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Moore J, van de Graaf VA, Wood JA, Humburg P, Colyn W, Bellemans J, Chen DB, MacDessi SJ. Windswept deformity of the knee: prevalence and predictive factors in osteoarthritic and healthy populations. Bone Jt Open 2024; 5:879-885. [PMID: 39397665 PMCID: PMC11472183 DOI: 10.1302/2633-1462.510.bjo-2024-0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2024] Open
Abstract
Aims This study examined windswept deformity (WSD) of the knee, comparing prevalence and contributing factors in healthy and osteoarthritic (OA) cohorts. Methods A case-control radiological study was undertaken comparing 500 healthy knees (250 adults) with a consecutive sample of 710 OA knees (355 adults) undergoing bilateral total knee arthroplasty. The mechanical hip-knee-ankle angle (mHKA), medial proximal tibial angle (MPTA), and lateral distal femoral angle (LDFA) were determined for each knee, and the arithmetic hip-knee-ankle angle (aHKA), joint line obliquity, and Coronal Plane Alignment of the Knee (CPAK) types were calculated. WSD was defined as a varus mHKA of < -2° in one limb and a valgus mHKA of > 2° in the contralateral limb. The primary outcome was the proportional difference in WSD prevalence between healthy and OA groups. Secondary outcomes were the proportional difference in WSD prevalence between constitutional varus and valgus CPAK types, and to explore associations between predefined variables and WSD within the OA group. Results WSD was more prevalent in the OA group compared to the healthy group (7.9% vs 0.4%; p < 0.001, relative risk (RR) 19.8). There was a significant difference in means and variance between the mHKA of the healthy and OA groups (mean -1.3° (SD 2.3°) vs mean -3.8°(SD 6.6°) respectively; p < 0.001). No significant differences existed in MPTA and LDFA between the groups, with a minimal difference in aHKA (mean -0.9° healthy vs -0.5° OA; p < 0.001). Backwards logistic regression identified meniscectomy, rheumatoid arthritis, and osteotomy as predictors of WSD (odds ratio (OR) 4.1 (95% CI 1.7 to 10.0), p = 0.002; OR 11.9 (95% CI 1.3 to 89.3); p = 0.016; OR 41.6 (95% CI 5.4 to 432.9), p ≤ 0.001, respectively). Conclusion This study found a 20-fold greater prevalence of WSD in OA populations. The development of WSD is associated with meniscectomy, rheumatoid arthritis, and osteotomy. These findings support WSD being mostly an acquired condition following skeletal maturity.
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Affiliation(s)
- Joss Moore
- Sydney Knee Specialists, Kogarah, Australia
- The Galway Clinic, Galway, Ireland
- Irish Institute of Trauma and Orthopaedic Surgery, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Victor A. van de Graaf
- Sydney Knee Specialists, Kogarah, Australia
- Department of Orthopaedic Surgery, Bergman Clinics, Amsterdam, The Netherlands
| | | | - Peter Humburg
- Mark Wainwright Analytical Centre, UNSW Sydney, Sydney, Australia
| | - William Colyn
- Department of Orthopedic Surgery, AZ Turnhout, Diepenbeek, Belgium
- Faculty of Medicine and Life Sciences, UHasselt, Diepenbeek, Belgium
| | - Johan Bellemans
- CPAK Research Group, Sydney, Australia
- University Hasselt, Vesalius Hospitals Tongeren, Leuven, Belgium
| | - Darren B. Chen
- Sydney Knee Specialists, Kogarah, Australia
- CPAK Research Group, Sydney, Australia
| | - Samuel J. MacDessi
- Sydney Knee Specialists, Kogarah, Australia
- CPAK Research Group, Sydney, Australia
- School of Clinical Medicine, University of NSW Medicine and Health, Sydney, Australia
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Ganokroj P, Fossum BW, Hollenbeck J, Whalen RJ, Garcia AR, Foster MJ, Provencher CAPTMT. Biomechanical Analysis Evaluating Meniscal Extrusion After Knotless Suture Anchor Fixation for Segmental Medial Meniscal Allograft Transplantation. Orthop J Sports Med 2023; 11:23259671231182978. [PMID: 37655248 PMCID: PMC10467413 DOI: 10.1177/23259671231182978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/05/2023] [Indexed: 09/02/2023] Open
Abstract
Background Segmental medial meniscal allograft transplantation (MAT) has been shown to restore knee biomechanics; however, stable fixation of the transplantation is critical to avoid extrusion and maximize healing. Purpose To evaluate the degree of meniscal extrusion and biomechanical function of segmental medial MAT performed with meniscocapsular sutures versus repair augmentation with knotless suture anchors. Study Design Controlled laboratory study. Methods Segmental midbody medial meniscectomy and subsequent segmental medial MAT were performed on 10 fresh-frozen cadaveric knees. The knees were then loaded in a dynamic tensile testing machine to 1000 N for 60 seconds at 0°, 30°, 60°, and 90° of flexion, and 4 conditions were tested: (1) intact, (2) segmental defect, (3) inside-out segmental repair, and (4) anchor plus inside-out segmental repair of the medial MAT. Meniscal extrusion was measured using high-fidelity ultrasound imaging. The mean contact area and the mean and peak contact pressures were assessed with submeniscal pressure-mapping sensors. Data from testing conditions were compared with 2-way repeated-measures analysis of variance, with pairwise comparison using the Bonferroni method. Results At 90° of flexion, the segmental defect state showed a higher degree of meniscal extrusion compared with all other states (P ≤ .012). There was no difference in the degree of meniscal extrusion between the intact state and the inside-out repair or anchor plus inside-out segmental repair states at all knee flexion angles (P > .05). There was no significant difference in the mean and peak contact pressures among the 4 states at all flexion angles except that at 0° of knee flexion there was significantly lower peak contact pressure at the medial compartment after anchor plus inside-out segmental repair compared with the segmental defect state (P = .048). Conclusion Meniscal extrusion was not significantly increased at any flexion angle after segmental resection. The addition of knotless anchors did not improve meniscal extrusion or contact pressures/area compared with capsular repair alone. The addition of knotless anchors did improve contact mechanics from the segmental defect state, but only at 0° of flexion. Clinical Relevance The addition of knotless suture anchors to segmental meniscal transplantation increased stabilization of the meniscus at full extension compared with repair with sutures alone. This increased stabilization may lead to better long-term outcomes.
