Severe Knee Research Articles

On the prediction of tibiofemoral contact forces for healthy individuals and osteoarthritis patients during gait: a comparative study of regression methods.

Knee osteoarthritis (OA) is a public health problem affecting millions of people worldwide. The intensity of the tibiofemoral contact forces is related to cartilage degeneration, and so is the importance of quantifying joint loads during daily activities. Although simulation with musculoskeletal models has been used to calculate joint loads, it demands high-cost equipment and a very time-consuming process. This study aimed to evaluate consolidated machine learning algorithms to predict tibiofemoral forces during gait analysis of healthy individuals and knee OA patients. Also, we evaluated three different datasets to train each model, considering different combinations of primary kinematic and kinetic data, and post-processing data. We evaluated 14 patients with severe unilateral knee OA and 14 healthy individuals during 3-5 gait trials. Data were split into 70% and 30% of the samples as training and test data. Test data was independently evaluated considering a mixture of pathological and healthy individuals, and only OA and Control patients. The main results showed that accurate predictions of the tibiofemoral contact forces were achieved using machine learning methods and that the predictions were sensitive to changes in the input data as training. The present study provided insights into the most promising regressions methods to predict knee contact forces representing an important starting point for the broader application of biomechanical analysis in clinical environments.

Effects of manual lymphatic drainage on total knee replacement: a systematic review and meta-analysis of randomized controlled trials

BackgroundTotal knee joint replacement (TKR) is an effective method for the treatment of severe knee osteoarthritis. With an increasing number of surgeries, complications such as lower limb edema, pain, and limited mobility have caused a heavy burden. Manual lymphatic drainage (MLD) may be a solution to solve the problem. The study aims to evaluate the efficacy of MLD in reducing knee edema, pain, and improving range of motion (ROM) in patients after TKR.MethodsA search was conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIPs, WanFang database, and Google Scholar from inception to June 2023. Only randomized controlled trials (RCTs) that compared the effects of MLD and non-MLD (or another physiotherapy) on improving knee edema, pain, and ROM after TKR were included. Stata 16.0 was used for meta-analysis. GRADE was used to assess the quality of evidence.ResultsIn total, 7 RCTs with 285 patients were identified. There were no significant differences found in the ROM of knee flexion (standardized mean difference (SMD) = 0.03, 95% confidence interval (CI): -0.22, 0.28, P = 0.812) and the ROM of knee extension (SMD= -0.30, 95%CI: -0.64, 0.04, P = 0.084). No differences were observed in the lower extremity circumference after TKR (SMD= -0.09, 95%CI: -0.27, 0.09, P = 0.324). For postoperative pain, there was no significant advantage between the MLD and non-MLD groups (SMD= -0.33, 95%CI: -0.71, 0.04, P = 0.083).ConclusionsBased on the current evidence from RCTs, manual lymphatic drainage is not recommended for the rehabilitation of patients following total knee replacement.

Total knee arthroplasty in patients with a proximal tibial stress fracture associated with bilateral severe knee osteoarthritis

Introduction/Objective. Proximal tibial stress fractures associated with bilateral severe knee osteoarthritis are rare and, due to possible consequences, are considered a treatment challenge. This paper aims to present the applied treatment method of these patients and its results. Methods. A prospective study followed 14 patients with an average age of 74.1 years and with unilateral proximal tibial stress fracture associated with bilateral severe knee osteoarthritis. Surgical treatment involved modular total knee arthroplasty (TKA) on the fracture side, in the first act, and contralateral standard TKA, in the second act, based on the severe osteoarthritis. Rehabilitation was performed for 21 days after both operations and included the following: kinesiotherapy, electrotherapy, magnetotherapy, hydrotherapy, and thermotherapy. Monitoring parameters were as follows: X-ray, range of motion, and WOMAC index. Monitoring periods were preoperative and three, six, and nine months after the first TKA surgery. Results. The radiological findings in all patients during these follow-up periods were normal. All tibial stress fractures healed within six months after surgery. Knee function was significantly improved nine months after the first TKA surgery compared to the preoperative finding. A statistically significant improvement in the physical functioning was found in all postoperative periods, especially nine months after the first TKA surgery (p < 0.05). Conclusion. Modular total knee arthroplasty on the tibial stress fracture side and delayed standard total knee arthroplasty of contralateral osteoarthritic knee combined by postoperative inpatient rehabilitation give optimal final functional outcome.

