Medial Knee Research Articles

Relationship between DXA measured systemic bone mineral density and subchondral bone cysts in postmenopausal female patients with knee osteoarthritis: a cross-sectional study

BackgroundIndividuals with high systemic bone mineral density (BMD) may have an increased risk of incident knee osteoarthritis (OA). Besides that, radiographic osteophytes are strongly associated with BMD. Because of these reasons, the aim of the study was to investigate the possible association between radiological subchondral bone cyst (SBC) grade and systemic BMD and vitamin D status in the postmenopausal female patients with knee OA in a crosss-sectional study.MethodsThis study included of 48 osteoporosis treatment-free postmenopausal patients diagnosed with symptomatic medial compartment knee OA. BMD analysis was performed using dual-energy X-ray absorptiometry (DXA) and serum vitamin D levels were measured after recording patients’ findings. Each knee was scanned using computed tomography (CT), and categorical SBC scores were graded for the medial and lateral tibiofemoral (TF) and patellofemoral (PF) compartments and further calculated as compartmental total, total TF and grand total of both TF compartments. SBC scores were analysed with correlation analysis.ResultsThe patient population was characterized by radiographic joint space narrowing, obesity and low vitamin D status. Median medial total and grand total TF SBC scores were significantly different between the patient groups according to the Kellgren-Lawrence (KL) radiographic grading (p = 0.006 and p = 0.007, respectively). There were no correlations between femoral BMD values and SBC scores. However, positive correlations were detected significantly between L1 − 4 DXA values and TF SBC scores, but not with PF SBC scores (p = 0.005 for the correlation between L1 − 4 BMD and medial compartments total TF SBC score, p = 0.021 for the correlation between L1 − 4 BMD and grand total TF SBC score). No significant correlations were found with Vitamin D levels.ConclusionsDevelopment of TF OA high-grade SBCs may be linked to systemic bone mass as represented by trabecular bone-rich lumbar vertebrae. The relationship might point to the importance of bone stiffness as an acting factor in knee OA possibly with mechanical energy transfer to the joint.

The relationship between knee flexion excursion and mechanical stress during gait in medial knee osteoarthritis

BackgroundA decrease in knee flexion excursion during the loading response may affect not only quadriceps muscle weakness, pain, and inflammatory symptoms, but also lead to physical function decline and activity limitation. The aim of this investigation was to clarify the relationship between knee flexion excursion during the loading response and mechanical stress on the knee joint, muscle strength, pain, and physical function in patients with knee osteoarthritis. MethodsTwenty patients diagnosed with medial knee osteoarthritis. The participants walked along a 10 m corridor in the laboratory at a comfortable pace. The kinematic and kinetic data were collected using a 3D motion analysis system. We employed to control for gait speed and age while examining the relationship between knee flexion excursion during the loading response and mechanical stress on the knee joint, muscle strength, pain, and physical function. FindingsKnee flexion excursion showed a significant positive correlation with the peak and angular impulse of knee flexion moment. In the partial correlation coefficients controlling for age and gait speed, significant negative correlations were found between knee flexion excursion and knee adduction moment angular impulse. InterpretationIt can be inferred that gait with reduced knee flexion movement during the loading response in patients with knee osteoarthritis may result in increased mechanical stress on the knee joint in the frontal plane. Exercise interventions aimed at increasing knee flexion excursion may result in a reduction in disease progression.

Dimorphic comparative histological and histometric study of the lateral and medial knee menisci in male and female human cadavers

The knee menisci are fibrocartilaginous discs present in between the femur and the tibia. They play a pivotal role in withstanding the weight-bearing forces and help to maintain the stability of the knee joint. Descriptive knowledge of the menisci is essential to understand the mechanism and design of the appropriate management of their pathological lesions. Several investigations have identified the anatomical and morphological differences between the medial (MMi) and lateral menisci (LMi) in humans. What remains unclear, however, is the comparative analysis of histological and histometric parameters of these menisci, especially between males and females. To evaluate and compare the different histological, histometric and biochemical parameters of different structural components (collagen, proteoglycans, cellularity, and vascularity) of MMi and LMi in male and female human cadavers, twenty-four knee joints, 12 males and 12 females, were dissected, and the menisci were excised and labeled. The middle region of each meniscus was cross-sectioned and subjected to different histological, histometric and biochemical studies. Histological examination of MMi and LMi in both males and females yielded several observations regarding different meniscal components; the orientation of collagen fibers was circumferential with intermingled radial fibers. Both fibroblasts and fibrochondrocytes were arranged singly or in rows alongside the direction of the collagen fibers. Also, the blood vessels were present toward the periphery, whereas the proteoglycans-rich areas were more evident in the inner region of each meniscus. Nevertheless, collagen fibers organization, safranin-O staining intensity, and cellular arrangement were all different between males and females. The analysis of these changes was further compared histometrically between MMI and LMi in males and females. The gained comparative histological, histometric and biochemical findings of this work are critical for providing detailed information on the microstructure and composition of both MMi and LMi in males and females. The present results also highlight the detrimental effects of histological structure on different meniscal injuries.

