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Zulian F, Pierobon B, Zannin ME, Politi C, Vittadello F, Meneghel A, Tirelli F, Martini G. Monoarticular juvenile idiopathic arthritis as a distinct clinical entity A proof-of-concept study. Pediatr Rheumatol Online J 2023; 21:81. [PMID: 37563674 PMCID: PMC10416450 DOI: 10.1186/s12969-023-00869-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Currently, monoarticular Juvenile Idiopathic Arthritis (monoJIA) is included in the ILAR classification as oligoarticular subtype although various aspects, from clinical practice, suggest it as a separate entity. OBJECTIVES To describe the clinical characteristics of persistent monoJIA. METHODS Patients with oligoJIA and with at least two years follow-up entered the study. Those with monoarticular onset and persistent monoarticular course were compared with those with oligoJIA. Variables considered were: sex, age at onset, presence of benign joint hypermobility (BJH), ANA, uveitis, therapy and outcome. Patients who had not undergone clinical follow-up for more than 12 months were contacted by structured telephone interview. RESULTS Of 347 patients with oligoJIA, 196 with monoarticular onset entered the study and 118 (60.2%), identified as persistent monoJIA, were compared with 229 oligoJIA. The mean follow-up was 11.4 years. The switch from monoarticular onset to oligoarticular course of 78 patients (38.8%) occurred by the first three years from onset. In comparison with oligoJIA, the most significant features of monoJIA were later age at onset (6.1 vs. 4.7 years), lower female prevalence (70.3 vs. 83.4%), higher frequency of BJH (61.9 vs. 46.3%), lower frequency of uveitis (14.4 vs. 34.1%) and ANA+ (68.6 vs. 89.5%) and better long-term outcome. CONCLUSIONS MonoJIA, defined as persistent arthritis of unknown origin of a single joint for at least three years, seems to be a separate clinical entity from oligoJIA. This evidence may be taken into consideration for its possible inclusion into the new classification criteria for JIA and open new therapeutic perspectives.
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Affiliation(s)
- Francesco Zulian
- Department of Woman and Child Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy.
| | - Beatrice Pierobon
- Department of Woman and Child Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy
| | - Maria Elisabetta Zannin
- Department of Woman and Child Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy
| | - Caterina Politi
- Legal Medicine, Caterina Politi, University of Padova, Padua, MD, Italy
| | | | - Alessandra Meneghel
- Department of Woman and Child Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy
| | - Francesca Tirelli
- Department of Woman and Child Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy
| | - Giorgia Martini
- Department of Woman and Child Health, University of Padova, Via Giustiniani 3, Padova, 35128, Italy
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Tofts LJ, Simmonds J, Schwartz SB, Richheimer RM, O'Connor C, Elias E, Engelbert R, Cleary K, Tinkle BT, Kline AD, Hakim AJ, van Rossum MAJ, Pacey V. Pediatric joint hypermobility: a diagnostic framework and narrative review. Orphanet J Rare Dis 2023; 18:104. [PMID: 37143135 PMCID: PMC10157984 DOI: 10.1186/s13023-023-02717-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/30/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD) are debilitating conditions. Diagnosis is currently clinical in the absence of biomarkers, and criteria developed for adults are difficult to use in children and biologically immature adolescents. Generalized joint hypermobility (GJH) is a prerequisite for hEDS and generalized HSD. Current literature identifies a large proportion of children as hypermobile using a Beighton score ≥ 4 or 5/9, the cut off for GJH in adults. Other phenotypic features from the 2017 hEDS criteria can arise over time. Finally, many comorbidities described in hEDS/HSD are also seen in the general pediatric and adolescent population. Therefore, pediatric specific criteria are needed. The Paediatric Working Group of the International Consortium on EDS and HSD has developed a pediatric diagnostic framework presented here. The work was informed by a review of the published evidence. OBSERVATIONS The framework has 4 components, GJH, skin and tissue abnormalities, musculoskeletal complications, and core comorbidities. A Beighton score of ≥ 6/9 best identifies children with GJH at 2 standard deviations above average, based on published general population data. Skin and soft tissue changes include soft skin, stretchy skin, atrophic scars, stretch marks, piezogenic papules, and recurrent hernias. Two symptomatic groups were agreed: musculoskeletal and systemic. Emerging comorbid relationships are discussed. The framework generates 8 subgroups, 4 pediatric GJH, and 4 pediatric generalized hypermobility spectrum disorders. hEDS is reserved for biologically mature adolescents who meet the 2017 criteria, which also covers even rarer types of Ehlers-Danlos syndrome at any age. CONCLUSIONS This framework allows hypermobile children to be categorized into a group describing their phenotypic and symptomatic presentation. It clarifies the recommendation that comorbidities should be defined using their current internationally accepted frameworks. This provides a foundation for improving clinical care and research quality in this population.
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Affiliation(s)
| | - Jane Simmonds
- Great Ormond Street Institute of Child Health, University College London, London, UK
- London Hypermobility Unit, Central Health Physiotherapy, London, UK
| | - Sarah B Schwartz
- Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Roberto M Richheimer
- Centro Médico ABC, Carlos Graef Fernández 154-1A, Col. Tlaxala, Alc. Cuajimalpa de Morelos, 05300, Mexico City, CDMX, Mexico
| | - Constance O'Connor
- Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada
| | - Ellen Elias
- University of Colorado School of Medicine, Denver, USA
- Ehlers-Danlos Center for Excellence and Special Care Clinic, Children's Hospital Colorado Special Care Clinic, Aurora, CO, USA
| | - Raoul Engelbert
- Department of Rehabilitation Medicine, Amsterdam University Medical Center (AMC), Meiberg Dreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Katie Cleary
- Ocean Kids Physio, Unit 1/2-8 Peninsula Blvd, Seaford, VIC, 3198, Australia
| | - Brad T Tinkle
- Peyton Manning Children's Hospital, 8402 Harcourt Rd, Ste 300, Indianapolis, IN, 46260, USA
| | - Antonie D Kline
- Greater Baltimore Medical Center, Harvey Institute for Human Genetics, 6701 N. Charles St., Suite 2326, Baltimore, MD, 21204, USA
| | - Alan J Hakim
- The Harley Street Clinic, HCA Healthcare, 16 Devonshire Street, London, UK.