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Affiliation(s)
- Phob Ganokroj
- Steadman Philippon Research Institute, Vail, Colorado, USA
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Ryan J. Whalen
- Steadman Philippon Research Institute, Vail, Colorado, USA
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Sezaki S, Otsuki S, Ikeda K, Ishitani T, Okamoto Y, Wakama H, Matsuyama J, Nakamura K, Neo M. Biomechanical assessment of a novel meniscal scaffold compared to partial meniscectomy: A study on porcine meniscal injury. J Biomed Mater Res B Appl Biomater 2023; 111:895-902. [PMID: 36374005 DOI: 10.1002/jbm.b.35199] [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: 04/12/2022] [Revised: 09/26/2022] [Accepted: 11/06/2022] [Indexed: 11/16/2022]
Abstract
This study aimed to investigate the appropriate size of scaffold implantation on stress distribution and evaluate its mechanical and biomechanical properties considering hydrolysis. The meniscus acts as a load distribution in the knee, and its biomechanical properties are essential for the development of the PGA scaffold. We established a novel meniscal scaffold, which consists of polyglycolic acid (PGA) covered with L-lactide-ε-caprolactone copolymer (P[LA/CL]). After 4 weeks of hydrolysis, the scaffold had a 7% volume reduction compared to the initial volume. In biomechanical tests, the implantation of scaffolds 20% larger than the circumferential and vertical defect size results in greater contact stress than the intact meniscus. In the mechanical evaluation associated with the decomposition behavior, the strength decreased after 4 weeks of hydrolysis. Meanwhile, in the biomechanical test considering hydrolysis, contact stress and area equivalent to intact were obtained after 4 weeks of hydrolysis. In conclusion, the implantation of the PGA scaffold might be a useful alternative to partial meniscectomy in terms of mechanical properties, and the PGA scaffold should be implanted up to 20% of the defect size.
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Affiliation(s)
- Shunsuke Sezaki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan.,QOL Research Laboratory, Gunze Limited, Kyoto, Japan
| | - Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Kuniaki Ikeda
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Takashi Ishitani
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yoshinori Okamoto
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Junya Matsuyama
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Kaito Nakamura
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan
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Wang M, Lin Z, Wang W, Chen L, Xia H, Zhang Y, Huang W. Kinematic Alterations After Anterior Cruciate Ligament Reconstruction via Transtibial Techniques With Medial Meniscal Repair Versus Partial Medial Meniscectomy. Am J Sports Med 2021; 49:3293-3301. [PMID: 34428082 DOI: 10.1177/03635465211033982] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The treatment strategies for meniscal injuries during anterior cruciate ligament (ACL) reconstruction remain a topic of debate. HYPOTHESIS After ACL reconstruction, knee kinematics would be affected by different medial meniscal treatment (partial medial meniscectomy [PMM] and medial meniscal repair [MMR]). STUDY DESIGN Controlled laboratory study. METHODS A total of 161 patients underwent primary single-bundle ACL reconstruction and simultaneous medial meniscal treatment. Of these, 32 patients were eligible to participate in the kinematic assessment at 24.8 ± 1.7 months after surgery. Patients were divided into 2 groups: (1) those who underwent MMR (Group MMR; n = 18) and (2) those who underwent PMM (Group PMM; n = 14). Twenty healthy participants (Group Intact) were recruited who were comparable in age, body mass index, and sex. The kinematic parameters were collected using an optical tracking system during treadmill gait. Range of motion and kinematic parameters at key events during the gait cycle were compared between the 3 groups. The primary outcomes were the differences in adduction/abduction and internal/external rotation. RESULTS Patients in Group PMM walked with increased adduction as compared with those in Group Intact during the early stance phase (P = .003; η2 = 0.172) and midstance phase (P = .003; η2 = 0.167). In terms of internal/external rotation, patients in Group PMM walked with significantly larger tibial external rotation when compared with Group MMR by approximately 3.4° to 3.7° (loading response: P = .026, η2 = 0.090; midstance: P = .035, η2 = 0.093) and Group Intact (P = .028; η2 = 0.095) in the early stance phase. In addition, there was significantly increased anterior tibial translation in Groups MMR and PMM compared with Group Intact. CONCLUSION ACL reconstruction (via transtibial technique) with concurrent PMM demonstrated larger adduction and external tibial rotation at 24 months of follow-up during level walking. CLINICAL RELEVANCE Patients undergoing different medial meniscal treatment strategies in the presence of ACL reconstruction showed distinct knee kinematics. These results suggest that MMR is strongly recommended during ACL reconstructive surgery to reduce the abnormal kinematics close to that of the ACL-intact condition.