Prediction of medial knee contact force using multisource fusion recurrent neural network and transfer learning.

Estimation of knee contact force (KCF) during gait provides essential information to evaluate knee joint function. Machine learning has been employed to estimate KCF because of the advantages of low computational cost and real-time. However, the existing machine learning models do not adequately consider gait-related data's temporal-dependent, multidimensional, and highly heterogeneous nature. This study is aimed at developing a multisource fusion recurrent neural network to predict the medial condyle KCF. First, a multisource fusion long short-term memory (MF-LSTM) model was established. Then, we developed a transfer learning strategy based on the MF-LSTM model for subject-specific medial KCF prediction. Four subjects with instrumented tibial prostheses were obtained from the literature. The results showed that the MF-LSTM model could predict medial KCF to a certain high level of accuracy (the mean of ρ = 0.970). The transfer learning model improved the prediction accuracy (the mean of ρ = 0.987). This study shows that the MF-LSTM model is a powerful and accurate computational tool for medial KCF prediction. Introducing transfer learning techniques could further improve the prediction performance for the target subject. This coupling strategy can help clinicians accurately estimate and track joint contact forces in real time.

Effects of Long-Term Walking Exercise on Structural Progression, Symptoms, and Extensor Muscle Strength in Patients With Mild or at High Risk of Knee Osteoarthritis: Data From the Osteoarthritis Initiative.

The aim of the study is to assess the relationship between walking exercise and medial joint space narrowing progression, symptoms, and knee extensor muscle strength in early knee osteoarthritis patients. This nested cohort study within the Osteoarthritis Initiative included participants aged 50 yrs and older with knee osteoarthritis (Kellgren-Lawrence grades 0-2). Walking exercisers were identified using a modified Historical Physical Activity Survey Instrument. Differences in medial joint space narrowing, Knee Injury and Osteoarthritis Outcome Score, and knee extensor muscle strength were evaluated through the three-way analysis of variance. Among 896 participants, 83.4% reported walking exercise. Female walkers showed significant improvements in symptoms (Knee Injury and Osteoarthritis Outcome Score-pain: P < 0.001; Knee Injury and Osteoarthritis Outcome Score-symptom: P < 0.001; Knee Injury and Osteoarthritis Outcome Score-quality of life: P < 0.001; Knee Injury and Osteoarthritis Outcome Score-function, sports, and recreational activities: P = 0.007). Similar results were observed in male walkers (Knee Injury and Osteoarthritis Outcome Score-pain: P < 0.001; Knee Injury and Osteoarthritis Outcome Score-symptom: P < 0.001; Knee Injury and Osteoarthritis Outcome Score-quality of life: P = 0.001; Knee Injury and Osteoarthritis Outcome Score-function, sports, and recreational activities: P = 0.009). Walkers showed significantly increased knee extensor muscle strength at 24 mos (female: P < 0.001; male: P = 0.003). Female nonwalkers had significantly decreased knee extensor muscle strength at 24 mos ( P < 0.001). Walkers showed significant improvement in medial joint space narrowing (odds ratio = 1.1, 95% confidence interval = 1.0-1.2) and Kellgren-Lawrence grade (OR = 1.0, 95% CI = 1.0-1.1) compared with nonwalkers. Walking exercise prevents structural progression and improves symptoms. Meanwhile, the increased knee extensor muscle strength in all walkers further supports the validity of recommending walking exercises for early-stage knee osteoarthritis patients.

