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Xin H, Li X, Zhang Y, Zeng C, Lei G, Yang T, Wei J. The mediation effects of malalignment on the relation of sex to the risk of incidence tibiofemoral osteoarthritis. Osteoarthritis Cartilage 2024; 32:1134-1140. [PMID: 38880429 DOI: 10.1016/j.joca.2024.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 05/15/2024] [Accepted: 06/10/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To investigate to what extent the higher risk of tibiofemoral radiographic osteoarthritis (TFROA) in females vs. males can be explained by knee malalignment. DESIGN Using data from Multicenter Osteoarthritis Study (MOST) and Osteoarthritis Initiative (OAI), we examined the relation of sex to the incident medial and lateral TFROA and performed mediation analyses to assess to what extent varus and valgus malalignments account for sex differences in the incident medial or lateral TFROA. RESULTS Of the 3462 knees without medial and lateral TFROA in MOST, the 7-year risks of medial and lateral TFROA were 16.9% and 10.0% in females, and 15.8% and 4.2% in males, respectively. Females had 2.31-fold (95% confidence interval [95% CI]: 1.73 to 3.08) higher incident lateral TFROA than males, and the relative risk (RR) of the indirect effect of sex on lateral TFROA through valgus malalignment was 1.15 (95% CI: 1.09 to 1.20), accounting for 23% of its total effect on lateral TFROA. In OAI (n = 3095 knees), females had 1.54-fold (95% CI: 1.15 to 2.04) higher incident lateral TFROA than males, and RR of the indirect effect of sex on lateral TFROA through valgus malalignment was 1.10 (95% CI: 1.04 to 1.21), accounting for 26% of its total effect on lateral TFROA. No apparent sex difference in the incident medial TFROA was found in MOST (RR = 1.05, 95% CI: 0.89 to 1.25) or OAI (RR = 1.02, 95% CI: 0.84 to 1.19). CONCLUSION Females had a higher risk of developing lateral TFROA than males; however, valgus malalignment only modestly explained such a difference.
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Affiliation(s)
- Haoyu Xin
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha 410008, China; Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xiaoxiao Li
- Hunan Key Laboratory of Joint Degeneration and Injury, Changsha 410008, China; Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital and The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha 410008, China; Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha 410008, China; Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha 410008, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Tuo Yang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha 410008, China; Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha 410008, China; Health Management Center, Xiangya Hospital and Central South University, Changsha 410008, China
| | - Jie Wei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha 410008, China; Hunan Key Laboratory of Joint Degeneration and Injury, Changsha 410008, China; Key Laboratory of Aging-related Bone and Joint Diseases Prevention and Treatment, Ministry of Education, Xiangya Hospital, Central South University, Changsha 410008, China; Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha 410008, China; FuRong Laboratory, Changsha 410078, Hunan, China.
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Abou-Abbas L, Hagemeister N, Ouakrim Y, Cagnin A, Laundry P, Richardson G, Dunbar MJ, Mezghani N. Unveiling distinct kinematic profiles among total knee arthroplasty candidates through clustering technique. J Orthop Surg Res 2024; 19:479. [PMID: 39143616 PMCID: PMC11325613 DOI: 10.1186/s13018-024-04990-8] [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: 07/11/2024] [Accepted: 08/08/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Characterizing the condition of patients suffering from knee osteoarthritis is complex due to multiple associations between clinical, functional, and structural parameters. While significant variability exists within this population, especially in candidates for total knee arthroplasty, there is increasing interest in knee kinematics among orthopedic surgeons aiming for more personalized approaches to achieve better outcomes and satisfaction. The primary objective of this study was to identify distinct kinematic phenotypes in total knee arthroplasty candidates and to compare different methods for the identification of these phenotypes. METHODS Three-dimensional kinematic data obtained from a Knee Kinesiography exam during treadmill walking in the clinic were used. Various aspects of the clustering process were evaluated and compared to achieve optimal clustering, including data preparation, transformation, and representation methods. RESULTS A K-Means clustering algorithm, performed using Euclidean distance, combined with principal component analysis applied on data transformed by standardization, was the optimal approach. Two unique kinematic phenotypes were identified among 80 total knee arthroplasty candidates. The two distinct phenotypes divided patients who significantly differed both in terms of knee kinematic representation and clinical outcomes, including a notable variation in 63.3% of frontal plane features and 81.8% of transverse plane features across 77.33% of the gait cycle, as well as differences in the Pain Catastrophizing Scale, highlighting the impact of these kinematic variations on patient pain and function. CONCLUSION Results from this study provide valuable insights for clinicians to develop personalized treatment approaches based on patients' phenotype affiliation, ultimately helping to improve total knee arthroplasty outcomes.
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Affiliation(s)
- Lina Abou-Abbas
- Applied and Artificial Intelligence Institute (I2A), TELUQ University, Montreal, Quebec, Canada.
- Electrical ad Computer Engineering Department, Lebanese American University, Byblos, Lebanon.
| | - Nicola Hagemeister
- Open Innovation Laboratory (OIL-ETS), Ecole de Technologie Superieure, Montreal, Quebec, Canada
- Department of Systems Engineering, Ecole de Technologie Superieure, Montreal, Quebec, Canada
| | - Youssef Ouakrim
- Applied and Artificial Intelligence Institute (I2A), TELUQ University, Montreal, Quebec, Canada
- Open Innovation Laboratory (OIL-ETS), Ecole de Technologie Superieure, Montreal, Quebec, Canada
| | | | | | - Glen Richardson
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael J Dunbar
- Division of Orthopaedic Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Neila Mezghani
- Applied and Artificial Intelligence Institute (I2A), TELUQ University, Montreal, Quebec, Canada
- Open Innovation Laboratory (OIL-ETS), Ecole de Technologie Superieure, Montreal, Quebec, Canada
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Li S, Wang S, Shao J, Wang J, Liu W, Chen L, Li Z, Zhang C, Song J. Toward the Improvement of the Mechanical and Tribological Properties of Braided Ligament for ACL Reconstruction: A "Carrot and Stick" Strategy. Adv Healthc Mater 2024; 13:e2304133. [PMID: 38484144 DOI: 10.1002/adhm.202304133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 02/21/2024] [Indexed: 05/03/2024]
Abstract
Bone tunnel enlargement has been troubling the clinical adoption of braided artificial ligaments for decades, to which mechanical and tribological performance promotion shall be an effective and promising approach. Herein, a "carrot and stick" strategy has been introduced with two types of polyethylene terephthalate (PET) fibers to fabricate hybrid textures, which is expected to advance fatigue and tribological performance without yielding essential mechanical strength and biocompatibility. Owing to advancements in such a "carrot and stick" strategy, the obtained grafts present three promising properties: i) enhancement of mechanical strength; ii) coefficient of friction (COF) reduction of 25% at the greatest extent, thus lowering the risk of bone tunnel enlargement; iii) final displacement shrinkage of graft length after cyclic loadings, favored in the clinic for isometric reconstruction. The results obtained in this study show that the "carrot and stick" strategy can be a creative and convenient method to optimize the service life, saving the complication rate of artificial ligaments for clinical applications.
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Affiliation(s)
- Shenglin Li
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, China
- Shenzhen Institute for Drug Control, Shenzhen Testing Center of Medical Devices, Shenzhen, 518057, China
| | - Shuhan Wang
- Shenzhen Institute for Drug Control, Shenzhen Testing Center of Medical Devices, Shenzhen, 518057, China
| | - Jiasheng Shao
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, China
| | - Jiali Wang
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, China
| | - Wenliang Liu
- Shenzhen Institute for Drug Control, Shenzhen Testing Center of Medical Devices, Shenzhen, 518057, China
| | - Linxin Chen
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, China
| | - Zeng Li
- Department of Orthopedics, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, 510080, China
| | - Chao Zhang
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, China
| | - Jian Song
- School of Biomedical Engineering, Shenzhen Campus of Sun Yat-sen University, Shenzhen, 518107, China
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Dubin J, Hameed D, Moore MC, Bains SS, Patel S, Nace J, Mont MA, Delanois RE. Methodological Assessment of the 100 Most-Cited Articles in Total Knee Arthroplasty in the Last Decade Compared to the All-Time List. J Arthroplasty 2024; 39:1434-1443.e5. [PMID: 38135168 DOI: 10.1016/j.arth.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/04/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Recent advances in total knee arthroplasty (TKA) have been driven by a growing focus on evidence-based medicine. This transition is reflected in the critical appraisal of both, the quality of work and the potential impact on the orthopedic community. The purpose of our study was to (1) identify the top 100 most-cited articles in TKA in the last decade and from all-time, and (2) compare methodological rigor of the most-cited articles in TKA in the last decade to articles all-time by level of evidence. METHODS The top 100 cited articles were recorded for manuscripts from the last decade, January 1, 2012 to December 31, 2022, and manuscripts from all-time for TKA. We collected authors, year of publication, journal of the article, country of origin of authors, article type (basic science article, clinical research article), level of evidence, methodological index for non-randomized studies score, physiotherapy evidence database scale, and citation density (total citations/years published). RESULTS The largest number of studies for all-time TKA (53.0%) and decade TKA (42.0%) were Level III. The average methodological index for non-randomized studies score for comparative studies was 18.7 for all-time TKA and 20.7 for decade TKA (P < .001). The average physiotherapy evidence database score was 6.1 for all-time TKA and 8.1 for decade TKA (P > .05). The highest citation density for all-time TKA was 111 and for past decade was 63. The number of level II studies in TKA increased from 19.0% from all time to 38.0% from the last decade (P < .05). CONCLUSIONS Our findings of improved methodologies over time reflect positive steps toward evidence-based practice in TKA. A continued focus on producing methodologically sound studies may guide evidence-based clinical decision-making.
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Affiliation(s)
- Jeremy Dubin
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Daniel Hameed
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Mallory C Moore
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Sandeep S Bains
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Saarang Patel
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - James Nace
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, LifeBridge Health, Sinai Hospital of Baltimore, Baltimore, Maryland
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Crane C, Wagner C, Wong S, Hall B, Hull J, Irwin K, Williams K, Brooks A. Glenohumeral Osteoarthritis: A Biological Advantage or a Missed Diagnosis? J Clin Med 2024; 13:2341. [PMID: 38673614 PMCID: PMC11051042 DOI: 10.3390/jcm13082341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/29/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
(1) Background: Osteoarthritis is a degenerative joint disease that is commonly diagnosed in the aging population. Interestingly, the lower extremity joints have a higher published incidence of osteoarthritis than the upper extremity joints. Although much is known about the disease process, it remains unclear why some joints are more affected than others. (2) Methods: A comprehensive literature review was conducted utilizing the search engines PubMed, Google Scholar, and Elsevier from 2014 to 2024, directing our search to osteoarthritis of various joints, with the focus being on glenohumeral osteoarthritis. (3) Results and Discussion: The literature review revealed a publication difference, which may be explained by the inconsistency in classification systems utilized in the diagnosis of shoulder osteoarthritis. For instance, there are six classification systems employed in the diagnosis of glenohumeral osteoarthritis, making the true incidence and, therefore, the prevalence unobtainable. Furthermore, susceptibility to osteoarthritis in various joints is complicated by factors such as joint anatomy, weight-bearing status, and prior injuries to the joint. (4) Conclusions: This review reveals the lack of understanding of shoulder osteoarthritis's true incidence and prevalence while considering the anatomy and biomechanics of the glenohumeral joint. In addition, this is the first paper to suggest a single criterion for the diagnosis of glenohumeral osteoarthritis.
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Affiliation(s)
- Camille Crane
- Colorado Campus, Rocky Vista University College of Osteopathic Medicine, 8401 South Chambers Road, Greenwood Village, CO 80112, USA; (B.H.); (K.I.)
| | - Caleb Wagner
- Utah Campus, Rocky Vista University College of Osteopathic Medicine, 855 East Center Street, Ivins, UT 84738, USA; (C.W.); (S.W.); (J.H.); (A.B.)
| | - Stephen Wong
- Utah Campus, Rocky Vista University College of Osteopathic Medicine, 855 East Center Street, Ivins, UT 84738, USA; (C.W.); (S.W.); (J.H.); (A.B.)
| | - Bryce Hall
- Colorado Campus, Rocky Vista University College of Osteopathic Medicine, 8401 South Chambers Road, Greenwood Village, CO 80112, USA; (B.H.); (K.I.)
| | - Jillian Hull
- Utah Campus, Rocky Vista University College of Osteopathic Medicine, 855 East Center Street, Ivins, UT 84738, USA; (C.W.); (S.W.); (J.H.); (A.B.)
| | - Katharine Irwin
- Colorado Campus, Rocky Vista University College of Osteopathic Medicine, 8401 South Chambers Road, Greenwood Village, CO 80112, USA; (B.H.); (K.I.)
| | - Kaitlin Williams
- Colorado Campus, Rocky Vista University College of Osteopathic Medicine, 8401 South Chambers Road, Greenwood Village, CO 80112, USA; (B.H.); (K.I.)
| | - Amanda Brooks
- Utah Campus, Rocky Vista University College of Osteopathic Medicine, 855 East Center Street, Ivins, UT 84738, USA; (C.W.); (S.W.); (J.H.); (A.B.)
