Search results for: knee osteoarthritis

Authors: Mokhtar Arazpour

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Objectives: Recently a new kind of stance control knee joint has been developed called the 'sensor lock.' This study aimed to develop and evaluate 'sensor lock', which could potentially solve the problems of walking parameters and gait symmetry in subjects with quadriceps weakness. Methods: Nine subjects with quadriceps weakness were enrolled in this study. A custom-made knee ankle foot orthosis (KAFO) with the same set of components was constructed for each participant. Testing began after orthotic gait training was completed with each of the KAFOs and subjects demonstrated that they could safely walk with crutches. Subjects rested 30 minutes between each trial. The 10 meters walking test is used to assess walking speed in meters/second (m/s). The total time taken to ambulate 6 meters (m) is recorded to the nearest hundredth of a second. 6 m is then divided by the total time (in seconds) taken to ambulate and recorded in m/s. The 6 Minutes Walking Test was used to assess walking endurance in this study. Participants walked around the perimeter of a set circuit for a total of six minutes. To evaluate Physiological cost index (PCI), the subjects were asked to walk using each type of KAFOs along a pre-determined 40 m rectangular walkway at their comfortable self-selected speed. A stopwatch was used to calculate the speed of walking by measuring the time between starting and stopping time and the distance walked. Results: The use of a KAFO fitted with the “sensor lock” knee joint resulted in improvements to walking speed, distance walked and physiological cost index when compared with the knee joint in lock mode. Conclusions: This study demonstrated that the use of a KAFO with the “sensor lock” knee joint could provide significant benefits for subjects with a quadriceps weakness when compared to a KAFO with the knee joint in lock mode.

Keywords: stance control knee joint, knee ankle foot orthosis, quadriceps weakness, walking, energy consumption

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Authors: Oksana Mykytyuk

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Chronic desynchronosis is an important factor of progression of osteoarthritis in shift workers. 80 patients with primary osteoarthritis (female:male ratio = 3:1, average age: 57.6 years, average disease duration: 6.4 years, radiological stage: II-III) were examined, 42% reported systematic night shift-work for more than two years. Full clinical examination was performed, all patients filled in SF-36, WOMAC questonnaries, marked visual analog scales for estimation of pain intensity and general well-being. Patients who had been exposed to night work had significantly worse clinical course of osteoarthritis marked by more (27.5%, p < 0.05) extensive pain syndrome, especially at night hours, (10.00 pm-2.00 am period) and estimated life quality as poorer comparing those working at day time. Osteoarthritis initiation occurred at earlier age in them comparing those who worked in non-shifted regimen. They showed a trend to generalized affliction of bigger quantity of joint groups, higher frequency of synovitis as well. Shift-workers administered higher doses of non-steroid anti-inflammatory drugs (NSAIDs) and estimated their effect as lower (39.6% average daily relief vs 62.5% in non-shift workers after 10 days of regular application of therapy). Frequency of chronic NSAID-induced gastropathy was 25% higher among night-workers. Shift-workers are predisposed to worse course of osteoarthritis with marked clinical symptoms, requiring higher doses on NSAIDs and with inclination towards bigger frequency of complication. That should be kept in mind while developing individual treatment and secondary prophylaxis strategy.

Keywords: desynchronosis, osteoarthritis, questionnaries, shift-work

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Authors: Trupti Chavan, Ramachandra Guda, Kameshwar Rao

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The lack of data is a pain problem in medical image analysis using a convolutional neural network (CNN). This work uses various spatial transformation techniques to address the medical image augmentation issue for knee detection and localization using an enhanced single shot detector (SSD) network. The spatial transforms like a negative, histogram equalization, power law, sharpening, averaging, gaussian blurring, etc. help to generate more samples, serve as pre-processing methods, and highlight the features of interest. The experimentation is done on the OpenKnee dataset which is a collection of knee images from the openly available online sources. The CNN called enhanced single shot detector (SSD) is utilized for the detection and localization of the knee joint from a given X-ray image. It is an enhanced version of the famous SSD network and is modified in such a way that it will reduce the number of prediction boxes at the output side. It consists of a classification network (VGGNET) and an auxiliary detection network. The performance is measured in mean average precision (mAP), and 99.96% mAP is achieved using the proposed enhanced SSD with spatial transformations. It is also seen that the localization boundary is comparatively more refined and closer to the ground truth in spatial augmentation and gives better detection and localization of knee joints.

Keywords: data augmentation, enhanced SSD, knee detection and localization, medical image analysis, openKnee, Spatial transformations

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Authors: Nosratollah Hedayatpour, Hamid Reza Taheri, Mehrdad Fathi

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Introduction: Quadriceps femoris muscle is frequently involved in various movements e.g., jumping, landing) during sport and/or daily activities. During ballistic movement when individuals are faced with unexpected knee perturbation, fast twitch muscle fibers contribute to force production to stabilize knee joint. Fast twitch muscle fiber is more susceptible to fatigue and therefor may reduce the ability of the quadriceps muscle to stabilize knee joint during fast perturbation. Aim: The aim of this study was to investigate the effect of fatigue on postural response of the knee extensor muscles to fast and slow perturbations. Methods: Fatigue was induced to the quadriceps muscle using a KinCom Isokinetic Dynamometer (Chattanooga, TN). Bipolar surface electromyography (EMG) signals were simultaneously recorded from quadriceps components (vastus medialis, rectus femoris, and vastus lateralis) during pre- and post-fatigue postural perturbation performed at two different velocities of 120 ms and 250 mes. Results: One-way ANOVA showed that maximal voluntary knee extension force and time to task failure, and associated EMG activities were significantly reduced after fatiguing knee exercise (P< 0.05). Two-ways ANOVA also showed that ARV of EMG during backward direction was significantly larger than forward direction (P< 0.05), and during fast-perturbation it was significantly higher than slow-perturbation (P< 0.05). Moreover, ARV of EMG was significantly reduced during post fatigue perturbation, with the largest reduction identified for fast-perturbation compared with slow perturbation (P< 0.05). Conclusion: A larger reduction in muscle activity of the quadriceps muscle was observed during post fatigue fast-perturbation to stabilize knee joint, most likely due to preferential recruitment of fast twitch muscle fiber which are more susceptible to fatigue. This may partly explain that why knee injuries is common after fast ballistic movement.

