Secondary Knee Osteoarthritis Research Articles

Particularities of the bone tissue regenerative properties of the proximal part of the tibia in patients with rheumatoid arthritis with multi-plane knee deformities

Background. Rheumatoid arthritis (RA) has no equal among the musculoskeletal system diseases in terms of the severity of joint damage. Knee joint damage was noted in 65–70 % of RA patients and it is the most common cause of disability. The purpose was to study the indices of osteogenic activity of stromal (mesenchymal) stem cells (MSCs) of the articular bone ends of the knee joint in patients with secondary knee osteoarthritis (KOA) due to RA in the presence of multi-plane deformations. Materials and methods. The studied material was samples of cancellous bone of the anterior and posterior parts of the plateau of the proximal part of the tibia and spongiosa from a depth of 1 cm and 3 cm from the articular surface, namely from the proximal epimetaphysis of the tibia, removed during knee arthroplasty of patients with secon­dary KOA due to RA and in patients with primary KOA in the presence of multi-plane deformations. Using the method of cloning colony-forming units of fibroblasts (CSF) of bone tissues, 38 patients were examined, including 9 patients with RA and 29 patients with primary KOA with damage to the knee joint in the presence of multi-plane deformations. Results. The total number of nucleated cells in 1 cm3 of spongiosa of the front part of the tibial plateau was 2.3 times lower compared to the parameter of this index in the posterior part (p < 0.05). The characteristics of spongy tissue in terms of the number of nucleated cells and the content of CSF in 1 cm3 from a depth of 3 cm from the articular surface of the proximal epimetaphysis of the tibia of patients with RA were almost 3 times higher compared to the indices of patients with primary KOA (p < 0.05). Conclusions. Changes in the renovation processes of bone tissue in patients with secondary KOA due to RA and in patients with primary KOA in the presence of multi-plane deformations are unidirectional, but their expressiveness is greater in patients with RA. At a depth of 3 cm from the articular surface of the proximal epimetaphysis of the tibia, the conditions for secondary fixation of the leg of the knee joint replacement are much better, all other conditions being equal, so the "survival" of the endoprosthesis with an elongated leg will be greater.

Recruitment and baseline characteristics of young adults at risk of early-onset knee osteoarthritis after ACL reconstruction in the SUPER-Knee trial

ObjectivesThe study aims to (1) report the process of recruiting young adults into a secondary knee osteoarthritis prevention randomised controlled trial (RCT) after anterior cruciate ligament reconstruction (ACLR); (2) determine...

Unconstrained one-stage total knee arthroplasty PS design in patient with secondary osteoarthritis due to granulomatous infection with medial femoral condyle defect: A case report.

Introduction and importanceGranulomatous Mycobacterium Tuberculosis Infection Causes Secondary Knee Osteoarthritis is still a point of contention in terms of therapy, whether it is done early in the first stage or later in the second stage of knee surgery. Early Total Knee Arthroplasty as a therapy for secondary knee osteoarthritis induced by Granulomatous mycobacterium tuberculosis infection is still performed rarely.Case presentationA case of left pain and swollen knee in males for 8 months. Because of pain and reduced knee range of motion, the patient now has an antalgic gait, which make him difficult to do daily activities. Treatment with medications and physiotherapy failed. Radiographs revealed juxta-articular osteoporosis, peripherally distributed osseous erosions, joint space narrowing, and a bony defect in the medial femoral condyle. This case was successfully treated using Unconstrained Knee Arthroplasty PS Design.Clinical discussionCase selection for granulomatous infection case is key element to determine whether a single TKA procedure can be used to treat knee pain problems as a result of secondary osteoarthritis.ConclusionThis case shows secondary knee osteoarthritis caused by Granulomatous Mycobacterium Tuberculosis Infection without pyogenic pus production might allow for early one-stage total knee arthroplasty. Three months following surgery, the patient's knee was stable and painless, with good wound healing and no signs of infection.