Biomechanical response of lower limb joints to lateral wedge insoles

Lateral wedge insole (LWI) is a frequently recommended treatment option for early and midterm stages of medial knee osteoarthritis. However, studies of its effects on the lower limb joints are incomplete and imperfect. The main purpose of this study was to quantitatively analyze the response of intervention of LWI on lower-limb joint kinematics, ground reaction forces (GRFs), and centre of pressure (COP). Gait analysis of 16 healthy subjects was conducted. Three-dimensional motion data and force plate measurements were collected in the control (barefoot) and experimental conditions (wearing a pair of assigned shoes with 0, 7, and 10 mm LWIs). Results showed that the peak knee flexion angle was increased by 3.43°, 3.09°, and 3.27° with 0, 7, and 10 mm LWIs, respectively (p < 0.01). The ankle peak dorsiflexion angle was significantly decreased by 3.79°, 2.19°, and 1.66° with 0, 7, and 10 mm LWIs, respectively (p = 0.02). The internal rotation angle was increased by 2.78°, 3.76°, and 4.58° with 0, 7, and 10 mm LWIs, respectively (p < 0.01). The forefoot with LWIs showed highly significantly smaller inversion, eversion, and adduction angles (all p < 0.01). The 1st peak of the vertical GRF (p = 0.016) also increased significantly by a maximum of 0.06 body weight (BW) with LWIs. These results indicated that biomechanical changes and limitations of lateral wedges insole should be analyzed in more detail, possibly leading to new guidelines for the design and application.

GLUEING OSTEOCHONDRAL FRAGMENTS: DEVELOPMENT OF A NOVEL DUAL ADHESIVE PRECLINICAL MODEL STRATEGY

The fixation of articular fractures, with many small osteochondral fragments, is a challenging unmet need where a bone adhesive would be a useful adjunct to standard treatments. Whilst there are no such adhesives in current clinical use, preclinical animal models have demonstrated good healing of bone in unloaded models using an adhesive based on phosphoserine modified calcium phosphate cement (PM-CPC). An ex-vivo human bone core model has shown that this adhesive bonds freshly harvested human bone. To confirm this adhesive is capable of supporting loaded osteochondral fragments a porcine model has been developed initially ex-vivo on the path to an in-vivo study. In this model bone cores, harvested from the medial knee condyle, are glued in place with the adhesive. In-vivo adjacent pairs of bone cores would be replaced with adhesive and a control with conventional pin fixation respectively. As osteochondral bone fragments have both bone and cartilage components, this suggested a dual adhesive strategy in which components designed for each tissue type are used. This concept has been explored in an ex-vivo porcine pilot study presented herewith. At the subchondral bone level, the PM-CPC was used. At the cartilage level, a second adhesive, a methacrylated phosphoserine containing hyaluronic acid (MePHa) hydrogel designed specifically for soft tissues was applied. This is a challenging model as both adhesives have to be used simultaneously in a wet field. The pilot showed that once the subchondral component is glued in place, the PM-CPC adhesive intruding into the cartilage gap can be removed before applying the cartilage adhesive. This enabled the MePHa adhesive to be injected between the cut cartilage edges and subsequently light-cured. This two-stage gluing method is demanding and an in-vivo pilot is necessary to perfect and prove the operative technique.Acknowledgements: The human bone core project was partially financed by Innovation Fund of Västra Götaland Region, Sweden. The MePHa hydrogel work was supported by a Swiss National Fund grant # CR23I3_159301.

The Impact of Pes Planus on Knee Function and Its Association with Medial Compartment Knee Osteoarthritis.

Pes planus, commonly known as flat foot, is characterized by the lowering of the medial longitudinal arch of the foot, leading to alterations in lower limb biomechanics and potential pain and injury. This condition can affect the mechanical alignment and dynamic function of the lower limb, potentially contributing to the development and progression of knee osteoarthritis (OA). This study aims to investigate the association between pes planus and medial compartment knee OA as well as its impact on the knee functional score. This cross-sectional study included 165 patients aged 20-72 years. Inclusion criteria were individuals with unilateral or bilateral flat feet, while exclusion criteria were other foot conditions, history of knee or ankle surgeries, rheumatoid arthritis, and limb length discrepancies. Clinical assessments included knee joint tenderness, foot arch measurement using the foot arch index, and radiographic evaluations of Meary's angle and tibiofemoral (TF) angle. The knee injury and osteoarthritis outcome score (KOOS) was used to assess knee function. The study population had a mean age of 43.98 ± 13.17 years. Meary's angle ranged from 5 to 19° (mean 9.46), and the foot arch index ranged from 0.220 to 0.520 (mean 0.33). The TF angle ranged from 1.7 to 7.5° (mean 4.98). KOOS scores varied from 10 to 100 (mean 62.40). Patients with more severe flat feet (higher Meary's angle and foot arch index) had significantly lower KOOS scores, indicating worse knee function and greater pain. The correlations between foot arch index, Meary's angle, and KOOS scores were statistically significant (P = 0.001). This study demonstrates a strong association between flat foot severity and knee OA. Increased Meary's angle and foot arch index were correlated with worsened knee function and increased pain, as measured by KOOS scores. These findings highlight the importance of assessing foot posture in patients with medial compartment OA and suggest that early intervention and orthotic management could be beneficial in mitigating the progression and severity of knee OA in patients with pes planus.