Influencing factors on the quality of recovery after total knee arthroplasty: development of a predictive model.

Total Knee Arthroplasty (TKA) is a widely performed procedure that significantly benefits patients with severe knee degeneration. However, the recovery outcomes post-surgery can vary significantly among patients. Identifying the factors influencing these outcomes is crucial for improving patient care and satisfaction. In this retrospective study, we analyzed 362 TKA cases performed between January 1, 2018, and July 1, 2022. Multivariate logistic regression was employed to identify key predictors of recovery within the first year after surgery. The analysis revealed that Body Mass Index (BMI), age-adjusted Charlson Comorbidity Index (aCCI), sleep quality, Bone Mineral Density (BMD), and analgesic efficacy were significant predictors of poor recovery (p < 0.05). These predictors were used to develop a clinical prediction model, which demonstrated strong predictive ability with an Area Under the Receiver Operating Characteristic (AUC) curve of 0.802. The model was internally validated. The findings suggest that personalized postoperative care and tailored rehabilitation programs based on these predictors could enhance recovery outcomes and increase patient satisfaction following TKA.

Health equity profile of knee replacement patients in the South African public sector: A descriptive study.

Knee replacement surgery can significantly improve the quality of life of patients with severe knee osteoarthritis. Equitable access to knee replacement surgery is important to ensure that everyone, regardless of their socioeconomic status or geographical location, have fair and timely access. The aim of our study was to (1) describe the health equity profile and quality of life of patients awaiting knee replacement at a single academic hospital in South Africa and to (2) describe the association between these health equity factors and the waiting time. A cross-sectional survey and retrospective record review of patients awaiting knee replacement was conducted using the PROGRESS-Plus health equity framework. Chi-square statistics were used to calculate association between health equity factors and the waiting time. Three-hundred and two (N = 302) patients (77% female; mean age 67 years) participated, of whom one in three patients waited 5 years or longer for surgery. Elderly patients (> 70 years) and patients from lower socio-economic background were less likely to have equitable access to surgery. The current screening protocol for knee replacement surgery in the public health care sector does not provide equitable access to surgery. A more holistic screening approach alongside selective surgical prioritisation and rehabilitation could reduce the waiting list and facilitate equitable access to care. Health equity factors such as socioeconomic status, age, and other patient characteristics such as life roles and employability should be taken into consideration when screening patients for elective knee replacement waiting lists.

Management of Delayed Hemolytic Transfusion Reaction in a Patient with Sickle Cell Disease: A Case Report

Background: Sickle cell disease (SCD) is a group of inherited blood disorders characterized by abnormalities in hemoglobin (Hb), leading to distortion in shape of red blood cells (RBCs) and their breakdown, potentially blocking blood flow and resulting in pain and anemia. This can significantly impact the patient’s quality of life. Patients often require multiple blood transfusions to prevent complications associated with SCD by reducing the concentration of damaged hemoglobin. However, one of the significant complications of blood transfusions is Delayed Hemolytic Transfusion Reaction (DHTR), which occurs due to RBC alloimmunization (i.e., formation of antibodies against donor RBC antigens). DHTR can manifest as a sudden decrease in hemoglobin levels, which may progress to rapid multiorgan failure and death. Thus, prompt diagnosis is crucial for timely management. This case report highlights the diagnosis and management of a 56-year-old African American female with SCD who presented with bilateral severe knee pain and low Hb levels. Case Presentation: The patient’s symptoms, past medical history, and investigation findings led to a diagnosis of DHTR. Management was conducted within the framework of Bloodless Medicine, incorporating strategies to minimize blood loss and optimize erythropoiesis. Treatment included the use of erythropoietin (EPO) to manage hemoglobin levels and the administration of opioids and supplemental oxygen for symptom relief. Conclusion: Our case report highlights the challenges and various management strategies employed in treating DHTR in SCD patients. It emphasizes the importance of early recognition of the complication and compares the risks and benefits of additional blood transfusions in such patients. By presenting this case, we aim to contribute to the growing literature on DHTR in SCD patients and highlight the need for further research and optimized management strategies in this population.