| | | | - Verity Pacey
- Macquarie University, 75 Talavera Rd, Sydney, NSW, 2109, Australia
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Küpper JC, Zandiyeh P, Ronsky JL. Empirical joint contact mechanics: A comprehensive review. Proc Inst Mech Eng H 2023; 237:147-162. [PMID: 36468563 DOI: 10.1177/09544119221137397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Empirical joint contact mechanics measurement (EJCM; e.g. contact area or force, surface velocities) enables critical investigations of the relationship between changing joint mechanics and the impact on surface-to-surface interactions. In orthopedic biomechanics, understanding the changes to cartilage contact mechanics following joint pathology or aging is critical due to its suggested role in the increased risk of osteoarthritis (OA), which might be due to changed kinematics and kinetics that alter the contact patterns within a joint. This article reviews and discusses EJCM approaches that have been applied to articulating joints such that readers across different disciplines will be informed of the various measurement and analysis techniques used in this field. The approaches reviewed include classical measurement approaches (radiographic and sectioning, dye staining, casting, surface proximity, and pressure measurement), stereophotogrammetry/motion analysis, computed tomography (CT), magnetic resonance imaging (MRI), and high-speed videoradiography. Perspectives on approaches to advance this field of EJCM are provided, including the value of considering relative velocity in joints, tractional stress, quantification of joint contact area shape, consideration of normalization techniques, net response (superposition) of multiple input variables, and establishing linkages to regional cartilage health status. EJCM measures continue to provide insights to advance our understanding of cartilage health and degeneration and provide avenues to assess the efficacy and guide future directions of developing interventions (e.g. surgical, biological, rehabilitative) to optimize joint's health and function long term.
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Affiliation(s)
- Jessica C Küpper
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, AB, Canada.,McCaig Institute for Bone and Joint Health, Calgary, AB, Canada
| | - Payam Zandiyeh
- Department of Orthopaedic Surgery, University of Texas Health Sciences Center, Houston, TX, USA
| | - Janet L Ronsky
- McCaig Institute for Bone and Joint Health, Calgary, AB, Canada.,Departments of Mechanical and Manufacturing Engineering and Biomedical Engineering, University of Calgary, Calgary, AB, Canada
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Takahata K, Arakawa K, Enomoto S, Usami Y, Nogi K, Saitou R, Ozone K, Takahashi H, Yoneno M, Kokubun T. Joint instability causes catabolic enzyme production in chondrocytes prior to synovial cells in novel non-invasive ACL ruptured mouse model. Osteoarthritis Cartilage 2022; 31:576-587. [PMID: 36528308 DOI: 10.1016/j.joca.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/07/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The Anterior Cruciate Ligament (ACL)-deficient model helps to clarify the mechanism of knee osteoarthritis (OA); however, the conventional ACL injury model could have included concurrent onset factors such as direct compression stress to cartilage and subchondral bone. In this study, we established a novel Non-invasive ACL-Ruptured mouse model without concurrent injuries and elucidated the relationship between OA progression and joint instability. DESIGN We induced the ACL-Rupture non-invasively in twelve-week-old C57BL/6 male mice and evaluated histological, macroscopical, and morphological analysis at 0 days. Next, we created the ACL-R, controlled abnormal tibial translation (CATT), and Sham groups. Then, the joint stability and OA pathophysiology were analyzed at 2, 4, and 8 weeks. RESULTS No intra-articular injuries, except for ACL rupture, were observed in the ACL-R model. ACL-R mice increased anterior tibial displacement compared to the Sham group (P < 0.001, 95% CI [-1.509 to -0.966]) and CATT group (P < 0.001, 95% CI [-0.841 to -0.298]) at 8 weeks. All mice in the ACL-R group caused cartilage degeneration. The degree of cartilage degeneration in the ACL-R group was higher than in the CATT group (P = 0.006) at 8 weeks. The MMP-3-positive cell rate of chondrocytes increased in the ACL-R group than CATT group from 4 weeks (P = 0.043; 95% CI [-28.32 to -0.364]) while that of synovial cells increased at 8 weeks (P = 0.031; 95% CI [-23.398 to -1.021]). CONCLUSION We successfully established a Non-invasive ACL-R model without intra-articular damage. Our model revealed that chondrocytes might react to abnormal mechanical stress prior to synovial cells while the knee OA onset.
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Affiliation(s)
- K Takahata
- Graduate School of Health, Medicine, and Welfare, Saitama Prefectural University, Saitama, Japan; Japan Society for the Promotion of Science, Tokyo, Japan.
| | - K Arakawa
- Graduate School of Health, Medicine, and Welfare, Saitama Prefectural University, Saitama, Japan.
| | - S Enomoto
- Graduate School of Health, Medicine, and Welfare, Saitama Prefectural University, Saitama, Japan.
| | - Y Usami
- Graduate School of Health, Medicine, and Welfare, Saitama Prefectural University, Saitama, Japan.
| | - K Nogi
- Graduate School of Health, Medicine, and Welfare, Saitama Prefectural University, Saitama, Japan.
| | - R Saitou
- Graduate School of Health, Medicine, and Welfare, Saitama Prefectural University, Saitama, Japan.
| | - K Ozone
- University of Tsukuba Hospital, Ibaraki, Japan.
| | - H Takahashi
- Graduate School of Health, Medicine, and Welfare, Saitama Prefectural University, Saitama, Japan.
| | - M Yoneno
- Graduate School of Health, Medicine, and Welfare, Saitama Prefectural University, Saitama, Japan.
| | - T Kokubun
- Graduate School of Health, Medicine, and Welfare, Saitama Prefectural University, Saitama, Japan; Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan.
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Nomogram in Knee Instability: 3D Gait Analysis of Knee Osteoarthritis Patients. Indian J Orthop 2022; 56:1554-1564. [PMID: 36052386 PMCID: PMC9385908 DOI: 10.1007/s43465-022-00644-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 04/12/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Measures of knee stability by symptoms, physical examination, and imaging do not accurately reflect the condition of knee movement. Therefore, this study aimed to introduce a model for assessing knee stability during walking in patients with knee osteoarthritis (OA). AIMS Three dimensional(3D) gait analysis system was used to quantify the gait of patients and display the clinical diagnosis model of knee instability with nomogram to guide clinical diagnosis and treatment. METHODS This cross-sectional study performed a 3D gait analysis in 93 participants with knee OA and 40 healthy control subjects. Multiple linear regression analysis investigated the correlation between gait parameters and knee extension/flexion stability. The predicting models were built applied multinomial logistic regression analysis and calibration plot, C-index, decision curve analysis, bootstrapping validation were used to assess the predicting nomograms' clinical usefulness and internal validation. RESULTS Multiple linear regression analysis indicated knee extension stability was correlated with walking speed (β = 0.256, P = 0.006), knee extensor strength (β = -0.196, P = 0.03), static HKA (β = 0.218, P = 0.016), width of the femoral diaphysis (β = -0.282, P = 0.002) and WOMAC score (β = 0.281, P = 0.002); however, knee flexion stability was correlated with walking speed (β = 0.340, P < 0.001), knee flexor strength (β = -0.327, P < 0.001), posterior tibial slope (PTS) (β = 0.291, P < 0.001), knee flexion/extension range of motion (ROM) (β = 0.177, P = 0.018) and HSS score (β = -0.173, P = 0.028). We developed and internally validated a knee instability risk nomogram in patients with knee OA. CONCLUSIONS These results indicated that using the 3D motion analysis system is feasible to quantify knee instability. The current prediction models could serve as a reliable tool to quantify the possibility of knee instability in OA patients. TRIAL REGISTRATION NUMBER TRN ChiCTR2100051302; Date of registration: Sep 18, 2021; retrospectively registered.
