African Americans

We conducted a cross-sectional study to describe the prevalence of tibiofemoral joint space narrowing (JSN) in medial and lateral compartments and assess whether it differs by sex and ethnic groups, and, if it does, to what extent such a difference is accounted for by knee malalignment. The Multicenter Osteoarthritis Study is an observational study of persons ages 50-79 years with either symptomatic knee osteoarthritis or high risk of disease. Knee radiographs were assessed for JSN in each tibiofemoral compartment. Mechanical axis angle was measured using full-extremity films. We compared the proportion of knees with medial compartment JSN and with lateral JSN between men and women, as well as between whites and African Americans, using a logistic regression model adjusting for covariates (race or sex and body mass index, age, education, and clinic site). We used generalized estimating equations to account for correlation between 2 knees within a person. Of 5,202 knees (2,652 subjects), 1,532 (29.5%) had medial JSN and 427 (8.2%) had lateral JSN. Lateral JSN was more prevalent in the knees of women than in men (odds ratio [OR] 1.9, 95% confidence interval [95% CI] 1.5-2.4) and was also higher in the knees of African Americans than in whites (OR 2.4, 95% CI 1.7-3.3). Further adjustment for malalignment attenuated the OR for sex but not the OR for race. Women and African Americans are more likely to have lateral JSN than men and whites, respectively. Valgus malalignment may contribute to the higher prevalence in women.

Implant Survival, Knee Function, and Pain Relief After TKA: Are There Differences Between Men and Women?

As efforts continue to improve the results of TKA, the potential influence of sex and gender on long-term survival of implants, knee function, pain relief, and patient satisfaction remains relevant, particularly given the increased incidence of osteoarthritis of the knee in women and reports that women derive equal benefit from TKA. This article reviews the literature pertinent to the question of whether long-term survival, knee function, pain relief, and patient satisfaction after TKA differ between men and women. Large clinical series (> 1000 patients) published in the last 10 years were identified in PubMed and reviewed. Men may be at higher risk of revision surgery than women. Sex/gender has been consistently shown to impact both function and pain relief both before and after TKA. Although women achieve at least the same degree of functional improvement as men, women have worse preoperative physical function and do not reach the same final level of physical function as men. Likewise women may have similar or even greater improvement in pain after arthroplasty than men but still have final pain scores that are less favorable. Further research is required to understand the sex and gender differences contributing to implant survival, physical function, and pain relief after TKA. Strategies need to be developed to identify any patient who is at higher risk of implant failure, suboptimal postoperative function, and incomplete pain relief.

The Effect of Aquatic Exercise on the Peak Torque and Stability of Knee Joints of Elderly Women

Purpose) The purpose of this study was to examine the effect of aquatic exercise using Taekwondo Poomsae motions on the peak torque and stability of elderly women's knee joints. (Subjects) The study subjects were conducted with 23 elderly women who were divided into an Aquatic Exercise Group (AEG, n=12) and a Control Group (CG, n=11). (Methods) The knee joint peak torque was assessed using an ISOMED 2000 (D&R GmbH, Germany) and the stability was analyzed using a Balance System SD (BIODEX, U.S.A). (Results) Based on the results of the analysis of changes in knee joint peak torque and stability, the AEG showed significant improvement in all items of knee joint peak torque (RFF, RFE, LFF, LFE) and stability (O, A/P, M/L) after the intervention compared to before the intervention, while the CG did not show any significant changes. (Conclusion) Aquatic exercises using Taekwondo Poomsae motions can be utilized as a new exercise program to help reinforce

Axial and Sagittal Knee Geometry as a Risk Factor for Noncontact Anterior Cruciate Ligament Tear: A Case-Control Study

The purpose of this study was to compare the axial and sagittal geometry of the distal femur and proximal tibia in men and women with and without noncontact anterior cruciate ligament (ACL) tears to determine whether a difference existed in these groups. Twenty men and 20 women with noncontact ACL tears and preoperative magnetic resonance imaging scans of their knees were compared with 20 men and 20 women who had magnetic resonance imaging for meniscal pathology. Patients were not matched for age, weight, or height. We measured the anteroposterior dimensions of the femoral condyles, the medial-lateral width of the femur, and the angle of intersection between the transepicondylar axis and the long axis of the femoral condyles. We also measured the anteroposterior dimension of the tibial plateaus, as well as the width of the proximal tibia. Finally, the posterior tibial slope was measured for the medial and lateral tibial plateaus. All dimensional measurements were standardized and compared statistically. When compared with normal men, normal women had proportionally deeper medial (3%, P = .049) and lateral (7%, P < .001) femoral condyles, as well as deeper medial tibial plateaus (5%, P = .025). There were no differences between normal women and women with ACL tears (P = .09 to .83). Men with ACL tears had deeper medial (5%, P = .04) and lateral (10%, P = .01) tibial plateaus, as well as an increased posterior slope of the lateral tibial plateau (12 degrees vs 8 degrees , P = .006), when compared with normal men. We compared normal men and women with those with noncontact ACL tears and found that women's knees were characterized by proportionally deeper medial and lateral femoral condyles, as well as deeper medial tibial plateaus. When compared with normal men, men with ACL tears had deeper medial and lateral tibial plateaus, as well as an increased posterior slope of the lateral tibial plateau. Level III, case-control study.