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Starbuck C, Walters V, Herrington L, Barkatali B, Jones R. Knee Offloading by Patients During Walking and Running After Meniscectomy. Orthop J Sports Med 2024; 12:23259671231214766. [PMID: 38524891 PMCID: PMC10958822 DOI: 10.1177/23259671231214766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/19/2023] [Indexed: 03/26/2024] Open
Abstract
Background Changes in knee loading have been reported after meniscectomy. Knee loading has previously been assessed during jogging and treadmill running rather than overground running, which could give altered results. Purpose/Hypothesis The purpose of this study was to evaluate knee function during overground running and walking after meniscectomy. It was hypothesized that the affected limb would demonstrate higher external knee adduction moment, lower knee flexion moment (KFM), and lower knee rotation moment (KRM) compared with the contralateral limb and with healthy individuals. Study Design Controlled laboratory study. Methods Kinematic and kinetic data were collected during running and walking in individuals after a meniscectomy and healthy individuals. Total knee joint moments (TKJM) were calculated from the sagittal, frontal, and transverse knee moments. Isometric quadriceps strength, perceived knee function, and kinesiophobia were also assessed. A mixed linear model compared differences between the affected leg, the contralateral leg, and the healthy leg. Results Data were collected on 20 healthy individuals and 30 individuals after a meniscectomy (mean ± SD, 5.7 ± 2.9 months postsurgery), with 12, 16, and 2 individuals who had medial, lateral, and both medial and lateral meniscectomy, respectively. The affected limb demonstrated lower TKJM (P < .001), KFM (P = .004), and KRM (P < .001) during late stance of walking compared with the healthy group. Lower TKJM and KFM were observed during running in the affected limb compared with the contralateral limb and healthy group. No significant differences were observed between contralateral and healthy limbs except for KRM during late stance of walking. Lower quadriceps strength was observed in the affected (P < .001) and contralateral limbs (P = .001) compared with the healthy group. Individuals after a meniscectomy also reported greater kinesiophobia (P = .006) and lower perceived knee function (31.1%; P < .001) compared with the healthy group. Conclusion After meniscectomy, individuals who sustained a traumatic meniscal injury showed lower TKJM in the affected limb compared with the contralateral limb and healthy individuals. This decrease in TKJM can be attributed to altered knee-loading strategies in the sagittal and transverse planes. Clinical Relevance Improving movement strategies, quadriceps strength, and kinesiophobia through rehabilitation approaches will allow individuals to load their knee appropriately when returning to sport. Registration NCT03379415 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Chelsea Starbuck
- Applied Sports, Technology, Exercise and Medicine Research Centre, Faculty of Science and Engineering, Swansea University, Swansea, UK
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
- Manchester Institute of Health and Performance, Manchester, UK
| | - Vanessa Walters
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
- Manchester Institute of Health and Performance, Manchester, UK
| | - Lee Herrington
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
| | | | - Richard Jones
- Human Movement and Rehabilitation, School of Health and Society, University of Salford, Salford, UK
- Manchester Institute of Health and Performance, Manchester, UK
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Davis-Wilson HC, Thoma LM, Franz JR, Blackburn JT, Longobardi L, Schwartz TA, Hackney AC, Pietrosimone B. Physical Activity Associates with T1rho MRI of Femoral Cartilage After Anterior Cruciate Ligament Reconstruction. Med Sci Sports Exerc 2024; 56:411-417. [PMID: 37796166 PMCID: PMC10922225 DOI: 10.1249/mss.0000000000003318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
PURPOSE Less physical activity has been associated with systemic biomarkers of cartilage breakdown after anterior cruciate ligament reconstruction (ACLR). However, previous research lacks analysis of deleterious cartilage compositional changes and objective physical activity after ACLR. The purpose of this study was to determine the association between physical activity quantified via accelerometer-based measures of daily steps and time in moderate-to-vigorous physical activity (MVPA), and T1rho magnetic resonance imaging (MRI) of the femoral articular cartilage, a marker of proteoglycan density in individuals with ACLR. METHODS Daily steps and MVPA were assessed over 7 d using an accelerometer worn on the hip in 26 individuals between 6 and 12 months after primary unilateral ACLR. Resting T1rho MRI was collected bilaterally, and T1rho MRI interlimb ratios (ILR: ACLR limb/contralateral limb) were calculated for lateral and medial femoral condyle regions of interest. We conducted univariate linear regression analyses to determine associations between T1rho MRI ILRs and daily steps and MVPA with and without controlling for sex. RESULTS Greater T1rho MRI ILR of the central lateral femoral condyle, indicative of less proteoglycan density in the ACLR limb, was associated with greater time in MVPA ( R2 = 0.178, P = 0.032). Sex-adjusted models showed significant interaction terms between daily steps and sex in the anterior ( P = 0.025), central ( P = 0.002), and posterior ( P = 0.002) medial femoral condyle. CONCLUSIONS Lesser physical activity may be a risk factor for maintaining cartilage health after ACLR; additionally, the relationship between physical activity and cartilage health may be different between males and females.
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Affiliation(s)
- Hope C. Davis-Wilson
- Department of Physical Medicine and Rehabilitation, University of Colorado, Aurora, CO
- VA Eastern Colorado Geriatric Research, Education, and Clinical Center, Rocky Mountain Regional VA Medical Center, Aurora, CO
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Louise M. Thoma
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jason R. Franz
- Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Chapel Hill, NC
| | - J. Troy Blackburn
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Lara Longobardi
- Department of Medicine, Division of Rheumatology, Allergy, and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Todd A. Schwartz
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Biostatistics, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Anthony C. Hackney
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Brian Pietrosimone
- MOTION Science Institute, Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Orthopaedics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Song JH, Kim JM, Bin SI, Lee BS, Lee J. Risk Factor for Clinical Failure of Medial Meniscal Allograft Transplant: Early vs Late Graft Tear. Am J Sports Med 2024; 52:368-373. [PMID: 38186334 DOI: 10.1177/03635465231214221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
BACKGROUND Graft tears are common postoperative findings in meniscal allograft transplant (MAT). Graft tear in medial MAT may be different from that of lateral MAT, considering the difference between medial meniscal tears and lateral meniscal tears. Moreover, medial MAT is frequently accompanied by ligament reconstruction, which is associated with graft tear. The effect of graft tear on the long-term survivorship of medial MAT has not been investigated. HYPOTHESIS Graft tear would adversely affect the survivorship of medial MAT and the effect would be different according to the timing of graft tear. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 55 patients undergoing medial MAT between June 2019 and March 2000 were retrospectively reviewed. Postoperative magnetic resonance imaging (MRI) scans were reviewed to identify graft tears, and the timing of their occurrence was investigated. Postoperative MRI was performed routinely during the first postoperative year and every 2 years thereafter. The patients were classified into a no graft tear (NT) group, early graft tear (occurring within 1 year; ET) group, and late graft tear (occurring 1 year after surgery; LT) group. The survival rate of medial MAT was estimated according to graft tear, with a failure being defined as (1) reoperations including arthroplasty, realignment osteotomy, revision MAT, and meniscectomy (>50% of the graft or to the zone of the meniscocapsular junction) or (2) Lysholm score <65. Clinical scores were compared between the groups. RESULTS The mean follow-up duration was 8.6 ± 5.3 years. During that period, clinical failures occurred in 6 (10.9%) patients. The overall survival rate at 5 years was 94.0% (95% CI, 90.6%-97.4%). Graft tears were seen in 18 patients: 6 patients in the ET group and 12 patients in the LT group. The median time when the graft tear was noted on MRI scans was 5.5 months (range, 1-11 months) postoperatively in the ET group and 99.5 months (range, 19-264 months) postoperatively in the LT group. Five patients in the ET group had root tears, whereas 9 patients in the LT group had complex or horizontal tears. The 5-year survival rate of the ET group was 62.5% (95% CI, 41.2%-83.8%), which was significantly lower than that of the NT group (96.8%; 95% CI, 93.6%-99.9%) and the LT group (85.7%; 95% CI, 72.5%-98.9%; P = .002). The mean postoperative Lysholm scores were 85.6 ± 17.9 in the NT group, 93.0 ± 2.8 in the ET group, and 79.3 ± 11.6 in the LT group, showing no significant difference between the groups (Kruskal-Wallis test, P = .058). CONCLUSION Clinical relevance of graft tear that occurred after medial MAT was dependent upon its timing. ET was a risk factor for clinical failure, whereas LT did not adversely affect graft survivorship. Lysholm scores did not differ according to graft tear.
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Affiliation(s)
- Ju-Ho Song
- Department of Orthopedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea
- University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jong-Min Kim
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong-Il Bin
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Bum-Sik Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jongjin Lee
- Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Stoltze JS, Oliveira ASC, Rasmussen J, Andersen MS. Evaluation of an Unloading Concept for Knee Osteoarthritis: A Pilot Study in a Small Patient Group. J Biomech Eng 2024; 146:011010. [PMID: 37943157 DOI: 10.1115/1.4064031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/05/2023] [Indexed: 11/10/2023]
Abstract
Joint compressive forces have been identified as a risk factor for osteoarthritis disease progression. Therefore, unloader braces are a common treatment with the aim of relieving pain, but their effects are not clearly documented in the literature. A knee brace concept was tested with the aim of reducing joint loads and pain in knee osteoarthritis patients by applying an extension moment exclusively during the stance phase. The ideal effects were evaluated during gait based on musculoskeletal modeling of six patients, and experimental tests with a prototype brace were conducted on one patient. The effects were evaluated using electromyography measurements and musculoskeletal models to evaluate the muscle activation and knee compressive forces, respectively. The ideal brace simulations revealed a varying reduction of the first peak knee force between 3.5% and 33.8% across six patients whereas the second peak was unaffected. The prototype reduced the peak vasti muscle activation with 7.9% and musculoskeletal models showed a reduction of the first peak knee compressive force of up to 26.3%. However, the prototype brace increased the knee joint force impulse of up to 17.1% and no immediate pain reduction was observed. The reduction of the first peak knee compressive force, using a prototype on a single patient, indicates a promising effect from an applied knee extension moment for reducing knee joint loads during normal gait. However, further clinical experiments with this brace method are required to evaluate the long-term effects on both pain and disease progression in knee osteoarthritis patients.
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Affiliation(s)
- Jonas S Stoltze
- Department of Material and Production, Aalborg University, Fibigerstraede 16, Aalborg East DK-9220, Denmark
| | - Anderson S C Oliveira
- Department of Material and Production, Aalborg University, Fibigerstraede 16, Aalborg East DK-9220, Denmark
| | - John Rasmussen
- Department of Material and Production, Aalborg University, Fibigerstraede 16, Aalborg East DK-9220, Denmark
| | - Michael S Andersen
- Department of Material and Production, Aalborg University, Fibigerstraede 16, Aalborg East DK-9220, Denmark
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10
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Sarrel K, Weinberg M, Scuderi G. Achieving Correct Balance in Total Knee Arthroplasty with Fixed Varus Deformity. J Knee Surg 2024; 37:92-97. [PMID: 37800176 DOI: 10.1055/a-2186-5942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Varus knee deformity is one of the most common deformities presenting for total knee arthroplasty (TKA). When present, a varus knee deformity contributes to overload of the medial joint compartment during gait, leading to increased medial compartment forces as well as lateral soft tissue lengthening. Additionally, a fixed varus deformity is associated with medial soft tissue contractures of the deep and superficial medial collateral ligament (MCL) and posteromedial capsule. With a fixed varus deformity, soft tissue releases may be necessary to create equivalent and rectangular flexion and extension gaps. There may also be anteromedial tibial bone defects, medial femoral condyle defects, and occasionally flexion contractures, especially in more severe cases. In cases of severe varus deformity with medial tibial bone loss, bone defects must be addressed to ensure adequate implant support. In many cases, a primary knee implant can be utilized in cases of varus knee deformity, but occasionally prostheses with higher levels of constraint may be required to balance and stabilize the knee. TKA has had a successful track record, with high levels of long-term implant survivorship even in cases of severe varus. Iatrogenic MCL instability and tibial aseptic loosening are complications associated with TKA in cases of severe varus, and multiple methods to avoid complications are presented here.
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Affiliation(s)
- Kara Sarrel
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
| | - Maxwell Weinberg
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
| | - Giles Scuderi
- Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, New York
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11
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Cowie RM, Macri-Pellizzeri L, McLaren J, Sanderson WJ, Felfel RM, Scotchford CA, Scammell BE, Grant DM, Sottile V, Jennings LM. Functional performance of a bi-layered chitosan-nano-hydroxyapatite osteochondral scaffold: a pre-clinical in vitro tribological study. ROYAL SOCIETY OPEN SCIENCE 2024; 11:230431. [PMID: 38204795 PMCID: PMC10776221 DOI: 10.1098/rsos.230431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024]
Abstract
Osteochondral grafts are used for repair of focal osteochondral lesions. Autologous grafts are the gold standard treatment; however, limited graft availability and donor site morbidity restrict use. Therefore, there is a clinical need for different graft sources/materials which replicate natural cartilage function. Chitosan has been proposed for this application. The aim of this study was to assess the biomechanics and biotribology of a bioresorbable chitosan/chitosan-nano-hydroxyapatite osteochondral construct (OCC), implanted in an in vitro porcine knee experimental simulation model. The OCC implanted in different surgical positions (flush, proud and inverted) was compared to predicate grafts in current clinical use and a positive control consisting of a stainless steel graft implanted proud of the cartilage surface. After 3 h (10 800 cycles) wear simulation under a walking gait, subsidence occurred in all OCC samples irrespective of surgical positioning, but with no apparent loss of material and low meniscus wear. Half the predicate grafts exhibited delamination and scratching of the cartilage surfaces. No graft subsidence occurred in the positive controls but wear and deformation of the meniscus were apparent. Implanting a new chitosan-based OCC either optimally (flush), inverted or proud of the cartilage surface resulted in minimal wear, damage and deformation of the meniscus.