Custom-made hinged total knee arthroplasties in the context of extra-articular deformity: a case series

PurposeTreatment of secondary knee osteoarthritis with a significant extra-articular deformity can be challenging. In such cases, an osteotomy or a custom-made hinged knee arthroplasy (CMH) are treatment options. However, there are limited data on the outcomes of using CMHs. Thus, the aim of this retrospective study was to assess the clinical results and subjective outcomes of CMHs.MethodsWe reviewed 9 CMHs (Endo-Model, LINK) in 7 patients with a minimum of 2-year follow-up. Upon the last follow-up, we evaluated MA, stability and range of movement (ROM). Oxford Knee Score (OKS) was used to evaluate patient-reported outcomes.ResultsThe average age upon surgery was 61 years (48–76 years), and the follow-up period was 66 months. There were no early complications. Two CMHs were revised, one due to aseptic loosening and one due to late-onset haematogenic infection. Pre-operatively, MA varied from 18° (average 11°) valgus-deformity to 30° (average 17°) varus-deformity. Post-operatively, 7/9 (78%) of patients achieved better MA. Upon follow-up, the average OKS was 41/48, and ROM was 113°.ConclusionsPatients treated with CMHs achieved good clinical and patient-reported outcomes. There were no early reoperations, and revision rate was relatively low. Overall, CMH could be considered for low-demand patients with increased operative risks.

Primary total knee arthroplasty assisted by computed tomography-free navigation for secondary knee osteoarthritis following massive calcium phosphate cement packing for distal femoral giant-cell bone tumor treatment: a case report

BackgroundGiant cell tumor of bone (GCTB) is an intermediate tumor commonly arising from the epiphysis of the distal femur and proximal tibia. Standard GCTB treatment is joint-preserving surgery performed using thorough curettage and the filling of the cavity with allo-, auto-, polymethyl methacrylate (PMMA), or synthetic bone graft. Calcium phosphate cement (CPC) is an artificial bone substitute, which has the benefit of being able to adjust defects, consequently inducing immediate mechanical strength, and promoting biological healing. Secondary osteoarthritis may occur following GCTB treatment and may need additional surgery if severe. However, details regarding surgery for secondary osteoarthritis have not been fully elucidated. There are no reports on the use of total knee arthroplasty (TKA) for the treatment of secondary osteoarthritis following CPC packing. The insertion of an alignment rod is a standard procedure in TKA; however, it was difficult to perform in this case due to CPC. Therefore, we used a computed tomography (CT)-free navigation system to assist the distal femur cut. This study presents a knee joint secondary osteoarthritis case following CPC packing for GCTB curettage that was treated with standard TKA.Case presentationA 67-year-old Japanese woman, who was previously diagnosed with left distal femur GCTB and was treated by curettage and CPC packing 7 years ago, complained of severe knee pain. Left knee joint plain radiography revealed Kellgren and Lawrence (K-L) grade 4 osteoarthritis without evidence of tumor recurrence. Therefore, she was scheduled for TKA. There are no reports on the cutting of a femoral condyle surface with massive CPC with accurate alignment. Because it is difficult to insert the alignment rod intramedullary and cut the femoral condyle with CPC, we planned CT-free navigation-guided surgery for accurate bone cutting using an oscillating tip saw system to prevent CPC cracks. We performed standard TKA without complications, as planned. Postoperative X-ray showed normal alignment. Knee Society Knee Score (KSKS) and Knee Society Function Score (KSFS) ameliorated from 27 and 29 to 64 and 68, respectively The patient can walk without a cane postoperatively.ConclusionThere was no report about the surface TKA guided by CT-free navigation after primary GCT surgery with CPC. We believe that this case report will help in planning salvage surgery for secondary osteoarthritis after CPC packing.

Anterior cruciate ligament innervation in primary knee osteoarthritis.

To relate the Anterior Cruciate Ligament (ACL) innervation and histologic degeneration status to the knee osteoarthritis radiologic and functional status. Prospective observational study including 30 consecutive patients affected by primary knee osteoarthritis undergoing Total Knee Arthroplasty (TKA). All patients suffering secondary knee osteoarthritis, an antecedent of an infectious process, malignant process, autoimmune disorder, or previous knee surgery were excluded. We recorded biodemographic, clinical, and radiologic variables of all participants previous to the TKA procedure. ACL tissue was harvested during TKA standard procedure and the obtained sample was fixed in 4% formalin and paraffin-embedded. ACL cross-sections were stained by haematoxylin-eosin and Gallego staining for elastic and collagen fibers, and Sevier-Munger silver staining for nervous tissue. ACL samples histologic degeneration classification reported 15.4% normal, 23.1% slight, 26.9% mild, 11.5% moderate and 23.1% marked. We noted 46.2% large nervous fascicles, 15.4% medium fascicles, 3.8% small fascicles, and no nerve fibers were found in 34.6% ACL samples. No significant correlation was found between the histologic degeneration and the nervous fiber quantification (p>0.05, in all cases). We noted a significant histologic degeneration inverse correlation with the VAS scale (p=0.016), and nervous fiber quantification correlation with Lequesne maximum distance walked punctuation (p=0.043). We also noted greater nervous fiber quantification with minor radiological knee osteoarthritis (Kellgren-Lawrence grade II). ACL degeneration and innervation deficit may play a role in primary knee osteoarthritis onset, but the lack of a defining relationship among the different parameters assessed justifies further research in greater populations.

