Post-traumatic Knee Osteoarthritis Research Articles

Early intervention of swimming exercises attenuate articular cartilage destruction in a rat model of anterior cruciate ligament and meniscus knee injuries

AimThe anterior cruciate ligament (ACL) and meniscus injuries often cause post-traumatic knee osteoarthritis (PTOA), which can place great limitations on patients. But to date there is no effective therapy to delay the progression of cartilage destruction in PTOA. This study aimed to compare the effects of early versus delayed swimming exercise on the chondroprotective effects in a rat PTOA model with ACL and meniscus injuries. Main methodsThirty-two adult male Sprague-Dawley rats received unilateral ACL transection and medial meniscectomy (ACLMT). These were randomly allocated to four groups: early swimming (eSW), delayed swimming (dSW), sham-operated early swimming (sham-eSW) and sham-operated delayed swimming (sham-dSW). Swimming (30 min per session) continuing for 28 days was started three days and three months after ACLMT surgery as a protocol for eSW and dSW intervention. Cartilage quality was assessed by Mankin HHGS examination (H&E, Safranin-O stain) and collagen type II (CoII) and matrix metalloproteases-13 (MMP13) immunohistochemistry. Key findingsACLMT induced the PTOA histopathological changes, inhibited CoII and enhanced MMP13 expressions in cartilage for both sham-eSW and sham-dSW groups. eSW intervention significantly enhanced CoII expression and suppressed MMP13 overexpression in superficial and transitional zones of cartilage, as well as better Mankin scores, corresponding to sham-swimming controls (P < 0.05). dSW intervention provided less enhancement of CoII expression and improvement of histopathological scoring, but significantly reduced MMP13 overexpression compared to animals in eSW (P < 0.05). SignificanceEarly intervention by swimming at very early stages of cartilage damage provides greater benefits than delayed intervention when PTOA has already developed.

Quadriceps Function and Patient-Reported Outcomes After Anterior Cruciate Ligament Reconstruction in Patients With or Without Knee Osteoarthritis.

Relationships between quadriceps function and patient-reported outcomes after anterior cruciate ligament reconstruction (ACLR) are variable and may be confounded by including patients at widely different time points after surgery. Understanding these relationships during the clinically relevant phases of recovery may improve our knowledge of specific factors that influence clinical outcomes. To identify the relationships between quadriceps function and patient-reported outcomes in patients <2 years (early) and >2 years (late) after ACLR, including those with posttraumatic knee osteoarthritis. Cross-sectional study. Laboratory. A total of 72 patients after ACLR: early (n = 34, time from surgery = 9.0 ± 4.3 months), late (n = 30, time from surgery = 70.5 ± 41.6 months), or osteoarthritis (n = 8, time from surgery = 115.9 ± 110.0 months). The total Knee Injury and Osteoarthritis Outcome Score (KOOS) and Veterans RAND 12-Item Health Survey (VR-12) were used to quantify knee function and global health. Predictors of patient-reported outcomes were involved-limb and symmetry indices of quadriceps function (isokinetic strength [peak torque, total work, average power], maximum voluntary isometric contraction torque, fatigue index, central activation ratio, Hoffmann reflex, active motor threshold) and demographics (age, activity level, pain, kinesiophobia, time since surgery). Multiple linear regression analyses were used to predict KOOS and VR-12 scores in each group. In the early patients, knee-extensor work, active motor threshold symmetry, pain, and activity level explained 67.8% of the variance in the KOOS score ( P < .001); knee-extensor work, activity level, and pain explained 53.0% of the variance in the VR-12 score ( P < .001). In the late patients, age and isokinetic torque symmetry explained 28.9% of the variance in the KOOS score ( P = .004). In the osteoarthritis patients, kinesiophobia and isokinetic torque explained 77.8% of the variance in the KOOS score ( P = .010); activity level explained 86.4% of the variance in the VR-12 score ( P = .001). Factors of muscle function and demographics that explain patient-reported outcomes were different in patients early and late after ACLR and in those with knee osteoarthritis.