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Augmentation of Anterolateral Structures of the Knee Causes Undesirable Tibiofemoral Cartilage Contact in Double-Bundle Anterior Cruciate Ligament Reconstruction-A Randomized In-Vivo Biomechanics Study. Arthroscopy 2022; 38:1224-1236. [PMID: 34509591 DOI: 10.1016/j.arthro.2021.08.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To analyze the in vivo tibiofemoral cartilage contact patterns in knees undergoing double-bundle anterior cruciate ligament reconstruction(DB-ACLR) with or without anterolateral structure augmentation (ALSA). METHODS Twenty patients with an ACL-ruptured knee and a healthy contralateral side were included. Nine patients received an isolated DB-ACLR (DB-ACLR group), and 11 patients had a DB-ACLR with ALSA (DB+ALSA group). At 1-year follow-up, a combined computed tomography, magnetic resonance imaging, and dual fluoroscopy imaging system analysis was used to capture a single-legged lunge of both the operated and healthy contralateral side. Tibiofemoral contact points (CPs) of the medial and lateral compartments were compared. CP locations were expressed as anteroposterior (AP, +/-) and medial-lateral (ML, -/+) values according to the tibia. RESULTS In the DB-ACLR knees, no significant differences were found in CPs when compared with the healthy contralateral knees (P ≥ .31). However, in the DB+ALSA knees, the CPs in the lateral compartment had a significantly more anterior (mean AP: operative, -2.8 mm, 95% confidence interval [CI] -5.0 to-0.7 vs healthy, -5.0 mm, 95% CI -6.7 to -3.2; P = .006) and lateral (mean ML: operative, 23.2 mm, 95% CI 21.9-24.5 vs healthy, 21.8 mm, 95% CI 20.2-23.3; P = .013) location. The CPs in the medial compartment were located significantly more posterior (mean AP: operative, -3.4, 95% CI -5.0 to -1.9 vs healthy, -1.3, 95% CI -2.6 to -0.1; P = .006) and lateral (mean ML: operative, -21.3, 95% CI -22.6 to -20.0 vs healthy, -22.6, 95% CI -24.2 to -21.0; P = .021). CONCLUSIONS DB-ACLR restored the tibiofemoral cartilage contact mechanics to near-normal values at 1-year follow-up. Adding the ALSA to the DB-ACLR resulted in significantly altered tibiofemoral cartilage contact locations in both the medial and lateral compartments. CLINICAL RELEVANCE In DB-ACLR knees, the addition of an ALSA may be unfavorable as it caused significantly changed arthrokinematics.
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Accuracy of the tibiofemoral contact forces estimated by a subject-specific musculoskeletal model with fluoroscopy-based contact point trajectories. J Biomech 2020; 113:110117. [PMID: 33197692 DOI: 10.1016/j.jbiomech.2020.110117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 11/22/2022]
Abstract
Accurate estimation of the tibiofemoral contact forces relies on exact kinematics and joint geometry. Subject-specific kinematic constraints representing contact point trajectories derived from fluoroscopic measurements during lunge are introduced in a musculoskeletal model of the lower limb and compared to generic kinematic constraints. The medial, lateral, and total contact forces during gait and squat are validated using the data of four patients with an instrumented prosthesis. The accuracy of the estimated contact forces (both with subject-specific and generic kinematic constraints) remains close to the level reported in the literature. The mean root mean square errors range from 0.32 to 0.52 body weights for gait and from 0.27 to 0.72 body weights for squat. The impact of the subject-specific contact point trajectories is not found substantial or consistent between patients and tasks. Indeed, the kinematics of the total knee prostheses remains close to the kinematics of a hinge joint and the contact point locations remain generally centred at 20 mm from the tibia centreline (close to the constant value defined in the generic constraints). The contact point trajectories are also suspected to differ between tasks (lunge vs. gait and squat). While the contact point trajectories have been reported to be sensitive model parameters, no clear improvement of the contact force accuracy is demonstrated on patients with instrumented prosthesis. The introduction (as kinematic constraints) of fluoroscopy-based contact point trajectories may be considered in cases where these trajectories are significantly altered, as reported for osteoarthritis patients.
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Tibio-femoral kinematics of the healthy knee joint throughout complete cycles of gait activities. J Biomech 2020; 110:109915. [PMID: 32827791 DOI: 10.1016/j.jbiomech.2020.109915] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/02/2020] [Accepted: 06/25/2020] [Indexed: 12/30/2022]
Abstract
Accurate assessment of 3D tibio-femoral kinematics is essential for understanding knee joint functionality, but also provides a basis for assessing joint pathologies and the efficacy of musculoskeletal interventions. Until now, however, the assessment of functional kinematics in healthy knees has been mostly restricted to the loaded stance phase of gait, and level walking only, but the most critical conditions for the surrounding soft tissues are known to occur during high-flexion activities. This study aimed to determine the ranges of tibio-femoral rotation and condylar translation as well as provide evidence on the location of the centre of rotation during multiple complete cycles of different gait activities. Based on radiographic images captured using moving fluoroscopy in ten healthy subjects during multiple cycles of level walking, downhill walking and stair descent, 3D femoral and tibial poses were reconstructed to provide a comprehensive description of tibio-femoral kinematics. Despite a significant increase in joint flexion, the condylar antero-posterior range of motion remained comparable across all activities, with mean translations of 6.3-8.3 mm and 7.3-9.3 mm for the medial and lateral condyles respectively. Only the swing phase of level walking and stair descent exhibited a significantly greater range of motion for the lateral over the medial compartment. Although intra-subject variability was low, considerable differences in joint kinematics were observed between subjects. The observed subject-specific movement patterns indicate that accurate assessment of individual pre-operative kinematics together with individual implant selection and/or surgical implantation decisions might be necessary before further improvement to joint replacement outcome can be achieved.