Keywords: electromyography, fast-slow perturbations, fatigue, quadriceps femoris muscle

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Authors: G. Espriú-Pérez, F. A. Vargas-Oviedo, I. Zenteno-Aguirrezábal, M. D. Moya-Bencomo

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One of the injuries with a higher incidence among university-level athletes in the North of Mexico is presented in the knee. This injury generates absenteeism in training and competitions for at least 8 weeks. There is no active quantitative methodology, or protocol, that directly contributes to the clinical evaluation performed by the medical personnel at the prevalence of knee injuries. The main objective is to contribute with a quantitative tool that allows further development of preventive and corrective measures to these injuries. The study analyzed 55 athletes for 6 weeks, belonging to the disciplines of basketball, volleyball, soccer and swimming. Using a motion capture system (Nexus®, Vicon®), a three-dimensional analysis was developed that allows the measurement of the range of movement of the joint. To focus on the performance of the lower limb, eleven different movements were chosen from the Functional Performance Test, Functional Movement Screen, and the Cincinnati Jump Test. The research identifies the profile of the natural movement of a healthy knee, with the use of medical guidance, and its differences between each sport. The data recovered by the single-leg crossover hop managed to differentiate the type of knee movement among athletes. A maximum difference of 60° of offset was found in the adduction movement between male and female athletes of the same discipline. The research also seeks to serve as a guideline for the implementation of protocols that help identify the recovery level of such injuries.

Keywords: Cincinnati jump test, functional movement screen, functional performance test, knee, motion capture system

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Authors: Pedro Ferraz-Gameiro

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Introduction: The Pellegrini-Stieda lesion is the result of post-traumatic calcification and/or ossification on the medial collateral ligament (MCL) of the knee. When this calcification is accompanied by gonalgia and limitation of knee flexion, it is called Pellegrini-Stieda syndrome. The pathogenesis is probably the calcification of a post-traumatic hematoma at least three weeks after the initial trauma or secondary to repetitive microtrauma. On anteroposterior radiographs, a Pellegrini-Stieda lesion is a linear vertical ossification or calcification of the proximal portion of the MCL and usually near the medial femoral condyle. Patients with Pellegrini-Stieda syndrome present knee pain associated with loss of range of motion. The treatment is usually conservative with analgesic and anti-inflammatory drugs, either systemic or intra-articular. Physical medicine and rehabilitation techniques associated with shock wave therapy can be a way of reduction of pain/inflammation. Patients who maintain instability with significant limitation of knee mobility may require surgical excision. Methods: Research was done using PubMed central using the terms Pellegrini-Stieda syndrome. Discussion/conclusion: Medical treatment is the rule, with initial rest, anti-inflammatory, and physiotherapy. If left untreated, this ossification can potentially form a significant bone mass, which can compromise the range of motion of the knee. Physical medicine and rehabilitation techniques associated with shock wave therapy are a way of reduction of pain/inflammation.

Keywords: knee, Pellegrini-Stieda syndrome, rehabilitation, shock waves therapy

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Authors: Arash Sharafat Vaziri, Leila Aghaghazvini, Soodeh Jahangiri, Mohammad Tahami, Roham Borazjani, Mohammad Naghi Tahmasebi, Hamid Rabie, Hesan Jelodari Mamaghani, Fardis Vosoughi, Maryam Salimi

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Aims: It is essential to know the normal extrusion measures in order to detect pathological ones. In this study, we aimed to define some normal reference values for meniscal extrusion in the normal knees during different ranges of motion. Methods: The amount of anterior and posterior portion of meniscal extrusion among twenty-one asymptomatic volunteers (42 knees) were tracked at 0, 45, and 90 degrees of knee flexion using an ultrasound machine. The repeated measures analysis of variance (ANOVA) was used to show the interaction between the amounts of meniscal extrusion and the different degrees of knee flexion. Result: The anterior portion of the lateral menisci at full knee extension (0.59±1.40) and the posterior portion of the medial menisci during 90° flexion (3.06±2.36) showed the smallest and the highest mean amount of extrusion, respectively. The normal average amounts of anterior extrusion were 1.12± 1.17 mm and 0.99± 1.34 mm for medial and lateral menisci, respectively. The posterior meniscal normal extrusions were significantly increasing in both medial and lateral menisci during the survey (F= 20.250 and 11.298; both P-values< 0.001) as they were measured at 2.37± 2.16 mm and 1.53± 2.18 mm in order. Conclusion: The medial meniscus can extrude 1.74± 1.84 mm normally, while this amount was 1.26± 1.82 mm for the lateral meniscus. These measures commonly increased with the rising of knee flexion motion. Likewise, the posterior portion showed more extrusion than the anterior portion on both sides. These measures commonly increased with higher knee flexion.

Keywords: meniscal extrusion, ultrasonography, knee

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Authors: S. Alireza Mirghasemi, Javad Parvizi, Narges R. Gabaran, Shervin Rashidinia, Mahdi M. Bijanabadi, Dariush G. Savadkoohi

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Background: The anterior cruciate ligament is one of the most frequent ligament to be disrupted. Surgical reconstruction of the anterior cruciate ligament is a common practice to treat the disability or chronic instability of the knee. Several factors associated with success or failure of the ACL reconstruction including preoperative laxity of the knee, selection of the graft material, surgical technique, graft tension, and postoperative rehabilitation. We aimed to examine the biomechanical properties of any graft type and initial graft tensioning during ACL reconstruction using 3-dimensional computational finite element simulation. Methods: In this paper, 3-dimensional model of the knee was constructed to investigate the effect of graft tensioning on the knee joint biomechanics. Four different grafts were compared: 1) Bone-patellar tendon-bone graft (BPTB) 2) Hamstring tendon 3) BPTB and a band of gracilis4) Hamstring and a band of gracilis. The initial graft tension was set as “0, 20, 40, or 60N”. The anterior loading was set to 134 N. Findings: The resulting stress pattern and deflection in any of these models were compared to that of the intact knee. The obtained results showed that the combination of a band of gracilis with the former graft (BPTB or Hamstring) increases the structural stiffness of the knee. Conclusion: Required pretension during surgery decreases significantly by adding a band of gracilis to the proper graft.