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Affiliation(s)
- Ming Wang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China.,Department of Orthopaedics and Traumatology, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Zefeng Lin
- Department of Orthopaedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China.,Guangdong Key Lab of Orthopaedic Technology and Implant Materials, Guangzhou, China
| | - Wanshun Wang
- Department of Orthopaedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China.,Guangdong Key Lab of Orthopaedic Technology and Implant Materials, Guangzhou, China
| | - Lingling Chen
- Department of Orthopaedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China.,Guangdong Key Lab of Orthopaedic Technology and Implant Materials, Guangzhou, China
| | - Hong Xia
- Department of Orthopaedics, General Hospital of Southern Theater Command of PLA, Guangzhou, China.,Guangdong Key Lab of Orthopaedic Technology and Implant Materials, Guangzhou, China
| | - Yu Zhang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
| | - Wenhan Huang
- Department of Orthopaedics, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, China
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Haber DB, Douglass BW, Arner JW, Miles JW, Peebles LA, Dornan GJ, Vidal AF, Provencher CMT. Biomechanical Analysis of Segmental Medial Meniscal Transplantation in a Human Cadaveric Model. Am J Sports Med 2021; 49:3279-3286. [PMID: 34494894 DOI: 10.1177/03635465211036441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal deficiency has been reported to increase contact pressures in the affected tibiofemoral joint, possibly leading to degenerative changes. Current surgical options include meniscal allograft transplantation and insertion of segmental meniscal scaffolds. Little is known about segmental meniscal allograft transplantation. PURPOSE To evaluate the effectiveness of segmental medial meniscal allograft transplantation in the setting of partial medial meniscectomy in restoring native knee loading characteristics. STUDY DESIGN Controlled laboratory study. METHODS Ten fresh-frozen human cadaveric knees underwent central midbody medial meniscectomy and subsequent segmental medial meniscal allograft transplantation. Knees were loaded in a dynamic tensile testing machine to 1000 N for 20 seconds at 0°, 30°, 60°, and 90° of flexion. Four conditions were tested: (1) intact medial meniscus, (2) deficient medial meniscus, (3) segmental medial meniscal transplant fixed with 7 meniscocapsular sutures, and (4) segmental medial meniscal transplant fixed with 7 meniscocapsular sutures and 1 suture fixed through 2 bone tunnels. Submeniscal medial and lateral pressure-mapping sensors assessed mean contact pressure, peak contact pressure, mean contact area, and pressure mapping. Two-factor random-intercepts linear mixed effects models compared pressure and contact area measurements among experimental conditions. RESULTS The meniscal-deficient state demonstrated a significantly higher mean contact pressure than all other testing conditions (mean difference, ≥0.35 MPa; P < .001 for all comparisons) and a significantly smaller total contact area as compared with all other testing conditions (mean difference, ≤140 mm2; P < .001 for all comparisons). There were no significant differences in mean contact pressure or total contact area among the intact, transplant, or transplant-with-tunnel groups or in any outcome measure across all comparisons in the lateral compartment. No significant differences existed in center of pressure and relative pressure distribution across testing conditions. CONCLUSION Segmental medial meniscal allograft transplantation restored the medial compartment mean contact pressure and mean contact area to values measured in the intact medial compartment. CLINICAL RELEVANCE Segmental medial meniscal transplantation may provide an alternative to full meniscal transplantation by addressing only the deficient portion of the meniscus with transplanted tissue. Additional work is required to validate long-term fixation strength and biologic integration.
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Affiliation(s)
- Daniel B Haber
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Vail, Colorado, USA
| | | | - Justin W Arner
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Jon W Miles
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Liam A Peebles
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Armando F Vidal
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Vail, Colorado, USA
| | - Capt Matthew T Provencher
- The Steadman Clinic, Vail, Colorado, USA.,Steadman Philippon Research Institute, Vail, Colorado, USA
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Seiter MN, Haber DB, Ruzbarsky JJ, Arner JW, Peebles AM, Provencher MT. Segmental Meniscus Allograft Transplantation. Arthrosc Tech 2021; 10:e697-e703. [PMID: 33738204 PMCID: PMC7953169 DOI: 10.1016/j.eats.2020.10.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/25/2020] [Indexed: 02/03/2023] Open
Abstract
Meniscal tears treated with partial meniscectomies have been shown to significantly increase contract pressures within the tibiofemoral joint, and a complete focal meniscal deficiency may render the entirety of the meniscus functionally incompetent. Although various techniques of meniscal transplantation have been described, these techniques may require the excision of a considerable amount of healthy meniscal tissue. Furthermore, failures continue to frequently occur. Therefore, attempts to restoring normal knee kinematics and biomechanical forces are essential. Segmental meniscus allograft transplantations may offer the advantage of a robust repair by both maintaining knee biomechanics and biology while maximizing preservation of native meniscal tissue. Also, most meniscal deficiency involves only a portion of the meniscus, and thus we developed this technique to segmentally transplant only the deficient portion. The purpose of this Technical Note is to describe a technique of segmental medial meniscus allograft transplantation in a patient with focal medial meniscus deficiency.