Early Intervention with Therapeutic Low-Intensity Pulsed Ultrasound in Halting the Progression of Post-traumatic Osteoarthritis in a Rat Model

Anterior cruciate ligament (ACL) and meniscus injuries are highly correlated with post-traumatic knee osteoarthritis (PTOA). The aim of this study was to examine whether early intervention with low-intensity pulsed ultrasound (LIPUS) at an intensity of 0.1 W/cm2 helps delay PTOA progression. A PTOA model was established by ACL transection and meniscectomy in male Sprague–Dawley rats. LIPUS intervention (1.0 MHz, 0.1 W/cm2) started on the third day after surgery and continued for 4 consecutive wk. Histopathological analyses and immunoassays of collagen type II and matrix metallopeptidase 13 in joints were conducted. Results indicated that compared with the sham treatment, LIPUS significantly reduced Mankin scores, inflammatory cells and matrix metallopeptidase 13 expression and increased collagen type II expression in rats with PTOA (p < 0.05). Early intervention with LIPUS has beneficial effects on delaying cartilage degradation by reducing synovial inflammation and matrix metallopeptidase 13 expression, as well as enhancing collagen type II expression in cartilage.

Platelet autologous plasma for the treatment of posttraumatic osteoarthritis and knee injury: clinical findings of 12 months follow-up

Osteoarthritis (OA) is the most common form of arthritis in the world. In the general structure of morbidity, the portion of OA is 12%. The main reason for the development of secondary knee OA in young patients is traumatic injury, which leads to the gradual degradation of the articular cartilage with the development of symptomatic OA in the first 3-5 years after injury.The objective: to investigate the clinical safety and efficacy of platelet autologous plasma (PAP) comparing to standard treatment in young patients with symptomatic post-traumatic knee OA (PTOA) and in the early period after the knee injury.Materials and methods. The stady included 122 patients (mean age 34,81±4,28 years), 62 – with established symptomatic PTOA (mean time from trauma –46,87±2,09 months), and 60 – in early period after intra-articular knee trauma (confirmed by MRI, 20,15±1,72 days after injury). Patients with established PTOA and knee trauma were divided in 2 groups – Gr.1 received standard treatment (NSAIDs, exercises, complex physical therapy for patients with PTOA and NSAIDs, complex physical therapy for patients with knee trauma), Gr.2 –in addition to the standard treatment received course of 3 intra-articular injections of PAP. Efficacy of treatment in both group was evaluated by standard recommended scales (KOOS questionnaire (Knee injury and Osteoarthritis Outcome Score) and VAS pain score (Visual Analogue Scale).Results. Patients of both groups with PTOA demonstrated positive dynamics of clinical manifestations of OA and functional activity, which affected the improvement of KOOS parameters. However, Gr.2 showed better results compared to Gr.1. During the follow-up period, in both groups of patients with knee injury, positive dynamics were observed for all KOOS subscales. However, the functional state of patients who received intraarticular PAP injection had a more significant dynamic, accompanied by significant differences in indicators with repeated monitoring.Conclusions. Use of the intraarticular injections of PAP for the treatment of symptomatic knee PTOA, as well as in the early period after a knee injury is safe and effitient part of the complex therapy, which improves both early and long-term results of the treatment. In patients with PTOA, PAP use allows to reduce the number of exacerbations arthritis within 12 months. In patients after knee trauma PAP use accelerates the improvement in the functional activity comparing to treatment with standard therapy.

Quadriceps Neuromuscular Function in Patients With Anterior Cruciate Ligament Reconstruction With or Without Knee Osteoarthritis: A Cross-Sectional Study.

Central and peripheral neural adaptations have been identified after anterior cruciate ligament (ACL) injury and reconstruction (ACLR) and are hypothesized to contribute to posttraumatic muscle dysfunction. Limited evidence exists about the temporal nature of neuromuscular adaptations during early and late-term phases of recovery after ACLR, and no researchers have studied patients with posttraumatic osteoarthritis. To compare quadriceps neuromuscular function less than 2 years ( early) and more than 2 years ( late) after ACLR, including in patients who experienced posttraumatic knee osteoarthritis. Cross-sectional study. Laboratory. A total of 72 patients after ACLR, consisting of 34 early (9.0 ± 4.3 months postsurgery), 30 late (70.5 ± 41.6 months postsurgery), and 8 with osteoarthritis (115.9 ± 110.0 months postsurgery), and 30 healthy control volunteers. Quadriceps function was measured bilaterally during a single visit to determine normalized Hoffmann reflex (H : M ratio), knee-extension maximal voluntary isometric contraction torque (Nm/kg), central activation ratio (%), fatigue index (% decline), and active motor threshold (%). Comparisons were made using 2-way analyses of variance to identify the effect of limb and group on each outcome measure. We calculated Cohen d effect sizes to assess the magnitude of difference between ACLR and matched control limbs for each group. Compared with healthy control limbs, involved-limb maximal voluntary isometric contraction was lower among all patients after ACLR ( P < .001, Cohen d values = -1.00 to -1.75). The central activation ratio ( P < .001, Cohen d = -1.74) and fatigue index ( P = .003, Cohen d = -0.95) were lower among patients only early after ACLR. The active motor threshold was higher among all patients after ACLR ( P < .001, Cohen d values = -0.42 to -1.56). Neuromuscular impairments were present in patients early and late after ACLR, regardless of osteoarthritis status. Quadriceps strength and corticospinal excitability were impaired at each time point compared with values in healthy control individuals, suggesting the need to address cortical function early after ACLR.