Posterior cruciate ligament rupture : state of the art

Posterior cruciate ligament (PCL) ruptures can cause severe knee instability and disability and thus, appropriate management is crucial for the successful restoration of patients' knee function. Rupture of the PCL can occur during sporting activity but more often, as a part of high-energy trauma. The diagnosis can be made using various clinical tests, such as the posterior drawer test or the quadriceps active test. MRI is the gold standard in imaging. PCL injuries can be classified from grade I to grade III, with increasing severity. Treatment can be conservative or surgical and should be personalized based on patients' demographic characteristics, grade of injury, level of instability, associated injuries and activity levels.

Improvement in Gait Speed Affects Short-term Improvement in Activities of Daily Living in Patients with Moderate and Severe Knee Osteoarthritis.

It is unclear whether improvements in knee pain or physical function lead to improvements in activities of daily living (ADL) and quality of life (QOL) in patients with moderate to severe knee osteoarthritis (KOA). This study aimed to investigate whether improvements in knee pain and physical function, achieved through exercise therapy, lead to improvements in ADL and QOL in patients with moderate to severe KOA. This case-control study included 18 patients with KOA. We evaluated knee range of motion, knee extension muscle strength (KEM), gait speed, knee pain, Knee Injury and Osteoarthritis Outcome Score (KOOS)-ADL, and KOOS-QOL at the first visit and after 3 months of exercise therapy. Patients were classified into the ADL and QOL improvement or no-improvement groups. Statistical analysis used split factorial analysis of variance with time and group as the main effects. When interactions were observed, post-hoc analysis was performed with two-sample t-tests. For ADL improvement, the improvements in KEM of the affected side and gait speed were statistically significant. At 3 months, the gait speed of the improvement group was significantly higher than that of the no-improvement group. For QOL improvement, there was no significant interaction for any of the factors evaluated. No factor showed significant contribution to improved QOL in patients with moderate to severe KOA. However, increased gait speed may improve ADL and contribute to the development of efficient rehabilitation programs for patients with moderate to severe KOA.

Surgical approach to correction of severe knee malalignment in a pediatric population in Tanzania.

Severe knee malalignment in children usually needs surgery with different options available in surgical approaches. The aim of this study was to report the results of the surgical correction of severe knee malalignment in children treated with femoral and tibial osteotomy, temporarily fixed with percutaneous Kirschner wires, in a low- and middle-income country (LMIC), with limited medical resources.

Understanding muscle coordination during gait based on muscle synergy and its association with symptoms in patients with knee osteoarthritis.

We aimed to investigate the muscle coordination differences between a control group and patients with mild and severe knee osteoarthritis (KOA) using muscle synergy analysis and determine whether muscle coordination was associated with symptoms of KOA. Fifty-three women with medial KOA and 19 control patients participated in the study. The gait analyses and muscle activity measurements of seven lower limb muscles were assessed using a motion capture system and electromyography. Gait speed and knee adduction moment impulse were calculated. The spatiotemporal components of muscle synergy were extracted using non-negative matrix factorization, and the dynamic motor control index during walking (walk-DMC) was computed. The number of muscle synergy and their spatiotemporal components were compared among the mild KOA, severe KOA, and control groups. Moreover, the association between KOA symptoms with walk-DMC and other gait parameters was evaluated using multi-linear regression analysis. The number of muscle synergies was lower in mild and severe KOA compared with those in the control group. In synergy 1, the weightings of biceps femoris and gluteus medius in severe KOA were higher than that in the control group. In synergy 3, the weightings of higher tibial anterior and lower gastrocnemius lateralis were confirmed in the mild KOA group. Regression analysis showed that the walk-DMC was independently associated with knee-related symptoms of KOA after adjusting for the covariates. Muscle coordination was altered in patients with KOA. The correlation between muscle coordination and KOA may be attributed to the knee-related symptoms. Key points • Patients with knee osteoarthritis (OA) experienced a deterioration in muscle coordination when walking. • Loss of muscle coordination was associated with severe knee-related symptoms in knee OA. • Considering muscle coordination as a knee OA symptom-related factor may provide improved treatment.