Keywords: ACL reconstruction, deflection, finite element simulation, stress pattern

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Authors: Anuj Pathare, Aleksandra Birn-Jeffery

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Background: The Anterior Cruciate Ligament(ACL) helps stabilize the knee joint minimizing tibial anterior translation. Anterior Cruciate Ligament (ACL) injury is common in racquet sports and often occurs due to sudden acceleration, deceleration or changes of direction. This mechanism in badminton most commonly occurs during landing after an overhead stroke. Knee biomechanics during dynamic movements such as walking, running and stair negotiation, do not return to normal for more than a year after an ACL reconstruction. This change in the biomechanics may lead to re-injury whilst performing non-steady movements during sports, where these injuries are most prevalent. Aims: To compare if the knee kinetics and kinematics in ACL injury recovered athletes return to the same level as those from an uninjured cohort during standard movements used for clinical assessment and badminton shots. Objectives: The objectives of the study were to determine: Knee valgus during the single leg squat, vertical drop jump, net shot and drop shot; Degree of internal or external rotation during the single leg squat, vertical drop jump, net shot and drop shot; Maximum knee flexion during the single leg squat, vertical drop jump and net shot. Methods: This case-control study included 14 participants with three ACL injury recovered athletes and 11 uninjured participants. The participants performed various functional tasks including vertical drop jump, single leg squat; the forehand net shot and the forehand drop shot. The data was analysed using the two-way ANOVA test, and the reliability of the data was evaluated using the Intra Class Coefficient. Results: The data showed a significant decrease in the range of knee rotation in ACL injured participants as compared to the uninjured cohort (F₇,₅₅₆=2.37; p=0.021). There was also a decrease in the maximum knee flexion angles and an increase in knee valgus angles in ACL injured participants although they were not statistically significant. Conclusion: There was a significant decrease in the knee rotation angles in the ACL injured participants which could be a potential cause for re-injury in these athletes in the future. Although the results for decrease in maximum knee flexion angles and increase in knee valgus angles were not significant, this may be due to a limited sample of ACL injured participants; there is potential for it to be identified as a variable of interest in the rehabilitation of ACL injuries. These changes in the knee biomechanics could be vital in the rehabilitation of ACL injured athletes in the future, and an inclusion of sports based tasks, e.g., Net shot along with standard protocol movements for ACL assessment would provide a better measure of the rehabilitation of the athlete.

Keywords: ACL, biomechanics, knee injury, racquet sport

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Authors: Alò Roberta, Bottiglione Francesco, Mantriota Giacomo

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The efficiency of the actuation system of lower limb exoskeletons and of active orthoses is a significant aspect of the design of such devices because it affects their efficacy. F-IVT is an innovative actuation system to power artificial knee joint with energy recovery capabilities. Its key and non-conventional elements are a flywheel, that acts as a mechanical energy storage system, and an Infinitely Variable Transmission (IVT). The design of the F-IVT can be optimized for a certain walking condition, resulting in a heavy reduction of both the electric energy consumption and of the electric peak power. In this work, by means of simulations of level ground walking at different speeds, it is demonstrated how F-IVT is still an advantageous actuator, even when it does not work in nominal conditions.

Keywords: active orthoses, actuators, lower extremity exoskeletons, knee joint

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Authors: Johnson C. Y. Pang, Bo Pengb, Kara K. L. Reevesc, Allan C. L. Fud

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Objective: Dry needling (DN) has long been used as a treatment method for various musculoskeletal pain conditions. However, the evidence level of the studies was low due to the limitations of the methodology. Lack of randomization and inappropriate blinding are potentially the main sources of bias. A method that can differentiate clinical results due to the targeted experimental procedure from its placebo effect is needed to enhance the validity of the trial. Therefore, this study aimed to validate the method as a placebo ultrasound(US)-guided DN for patients with knee osteoarthritis (KOA). Design: This is a randomized controlled trial (RCT). Ninety subjects (25 males and 65 females) aged between 51 and 80 (61.26±5.57) with radiological KOA were recruited and randomly assigned into three groups with a computer program. Group 1 (G1) received real US-guided DN, Group 2 (G2) received placebo US-guided DN, and Group 3 (G3) was the control group. Both G1 and G2 subjects received the same procedure of US-guided DN, except the US monitor was turned off in G2, blinding the G2 subjects to the incorporation of faux US guidance. This arrangement created the placebo effect intended to permit comparison of their results to those who received actual US-guided DN. Outcome measures, including the visual analog scale (VAS) and Knee injury and Osteoarthritis Outcome Score (KOOS) subscales of pain, symptoms and quality of life (QOL), were analyzed by repeated-measures analysis of covariance (ANCOVA) for time effects and group effects. The data regarding the perception of receiving real US-guided DN or placebo US-guided DN were analyzed by the chi-squared test. The missing data were analyzed with the intention-to-treat (ITT) approach if more than 5% of the data were missing. Results: The placebo US-guided DN (G2) subjects had the same perceptions as the use of real US guidance in the advancement of DN (p<0.128). G1 had significantly higher pain reduction (VAS and KOOS-pain) than G2 and G3 at 8 weeks (both p<0.05) only. There was no significant difference between G2 and G3 at 8 weeks (both p>0.05). Conclusion: The method with the US monitor turned off during the application of DN is credible for blinding the participants and allowing researchers to incorporate faux US guidance. The validated placebo US-guided DN technique can aid in investigations of the effects of US-guided DN with short-term effects of pain reduction for patients with KOA. Acknowledgment: This work was supported by the Caritas Institute of Higher Education [grant number IDG200101].