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Affiliation(s)
- Max N. Seiter
- The Steadman Clinic, Vail, Colorado, U.S.A
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Daniel B. Haber
- The Steadman Clinic, Vail, Colorado, U.S.A
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Joseph J. Ruzbarsky
- The Steadman Clinic, Vail, Colorado, U.S.A
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Justin W. Arner
- The Steadman Clinic, Vail, Colorado, U.S.A
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | | | - Matthew T. Provencher
- The Steadman Clinic, Vail, Colorado, U.S.A
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
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Time to Achievement of Clinically Significant Outcomes After Isolated Arthroscopic Partial Meniscectomy: A Multivariate Analysis. Arthrosc Sports Med Rehabil 2020; 2:e723-e733. [PMID: 33364610 PMCID: PMC7754524 DOI: 10.1016/j.asmr.2020.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/04/2020] [Indexed: 12/31/2022] Open
Abstract
Purpose To define the time required to achieve the minimally clinically important difference (MCID), substantial clinical benefit (SCB) and patient acceptable symptomatic state (PASS) for isolated arthroscopic partial meniscectomy (APM), and define preoperative and intraoperative factors that predict both early and late achievement of the stated metrics. Methods Patients who underwent isolated APM between 2014 and 2017 were retrospectively included. Patients without preoperative and 6-month patient-reported outcome measure scores, revision procedures, and significant concomitant procedures were excluded. The MCID, SCB, and PASS were calculated for knee-based patient-reported outcome measure scores using receiver operating curve analysis. Kaplan-Meier survival analysis established the time required to achieve MCID, SCB and PASS. Hazard ratios from multivariate Cox regression allowed for the isolation of demographic and intraoperative factors predictive of the delayed time required to achieve MCID, SCB and PASS. Results A total of 126 patients (42.86% female, age: 48.9 ± 12.4 years) were included. Overall achievement rates ranged between 73.0% and 89.7% for MCID, 43.7% and 68.2% for SCB, and 50.8% and 68.3% for PASS. Median achievement time for MCID was 5.68-5.78 months, 5.73-6.05 months for SCB and 6.54-7.72 months for PASS. Multivariate Cox regression identified older age, workers' compensation status, diabetes, and various tear types (i.e., longitudinal, transverse, bucket handle, complex) as predictors of early clinically significant outcome achievement (hazard ratio: 1.02-24.72), whereas subsequent steroid injection, higher preoperative scores and root and flap tears predicted delays in clinically significant outcome achievement (hazard ratio: 0.12-0.99). Conclusions The majority of patients undergoing APM achieve benefit within 6 months of surgery, with diminishing proportions at later timepoints. Important factors for consideration of the the timeline of achieving clinically significant outcome include age, diabetes, workers' compensation, preoperative score, and tear type. The timeline for achieving improvement that was established by this study may aid in setting patient expectations and designing future outcome studies involving APM. Study design Level IV, Therapeutic Case Series.
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Fischer AG, Erhart-Hledik JC, Asay JL, Chu CR, Andriacchi TP. Utilizing the somatosensory system via vibratory stimulation to mitigate knee pain during walking: Randomized clinical trial. Gait Posture 2020; 80:37-43. [PMID: 32485422 DOI: 10.1016/j.gaitpost.2020.05.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pain and proprioception deficits are often associated with knee pathologies and resultant quadriceps muscle inhibition. There is a need for new approaches to mitigate active knee pain and restore muscle function during walking. Activating properties of the somatosensory system with common pain and sensory pathways offers a novel opportunity to enhance quadriceps function during walking. RESEARCH QUESTION Conduct a controlled clinical trial that investigates the effects of applying intermittent vibrational cutaneous stimulation during walking on knee pain and symptoms and their correlations to gait parameters. METHODS This longitudinal controlled cross-over clinical study included thirty-two patients randomly and blindly assigned to active Treatment A and passive Treatment B for 4 weeks with a 2-week washout period between treatments. RESULTS Subjects when wearing active Treatment A for 4 weeks had significant (p = 0.04) improvement in patient reported outcomes, while they had no significant differences with passive Treatment B (p > 0.7) compared to the no treatment condition. For Treatment A, subjects with low knee flexion moment and knee flexion angle in no-treatment condition exhibited the greatest increase in knee flexion moment/angle in the active treatment condition (R > 0.57, p < 0.001). These changes in gait measures were correlated significantly to changes in pain. SIGNIFICANCE This clinical trial indicates that knee pain can be reduced, and gait improved in a manner that enhances quadriceps function by applying intermittent cutaneous stimulation during gait in patients following knee injury or disease. The correlation between decreased pain and improved gait suggests that rehabilitation and exercise therapy may benefit from this treatment.
