Digital radiographic measurement of normal knee joint space in adults at Kano, Nigeria

Medial Knee Joint Space in Relation to Joint Function and Early Knee Pain in 20-45-Year Adults: A Cross Sectional Study

Background

Anterior knee pain is very common in the young and active age groups but there are no significant studies on the normal population. Therefore, the objective of the study was to understand the relation between medial knee joint space to the development of knee pain and functional disability with special reference to the 20-45-year age group.

Materials and methods

250 cases with mean age of 36.36 years presenting with knee pain for at least 1 month were included in this prospective study (July 2021 and June 2022) and were asked to self-complete questionnaires on knee pain which included KNEST, AKPQ, VAS and IPAQ. Patients underwent X-rays of bilateral knees in AP view with weight bearing and then medial and lateral knee joint spaces were calculated.

Results

There was a higher incidence of knee pain in women compared to men. The average medial and lateral joint space widths (MJSW and LJSW) of the right knee were 4.22 mm and 4.57 mm, respectively. For the left knee it was 4.19 mm and 4.42 mm, respectively. There is a decrease in MJSW with increasing age, level of pain and BMI. Also, with an increase in physical activity, there was a higher incidence of knee pain.

Conclusion

Overuse injuries are the main cause of knee pain in this age group. There is a significant association between medial joint space width and age, gender, level of pain, and BMI. Rising BMI patterns at a young age, leads to an increase in physical activity, which in turn leads to early knee pain and also predisposes to osteoarthritis.

Artificial Intelligence in osteoarthritis: repair by knee joint distraction shows association of pain, radiographic and immunologic outcomes

OBJECTIVES

Knee joint distraction (KJD) has been associated with clinical and structural improvement and synovial fluid (SF) marker changes. The current objective was to analyze radiographic changes after KJD using an automatic AI-based measurement method, and relate these to clinical outcome and SF markers.

METHODS

20 knee osteoarthritis patients were treated with KJD in regular care. Radiographs and WOMAC were collected before and ∼1-year post-treatment. SF was aspirated before, during, and after treatment; biomarker levels were assessed by immunoassay. Radiographs were analyzed to obtain compartmental minimum and standardized joint space width (JSW), Kellgren-Lawrence (KL) grades, compartmental joint space narrowing (JSN) scores, and osteophytosis and sclerosis scores. Results were analyzed for the most (MAC) and least affected compartment. Radiographic changes were analyzed using Wilcoxon Signed Rank tests for categorical and paired t-test for continuous variables. Linear regression was used to calculate associations between changes in JSW, WOMAC pain, and SF markers.

RESULTS

16 Patients could be evaluated. JSW, KL and JSN improved in around half of the patients, significant only for MAC JSW (p< 0.05). MAC JSW change was positively associated with WOMAC pain change (p< 0.04). Greater MCP-1 and lower TGFβ-1 increases were significantly associated with changes in MAC JSW (p< 0.05). MCP-1 changes were positively associated with WOMAC pain changes (p< 0.05).

CONCLUSION

Automatic radiographic measurements show improved joint structure in most patients after KJD in regular care. MAC JSW increased significantly and was associated with SF biomarker level changes and even with improvements in pain as experienced by these patients.

Do Weight-Bearing Knee Digital Radiographs Help to Track the Severity of OA?

OBJECTIVE

Weight-bearing radiographs are preferred for joint space width (JSW) assessment in OA, sometimes non-weight-bearing radiographs are also done. This study aims to evaluate (1) The knee JSW in weight-bearing (WB) and non-weight-bearing (NWB) X-ray images. (2) Quadriceps angle (Q angle) at weight-bearing and non-weight-bearing positions.

MATERIALS AND METHODS

Patients above 50 years old with symptoms (knee pain, functional limitations, and crepitus) from April 2019 to November 2019 were included in the study. Expert exclude patients with post-surgical evaluation, trauma, and infection. JSW and Q angle measurements with respect to weight-bearing and non-weight-bearing positions were made by the same medical expert to avoid inter-observer variation.

RESULTS

Medial knee JSW varies from 0.49 to 5.75 mm in weight-bearing radiograph and 0.53 mm to 6.16 mm in non-weight-bearing radiograph. Q angle varies from 8.72° to 14.58° in weight-bearing position and 10.13° to 14.92° in non-weight-bearing position. Q angle (< 11.72°) and medial JSW (< 3.725 mm) were found to be significantly associated with the rapid progression of knee varus OA (p < 0.001).

CONCLUSION

NWB digital X-ray images overestimate early and underestimate severe OA. There is a possibility of increasing tibia internal rotation and reduction of joint space width in a standing position (WB) as the phase of knee OA diagnosis. These findings show that weight-bearing knee joint radiographs are helpful to track the progression of knee varus OA and have strong clinical usage than non-weight-bearing radiographs. Patients whose Q angle and knee JSW measures are below the limitations need more attention.

Can an OA Knee Brace Effectively Offload the Medial Condyle? An In Vivo Fluoroscopic Study

BACKGROUND

Previous studies evaluating the effectiveness of OA offloading knee braces focused on qualitative results. The objective of this study was to analyze the effectiveness of an off-loading knee brace with respect to in vivo three-dimensional knee kinematics to quantitatively measure the changes in medial joint space and relative bone alignment when wearing the brace.

METHODS

Twenty subjects diagnosed with medial compartmental joint space narrowing and varus deformity due to OA were recruited. During fluoroscopic surveillance, subjects performed normal gait on a treadmill with and without the brace. Images were sequenced at heel-strike and mid-stance during the weight-bearing portion of gait. 3D-to-2D image registration was performed on each subject using 3D bone models derived from CT segmentation and 3D ultrasound scans.

RESULTS

Medial joint space was to increase when the brace was applied in all subjects (1.6 ± 0.7 mm at heel-strike, 1.6 ± 0.8 mm at mid-stance) and was statistically significant (P < .001). It was also found that sixteen of the twenty subjects experienced a medial joint space increase of more than 1.0 mm during heel-strike while thirteen of twenty experienced this change at mid-stance. While wearing the brace, over half of the subjects experienced a valgus correction to their alignment.

CONCLUSIONS

All subjects in this study experienced a positive change in the medial joint space when wearing the offloading knee brace. In addition, many subjects also saw joint space values representative of previously documented, nonosteoarthritic subjects and valgus changes in bone alignment more akin to the normal knee.

Percutaneous Partial Outside-In Release of Medial Collateral Ligament for Arthroscopic Medial Meniscus Surgery With Tight Medial Compartment by Finding a "Magic Point"

The medial meniscus is one of the more commonly injured structures as compared with the lateral meniscus. In patients with tight medial joint space, it is difficult to visualize the posterior horn and posterior root of medial meniscus and even more difficult to use instrumentation for surgical procedures. Normally, the mean medial joint space (4.74 ± 0.75 mm) is less than the mean lateral joint space width (5.63 ± 0.86). Forceful instrumentation in a tight and a narrow medial joint compartment may cause damage to the articular cartilage, which may increase chances of arthritis in future. To increase the opening of the medial compartment after valgus extension stress position of the knee, different techniques of medial collateral ligament release have been described in the literature. However, the majority of articles describe a multiple-puncture method to the medial collateral ligament called the "pie-crusting" method, not explaining the exact point or precise location of release. Here, we describe a simple and reliable method of medial collateral ligament release by finding the exact release point, a "magic point" to increase the medial joint compartment width to facilitate better visualization and instrumentation for surgical procedures.