Keywords: reliability, jumping, 3D motion analysis, anterior crucial ligament reconstruction

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Authors: Masoumeh Shojaei, Natalie Gedayloo, Amir Sarshin

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The purpose of the present study was to investigate the effect of Isokinetic fatigue of muscles around the ankle, knee, and hip on the indicators of dynamic postural stability. Therefore, 15 female university students (age 19.7± 0.6 years old, weight 54.6± 9.4 kg, and height 163.9± 5.6 cm) participated in within-subjects design for 5 different days. In the first session, the postural stability indices (time to stabilization after jump-landing) without fatigue were assessed by force plate and in each next sessions, one of muscle groups of the lower limb including the muscles around ankles, knees, and hip was randomly exhausted by Biodex Isokinetic dynamometer and the indices were assessed immediately after the fatigue of each muscle group. The method involved landing on a force plate from a dynamic state, and transitioning balance into a static state. Results of ANOVA with repeated measures indicated that there was no significant difference between the time to stabilization (TTS) before and after Isokinetic fatigue of the muscles around the ankle, knee and hip in medial – lateral direction (p > 0.05), but in the anterior – posterior (AP) direction, the difference was statistically significant (p < 0.05). Least Significant Difference (LSD) post hoc test results also showed that there was significant difference between TTS in knee and hip muscles before and after isokinetic fatigue in AP direction. In the other hand knee and hip muscles group were affected by isokinetic fatigue only in AP surface (p < 0.05).

Keywords: dynamic balance, fatigue, lower limb muscles, postural control

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Authors: Shaival Dalal, Nilesh Shah, Dinshaw Pardiwala, David Rajan, Satyen Sanghavi, Charul Bhanji

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Autologous Chondrocyte Implantation (ACI) is used worldwide since 1998 to treat cartilage defect. GEL based ACI is a new tissue-engineering technique to treat full thickness cartilage defect with fibrin and thrombin as scaffold for chondrocytes. Purpose of this study is to see safety and efficacy of gel based ACI for knee cartilage defect in multiple centres with different surgeons. Gel-based Autologous Chondrocyte Implantation (GACI) has shown effectiveness in treating isolated cartilage defect of knee joint. Long term results are still needed to be studied. This study was followed-up up to two years and showed benefit to patients. All enrolled patients with a mean age of 28.5 years had an average defect size of3 square centimeters, and were grade IV as per ICRS grading. All patients were followed up several times and at several intervals at 6th week, 8th week, 11th week, 17th week, 29th week, 57th week after surgery. The outcomes were measured based on the IKDC (subjective and objective) and MOCART scores.

Keywords: knee, chondrocyte, autologous chondrocyte implantation, fibrin gel based

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Authors: Robert E. Kenney, Richard B. Aguilar, Efrain Antunez, Gregory Schor-Haskin, Rafael Rey, Catie Falcon, Luis Arce

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This study sought to explore the effect of Sarapin injections on chronic knee pain (CKP). Many adults suffer from CKP which is most often attributed to osteoarthritis. Current treatment regimens for CKP involve the use NSAIDS medications, injections with steroids/analgesic, platelet rich plasma injections, or orthopedic surgical interventions. Sarapin is a commercially available homeopathic aqueous extract from the pitcher plant. Studies on the use of Sarapin as a treatment for cervical, thoracic, and lumbosacral facet joint nerve blocks have been performed with mixed results. There is little available evidence on the use of Sarapin in CKP. This study examines the effect of a series of 3 weekly injections of aqueous Sarapin in 95 elderly patients with CKP in a primary care setting. Cano Health, a primary care group, identified 95 successive patients with CKP from its multimodal physiotherapy program for chronic pain. Patients underwent evaluation by a clinician, underwent diagnostic Xrays of the knees, and the treatment plan with three weekly Sarapin injections was discussed. A pain and functional limitation survey (a modified Lower Extremity Functional Scale (mLEFS)) was administered prior to initiating treatment (Entry Survey (ES)). Each patient received an intraarticular injection of 2 cc of aqueous Sarapin with 1cc 1% lidocaine during weeks 1, 2 and 3. The mLEFS was administered again at week 4, one week after the third Sarapin injection (Exit Survey (ExS)). Demographics: Mean Age 62 +/- 9.8; 73% female; 89% Hispanic/Latino; mean time between ES and ExS was 27.5 +/-8.2 days. Survey: The mLEFS was based on a published Lower Extremity Functional Scale and each patient rated their pain or functional limitation from 0 (no difficulty) to 5 (severe difficulty) for 10 questions. Answers were summed and compared. Maximum score for severe difficulty would be 50 points. Results: Mean pain/functional scores: ES was 30.3 +/-12.1 and ExS was 19.5 +/- 12.5. This represents a relative improvement of 35.7% (P<0.00001). A total of 81% (77/95) of the patients showed improvement in symptoms at week four as assessed by the mLEFS. There were 11 patients who reported an increase in their survey scores while 7 patients reported no change. When evaluating the cohort that reported improvement, the ES was 30.9 +/-11.4 and ExS was 16.3 +/-9.8 yielding a 47.2% relative improvement (P<0.00001). Injections were well tolerated, and no adverse events were reported. Conclusions: In this cohort of 95 elderly patients with CKP, treatment with 3 weekly injections of Sarapin significantly improved pain and function as assessed by a mLEFS survey. The majority (81%) of patients responded positively to therapy, 12% had worsening symptoms and 7% reported no change. The use of intraarticular injections of Sarapin for CKP was shown to be an effective modality of treatment. Sarapin’s low cost, tolerability, and ease of use make it an attractive alternative to NSAIDS, steroids, PRP or surgical intervention for this common debilitating condition.

Keywords: Sarapin, intraarticular, chronic knee pain, osteoarthritis

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Authors: Gabriel Sitler, Yousef Sardahi, Asad Salem

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This paper presents an optimal and robust sliding mode controller (SMC) to regulate the position of the knee joint angle for patients suffering from knee injuries. The controller imitates the role of active orthoses that produce the joint torques required to overcome gravity and loading forces and regain natural human movements. To this end, a mathematical model of the shank, the lower part of the leg, is derived first and then used for the control system design and computer simulations. The design of the controller is carried out in optimal and multi-objective settings. Four objectives are considered: minimization of the control effort and tracking error; and maximization of the control signal smoothness and closed-loop system’s speed of response. Optimal solutions in terms of the Pareto set and its image, the Pareto front, are obtained. The results show that there are trade-offs among the design objectives and many optimal solutions from which the decision-maker can choose to implement. Also, computer simulations conducted at different points from the Pareto set and assuming knee squat movement demonstrate competing relationships among the design goals. In addition, the proposed control algorithm shows robustness in tracking a standard gait signal when accounting for uncertainty in the shank’s parameters.