Establishing patient-centered metrics for the knee injury and osteoarthritis outcome score following medial unicompartmental knee arthropalsty.

This study aimed to determine the minimal clinically important difference (MCID) and the patient acceptable symptoms state (PASS) threshold for the knee injury and osteoarthritis outcome score (KOOS) pain subscore, KOOS physical short form (PS), and KOOS joint replacement (JR) following medial unicompartmental knee arthroplasty (mUKA). Prospectively collected data from 743 patients undergoing mUKA from a single academic institution from April 2015 through March 2020 were analyzed. Patient-reported outcome measures (PROMs) were collected both pre-operatively and 1-year post-operatively. Distribution-based and anchored-based approaches were used to estimate MCIDs and PASS, respectively. The optimal cut-off point and the percentage of patients who achieved PASS were also calculated. MCID for KOOS-pain, KOOS-PS, and KOOS-JR following mUKA were calculated to be 7.6, 7.3, and 6.2, respectively. The PASS threshold for KOOS pain, PS, and JR were 77.8, 70.3, and 70.7, with 68%, 66%, and 64% of patients achieving satisfactory outcomes, respectively. Cut-off values for delta KOOS pain, PS, and JR were found to be 25.7, 14.3, and 20.7 with 73%, 69%, and 68% of patients achieving satisfactory outcomes, respectively. The current study identified useful values for the MCID and PASS thresholds at 1year following medial UKA of KOOS pain, KOOS PS, and KOOS JR scores. These values may be used as targets for surgeons when evaluating PROMS using KOOS to determine whether patients have achieved successful outcomes after their surgical intervention. Potential uses include the integration of these values into predictive models to enhance shared decision-making and guide more informed decisions to optimize patient outcomes. III.

Comparison of Physical Therapy and Orthosis on Clinical Outcomes in Patients with Medial Knee Osteoarthritis

ABSTRACT INTRODUCTION Orthosis and physical therapy are two conservative managements for knee osteoarthritis (OA), but the question is which is better for alleviating pain and improving function? The aim of this study was to compare two interventions of orthosis and physical therapy on pain and function in patients with knee OA. METHODS In this quasi-experimental study, 31 individuals with medial knee OA were recruited into two groups including orthosis group (combination of insole and brace [n = 14]) and physical therapy group (n = 17). Pain severity was measured by visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. Also, daily activity was measured by the WOMAC questionnaire at baseline and after 6-week follow-up. Wilcoxon signed rank and Mann-Whitney U tests were used to determine significant difference for intragroup and intergroup comparisons, respectively. RESULTS The orthosis group (using both knee brace and LWLs) had a better result for pain score related to VAS than the physical therapy group immediately after and 6 weeks of using the intervention, with a significant difference between the two groups (P = 0.006). Regarding the WOMAC items including pain and daily activity, both groups had significant differences after the 6-week period of using the intervention, with no significant difference between the groups. CONCLUSIONS Based on the findings, pain and daily activity related to the WOMAC questionnaire were improved in both orthosis and physical therapy groups, with no differences between the two interventions. The orthosis group had better results in pain related to VAS. CLINICAL RELEVANCE The aim of this study was to find whether physical therapy or orthosis best improves pain and function of knee OA patients.

Unicompartmental knee replacement combined with anterior cruciate ligament reconstruction provides comparable results to total knee replacement with no increased risk of complications.

