Significant Knee Injury Research Articles

Comparison of Intact Knee Cartilage Thickness in Patients with Traumatic Lower Extremity Amputation and Nonimpaired Individuals.

The aim of this study was to assess the femoral articular cartilage thickness of the intact knee in patients with traumatic lower extremity amputation compared with nonimpaired individuals. A total of 30 male patients with traumatic lower extremity amputation (mean [SD] age, 31.2 [6.3] yrs) and a random sample of 53 age-matched and body mass index-matched male nonimpaired individuals (mean [SD] age, 29.8 [6.3] yrs) participated in the study. Exclusion criteria were age younger than 18 yrs, history of significant knee injury, previous knee surgery, or rheumatic disease. The femoral articular cartilage thickness was measured using ultrasound at the midpoints of the medial condyle, the intercondylar notch, and the lateral condyle. Ultrasonographic cartilage measurement was performed on the intact side of the patients with amputation and on both sides of the nonimpaired individuals. The femoral articular cartilage thickness of the intact knees of the patients with amputation was significantly decreased at the lateral and medial condyles compared with the nonimpaired individuals (P < 0.05). There was no significant difference in the measurements at the intercondylar notch between the patients with amputation and the nonimpaired individuals (P > 0.05). There was a premature cartilage loss in the intact limb knee of the patients with traumatic amputation. This result supports the view that patients with traumatic lower extremity amputation are at increased risk for developing knee osteoarthritis in the intact limb.

Association between popliteal artery wall thickness and knee cartilage volume loss in community-based middle-aged women without clinical knee disease

ObjectiveIncreasing evidence suggests a role of vascular pathology in the pathogenesis of osteoarthritis. This study examined the association between popliteal artery wall thickness, a surrogate marker of cardiovascular disease, and knee cartilage volume loss in an asymptomatic cohort of women. Study designProspective cohort study of 170 women with no significant knee pain, injury, or history of clinical knee disease. Participants underwent knee magnetic resonance imaging at baseline and 2 years later. Popliteal artery wall thickness was assessed using validated methods. Main outcome measuresTibial cartilage volume assessed using validated methods. Results142 women (83.5%) completed 2-year follow-up. After adjusting for age, body mass index and tibial bone area, greater popliteal artery wall thickness was associated with increased rate of medial tibial cartilage volume loss. With increasing tertiles of popliteal artery wall thickness, the mean (standard error) of annual medial tibial cartilage volume loss was 1.62 (0.45)%, 2.18 (0.43)%, and 2.98 (0.48)%, respectively, p for trend=0.04. No significant association was observed in lateral tibial cartilage. ConclusionIn community-based women greater popliteal artery wall thickness is associated with increased rate of tibial cartilage volume loss over 2 years. These findings suggest an adverse effect of vascular pathology on articular knee cartilage, supporting the hypothesis that there might be a vascular contribution to the development of knee osteoarthritis. Although needing to be confirmed in other studies, these results suggest that targeting vascular pathology may provide a potential target for the prevention and early treatment of knee osteoarthritis in women.

Association between popliteal artery wall thickness and knee structure in adults without clinical disease of the knee: a prospective cohort study.

There is evidence of a vascular contribution to the pathogenesis of osteoarthritis (OA). The aim of this study was to examine the association between popliteal artery wall thickness, which was previously shown to be associated with the risk of OA, and structural changes in the knee in an asymptomatic cohort. A total of 297 adults with no significant knee pain, injury, or history of clinical knee disease were recruited. Participants underwent magnetic resonance imaging of the knee at baseline and 2 years later. Popliteal artery wall thickness, knee cartilage volume, and bone marrow lesions (BMLs) were assessed. Of 278 participants with valid popliteal artery wall thickness measurements, 254 (91.4%) completed the 2-year followup assessment. After adjusting for age, sex, body mass index, and tibial bone area, increased popliteal artery wall thickness was found to be associated with a reduced medial tibial cartilage volume (B = -6.7 [95% confidence interval (95% CI) -12.9, -0.6], P = 0.03) and an increased rate of medial tibial cartilage volume loss (B = 0.06 [95% CI 0.01, 0.12], P = 0.03). There was a trend toward worsening of medial tibiofemoral BMLs in relation to increased popliteal artery wall thickness (odds ratio 1.07 [95% CI 0.99, 1.15]; P = 0.07). No significant associations with the lateral tibiofemoral compartment were observed. Increased popliteal artery wall thickness was associated with adverse changes in knee structure, as evidenced by reduced medial tibial cartilage volume, increased rate of cartilage volume loss, and a trend toward worsening of BMLs over 2 years. These findings suggest an association between vascular pathology and early structural changes in the knee, which supports the hypothesis that vascular health may play a role in the development of knee OA.