Keywords: optimal control, multi-objective optimization, sliding mode control, wearable knee exoskeletons

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Authors: Taraneh Ashrafi Motlagh, Abdolrasoul Daneshjoo

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Background and Aim: Increased fatigue causes injuries; the purpose of this article was to investigate the angular displacement of the hip and knee joints in girls with patellofemoral syndrome. Materials and Methods: Thirty girls with an average age (age 28.73±1.83, height 168.49±5.59, weight 63.73±12.73) participated in this study in two groups of 15, experimental and control. The jet evaluation test was taken from the subjects' knee and thigh angle, and then these tests were repeated with the application of different inclines of the treadmill; the tests were examined in a neutral position and in a positive and negative slope of 5 degrees. The mean and standard deviation were used to describe the data, and the Shapirovik test was used for the normalization of the data to compare and examine the variables in the two research groups using an independent t-test and repeated analysis of variance at a significance level of 0.05. Conclusion: In general, according to the current studies of people with patellofemoral syndrome, running on steep inclines, as well as running on a treadmill and making the incline angle of the treadmill within the limit of minus 5% to plus 5%, does not affect the improvement of this condition, and it is not recommended. And according to the research, girls with patellofemoral syndrome should be placed on the treadmill at an inclined angle to run.

Keywords: patellofemoral syndrome, angular displacement of the knee, angular displacement of the thigh

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Authors: So Youn Park, Yi Sle Lee, Ki Whan Hong, Chi Dae Kim

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The role of metabolism in the pathogenesis of osteoarthritis is an emerging field. Metabolic alterations may be a role in osteoarthritis (OA) pathogenesis, and these changes influence joint destruction via several cytokine. Especially, in OA patients, levels of IL-1β are elevated in the synovial fluid, synovial membrane, subchondral bone, and cartilage. The IL-1β is activated by NLRP3 inflammasomes, and NLRP3 inflammasomes are cytosolic complexes that drive the production of other inflammatory cytokines, including IL-1β. In this study, we examined that SIRT1 suppresses IL-1β through inhibiting NLRP3 inflammasomes and SIRT1 ameliorates osteoarthritis. OA fibroblasts were isolated from synovium of OA patients. IL-1β and NLRP3 were detected in synovium of OA patients by immunohistochemistry. Lipopolysaccharides (LPS) stimulated the expression of active IL-1β mRNA in OA fibroblasts and combination of LPS, and adenosine triphosphate increased more the expression of active IL-1β in OA fibroblasts. The level of IL-1β was measured by western blot and ELISA assay. NLRP3 inflammasomes complex were measured by western blot. SIRT1 did not inhibit expression of NLRP3 inflammasome. So caspase-1, apoptotic speck-like protein containing a caspase recruitment domain (ASC) and NLRP3 protein were expressed in OA fibroblasts. But SIRT1 suppressed activation of IL-1β by inhibiting activity of caspase-1 via NLRP3 inflammasome in OA fibroblasts under LPS plus ATP stimulation. These results suggest that SIRT1 is a modulator of NLRP3 inflammasomes in OA fibroblasts and ameliorate IL-1β, so expression of SIRT1 in OA fibroblast may be a potential strategy for OA inflammation treatment.

Keywords: osteoarthritis, inflammasome, SIRT1, IL-1beta

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Authors: Priya Kulkarni, Soumya Koppikar, Narendrakumar Wagh, Dhanshri Ingle, Onkar Lande, Abhay Harsulkar

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Cartilage is an extracellular matrix composed of aggrecan, which imparts it with a great tensile strength, stiffness and resilience. Disruption in cartilage metabolism leading to progressive degeneration is a characteristic feature of Osteoarthritis (OA). The process involves enzymatic depolymerisation of cartilage specific proteoglycan, releasing free glycosaminoglycan (GAG). This released GAG in synovial fluid (SF) of knee joint serves as a direct measure of cartilage loss, however, limited due to its invasive nature. Western Ontario and McMaster Universities Arthritis Index (WOMAC) is widely used for assessing pain, stiffness and physical-functions in OA patients. The scale is comprised of three subscales namely, pain, stiffness and physical-function, intends to measure patient’s perspective of disease severity as well as efficacy of prescribed treatment. Twenty SF samples obtained from OA patients were analysed for their GAG values in SF using DMMB based assay. LK 1.0 vernacular version was used to attain WOMAC scale. The results were evaluated using SAS University software (Edition 1.0) for statistical significance. All OA patients revealed higher GAG values compared to the control value of 78.4±30.1µg/ml (obtained from our non-OA patients). Average WOMAC calculated was 51.3 while pain, stiffness and function estimated were 9.7, 3.9 and 37.7, respectively. Interestingly, a strong statistical correlation was established between WOMAC function subscale and GAG (p = 0.0102). This subscale is based on day-to-day activities like stair-use, bending, walking, getting in/out of car, rising from bed. However, pain and stiffness subscale did not show correlation with any of the studied markers and endorsed the atypical inflammation in OA pathology. On one side, where knee pain showed poor correlation with GAG, it is often noted that radiography is insensitive to cartilage degenerative changes; thus OA remains undiagnosed for long. Moreover, active cartilage degradation phase remains elusive to both, patient and clinician. Through analysis of large number of OA patients we have established a close association of Kellgren-Lawrence grades and increased cartilage loss. A direct attempt to correlate WOMAC and radiographic progression of OA with various biomarkers has not been attempted so far. We found a good correlation in GAG levels in SF and the function subscale.

Keywords: cartilage, Glycosaminoglycan, synovial fluid, western ontario and McMaster Universities Arthritis Index

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Authors: Abdulkader Helwan

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Rheumatoid joint inflammation is characterized as a perpetual incendiary issue which influences the joints by hurting body tissues Therefore, there is an urgent need for an effective intelligent identification system of knee Rheumatoid arthritis especially in its early stages. This paper is to develop a new intelligent system for the identification of Rheumatoid arthritis of the knee utilizing image processing techniques and neural classifier. The system involves two principle stages. The first one is the image processing stage in which the images are processed using some techniques such as RGB to gryascale conversion, rescaling, median filtering, background extracting, images subtracting, segmentation using canny edge detection, and features extraction using pattern averaging. The extracted features are used then as inputs for the neural network which classifies the X-ray knee images as normal or abnormal (arthritic) based on a backpropagation learning algorithm which involves training of the network on 400 X-ray normal and abnormal knee images. The system was tested on 400 x-ray images and the network shows good performance during that phase, resulting in a good identification rate 97%.