Custom Made Implant in Revision Knee Arthroplasty with AORI 3 Bone Defect: а Case Report

Background. Replacement of extensive bone defects during revision knee arthroplasty (RKA) is a certain problem. The development of additive technologies allows us to produce an individual titanium augment to restore the lost bone tissue. The aim of the study is to show the possibility of replacing extensive tibia defects with an custom made augment during revision knee artroplasty. Case presentation. The patient is 66 years old. At the age of 58, due to secondary knee osteoarthritis in 2 years interval, the patient underwent total knee arthroplasty: left in 2012, right in 2014. Subsequently, several revision interventions were required for early periprosthetic infection of the right knee joint. From 2015 to 2018, due to the infection remission, the function of the right knee joint was satisfactory. In 2018, the patient admitted to our clinic with the periprosthetic infection relapse. Due to the previous treatment, the patient had type 3 bone defect according to the AORI classification. A two-stage revision knee arthroplasty was performed. To compensate the extensive tibial defect, the individual tibial implant was manufactured using additive technologies, and a semiconstrained endoprosthesis was implanted. There was no relapse of infection during the observation. There is deficit of active extension, there are no radiological signs of the implant instability. Conclusion. In our case, we were able to achieve satisfactory results in patient with a complex anamnesis and extensive bone defects. The use of individual implant helped to avoid arthrodesis, preserve the weight-bearing of the lower limb and articulation in the knee joint. The use of implants made using 3D technologies is a promising solution for compensating defects of types 2B and 3 according to the AORI classification.

A potential diagnostic serum immunological marker panel to differentiate between primary and secondary knee osteoarthritis.

Inflammation contributes to knee osteoarthritis (KOA) where many immunological mediators participate in its initiation and progression. Most clinicians manage primary (pKOA) and secondary osteoarthritis (sKOA) alike. Whether immunological profiles of pKOA and sKOA differ remains obscure. Hence, we aimed to differentially identify potential serum immunologic diagnostic markers of pKOA and of sKOA. This case control study used 46 KOA patients (pKOA, n = 30; sKOA, n = 16), and 60 age, gender matched controls (normal healthy, n = 30; systemic lupus erythematosus [SLE] disease controls, n = 30) where serum was assayed for cytokines (TNF-α, IL-1β, IL-6, IL-10) and nitric oxide derivatives (NOx). Sandwich ELISA assessed cytokine levels, while the 'Griess assay' quantified NOx levels. The diagnostic accuracy of optimal marker combinations was evaluated by the CombiROC web tool. Compared with pKOA, sKOA serum displayed significantly elevated levels of pro inflammatory cytokines (TNF-α, IL-1β, IL-6) with a concurrent decrease in the anti-inflammatory cytokine, IL-10 (P<0.05). This was reiterated by significantly higher Th1:Th2 (TNF-α: IL-10) serum cytokine ratio observed in sKOA compared to that of pKOA. The CombiROC curves identified TNF-α, IL-1β, IL-6 and NOx as the best performing panel of potential diagnostic markers to discriminate pKOA from control groups (~97% accuracy, 90% Sensitivity [SE] and 98% specificity [SP]), while TNF-α, IL-1β and IL-6 discriminated sKOA from control groups (~100% accuracy, 100% SE, and 98% SP). The study identified discrete serum immune biomarker panels to differentiate between pKOA (TNF-α, IL-1β, IL-6 and NOx) and sKOA (TNF-α, IL-1β and IL-6). These findings may assist in developing distinct therapeutic agents for the two types of KOA.

Efficacy and safety of magnet therapy using portable device for knee osteoarthritis. 55-week double-blind study results