Epidemiology and treatment of pain associated with osteoarthritis of the knee in Germany: A retrospective health claims data analysis

ObjectiveOsteoarthritis of the knee (knee OA) is a serious joint disease leading to pain and reduced quality of life. Pharmacological treatments include anti-inflammatories, analgesics, intraarticular hyaluronic acid, and intraarticular corticosteroids while for severe knee OA, knee replacement is an option. This study examined the incidence, prevalence, patient characteristics, and uptake of medical and surgical treatments in knee OA patients in Germany. DesignA non-interventional, retrospective health claims data analysis with anonymized data from the InGef database was performed. Patients ≥18 years were analyzed cross-sectionally for each year 2015–2020. Newly diagnosed patients in 2015 were also longitudinally analyzed until end of 2020. ResultsAnnual knee OA prevalence increased from 7.07 ​% in 2015 to 7.39 ​% in 2020. Annual incidence proportions ranged from 1.71 ​% in 2015 to 1.46 ​% in 2020. Knee replacement was the most common surgery, with rising patient numbers (e.g., 7918 patients in 2015 and 8975 patients in 2019). Approximately 62 ​% of patients newly diagnosed in 2015 received prescription pharmacological pain treatment during follow-up. Most (96.95 ​%) received non-opioid analgesics, followed by weak opioids (8.14 ​%) and strong opioids (3.00 ​%) as first-line treatment (combinations possible). Knee surgery was performed in 16.6 ​% of patients during follow-up. Median time from first diagnosis until surgery was 346 days for any knee surgery and 564 days for knee replacement. ConclusionsThe number of patients with knee OA in Germany is steadily rising, along with an increasing number of surgical interventions, especially knee replacement. Time until first surgery and knee replacement is relatively short, even for newly diagnosed patients.

Predicting Leg Forces and Knee Moments Using Inertial Measurement Units: An In Vitro Study.

We compared the ability of seven machine learning algorithms to use wearable inertial measurement unit (IMU) data to identify the severe knee loading cycles known to induce microdamage associated with anterior cruciate ligament rupture. Sixteen cadaveric knee specimens, dissected free of skin and muscle, were mounted in a rig simulating standardized jump landings. One IMU was located above and the other below the knee, the applied three-dimensional action and reaction loads were measured via six-axis load cells, and the three-dimensional knee kinematics were also recorded by a laboratory motion capture system. Machine learning algorithms were used to predict the knee moments and the tibial and femur vertical forces; 13 knees were utilized for training each model, while three were used for testing its accuracy (i.e., normalized root-mean-square error) and reliability (Bland-Altman limits of agreement). The results showed the models predicted force and knee moment values with acceptable levels of error and, although several models exhibited some form of bias, acceptable reliability. Further research will be needed to determine whether these types of models can be modified to attenuate the inevitable in vivo soft tissue motion artifact associated with highly dynamic activities like jump landings.

Exploring biomarkers associated with severity of knee osteoarthritis in Southern China using widely targeted metabolomics

BackgroundMetabolomics is a tool to study the pathogenesis of diseases and their associated metabolites, but there are still insufficient metabolomic studies on severe knee osteoarthritis.To investigate the differences in serum metabolites between healthy populations and knee osteoarthritis (KOA) patients in Southern China using widely targeted metabolomics, and to explore biomarkers and their metabolic pathways that could be associated with the severity of KOA.MethodsThere were 10 healthy individuals in the control group and 32 patients with KOA. According to the Kellgren–Lawrence (KL) grading system, KOA was further divided into mild (n = 13, KL grade 1 and 2) and severe (n = 19, KL grade 3 and 4). Serum samples from all participants were collected and analyzed metabolomics based on ultra-performance liquid chromatography/electrospray ionization/tandem mass spectrometry. We screened for differential metabolites between patients and controls, and between mild and severe KOA. We explored the metabolic pathways involved in differential metabolism using the Kyoto Encyclopedia of Genes and Genomes database.ResultsSixty-one metabolites were differentially expressed in the sera of the patient group compared with the control group (45 upregulated and 16 downregulated). Analysis of the mild and severe KOA groups showed a total of 12 differential metabolites. Receiver operating characteristic curve analysis showed N-alpha-acetyl-L-asparagine was a good predictor of advanced osteoarthritis(OA).Differential metabolites are enriched in multiple pathways such as arachidonic acid metabolism.ConclusionWidely targeted metabolomics found that upregulation of the amino acid metabolite N-α-acetyl-L-asparagine was significantly associated with severe KOA and could be a biomarker for predicting severity of KOA. Arachidonic acid metabolism may play an important role in patients with severe KOA.