Keywords: rheumatoid arthritis, intelligent identification, neural classifier, segmentation, backpropoagation

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Authors: Carl Ashworth, Matthys Campher

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Spinal anaesthesia has been identified as the “gold standard” for primary elective total hip and knee arthroplasty, which is most commonly performed using longer-acting local anaesthetics, such as hyperbaric bupivacaine, to prolong the duration of anaesthesia and analgesia suitable for these procedures. Ketamine is known to have local anaesthetic effects with potent analgesic properties and has been evaluated as a sole anaesthetic agent via intrathecal administration; however, the use of intrathecal ketamine as an adjunct to intrathecal hyperbaric bupivacaine, morphine, and fentanyl has not been extensively studied. The objective of this study was to identify the potential analgesic effects of the addition of intrathecal ketamine to spinal anaesthesia and to compare the efficacy and safety of adding intrathecal ketamine to spinal anaesthesia for hip- or knee arthroplasty with spinal anaesthesia for hip- or knee arthroplasty without intrathecal ketamine. The medical records of patients who underwent elective hip- or knee arthroplasty under spinal anaesthesia performed by an individual anaesthetist with either intrathecal hyperbaric bupivacaine, morphine and fentanyl or intrathecal hyperbaric bupivacaine, morphine, fentanyl and ketamine between June 4, 2020, and June 4, 2022, were retrospectively reviewed. These encounters were reviewed and analyzed from a perioperative pain perspective, with the primary outcome measure as the oral morphine equivalent (OME) usage in the 48 hours post-spinal anaesthesia, and secondary outcome measures including time to breakthrough analgesia, self-reported pain scores at rest and during movement at 24 and 48 hours after surgery, adverse effects of analgesia, complications, and length of stay. There were 26 patients identified who underwent TKR between June 4, 2020, and June 4, 2022, and 25 patients who underwent THR with the same conditions. It was identified that patients who underwent traditional spinal anaesthesia with the addition of ketamine for elective hip- or knee arthroplasty had a lower mean total OME in the 48 hours immediately post-spinal anaesthesia yet had a shorter time to breakthrough analgesia administration. The proposed mechanism of action for intrathecal ketamine as an additive to traditional spinal anaesthesia for elective hip- or knee arthroplasty is that it may prolong and attenuate the analgesic effect of traditional spinal anaesthesia. There were no significant differences identified in comparing the efficacy and safety of adding intrathecal ketamine to spinal anaesthesia for hip- or knee arthroplasty with spinal anaesthesia for hip- or knee arthroplasty without intrathecal ketamine.

Keywords: anaesthesia, spinal, intra-thecal, ketamine, spinal-morphine, bupivacaine

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Authors: Muhammad Yasir Tarar

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Background: Intraarticular steroid injections are an effective option in alleviating the symptoms of conditions like osteoarthritis, rheumatoid arthritis, crystal arthropathy, and rotator cuff tendinopathy. Most of these injections are conducted in the elderly who are on polypharmacy, including anticoagulants at times. Up to 6% of patients aged 80-84 years have been reported to be taking Warfarin. The literature availability on safety quotient for patients undergoing intraarticular injections on Warfarin is scarce. It has remained debatable over the years which approach is safe for these patients. Continuing warfarin has a theoretical bleeding risk, and stopping it can lead to even severe life-threatening thromboembolic events in high-risk patients. Objectives: To evaluate the risk of bleeding complications in patients on warfarin undergoing intraarticular injections or arthrocentesis. Study Design & Methods: A literature search of MEDLINE (1946 to present), EMBASE (1974 to present), and Cochrane CENTRAL (1988 to present) databases were conducted using any combination of the keywords, Injection, Knee, Shoulder, Joint, Intraarticular, arthrocentesis, Warfarin, and Anticoagulation in November 2020 for articles published in any language with no publication year limit. The study inclusion criteria included reporting on the rate of bleeding complications following injection of the knee or shoulder in patients on warfarin treatment. Randomized control trials and prospective and retrospective study designs were included. An electronic standardized Performa for data extraction was made. The Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) the methodology was used. The articles were appraised using the methodological index for nonrandomized studies. The Cochrane Risk of Bias Tool used to assess the risk of bias in included RCTs and the MINORS tool for assessment of bias in observational studies. Results: The search of databases resulted in a total of 852 articles. Relevant articles as per the inclusion criteria were shortlisted, 7 articles deemed suitable to be include. A total of 1033 joints sample size was undertaken with specified knee and shoulder joints of a total of 820. Only 6 joints had bleeding complications, 5 early bleeding at the time of injection or aspiration, and one late bleeding complication with INR of 5, additionally, 2 patients complained of bruising, 3 of pain, and 1 managed for infection. Conclusions: The results of the metanalysis show that it is relatively safe to perform intraarticular injections in patients on Warfarin regardless of the INR range.

Keywords: arthrocentesis, warfarin, bleeding, injection

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Authors: Mohammad Nasb, Muhammad Rehan, Chen Hong

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Background Meniscus defects critically alter knee function and lead to degenerative changes. Regenerative medicine applications including stem cell transplantation have showed a promising efficacy in finding alternatives to overcome traditional treatment limitations. However, stem cell therapy remains limited due to the substantially reduced viability and inhibitory microenvironment. Since tissue growth and repair are under the control of biochemical and mechanical signals, several approaches have recently been investigated (e.g., low intensity pulsed ultrasound [LIPUS]) to promote the regeneration process. This study employed LIPUS to improve growth and osteogenic differentiation of mesenchymal stem cells derived from human embryonic stem cells to improve the regeneration of meniscus tissue. Methodology: The Mesenchymal stromal cells (MSCs) were transplanted into the epicenter of the injured meniscus in rabbits, which were randomized into two main groups: a treatment group (n=32 New Zealand rabbits) including 4 subgroups of 8 rabbits in each subgroup (LIPUS treatment, MSC treatment, LIPUS with MSC and control), and a second group (n=9) to track implanted cells and their progeny using green fluorescence protein (GFP). GFP consists of the MSC and LIPUS-MSC combination subgroups. Rabbits were then subjected to histological, immunohistochemistry, and MRI assessment. Results: The quantity of the newly regenerated tissue in the combination treatment group that had Ultrasound irradiation after mesenchymal stem cells were better at all end points. Likewise, Tissue quality scores were also greater in knees treated with both approaches compared with controls and single treatment at all end points, achieving significance at twelve and twenty-four weeks [p < 0.05], and [p = 0.008] at twelve weeks. Differentiation into type-I and II collagen-expressing cells were higher in the combination group at up to twenty-four weeks. Conclusions: the combination of mesenchymal stem cells and LIPUS showed greater adhering to the sites of meniscus injury, differentiate into cells resembling meniscal fibrochondrocytes, and improve both quality and quantity of meniscal regeneration.