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Murata K, Kokubun T, Onitsuka K, Oka Y, Kano T, Morishita Y, Ozone K, Kuwabara N, Nishimoto J, Isho T, Takayanagi K, Kanemura N. Controlling joint instability after anterior cruciate ligament transection inhibits transforming growth factor-beta-mediated osteophyte formation. Osteoarthritis Cartilage 2019; 27:1185-1196. [PMID: 31026650 DOI: 10.1016/j.joca.2019.03.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 02/14/2019] [Accepted: 03/04/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Abnormal joint instability contributes to cartilage damage and osteophyte formation. We investigated whether controlling joint instability inhibited chronic synovial membrane inflammation and delayed osteophyte formation and examined the role of transforming growth factor-beta (TGF-β) signaling in the associated mechanism. DESIGN Rats (n = 94) underwent anterior cruciate ligament (ACL) transection. Anterior tibial instability was either controlled (CAM group) or allowed to continue (SHAM group). At 2, 4, and 8 weeks after surgery, radiologic, histopathologic, immunohistochemical, immunofluorescent, and enzyme-linked immunosorbent assay examinations were performed to evaluate osteophyte formation and TGF-β signaling. RESULTS Joint instability increased cartilage degeneration score and osteophyte formation, and cell hyperplasia and proliferation and synovial thickening were observed in the synovial membrane. Major findings were increased TGF-β expression and Smad2/3 following TGF-β phosphorylation in synovial membarene, articular cartilage, and the posterior tibial growth plate (TGF-β expression using ELISA: 4 weeks; P = 0.009, 95% CI [260.1-1340.0]) (p-Smad2/3 expression density: 4 weeks; P = 0.024, 95% CI [1.67-18.27], 8 weeks; P = 0.034, 95% CI [1.25-25.34]). However, bone morphogenetic protein (BMP)-2 and Smad1/5/8 levels were not difference between the SHAM model and the CAM model. CONCLUSIONS This study showed that the difference between anterior tibial instability caused a change in the expression level of TGF in the posterior tibia and synovial membrane, and the reaction might be consequently involved in osteophyte formation.
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Affiliation(s)
- K Murata
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan.
| | - T Kokubun
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan.
| | - K Onitsuka
- Department of Rehabilitation, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan.
| | - Y Oka
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan.
| | - T Kano
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan.
| | - Y Morishita
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan.
| | - K Ozone
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan.
| | - N Kuwabara
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan.
| | - J Nishimoto
- Department of Health and Social Services, Health and Social Services, Graduate School of Saitama Prefectural University, Saitama, Japan.
| | - T Isho
- Department of Rehabilitation, Fujioka General Hospital, Gunma, Japan.
| | - K Takayanagi
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan.
| | - N Kanemura
- Department of Physical Therapy, School of Health and Social Services, Saitama Prefectural University, Saitama, Japan.
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Schrijvers JC, van den Noort JC, van der Esch M, Dekker J, Harlaar J. Objective parameters to measure (in)stability of the knee joint during gait: A review of literature. Gait Posture 2019; 70:235-253. [PMID: 30909003 DOI: 10.1016/j.gaitpost.2019.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/22/2019] [Accepted: 03/19/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Instability of the knee joint during gait is frequently reported by patients with knee osteoarthritis or an anterior cruciate ligament rupture. The assessment of instability in clinical practice and clinical research studies mainly relies on self-reporting. Alternatively, parameters measured with gait analysis have been explored as suitable objective indicators of dynamic knee (in)stability. RESEARCH QUESTION This literature review aimed to establish an inventory of objective parameters of knee stability during gait. METHODS Five electronic databases (Pubmed, Embase, Cochrane, Cinahl and SPORTDiscuss) were systematically searched, with keywords concerning knee, stability and gait. Eligible studies used an objective parameter(s) to assess knee (in)stability during gait, being stated in the introduction or methods section. Out of 10717 studies, 89 studies were considered eligible. RESULTS Fourteen different patient populations were investigated with kinematic, kinetic and/or electromyography measurements during (challenged) gait. Thirty-three possible objective parameters were identified for knee stability, of which the majority was based on kinematic (14 parameters) or electromyography (12 parameters) measurements. Thirty-nine studies used challenged gait (i.e. external perturbations, downhill walking) to provoke knee joint instability. Limited or conflicting results were reported on the validity of the 33 parameters. SIGNIFICANCE In conclusion, a large number of different candidates for an objective knee stability gait parameter were found in literature, all without compelling evidence. A clear conceptual definition for dynamic knee joint stability is lacking, for which we suggest : "The capacity to respond to a challenge during gait within the natural boundaries of the knee". Furthermore biomechanical gait laboratory protocols should be harmonized, to enable future developments on clinically relevant measure(s) of knee stability during gait.
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Affiliation(s)
- Jim C Schrijvers
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands.
| | - Josien C van den Noort
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Musculoskeletal Imaging Quantification Center (MIQC), Department of Radiology and Nuclear Medicine, Amsterdam Movement Sciences, Meibergdreef 9, Amsterdam, the Netherlands
| | - Martin van der Esch
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, the Netherlands; Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Joost Dekker
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of rehabilitation medicine, Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute, de Boelelaan 1117, Amsterdam, the Netherlands
| | - Jaap Harlaar
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, de Boelelaan 1117, Amsterdam, the Netherlands; Delft University of Technology, Department of Biomechanical Engineering, Delft, the Netherlands
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Abstract
Patient-reported instability is a common complaint amongst those with knee arthritis. Much research has examined the assessment of self-reported instability in the knee; however, no definitive quantitative measure of instability has been developed. This review focuses on the current literature investigating the nature of self-reported instability in the arthritic knee and discusses the possibilities of further investigation.