There is controversy about the management of unicompartmental knee osteoarthritis (OA) in young, active patients with anterior cruciate ligament (ACL) insufficiency. This study compares the subjective, radiological, and functional results of total knee replacement (TKR) vs. combined medial unicompartmental knee replacement (UKR) with ACL reconstruction. Twelve patients suffering from medial OA and ACL deficiency with varus knee deformity and/or tibial slope<10° and absence of patellofemoral-related problems were eligible for combined UKR and ACL reconstruction (Group A). Twenty-six patients matched for age, male/female ratio and body mass index who received TKR in the same time frame were included as a control group (Group B). Oxford Knee Score (OKS), WOMAC index of osteoarthritis, Knee Osteoarthritis Outcome Score (KOOS), and routine X-rays were used for assessment. Ten years after surgery, the mean overall KOOS score, OKS, WOMAC index increased from preoperatively, showing a statistically significant difference (p<0.001). In terms of KOOS, OKS, or WOMAC scores at the most recent follow-up, there was no discernible difference between the groups (p=n.s.). Three years following surgery, one female patient in group A received revision TKR due to the lateral compartment's osteoarthritis developing and the patient's pain persisting. Concerning radiographic assessment, at the most recent follow-up (average 7.9years in group A and 8.8years in group B), there were no radiographic indications of implant loosening or proof of pathologic radiolucent lines. UKR combined with ACL restoration offers clinical and radiographic outcomes comparable to TKR 10years following surgery with no elevated risk of complications.

Patient-specific cutting guides increase accuracy of medial opening wedge high tibial osteotomy procedure: A retrospective case-control study.

To compare the accuracy of patient-specific guides (PSCG) to the standard technique in medial open-wedge high tibial osteotomy (OWHTO). Secondary objectives were to evaluate factors that could influence accuracy and to compare the complication rate and operating time for both procedures. A retrospective analysis of prospective collected data was performed. Between March 2011 and May 2018, 49 patients with isolated medial knee osteoarthritis who were operated for OWHTO using PSCG and 38 patients using the standard technique were included. Preoperative and postoperative deformities were evaluated on long leg radiographs by measuring the mechanical medial proximal tibial angle, mechanical lateral distal femoral angle, hip knee ankle angle (HKA), and joint line convergence angle. Pre- and postoperative posterior tibial slope was also evaluated. Accuracy was evaluated by analysing the difference between the preoperative planned and the actual postoperative HKA. Operating time and complication rate were also recorded in both groups. The mean preoperative HKA was 173.4° (±3.1°) in the PSCG group and 173.3° (±2.4°) in the standard group (p = 0.8416). Mean planned HKA were 182.8° (±1.1°) and 184.0° (±0°) respectively for the PSCG and the standard group. Mean postoperative HKA were 181.9° (±1.9°) and 182.6° (±3.1°) respectively for the PSCG and the standard group. An accuracy of ±2° in the HKA was achieved in 44 (90%) in the PSCG group and 24 (65%) in the standard group (p = 0.006). The probability of achieving a HKA accuracy was four times higher for patients in the PSCG group (odds ratio [OR] = 4.06, [1.1; 15.3], p = 0.038). Also, higher preoperative Ahlback grade was associated with precision, all other parameters being equal (OR = 4.2, [0.13; 0.97], p = 0.04). In this study, the PSCG technique was significantly more accurate for achieving the planned HKA in OWHTO. Complication rates and operating times were comparable between groups. Level IV, case-control study.

Economic evaluation of high tibial osteotomy: Closing wedge is more cost-effective than open wedge technique when analysing the KOOS-12 improvement.