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Affiliation(s)
- Arielle G Fischer
- BioMotion Laboratory, Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA.
| | - Jennifer C Erhart-Hledik
- BioMotion Laboratory, Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA; Palo Alto Veterans Hospital, Palo Alto, CA, USA
| | - Jessica L Asay
- BioMotion Laboratory, Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA; Palo Alto Veterans Hospital, Palo Alto, CA, USA
| | - Constance R Chu
- BioMotion Laboratory, Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA; Palo Alto Veterans Hospital, Palo Alto, CA, USA
| | - Thomas P Andriacchi
- BioMotion Laboratory, Department of Mechanical Engineering, Stanford University, Stanford, CA 94305, USA
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Rodeo SA, Monibi F, Dehghani B, Maher S. Biological and Mechanical Predictors of Meniscus Function: Basic Science to Clinical Translation. J Orthop Res 2020; 38:937-945. [PMID: 31799733 DOI: 10.1002/jor.24552] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 11/03/2019] [Indexed: 02/04/2023]
Abstract
Progressive knee joint degeneration occurs following removal of a torn meniscus. However, there is significant variability in the rate of development of post-meniscectomy osteoarthritis (OA). While there is no current consensus on the risk factors for development of knee OA in patients with meniscus tears, it is likely that both biological and biomechanical factors play critical roles. In this perspective paper, we review the mechanical and the biological predictors of the response of the knee to partial meniscectomy. We review the role of patient-based studies, in vivo animal models, cadaveric models, bioreactor systems, and statistically augmented computational models for the study of meniscus function and post-meniscectomy OA, providing insight into the important interplay between biomechanical and biologic factors. We then discuss the clinical translation of these concepts for "biologic augmentation" of meniscus healing and meniscus replacement. Ultimately, collaborative studies between engineers, biologists, and clinicians is the optimal way to improve our understanding of meniscus pathology and response to injury and/or disease, and to facilitate effective translation of laboratory findings to improved treatments for our patients. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:937-945, 2020.
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Affiliation(s)
- Scott A Rodeo
- Orthopaedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York
| | - Farrah Monibi
- Orthopaedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York
| | - Bijan Dehghani
- Orthopaedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York
| | - Suzanne Maher
- Orthopaedic Soft Tissue Research Program, Hospital for Special Surgery, New York, New York
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Hirose T, Mae T, Tachibana Y, Ohori T, Fujie H, Yoshikawa H, Nakata K. Reduction of in situ force through the meniscus with phased inner resection of medial meniscus: an experimental study in a porcine model. J Exp Orthop 2020; 7:21. [PMID: 32303852 PMCID: PMC7163857 DOI: 10.1186/s40634-020-00240-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/06/2020] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Partial meniscectomy can cause osteoarthritic changes in knees, as inner portion as well as peripheral portion of meniscus is important. The hypothesis of this study was that the amount of the inner resection of medial meniscus affected the in situ forces through the meniscus and the tibial varus and external rotation under axial load. METHODS Fourteen intact porcine knees were investigated with a six-degree of freedom robotic system and force/moment, and the three-dimensional path of intact knees were recorded by universal force sensor when an axial load of 300-N was applied at four different flexion angles (30°, 60°, 90°, and 120°). The same examination was performed on three phased inner resections (30%, 60%, and 90% width) of the medial meniscus. Finally, all paths were reproduced after total medial meniscectomy, and in situ forces of the medial meniscus were calculated based on the superposition principle. Changes in tibiofemoral varus/valgus and internal/external rotation alignment during an axial load were also calculated. RESULTS In situ forces of the medial meniscus decreased according to the amount of meniscal resection at all flexion angles. The reduction was significant in knees with inner resections of > 60% width at all flexion angles and even of 30% width at a flexion angle of 120° (p < .05). Incremental changes in the tibiofemoral varus alignment increased depending on the inner resection width at all flexion angles (p < .05). CONCLUSION The amount of inner resection of the medial meniscus was related to reduction of its in situ forces and increment of the tibial varus rotation under axial load.
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Affiliation(s)
- Takehito Hirose
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, 565-0871, Japan
| | - Tatsuo Mae
- Department of Sports Medical Biomechanics, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, 565-0871, Japan.
| | - Yuta Tachibana
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, 565-0871, Japan
| | - Tomoki Ohori
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, 565-0871, Japan
| | - Hiromichi Fujie
- Department of Mechanical Systems Engineering, Tokyo Metropolitan University, 6-6, Asahiga-oka, Hino-city, Tokyo, 191-0065, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, 565-0871, Japan
| | - Ken Nakata
- Department of Medicine for Sports and Performing Arts, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita-city, Osaka, 565-0871, Japan
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Lau BC, Conway D, Mulvihill J, Zhang AL, Feeley BT. Biomechanical Consequences of Meniscal Tear, Partial Meniscectomy, and Meniscal Repair in the Knee. JBJS Rev 2019; 6:e3. [PMID: 29613868 DOI: 10.2106/jbjs.rvw.17.00125] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
UPDATE This article was updated on April 26, 2018, because of a previous error. On pages 1 and 14, the author name that had read "Alan Z. Zhang, MD" now reads "Alan L. Zhang, MD."