Animal Model of Osteoarthritis

Osteoarthritis (OA) is the most common arthritis which leads to chronic disability. Because patients usually present at medical care at an advanced stage of disease, research on pathogenesis of OA using human subjects is difficult. Therefore, animal models of OA are used extensively in search of pathogenesis of degenerative joint disease and in search of potential disease modifying anti-OA drugs. For induction of OA, chemical and surgical methods have been employed widely due to several advantages, such as faster onset of disease and reproducible induction of arthritic change. Intra-articular injection of a chemical such as monosodium iodoacetate or collagenase can cause the degeneration of cartilage and the development of osteoarthritis by inhibition of the activity of glyceraldehyde-3-phosphate dehydrogenase in chondrocytes or by induction of synovial inflammation and degeneration of supporting structure and resultant instability, respectively. Surgical induction involves destabilizing the knee joint by transection of the cranial cruciate ligament, collateral ligaments, or meniscotibial ligament with or without removing all or part of the meniscus. Surgical models are used not only in small animals but also in larger animals such as rabbits, sheep and dogs. Additionally, genetically modified mouse models offer opportunities to look into a specific role of a molecule or signaling pathway in the joint degradation. On the other hand, whether these models, chemically or surgically induced, or genetically modified, properly represent human OA is a critical question. Except for a limited number of cases, most human OA develops insidiously over decades without significant antecedent knee injury. In this sense, spontaneous model which develops in mice and guinea pigs might more closely resemble human OA. In this review, widely used animal models of OA are presented, focusing on the methods of its induction, their use for determining the pathophysiology of OA, and advantages and limitations of its use.

Rate and Risk of Anterior Cruciate Ligament Injury Among Sportswomen in Slovenia

Anterior cruciate ligament (ACL)-injury rate is greater among female athletes than among male athletes. To investigate the rate and risk of ACL injury among Slovenian sportswomen playing professional basketball, team handball, or volleyball. Prospective cohort study. The Slovenian National Organizations of basketball, team handball, and volleyball. During the 2003-2004 season, we prospectively followed 585 Slovenian sportswomen registered in the Slovenian National Organizations of basketball, team handball, and volleyball. We asked sportswomen and coaches to document the occurrence of every significant traumatic knee injury requiring medical attention. Injury rate and injury risk were calculated for sportswomen in each sport group. To calculate injury rate, we estimated the average exposure of each sportswoman during the research period. During the 2003-2004 season, 585 Slovenian sportswomen sustained 12 ACL injuries. The ACL-injury risk was different in athletes participating in the various sports, with basketball players having the greatest ACL-injury risk and volleyball players having the lowest ACL-injury risk (P = .04). The risk of ACL injury among Slovenian sportswomen was 2.1 per 100 athletes (95% confidence interval = 0.9, 3.2), whereas the rate of ACL injury was 0.037 per 1000 exposure hours (95% confidence interval = 0.016, 0.06). Overall differences in injury risk were found among sports, but no differences were noted among divisions within sports. No differences for injury rate were observed between or within sports. The rate and risk of ACL injury among Slovenian sportswomen are high, with basketball players having the greatest ACL-injury risk.