Proinflammatory mediators and gene polymorphism of ММР1 and ММР12 in post-traumatic knee osteoarthritis.

Joint injury is a well-established risk factor for development of post-traumatic knee osteoarthritis (PTOA) and may lead to joint inflammation. The aims of the study were: the investigation of proinflammatory mediators - the levels of IL-1β and uric acid (UA), the activity of xanthine oxidoreductase (XOR) - in the plasma and synovial fluid (SF) of patients with PTOA; the search for putative predictors of progression and predisposition to the PTOA development among these mediators and polymorphic gene loci of matrix metalloproteinases (MMP) - rs1799750 ММР1 and rs2276109 ММР12. Patients with a radiographically diagnosed PTOA (Kellgren-Lawrence, K/L grades I-III, N = 71) and 44 healthy controls were enrolled in the study of the levels of proinflammatory mediators. The XOR activity was measured by quantitation of uric acid accumulation at 293 nm as a result of xanthine oxidation. The uric acid level was determined using a commercially available kit (“Vital”, Russia) and spectrophotometer. The level of IL-1β was measured using commercially available enzyme-linked immunosorbent assay (ELISA) kit (“Vector-Best”, Russia) according to the manufacturers’ instructions. We used PCR followed by agarose gel electrophoresis (“SNP-Express” kits, “Lytech”, Russia) for SNP-genotyping. The XOR activity, the levels of proinflammatory mediators uric acid and IL-1β were determined to be significantly increased in the plasma of PTOA patients - by 20% (p = 0,03), 49% (p = 0,009) and 41% (p = 0,044), respectively. Multiple regression adjusted for age, gender, BMI of patients showed that xanthine oxidase activity was a significant predictor of radiographic knee osteoarthritis (β = 0,373, p &lt; 0,01). Genetic analyses of 184 patients with PTOA and 113 healthy controls demonstrated that G-allele of polymorphic locus A-82G ММР-12 was associated with higher risk of post-traumatic knee osteoarthritis development (OR = 1,803, p = 0,028). The -82G-allele of ММР-12 may abrogate angiostatic effect of MMP-12 by decreasing its expression and promote activated macrophage recruitment and degradation of the cartilage.

Gait kinematics changes in post traumatic knee osteoarthritis with destabilized medial meniscus in rat

Gait kinematics changes in post traumatic knee osteoarthritis with destabilized medial meniscus in rat

Risk of post traumatic knee osteoarthritis after traumatic knee injury in deployed military service members

Risk of post traumatic knee osteoarthritis after traumatic knee injury in deployed military service members

Male and female gait compensations in a mouse model of medial meniscus destabilization