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Affiliation(s)
- Brian C Lau
- Division of Shoulder and Sports Medicine Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California
| | - Devin Conway
- Tulane University School of Medicine, New Orleans, Louisiana
| | - Jeffrey Mulvihill
- Division of Shoulder and Sports Medicine Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California
| | - Alan L Zhang
- Division of Shoulder and Sports Medicine Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California
| | - Brian T Feeley
- Division of Shoulder and Sports Medicine Surgery, Department of Orthopaedic Surgery, University of California San Francisco Medical Center, San Francisco, California
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12
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Otsuki S, Nakagawa K, Murakami T, Sezaki S, Sato H, Suzuki M, Okuno N, Wakama H, Kaihatsu K, Neo M. Evaluation of Meniscal Regeneration in a Mini Pig Model Treated With a Novel Polyglycolic Acid Meniscal Scaffold. Am J Sports Med 2019; 47:1804-1815. [PMID: 31172797 DOI: 10.1177/0363546519850578] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal injury is a severe impediment to movement and results in accelerated deterioration of the knee joint. PURPOSE To evaluate the effect of a novel meniscal scaffold prepared from polyglycolic acid coated with polylactic acid/caprolactone on the treatment of meniscal injury in a mini pig model. STUDY DESIGN Controlled laboratory study. METHODS The model was established with a 10-mm resection at the anterior medial meniscus on both knee joints. A scaffold was implanted in the right knee joint. The meniscal scaffold was inserted and sutured next to the native meniscus. The histological analysis was performed to determine meniscal regeneration with safranin O staining, cell proliferation with PCNA, inflammation with TNF, and collagen structure and production with picrosirius red and immunofluorescence. Cartilage degeneration was evaluated with Safranin O. Meniscal regeneration and joint fluid were evaluated with magnetic resonance imaging. RESULTS Although compressive stress and elastic modulus were significantly lower in the scaffold than in the native porcine menisci, ultimate tensile stress was similar. Implanted scaffolds were covered with tissue beginning at 4 weeks, with increased migration of proliferating cells to the implant area at 4 and 8 weeks. Scaffolds were absorbed with freshly produced collagen at 24 weeks. Cartilage degeneration was significantly lower in the meniscus-implanted group than in the meniscectomy group. Magnetic resonance imaging results did not show severe accumulation of joint fluids, suggesting negligible inflammation. Density of the implanted menisci was comparable with that of the native menisci. CONCLUSION Meniscal scaffold prepared from polyglycolic acid has therapeutic potential for meniscal regeneration. CLINICAL RELEVANCE This meniscal scaffold can improve biological knee reconstruction and prevent the increase of total knee arthroplasty.
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Affiliation(s)
- Shuhei Otsuki
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Kosuke Nakagawa
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Tomohiko Murakami
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | | | - Hideki Sato
- Gunze Limited, QOL Research Laboratory, Kyoto, Japan
| | | | - Nobuhiro Okuno
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | - Hitoshi Wakama
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
| | | | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Japan
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13
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Temporary postoperative treatment with compartment-unloading knee braces or wedge insoles does not improve clinical outcome after partial meniscectomy. Knee Surg Sports Traumatol Arthrosc 2019; 27:814-821. [PMID: 30159739 PMCID: PMC6510808 DOI: 10.1007/s00167-018-5106-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/13/2018] [Indexed: 11/03/2022]
Abstract
PURPOSE To investigate whether temporary postoperative compartment-unloading therapy after arthroscopic partial meniscectomy (APM)-with either knee braces or wedge insoles-leads to superior clinical outcome as compared to controls. This difference in clinical outcome was tested in the form of two knee scores, physical activity and general health outcome over the first postoperative year. METHODS Sixty-three patients who underwent arthroscopic partial meniscectomy (APM) were randomized to one of the following three groups: 12 weeks postoperative knee compartment-unloading therapy with either a knee brace (brace group) or wedge insoles (insole group) or no specific postoperative therapy (control group). Patient-reported outcome was assessed with the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC Score), the Knee Injury and Osteoarthritis Outcome Score (KOOS), the MARX score (physical activity) and the SF-12 (general health). RESULTS Sixty-three patients were available for analysis. Except for the SF-12 mental score, all other scores showed significant improvement over time. With regard to the hypotheses proposed, no significant group * time interactions were observed for any of the outcome parameters. This means that the group (i.e. the type of postoperative treatment) was not related to the degree of improvement of any of the scores. CONCLUSIONS It was concluded that 12 weeks of compartment-unloading therapy-with either a knee brace or wedge insoles-is ineffective with regard to clinical outcome after APM. This applies to the knee score outcome, physical activity and general health outcome over the first year following APM. LEVEL OF EVIDENCE Randomized controlled trial, Level I.