Cite this article: EFORT Open Rev 2019;4:70-76. DOI: 10.1302/2058-5241.4.170079
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Affiliation(s)
- David T Wallace
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK.,Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, UK
| | - Philip E Riches
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Frédéric Picard
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK.,Department of Orthopaedics, Golden Jubilee National Hospital, Clydebank, UK
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12
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Gray HA, Guan S, Thomeer LT, Schache AG, de Steiger R, Pandy MG. Three-dimensional motion of the knee-joint complex during normal walking revealed by mobile biplane x-ray imaging. J Orthop Res 2019; 37:615-630. [PMID: 30680795 DOI: 10.1002/jor.24226] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 01/08/2019] [Indexed: 02/04/2023]
Abstract
Accurate knowledge of knee kinematics is important for a better understanding of normal joint function and for improving patient outcomes subsequent to joint reconstructive surgery. Limited information is available that accurately describes the relative movements of the bones at the knee in vivo, even for the most common of all activities: walking. We used a mobile X-ray imaging system to measure the three-dimensional motion of the entire knee-joint complex-femur, tibia, and patella-when humans walk over ground at their natural speeds. Data were recorded from 15 healthy individuals (9 males, 6 females; age 30.5 ± 6.2 years). The most pronounced rotational motion of the tibia was flexion-extension followed by internal-external rotation and abduction-adduction (peak-to-peak displacements: 70.7°, 9.2°, and 1.9°, respectively). Maximum anterior translation of the tibia was 6.5 mm and occurred in early swing, coinciding with peak knee flexion and peak internal rotation. The most prominent rotational motion of the patella was flexion-extension (peak-to-peak displacement: 50.5°). The tibia pivoted about the medial compartment of the tibiofemoral joint, conferring greater movements of the contact centers in the lateral compartment than the medial compartment (15.4 and 9.7 mm, respectively). Internal-external rotation, anterior-posterior translation and medial-lateral shift of the tibia as well as flexion-extension and anterior-posterior translation of the patella were each coupled to the knee flexion angle, as were movements of the contact centers at each joint. These fundamental data serve as a valuable resource for evaluating knee joint function in normal and pathological gait. The data are available in Supplementary_Material_Data.xlsx. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Hans A Gray
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Shanyuanye Guan
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Lucas T Thomeer
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Anthony G Schache
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Richard de Steiger
- Department of Surgery, Epworth Health Care, University of Melbourne, Victoria 3010, Australia
| | - Marcus G Pandy
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
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Neelapala YVR. Self-reported Instability in Knee Osteoarthritis: A Scoping Review of Literature. Curr Rheumatol Rev 2018; 15:110-115. [PMID: 29952262 DOI: 10.2174/1573397114666180628111858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/07/2018] [Accepted: 06/22/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND Knee Osteoarthritis (OA) is a disabling musculoskeletal condition among the elderly. Self-reported instability is one of the impairments associated with osteoarthritis. A complete understanding of the self-reported instability in knee OA is essential, to identify the best strategies for overcoming this impairment. The focus of this scoping review is to provide an overview of evidence supported information about the prevalence and other associated features of selfreported instability in Knee OA. A broad search of the database PubMed with keywords such as knee osteoarthritis and instability resulted in 1075 articles. After title abstract and full-text screening, 19 relevant articles are described in the review. Overall, there is less amount of published literature on this topic. Studies reported prevalence rates of more than 60% for self-reported instability in knee osteoarthritis, which causes functional deterioration and high fear of falls. The most probable causative factors for self-reported instability in knee OA were altered sensory mechanisms and decreased muscle strength. CONCLUSION To conclude, self-reported knee instability in knee OA requires thorough evaluation and directed treatment with further studies providing rationalistic evidence-based management strategies. The current literature regarding self-reported knee instability is summarized, highlighting the research gaps.
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Affiliation(s)
- Y V Raghava Neelapala
- Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
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14
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Scarvell JM, Galvin CR, Perriman DM, Lynch JT, van Deursen RW. Kinematics of knees with osteoarthritis show reduced lateral femoral roll-back and maintain an adducted position. A systematic review of research using medical imaging. J Biomech 2018; 75:108-122. [DOI: 10.1016/j.jbiomech.2018.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 10/16/2022]
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15
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Development and validation of a subject-specific moving-axis tibiofemoral joint model using MRI and EOS imaging during a quasi-static lunge. J Biomech 2018; 72:71-80. [DOI: 10.1016/j.jbiomech.2018.02.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/21/2018] [Accepted: 02/23/2018] [Indexed: 11/18/2022]
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16
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Zeighami A, Aissaoui R, Dumas R. Knee medial and lateral contact forces in a musculoskeletal model with subject-specific contact point trajectories. J Biomech 2018; 69:138-145. [PMID: 29397108 DOI: 10.1016/j.jbiomech.2018.01.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 01/08/2018] [Accepted: 01/14/2018] [Indexed: 01/27/2023]
Abstract
Contact point (CP) trajectory is a crucial parameter in estimating medial/lateral tibio-femoral contact forces from the musculoskeletal (MSK) models. The objective of the present study was to develop a method to incorporate the subject-specific CP trajectories into the MSK model. Ten healthy subjects performed 45 s treadmill gait trials. The subject-specific CP trajectories were constructed on the tibia and femur as a function of extension-flexion using low-dose bi-plane X-ray images during a quasi-static squat. At each extension-flexion position, the tibia and femur CPs were superimposed in the three directions on the medial side, and in the anterior-posterior and proximal-distal directions on the lateral side to form the five kinematic constraints of the knee joint. The Lagrange multipliers associated to these constraints directly yielded the medial/lateral contact forces. The results from the personalized CP trajectory model were compared against the linear CP trajectory and sphere-on-plane CP trajectory models which were adapted from the commonly used MSK models. Changing the CP trajectory had a remarkable impact on the knee kinematics and changed the medial and lateral contact forces by 1.03 BW and 0.65 BW respectively, in certain subjects. The direction and magnitude of the medial/lateral contact force were highly variable among the subjects and the medial-lateral shift of the CPs alone could not determine the increase/decrease pattern of the contact forces. The suggested kinematic constraints are adaptable to the CP trajectories derived from a variety of joint models and those experimentally measured from the 3D imaging techniques.
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Affiliation(s)
- A Zeighami
- Laboratoire de Recherche en Imagerie et Orthopédie (LIO), École de Technologie Supérieure (ÉTS), Center de Recherche du CHUM, Montréal, Québec, Canada.
| | - R Aissaoui
- Laboratoire de Recherche en Imagerie et Orthopédie (LIO), École de Technologie Supérieure (ÉTS), Center de Recherche du CHUM, Montréal, Québec, Canada.
| | - R Dumas
- Université Lyon, Université Claude Bernard Lyon 1, IFSTTAR, UMR_T9406, LBMC, F69622 Lyon, France.
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Zheng L, Carey R, Thorhauer E, Tashman S, Harner C, Zhang X. In vivo tibiofemoral skeletal kinematics and cartilage contact arthrokinematics during decline walking after isolated meniscectomy. Med Eng Phys 2017; 51:41-48. [PMID: 29122451 DOI: 10.1016/j.medengphy.2017.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 10/16/2017] [Accepted: 10/29/2017] [Indexed: 10/18/2022]
Abstract
We investigated the effects of isolated meniscectomy on tibiofemoral skeletal kinematics and cartilage contact arthrokinematics in vivo. We recruited nine patients who had undergone isolated medial or lateral meniscectomy, and used a dynamic stereo-radiography (DSX) system to image the patients' knee motion during decline walking. A volumetric model-based tracking process determined 3D tibiofemoral kinematics from the recorded DSX images. Cartilage contact arthrokinematics was derived from the intersection between tibial and femoral cartilage models co-registered to the bones. The kinematics and arthrokinematics were analyzed for early stance and loading response phase (30% of a gait cycle), comparing the affected and intact knees. Results showed that four patients with medial meniscectomy had significantly greater contact centroid excursions in the meniscectomized medial compartments while five patients with lateral meniscectomy had significantly greater cartilage contact area and lateral shift of contact centroid path in the meniscectomized lateral compartments, comparing to those of the same compartments in the contralateral intact knees. No consistent difference however was identified in the skeletal kinematics. The current study demonstrated that cartilage-based intra-articular arthrokinematics is more sensitive and insightful than the skeletal kinematics in assessing the meniscectomy effects.