Purpose: Destabilization of the medial meniscus (DMM) has become a common method for modeling the development of post-traumatic knee osteoarthritis in mice. Moreover, following a DMM surgery, male and female mice develop histologic signs of cartilage damage at different rates. Less is known about the development of disability in this model, as characterizations of the mouse gait pattern have been limited and primarily focused on spatiotemporal gait patterns. Recently, our group developed a highly sensitive gait analysis platform capable of detecting rodent spatiotemporal gait patterns in conjunction with ground reaction forces. Therefore, the aim of this study is to evaluate quadrupedal gait compensations and joint degeneration in male and female mice after DMM. Methods: For 20 C57/Bl6 mice, a medial para-patellar ligament incision was made on the right hind limb, and blunt dissection revealed the medial meniscotibial ligament. Sham animals (5 male, 5 female) were then closed. For DMM animals (5 male, 5 female), the meniscotibial ligament was transected and animals were closed. Ground reaction force data and spatiotemporal gait data were collected at 2, 4, 6, 9, and 12 weeks post-surgery. Animals were placed in a gait arena and allowed to freely explore. Ultra-high speed video (500fps) recorded sagittal and ventral views as the animal crossed the arena and walked over force panels. A linear regression was used to describe the expected gait for male or female sham animals at a given velocity and body weight. Residuals were calculated from this control line to determine the expected gait pattern at a given velocity and body weight. Groups were compared using a 2-way ANOVA with interaction (α = 0.05), while gait symmetries and imbalances were compared to expected values using Bonferroni-corrected student's t-tests. After 12 weeks, animals were euthanized, and knees were processed for histological grading. Results: Male DMM mice used higher hind limb duty factors in both limbs compared to sham animals (Fig 1A, left P = 0.001, right P = 0.037). Male DMM mice also used shorter stride lengths (P = 0.007). Both fore and hind limb peak vertical forces were lower in male DMM mice compared to sham mice (Fig 1C & 1E, fore left P = 0.001, fore right P = 0.029, hind left P = 0.010). Female DMM mice walked with lower hind limb duty factors compared to sham animals (Fig 1B, left P = 0.045, right P = 0.001), were temporally asymmetric in the hind limbs at week 12 (P = 0.005), and significantly loaded the right hind limb more than sham animals (Fig 1F, P = 0.039). Female DMM mice also took longer to load the right hind limb (P = 0.004). Histology confirmed no cartilage loss or osteophyte formation in sham animals. Male and female DMM animals presented similar cartilage matrix loss at the surface and at 50% lesion depths at 12 weeks. Additionally, total cartilage degeneration width was similar between genders (male = 69.81 ± 18.5%, female = 69.9 ± 28.9%). Conclusions: Male and female mice selected different gait compensations following meniscus destabilization. Male mice developed higher hind limb duty factors, indicating more time spent in stance on both limbs. Additionally, male DMM mice had shorter stride lengths and normal gait symmetries. Male DMM mice also had lower peak vertical forces on both hind limbs. Combined, these data indicate a bilateral shuffle-step compensation. Shuffle-stepping may protect the limb by reducing time where either leg must support load without contralateral support. Female DMM mice used lower hind limb duty factors in the right hind limb (injured). Additionally, female mice placed more load on the right hind limb, but also took longer to load the injured limb. Combined, these data may indicate a steppage gait compensation. It is not clear why male shuffle-step and female mice use a steppage-like compensation. These gender differences warrant further exploration, but may be important to how male and female animals respond to orthopaedic injuries. Finally, our histological data demonstrate the development of OA lesions in both male and female mice at 12 weeks. While prior reports have detailed more severe OA lesions in male mice relative to female mice, these histological investigations largely focused on post-operative timepoints of 8 weeks or less. Thus, it is plausible that the severity of OA in female mice had approached that of male mice by 12 weeks. Regardless, the two sexes developed different gait compensations in response to the injury, further highlighting sex differences in the progression of OA in mice.

Cartilage Subsurface Changes to Magnetic Resonance Imaging UTE-T2* 2 Years After Anterior Cruciate Ligament Reconstruction Correlate With Walking Mechanics Associated With Knee Osteoarthritis

Background: Anterior cruciate ligament (ACL) injury increases risk for posttraumatic knee osteoarthritis (OA). Quantitative ultrashort echo time enhanced T2* (UTE-T2*) mapping shows promise for early detection of potentially reversible subsurface cartilage abnormalities after ACL reconstruction (ACLR) but needs further validation against established clinical metrics of OA risk such as knee adduction moment (KAM) and mechanical alignment. Hypothesis: Elevated UTE-T2* values in medial knee cartilage 2 years after ACLR correlate with varus alignment and higher KAM during walking. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Twenty patients (mean age, 33.1 ± 10.5 years; 11 female) 2 years after ACLR underwent 3.0-T knee magnetic resonance imaging (MRI), radiography, and gait analysis, after which mechanical alignment was measured, KAM during walking was calculated, and UTE-T2* maps were generated. The mechanical axis and the first and second peaks of KAM (KAM1 and KAM2, respectively) were tested using linear regressions for correlations with deep UTE-T2* values in the central and posterior medial femoral condyle (cMFC and pMFC, respectively) and central medial tibial plateau (cMTP). UTE-T2* values from ACL-reconstructed patients were additionally compared with those of 14 uninjured participants (mean age, 30.9 ± 8.9 years; 6 female) using Mann-Whitney U and standard t tests. Results: Central weightbearing medial compartment cartilage of ACL-reconstructed knees was intact on morphological MRI. Mean UTE-T2* values were elevated in both the cMFC and pMFC of ACL-reconstructed knees compared with those of uninjured knees (P = .003 and P = .012, respectively). In ACL-reconstructed knees, UTE-T2* values of cMFC cartilage positively correlated with increasing varus alignment (R = 0.568). Higher UTE-T2* values in cMFC and cMTP cartilage of ACL-reconstructed knees also correlated with greater KAM1 (R = 0.452 and R = 0.463, respectively) and KAM2 (R = 0.465 and R = 0.764, respectively) and with KAM2 in pMFC cartilage (R = 0.602). Conclusion: Elevated deep UTE-T2* values of medial knee cartilage 2 years after ACLR correlate with 2 clinical markers of increased risk of medial knee OA. These results support the clinical utility of MRI UTE-T2* for early diagnosis of subsurface cartilage abnormalities. Longitudinal follow-up of larger cohorts is needed to determine the predictive and staging potential of UTE-T2* for posttraumatic OA.