To study the efficacy and safety of long-term use of the portable magnet therapy device ALMAG+ (Almag Active) in knee OA (KOA). A double-blind, randomized, placebo-controlled, prospective, 55-week clinical trial of the medical device was conducted. The study included patients with primary and secondary (associated with immunoinflammatory rheumatic diseases) KOA stages I-III according to Kellgren-Lawrence diagnosed using generally accepted criteria (R. Altman et al., 1986). Enrollment of patients with secondary KOA was allowed given that the remission or low disease activity was achieved. During the study patients had to receive steady drug therapy. No intra-articular injections of glucocorticosteroids, hyaluronic acid, PRP, and physiotherapy procedures for knees (electrotherapy, shockwave therapy, heat therapy, hydrotherapy, peloid therapy) were allowed three months or less before the enrollment and throughout the study. According to the approved protocol, 77 patients (mean age 52.73±12.97 years) from two research centers participated in the study: 32 (41.6%) were males, and 45 (58.4%) were females. Primary KOA occurred in 41 (52%) patients, 36 (46.8%) patients had secondary KOA (associated with rheumatoid arthritis, ankylosing spondylitis, Sjögren's disease, psoriatic arthritis, systemic lupus erythematosus, or diffuse scleroderma). All patients received NSAIDs as a concomitant therapy, 24.7% received diacerein, 28.6% received disease-modifying anti-rheumatic drugs, 2.6% received methylprednisolone up to 8 mg/day, and 9% received biologic therapy. After randomization, 40 (52%) patients received placebo treatments (Group 1) and 37 (48%) received active treatments (Group 2). Both groups were comparable in the main parameters. The proportion of smokers was higher in Group 2, but the difference was not statistically significant. During the 55-week follow-up, three courses of 18 daily home magnet therapy procedures each were performed. In both groups, starting from week 5 of the study, an improvement of pain on movement and at rest according to VAS compared to the baseline (p<0.01 at all assessment time points) was observed, which can be explained by a pronounced placebo effect, often observed in OA. The improvement of pain at rest was more prominent in Group 2 vs. Group 1 at Week 21 (p=0.038) and Week 55 (p=0.017) of the study, probably due to the anti-inflammatory effect. The overall WOMAC index score was also lower in Group 2 vs. Group 1 at Weeks 21 and 55 (p=0.03 at both time points). The mean articular cartilage thickness, determined by ultrasound, reduced in Group 1 and remained practically unchanged in Group 2 (p=0.011). No adverse events associated with the use of the ALMAG+ (Almag Active) device, according to the attending physician, and no exacerbations of immunoinflammatory rheumatic diseases during the study period were reported. The results of a double-blind, placebo-controlled study of magnet therapy using a portable device demonstrated analgesic, anti-inflammatory, and structure-modifying effects of this type of physiotherapeutic treatment. No adverse events and exacerbations of rheumatic diseases associated with the study treatment have been reported.

Secondary Knee Osteoarthritis with Medial Instability and Tibial Defect due to Chronic Abscess Treated by Total Knee Arthroplasty with Metal Augmentation - Case Report

Background:Knee osteoarthritis (OA), known as degenerative joint disease, is typically the result of wear and tear and progressive loss of articular cartilage, most common in elderly women and men. Knee OA is a leading cause of disability and increase with an aging and overweight population. Total Knee Arthroplasty (TKA) is a common surgical treatment of OA knee that highly cost-effective procedure. Stable placement of components is difficult and thus it presents technical challenges for the surgeon but various options are available for managing these defects. Case Report: A 58 years-old housewife came to our clinic due to chronic left knee pain with associated instability since two years ago and getting worse in last three months. She already had knee joint supplementation injections and physical therapy but no improvements. Based on our clinical and radiological findings, our assessment was secondary left knee osteo-arthritis with medial instability and tibial defect due to chronic abscess. Patient underwent TKA to correct this condition. A revised implant was used to close the defect in the medial part of the tibia and soft tissue reconstruction procedure was used to correct the instability. Result: On the first postoperative month, the patient underwent rehabilitation and physical therapy to strengthen her lower limb muscles. On the second month, she started to walk using walking assisted device. On the ninth months follow-up, the patient was able to walk normally without assisted device, the pain disappeared and the symptoms of knee instability were reduced. Conclusion:Bone defects are commonly encountered during TKA, which still has no standard treatment to cure. In this case, the use of metal augmentation with revision implant give satisfactory results with good clinical outcome. Keywords: Osteoarthritis, Total Knee Arthro¬plasty, knee instability, tibial defect, metal augmentation Correspondence: Bintang Soetjahjo. Dr. Moewardi Hospital. Jl. Kolonel Sutarto 132, Jebres, Surakarta, Central Java 57126, Indonesia. Mobile: +628122987359. Email: bjortho@yahoo.com Indonesian Journal of Medicine (2021), 06(02): 168-176 https://doi.org/10.26911/theijmed.2021.06.02.06