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Affiliation(s)
- Liying Zheng
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA; Health Effects Lab Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Robert Carey
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric Thorhauer
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Scott Tashman
- Department of Orthopaedic Surgery, University of Texas, Houston, TX, USA
| | - Christopher Harner
- Department of Orthopaedic Surgery, University of Texas, Houston, TX, USA
| | - Xudong Zhang
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA; Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX, USA; Department of Mechanical Engineering, Texas A&M University, College Station, TX, USA.
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van den Noort JC, Sloot LH, Bruijn SM, Harlaar J. How to measure responses of the knee to lateral perturbations during gait? A proof-of-principle for quantification of knee instability. J Biomech 2017; 61:111-122. [DOI: 10.1016/j.jbiomech.2017.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 06/15/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
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Sensitivity of medial and lateral knee contact force predictions to frontal plane alignment and contact locations. J Biomech 2017; 57:125-130. [DOI: 10.1016/j.jbiomech.2017.03.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 03/03/2017] [Accepted: 03/04/2017] [Indexed: 01/01/2023]
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20
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Cecchin V, Sperotto F, Balzarin M, Vittadello F, Martini G, Zulian F. Joint hypermobility and oligoarticular juvenile idiopathic arthritis: What relationship? J Paediatr Child Health 2017; 53:374-377. [PMID: 28052441 DOI: 10.1111/jpc.13450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 08/28/2016] [Accepted: 11/10/2016] [Indexed: 11/30/2022]
Abstract
AIM Oligoarticular onset juvenile idiopathic arthritis (oJIA) is characterised by a prevalent lower limb involvement, antinuclear antibodies (ANA) positivity and high risk of anterior uveitis. As we observed that oJIA patients frequently present with joint hypermobility (JH), we investigated whether there was a relationship between oJIA and JH. METHODS Our series consisted of children with oJIA, as defined by the International League of Associations for Rheumatology criteria, for whom complete clinical data of at least 2 years' duration were available. Clinical and laboratory data, collected at disease onset and at the last follow-up, included: sex, age, presence of JH according to the Beighton score, disease activity, presence of uveitis, ANA, treatment and outcome. RESULTS A total of 274 oligoarticular JIA patients (224 female, 50 male; mean age: 11.5) followed on average for 6.6 years, entered the study. The mean age at disease onset was 4.9 years, ANA were positive in 83.9% and uveitis occurred in 20.8%. JH was present in 70.8% of cases at onset, in 44.5% at the last evaluation. JH was more frequent in females (73.7%) than in males (58.0%) (P = 0.028). Uveitis was less frequent in hypermobile children both at diagnosis (17.5 vs. 28.7%, P = 0.037) and during overall disease course (23.7 vs. 36.3%, P = 0.034). Of 163 subjects with at least 5-year follow-up, the full clinical remission rate was significantly higher in JH patients (50.5%) than in those without JH (42.3%; P = 0.042). CONCLUSION In patients with oligoarticular JIA, JH is more frequent than in healthy subjects, uveitis less frequent and the long-term outcome better.
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Affiliation(s)
- Vanessa Cecchin
- Department of Pediatrics, University of Padua, Padova, Italy
| | | | - Marta Balzarin
- Department of Pediatrics, University of Padua, Padova, Italy
| | | | - Giorgia Martini
- Department of Pediatrics, University of Padua, Padova, Italy
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ÖZADA NERIMAN. THE EFFECT OF COLLATERAL LIGAMENT INJURY ON CARTILAGE CONTACT IN KNEE JOINTS MODELED WITH SIX DEGREES OF FREEDOM. J MECH MED BIOL 2016. [DOI: 10.1142/s0219519416500809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to create a kinematic model of the knee joint with six degrees of freedom (DOF) and evaluate the effect of medial collateral ligament (MCL) and lateral collateral ligament (LCL) rupture on cartilage contact point distribution on the tibia during flexion. We hypothesized that collateral ligament contributions vary over six DOF of knee joint articulation and affect the cartilage contact point distribution during joint articulation. The ligament contributions and distribution of joint cartilage contact points cannot be fully assessed with simplified joint models or invasive experiments. Therefore, we developed a new model in which the tibia and femur centers of mass were determined from their surface geometry, and the displacement of the moving tibia was determined from the displacements of the attached ligaments. Compared to the intact knee, the tibia with the LCL removed had higher medial translation and lower valgus rotation. The tibia with the MCL removed had higher lateral translation and higher valgus rotation than the intact knee. At 0[Formula: see text], 30[Formula: see text], and 60[Formula: see text], the tibia with the LCL removed had more internal rotation than the intact knee. Understanding six DOF knee joint kinematics with integration of ligament contributions and cartilage contact positions is useful for the diagnosis of ligament injuries and the design of articulating surfaces for total arthroplasty.
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Affiliation(s)
- NERIMAN ÖZADA
- Department of Mechanical Engineering, Eastern Mediterranean University, Gazimagusa, North Cyprus, Turkey
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22
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Yazdi H, Mallakzadeh M, Sadat Farshidfar S, Givehchian B, Daneshparvar H, Behensky H. The effect of tibial rotation on knee medial and lateral compartment contact pressure. Knee Surg Sports Traumatol Arthrosc 2016; 24:79-83. [PMID: 25236684 DOI: 10.1007/s00167-014-3321-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 09/10/2014] [Indexed: 01/30/2023]
Abstract
PURPOSE The progression of knee osteoarthritis (OA) is determined in part by mechanical effects on local structures. The mechanical influences of limb malalignment on cartilage loss are well known; however, the effect of rotational deformities on knee OA is not yet known. The aim of the current study was to evaluate the effect of tibial rotation on knee medial and lateral compartment contact pressure. METHODS The left knees of six fresh whole-body cadavers were used in this study. Fujifilm Prescale super-low type film was used for contact pressure measurement. The films were inserted into the joint after arthrotomy. The cadavers were stabilized with a custom-made device, and axial force of half body weight specific to each cadaver was applied to the plantar surface of the feet. The examination was repeated after osteotomy of the fibula and tibia, and the tibia was then rotated 15° or 30° internally (IR) or externally (ER) and securely fixed. The resulting films were scanned, and CP was determined using appropriate software. RESULTS The p values for increased medial compartment contact pressure at 15° and 30° IR and 30° ER were 0.016, 0.025, and 0.025, respectively. For decreased medial compartment contact pressure at 15° ER, the p value was 0.020. The p values for increased lateral compartment contact pressure at 15° and 30° ER were 0.010 and 0.030, respectively. In this compartment, contact pressure changes at 15° and 30° IR were not significant. CONCLUSION This experimental study demonstrated that 15° IR of the tibial shaft increased contact pressure and 15° ER decreased contact pressure over the knee medial compartment.