Landing Impact, Hip Kinematics, and Hip Strength Predict Dynamic Postural Stability in Army 101st Airborne

Postural instability contributes to unintentional lower extremity musculoskeletal injury. It is unclear if reported contributors to knee injury influence dynamic postural stability. PURPOSE: To determine if peak vertical ground reaction force (vGRF), sagittal and frontal plane knee and hip kinematics at initial contact, knee flexor/extensor strength, and hip abductor/adductor strength significantly predict dynamic postural stability index (DPSI). METHODS: Thirty nine male Army 101st Airborne (Air Assault) soldiers participated (26.3±5.6 yrs, 176.9±8.5 cm, 81.0±17.7 kg). Three dimensional kinematic and ground reaction forces (GRFs) were captured with a motion capture system interfaced with a force plate. Subjects performed a double-leg forward jump over a 12" hurdle with a single-leg landing on a force plate positioned at a distance of 40% subject height. Subjects landed on the dominant limb, stabilized as quickly as possible, and maintained single-leg balance with hands at the waist. DPSI was calculated using three dimensional GRFs from the first three seconds following initial contact. Isokinetic knee strength at 60o/sec and side-lying isometric hip strength at 10o hip abduction were tested using a multi-mode dynamometer. Strength and peak vGRF were normalized to % body weight. A stepwise multiple linear regression was performed to determine if the independent variables significantly predicted DPSI. The F probability for variable entry of.05, F probability for variable removal of.10, and alpha level of.05 for model significance was set a priori. RESULTS: Significant predictors in the linear regression model of DPSI include peak vGRF, hip abduction strength, and hip flexion/extension angle at initial contact (p <.001; R2 =.88; respective b=.0001, -.0013,.0018; constant=.0141). CONCLUSIONS: Dynamic postural stability for soldiers of the Army 101st Airborne (Air Assault) may be optimized by decreasing landing impact, increasing hip abduction strength, and increasing hip flexion at initial contact during landing tasks. Current injury prevention strategies targeting the significant knee injury contributors may concurrently benefit dynamic postural stability. Investigations are warranted to assess effects of training targeting the hip on dynamic postural stability.

High sensitivity C-reactive protein is associated with lower tibial cartilage volume but not lower patella cartilage volume in healthy women at mid-life

IntroductionElevated serum high sensitivity C-reactive protein (hsCRP) has been reported in established osteoarthritis (OA). The aim of this study was to determine whether serum levels of hsCRP are associated with the variation in tibial and patella cartilage volumes in women without evidence of OA.MethodsParticipants were recruited from a database established from the Australian electoral roll, and were aged 40 to 67 years, were not hysterectomized and had no significant knee pain or knee injury in the last 5 years. Tibial and patella cartilage volumes were measured from magnetic resonance imaging (MRI) of each woman's dominant knee and hsCRP measured in serum. Linear regression models were used to explore the major determinants of variation in both tibial and patella cartilage volume and to assess whether serum hsCRP made an independent contribution to variation in the volumes of cartilage in the two knee compartments.ResultsThe mean age of the 176 participants was 52.3 ± 6.6 years. Compared with a standard model for tibial cartilage volume that included bone area, age, smoking and alcohol status, the addition of an hsCRP term made an independent negative contribution to variation in tibial cartilage volume, irrespective of whether body mass index (BMI) was included in the model or not. By contrast, using a similar approach, hsCRP did not contribute independently to variation in patella cartilage volume.ConclusionIn asymptomatic women aged 40 to 67 years, serum hsCRP is independently negatively associated with the volume of tibial but not patella cartilage suggesting that subclinical inflammation may predispose to knee cartilage loss in the tibial compartment. This should be further assessed by a longitudinal study.

The cross-sectional relationship between fortnightly exercise and knee cartilage properties in healthy adult women in midlife

Exercise has been strongly promoted for the prevention of the major diseases of aging in women, such as cardiovascular disease and osteoporosis. However, conflicting data exist as to whether exercise benefits joint health and thus helps protect against degenerative processes such as knee osteoarthritis. The aim of this study was to examine the cross-sectional relationship between exercise and knee joint cartilage in women at midlife. A total of 176 women aged 40 to 67 years with no clinical knee osteoarthritis or history of significant knee injury were recruited from the community and had magnetic resonance imaging performed on their dominant knee to assess tibial cartilage volume and defects. The women completed a questionnaire to determine fortnightly exercise participation and frequency. Fortnightly participation in exercise at an intensity that caused tachypnea and an increased pulse rate for at least 20 minutes was positively associated with the volume of the medial tibial cartilage (P=0.02). There was a tendency for the frequency of exercise at this intensity to be positively associated with medial tibial cartilage volume (P=0.07). Exercise participation was not significantly associated with the presence of knee cartilage defects. Participation in exercise that causes tachypnea and an increased pulse rate for at least 20 minutes was associated with greater medial tibial cartilage volume, but not knee cartilage defects in non-healthcare-seeking women at midlife. More frequent exercise also tended to be associated with greater medial tibial cartilage volume. Although our findings need to be confirmed longitudinally, they provide further support for a beneficial effect of regular exercise on diseases related to aging.