Apparatus physiotherapy in the treatment of rheumatic diseases

To evaluate the efficiency and safety of the ALMAG + magnetic therapy device in the treatment of osteoarthritis of the knee joints». The article presents preliminary data of a double-blind, placebo-controlled study «Evaluation of the efficacy and safety of the ALMAG + magnetic therapy device in the treatment of osteoarthritis of the knee joints». The study includes 70 patients (25 men, 45 women) of which 34 (48.6%) are patients with primary osteoarthritis (OA) of the knee joints (OAKS) and 36 (51.4%) are with secondary knee OA (on the background of immunoinflammatory rheumatic diseases). The patients were randomely divided into 2 groups: the main group (active devices) with 34 (48.6%) patients and the control group (placebo devices) - 36 (51.4%) patients. Patients of the main and control groups were comparable in all main parameters. During the study, the patients underwent 3 courses of treatment with the ALMAG + apparatus or with a placebo apparatus during the year. The preliminary analysis includes data on 58 patients who underwent at least 2 courses of therapy (28 patients from the main group and 30 from the control group). Pain at rest decreased in the main group by 4.0±2.9 mm, in the control group - by 1.07±2.21 mm (p=0.420), after the second course - by 5.13±3.4 and 1.81±2.19 mm (p=0.406), respectively. In the main group, the total WOMAC index decreased after the 1st course of physiotherapy from 24.0±14.9 to 20.25±14.31 mm (p=0.038), after the 2nd course it slightly increased - to 22.96±14.8 mm (p=0.314), in the control group the WOMAC index did not change statistically significantly: it decreased after the 1st course from 26.3±21.9 to 24.6±20.83 mm (p=0.112), after the 2nd course it increased to 27.04±21.9 mm (p=0.088). Thus, the use of the ALMAG + apparatus at home contributed to a decrease in pain at rest and a significant decrease in the WOMAC index in patients with primary and secondary OA of the knee joints. Pulsed magnetotherapy did not cause adverse events or exacerbation of immunoinflammatory diseases.

Повреждения задней крестообразной связки: биомеханика, основные направления диагностики, лечения и профилактики вторичного остеоартрита

The literature was reviewed for reports on the pathogenesis, diagnosis and treatment of injuries to the posterior cruciate ligament (PCL). PCL is the largest intra-articular ligament in the knee joint and has good tensile mechanical properties. Optimal diagnosis and appropriate treatment strategies for PCL injury are discussed. Nonoperative treatment of isolated PCL injuries is associated with a significant risk of degeneration of the knee structures and impaired function. A comprehensive line of PCL reconstruction options are offered for the surgical approach to PCL reconstruction to restore functional joint stability in the knee.Literature data on protective effect of glucosamine, chondroitin sulfate in the prevention of secondary knee osteoarthritis caused by PCL ruptures were reviewed.

Functional outcomes of total knee arthroplasty in patients with Parkinson's disease: A case control study

BackgroundParkinson's disease is a neurodegenerative condition causing coordination loss in musculoskeletal system. Many studies suggest that total knee arthroplasty in patients with Parkinson's disease has unfavorable treatment results and high complication rates. Our hypothesis was that total knee arthroplasty might be an effective procedure in patients with Parkinson's disease. MethodsParkinson's disease patients who underwent total knee arthroplasty between 2006 and 2018 were retrospectively evaluated. Patients who had Parkinson's disease diagnosis before surgery and who had a minimum follow-up duration of 12 months were included. Secondary knee osteoarthritis patients were excluded. A matched control group was randomly formed. Outcome measures were evaluated by preoperative and postoperative Knee Society Score and joint range of motion values. Comparison was made by means of increase in Knee Society Score and range of motion values. Study group patients were reviewed according to Columbia Classification System to determine disease severity. Stages I-II were accepted as “low-grade” and III-IV-V as “high-grade” disease. Another comparison was made between “low-grade” and “high-grade” patients. Patient who showed disease progression after surgery were also compared to patients without progression. ResultsThere were 13 patients in both groups. In study group, mean preoperative and postoperative Knee Society Score values were 45.4 (±16.8) and 85.6 (±7.60); range of motion values were 93.9° (±17.0°) and 99.5° (±9.37°) respectively with a mean follow-up of 64.5 (±44.7) months. In control group, mean preoperative and postoperative Knee Society Score values were 38.8 (±11.5) and 86.1 (±10.0); range of motion values were 100.4° (±14.6°) and 109.2° (±10.2°) respectively with a mean follow-up of 51.8 (±13.6) months. No significant difference was observed between 2 groups (p > 0.05). Mean preoperative KSS and ROM values were significantly lower in high-grade patients (30.0 (±17.0) and 78.8° (±11.8°) respectively) compared to low-grade patients (52.2 (±11.9) and 100.6° (±14.7°) respectively) (p < 0.05). However, mean increase in KSS and ROM values were significantly higher for high-grade patients (p < 0.05). Mean increase in Knee Society Score and range of motion was 32.4 (±10.9) and 1.00° (±9.46°) respectively in patients with progression, 45.4 (±16.8) and 8.63° (±8.00°) in patients without progression (p > 0.05). ConclusionTotal knee arthroplasty is a successful treatment of knee osteoarthritis in Parkionson's disease patients with similar outcomes compared to general population despite disease severity and progression.