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Affiliation(s)
- Hamidreza Yazdi
- Department of Knee Surgery, Firoozgar Hospital, School of Medicine, Iran University of Medical Science, Tehran, Iran.
| | - Mohammadreza Mallakzadeh
- Biomechanics Department, School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Sara Sadat Farshidfar
- Biomechanics Department, School of Mechanical Engineering, Iran University of Science and Technology, Tehran, Iran
| | - Behrooz Givehchian
- Shafa Rehabilitation Hospital, School of Medicine, Iran University of Medical Science, Tehran, Iran
| | | | - Hannes Behensky
- Department of Orthopedic Surgery, Medical University Innsbruck, Innsbruck, Austria
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Farrokhi S, Voycheck CA, Gustafson JA, Fitzgerald GK, Tashman S. Knee joint contact mechanics during downhill gait and its relationship with varus/valgus motion and muscle strength in patients with knee osteoarthritis. Knee 2016; 23:49-56. [PMID: 27030846 PMCID: PMC4817272 DOI: 10.1016/j.knee.2015.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this exploratory study was to evaluate tibiofemoral joint contact point excursions and velocities during downhill gait and assess the relationship between tibiofemoral joint contact mechanics with frontal-plane knee joint motion and lower extremity muscle weakness in patients with knee osteoarthritis (OA). METHODS Dynamic stereo X-ray was used to quantify tibiofemoral joint contact mechanics and frontal-plane motion during the loading response phase of downhill gait in 11 patients with knee OA and 11 control volunteers. Quantitative testing of the quadriceps and the hip abductor muscles was also performed. RESULTS Patients with knee OA demonstrated larger medial/lateral joint contact point excursions (p < 0.02) and greater heel-strike joint contact point velocities (p < 0.05) for the medial and lateral compartments compared to the control group. The peak medial/lateral joint contact point velocity of the medial compartment was also greater for patients with knee OA compared to their control counterparts (p = 0.02). Additionally, patients with knee OA demonstrated significantly increased frontal-plane varus motion excursions (p < 0.01) and greater quadriceps and hip abductor muscle weakness (p = 0.03). In general, increased joint contact point excursions and velocities in patients with knee OA were linearly associated with greater frontal-plane varus motion excursions (p < 0.04) but not with quadriceps or hip abductor strength. CONCLUSION Altered contact mechanics in patients with knee OA may be related to compromised frontal-plane joint stability but not with deficits in muscle strength.
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Affiliation(s)
- Shawn Farrokhi
- Assistant Professor & Co-director of the Human Movement Research Laboratory, Department of Physical Therapy, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Carrie A. Voycheck
- Posdoctoral Fellow, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jonathan A. Gustafson
- Doctoral Student, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - G. Kelley Fitzgerald
- Professor & Director of the Physical Therapy Clinical and Translational Research Center, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott Tashman
- Associate Professor & Director of Biodynamics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, PA, USA
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Gustafson JA, Gorman S, Fitzgerald GK, Farrokhi S. Alterations in walking knee joint stiffness in individuals with knee osteoarthritis and self-reported knee instability. Gait Posture 2016; 43:210-5. [PMID: 26481256 PMCID: PMC5572142 DOI: 10.1016/j.gaitpost.2015.09.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Revised: 08/23/2015] [Accepted: 09/23/2015] [Indexed: 02/02/2023]
Abstract
Increased walking knee joint stiffness has been reported in patients with knee osteoarthritis (OA) as a compensatory strategy to improve knee joint stability. However, presence of episodic self-reported knee instability in a large subgroup of patients with knee OA may be a sign of inadequate walking knee joint stiffness. The objective of this work was to evaluate the differences in walking knee joint stiffness in patients with knee OA with and without self-reported instability and examine the relationship between walking knee joint stiffness with quadriceps strength, knee joint laxity, and varus knee malalignment. Overground biomechanical data at a self-selected gait velocity was collected for 35 individuals with knee OA without self-reported instability (stable group) and 17 individuals with knee OA and episodic self-reported instability (unstable group). Knee joint stiffness was calculated during the weight-acceptance phase of gait as the change in the external knee joint moment divided by the change in the knee flexion angle. The unstable group walked with lower knee joint stiffness (p=0.01), mainly due to smaller heel-contact knee flexion angles (p<0.01) and greater knee flexion excursions (p<0.01) compared to their knee stable counterparts. No significant relationships were observed between walking knee joint stiffness and quadriceps strength, knee joint laxity or varus knee malalignment. Reduced walking knee joint stiffness appears to be associated with episodic knee instability and independent of quadriceps muscle weakness, knee joint laxity or varus malalignment. Further investigations of the temporal relationship between self-reported knee joint instability and walking knee joint stiffness are warranted.
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Affiliation(s)
- Jonathan A. Gustafson
- Doctoral Student, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shannon Gorman
- Research Assistant, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - G. Kelley Fitzgerald
- Professor, Department of Physical Therapy, Director, Physical Therapy Clinical and Translational Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawn Farrokhi
- Assistant Professor, Departments of Physical Therapy & Bioengineering, Co-director, Human Movement Research Laboratory, University of Pittsburgh, Pittsburgh, PA, USA
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Alterations in knee contact forces and centers in stance phase of gait: A detailed lower extremity musculoskeletal model. J Biomech 2015; 49:185-92. [PMID: 26708962 DOI: 10.1016/j.jbiomech.2015.12.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/13/2015] [Accepted: 12/03/2015] [Indexed: 11/21/2022]
Abstract
Evaluation of contact forces-centers of the tibiofemoral joint in gait has crucial biomechanical and pathological consequences. It involves however difficulties and limitations in in vitro cadaver and in vivo imaging studies. The goal is to estimate total contact forces (CF) and location of contact centers (CC) on the medial and lateral plateaus using results computed by a validated finite element model simulating the stance phase of gait for normal as well as osteoarthritis, varus-valgus and posterior tibial slope altered subjects. Using foregoing contact results, six methods commonly used in the literature are also applied to estimate and compare locations of CC at 6 periods of stance phase (0%, 5%, 25%, 50%, 75% and 100%). TF joint contact forces are greater on the lateral plateau very early in stance and on the medial plateau thereafter during 25-100% stance periods. Large excursions in the location of CC (>17mm), especially on the medial plateau in the mediolateral direction, are computed. Various reported models estimate quite different CCs with much greater variations (~15mm) in the mediolateral direction on both plateaus. Compared to our accurately computed CCs taken as the gold standard, the centroid of contact area algorithm yielded least differences (except in the mediolateral direction on the medial plateau at ~5mm) whereas the contact point and weighted center of proximity algorithms resulted overall in greatest differences. Large movements in the location of CC should be considered when attempting to estimate TF compartmental contact forces in gait.