Cruciate ligament integrity in osteoarthritis of the knee

To evaluate, using magnetic resonance imaging (MRI), the prevalence of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) rupture in knees with symptomatic osteoarthritis (OA) compared with those without OA, and the relationship to pain and recalled injury. MRI and plain radiography of the knee were performed in a group of 360 subjects with painful knee OA (cases; 66.7% male, mean age 67.1 years) and 73 without knee pain (controls; 57.5% male, mean age 66.1 years). MRIs were read for the presence or absence of complete or partial ACL or PCL tear. Subjects with knee pain were asked to quantify severity of pain on a visual analog scale and to report whether they could recall a significant knee injury (requiring use of a cane or crutches). We compared the prevalence of ACL and PCL rupture in those with and those without knee pain and also evaluated whether, in cases, there was any association with recalled knee injury. The proportion of cases who had complete ACL rupture was 22.8%, compared with 2.7% of controls (P = 0.0004). PCL rupture was rare both in cases (0.6%) and in controls (0%). Cases with ACL rupture had more severe radiologic OA (P < 0.0001) and were more likely to have medial joint space narrowing (P < 0.0001) than cases with intact ACLs, but did not have higher pain scores. Among cases, only 47.9% of those with complete ACL tears reported a previous knee injury, compared with 25.9% of those without complete ACL tears (P = 0.003). ACL rupture is more common among those with symptomatic knee OA compared with those without knee OA. Fewer than half of subjects with ACL rupture recall a knee injury, suggesting that this risk factor for knee OA is underrecognized.

The epidemiology of knee and ankle injuries on Macquarie Island

Macquarie Island is a small, rugged sub-Antarctic island with a scientific research station and a considerable reputation for knee and ankle injuries amongst the Australian Antarctic Division expeditioner population. In order to examine the accuracy of this reputation, a 10-year retrospective analysis of all knee and ankle injuries recorded by the Macquarie Island Medical Officer in the medical logs was undertaken. Knee and ankle injuries comprised 13% of the 2,678 recorded medical consultations. The majority of initial injuries occurred in the field and almost a third occurred during work related activities. Ankle ligament sprains were the most commonly recorded injury (17%), followed by achilles tendonitis (14%), enthesopathy of the knee (16%), and chondromalacia patellae (10%). Meniscal tears and collateral ligament of the knee sprains contributed a further 11 and 9%, respectively. While there were few significant knee and ankle injuries during this period, around a third of the expeditioners represented to the Medical Officer with recurrent difficulties.

PEDIATRIC AND ADOLESCENT SPORTS INJURIES

Scholastic-age sports are generally safe, and major musculoskeletal injuries are uncommon. Injuries are proportional to the athlete's age, size, and type of sport. Significant knee injuries do occur, especially during adolescence, and they require prompt, accurate diagnosis and specific treatment. The team physician plays a major role in injury prevention and management.

Anterior Cruciate Ligament Injury in the Skeletally Immature Patient: Diagnosis and Treatment

Significant intra-articular knee injuries, including tears of the anterior cruciate ligament (ACL), are now being recognized more frequently in skeletally immature patients. Previously reported data on ACL tears in this age group are sparse, and studies have been of limited quality. Improvements in diagnostic techniques (e.g., physical examination signs, arthrometric testing, magnetic resonance imaging, and arthroscopy) have facilitated identification of such injuries. Hemarthrosis must be regarded as a herald of a major intra-articular injury. Surgical reconstruction options vary according to the specific diagnosis and the stage of maturity, and the available options for the very skeletally immature patient are limited. Therefore, treatment must be predicated on assessment of maturity, as determined on the basis of chronologic, radiologic, and physiologic criteria. An ACL injury in this age group is not a surgical emergency; therefore, time for discussion with the patient and his or her parents is available, so that all appropriate options can be considered.