Keywords: stem cells, regenerative medicine, osteoarthritis, knee

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Authors: Boonyalitpun P., Pruckpattranon P., Thonghom A., Rotpenpian N.

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Osteoarthritis is a musculoskeletal and neuromuscular abnormality, masticatory muscle, and other tissue that causes pain and breaks down the articular surface of the temporomandibular joint (TMJ). The aim of this study is to investigate the change in the mandibular condyle, in terms of thickness and porosity, and osteoclast marker in the mandibular condyle of TMJ induced osteoarthritis mice (TMJ-OA mice). We investigated the bony changes in the TMJ structure of a complete Freund adjuvant (CFA)-injected TMJ in a mice model over 28 days. On day 28, we observed any change in the TMJ by a micro computed tomography scan (micro-CT scan) in the parameters of trabecular microarchitecture. Then we studied the thickness of the condyles by hematoxylin and eosin staining. Moreover, we calculated the area around the TMJ’s condylar head containing the osteoclast expression by TRAP (Tartrate-resistant acid phosphatase) immunohistochemistry staining. The result found that the parameter of a micro-CT scan was no different from microarchitecture in the TMJ compared with the control group; however, mandibular condyles of the TMJ-OA group was significantly thinner than the control groups, and the osteoclast expression significantly increased in the TMJ-OA group. Therefore, our findings suggest that CFA-induced TMJ-OA represents an expression of osteoclast mandibular condyle of the TMJ, which is the proposed mechanism for a TMJ-OA model.

Keywords: condyle, osteoarthritis, osteoclast, temporomandibular joint

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Authors: Rohith J. K., Amir Nazemi, Abbas S. Milani

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In Paralympic sports, athletes often depend on some form of equipment to enable competitive sporting, where most of this equipment would only allow passive physiological supports and discrete physiological measurements. Active feedback physiological support and continuous detection of performance indicators, without time or space constraints, would be beneficial in more effective training and performance measures of Paralympic athletes. Moreover, occasionally the athletes suffer from fatigue and muscular stains due to improper monitoring systems. The latter challenges can be overcome by using Smart Composites technology when manufacturing, e.g., knee brace and other sports wearables utilities, where the sensors can be fused together into the fabric and an assisted system actively support the athlete. This paper shows how different sensing functionality may be created by intrinsic and extrinsic modifications onto different types of composite fabrics, depending on the level of integration and the employed functional elements. Results demonstrate that fabric sensors can be well-tailored to measure muscular strain and be used in the fabrication of a smart knee brace as a sample potential application. Materials, connectors, fabric circuits, interconnects, encapsulation and fabrication methods associated with such smart fabric technologies prove to be customizable and versatile.

Keywords: smart composites, sensors, smart fabrics, knee brace

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Authors: Chirawat Wattanapanich, Hong Wei

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This study presents new gait representations for improving gait recognition accuracy on cross gait appearances, such as normal walking, wearing a coat and carrying a bag. Based on the Gait Energy Image (GEI), two ideas are implemented to generate new gait representations. One is to append lower knee regions to the original GEI, and the other is to apply convolutional operations to the GEI and its variants. A set of new gait representations are created and used for training multi-class Support Vector Machines (SVMs). Tests are conducted on the CASIA dataset B. Various combinations of the gait representations with different convolutional kernel size and different numbers of kernels used in the convolutional processes are examined. Both the entire images as features and reduced dimensional features by Principal Component Analysis (PCA) are tested in gait recognition. Interestingly, both new techniques, appending the lower knee regions to the original GEI and convolutional GEI, can significantly contribute to the performance improvement in the gait recognition. The experimental results have shown that the average recognition rate can be improved from 75.65% to 87.50%.

Keywords: convolutional image, lower knee, gait

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Authors: Rajendra Kanojia

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Femoral components with inbuilt rotation require thicker flexion resection of the lateral femoral condyle and could potential risk to damage the popliteus tendon especially in the smaller Asian knees. We prospectively evaluated 10 patients with bilateral varus osteoarthritis knee to size the cuts and their location in relation to the popliteus tendon. Two different types of implant were used on either side, one side requires resection in 3° external rotation (group A) and other side femoral component with inbuilt external roation (group B). We had popliteus tendon injury in 3 knees all from group B. Risk of damaging the popliteus tendon was found higher in group B.

Keywords: popliteaus tendon injury, TKA, orthopaedic surgery, biomechanics and clinical applications

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Authors: Mohamadreza Hatefi, Malihe Hadadnezhad

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It is well established that jump-landing-related biomechanical deficiencies, such as dynamic knee valgus (DKV), can be improved by using various forms of feedback; However, the effectiveness of these interventions synchronously on athletes' jumping performance remains unknown. Twenty-one recreational athletes with DKV performed countermovement jump (CMJ) and drop vertical jump (DVJ) tasks before and after feedback intervention while the kinematic, force plate and electromyography data of the lower extremity were synchronously captured. The athletes’ jumping performance was calculated by using the reactive strength index-modified (RSIₘₒ𝒹). The athletes at the post-intervention exhibited significantly less hip adduction and more tibial internal rotation during both CMJ and DVJ tasks and maximum knee flexion just during DVJ task. Moreover, athletes exhibited increased time to take-off and consequently decreased RSIₘₒ𝒹 during DVJ task, but no difference was observed in CMJ task. Feedback immediately improved DKV without disturbing the athletes’ jumping height during both tasks, But athletes exhibited increased time to take-off and consequently decreased RSIₘₒ𝒹 only during DVJ task, which suggests that the results may differ according to the nature of jumping task. Nevertheless, the effectiveness of landing-related biomechanical deficiencies improvement on athletes' jumping performance must be investigated in the long-term as a new movement pattern.