Myrtol improves post‑traumatic knee osteoarthritis by regulation of reactive oxygen species, transforming growth factor β1 and apoptosis in a mouse model

The present study tested whether myrtol improves post-traumatic knee osteoarthritis (PTKO) by regulating the reactive oxygen species (ROS), transforming growth factor β1 (TGF-β1) and apoptosis in a mouse model. PTKO model mice were administered with 150, 300 or 450 mg/kg myrtol for 8 weeks. ELISA analysis was used to measure tumor necrosis factor-α, interleukin-6, malondialdehyde, superoxide dismutase, reactive oxygen species and TGF-β1 levels. Caspase-3 and Bax protein expressions were analyzed using western blot analysis. In the current study, treatment with myrtol improved the tissue damage and osteoarthritis score, while it also reversed the subchondral bone thickness, subchondral bone density, trabecular bone volume/relative trabecular bone volume ratio and trabecular bone spacing in PTKO mice. The activity of tumor necrosis factor α, interleukin-6, TGF-β1, malondialdehyde, superoxide dismutase and ROS were effectively inhibited, and the protein expression of caspase-3 and Bax were clearly suppressed by treatment with myrtol in a mouse model of PTKO. In conclusion, the results demonstrated that myrtol treatment improved PTKO through the suppression of inflammation, oxidative stress, ROS, TGF-β1 and Bax/caspase-3 in mice, and myrtol may be a potential agent for clinical therapy.

Circulating levels of proinflammatory mediators as potential biomarkers of post-traumatic knee osteoarthritis development

BackgroundThe identification of biomarkers of post-traumatic osteoarthritis (PTOA) progression is of clinical importance. The aims of this study were: (1) to assess the abilities of various soluble proinflammatory mediators in plasma to distinguish patients with knee PTOA from controls; (2) to determine the correlations between the mediators in plasma and those mediators in synovial fluid (SF); and (3) to explore the associations of the mediators with radiographic PTOA severity.Materials and methodsThe concentrations of IL-1β, IL-6, IL-18, TNFα, and leptin were measured using ELISA. Nitric oxide was determined as nitrite/nitrate (NOx) using the Griess reaction.ResultsWe included 171 subjects (134 PTOA patients and 37 controls) and excluded patients with rheumatoid arthritis or gout. The ROC curve of plasma NOx had the highest AUC, a specificity of 100%, and a sensitivity of 84.4%. The combination of IL-6 and leptin proved to be the most discriminatory, with an AUC value of 0.933, a specificity of 96.7%, and a sensitivity of 85.7%. The levels of NOx, IL-6, IL-18, and leptin in plasma were significantly correlated with their levels in SF. Leptin levels in both plasma (p = 0.036) and SF (p = 0.041) and the synovial IL-18 level (p = 0.045) were correlated with the Kellgren–Lawrence (KL) grade. Early-stage PTOA (KL 1–2) was associated with a high concentration of IL-1β in plasma before and after (OR 6.235, 95% CI 1.362 to 28.552, p = 0.018) adjusting for age, gender, and BMI.ConclusionsCirculating NOx level and a combination of IL-6 and leptin permitted the strongest discrimination of patients with PTOA from controls. PTOA severity was correlated with leptin levels in plasma and SF and with the synovial IL-18 level. Early PTOA was associated with the circulating level of IL-1β.Level of evidenceIII (case–control study).