Medium- and long-term results of high tibial osteotomy in patients with primary and secondary knee osteoarthritis with varus deformity

The most common operation for knee osteoarthritis (OA) is total knee arthroplasty (TKA); however, the latter is associated with the development of severe complications. This was the reason for the revival of the interest of orthopedic traumatologists in high tibial osteotomy (HTO), the essence of which is to transfer the load away from the affected medial part of the knee joint (KJ) to the intact lateral one.Objective: to evaluate the medium- and long-term results of open-wedge (OW) HTO in primary and secondary I–III stage knee OA.Patients and methods. The Laboratory of Orthopedic Rheumatology and Rehabilitation, V.A. Nasonova Research Institute of Rheumatology, performed 10 OW HTOs in 9 patients in 2005 to 2009 and 21 more OW HTOs in 19 patients in 2014 to 2018 (a total of 31 operations). The male/female ratio was 2.5:1. The mean age of the patients was 57.6±12.5 years; the body mass index (BMI) was 28.5±3.6 kg/m2 ; the correction angle was 11.7±2.5°. Preoperative planning was performed using the Miniaci method; the X-ray stage of knee OA was evaluated according to the Kellgren–Lawrence classification. OW HTO was carried out. For assessment of its results, the investigators determined the degree of pain using a visual analogue scale (VAS) and the KJ status by the Knee Society Score (KSS) scale. The results were assessed at one (n=31), 3.5±0.6 (n=28), and 8.5±1.3 (n=10) years.Results and discussion. There was a tendency to worsen surgical results over time. The mean VAS values for pain at 1, 3.5, and 8.5 years were as follows: 9.8±10.3; 21.2±16.2 and 38±15.5 mm, respectively. In the same periods, the KSS functional scores were 83.6±14.8, 85.2±12.6, and 80.5±14.2; the objective scores were 80.7±8.5, 75.2±12.7, and 67.8±16.3. There was a strong correlation between the severity of pain and the functional and objective KSS scores (-0.78, -0.81 years, and -0.91 at 1, 3.5, and 8.5 years, respectively; p&lt;0.05). At 3.5±0.6 years, the survival rate after OW HTO was 96.6%. None of the patients examined at 8.5±1.3 years after OW HTO needed TKA. The surgical result was studied in 2 patients at 14 years; one patient underwent TKA, the other refused surgical intervention, the result was satisfactory.Conclusion. OW HTO has limited indications for use. However, in patients who are allowed to undergo this operation, pain syndrome can be relieved, by maintaining and/or improving KJ function; in most cases, TKA can be delayed for more than 10 years.

Psychometric properties of knee proprioception tests targeting healthy individuals and those with anterior cruciate ligament injury managed with or without reconstruction: a systematic review protocol

Introduction An anterior cruciate ligament (ACL) injury affects knee proprioception and sensorimotor control and might contribute to an increased risk of a second ACL injury and secondary knee osteoarthritis. Therefore,...

Effect of Myofascial Release and Trigger Point Release among Osteoarthritis Knee Patients

Background of the study: Osteoarthritis (OA) is the most widespread reason for knee joint pain and musculoskeletal disability. The knee is the most common site of OA. Osteoarthritis is the second most common rheumatologic problem. Objective: The purpose of this study was to investigate the effect of myofascial and trigger point release on quadriceps muscle pain and daily functional activities of patients with knee osteoarthritis. Methodology: This was quasi-experimental study done in ACS medical college and hospital, Chennai for 25 subjects. The patients with primary knee osteoarthritis were taken from both genders with age of 40 to 65. Patients with increased pain on resisted knee flexion, pain localized to the thigh and knee joint were included for the study. Patients with history of fracture of lower limb, secondary knee osteoarthritis, pain and tenderness located over the tibio-fibular joint, coagulation disorders and tumors were excluded. The duration of study will be 3 weeks. Visual analogue scale and knee injury and osteoarthritis outcome score questionnaire were used as outcome measures. Result: On comparing the mean value of the groups on KOOS score and VAS, it shows significant decreases in post mean values with P<0.0001. Conclusion: Myofascial release on quadriceps muscle is more effective to reduce the pain and improve the functional activities of Osteoarthritis knee patients.