Development of a clinical prediction rule for mobility status at discharge in patients with total knee arthroplasty: Using a decision tree model

BackgroundTotal knee arthroplasty (TKA) is an effective treatment to improve mobility in patients with severe knee osteoarthritis. However, some patients continue to have poor mobility after surgery. The preoperative identification of patients with poor mobility after TKA allows for better treatment selection and appropriate goal setting. The purpose of this study was to develop a clinical prediction rule (CPR) to predict mobility after TKA. MethodsThis study included patients undergoing primary TKA. Predictors of outcome included patient characteristics, physical function, and psychological factors, which were measured preoperatively. The outcome measure was the Timed Up and Go test, which was measured at discharge. Patients with a score of ≥11 s were considered having a low-level of mobility. The classification and regression tree methodology of decision tree analysis was used for developing a CPR. ResultsOf the 101 cases (mean age, 72.2 years; 71.3 % female), 26 (25.7 %) were classified as low-mobility. Predictors were the modified Gait Efficacy Scale, age, knee pain on the operated side, knee extension range of motion on the non-operated side, and Somatic Focus, a subscale of the Tampa Scale for Kinesiophobia (short version). The model had a sensitivity of 50.0 %, a specificity of 98.7 %, a positive predictive value of 92.9 %, a positive likelihood ratio of 37.5, and an area under the receiver operating characteristic curve of 0.853. ConclusionWe have developed a CPR that, with some accuracy, predicts the mobility outcomes of patients after TKA. This CPR may be useful for predicting postoperative mobility and clinical goal setting.

Neutrophil-Dependent Immune Response Promotes Joint Damage in Hemophilia

Background: Hemophilic arthropathy (HA) is the predominant pathophysiology resulting from recurrent joint bleeding in individuals with hemophilia and leads to permanent joint damage, chronic pain and reduced quality of life. Although FVIII replacement therapy or FVIII mimetics like HEMLIBRA have significantly improved the disease outcome, joint bleeding continues to occur in severely hemophilic patients (FVIII&amp;lt;1%). HA starts at an early age and develops progressively over time, warranting the need for a therapy that can intervene the progression of HA. Unfortunately, such therapy does not exist and the etiological mechanism of HA remains poorly understood. Aim: To determine whether neutrophil Gasdermin-D (GSDMD)-dependent generation of neutrophil extracellular traps (NETs) in in the joint promotes HA. Methods: Knee joints in FVIII-total knockout (F8 TKO) or littermate WT male mice were injured using a needle . Scoring of the bleeding severity and histology of injured joints were conducted to assess the joint injury in mice.Imaging-flow-cytometry and ELISA assays were used to evaluate the number of circulating NETs in the blood samples of patients diagnosed with HA and mice with following knee injury. Neutrophils from HA patients, F8 TKO mice and matched controls were isolated, activation of GSDMD-pathway components was evaluated in neutrophils using qRT-PCR (gene expression) and western blotting (protein levels and cleavage). Results: F8 TKO but not control mice manifested unresolved joint injury and severe bleeding 5-days post knee injury. Circulating NETs (cNETs) and cNETs markers llike neutrophil elastase or citrulinated histones were significantly elevated in the plasma of hemophilia patients diagnosed with HA and injured F8 TKO mice but not plasma of control humans or injured WT mice or uninjured F8 TKO mice. Major genes (mRNA levels) associated with GSDMD-mediated NETs generation were significantly elevated in neutrophils of HA patients and injured F8 TKO mice compared to matched controls. Finally, western blot analysis revealed activation of GSDMD pathway in neutrophils isolated from HA patients and F8 TKO mice but not matched controls. Conclusions: These findings are the first to suggest that GSDMD-dependent generation of NETs contributes to the pathogenesis of HA