Hip joint biomechanics in those with and without post-traumatic knee osteoarthritis after anterior cruciate ligament injury

BackgroundAnterior cruciate ligament injury results in altered kinematics and kinetics in the knee and hip joints that persist despite surgical reconstruction and rehabilitation. Abnormal movement patterns and a history of osteoarthritis are risk factors for articular cartilage degeneration in additional joints. The purpose of this study was to determine if hip joint biomechanics early after anterior cruciate ligament injury and reconstruction differ between patients with and without post-traumatic knee osteoarthritis 5years after reconstruction. The study's rationale was that individuals who develop knee osteoarthritis after anterior cruciate ligament injury may also demonstrate large alterations in hip joint biomechanics. MethodsNineteen athletes with anterior cruciate ligament injury completed standard gait analysis before (baseline) and after (post-training) extended pre-operative rehabilitation and at 6months, 1year, and 2years after reconstruction. Weightbearing knee radiographs were completed 5years after reconstruction to identify medial compartment osteoarthritis. FindingsFive of 19 patients had knee osteoarthritis at 5years after anterior cruciate ligament reconstruction. Patients with knee osteoarthritis at 5years walked with smaller sagittal plane hip angles (P: 0.043) and lower sagittal (P: 0.021) and frontal plane (P: 0.042) external hip moments in the injured limb before and after reconstruction compared to those without knee osteoarthritis. InterpretationThe current findings suggest hip joint biomechanics may be altered in patients who develop post-traumatic knee osteoarthritis. Further study is needed to confirm whether the risk of non-traumatic hip pathology is increased after anterior cruciate ligament injury and if hip joint biomechanics influence its development.

Accelerated Return to Sport After Anterior Cruciate Ligament Reconstruction and Early Knee Osteoarthritis Features at 1 Year: An Exploratory Study

BackgroundA timely return to competitive sport is a primary goal of anterior cruciate ligament reconstruction (ACLR). It is not known whether an accelerated return to sport increases the risk of early-onset knee osteoarthritis (KOA). ObjectiveTo determine whether an accelerated return to sport post-ACLR (ie, <10 months) is associated with increased odds of early KOA features on magnetic resonance imaging (MRI) 1 year after surgery and to evaluate the relationship between an accelerated return to sport and early KOA features stratified by type of ACL injury (isolated or concurrent chondral/meniscal injury) and lower limb function (good or poor). DesignCross-sectional study. SettingPrivate radiology clinic and university laboratory. ParticipantsA total of 111 participants (71 male; mean age 30 ± 8 years) 1-year post-ACLR. MethodsParticipants completed a self-report questionnaire regarding postoperative return-to-sport data (specific sport, postoperative month first returned), and isotropic 3-T MRI scans were obtained. Outcome MeasuresEarly KOA features (bone marrow, cartilage and meniscal lesions, and osteophytes) assessed with the MRI OA Knee Score. Logistic regression analyses evaluated the odds of early KOA features with an accelerated return to sport (<10 months post-ACLR versus ≥10 months or no return to sport) in the total cohort and stratified by type of ACL injury and lower limb function. ResultsForty-six (41%) participants returned to competitive sport <10 months post-ACLR. An early return to sport was associated with significantly increased odds of bone marrow lesions (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.3-6.0) but not cartilage (OR 1.2, 95% CI 0.5-2.6) or meniscal lesions (OR 0.8, 95% CI 0.4-1.8) or osteophytes (OR 0.6, 95% CI 0.3-1.4). In those with poor lower limb function, early return to sport exacerbated the odds of bone marrow lesions (OR 4.6, 95% CI 1.6-13.5), whereas stratified analyses for type of ACL injury did not reach statistical significance. ConclusionAn accelerated return to sport, particularly in the presence of poor lower limb function, may be implicated in posttraumatic KOA development. Level of evidenceIV

Comparison of Clinical Outcomes Following Anatomic Single vs. Double-Bundle ACL Reconstruction: A Randomized Clinical Trial