Primary Total Knee Arthroplasty (TKA) with revision Total Stabilizer Prosthesis in a 66-year-old patient with secondary knee osteoarthritis and valgus deformity. Case Report

Abstract Knee osteoarthritis (gonarthrosis) is the most prevalent knee pathology encountered nowadays in the third age population, leading to severe disability and reduced life quality. Secondary gonarthrosis may be caused by a traumatic event, which subjects the knee joint to a transitory highly increased mechanical stress, initiating a rapidly progressive degrading process of the articular cartilage and subjacent bone tissue. TKA is intended to replace all the intra-articular components with artificial parts, in order to relieve pain, compensate for ligament instability, correct deformities, and restore proper joint functionality. Semi-constrained, non-hinged implants are usually used for revision TKA, in knees that already had a primary TKA but sustained complications. Nevertheless, here we reported the case of a 66-year-old female patient diagnosed with posttraumatic gonarthrosis who underwent TKA with a revision total stabilizer implant as primary treatment due to severe joint instability and high grade valgus deviation. The outcome of the surgical procedure was positive, with significant pain relief and increased knee stability. The valgus angle was reduced from 37° to 4° and the KSS score increased from 3 to 87 points. Therefore, revision semi-constrained prosthesis may be used as a primary implant with promising result in severe cases.

Primary ACL Repair vs Reconstruction: Investigating the Current Conventional Wisdom

BACKGROUND: “Why try to convert other collagen substitutes into ligament if the original can be preserved?” said Sherman1. Nowadays, reconstruction became the gold standard treatment for ACL injuries. Despite current treatment, secondary knee osteoarthritis has been described in more than 70% of the injured patients after 10 years follow up.2 Recent studies have reported that tears involving the proximal ACL have an intrinsic healing response. This response has been compared to the one observed in MCL injuries.3, 4. OBJECTIVE: The aim of this study is to initiate a scientific analysis of our experience in patients diagnosed with an acute, proximal ACL tear treated with a primary repair arthroscopic technique. We suggest the creation of a symposium that reconsiders the ACL repair as a tool for treatment, on a selected subset of patients. METHODS: We analyzed retrospectively the data of 12 consecutive patients diagnosed clinically and radiologically (MRI) with proximal ACL tears in our clinic. The inclusion criteria were: proximal ACL tear (type 1 tear in Sherman´s classification), good remaining ACL quality tissue and less than 3 months from injury. The mean age at time of surgery was 33 years (16 to 55). Patients included in this study are athletes either at an amateur or professional level. The technique consists of an anatomical reinsertion of native ACL by reinforcing the anteromedial and posterolateral bundles of the ACL with a series of high strength locking Bunnell-type sutures, moving up the ligament from distal to proximal with an arthroscopic suture passer. The normal ACL insertional footprint within the notch is then debrided to provide a bleeding surface for healing. Finally, the torn ligament is opposed to the native footprint using 1-2 absorbable anchors that recreate the anatomic bundle insertional sites of the native ACL. RESULTS: Associated injuries were found in 7 of the 12 patients, these included 4 knees with lateral and 1 with medial meniscal tear which were repaired in the same procedure. Also, one knee had a medial bucket handle tear, partial meniscectomy was performed, and one knee with a combined ACL/MCL injury in which the MCL was simultaneously repaired. In our ongoing series, were excluded patients that had sustained complex knee injuries with multi-ligament damage (except ACL/MCL injuries), those with ACL re-ruptures, and previous knee surgery with cartilage repair procedures. Validated functional outcomes scores were collected after a mean follow up of 20 months (14-26). For the IKDC subjective score 11 of 12 patients rated their knees as normal or nearly normal. Lachman and Pivot Shift was negative in all patients. Lysholm score postoperatively averaged 93.5 ± 7; preoperatively 48 ± 7. Tegner preinjury 7.5 ± 1.2 postinjury: 7 ± 1.4. The KT-1000 knee arthrometer, objectively measured &lt; 3 mm of anterior tibial motion relative to the femur in the injured knee compared to the non-injured knee at all levels of force, including manual max tests, in all patients included in the study. No complications or further surgeries are reported up to date. CONCLUSION: The keys to success include: Proper patient selection, early intervention, all arthroscopic technique, appropriate suture control of the torn ACL fibers, and stable opposition to a bleeding bone surface at the native attachment site within the femoral notch. Long-term data is pending. However, basic science and early clinical studies are promising. REFERENCES Mark F. Sherman, MD, Lawernce Lieber, MD, Joel R. Bonamo, MD, Luga Podesta, MD, Ira Reiter, RPT., The long-term followup of primary anterior cruciate ligament repair, 1991, The American Journal of Sports Medicine, Vol. 19, No 3. Martha M. Murray, MD. Current Status and Potential for Primary ACL Repair. 2009. Clin Ssports Med. Duy Tan Nguyen, Tamara H. Ramwadhdoebe, Cor P. van der Hart, Leendert Blankervoort, Paul Peter Tak, Cornelis Niek van Dijk., Intrinsic Healing Response of the Human Anterior Cruciate Ligament: An Histological Study of Reattached ACL Remnants, 2014, Journal of Orthopaedic Research. Martha M. Murray, MD, Braden C. Fleming, Ph.D., Use of a Bioactive Scaffold to Stimulate ACL Healing Also Minimizes Post-traumatic Osteoarthritis after Surgery, 2014, American Journal of Sports Medicine. Primary ACL Repair vs Reconstruction: Investigating the Current Conventional Wisdom