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Affiliation(s)
- Raelene M. Cowie
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
| | - Laura Macri-Pellizzeri
- Academic Unit Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Jane McLaren
- Academic Unit Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Reda M. Felfel
- Advanced Materials Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK
- Department of Mechanical and Aerospace Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, UK
- Physics Department, Faculty of Science, Mansoura University, Mansoura, Egypt
| | - Colin A. Scotchford
- Advanced Materials Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - Brigitte E. Scammell
- Academic Unit Injury, Recovery and Inflammation Sciences (IRIS), School of Medicine, University of Nottingham, Nottingham, UK
| | - David M. Grant
- Advanced Materials Research Group, Faculty of Engineering, University of Nottingham, Nottingham, UK
| | - Virginie Sottile
- Academic Unit Translational Medical Sciences, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Louise M. Jennings
- Institute of Medical and Biological Engineering, University of Leeds, Leeds, UK
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12
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Falvey KT, Kinshaw CM, Warren GL, Tsai LC. Persistent altered knee loading in patients with meniscectomy: A systematic review and meta-analysis. Phys Ther Sport 2024; 65:14-22. [PMID: 37980779 DOI: 10.1016/j.ptsp.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/21/2023]
Abstract
OBJECTIVES To determine the changes in knee flexion moment (KFM) and knee adduction moment (KAM) during weight-bearing activities following meniscectomy. DESIGN Meta-Analysis. SETTING Laboratory. PARTICIPANTS 332 meniscectomy patients and 137 healthy controls (from 13 qualified studies) MAIN OUTCOME MEASURES: Cohen's d effect sizes (ESs) were calculated to compare KAM and KFM values of the surgical legs to the non-surgical and to healthy control legs. RESULTS When compared to healthy controls, meniscectomy patients' surgical legs demonstrated a significantly greater KAM (ES = 0.310; P = 0.002) but no significant difference in KFM (ES = -0.182; P = 0.051). When compared to the patients' non-surgical legs, however, the surgical legs showed no difference in KAM (ES = -0.024; P = 0.716) but a significantly lower KFM (ES = -0.422; P < 0.001). High heterogeneity among study ESs was observed in patients' between-limb comparison for KAM (Q-value = 20.08, P = 0.005; I2 = 65.1%) and KFM (Q-value = 43.96, P < 0.001; I2 = 79.5%). However, no significant differences in study ESs (all P > 0.102) of KFM and KAM were identified when comparing studies with various times post-surgery, weight-bearing tasks, walking speeds, or patient demographics. CONCLUSION Elevated KAM and reduced/asymmetrical KFM observed in meniscectomy patients may contribute to the increased risk of knee OA. Rehabilitation should focus on movement education to restore between-limb KFM symmetry and reduce KAM bilaterally post-meniscectomy.
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Affiliation(s)
- Kyle T Falvey
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Chad M Kinshaw
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Gordon L Warren
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA
| | - Liang-Ching Tsai
- Department of Physical Therapy, Georgia State University, Atlanta, GA, USA.
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13
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Ivanov I, Ranchev S, Stoychev S. Experimental Ultrasound Approach for Studying Knee Intra-Articular Femur-Tibia Movements under Different Loads. J Funct Morphol Kinesiol 2023; 9:8. [PMID: 38249085 PMCID: PMC10801608 DOI: 10.3390/jfmk9010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
The purpose of the present study was to develop an experimental model for the study of intra-articular knee movements depending on the function of the knee joint and involved muscle groups under isometric stretching conditions with different loads. The experimental procedure included an ultrasound examination of a knee joint after isometric stretching in healthy men (n = 32). The changes (in millimeters) in the distances between the femur and tibia were measured using an ultrasound sonographer at three stages. The first stage was performed on ten (n = 10) healthy men in five different sitting and upright positions. In the second and third experimental model stages, lower limbs loading was applied to 22 participants. Our hypothesis, which was confirmed, was that as a result of increased loads on the participant's back, an intra-articular decrease in the femur-tibia cartilage surface distance would be observed. The accuracy of the created experimental model was improved over its three stages from 30% to 9%. Quantitative model data can help to create a mathematical model of the mechanical effects during the deformation of knee joint bone cartilage and it can also help outline some future tasks: increasing loading weights, enlarging participant groups, performing comparisons of men and women, and performing comparisons of healthy and pathological individuals.
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Affiliation(s)
- Ivan Ivanov
- National Sports Academy “Vassil Levski”, 1700 Sofia, Bulgaria
- Institute of Mechanics, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria; (S.R.); (S.S.)
| | - Sergey Ranchev
- Institute of Mechanics, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria; (S.R.); (S.S.)
| | - Stoyan Stoychev
- Institute of Mechanics, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria; (S.R.); (S.S.)
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14
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Jones BW, Willson JD, DeVita P, Wedge RD. Tibiofemoral Load Magnitude and Distribution During Load Carriage. J Appl Biomech 2023; 39:432-439. [PMID: 37739402 DOI: 10.1123/jab.2022-0257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 07/26/2023] [Accepted: 08/02/2023] [Indexed: 09/24/2023]
Abstract
Chronic exposure to high tibiofemoral joint (TFJ) contact forces can be detrimental to knee joint health. Load carriage increases TFJ contact forces, but it is unclear whether medial and lateral tibiofemoral compartments respond similarly to incremental load carriage. The purpose of our study was to compare TFJ contact forces when walking with 15% and 30% added body weight. Young healthy adults (n = 24) walked for 5 minutes with no load, 15% load, and 30% load on an instrumented treadmill. Total, medial, and lateral TFJ contact peak forces and impulses were calculated via an inverse dynamics informed musculoskeletal model. Results of 1-way repeated measures analyses of variance (α = .05) demonstrated total, medial, and lateral TFJ first peak contact forces and impulses increased significantly with increasing load. Orthogonal polynomial trends demonstrated that the 30% loading condition led to a curvilinear increase in total and lateral TFJ impulses, whereas medial first peak TFJ contact forces and impulses responded linearly to increasing load. The total and lateral compartment impulse increased disproportionally with load carriage, while the medial did not. The medial and lateral compartments responded differently to increasing load during walking, warranting further investigation because it may relate to risk of osteoarthritis.
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Affiliation(s)
- Blake W Jones
- Department of Kinesiology, East Carolina University, Greenville, NC,USA
- Department of Physical Therapy, East Carolina University, Greenville, NC,USA
| | - John D Willson
- Department of Physical Therapy, East Carolina University, Greenville, NC,USA
| | - Paul DeVita
- Department of Kinesiology, East Carolina University, Greenville, NC,USA
| | - Ryan D Wedge
- Department of Physical Therapy, East Carolina University, Greenville, NC,USA
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15
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Liu S, Amiri P, McGregor AH, Bull AMJ. Bilateral Asymmetry in Knee and Hip Musculoskeletal Loading During Stair Ascending/Descending in Individuals with Unilateral Mild-to-Moderate Medial Knee Osteoarthritis. Ann Biomed Eng 2023; 51:2490-2503. [PMID: 37482575 PMCID: PMC10598163 DOI: 10.1007/s10439-023-03289-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 06/19/2023] [Indexed: 07/25/2023]
Abstract
Most cases of unilateral knee osteoarthritis (OA) progress to bilateral OA within 10 years. Biomechanical asymmetries have been implicated in contralateral OA development; however, gait analysis alone does not consistently detect asymmetries in OA patient gait. Stair ambulation is a more demanding activity that may be more suited to reveal between-leg asymmetries in OA patients. The objective of this study was to investigate the between-leg biomechanical differences in patients with unilateral mild-to-moderate knee OA. Sixteen unilateral mild-to-moderate medial knee OA patients and 16 healthy individuals underwent kinematic and kinetic analysis of stair ascent and descent. Stair ascent produced higher loading and muscle forces in the unaffected limb compared to the OA limb, and stair descent produced lower loading on the OA limb compared to healthy subjects. These biomechanical differences were apparent in the ankle, knee, and hip joints. The implications of these findings are that OA patients rely more heavily on their unaffected sides than the affected side in stair ascent, a strategy that may be detrimental to the unaffected joint health. The reduction in affected limb loading in stair descent is thought to be related to minimizing pain.
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Affiliation(s)
- Sirui Liu
- Department of Bioengineering, Imperial College London, Sir Michael Uren Hub, Imperial College London White City Campus, 86 Wood Ln, London, W12 0BZ, UK.
| | - Pouya Amiri
- Department of Bioengineering, Imperial College London, Sir Michael Uren Hub, Imperial College London White City Campus, 86 Wood Ln, London, W12 0BZ, UK
| | - Alison H McGregor
- Department of Surgery and Cancer, Imperial College London, Sir Michael Uren Hub, Imperial College London White City Campus, 86 Wood Ln, London, W12 0BZ, UK
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, Sir Michael Uren Hub, Imperial College London White City Campus, 86 Wood Ln, London, W12 0BZ, UK
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16
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Kainz H, Mindler GT, Kranzl A. Influence of femoral anteversion angle and neck-shaft angle on muscle forces and joint loading during walking. PLoS One 2023; 18:e0291458. [PMID: 37824447 PMCID: PMC10569567 DOI: 10.1371/journal.pone.0291458] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/30/2023] [Indexed: 10/14/2023] Open
Abstract
Femoral deformities, e.g. increased or decreased femoral anteversion (AVA) and neck-shaft angle (NSA), can lead to pathological gait patterns, altered joint loads, and degenerative joint diseases. The mechanism how femoral geometry influences muscle forces and joint load during walking is still not fully understood. The objective of our study was to investigate the influence of femoral AVA and NSA on muscle forces and joint loads during walking. We conducted a comprehensive musculoskeletal modelling study based on three-dimensional motion capture data of a healthy person with a typical gait pattern. We created 25 musculoskeletal models with a variety of NSA (93°-153°) and AVA (-12°-48°). For each model we calculated moment arms, muscle forces, muscle moments, co-contraction indices and joint loads using OpenSim. Multiple regression analyses were used to predict muscle activations, muscle moments, co-contraction indices, and joint contact forces based on the femoral geometry. We found a significant increase in co-contraction of hip and knee joint spanning muscles in models with increasing AVA and NSA, which led to a substantial increase in hip and knee joint contact forces. Decreased AVA and NSA had a minor impact on muscle and joint contact forces. Large AVA lead to increases in both knee and hip contact forces. Large NSA (153°) combined with large AVA (48°) led to increases in hip joint contact forces by five times body weight. Low NSA (108° and 93°) combined with large AVA (48°) led to two-fold increases in the second peak of the knee contact forces. Increased joint contact forces in models with increased AVA and NSA were linked to changes in hip muscle moment arms and compensatory increases in hip and knee muscle forces. Knowing the influence of femoral geometry on muscle forces and joint loads can help clinicians to improve treatment strategies in patients with femoral deformities.
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Affiliation(s)
- Hans Kainz
- Centre for Sport Science and University Sports, Department of Biomechanics, Kinesiology and Computer Science in Sport, Neuromechanics Research Group, University of Vienna, Vienna, Austria
| | - Gabriel T. Mindler
- Department of Pediatric Orthopaedics, Orthopaedic Hospital Speising, Vienna, Austria
- Vienna Bone and Growth Center, Vienna, Austria
| | - Andreas Kranzl
- Vienna Bone and Growth Center, Vienna, Austria
- Laboratory for Gait and Movement Analysis, Orthopaedic Hospital Speising, Vienna, Austria
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17
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Ishii Y, Ishikawa M, Nakashima Y, Takahashi M, Hashizume T, Okamoto S, Hashiguchi N, Nakamae A, Kamei G, Adachi N. Visualization of lateral meniscus extrusion during gait using dynamic ultrasonographic evaluation. J Med Ultrason (2001) 2023; 50:531-539. [PMID: 37286813 DOI: 10.1007/s10396-023-01330-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/06/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE Medial meniscus extrusion is one of the risk factors for knee osteoarthritis (OA). However, lateral meniscus extrusion has not been discussed, and detailed information remains unknown. In particular, the lateral meniscus has high mobility and is expected to be difficult to evaluate in terms of its behavior under static conditions. Dynamic ultrasonographic evaluation was introduced to detect the dynamic behavior of the meniscus during walking. In this study, we aimed to investigate the behavior of the lateral meniscus during walking using dynamic ultrasonographic evaluation. METHODS Sixteen participants with knee OA were recruited in this study. The change of lateral meniscus extrusion during walking was recorded using ultrasonography. Medial and lateral meniscal extrusion during the stance phase was measured, and meniscal mobility was defined as the difference in meniscal extrusion between minimum and maximum values (mm), medial meniscal extrusion (∆MME), and lateral meniscal extrusion (∆LME), respectively. The walking cycle and gait forms of lateral thrust were also evaluated using three-dimensional motion analysis systems and analyzed in terms of the correlation with ∆MME and ∆LME. RESULTS The lateral meniscus was depicted in the articular plane, and extrusion decreased during the stance phase of the gait cycle. The ∆LME was significantly higher than the ∆MME (p < 0.01). There was a significant positive correlation between ∆LME and lateral thrust (r = 0.62, p < 0.05). CONCLUSIONS We found that dynamic ultrasonographic evaluation can be used to visualize lateral meniscus extrusion during walking, and that its behavior is correlated to the degree of lateral thrust.
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Affiliation(s)
- Yosuke Ishii
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
| | - Masakazu Ishikawa
- Department of Orthopaedic Surgery, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yuko Nakashima
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Makoto Takahashi
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Takato Hashizume
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Saeko Okamoto
- Department of Biomechanics, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Naofumi Hashiguchi
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Atsuo Nakamae
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Goki Kamei
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Nobuo Adachi
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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18
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Sun R, Vats K, Jn Baptiste J, Adeeb S, Jomha N, Westover L. Comparison of wear on articular cartilage by titanium alloy, ultra-high-molecular-weight polyethylene, and carbon fibre reinforced polyether-ether-ketone: A pilot study. Med Eng Phys 2023; 120:104042. [PMID: 37838396 DOI: 10.1016/j.medengphy.2023.104042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 08/15/2023] [Accepted: 08/25/2023] [Indexed: 10/16/2023]
Abstract
Artificial implant materials may articulate against native articular cartilage in certain clinical scenarios and the selection of an implant material that results in the least wear on articular cartilage is preferred to maintain normal joint architecture and function. This project compared the wear on porcine femoral condyles induced by articulation against porcine patellae, titanium alloy (Ti6Al4V), ultra high molecular weight polyethylene (UHMWPE), and carbon fibre reinforced polyether-ether-ketone (CFR-PEEK) through an ex vivo experimental setup. A sinusoidal compressive load of 30-160 N, representing an approximate joint pressure of 0.19-1 MPa at a frequency of 3 Hz coupled with a rotational displacement of +/- 10⁰ at 3 Hz was used to simulate physiological joint motion. Wear was characterized via gross examination and histologically using the OARSI scoring system after 43,200 cycles. CFR-PEEK resulted in the most significant wear on articular cartilage compared to titanium alloy and UHMWPE whereas titanium alloy and UHMWPE resulted in similar levels of wear. All materials caused more wear compared to cartilage-on-cartilage testing. The wear mechanism was characterized by progressive loss of proteoglycan content in cartilage in histology samples.