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Gustafson JA, Robinson ME, Fitzgerald GK, Tashman S, Farrokhi S. Knee motion variability in patients with knee osteoarthritis: The effect of self-reported instability. Clin Biomech (Bristol, Avon) 2015; 30:475-80. [PMID: 25796536 PMCID: PMC4428966 DOI: 10.1016/j.clinbiomech.2015.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 03/06/2015] [Accepted: 03/06/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Knee osteoarthritis has been previously associated with a stereotypical knee-stiffening gait pattern and reduced knee joint motion variability due to increased antagonist muscle co-contractions and smaller utilized arc of motion during gait. However, episodic self-reported instability may be a sign of excessive motion variability for a large subgroup of patients with knee osteoarthritis. The objective of this work was to evaluate the differences in knee joint motion variability during gait in patients with knee osteoarthritis with and without self-reported instability compared to a control group of older adults with asymptomatic knees. METHODS Forty-three subjects, 8 with knee osteoarthritis but no reports of instability (stable), 11 with knee osteoarthritis and self-reported instability (unstable), and 24 without knee osteoarthritis or instability (control) underwent Dynamic Stereo X-ray analysis during a decline gait task on a treadmill. Knee motion variability was assessed using parametric phase plots during the loading response phase of decline gait. FINDINGS The stable group demonstrated decreased sagittal-plane motion variability compared to the control group (p=0.04), while the unstable group demonstrated increased sagittal-plane motion variability compared to the control (p=0.003) and stable groups (p<0.001). The unstable group also demonstrated increased anterior-posterior joint contact point motion variability for the medial tibiofemoral compartment compared to the control (p=0.03) and stable groups (p=0.03). INTERPRETATION The finding of decreased knee motion variability in patients with knee osteoarthritis without self-reported instability supports previous research. However, presence of self-reported instability is associated with increased knee motion variability in patients with knee osteoarthritis and warrants further investigation.
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Affiliation(s)
- Jonathan A. Gustafson
- Doctoral Student, Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Megan E. Robinson
- Research Assistant, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA
| | - G. Kelley Fitzgerald
- Professor, Department of Physical Therapy, Director, Physical Therapy Clinical and Translational Research Center, University of Pittsburgh, Pittsburgh, PA, USA
| | - Scott Tashman
- Associate Professor Department of Orthopaedic Surgery, Department of Bioengineering, Director, Biodynamics Laboratory, University of Pittsburgh, PA, USA
| | - Shawn Farrokhi
- Assistant Professor, Departments of Physical Therapy & Bioengineering, Co-director, Human Movement Research Laboratory, University of Pittsburgh, Pittsburgh, PA, USA
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Function of the medial meniscus in force transmission and stability. J Biomech 2015; 48:1383-8. [DOI: 10.1016/j.jbiomech.2015.02.055] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 02/28/2015] [Indexed: 11/23/2022]
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Blalock D, Miller A, Tilley M, Wang J. Joint instability and osteoarthritis. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2015; 8:15-23. [PMID: 25741184 PMCID: PMC4337591 DOI: 10.4137/cmamd.s22147] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 01/11/2015] [Accepted: 01/11/2015] [Indexed: 12/26/2022]
Abstract
Joint instability creates a clinical and economic burden in the health care system. Injuries and disorders that directly damage the joint structure or lead to joint instability are highly associated with osteoarthritis (OA). Thus, understanding the physiology of joint stability and the mechanisms of joint instability-induced OA is of clinical significance. The first section of this review discusses the structure and function of major joint tissues, including periarticular muscles, which play a significant role in joint stability. Because the knee, ankle, and shoulder joints demonstrate a high incidence of ligament injury and joint instability, the second section summarizes the mechanisms of ligament injury-associated joint instability of these joints. The final section highlights the recent advances in the understanding of the mechanical and biological mechanisms of joint instability-induced OA. These advances may lead to new opportunities for clinical intervention in the prevention and early treatment of OA.
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Affiliation(s)
- Darryl Blalock
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Andrew Miller
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Michael Tilley
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jinxi Wang
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
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Lansdown DA, Zaid M, Pedoia V, Subburaj K, Souza R, Benjamin C, Li X. Reproducibility measurements of three methods for calculating in vivo MR-based knee kinematics. J Magn Reson Imaging 2014; 42:533-8. [PMID: 25545617 DOI: 10.1002/jmri.24790] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 10/16/2014] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To describe three quantification methods for magnetic resonance imaging (MRI)-based knee kinematic evaluation and to report on the reproducibility of these algorithms. MATERIALS AND METHODS T2 -weighted, fast-spin echo images were obtained of the bilateral knees in six healthy volunteers. Scans were repeated for each knee after repositioning to evaluate protocol reproducibility. Semiautomatic segmentation defined regions of interest for the tibia and femur. The posterior femoral condyles and diaphyseal axes were defined using the previously defined tibia and femur. All segmentation was performed twice to evaluate segmentation reliability. Anterior tibial translation (ATT) and internal tibial rotation (ITR) were calculated using three methods: a tibial-based registration system, a combined tibiofemoral-based registration method with all manual segmentation, and a combined tibiofemoral-based registration method with automatic definition of condyles and axes. Intraclass correlation coefficients and standard deviations across multiple measures were determined. RESULTS Reproducibility of segmentation was excellent (ATT = 0.98; ITR = 0.99) for both combined methods. ATT and ITR measurements were also reproducible across multiple scans in the combined registration measurements with manual (ATT = 0.94; ITR = 0.94) or automatic (ATT = 0.95; ITR = 0.94) condyles and axes. CONCLUSION The combined tibiofemoral registration with automatic definition of the posterior femoral condyle and diaphyseal axes allows for improved knee kinematics quantification with excellent in vivo reproducibility.
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Affiliation(s)
- Drew A Lansdown
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Musa Zaid
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Valentina Pedoia
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | | | - Richard Souza
- Musculoskeletal and Quantitative Imaging Research, Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - C Benjamin
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Xiaojuan Li
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
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