Study of metabolic syndrome frequency in elderly patients with knee osteoarthritis and its impact on the physical activity

Background Obesity is associated with an increased risk of osteoarthritis (OA). Metabolic syndrome (Met S) has been associated with a state of chronic low-grade inflammation and increased macrophages in the fat tissue. Hypertension and hyperglycaemia seem to be important BMI-independent factors of changes in osteoarthritic joints. Moreover, type 2 diabetes mellitus (DM) has been found to be an independent risk predictor for arthroplasty. Aim of the work To determine frequency and association of metabolic syndrome with knee osteoarthritis in elderly patients and its impact on the physical activity in elderly patients with knee osteoarthritis. Patients The study included patients aged above 65 years complaining of primary knee OA. The study included two groups: Gp A: Sixty patients >65 years with primary OA. Gp B: Forty apparently healthy elderly persons without knee OA as a control group. Exclusion Criteria: Patients with secondary knee OA. Methods All Patients were subjected to the following: Complete history taking, self-rated was measured by (SF-36), BMI, complete clinical musculoskeletal examination. C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) 1st hr,fasting glucose level, 2 hr-post-prandial glucose level, triglycerides (TG), cholesterol, uric acid, high density lipoprotein cholesterol (HDL-c), low density lipoprotein cholesterol (LDL-c) and radiographic imaging of affected knee joints. Results According to (k/L) score of severity; grade 3 and grade 4 OA were significantly higher in patients with Met S than patients without Met S. The mean WOMAC pain subscale score was significantly higher in patients with OA and Met S than in patients with OA and without Met S with P value ( Conclusion Elevated systemic markers of inflammation are linked with components of Met S, with an increased prevalence of radiographic OA and joint symptoms.

Effect of an Educational Program Promoting Regular Physical Exercises in Subjects With Knee Osteoarthritis

PURPOSE: The purpose of this study was to investigate the effects of an educational program emphasizing the regular practice of physical exercise on physical fitness, functional capacity and daily- living physical activity levels in patients with knee osteoarthritis (OA). METHODS: Two hundred and thirty-nine (239) patients in the public health system (male and female), with primary or secondary knee OA (degree I to IV in the Kelgreen and Lawrence scale), and with referral for OA clinical treatment were randomly allocated to intervention (IG; n = 112) and control groups (CG; n = 127). All subjects of both groups underwent assessment for physical fitness (six-minute-walking- tests), functional capacity (seat-to-stand, Up-and-Down-stairs and Timed-Up-and-Go tests) and daily-living physical activity (IPAQ short-version), before (pre), during (6-months) and after (12- months) the follow-up. Statistical analysis was performed with ANOVA two-way (group x time) with repeated measurements, Chi-square test and the Bonferroni’s t test. RESULTS: During six months of follow-up, the IG showed significant improvements (P < 0,05) in Up-and-Down-stairs (19%), seat-to-stand (30%) and Timed-Up-and-Go (32,5%) tests, as well as a reduction of Body Mass Index (BMI) (P < 0,05), which were maintained during the 12 months. There was also an increase in the percentage of self identified “actives” and “very actives” subjects and reduction in the percentage of sedentary subjects in the IG during follow-up (P < 0,05). The CG improved only the Up-and-Down-stairs tests during the 6-months (12%, P < 0,05), but the improvement was not maintained during the 12 months follow-up. There was also an increase in the percentage of very actives subjects in GC, however, this increase was lower than that was observed in the IG. There were no significant improvements on muscular capacity, aerobic capacity and flexibility during the 12-months follow-up in both groups. CONCLUSIONS: These results suggest that an educational program promoting the regular practice of physical exercise may be an effective tool for improving functional capacity in patients with knee OA.