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Affiliation(s)
- Ruixiang Sun
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton AB Canada
| | - Karan Vats
- Department of Biomedical Engineering, Faculty of Engineering, University of Alberta, Edmonton AB Canada
| | - Jonelle Jn Baptiste
- Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton AB Canada
| | - Samer Adeeb
- Department of Civil and Environmental Engineering, Faculty of Engineering, University of Alberta, Edmonton AB Canada
| | - Nadr Jomha
- Department of Surgery, Faculty of Medicine & Dentistry, University of Alberta, Edmonton AB Canada
| | - Lindsey Westover
- Department of Biomedical Engineering, Faculty of Engineering, University of Alberta, Edmonton AB Canada; Department of Mechanical Engineering, Faculty of Engineering, University of Alberta, Edmonton AB Canada.
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19
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Jolas E, Simonsen MB, Andersen MS. Simulated Increase in Monoarticular Hip Muscle Strength Reduces the First Peak of Knee Compression Forces During Walking. J Biomech Eng 2023; 145:101011. [PMID: 37338263 DOI: 10.1115/1.4062781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
Reducing compressive knee contact forces (KCF) during walking could slow the progression and reduce symptoms of knee osteoarthritis. A previous study has shown that compensating for the hip flexion/extension moment could reduce the KCF peak occurring during early stance (KCFp1). Therefore, this study aimed to identify if monoarticular hip muscle could allow this compensation while considering different walking strategies. Gait trials from 24 healthy participants were used to make musculoskeletal models, and five load-cases were examined: (I) Normal, (II) with an applied external moment compensating for 100% of the hip flexion/extension moment, and (III-V) three conditions with isolated/combined 30% increase of peak isometric strength of gluteus medius and maximus. Knee contact forces, hip muscle forces, and joint moments were computed. A cluster analysis of the Normal condition was performed with hip and knee flexion/extension moment during KCFp1 as input to examine the influence of different walking strategies. The cluster analysis revealed two groups having significantly different hip and knee moments in early-stance (p < 0.01). The reduction in KCFp1 from the Normal condition, although present in both groups, was greater for the group with the highest hip and lowest knee flexion/extension moments for all conditions tested (II: -21.82 ± 8.71% versus -6.03 ± 6.68%, III: -3.21 ± 1.09% versus -1.59 ± 0.96%, IV: -3.00 ± 0.89% versus -1.76 ± 1.04%, V: -6.12 ± 1.69 versus -3.09 ± 1.95%). This reduction in KCFp1 occurred through a shift in force developed by the hamstrings during walking (biarticular) to the gluteus medius and maximus (monoarticular), whose isometric strength was increased. The differences between the groups suggest that this reduction depends on the walking strategy.
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Affiliation(s)
- Elisa Jolas
- Department of Materials and Production, Aalborg University, Aalborg East DK-9220, Denmark; Department of Sport Sciences and Physical Education, Ecole Normale Supérieure de Rennes, Bruz 35170, France; Center for Mathematical Modeling of Knee Osteoarthritis, Aalborg University, Fibigerstræde 14 and 16, Aalborg East DK-9220, Denmark
| | - Morten Bilde Simonsen
- Department of Materials and Production, Aalborg University, Aalborg East DK-9220, Denmark; Center for Mathematical Modeling of Knee Osteoarthritis, Aalborg University, Fibigerstræde 14 and 16, Aalborg East DK-9220, Denmark
| | - Michael Skipper Andersen
- Department of Materials and Production, Aalborg University, Aalborg East DK-9220, Denmark; Center for Mathematical Modeling of Knee Osteoarthritis, Aalborg University, Fibigerstræde 14 and 16, Aalborg East DK-9220, Denmark
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20
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Valente G, Grenno G, Dal Fabbro G, Zaffagnini S, Taddei F. Medial and lateral knee contact forces during walking, stair ascent and stair descent are more affected by contact locations than tibiofemoral alignment in knee osteoarthritis patients with varus malalignment. Front Bioeng Biotechnol 2023; 11:1254661. [PMID: 37731759 PMCID: PMC10507691 DOI: 10.3389/fbioe.2023.1254661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction: Knee OA progression is related to medial knee contact forces, which can be altered by anatomical parameters of tibiofemoral alignment and contact point locations. There is limited and controversial literature on medial-lateral force distribution and the effect of anatomical parameters, especially in motor activities different from walking. We analyzed the effect of tibiofemoral alignment and contact point locations on knee contact forces, and the medial-lateral force distribution in knee OA subjects with varus malalignment during walking, stair ascending and stair descending. Methods: Fifty-one knee OA subjects with varus malalignment underwent weight-bearing radiographs and motion capture during walking, stair ascending and stair descending. We created a set of four musculoskeletal models per subject with increasing level of personalization, and calculated medial and lateral knee contact forces. To analyze the effect of the anatomical parameters, statistically-significant differences in knee contact forces among models were evaluated. Then, to analyze the force distribution, the medial-to-total contact force ratios were calculated from the fully-informed models. In addition, a multiple regression analysis was performed to evaluate correlations between forces and anatomical parameters. Results: The anatomical parameters significantly affected the knee contact forces. However, the contact points decreased medial forces and increased lateral forces and led to more marked variations compared to tibiofemoral alignment, which produced an opposite effect. The forces were less medially-distributed during stair negotiation, with medial-to-total ratios below 50% at force peaks. The anatomical parameters explained 30%-67% of the variability in the knee forces, where the medial contact points were the best predictors of medial contact forces. Discussion: Including personalized locations of contact points is crucial when analyzing knee contact forces in subjects with varus malalignment, and especially the medial contact points have a major effect on the forces rather than tibiofemoral alignment. Remarkably, the medial-lateral force distribution depends on the motor activity, where stair ascending and descending show increased lateral forces that lead to less medially-distributed loads compared to walking.
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Affiliation(s)
- Giordano Valente
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giulia Grenno
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giacomo Dal Fabbro
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- 2nd Orthopedics and Trauma Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Fulvia Taddei
- Bioengineering and Computing Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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21
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Lee YR, Briggs MT, Kuliwaba JS, Jagiello J, Anderson PH, Hoffmann P. High-Resolution N-Glycan MALDI Mass Spectrometry Imaging of Subchondral Bone Tissue Microarrays in Patients with Knee Osteoarthritis. Anal Chem 2023; 95:12640-12647. [PMID: 37583288 PMCID: PMC10470451 DOI: 10.1021/acs.analchem.3c00348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 07/12/2023] [Indexed: 08/17/2023]
Abstract
N-glycan alterations contribute to the progression of several joint diseases, including knee osteoarthritis (KOA). However, molecular changes in KOA subchondral trabecular bone, when exposed to different joint loading forces, are still unknown. The aim of this study was, therefore, to demonstrate the feasibility to differentiate N-glycan changes in subchondral trabecular bone from four different joint loading forces of the tibial plateau regions (i.e., Lateral Anterior (L-A), Lateral Posterior (L-P), Medial Anterior (M-A), and Medial Posterior (M-P)) in KOA patients (n = 10) using matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) at 20 μm spatial resolution. The degree of cartilage degeneration was evaluated histologically, and the subchondral bone tissue microarrays (TMAs) were subsequently manually constructed from formalin-fixed paraffin-embedded (FFPE) KOA osteochondral (i.e., cartilage-subchondral bone) tissues. Overall, the Osteoarthritis Research Society International (OARSI) histological grade was significantly higher and the size of chondrocytes in the superficial zone was much larger for both M-A and M-P compared to L-A and L-P of cartilage (p = 0.006, p = 0.030, p = 0.028, and p = 0.010; respectively). Among the 65 putative N-glycans observed by MALDI-MSI, 2 core fucosylated bi-antennary N-glycans, m/z 1809.64; (Hex)5(HexNAc)4(Fuc)1 and 2100.73; (NeuAc)1(Hex)5(HexNAc)4(Fuc)1, were significantly higher in intensity in M-A compared to L-A of the trabecular bone (p = 0.027, and p = 0.038, respectively). These N-glycans were then further structurally characterized by in situ MS/MS fragmentation post-MALDI-MSI. Our results demonstrate, for the first time, N-glycan alterations can occur at different joint loading forces in the KOA tibial plateau and the feasibility of subchondral bone TMA construction for N-glycan MALDI-MSI.
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Affiliation(s)
- Yea-Rin Lee
- Clinical
and Health Sciences, Health and Biomedical Innovation, University of South Australia, Adelaide, SA 5000, Australia
- Clinical
and Health Sciences, University of South
Australia, Adelaide, SA 5000, Australia
- Discipline
of Orthopaedics and Trauma, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Matthew T. Briggs
- Clinical
and Health Sciences, University of South
Australia, Adelaide, SA 5000, Australia
| | - Julia S. Kuliwaba
- Discipline
of Orthopaedics and Trauma, Adelaide Medical School, The University of Adelaide, Adelaide, SA 5000, Australia
| | - Jakub Jagiello
- Department
of Orthopaedics and Trauma Surgery, Royal
Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Paul H. Anderson
- Clinical
and Health Sciences, Health and Biomedical Innovation, University of South Australia, Adelaide, SA 5000, Australia
| | - Peter Hoffmann
- Clinical
and Health Sciences, University of South
Australia, Adelaide, SA 5000, Australia
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22
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Mononen ME, Paz A, Liukkonen MK, Turunen MJ. Atlas-based finite element analyses with simpler constitutive models predict personalized progression of knee osteoarthritis: data from the osteoarthritis initiative. Sci Rep 2023; 13:8888. [PMID: 37264050 DOI: 10.1038/s41598-023-35832-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 05/24/2023] [Indexed: 06/03/2023] Open
Abstract
New technologies are required to support a radical shift towards preventive healthcare. Here we focus on evaluating the possibility of finite element (FE) analysis-aided prevention of knee osteoarthritis (OA), a disease that affects 100 million citizens in the US and EU and this number is estimated to increase drastically. Current clinical methods to diagnose or predict joint health status relies on symptoms and tissue failures obtained from clinical imaging. In a joint with no detectable injuries, the diagnosis of the future health of the knee can be assumed to be very subjective. Quantitative approaches are therefore needed to assess the personalized risk for the onset and development of knee OA. FE analysis utilizing an atlas-based modeling approach has shown a preliminary capability for simulating subject-specific cartilage mechanical responses. However, it has been verified with a very limited subject number. Thus, the aim of this study is to verify the real capability of the atlas-based approach to simulate cartilage degeneration utilizing different material descriptions for cartilage. A fibril reinforced poroviscoelastic (FRPVE) material formulation was considered as state-of-the-art material behavior, since it has been preliminary validated against real clinical follow-up data. Simulated mechanical tissue responses and predicted cartilage degenerations within knee joint with FRPVE material were compared against simpler constitutive models for cartilage. The capability of the atlas-based modeling to offer a feasible approach with quantitative evaluation for the risk for the OA development (healthy vs osteoarthritic knee, p < 0.01, AUC ~ 0.7) was verified with 214 knees. Furthermore, the results suggest that accuracy for simulation of cartilage degeneration with simpler material models is similar to models using FPRVE materials if the material parameters are chosen properly.
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Affiliation(s)
- Mika E Mononen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland.
| | - Alexander Paz
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
- Escuela de Ingeniería Civil y Geomática, Universidad del Valle, Cali, Colombia
| | - Mimmi K Liukkonen
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
| | - Mikael J Turunen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
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23
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Longstaffe R, Shahid K, Verrelli A, Loucks L, Bohm E. Outcomes and motives for not proceeding with the second stage bilateral knee replacement: a comparison of cancelled and completed bilateral total knee arthroplasty. Can J Surg 2023; 66:E97-E102. [PMID: 36813302 PMCID: PMC9970620 DOI: 10.1503/cjs.008621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Staged bilateral total knee arthroplasty (TKA) is a common treatment option for patients with bilateral symptomatic knee osteoarthritis, yet some patients do not proceed with their second procedure. Our study aimed to identify the rate and reasons why patients did not proceed with their second procedure and compare their functional outcomes, satisfaction and complication rates with those of patients who had completed a staged bilateral TKA. METHODS We determined the proportion of patients who underwent TKA but did not proceed with planned surgery for the second knee within 2 years, and compared their satisfaction with surgery, improvement in the Oxford Knee Score (OKS) and complications between groups. RESULTS Our study included 268 patients: 220 patients who underwent staged bilateral TKA and 48 patients who cancelled their second procedure. The most common reason for not proceeding with the second procedure was a slow recovery after the first TKA (43.2%), followed by functional improvement in symptoms in the unoperated knee negating the need for surgery (27.3%), poor experience with the first surgery (22.7%), treatment of other comorbidities necessitating cancellation of their second procedure (4.6%) and employment reasons (2.3%). Patients who cancelled their second procedure were noted to have a worse postoperative OKS improvement (p < 0.001) and lower satisfaction rate (p < 0.001), than patients who underwent staged bilateral TKA. CONCLUSION About one-fifth of patients scheduled for staged bilateral TKA declined to proceed with the second knee surgery within 2 years showing a substantially decreased functional outcome and satisfaction rate. However, more than one-quarter (27.3%) of patients noted improvements in their contralateral (unoperated) knee, such that a second surgery was no longer felt to be necessary.
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Affiliation(s)
- Robert Longstaffe
- Concordia Hip and Knee Institute (Longstaffe, Shahid, Verrelli, Loucks, Bohm); Department of Surgery (Longstaffe, Bohm), University of Manitoba; Pan Am Clinic (Longstaffe), Winnipeg, Man; Practice Plus Group Hospital (Shahid), Shepton Mallet, UK
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24
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Holder J, van Drongelen S, Uhlrich SD, Herrmann E, Meurer A, Stief F. Peak knee joint moments accurately predict medial and lateral knee contact forces in patients with valgus malalignment. Sci Rep 2023; 13:2870. [PMID: 36806297 PMCID: PMC9938879 DOI: 10.1038/s41598-023-30058-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
Compressive knee joint contact force during walking is thought to be related to initiation and progression of knee osteoarthritis. However, joint loading is often evaluated with surrogate measures, like the external knee adduction moment, due to the complexity of computing joint contact forces. Statistical models have shown promising correlations between medial knee joint contact forces and knee adduction moments in particularly in individuals with knee osteoarthritis or after total knee replacements (R2 = 0.44-0.60). The purpose of this study was to evaluate how accurately model-based predictions of peak medial and lateral knee joint contact forces during walking could be estimated by linear mixed-effects models including joint moments for children and adolescents with and without valgus malalignment. Peak knee joint moments were strongly correlated (R2 > 0.85, p < 0.001) with both peak medial and lateral knee joint contact forces. The knee flexion and adduction moments were significant covariates in the models, strengthening the understanding of the statistical relationship between both moments and medial and lateral knee joint contact forces. In the future, these models could be used to evaluate peak knee joint contact forces from musculoskeletal simulations using peak joint moments from motion capture software, obviating the need for time-consuming musculoskeletal simulations.