The purpose of this study was to compare the cost-effectiveness of two techniques for performing a knee valgus osteotomy: opening wedge high tibial osteotomy (OW-HTO) vs closing wedge high tibial osteotomy (CW-HTO). In this economic evaluation study, a cost-effectiveness analysis from the perspective of the Spanish public healthcare system was performed, comparing OW-HTO with CW-HTO. All patients with medial knee osteoarthritis who underwent one of these procedures between 2018 and 2020 in our institution were included. The cost analysis included operating room, implant, graft and hospital admission costs. Functional outcomes (KOOS-12, Tegner activity scale, pain and satisfaction) and radiological outcomes (hip-knee-ankle angle, medial proximal tibial angle, tibial slope and patellar height) were analysed. The cost-effectiveness ratio was obtained by calculating the cost of improving the minimal clinically important difference (MCID) of KOOS-12 for each procedure. All costs are expressed in 2020 euros. Fifty-one patients met the inclusion criteria (27 OW-HTO and 24 CW-HTO). Good to excellent functional outcomes, significant pain reduction (>6 points) and high patient satisfaction (>9/10) were observed in both groups. Both techniques yielded excellent radiological outcomes. N.s. differences in functional or radiological outcomes improvements between both procedures were found. However, the OW-HTO group presented a higher total cost than the CW-HTO group (4612.1 ± 765.6€ vs. 1827.1 ± 701.9€; p < 0.001). The cost-effectiveness ratio was 818.1 ± 46.8 €/MCID for the CW-HTO procedure and 2414.3 ± 115.2 €/MCID for the OW-HTO procedure (p = 0.025). The CW-HTO procedure presented a cost-effectiveness ratio almost three times lower than the OW-HTO procedure. Both techniques allowed to achieve of good to excellent functional outcomes, significant pain reduction and high patient satisfaction while correcting the varus limb malalignment and the metaphyseal tibial varus in patients with medial compartment osteoarthritis. Level III; economic study.

THE EFFECTS OF DRAINAGE TUBE ON PAIN AND FUNCTIONAL RECOVERY AFTER UNICOMPARTMENTAL KNEE ARTHROPLASTY.

The objective of this study was to evaluate the impact of drainage tube placement on postoperative pain, recovery, and opioid consumption within a 72-hour period following unicompartmental knee arthroplasty (UKA). Patients with medial knee osteoarthritis who underwent UKA from January 2019 to August 2020 were enrolled in the study and divided into two groups based on whether they received a drain postoperatively. The drainage group had significantly lower VAS scores on day 1, day 2, and day 3, in addition to significantly smaller changes in the circumference of the knee joint within 3 days postoperatively (P <0.05). The ROM in the drainage group significantly increased at 3 days and 1 month post-surgery, with a statistically significant difference in morphine consumption between the two groups at 3 days (P<0.05). The incidence of postoperative nausea and vomiting (5 cases) and wound bleeding (1 case) was lower in the drainage group compared to the non-drainage group (P<0.05). The placement of a drainage tube in UKA may reduce the swelling of knee joint and pain, which not only reduces the use of Opioid but also facilitates early functional activities of the knee joint. Level of Evidence III; Retrospective Comparative Study.

Ambulatory forTotal Hip &amp; Medial Unicompartmental Knee Arthroplasties

Ambulatory forTotal Hip &amp; Medial Unicompartmental Knee Arthroplasties

Reconstruction of the Medial Collateral Ligament Complex With a Flat Allograft Semitendinosus Tendon

The aim of this Technical Note is to reconstruct the medial collateral ligament complex with the superior medial collateral ligament and posterior oblique ligament as anatomically as possible. An allograft or contralateral semitendinosus autograft is used for anatomic reconstruction of the superior medial collateral ligament and posterior oblique ligament. After bony fixation, the tendon bundles are sutured to the remnants of the medial collateral ligament complex. Thus, the tubular grafts are pulled apart to form a flat shape that resembles that of the normal medial ligaments.

Medial meniscus extrusion is invariably observed and consistent with tibial osteophyte width in elderly populations: The Bunkyo Health Study

We reported that the full-length width of medial tibial osteophytes comprising cartilage and bone parts correlates with medial meniscus extrusion (MME) in early-stage knee osteoarthritis (OA). However, no data exist on the prevalence of MME and its relationship with osteophytes in the elderly population. 1191 elderly individuals (females 57%; 72.9 years old on average) in the Bunkyo Health Study underwent standing plain radiograph and proton density-weighted MRI on knee joints. MRI-detected OA changes were evaluated according to the Whole-Organ Magnetic Resonance Imaging Score. A new method of assessing the cartilage and bone parts of osteophytes was developed using pseudo-coloring images of proton density-weighted fat-suppressed MRI. Most subjects showed Kellgren-Lawrence grade 1 or 2 radiographic medial knee OA (88.1%), MME (98.7%, 3.90 ± 2.01 mm), and medial tibial osteophytes (99.3%, 3.27 ± 1.50 mm). Regarding OA changes, MME was closely associated with the full-length width of medial tibial osteophytes (β = 1.114; 95% CI 1.069–1.159; p < 0.001) in line with osteophyte width (intraclass correlation coefficient, 0.804; 95% CI 0.783–0.823). Our data revealed that MME and medial tibial osteophytes are observed in the elderly and demonstrate that the degree of MME is consistent with the full-length width of medial tibial osteophytes, suggesting that osteophytes might be implicated in MME.