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14
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Firner S, Willwacher S, de Marées M, Bleuel J, Zaucke F, Brüggemann GP, Niehoff A. Effect of increased mechanical knee joint loading during running on the serum concentration of cartilage oligomeric matrix protein (COMP). J Orthop Res 2018; 36:1937-1946. [PMID: 29369406 DOI: 10.1002/jor.23859] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/15/2018] [Indexed: 02/04/2023]
Abstract
The purpose of the study was to investigate the effect of an increase in mechanical knee joint loading during running on the serum COMP level. On two different test days, 20 healthy men ran with knee orthoses for 30 min on a treadmill (v = 2.2 m/s). On day 1, the orthoses were passive, whereas on day 2 they were pneumatically driven (active) and thus increased the external knee flexion moments (+30.9 Nm) during stance phase. Lower-limb mechanics and serum COMP levels (baseline; 0, 0.5, 1, 2 h post running) were analyzed. COMP levels increased immediately after running with passive (+35%; pre: 7.5 U/l, 95%CI: 6.4, 8.7, post: 9.8 U/l, 95%CI: 8.8, 10.8, p < 0.001) and active orthoses (+45%; pre: 7.6 U/l; 95%CI: 6.4, 8.8, post: 10.3 U/l, 95%CI: 9.2, 11.5, p < 0.001), but they did not differ between interventions. While running with active orthoses, greater ankle dorsiflexion angles, knee flexion angles, and moments occurred (p < 0.05). Comparing both interventions, the Δ COMP pre-post, meaning the difference (Δ) between running with active and passive orthoses in pre to post COMP level change (=level after (post) running minus level before (pre) running), correlated negatively with Δ COMP baseline (difference between the baseline COMP level before running with active and passive orthoses, r = -0.616; p = 0.004), and with a positive tendence with the Δ maximum knee flexion (r = 0.388; p = 0.091). Therefore, changes in COMP concentration after physical activity seem to be highly influenced by the COMP baseline level. In addition, correlation analysis indicates that modifications in knee joint kinematics have a greater effect on cartilage metabolism than an increase in joint moments. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1937-1946, 2018.
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Affiliation(s)
- Sara Firner
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Steffen Willwacher
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Markus de Marées
- Faculty of Sport Science, Department of Sports Medicine and Sports Nutrition, Ruhr-University Bochum, Bochum, Germany
| | - Judith Bleuel
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Frank Zaucke
- Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Orthopedic University Hospital Friedrichsheim gGmbH, Frankfurt, Germany.,Cologne Center for Musculoskeletal Biomechanics (CCMB), Medical Faculty, University of Cologne, Cologne, Germany
| | - Gert-Peter Brüggemann
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany.,Cologne Center for Musculoskeletal Biomechanics (CCMB), Medical Faculty, University of Cologne, Cologne, Germany
| | - Anja Niehoff
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany.,Cologne Center for Musculoskeletal Biomechanics (CCMB), Medical Faculty, University of Cologne, Cologne, Germany
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15
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Akpinar B, Thorhauer E, Irrgang JJ, Tashman S, Fu FH, Anderst WJ. Alteration of Knee Kinematics After Anatomic Anterior Cruciate Ligament Reconstruction Is Dependent on Associated Meniscal Injury. Am J Sports Med 2018; 46:1158-1165. [PMID: 29498884 DOI: 10.1177/0363546517753386] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Limited in vivo kinematic information exists on managing meniscal injury during anterior cruciate ligament reconstruction (ACLR). HYPOTHESIS Isolated anatomic ACLR restores knee kinematics, whereas ACLR in the presence of medial meniscal injury is associated with altered long-term knee kinematics. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS From March 2011 to December 2012, 49 of 57 participants in a clinical trial underwent anatomic ACLR with successful kinematic testing at 24 months after ACLR. Twenty-five patients had associated meniscal tears: medial (n = 11), lateral (n = 9), or bilateral (n = 5). With a dynamic stereo radiography system with superimposed high-resolution computed tomography scans of patient knees, kinematics were measured during downhill running. The initial single-support phase of the gait cycle (0%-10%) was analyzed. RESULTS Anterior tibial translation (ATT) was the only kinematic outcome between patients' ACLR and contralateral knees that had significant interactions among meniscal groups ( P = .007). There was significant difference in ATT between patients with intact menisci and medial tears ( P = .036) and with medial tears and lateral tears ( P = .025). Patients with intact menisci had no difference in ATT, with a negligible effect size between the ACLR and contralateral knees (mean ± SEM: 13.1 ± 0.7 mm vs 12.6 ± 0.5 mm, P = .24, Cohen d = 0.15, n = 24), while patients with medial meniscal tears had an increase in ATT, with a medium effect size between the ACLR and contralateral knees (15.4 ± 1.0 mm vs 13.2 ± 1.0 mm, P = .024, Cohen d = 0.66, n = 11). CONCLUSION Associated medial meniscal injury in the setting of ACLR leads to increased ATT at 24-month follow-up. Furthermore, isolated anatomic ACLR in the absence of meniscal injury demonstrated no significant difference from native knee kinematics at 24-month follow-up during rigorous "high demand" knee activity with the current sample size. Patients undergoing anatomic ACLR in the presence of medial meniscal injury remained at a higher likelihood of sustaining altered long-term knee kinematics.
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Affiliation(s)
- Berkcan Akpinar
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - James J Irrgang
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Scott Tashman
- University of Texas Health Science Center, Houston, Texas, USA
| | - Freddie H Fu
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - William J Anderst
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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16
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Zheng L, Carey R, Thorhauer E, Tashman S, Harner C, Zhang X. In vivo tibiofemoral skeletal kinematics and cartilage contact arthrokinematics during decline walking after isolated meniscectomy. Med Eng Phys 2017; 51:41-48. [PMID: 29122451 DOI: 10.1016/j.medengphy.2017.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 10/16/2017] [Accepted: 10/29/2017] [Indexed: 10/18/2022]
Abstract
We investigated the effects of isolated meniscectomy on tibiofemoral skeletal kinematics and cartilage contact arthrokinematics in vivo. We recruited nine patients who had undergone isolated medial or lateral meniscectomy, and used a dynamic stereo-radiography (DSX) system to image the patients' knee motion during decline walking. A volumetric model-based tracking process determined 3D tibiofemoral kinematics from the recorded DSX images. Cartilage contact arthrokinematics was derived from the intersection between tibial and femoral cartilage models co-registered to the bones. The kinematics and arthrokinematics were analyzed for early stance and loading response phase (30% of a gait cycle), comparing the affected and intact knees. Results showed that four patients with medial meniscectomy had significantly greater contact centroid excursions in the meniscectomized medial compartments while five patients with lateral meniscectomy had significantly greater cartilage contact area and lateral shift of contact centroid path in the meniscectomized lateral compartments, comparing to those of the same compartments in the contralateral intact knees. No consistent difference however was identified in the skeletal kinematics. The current study demonstrated that cartilage-based intra-articular arthrokinematics is more sensitive and insightful than the skeletal kinematics in assessing the meniscectomy effects.