Keywords: reactive strength index, feedback, biomechanics, dynamic knee valgus

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Authors: A. Drapeaux, S. Aviles, E. Garfoot

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Stem cell injections are a promising alternative treatment for hip osteoarthritis. Current literature has focused on short-term outcomes for both knee and hip osteoarthritis; however, there is a significant gap for longitudinal benefits for hip OA and limited firm conclusions due to small sample sizes. The purpose of this prospective study was to determine longitudinal changes in pain, function, and radiographs following bone marrow concentrate injection (BMAC) into the osteoarthritic hip joint. Methods: A prospective, cross-sectional study was conducted over the course of 12 months at an orthopedic practice. The study recruited 15 osteoarthritic pre-surgical hips with mild to moderate osteoarthritic severity who were scheduled to undergo hip arthroscopy. Data was collected at both pre-operative and post-operative time frames. Data collected included: hip radiographs, i-HOT-33 questionnaire data, BMAC autologous volume, and demographics. Questionnaire data was captured using Qualtrics XM software, and participants were sent an anonymous link at the following time frames: pre-operative, 2 weeks, 6 weeks, 12 weeks, 6 months, 12 months, and 24 months. Radiographic changes and BMAC volume were collected and reviewed by an orthopedic surgeon and sent to the primary investigator. Data was exported and analyzed in IBM-SPSS. Results: A total of 15 hips from 15 participants (mean age: 49, gender: 50% males, 50% females, BMI: 29.7) were used in the final analysis. Summative i-HOT 33 mean scores significantly changed between pre-operative status and 2-6 weeks post-operative status (p <.001) and pre-operative status and 3-6 months post-operative status (p <.001). There were no significant changes between other post-operative phases or between pre-operative status and 12 months post-operative. Significant improvements were found between summative i-HOT 33 mean (p<.001), daily pain (p<.001), daily sitting (p=.02), daily distance walked (p =.003), and daily limp (p=0.03) and post-operative status (2-6 weeks). No significant differences between demographic variables (gender, age, tobacco use, or diabetes) and i-HOT 33 summative mean scores. Discussion/Implications: The purpose of this study was to determine longitudinal changes in pain and function following a hip joint bone marrow concentrate injection. Results indicate that participants experience a significant improvement in pain and function between pre-operative and 2-6 weeks and 3-6 months post-injection. Participants also self-reported a significant change in average daily pain with sitting and walking between pre-operation and 2-6 weeks post-operative. This study includes a larger sample size of hip osteoarthritis cases; however, future research is warranted to include random controlled trials with a larger sample size.

Keywords: adult stem cell, orthopedics, osteoarthritis (hip), patient outcome assessment

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Authors: Fedili Benamar, Beloulou Mohamed Lamine, Ouahes Hassane, Ghattas Samir

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 Background and aims: Peripheral regional anesthesia has been integrated into most analgesia protocols for total knee arthroplasty which considered among the most painful surgeries with a huge potential for chronicization. The adductor canal block (ACB) has gained popularity. Similarly, the IPACK block has been described to provide analgesia of the posterior knee capsule. This study aimed to evaluate the analgesic efficacy of this block in patients undergoing primary PTG. Methods: 90 patients were randomized to receive either an IPACK, an anterior sciatic block, or a sham block (30 patients in each group + multimodal analgesia and a catheter in the KCA adductor canal). GROUP 1 KCA GROUP 2 KCA+BSA GROUP 3 KCA+IPACK The analgesic blocks were done under echo-guidance preoperatively respecting the safety rules, the dose administered was 20 cc of ropivacaine 0.25% was used. We were to assess posterior knee pain 6 hours after surgery. Other endpoints included quality of recovery after surgery, pain scores, opioid requirements (PCA morphine)(EPI info 7.2 analysis). Results: -groups were matched -A predominance of women (4F/1H). -average age: 68 +/-7 years -the average BMI =31.75 kg/m2 +/- 4. -70% of patients ASA2 ,20% ASA3. -The average duration of the intervention: 89 +/- 19 minutes. -Morphine consumption (PCA) significantly higher in group 1 (16mg) & group 2 (8mg) group 3 (4mg) - The groups were matched . -There was a correlation between the use of the ipack block and postoperative pain Conclusions :In a multimodal analgesic protocol, the addition of IPACK block decreased pain scores and morphine consumption ,

Keywords: regional anesthesia, analgesia, total knee arthroplasty, the adductor canal block (acb), the ipack block, pain

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Authors: B. S. Abdelwahed, B. B. Belkassem

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Beam-column joints are a critical part in reinforced concrete RC frames designed for inelastic response to several external loads. Investigating the behaviour of the exterior RC beam-column joints has attracted many researchers in the past decades due to its critical influence on the overall behaviour of RC moment-resisting frames subjected to lateral loads. One of the most critical zones in moment-resistant frames is the knee joints because of restraints associated with providing limited anchorage length to the beam and column longitudinal reinforcement in it and consequentially causes a lot of damage in such building frames. Previous numerical simulations focussed mainly on the exterior and interior joints, for knee joint further work is still needed to investigate its behaviour and discuss its affecting parameters. Structural response for an RC knee beam-column joint is performed in this study using LS-DYNA. Three-dimensional finite element (FE) models of an RC knee beam-column joint are described and verified with experimental results available in literature; this is followed by a parametric study to investigate the influence of the concrete compressive strength, the presence of lateral beams and increasing beam reinforcement ratio. It is shown that the concrete compressive strength has a significant effect on shear capacity, load-deflection characteristics and failure modes of an RC knee beam-column joints but to a certain limit, the presence of lateral beams increased the joint confinement and reduced the rate of concrete degradation in the joint after reaching ultimate joint capacity, added to that an increase in the maximum load resistance. Increasing beam reinforcement ratio is found to improve the flexural resistance of the anchored beam bars and increase the joint maximum load resistance.

Keywords: beam reinforcement ratio, joint confinement, numerical simulation, reinforced concrete beam-column joints, structural performance

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