Short term outcomes following robotic arm-assisted lateral unicompartmental knee arthroplasty.

Robotic-arm assisted medial unicompartmental knee arthroplasty (RA-UKA) is associated with improved accuracy of implant positioning and excellent early functional outcomes. However, there is paucity of evidence regarding outcomes following RA-UKA for isolated lateral compartment osteoarthritis. The purpose of this study was to assess the short-term clinical and patient reported outcomes of lateral compartment UKA, utilising robotic-arm assistance. This was a retrospective study of prospectively collected data of 21 consecutive patients who underwent lateral RA-UKA. The study included 9 (42.9%) males and 12 (57.1%) females with a mean age of 63.4 ± 9.2 years. The Oxford Knee Score (OKS) was measured pre-operatively and at 1-year post-operatively, while range of motion (ROM) and complications were also recorded. There was significant improvement of OKS at 1 year's follow up compared with the baseline score (21.8 ± 5.6 vs. 45.2 ± 2.8 respectively; p < 0.001). There was also an improvement in pre-operative ROM when compared to ROM at 1 year's follow up (123.5° ± 8° vs. 131.5° ± 6.3° respectively; p < 0.001). None of the study patients underwent revision surgery within 1 year's follow-up. In our study, lateral RA-UKA resulted in significant improvements in clinical and patient reported outcomes with low complications rates. Further long-term comparative studies are needed to assess the utility of lateral RA-UKA vs. conventional UKA.

Non-operative Management of Acute Knee Injuries.

Acute knee injuries are commonly encountered in both the clinical and sideline setting and may be treated operatively or non-operatively. This article describes an evidence-based approach to non-operative acute knee injury. This includes history, physical exam, imaging, and initial management. In addition, the non-operative management of three such injuries-ligament injury, meniscus injury, and patellar dislocation injury-will be discussed via a case-based practical approach. Aside from grade III ACL tears, most acute knee ligament injuries, especially in the absence of other concurrent injuries, can be treated non-operatively. There is new evidence that acute traumatic meniscus tears in those younger than 40 can be successfully treated non-operatively and can do equally, as well as those that undergo surgery, at 1year out from injury. Based on the current literature, a short period of knee bracing in extension with progression to weightbearing to tolerance is recommended after initial patellar dislocation. Many of the most common acute knee injuries, including MCL tears, meniscus tears, and patellar dislocations, can be managed non-operatively. A detailed systemic approach to initial evaluation, including pertinent history, physical exam, and appropriate imaging, is essential and complementary to the subsequent non-operative treatment algorithm.

Effectiveness of Lateral Shoe Wedging along with Quadriceps Strengthening and Life Style Modification in Knee Osteoarthritis

Background: Knee osteoarthritis (OA), a common degenerative joint disorder, significantly impairs quality of life due to pain and functional limitations. Non-surgical interventions like lateral shoe wedging and quadriceps strengthening exercises are increasingly considered viable options for managing OA symptoms. Objective: To assess the efficacy of lateral shoe wedges, both alone and in combination with quadriceps strengthening exercises, in treating medial knee OA. Methods: In this randomized controlled trial, 60 adults with medial knee OA were assigned to one of three groups: Group A received only lateral shoe wedges; Group B received lateral shoe wedges and quadriceps strengthening exercises; Group C received lateral shoe wedges with lifestyle modifications. Measurements for pain, stiffness, and physical function were taken using the Numeric Pain Scale and WOMAC scale at baseline, 8 weeks, and 16 weeks. Results: By Week 16, Group A (wedge only) reported a 70% compliance rate, with no significant changes in WOMAC stiffness and physical function scores. Group B (wedge &amp; exercise) showed an 80% compliance rate, with pain scores reducing from 2.50±0.945 to 1.40±1.231 and significant improvements in WOMAC stiffness (1.40±1.231) and physical function (1.50±1.147). Group C (wedge &amp; lifestyle modification) achieved a 100% compliance rate, with moderate improvements in all measured parameters. Conclusion: The study concludes that the combination of lateral shoe wedging and quadriceps strengthening exercises (Group B) was most effective in alleviating pain and improving physical function in patients with medial knee OA. This suggests that a multimodal approach may be superior to singular interventions for managing OA symptoms.