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Affiliation(s)
- Jana Holder
- Movement Analysis Laboratory, Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt/Main, Germany. .,Department of Sport and Exercise Science, University of Salzburg, Salzburg, Austria.
| | - Stefan van Drongelen
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Scott David Uhlrich
- grid.168010.e0000000419368956Department of Bioengineering, Stanford University, Stanford, CA USA ,grid.280747.e0000 0004 0419 2556Musculoskeletal Research Lab, VA Palo Alto Healthcare System, Palo Alto, CA USA
| | - Eva Herrmann
- grid.7839.50000 0004 1936 9721Institute of Biostatistics and Mathematical Modeling, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - Andrea Meurer
- Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt/Main, Germany ,Present Address: Medical Park St. Hubertus Klinik, Bad Wiessee, Germany
| | - Felix Stief
- Movement Analysis Laboratory, Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt/Main, Germany ,Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Department of Orthopedics (Friedrichsheim), University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt/Main, Germany
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25
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Amiri P, Davis EM, Outerleys J, Miller RH, Brandon S, Astephen Wilson JL. High tibiofemoral contact and muscle forces during gait are associated with radiographic knee OA progression over 3 years. Knee 2023; 41:245-256. [PMID: 36745960 DOI: 10.1016/j.knee.2023.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/19/2022] [Accepted: 01/13/2023] [Indexed: 02/08/2023]
Abstract
BACKGROUND The objective of this study was to investigate differences in tibiofemoral joint contact forces between individuals with moderate medial OA who exhibit radiographic knee OA progression within 3 years versus those who do not, and to understand the relationship between model-predicted contact forces and net external moments for this population. METHODS 27 individuals with moderate medial compartment knee OA underwent baseline instrumented gait analysis. OA progressors were defined as those who experienced at least a one grade increase in medial joint space narrowing at three years. An electromyography-driven musculoskeletal model was used to estimate muscle and tibiofemoral contact forces at baseline, which were compared between progressors and non-progressors using t-tests. RESULTS Seven individuals experienced radiographic OA progression by 3 years. Progressors walked with significantly higher peaks of medial and total tibiofemoral contact forces, and higher impulse of medial contact forces. Significant and high correlations were found between: first peaks of medial and total contact forces with first peak of the knee adduction moment (R2 = 0.74; R2 = 0.59); second peaks of medial and total knee contact forces with second peaks of knee adduction and flexion moments (R2 = 0.71; R2 = 0.68); medial knee contact force impulse with knee adduction moment impulse (R2 = 0.76). CONCLUSIONS Higher tibiofemoral joint contact forces during walking were associated with three-year radiographic knee OA progression based on medial joint space narrowing. These results support the need for strategies that reduce compressive knee contact forces through the reduction of adduction and flexion moments during walking.
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Affiliation(s)
- Pouya Amiri
- School of Kinesiology and Health Studies, Queen's University, Kingston, Canada.
| | - Elysia M Davis
- School of Biomedical Engineering, Dalhousie University, Halifax, Canada
| | - Jereme Outerleys
- Department of Mechanical and Materials Engineering, Queen's University, Kingston, Canada
| | - Ross H Miller
- Department of Kinesiology, University of Maryland, Maryland, USA
| | - Scott Brandon
- School of Engineering, University of Guelph, Guelph, Canada
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26
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The biomechanical fingerprint of hip and knee osteoarthritis patients during activities of daily living. Clin Biomech (Bristol, Avon) 2023; 101:105858. [PMID: 36525720 DOI: 10.1016/j.clinbiomech.2022.105858] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Osteoarthritis is a highly prevalent disease affecting the hip and knee joint and is characterized by load-mediated pain and decreased quality of life. Dependent on involved joint, patients present antalgic movement compensations, aiming to decrease loading on the involved joint. However, the associated alterations in mechanical loading of the ipsi- and contra-lateral lower limb joints, are less documented. Here, we documented the biomechanical fingerprint of end-stage hip and knee osteoarthritis patients in terms of ipsilateral and contralateral hip and knee loading during walking and stair ambulation. METHODS Three-dimensional motion-analysis was performed in 20 hip, 18 knee osteoarthritis patients and 12 controls during level walking and stair ambulation. Joint contact forces were calculated using a standard musculoskeletal modelling workflow in Opensim. Involved and contralateral hip and knee joint loading was compared against healthy controls using independent t-tests (p < 0.05). FINDINGS Both hip and knee cohorts significantly decreased loading of the involved joint during gait and stair ambulation. Hip osteoarthritis patients presented no signs of ipsilateral knee nor contralateral leg overloading, during walking and stair ascending. However, knee osteoarthritis patients significantly increased loading at the ipsilateral hip, and contralateral hip and knee joints during stair ambulation compared to controls. INTERPRETATION The biomechanical fingerprint in knee and hip osteoarthritis patients confirmed antalgic movement strategies to unload the involved leg during gait. Only during stair ambulation in knee osteoarthritis patients, movement adaptations were confirmed that induced unbalanced intra- and inter-limb loading conditions, which are known risk factors for secondary osteoarthritis.
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27
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Tomasi M, Artoni A, Mattei L, Di Puccio F. On the estimation of hip joint loads through musculoskeletal modeling. Biomech Model Mechanobiol 2022; 22:379-400. [PMID: 36571624 DOI: 10.1007/s10237-022-01668-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 12/04/2022] [Indexed: 12/27/2022]
Abstract
Noninvasive estimation of joint loads is still an open challenge in biomechanics. Although musculoskeletal modeling represents a solid resource, multiple improvements are still necessary to obtain accurate predictions of joint loads and to translate such potential into practical utility. The present study, focused on the hip joint, is aimed at reviewing the state-of-the-art literature on the estimation of hip joint reaction forces through musculoskeletal modeling. Our literature inspection, based on well-defined selection criteria, returned seventeen works, which were compared in terms of methods and results. Deviations between predicted and in vivo measured hip joint loads, taken from the OrthoLoad database, were assessed through quantitative deviation indices. Despite the numerous modeling and computational improvements made over the last two decades, predicted hip joint loads still deviate from their experimental counterparts and typically overestimate them. Several critical aspects have emerged that affect muscle force estimation, hence joint loads. Among them, the physical fidelity of the musculoskeletal model, with its parameters and geometry, plays a crucial role. Also, predicted joint loads are markedly affected by the selected muscle recruitment strategy, which reflects the underlying motor control policy. Practical guidelines for researchers interested in noninvasive estimation of hip joint loads are also provided.
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Affiliation(s)
- Matilde Tomasi
- Department of Civil and Industrial Engineering, Università di Pisa, Pisa, Italy
| | - Alessio Artoni
- Department of Civil and Industrial Engineering, Università di Pisa, Pisa, Italy
| | - Lorenza Mattei
- Department of Civil and Industrial Engineering, Università di Pisa, Pisa, Italy.,Sport and Anatomy Centre, Università di Pisa, Pisa, Italy
| | - Francesca Di Puccio
- Department of Civil and Industrial Engineering, Università di Pisa, Pisa, Italy. .,Sport and Anatomy Centre, Università di Pisa, Pisa, Italy.
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28
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Tayfur B, Charuphongsa C, Morrissey D, Miller SC. Neuromuscular joint function in knee osteoarthritis: A systematic review and meta-analysis. Ann Phys Rehabil Med 2022; 66:101662. [PMID: 35364316 DOI: 10.1016/j.rehab.2022.101662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/11/2022] [Accepted: 02/16/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Neuromuscular alterations are common in people with knee osteoarthritis (KOA). A comprehensive understanding of these alterations is important to enable targeted rehabilitation strategies. OBJECTIVES This systematic review and meta-analysis aimed to comprehensively understand the neuromuscular alterations around the knee joint in people with KOA. METHODS Moderate- and high-quality studies based on a modified version of the Downs and Black checklist, comparing neuromuscular function of peri‑articular muscles between people with KOA and controls were retrieved from five databases from inception to October 2020. Outcomes included normalized isokinetic strength, muscle size, voluntary activation, cortical and spinal-reflex excitability, and torque-related outcomes. Data were pooled according to structural KOA severity with sensitivity analysis based on sex. Evidence levels are presented in evidence gap maps. RESULTS A total of 7 high-quality and 22 moderate-quality studies were retained (1146 people with KOA and 1353 age- and sex-matched controls). Studies demonstrated quadriceps and hamstring strength deficits and increased hamstring-to-quadriceps strength ratios across KOA severities. Women presented lower quadriceps strength at early KOA (very limited evidence) and lower voluntary activation at end stage KOA (very limited evidence) as compared with controls, whereas men did not (moderate evidence). People with KOA also demonstrated lower quadriceps force control ability with no change in rapid force production (very limited evidence). Voluntary activation deficits for quadriceps were evident (moderate evidence), with no change in quadriceps cortical excitability (very limited evidence) or soleus spinal reflexes (very limited evidence). No muscle size change was demonstrated except for the vastus medialis (limited evidence). Evidence gaps were found for neural and torque-related measures and differences in hamstring, gastrocnemius, soleus, and popliteus. CONCLUSIONS Neuromuscular deficits are evident across different structural KOA severities and are seen in muscle strength, voluntary activation, muscle size, and force control ability. Women may exhibit these alterations to a greater extent than men. PROSPERO REGISTRATION NUMBER CRD42019160845.
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Affiliation(s)
- Beyza Tayfur
- Sports and Exercise Medicine, Queen Mary University of London, London, United Kingdom.
| | - Chedsada Charuphongsa
- Sports and Exercise Medicine, Queen Mary University of London, London, United Kingdom
| | - Dylan Morrissey
- Sports and Exercise Medicine, Queen Mary University of London, London, United Kingdom; Physiotherapy Department, Barts Health NHS trust, London E1 4DG, United Kingdom
| | - Stuart Charles Miller
- Sports and Exercise Medicine, Queen Mary University of London, London, United Kingdom
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29
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Wang S, Hase K, Kita S, Ogaya S. Biomechanical effects of medial meniscus radial tears on the knee joint during gait: A concurrent finite element musculoskeletal framework investigation. Front Bioeng Biotechnol 2022; 10:957435. [PMID: 36299291 PMCID: PMC9589217 DOI: 10.3389/fbioe.2022.957435] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/26/2022] [Indexed: 11/22/2022] Open
Abstract
The biomechanical variation in the knee during walking that accompanies medial meniscal radial tears stemming from knee osteoarthritis (OA) has not been explored. This study introduced a finite element musculoskeletal model using concurrent lower limb musculoskeletal dynamics and knee joint finite element analysis in a single framework and expanded the models to include knees with medial meniscal radial tears and total medial meniscectomy. The radial tears involved three locations: anterior horn, midbody, and posterior horn with grades of 33%, 50%, and 83% of the meniscus width. The shear and hoop stresses of the tear meniscus and tibial cartilage contact load, accompanying tears, and postmeniscectomy were evaluated during the stance phase of the gait cycle using the models. In the 83% width midbody tear group, shear stress at the end of the tear was significantly greater than in the intact meniscus and other tear groups, and the maximum shear stress was increased by 310% compared to the intact meniscus. A medial meniscus radial tear has a much smaller effect on the tibial cartilage load (even though in the 83% width tear, the cartilage/total load ratio increased by only 9%). However, the contact force on the tibial cartilage with total postmeniscectomy was increased by 178.93% compared with a healthy intact meniscus, and the peak contact pressure after meniscectomy increased from 11.94 to 12.45 MPa to 17.64 and 13.76 MPa, at the maximum weight acceptance and push-off, respectively. Our study shows that radial tears with larger medial meniscus widths are prone to high stress concentrations at the end of the tears, leading to the potential risk of complete meniscal rupture. Furthermore, although the tears did not change the cartilage load distribution, they disrupted the circumferential stress-transmitting function of the meniscus, thus greatly increasing the likelihood of the onset of knee OA. The significant increase in the tibial cartilage load with total postmeniscectomy indicates a potential risk of OA flare-ups. This study contributes to a better understanding of meniscal tear-induced OA biomechanical changes during human activities and offers some potential directions for surgical guidance of meniscectomies and the prophylaxis and treatment of OA.