Objectives:The shortcomings of anterior cruciate ligament reconstruction (ACL), including failure to restore normal structure and function of the knee, limited return to pre-injury level of sports participation and failure to prevent the development of post-traumatic knee osteoarthritis (OA) have recently been recognized. Anatomic methods to reconstruct the ACL, including anatomic single-bundle (SB) and double-bundle (DB) reconstruction, have been proposed to improve clinical outcomes after ACL reconstruction. We performed a double-blinded randomized clinical trial to compare clinical outcomes of anatomic SB to anatomic DB ACL reconstruction. We hypothesized that anatomic DB ACL reconstruction with a quadriceps tendon autograft with bone block would result in reduced knee laxity, better range of motion, patient-reported outcomes (PROs), return to sports and reduced risk of re-injury compared to anatomic SB ACL reconstruction.Methods:Individuals between 14 and 50 years of age participating in at least 100 hours of Level 1 or 2 sports activities that presented within 12 months of injury to both bundles of the ACL with or without injury to the medial or lateral meniscus were eligible to participate in this study. Individuals with prior injury or surgery of the ipsilateral or contralateral knee or greater than a grade 1 concomitant knee ligament injury were excluded. If the ACL insertion sites were between 14 and 18mm, as measured with an arthroscopic ruler at the time of arthroscopy, the subject was randomized to undergo SB or DB ACL reconstruction with a 10 mm quadriceps tendon autograft harvested with a patellar bone block. A single, anatomically placed femoral tunnel was used for all cases. For DB ACL reconstruction, the graft was split into to two arms and passed through two anatomically placed tibial tunnels. Subjects were followed at 3, 6, 12 and 24 months after randomization, with the primary endpoints occurring at 24 months. Outcome measures included the KT-1000 (side to side difference) and pivot shift tests, range of motion (ROM), IKDC Subjective Knee Form (IKDC-SKF) and return to pre-injury level of sports participation.Results:Fifty-seven subjects were randomized (29 DB) and two-year follow-up was attained from 51 (89.5%). There were no differences between groups in terms of age, proportion of males, body mass index (BMI), participation in competitive or recreational sports or concomitant meniscus procedures. At 24-month follow-up there were no between groups differences for the pivot shift and KT-1000 tests, ROM and IKDC-SKF scores (Table 1). Twenty-three (85.2%) DB’s and 24 (87.5%) SB’s reported returning to pre-injury level of sports 2 years after surgery (p=0.81). Three subjects (2 SB’s, 5.9% of total) suffered a graft rupture and 5 individuals (4 SB’s, 9.8% of total) had a subsequent meniscus injury.Conclusion:With the available sample size, we were unable to demonstrate significant differences in clinical outcome between anatomic SB and DB ACL reconstruction when performed with a quadriceps tendon autograft with a bone block in individuals with ACL insertion sites that ranged from 14 to 18 mm. Furthermore, both anatomic SB and DB ACL reconstruction lead to clinical outcomes that are comparable or superior to those reported for non-anatomical ACL reconstruction with minimal recurrent instability.Table 1Clinical Outcomes at 24 MonthsDouble Bundle (n=27)Single Bundle (n=24)p value6Normal Pivot Shift (n, %)25, 92.6%23, 95.8%0.48KT Arthrometer1 (30 lb) (mean ± SD)0.5 ± 1.30.6 ± 1.60.80KT Arthrometer1 (max manual) (mean ± SD)0.7 ± 1.20.8 ± 1.50.79Passive Extension of Involved Knee2 (mean ± SD)3.9 ± 3.03.8 ± 2.80.90Passive Extension Difference3 (mean ± SD)2.1 ± 1.91.7 ± 2.60.53Active Flexion of Involved Knee4 (mean ± SD)140.7 ± 5.7140.2 ± 6.30.76Active Flexion Difference5 (mean ± SD)0.3 ± 4.2-1.1 ± 9.00.47IKDC Subjective Knee Score (mean ± SD)89.4 ± 10.390.2 ± 11.10.791 Values are involved minus non-involved side to side difference in millimeters2Values are in degrees. Positive values indicate hyperextension 3 Non-involved minus involved knee difference in passive knee extension. Values are in degrees. Positive values indicate a loss of extension of the involved knee 4 Values are in degrees 5 Non-involved minus involved knee difference in active knee flexion. Values are in degrees. Positive values indicate a loss of flexion of the involved knee. 6 Independent t-tests were used for continuous variables and Fisher Exact Tests were used for nominal variables. p values were not adjusted for multiple comparisons.

Sivelestat sodium hydrate improves post-traumatic knee osteoarthritis through nuclear factor-κB in a rat model.