Outcomes of Physiotherapy Exercises After Total Knee Replacement Surgery

Introduction: Total knee replacement (TKR) surgery is a common procedure for severe knee osteoarthritis, improving the quality of life for many patients. Despite surgical success, optimal recovery heavily relies on effective post-operative rehabilitation. This systematic review aimed to evaluate the effectiveness of various physiotherapy exercises in enhancing recovery outcomes following TKR, focusing on knee function, pain reduction, and patient satisfaction. Methods: A comprehensive search of PubMed, Scopus, Cochrane Library, and Web of Science was conducted, focusing on interventional studies and clinical trials published in the last five years up to 2022. Studies included were those evaluating physiotherapy interventions post-TKR, with clear measures on efficacy regarding patient outcomes. Exclusion criteria encompassed non-exercise-based rehabilitations, observational studies, and non-English publications. Data extraction focused on intervention types, sample sizes, and outcome measures. Results: Twelve studies were included, with sample sizes ranging from 30 to over 200 participants. Interventions varied from in-person physiotherapy, home-based exercises, high-intensity training, to tele-rehabilitation. High-intensity physiotherapy programs were associated with a 40% greater improvement in knee function compared to standard care. Tele-rehabilitation provided comparable outcomes in terms of pain management and mobility improvements, with patient satisfaction exceeding 80% in some studies. However, adherence and exercise intensity were noted challenges in remote settings. Conclusions: The review highlights physiotherapy's pivotal role in post-TKR recovery, with high-intensity programs showing significant benefits in knee function. Tele-rehabilitation emerges as a promising alternative, potentially increasing access to care. These findings support the integration of structured physiotherapy into rehabilitation protocols to maximize recovery outcomes. Future research should explore strategies to enhance adherence and effectiveness of tele-rehabilitation services.

Preserving primary medial static stabilizer ligaments achieves physiological knee kinematics in total knee arthroplasty

PurposeAs postoperative knee instability has been reported to be one of the critical reasons for early failure in total knee arthroplasty (TKA), obtaining optimal knee stability—especially in medial—was indispensable for successful TKA. We hypothesized that preserving medial soft tissue structures was the key to maintain physiological medial knee stability. Thus, TKAs with preserving primary medial static stabilizer ligaments technique were performed, and the postoperative knee kinematics was evaluated. MethodsPrimary knee osteoarthritis patients with varus knee deformity and planed for primary TKA were enrolled. However, patients with severe varus knee deformities, valgus knee deformities, and rheumatoid arthritis were excluded. TKAs were performed by removing medial femoral and tibial osteophytes; however, the primary medial static stabilizer ligaments—the superficial medial collateral ligament (MCL), deep MCL, and posterior oblique ligament—were not released. The cruciate-retaining (CR), posterior-stabilized (PS), and medial-pivot (MP) inserts were implanted, and the knee kinematics was measured. These data were statistically analyzed using analysis of variance. The institutional review board approved the study. ResultsFrom full extension to maximum flexion, the lateral femoral condyle moved backward, greater than the medial femoral condyle, and consequently the femur external rotated on the tibia. These kinematics patterns were shown in CR, PS, and MP groups. ConclusionAs the knee kinematics of CR and PS are similar to that of MP, which has been reported to demonstrate physiological knee kinematics, preserving primary medial static stabilizer ligaments technique could potentially preserve physiological knee kinematics.