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Affiliation(s)
- Sentong Wang
- Human-Mechanical System Laboratory, Graduate School of Systems Design, Tokyo Metropolitan University, Hachioji, Japan
- *Correspondence: Sentong Wang, ; Kazunori Hase,
| | - Kazunori Hase
- Human-Mechanical System Laboratory, Faculty of Systems Design, Tokyo Metropolitan University, Hachioji, Japan
- *Correspondence: Sentong Wang, ; Kazunori Hase,
| | - Shunsuke Kita
- Biomechanics of Exercise and Sports in Physical Therapy Laboratory, Graduate Course of Health and Social Services, Saitama Prefectural University, Koshigaya, Japan
- Department of Rehabilitation, Soka Orthopedics Internal Medicine, Saitama, Japan
| | - Shinya Ogaya
- Biomechanics of Exercise and Sports in Physical Therapy Laboratory, Department of Physical Therapy, Saitama Prefectural University, Koshigaya, Japan
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30
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Tang Y, Li Y, Yang M, Zheng X, An B, Zheng J. The effect of hip abductor fatigue on knee kinematics and kinetics during normal gait. Front Neurosci 2022; 16:1003023. [PMID: 36267239 PMCID: PMC9577318 DOI: 10.3389/fnins.2022.1003023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/12/2022] [Indexed: 12/03/2022] Open
Abstract
Objective To investigate the effect of hip abductor fatigue on the kinematics and kinetics of the knee joint during walking in healthy people to provide a new approach for the prevention and treatment of knee-related injuries and diseases. Methods Twenty healthy participants, ten females, and ten males, with a mean age of 25.10 ± 1.2 years, were recruited. Isometric muscle strength testing equipment was used to measure the changes in muscle strength before and after fatigue, and the surface electromyography (SEMG) data during fatigue were recorded synchronously. The Vicon system and an AMTI© force platform were used to record the kinematic parameters and ground reaction force (GRF) of twenty participants walking at a self-selected speed before and after fatigue. Visual 3D software was used to calculate the angles and torques of the hip and knee joints. Results After fatigue, the muscle strength, median frequency (MF) and mean frequency (MNF) of participants decreased significantly (P < 0.001). The sagittal plane range of motion (ROM) of the knee (P < 0.0001) and hip joint (P < 0.01) on the fatigue side was significantly smaller than before fatigue. After fatigue, the first and second peaks of the external knee adduction moment (EKAM) in participants were greater than before fatigue (P < 0.0001), and the peak values of the knee abduction moment were also higher than those before fatigue (P < 0.05). On the horizontal plane, there is also a larger peak of internal moment during walking after fatigue (P < 0.01). Conclusion Hip abductor fatigue affects knee kinematics and kinetics during normal gait. Therefore, evaluating hip abductor strength and providing intensive training for patients with muscle weakness may be an important part of preventing knee-related injuries.
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Affiliation(s)
- Yuting Tang
- Department of Rehabilitation, Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yanfeng Li
- Department of Rehabilitation, Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Maosha Yang
- Department of Rehabilitation, The Second Rehabilitation Hospital, Shanghai, China
| | - Xiao Zheng
- Department of Rehabilitation, Municipal Hospital of Traditional Chinese Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Xiao Zheng,
| | - Bingchen An
- Department of Rehabilitation, HuaDong Hospital, FuDan University, Shanghai, China
- Bingchen An,
| | - Jiejiao Zheng
- Department of Rehabilitation, HuaDong Hospital, FuDan University, Shanghai, China
- Jiejiao Zheng,
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Alesi D, Bordini B, Fratini S, Ancarani C, Agostinone P, Grassi A, Marcheggiani Muccioli GM, Viceconti M, Zaffagnini S. Lateral unicompartmental knee arthroplasty (UKA) showed a lower risk of failure compared to medial unicompartmental knee arthroplasty in the Register of Prosthetic Orthopedic Implants (RIPO). Arch Orthop Trauma Surg 2022; 143:3363-3368. [PMID: 36156122 DOI: 10.1007/s00402-022-04631-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/18/2022] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The present study aimed to investigate differences in survivorship between medial and lateral unicompartmental knee arthroplasty (UKA) by analyzing the data of an Italian regional registry. The hypothesis was that, according to recent literature, lateral implants have comparable survivorship with regard to the medial implants. MATERIALS AND METHODS The Register of Orthopaedic Prosthetic Implants (RIPO) of Emilia-Romagna (Italy) database was searched for all UKAs between July 1, 2000, and December 31, 2019. For both cohorts, subject demographics and reasons for revision were presented as a percentage of the total cohort. Kaplan-Meier survivorship analysis was performed using revision of any component as the endpoint and survival times of unrevised UKAs taken as the last observation date (December 31, 2019, or date of death). RESULTS Patients living outside the region and symmetrical implants (which do not allow the compartment operated to be traced) were excluded. 5571 UKAs implanted on 5172 patients (5215 medial UKAs and 356 lateral UKAs) were included in the study. The survivorship analysis revealed 13 failures out of 356 lateral UKAs (3.7%) at a mean follow-up of 6.3 years and 495 failures out of 5215 medial UKAs (9.5%) at a mean follow-up of 6.7 years. The medial UKAs had a significantly higher risk of failure, with a Hazard Ratio of 2.6 (CI 95% 1.6-4.8; p < 0.001), adjusted for age, gender, weight, and mobility of the insert. Both the groups revealed a good survival rate, with 95.2% of lateral implants and 87.5% of medial implants still in situ at 10 years of follow-up. CONCLUSIONS Lateral UKA is a safe procedure showing longer survivorship than medial UKAs (95.2% and 87.5% at 10 years, respectively) in the present study. LEVEL OF EVIDENCE Level 3, therapeutic study.
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Affiliation(s)
- Domenico Alesi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy.
| | - Barbara Bordini
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, BO, Italy
| | - Stefano Fratini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
| | - Cristina Ancarani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, BO, Italy
| | - Piero Agostinone
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
| | | | - Marco Viceconti
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136, Bologna, BO, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica II, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, BO, Italy
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Finnilä MAJ, Das Gupta S, Turunen MJ, Hellberg I, Turkiewicz A, Lutz-Bueno V, Jonsson E, Holler M, Ali N, Hughes V, Isaksson H, Tjörnstrand J, Önnerfjord P, Guizar-Sicairos M, Saarakkala S, Englund M. Mineral Crystal Thickness in Calcified Cartilage and Subchondral Bone in Healthy and Osteoarthritic Human Knees. J Bone Miner Res 2022; 37:1700-1710. [PMID: 35770824 PMCID: PMC9540032 DOI: 10.1002/jbmr.4642] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 05/17/2022] [Accepted: 06/26/2022] [Indexed: 11/08/2022]
Abstract
Osteoarthritis (OA) is the most common joint disease, where articular cartilage degradation is often accompanied with sclerosis of the subchondral bone. However, the association between OA and tissue mineralization at the nanostructural level is currently not understood. In particular, it is technically challenging to study calcified cartilage, where relevant but poorly understood pathological processes such as tidemark multiplication and advancement occur. Here, we used state-of-the-art microfocus small-angle X-ray scattering with a 5-μm spatial resolution to determine the size and organization of the mineral crystals at the nanostructural level in human subchondral bone and calcified cartilage. Specimens with a wide spectrum of OA severities were acquired from both medial and lateral compartments of medial compartment knee OA patients (n = 15) and cadaver knees (n = 10). Opposing the common notion, we found that calcified cartilage has thicker and more mutually aligned mineral crystals than adjoining bone. In addition, we, for the first time, identified a well-defined layer of calcified cartilage associated with pathological tidemark multiplication, containing 0.32 nm thicker crystals compared to the rest of calcified cartilage. Finally, we found 0.2 nm thicker mineral crystals in both tissues of the lateral compartment in OA compared with healthy knees, indicating a loading-related disease process because the lateral compartment is typically less loaded in medial compartment knee OA. In summary, we report novel changes in mineral crystal thickness during OA. Our data suggest that unloading in the knee might be involved with the growth of mineral crystals, which is especially evident in the calcified cartilage. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Mikko A J Finnilä
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.,Medical Research Center, University of Oulu, Oulu, Finland
| | - Shuvashis Das Gupta
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Mikael J Turunen
- Department of Applied Physics, Faculty of Science and Forestry, University of Eastern Finland, Kuopio, Finland
| | - Iida Hellberg
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Aleksandra Turkiewicz
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | | | - Elin Jonsson
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Mirko Holler
- Paul Scherrer Institut, Villigen PSI, Switzerland
| | - Neserin Ali
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Velocity Hughes
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Jon Tjörnstrand
- Department of Orthopaedics, Skåne University Hospital, Lund, Sweden
| | - Patrik Önnerfjord
- Rheumatology and Molecular Skeletal Biology, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | | | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
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The Effect of Core Stabilization Training on Improving Gait and Self-Perceived Function in Patients with Knee Osteoarthritis: A Single-Arm Clinical Trial. PATHOPHYSIOLOGY 2022; 29:495-506. [PMID: 36136067 PMCID: PMC9505132 DOI: 10.3390/pathophysiology29030040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/26/2022] [Accepted: 08/27/2022] [Indexed: 11/17/2022] Open
Abstract
The treatment of patients with knee osteoarthritis is typically focused on the involved lower extremity. There is a gap in the literature concerning the effectiveness of core stabilization training on the treatment of patients with knee osteoarthritis. This investigation aimed to determine whether core stabilization improved the gait and functional ability of patients with knee osteoarthritis. Eighteen participants with knee osteoarthritis completed the six-week core stabilization intervention. Participants completed the gait motion analysis and the Knee Injury and Osteoarthritis Outcome Score to assess self-perceived function, pre- and post-intervention. Gait speed improved (p = 0.006, d = 0.59), while the external knee adduction moment decreased (p = 0.034, d = −0.90). Moreover, self-reported function improved (p < 0.001, d = 1.26). The gait speed and external knee adduction moment changes met minimal detectable change thresholds, while gait speed also met the minimal clinically important difference. A six-week core stabilization program can thus improve gait speed and reduce the external knee adduction moment, which is tied to disease progression. Increased functional scores post-intervention indicate an important clinical improvement. Core stabilization training is a safe and potentially effective treatment option for this population.
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Forgivingness of an Anteromedially Positioned Small Locked Plate for High Tibial Osteotomy in Case of Overcorrection and Lateral Hinge Fracture. LIFE (BASEL, SWITZERLAND) 2022; 12:life12081265. [PMID: 36013443 PMCID: PMC9409794 DOI: 10.3390/life12081265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 11/17/2022]
Abstract
High tibial osteotomy (HTO) represents a sensible treatment option for patients with moderate unicondylar osteoarthritis of the knee and extraarticular malalignment. The possibility of a continuously variable correction setting and a surgical approach low in complications has meant that the medial opening osteotomy has prevailed over the past decades. The objective of the present study was to determine whether anteromedially positioned small plates are nevertheless forgiving under biomechanically unfavourable conditions (overcorrection and lateral hinge fracture). In this study, a simulated HTO was performed on composite tibiae with a 10-mm wedge and fixed-angle anteromedial osteosynthesis with a small implant. Force was applied axially in a neutral mechanical axis, a slight and a marked overcorrection into valgus, with and without a lateral hinge fracture in each case. At the same time, a physiological gait with a dual-peak force profile and a peak load of 2.4 kN was simulated. Interfragmentary motion and rigidity were determined. The rigidity of the osteosynthesis increased over the cycles investigated. A slight overcorrection into valgus led to the lowest interfragmentary motion, compared with pronounced valgisation and neutral alignment. A lateral hinge fracture led to a significant decrease in rigidity and increase in interfragmentary motion. However, in no case was the limit of 1 mm interfragmentary motion critical for osteotomy healing exceeded. The degree of correction of the leg axis, and the presence of a lateral hinge fracture, have an influence on rigidity and interfragmentary motion. From a mechanically neutral axis ranging up to pronounced overcorrection, the implant investigated offers sufficient stability to allow healing of the osteotomy, even if a lateral hinge fracture is present.
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Wu W, Bryant AL, Hinman RS, Bennell KL, Metcalf BR, Hall M, Campbell PK, Paterson KL. Walking-related knee contact forces and associations with knee pain across people with mild, moderate and severe radiographic knee osteoarthritis: a cross-sectional study. Osteoarthritis Cartilage 2022; 30:832-842. [PMID: 35306125 DOI: 10.1016/j.joca.2022.02.619] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 01/28/2022] [Accepted: 02/22/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate knee contact forces (KCFs), and their relationships with knee pain, across grades of radiographic knee osteoarthritis (OA) severity. DESIGN Cross-sectional exploratory analysis of 164 participants with medial knee OA. Radiographic severity was classified as mild (grade 2), moderate (grade 3) or severe (grade 4) using the Kellgren & Lawrence (KL) scale. Walking knee pain was assessed using an 11-point numerical rating scale. External knee adduction moment (external KAM) and internal muscle forces were used to calculate medial, lateral and total KCFs using a musculoskeletal computational model. Force-time series across stance phase of gait were compared across KL grades using Statistical Parametric Mapping. Associations between KCFs and pain across KL grades were assessed using linear models. RESULTS Medial KCFs during early and middle stance were higher in participants with KL3 and KL4 compared to those with KL2. In contrast, lateral KCFs were higher in those with KL2 compared to KL3 and KL4 in middle to late stance. The external loading component (i.e., KAM) of the medial KCF during middle to late stance was also greater in participants with KL3 and KL4 compared to those with KL2, whereas the internal (i.e., muscle) component was greater in those with KL3 and KL4 compared to KL3 during early stance. There were no associations between medial KCF and knee pain in any KL grade. CONCLUSIONS Medial and lateral KCFs differ between mild, moderate and severe radiographic knee OA but are not associated with knee pain severity for any radiographic OA grade.
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Affiliation(s)
- W Wu
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - A L Bryant
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - R S Hinman
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - K L Bennell
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - B R Metcalf
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - M Hall
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - P K Campbell
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia
| | - K L Paterson
- Centre for Health, Exercise and Sports Medicine, The University of Melbourne, Melbourne, Australia.
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36
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Banger MS, Doonan J, Jones BG, MacLean AD, Rowe PJ, Blyth MJG. Are there functional biomechanical differences in robotic arm-assisted bi-unicompartmental knee arthroplasty compared with conventional total knee arthroplasty? A prospective, randomized controlled trial. Bone Joint J 2022; 104-B:433-443. [PMID: 35360949 DOI: 10.1302/0301-620x.104b4.bjj-2021-0837.r1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to compare any differences in the primary outcome (biphasic flexion knee moment during gait) of robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) at one year post-surgery. METHODS A total of 76 patients (34 bi-UKA and 42 TKA patients) were analyzed in a prospective, single-centre, randomized controlled trial. Flat ground shod gait analysis was performed preoperatively and one year postoperatively. Knee flexion moment was calculated from motion capture markers and force plates. The same setup determined proprioception outcomes during a joint position sense test and one-leg standing. Surgery allocation, surgeon, and secondary outcomes were analyzed for prediction of the primary outcome from a binary regression model. RESULTS Both interventions were shown to be effective treatment options, with no significant differences shown between interventions for the primary outcome of this study (18/35 (51.4%) biphasic TKA patients vs 20/31 (64.5%) biphasic bi-UKA patients; p = 0.558). All outcomes were compared to an age-matched, healthy cohort that outperformed both groups, indicating residual deficits exists following surgery. Logistic regression analysis of primary outcome with secondary outcomes indicated that the most significant predictor of postoperative biphasic knee moments was preoperative knee moment profile and trochlear degradation (Outerbridge) (R2 = 0.381; p = 0.002, p = 0.046). A separate regression of alignment against primary outcome indicated significant bi-UKA femoral and tibial axial alignment (R2 = 0.352; p = 0.029), and TKA femoral sagittal alignment (R2 = 0.252; p = 0.016). The bi-UKA group showed a significant increased ability in the proprioceptive joint position test, but no difference was found in more dynamic testing of proprioception. CONCLUSION Robotic arm-assisted bi-UKA demonstrated equivalence to TKA in achieving a biphasic gait pattern after surgery for osteoarthritis of the knee. Both treatments are successful at improving gait, but both leave the patients with a functional limitation that is not present in healthy age-matched controls. Cite this article: Bone Joint J 2022;103-B(4):433-443.