Knee Injuries in Female Athletes

Female athletes are at increased risk for certain sports-related injuries, particularly those involving the knee. Factors that contribute to this increased risk are the differences in sports undertaken and in gender anatomy and structure. Gender differences include baseline level of conditioning, lower extremity alignment, physiological laxity, pelvis width, tibial rotation and foot alignment. Sports like gymnastics and cheerleading create a noncontact environment, but can result in significant knee injuries. In quick stopping and cutting sports, females have an increased incidence of anterior cruciate ligament (ACL) injury by noncontact mechanisms. Patellofemoral (PF) disorders are also very common in female athletes. Awareness of these facts helps the sports medicine professional make an accurate diagnosis and institute earlier treatment-focused rehabilitation with or without surgery. Further prospective and retrospective research is needed in areas of epidemiology, mechanisms, severity and types of knee injuries. The goal is to lessen the severity of certain knee injuries and to prevent others.

Effect of surgical timing on return to sports activity after significant knee injuries.

When an athlete presents with an injury to the knee, one of the most frequently asked questions is, 'When will I be back to sports?' The answer de­ pends on multiple factors including the nature of the injury, degree of injury, specific demands of the particular sport, level of participation of the ath­ lete, and the timing of the injury relative to the season of the particular sport. With injuries that require surgical intervention, this question can be difficult to answer, since complications and indi­ vidual differences in rehabilitation occur. The quick­ est way to safely return an injured athlete to play is to: accurately diagnose the problem; surgically treat those injuries that require surgery in a timely fashion; schedule the surgical intervention to al­ low for minimal time lost from training; and ag­ gressively utilise physical therapy before and after surgery. The most frequent injuries in athletes' knees in­ volve the ligaments and menisci. Serious ligament injuries produce the greatest and longest athletic disability. A prompt accurate diagnosis allows treatment to begin as soon as possible. 1. Ligament Injuries of the Knee

868 Evaluation of Self-Motivation Inventory Score Differences Between Non-injured Athletes and Athletes with Significant Knee Injuries

868 Evaluation of Self-Motivation Inventory Score Differences Between Non-injured Athletes and Athletes with Significant Knee Injuries

Risk Factors for the Development of Osteoarthrosis of the Knee

The roles of physical activity (both work and leisure time), obesity, and history of significant knee injury on the development of severe osteoarthrosis (OA) of the knee were evaluated. A case-control design compared 46 cases with a history of severe OA of the knee with 46 community controls matched for age and gender. Data were gathered with a self-administered questionnaire. The OA cases were 3.5 times more likely than controls to have been obese at 20 years of age, two to three times more likely than controls to have performed heavy work, and almost five times more likely than controls to have had a significant knee injury. In contrast, leisure-time physical activity was not significantly different in cases compared with controls. Obesity, significant knee injury, and long-term heavy physical activity are important risk factors for the development of OA of the knee.

Arthroscopy in acute traumatic hemarthrosis of the knee. Incidence of anterior cruciate tears and other injuries.

In a prospective study, all injured knees that had traumatic hemarthrosis and absent or negligible instability on clinical examination underwent arthroscopy and examination under anesthesia. Eighty-five knees (eighty-three patients) were examined over a 125-week period. Some degree of disruption of the anterior cruciate ligament was found in sixty-one (72 per cent) of the knees (a partial tear in 28 per cent and a complete tear in 44 per cent), frequently associated with an injury of varying severity to other joint structures. These included minor ligament sprains without laxity in 41 per cent, a major associated ligament injury in 21 per cent, meniscal tears in 62 per cent (partial in 30 per cent and complete in 70 per cent), and a femoral chondral fracture or surface defect in 20 per cent. A popping sensation at injury occurred in 33 per cent of knees with a normal anterior cruciate ligament and in 36 per cent of those with a disruption. One-third of the knees had no to slight pain at the time of injury. The anterior drawer test without anesthesia was positive in only 24 per cent of the knees with a torn anterior cruciate ligament. We concluded that: (1) a traumatic hemarthrosis indicates a significant knee injury; (2) examination under anesthesia plus arthroscopy allows a more accurate diagnosis of injury to joint structures; and (3) such data are required for a rational treatment program to be outlined.