Assessing knee joint biomechanics and trunk posture according to medial osteoarthritis severity

During progression of knee osteoarthritis (OA), gait biomechanics changes three-dimensionally; however, its characteristics and trunk posture according to OA severity remain unknown. The present study investigated three-dimensional knee joint biomechanics and trunk posture according to knee OA severity. Overall, 75 patients (93 knees) with medial knee OA [Kellgren-Lawrence grade ≥ 2, grade 2: 20 patients with 24 knees (mean 60.0 years old); grade 3: 25 with 28 knees (mean 62.0 years old); grade 4: 30 with 41 knees (mean 67.9 years old)] and 14 healthy controls (23 knees, mean 63.6 years old) underwent gait analysis using an optical motion capture system and point cluster technique. In grade 2 knee OA, the relative contribution of the knee adduction moment (KAM) increased significantly (P < 0.05), and that of the knee flexion moment decreased (P < 0.05) prior to significant progression of varus knee deformity. Grade 3 knee OA showed significant exacerbation of varus knee deformity (P < 0.01) and KAM increase (P < 0.001). The maximum knee extension angle decreased (P < 0.05) and trunk flexion increased during gait in grade 4 knee OA (P < 0.001). Our study clarified the kinematics and kinetics of medial knee OA with trunk flexion according to severity. Kinetic conversion occurred in grade 2 knees prior to progression of varus deformities, knee flexion contractures, and sagittal imbalance during gait in patients with severe knee OA.

Prediction of Osteoarthritis in the Knee by KOA Diagnosis Using Artificial Intelligence Based Techniques

Knee Osteoarthritis is the most common form of knee arthritis. A healthy knee's articular cartilage, a smooth, slick tissue, allows for simple bending and straightening. The ends of the leg bones that make up your knee are covered, safeguarded, and cushioned by this material. Two c-shaped segments of meniscal cartilage between your bones serve as "shock absorbers" to cushion your knee joint. Osteoarthritis develops gradually. The cartilage becomes rough and ragged as it ages. It hurts to move the bones along this exposed area. The most prevalent signs and symptoms of knee osteoarthritis are pain and stiffness. After being inactive for a while or in the morning, symptoms typically worsen. The earlier you begin treatment, the better, as osteoarthritis gets worse with time. Your doctor may prescribe additional tests after reviewing your symptoms and medical history, such as X-rays, which can reveal bone and cartilage damage as well as the existence of bone spurs, and magnetic resonance imaging (MRI) scans. So, the KOA diagnosis will be based on two modalities: X-rays and MRIs. Depending upon the patient’s opinion about their knee problems, the doctor will decide whether to take X-rays or MRIs for KOA diagnosis. &#x0D; To avoid such severe knee issues, researchers used many various techniques for KOA diagnosis in the existing system in order to treat it at an early stage of knee problems. In order to do that, we conducted a survey of research articles based on the KOA diagnosis published in the years 2021 and 2022 for this work. From the conducted survey, the methodologies which are AI-based techniques used for KOA diagnosis are discussed and their performance metrics are compared. The current review paper's goal is to do research on the various KOA diagnosis approaches employed in the years 2021 and 2022. As a result of this study, the methodologies which are AI-based techniques used for KOA diagnosis achieves good efficiency in predicting the osteoarthritis in the knee.

Siddha &lt;i&gt;Varmam&lt;/i&gt; Therapy in the Management of Anterior Cruciate Ligament Tear Grade II - A Case Report

Anterior cruciate ligament rupture is one of the most common musculo-skeletal injuries in active individuals, especially athletes. Varmam treatment, as part of the Siddha, primarily treats traumatic injuries. A 25-year-old female patient came to Varma Maruthuvam OPD, National Institute of Siddha, Chennai, with complaints of severe right knee joint pain, swelling, walking difficulty, instability while walking, and difficulty in flexion and extension of the right knee joint for 10 days. Initially, she consulted an allopathic hospital, and after her MRI was done, she was diagnosed with an anterior cruciate ligament tear grade II and advised for surgery. The patient refused to go for surgery and came to our OPD for further management. She was treated with Siddha Varmam therapy and external medicine, Murivu ennai, for 50 days and followed up for four months. The ligament tear healed without any surgical treatment, and the patient returned to her regular work, which was assessed by a visual analogue scale. This case report summarizes the conservative management of an anterior cruciate ligament tear grade II by Siddha Varmam therapy.