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Affiliation(s)
- Matthew S Banger
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - James Doonan
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Bryn G Jones
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Angus D MacLean
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
| | - Philip J Rowe
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, UK
| | - Mark J G Blyth
- Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
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Esrafilian A, Stenroth L, Mononen ME, Vartiainen P, Tanska P, Karjalainen PA, Suomalainen JS, Arokoski JPA, Saxby DJ, Lloyd DG, Korhonen RK. Towards Tailored Rehabilitation by Implementation of a Novel Musculoskeletal Finite Element Analysis Pipeline. IEEE Trans Neural Syst Rehabil Eng 2022; 30:789-802. [PMID: 35286263 DOI: 10.1109/tnsre.2022.3159685] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Tissue-level mechanics (e.g., stress and strain) are important factors governing tissue remodeling and development of knee osteoarthritis (KOA), and hence, the success of physical rehabilitation. To date, no clinically feasible analysis toolbox has been introduced and used to inform clinical decision making with subject-specific in-depth joint mechanics of different activities. Herein, we utilized a rapid state-of-the-art electromyography-assisted musculoskeletal finite element analysis toolbox with fibril-reinforced poro(visco)elastic cartilages and menisci to investigate knee mechanics in different activities. Tissue mechanical responses, believed to govern collagen damage, cell death, and fixed charge density loss of proteoglycans, were characterized within 15 patients with KOA while various daily activities and rehabilitation exercises were performed. Results showed more inter-participant variation in joint mechanics during rehabilitation exercises compared to daily activities. Accordingly, the devised workflow may be used for designing subject-specific rehabilitation protocols. Further, results showed the potential to tailor rehabilitation exercises, or assess capacity for daily activity modifications, to optimally load knee tissue, especially when mechanically-induced cartilage degeneration and adaptation are of interest.
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Esrafilian A, Stenroth L, Mononen ME, Vartiainen P, Tanska P, Karjalainen PA, Suomalainen JS, Arokoski J, Saxby DJ, Lloyd DG, Korhonen RK. An EMG-assisted muscle-force driven finite element analysis pipeline to investigate joint- and tissue-level mechanical responses in functional activities: towards a rapid assessment toolbox. IEEE Trans Biomed Eng 2022; 69:2860-2871. [PMID: 35239473 DOI: 10.1109/tbme.2022.3156018] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Joint tissue mechanics (e.g., stress and strain) are believed to have a major involvement in the onset and progression of musculoskeletal disorders, e.g., knee osteoarthritis (KOA). Accordingly, considerable efforts have been made to develop musculoskeletal finite element (MS-FE) models to estimate highly detailed tissue mechanics that predict cartilage degeneration. However, creating such models is time-consuming and requires advanced expertise. This limits these complex, yet promising MS-FE models to research applications with few participants and makes the models impractical for clinical assessments. Also, these previously developed MS-FE models have not been used to assess activities other than gait. This study introduces and verifies a semi-automated rapid state-of-the-art MS-FE modeling and simulation toolbox incorporating an electromyography- (EMG) assisted MS model and a muscle-force driven FE model of the knee with fibril-reinforced poro(visco)elastic cartilages and menisci. To showcase the usability of the pipeline, we estimated joint- and tissue-level knee mechanics in 15 KOA individuals performing different daily activities. The pipeline was verified by comparing the estimated muscle activations and joint mechanics to existing experimental data. To determine the importance of EMG-assisted MS approach, results were compared to those from the same FE models but driven by static-optimization-based MS models. The EMG-assisted MS-FE pipeline bore a closer resemblance to experiments compared to the static-optimization-based MS-FE pipeline. Importantly, the developed pipeline showed great potential as a rapid MS-FE analysis toolbox to investigate multiscale knee mechanics during different activities of individuals with KOA. The template FE model of the study is freely available here.
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Zaki S, Blaker CL, Little CB. OA foundations - experimental models of osteoarthritis. Osteoarthritis Cartilage 2022; 30:357-380. [PMID: 34536528 DOI: 10.1016/j.joca.2021.03.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/01/2021] [Accepted: 03/10/2021] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) is increasingly recognised as a disease of diverse phenotypes with variable clinical presentation, progression, and response to therapeutic intervention. This same diversity is readily apparent in the many animal models of OA. However, model selection, study design, and interpretation of resultant findings, are not routinely done in the context of the target human (or veterinary) patient OA sub-population or phenotype. This review discusses the selection and use of animal models of OA in discovery and therapeutic-development research. Beyond evaluation of the different animal models on offer, this review suggests focussing the approach to OA-animal model selection on study objective(s), alignment of available models with OA-patient sub-types, and the resources available to achieve valid and translatable results. How this approach impacts model selection is discussed and an experimental design checklist for selecting the optimal model(s) is proposed. This approach should act as a guide to new researchers and a reminder to those already in the field, as to issues that need to be considered before embarking on in vivo pre-clinical research. The ultimate purpose of using an OA animal model is to provide the best possible evidence if, how, when and where a molecule, pathway, cell or process is important in clinical disease. By definition this requires both model and study outcomes to align with and be predictive of outcomes in patients. Keeping this at the forefront of research using pre-clinical OA models, will go a long way to improving the quality of evidence and its translational value.
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Affiliation(s)
- S Zaki
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Australia; Raymond Purves Bone and Joint Research Laboratory, Australia.
| | - C L Blaker
- Raymond Purves Bone and Joint Research Laboratory, Australia; Murray Maxwell Biomechanics Laboratory, The Kolling Institute, University of Sydney Faculty of Medicine and Health, At Royal North Shore Hospital, Australia.
| | - C B Little
- Raymond Purves Bone and Joint Research Laboratory, Australia.
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40
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Mixon A, Bahar-Moni AS, Faisal TR. Mechanical characterization of articular cartilage degraded combinedly with MMP-1 and MMP-9. J Mech Behav Biomed Mater 2022; 129:105131. [DOI: 10.1016/j.jmbbm.2022.105131] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/24/2021] [Accepted: 02/11/2022] [Indexed: 11/29/2022]
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Li M, Zeng Y, Nie Y, Wu Y, Liu Y, Wu L, Shen B. Varus-valgus knee laxity is related to a higher risk of knee osteoarthritis incidence and structural progression: data from the osteoarthritis initiative. Clin Rheumatol 2022; 41:1013-1021. [DOI: 10.1007/s10067-021-06015-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/16/2021] [Accepted: 12/04/2021] [Indexed: 01/02/2023]
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Hall M, van der Esch M, Hinman RS, Peat G, de Zwart A, Quicke JG, Runhaar J, Knoop J, van der Leeden M, de Rooij M, Meulenbelt I, Vliet Vlieland T, Lems WF, Holden MA, Foster NE, Bennell KL. How does hip osteoarthritis differ from knee osteoarthritis? Osteoarthritis Cartilage 2022; 30:32-41. [PMID: 34600121 DOI: 10.1016/j.joca.2021.09.010] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/01/2021] [Accepted: 09/21/2021] [Indexed: 02/02/2023]
Abstract
Hip and knee osteoarthritis (OA) are leading causes of global disability. Most research to date has focused on the knee, with results often extrapolated to the hip, and this extends to treatment recommendations in clinical guidelines. Extrapolating results from research on knee OA may limit our understanding of disease characteristics specific to hip OA, thereby constraining development and implementation of effective treatments. This review highlights differences between hip and knee OA with respect to prevalence, prognosis, epigenetics, pathophysiology, anatomical and biomechanical factors, clinical presentation, pain and non-surgical treatment recommendations and management.
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Affiliation(s)
- M Hall
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia
| | - M van der Esch
- Reade, Center for Rehabilitation and Rheumatology, Amsterdam, the Netherlands; Center of Expertise Urban Vitality, University of Applied Sciences Amsterdam, the Netherlands
| | - R S Hinman
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia
| | - G Peat
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
| | - A de Zwart
- Reade, Center for Rehabilitation and Rheumatology, Amsterdam, the Netherlands
| | - J G Quicke
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
| | - J Runhaar
- Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - J Knoop
- Vrije Universiteit Amsterdam, the Netherlands
| | - M van der Leeden
- Reade, Center for Rehabilitation and Rheumatology, Amsterdam, the Netherlands; Amsterdam UMC, Location VUmc, Department of Rheumatology, Amsterdam, the Netherlands
| | - M de Rooij
- Reade, Center for Rehabilitation and Rheumatology, Amsterdam, the Netherlands
| | | | | | - W F Lems
- Reade, Center for Rehabilitation and Rheumatology, Amsterdam, the Netherlands; Amsterdam UMC, Location VUmc, Department of Rheumatology, Amsterdam, the Netherlands
| | - M A Holden
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK
| | - N E Foster
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, UK; STARS Research and Education Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Hospital and Health Service, Queensland, Australia
| | - K L Bennell
- Centre for Health Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, The University of Melbourne, Australia.
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Increased patellar bone tracer uptake in preoperative SPECT/CT before medial opening high tibial osteotomy correlates with inferior clinical outcome. Knee Surg Sports Traumatol Arthrosc 2022; 30:397-406. [PMID: 34482416 PMCID: PMC8866278 DOI: 10.1007/s00167-021-06717-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/20/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE The purpose of this study was to investigate whether specific bone tracer uptake (BTU) patterns on preoperative SPECT/CT could predict which patients with varus alignment and medial overload would particularly benefit from medial opening-wedge high tibial osteotomy (MOWHTO). It was the hypothesis that an increased preoperative BTU relative to the reference BTU of the femur on SPECT/CT in the lateral and patellar compartments of the knee are predictive factors for inferior clinical outcome and that the clinical outcome correlates with the extent of alignment correction. METHODS Twenty-three knees from 22 patients who underwent MOWHTO for medial compartment overload were investigated preoperatively using Tc-99m-SPECT/CT. BTU was quantified and localised to specific joint areas according to a previously validated scheme. Pre- and postoperative mechanical alignment was measured. Clinical outcome was assessed at a median of 24 months (range 11-30) after MOWHTO by collecting the WOMAC score. RESULTS Significant correlations between BTU in the patellar area and the total WOMAC score and its subcategories pain and stiffness were found. Thus, BTU in the 1sPat area (superior lateral patellar compartment) correlated with total WOMAC (rho = 0.43, p = 0.04), pain subcategory (rho = 0.43, p = 0.04), and stiffness subcategory (rho = 0.59, p = 0.003). No significant correlations were found between alignment correction, age, gender and WOMAC. CONCLUSION This study highlights the role of preoperative SPECT in modern knee surgery to obtain information about the loading pattern on different compartments of the knee. Despite the limited number of participants, the present study shows that a preoperative SPECT/CT scan can help the treating surgeons to identify patients who may be at risk of inferior clinical outcome if an MOWHTO is considered, as an elevated BTU in the patellar region on preoperative SPECT/CT appears to be a potential risk factor for postoperative pain and stiffness. LEVEL OF EVIDENCE Level III.
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Wang S, Hase K, Ota S. A Computationally Efficient Lower Limb Finite Element Musculoskeletal Framework Directly Driven Solely by Inertial Measurement Unit Sensors. J Biomech Eng 2021; 144:1129236. [PMID: 34897395 DOI: 10.1115/1.4053211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Indexed: 11/08/2022]
Abstract
Finite element musculoskeletal (FEMS) approaches using concurrent musculoskeletal and finite element models driven by motion data such as marker-based motion trajectory can provide insight into the interactions between the knee joint secondary kinematics, contact mechanics, and muscle forces in subject-specific biomechanical investigations. However, these data-driven FEMS systems have two major disadvantages that make them challenging to apply in clinical environments: they are computationally expensive and they require expensive and inconvenient equipment for data acquisition. In this study, we developed an FEMS model of the lower limb driven solely by inertial measurement unit sensors that includes the tissue geometries of the entire knee joint and combines muscle modeling and elastic foundation theory-based contact analysis of knee into a single framework. The model requires only the angular velocities and accelerations measured by the sensors as input, and the target outputs (knee contact mechanics, secondary kinematics, and muscle forces) are predicted from the convergence results of iterative calculations of muscle force optimization and knee contact mechanics. To evaluate its accuracy, the model was compared with in vivo experimental data during gait. The maximum contact pressure (12.6 MPa) in the rigid body contact analysis occurred on the medial side of the cartilage at the maximum loading response. The proposed computationally efficient framework drastically reduced the computational time (97.5% reduction) in comparison with the conventional deformable finite element analysis. The developed framework combines measurement convenience and computational efficiency and shows promise for clinical applications.