As a specific inhibitor of neutrophil elastase, sivelestat sodium hydrate has primarily been used in the treatment of acute lung injury caused by various factors since its approval in 2002. Sivelestat sodium hydrate also improves post-traumatic knee osteoarthritis (KOA), although its underlying mechanisms of action have yet to be elucidated. The aim of the current study was to determine if sivelestat sodium hydrate improves post-traumatic KOA through nuclear factor (NF)-κB in a rat model. Treatment with sivelestat sodium hydrate significantly inhibited the induction of structural changes and significantly increased the vertical episode count and ipsilateral static weight bearing of the joint in KOA rats (all P<0.01). Sivelestat sodium hydrate significantly inhibited tumor necrosis factor-α and interleukin-6 production, serum nitrite levels, inducible nitric oxide synthase protein expression and high mobility group box 1 (HMGB1) secretion in KOA rats compared with the model group (all P<0.01). Sivelestat sodium hydrate also significantly suppressed p50/p65 DNA binding activity and NF-κB and phosphorylated inhibitor of κB protein expression in the joints of KOA rats compared with the model group (all P<0.01). These results suggest that sivelestat sodium hydrate improves post-traumatic KOA through HMGB1 and NF-κB in rats.

Clinical observation on acupoint pressure therapy plus electroacupuncture for post-traumatic knee osteoarthritis

To investigate the clinical efficacy of Zhang’s acupoint pressure therapy plus electroacupuncture (EA) in treating post-traumatic knee osteoarthritis. A total of 98 eligible patients with post-traumatic knee osteoarthritis were divided into group A and B by the random number table, 49 cases in each group. Group A was intervened by Zhang’s acupoint pressure therapy plus EA; group B was given medicinal fumigation. The clinical efficacies of the two groups were compared. The markedly effective rate of group A was significantly higher than that of group B. Zhang’s acupoint pressure therapy plus EA can produce a satisfactory clinical efficacy in treating post-traumatic knee osteoarthritis, and is worth promotion.

Quadriceps Function and Hamstrings Co-Activation After Anterior Cruciate Ligament Reconstruction

Individuals with anterior cruciate ligament reconstruction (ACLR) have quadriceps dysfunction that contributes to physical disability and posttraumatic knee osteoarthritis. Quadriceps function in the ACLR limb is commonly evaluated relative to the contralateral uninjured limb. Bilateral quadriceps dysfunction is common in individuals with ACLR, potentially biasing these evaluations. To compare quadriceps function between individuals with ACLR and uninjured control participants. Cross-sectional study. Research laboratory. Twenty individuals with unilateral ACLR (age = 21.1 ± 1.7 years, mass = 68.3 ± 14.9 kg, time since ACLR = 50.7 ± 21.3 months; females = 14; Tegner Score = 7.1 ± 0.3; 16 patellar tendon autografts, 3 hamstrings autografts, 1 allograft) matched to 20 control participants (age = 21.2 ± 1.2 years, mass = 67.9 ± 11.3 kg; females = 14; Tegner Score = 7.1 ± 0.4) on age, sex, body mass index, and Tegner Activity Scale. Maximal voluntary isometric knee extension was performed on an isokinetic dynamometer. Peak torque (PT), rate of torque development (RTD), electromyographic (EMG) amplitude, central activation ratio (CAR), and hamstrings EMG amplitude were assessed during maximal voluntary isometric knee extension and compared between groups using independent-samples t tests. Relationships between hamstrings co-activation and quadriceps function were assessed using Pearson correlations. Participants with anterior cruciate ligament reconstruction displayed lesser quadriceps PT (1.86 ± 0.74 versus 2.56 ± 0.37 Nm/kg, P = .001), RTD (39.4 ± 18.7 versus 52.9 ± 16.4 Nm/s/kg, P = .03), EMG amplitude (0.25 ± 0.12 versus 0.37 ± 0.26 mV, P = .04), and CAR (83.3% ± 11.1% versus 93.7% ± 3.2%, P = .002) and greater hamstrings co-activation (27.2% ± 12.8% versus 14.3% ± 3.7%, P < .001) compared with control participants. Correlations were found between hamstrings co-activation and PT (r = -0.39, P = .007), RTD (r = -0.30, P = .03), and EMG amplitude (r = -0.30, P = .03). Individuals with ACLR possessed deficits in PT, RTD, and CAR compared with control participants. Peak torque is the net result of all agonist and antagonist activity, and lesser PT in individuals with ACLR is partially attributable to greater hamstrings co-activation.

The relationship between measures of knee loading during gait and cartilage thickness in non-traumatic and post-traumatic knee osteoarthritis

The relationship between measures of knee loading during gait and cartilage thickness in non-traumatic and post-traumatic knee osteoarthritis

Histological Characterization of Epiphyseal Bone and Articular Cartilage in a Rat Model of Post-traumatic Knee Osteoarthritis

Histological Characterization of Epiphyseal Bone and Articular Cartilage in a Rat Model of Post-traumatic Knee Osteoarthritis