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Affiliation(s)
- Sentong Wang
- Graduate School of Systems Design, Tokyo Metropolitan University, Tokyo, Japan; 1-1 Minami-Osawa, Hachioji, Tokyo 192-0397, Japan
| | - Kazunori Hase
- Faculty of Systems Design, Tokyo Metropolitan University, Tokyo, Japan; 1-1 Minami-Osawa, Hachioji, Tokyo 192-0397, Japan
| | - Susumu Ota
- Department of Rehabilitation and Care, Seijoh University, Aichi, Japan; 2-172 Fukinodai, Tokai City 476-8588, Japan
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Mazumder O, Poduval M, Ghose A, Sinha A. Walking Pole Gait to Reduce Joint Loading post Total Knee Athroplasty: Musculoskeletal modeling Approach. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4605-4610. [PMID: 34892240 DOI: 10.1109/embc46164.2021.9630849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Excessive knee contact loading is precursor to osteoarthritis and related knee ailment leading to knee athroplasty. Reducing contact loading through gait modifications using assisted pole walking offers noninvasive process of medial load offloading at knee joint. In this paper, we evaluate the efficacy of different configuration of pole walking for reducing contact force at the knee joint through musculoskeletal (MSK) modeling. We have developed a musculoskeletal model for a subject with knee athroplasty utilizing in-vivo implant data and computed tibio-femoral contact force for different pole walking conditions to evaluate the best possible configuration for guiding rehabilitation, correlated with different gait phases. Effect of gait speed variation on knee contact force, hip joint dynamics and muscle forces are simulated using the developed MSK model. Results indicate some interesting trend of load reduction, dependent on loading phases pertaining to different pole configuration. Insights gained from the simulation can aid in designing personalized rehabilitation therapy for subjects suffering from Osteoarthritis.
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Li S, Ng WH, Abujaber S, Shaharudin S. Effects of resistance training on gait velocity and knee adduction moment in knee osteoarthritis patients: a systematic review and meta-analysis. Sci Rep 2021; 11:16104. [PMID: 34373507 PMCID: PMC8352951 DOI: 10.1038/s41598-021-95426-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 07/23/2021] [Indexed: 01/08/2023] Open
Abstract
The systematic review aimed to analyze the effects of resistance training in knee osteoarthritis (OA) rehabilitation from a biomechanical perspective. A meta-analysis was performed to determine the potential benefits of resistance training on patients with knee OA. Relevant studies based on the inclusion and exclusion criteria were selected from CENTRAL, PubMed, Scopus, and Web of Science databases inception to August 2020. Outcome measures included gait velocity and knee adduction moment (KAM). The mean differences of the data with a 95% confidence interval were analyzed using STATA 15.1 software The search identified eight studies that satisfied all the inclusion criteria, in which 164 patients were involved in gait velocity studies and another 122 patients were part of KAM studies. Analysis of the pooled data showed that resistance training significantly improved the gait velocity in patients with knee OA (p < 0.01, z = 2.73), ES (95% CI) = 0.03 (0.01, 0.06) m/s. However, resistance training had no significant effect on improving KAM in patients with knee OA (p = 0.98, z = 0.03), ES (95% CI) = 0.00 (− 0.16, 0.16) percentage of body weight × height (%BW × Ht). Therefore, resistance training may enhance gait velocity but not KAM in knee OA patients. The protocol was registered at PROSPERO (registration number: CRD42020204897).
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Affiliation(s)
- Shuoqi Li
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia
| | - Wei Hui Ng
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia.,Klinik Kesihatan Putrajaya Presint 9, Kementerian Kesihatan Malaysia, 62300, Putrajaya, Wilayah Persekutuan Putrajaya, Malaysia
| | - Sumayeh Abujaber
- School of Rehabilitation Sciences, The University of Jordan, Amman, Jordan
| | - Shazlin Shaharudin
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, 16150, Kota Bharu, Kelantan, Malaysia.
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Stensgaard Stoltze J, Pallari J, Eskandari B, Oliveira AS, Pirscoveanu CI, Rasmussen J, Andersen MS. Development and Functional Testing of An Unloading Concept for Knee Osteoarthritis Patients: A Pilot Study. J Biomech Eng 2021; 144:1114806. [PMID: 34286821 DOI: 10.1115/1.4051847] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Indexed: 11/08/2022]
Abstract
This paper presents a knee brace design that applies an extension moment to unload the muscles in stance phase during gait, and thereby the knee, as alternative to conventional valgus braces for knee osteoarthritis patients. The concept was tested on one healthy subject during normal gait with a prototype, which was designed to activate and deactivate in order to apply the extension moment in the stance phase only and hereby avoid any interference during the swing phase. Electromyography measurements and musculoskeletal models were used to evaluate the brace effects on muscle activation and knee compressive forces respectively. Simulations predicted an ideal reduction of up to 36%, whereas experimental tests revealed a reduction of up to 24% with the current prototype. The prototype brace also reduced the knee joint force impulse up to 9% and EMG peak signal of the vasti muscles with up to 19%. Due to these reductions on a healthy subject, this bracing approach seem promising for reducing knee loads during normal gait. However, further clinical experiments on knee osteoarthritis patients are required to evaluate the effect on both pain and disease progression.
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Affiliation(s)
| | - Jari Pallari
- Aalborg University, Department of Material and Production, Fibigerstraede 16, DK-9220 Aalborg East, Denmark
| | - Behrokh Eskandari
- Newcastle University, School of Engineering, Newcastle upon Tyne NE1 7RU, United Kingdom
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Mixon A, Savage A, Bahar-Moni AS, Adouni M, Faisal T. An in vitro investigation to understand the synergistic role of MMPs-1 and 9 on articular cartilage biomechanical properties. Sci Rep 2021; 11:14409. [PMID: 34257325 PMCID: PMC8277889 DOI: 10.1038/s41598-021-93744-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 06/30/2021] [Indexed: 11/09/2022] Open
Abstract
Matrix metalloproteinases (MMPs) play a crucial role in enzymatically digesting cartilage extracellular matrix (ECM) components, resulting in degraded cartilage with altered mechanical loading capacity. Overexpression of MMPs is often caused by trauma, physiologic conditions and by disease. To understand the synergistic impact MMPs have on cartilage biomechanical properties, MMPs from two subfamilies: collagenase (MMP-1) and gelatinase (MMP-9) were investigated in this study. Three different ratios of MMP-1 (c) and MMP-9 (g), c1:g1, c3:g1 and c1:g3 were considered to develop a degradation model. Thirty samples, harvested from bovine femoral condyles, were treated in groups of 10 with one concentration of enzyme mixture. Each sample was tested in a healthy state prior to introducing degradative enzymes to establish a baseline. Samples were subjected to indentation loading up to 20% bulk strain. Both control and treated samples were mechanically and histologically assessed to determine the impact of degradation. Young's modulus and peak load of the tissue under indentation were compared between the control and degraded cartilage explants. Cartilage degraded with the c3:g1 enzyme concentration resulted in maximum 33% reduction in stiffness and peak load compared to the other two concentrations. The abundance of collagenase is more responsible for cartilage degradation and reduced mechanical integrity.
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Affiliation(s)
- Allison Mixon
- Department of Mechanical Engineering, University of Louisiana at Lafayette, Lafayette, LA, 70503, USA
| | - Andrew Savage
- Department of Biology, University of Louisiana at Lafayette, Lafayette, LA, 70503, USA
| | - Ahmed Suparno Bahar-Moni
- Department of Orthopaedics, Advanced Medical and Dental Institute, Universiti Sains Malaysia, Bertam, 13200, Kepala Batas, Penang, Malaysia
| | - Malek Adouni
- Department of Mechanical Engineering, Australian College of Kuwait, P.O. Box 1411, East Meshrif, Kuwait
| | - Tanvir Faisal
- Department of Mechanical Engineering, University of Louisiana at Lafayette, Lafayette, LA, 70503, USA.
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Brisson NM, Agres AN, Jung TM, Duda GN. Gait Adaptations at 8 Years After Reconstruction of Unilateral Isolated and Combined Posterior Cruciate Ligament Injuries. Am J Sports Med 2021; 49:2416-2425. [PMID: 34115543 PMCID: PMC8283187 DOI: 10.1177/03635465211017147] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND It remains unclear how posterior cruciate ligament (PCL) reconstruction influences long-term lower extremity joint biomechanics. PURPOSE To determine whether patients who underwent PCL reconstruction exhibited long-term alterations in lower limb gait mechanics. STUDY DESIGN Controlled laboratory study. METHODS A total of 26 patients underwent gait analyses at 8.2 ± 2.6 years after primary unilateral PCL reconstruction. Sex- and age-matched healthy controls were analyzed for comparison. Gait data were collected using motion capture and force plates. Hip, knee, and ankle angles and moments were compared during initial contact, early stance, and late stance for the reconstructed and uninjured contralateral limbs of patients who underwent PCL reconstruction (PCL group) as well as the limbs of healthy control participants (CON group). RESULTS No side-to-side kinematic differences were noted between the reconstructed and contralateral limbs of the PCL group; some trivial differences were noted in knee and hip moments. However, major differences between the PCL and CON groups occurred at the knee. Reconstructed and contralateral limbs of the PCL group exhibited larger knee flexion angles during initial contact (Δ = 7.0° [P < .001] and Δ = 6.9° [P < .001], respectively), early stance (Δ = 5.8° [P = .003] and Δ = 6.7° [P < .001], respectively), and late stance (Δ = 7.9° [P < .001] and Δ = 8.0° [P < .001], respectively) compared with the CON group. During early stance, contralateral limbs of the PCL group displayed larger knee flexion moments (Δ = 0.20 N·m/kg; P = .014) compared with the CON group, and both reconstructed (Δ = 0.05 N·m/kg; P = .027) and contralateral (Δ = 0.07 N·m/kg; P = .001) limbs of the PCL group exhibited larger knee external rotation moments compared with the CON group. During late stance, reconstructed and contralateral limbs of the PCL group exhibited smaller knee extension moments (Δ = 0.24 N·m/kg [P < .001] and Δ = 0.26 N·m/kg [P < .001], respectively) and knee internal rotation moments (Δ = 0.06 N·m/kg [P < .001] and Δ = 0.06 N·m/kg [P < .001], respectively) compared with the CON group. No discrepancies were observed at the hip; minimal differences were noted in sagittal-plane ankle mechanics. CONCLUSION Patients who underwent PCL reconstruction generally exhibited bilateral gait symmetry at 8 years after surgery. However, they exhibited important biomechanical deviations in both knees compared with healthy controls. These modifications likely reflect adaptive gait strategies to protect the PCL after reconstruction. CLINICAL RELEVANCE Long-term follow-up analyses of patients who underwent PCL reconstruction should not use the uninjured contralateral limb as a "healthy" reference, as it also exhibits mechanical differences compared with controls. Results could inform the development of neuromuscular and strength training programs targeting the restoration of knee biomechanics similar to healthy controls to prevent early-onset degeneration that is frequently associated with altered biomechanics.
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Affiliation(s)
- Nicholas M. Brisson
- Julius Wolff Institute, Berlin Institute of Health and Charité–Universitätsmedizin Berlin, Berlin, Germany,Nicholas M. Brisson, PhD, Julius Wolff Institute, Berlin Institute of Health and Charité–Universitätsmedizin Berlin, Philippstrasse 13, Haus 11, Raum 2.18, Berlin, 10115, Germany ()
| | - Alison N. Agres
- Julius Wolff Institute, Berlin Institute of Health and Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias M. Jung
- Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Georg N. Duda
- Julius Wolff Institute, Berlin Institute of Health and Charité–Universitätsmedizin Berlin, Berlin, Germany,Center for Musculoskeletal Surgery, Charité–Universitätsmedizin Berlin, Berlin, Germany,Berlin Institute of Health Center for Regenerative Therapies, Berlin Institute of Health and Charité–Universitätsmedizin Berlin, Berlin, Germany
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Abusharkh HA, Mallah AH, Amr MM, Mendenhall J, Gozen BA, Tingstad EM, Abu-Lail NI, Van Wie BJ. Enhanced matrix production by cocultivated human stem cells and chondrocytes under concurrent mechanical strain. In Vitro Cell Dev Biol Anim 2021; 57:631-640. [PMID: 34129185 DOI: 10.1007/s11626-021-00592-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 05/10/2021] [Indexed: 11/28/2022]
Abstract
Conventional treatments of osteoarthritis have failed to re-build functional articular cartilage. Tissue engineering clinical treatments for osteoarthritis, including autologous chondrocyte implantation, provides an alternative approach by injecting a cell suspension to fill lesions within the cartilage in osteoarthritic knees. The success of chondrocyte implantation relies on the availability of chondrogenic cell lines, and their resilience to high mechanical loading. We hypothesize we can reduce the numbers of human articular chondrocytes necessary for a treatment by supplementing cultures with human adipose-derived stem cells, in which stem cells will have protective and stimulatory effects on mixed cultures when exposed to high mechanical loads, and in which coculture will enhance production of requisite extracellular matrix proteins over those produced by stretched chondrocytes alone. In this work, adipose-derived stem cells and articular chondrocytes were cultured separately or cocultivated at ratios of 3:1, 1:1, and 1:3 in static plates or under excessive cyclic tensile strain of 10% and results were compared to culturing of both cell types alone with and without cyclic strain. Results indicate 75% of chondrocytes in engineered articular cartilage can be replaced with stem cells with enhanced collagen over all culture conditions and glycosaminoglycan content over stretched cultures of chondrocytes. This can be done without observing adverse effects on cell viability. Collagen and glycosaminoglycan secretion, when compared to chondrocyte alone under 10% strain, was enhanced 6.1- and 2-fold, respectively, by chondrocytes cocultivated with stem cells at a ratio of 1:3.
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Affiliation(s)
- Haneen A Abusharkh
- Voiland School of Chemical Engineering and Bioengineering, Washington State University, 1505 NE Stadium Way, Pullman, WA, 99164-6515, USA
| | - Alia H Mallah
- Department of Biomedical Engineering and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, 78249, USA
| | - Mahmoud M Amr
- Department of Biomedical Engineering and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, 78249, USA
| | - Juana Mendenhall
- Department of Chemistry, Morehouse College, Atlanta, GA, 30314, USA
| | - Bulent A Gozen
- School of Mechanical and Materials Engineering, Washington State University, Pullman, WA, 99164-2920, USA
| | - Edwin M Tingstad
- Inland Orthopedic Surgery and Sports Medicine Clinic, Pullman, WA, 99163, USA
| | - Nehal I Abu-Lail
- Department of Biomedical Engineering and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, 78249, USA
| | - Bernard J Van Wie
- Voiland School of Chemical Engineering and Bioengineering, Washington State University, 1505 NE Stadium Way, Pullman, WA, 99164-6515, USA.
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