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Affiliation(s)
- Liying Zheng
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA; Health Effects Lab Division, National Institute for Occupational Safety and Health, Morgantown, WV, USA
| | - Robert Carey
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Eric Thorhauer
- Department of Mechanical Engineering, University of Washington, Seattle, WA, USA
| | - Scott Tashman
- Department of Orthopaedic Surgery, University of Texas, Houston, TX, USA
| | - Christopher Harner
- Department of Orthopaedic Surgery, University of Texas, Houston, TX, USA
| | - Xudong Zhang
- Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA; Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX, USA; Department of Mechanical Engineering, Texas A&M University, College Station, TX, USA.
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17
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Hall M, Wrigley TV, Metcalf BR, Hinman RS, Cicuttini FM, Dempsey AR, Lloyd DG, Bennell KL. Knee Biomechanics During Jogging After Arthroscopic Partial Meniscectomy: A Longitudinal Study. Am J Sports Med 2017; 45:1872-1880. [PMID: 28419809 DOI: 10.1177/0363546517698934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Altered knee joint biomechanics is thought to play a role in the pathogenesis of knee osteoarthritis and has been reported in patients after arthroscopic partial meniscectomy (APM) while performing various activities. Longitudinally, understanding knee joint biomechanics during jogging may assist future studies to assess the implications of jogging on knee joint health in this population. PURPOSE To investigate knee joint biomechanics during jogging in patients 3 months after APM and a healthy control group at baseline and 2 years later at follow-up. STUDY DESIGN Controlled laboratory study. METHODS Seventy-eight patients who underwent medial APM and 38 healthy controls underwent a 3-dimensional motion analysis during barefoot overground jogging at baseline. Sixty-four patients who underwent APM and 23 controls returned at follow-up. External peak moments (flexion and adduction) and the peak knee flexion angle during stance were evaluated for the APM leg, non-APM leg (nonoperated leg), and control leg. RESULTS At baseline, the peak knee flexion angle was 1.4° lower in the APM leg compared with the non-APM leg ( P = .03). No differences were found between the moments in the APM leg compared with the control leg (all P > .05). However, the normalized peak knee adduction moment was 35% higher in the non-APM leg compared with the control leg ( P = .008). In the non-APM leg, the normalized peak knee adduction and flexion moments were higher compared with the APM leg by 16% and 10%, respectively, at baseline ( P ≤ .004). Despite the increase in the peak knee flexion moment in the APM leg compared with the non-APM leg ( P < .001), there were no differences in the peak knee flexion moment or any other parameter assessed at 2-year follow-up between the legs ( P > .05). CONCLUSION Comparing the APM leg and control leg, no differences in knee joint biomechanics during jogging for the variables assessed were observed. Higher knee moments in the non-APM leg may have clinical implications for the noninvolved leg. Kinematic differences were small (~1.4°) and therefore of questionable clinical relevance. CLINICAL RELEVANCE These results may facilitate future clinical research regarding the implications of jogging on knee joint health in middle-aged, overweight patients after APM.
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Affiliation(s)
- Michelle Hall
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Tim V Wrigley
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Ben R Metcalf
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Rana S Hinman
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alasdair R Dempsey
- Centre for Musculoskeletal Research, Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia.,School of Psychology and Exercise Science, Murdoch University, Perth, Western Australia, Australia
| | - David G Lloyd
- Centre for Musculoskeletal Research, Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia
| | - Kim L Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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Maher SA, Wang H, Koff MF, Belkin N, Potter HG, Rodeo SA. Clinical platform for understanding the relationship between joint contact mechanics and articular cartilage changes after meniscal surgery. J Orthop Res 2017; 35:600-611. [PMID: 27410773 DOI: 10.1002/jor.23365] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 07/02/2016] [Indexed: 02/04/2023]
Abstract
Injury to the meniscus of the knee has been implicated as a significant risk factor for the subsequent development of osteoarthritis, but the mechanisms of joint degeneration are unclear. Our objective was to develop a clinically applicable methodology to evaluate the relationship of joint contact mechanics at the time of surgery to biological changes of articular cartilage as a function of time following surgery. A series of pre-, intra-, and post-operative protocols were developed which utilized electronic sensors for the direct measurement of contact mechanics, and advanced imaging to assess cartilage health. The tests were applied to a pilot cohort of young active patients undergoing meniscus allograft transplantation. Our study demonstrated significant variability across patients in terms of contact area and peak contact stress, both before and after transplantation. Nonetheless, the majority of patients exhibited decreased peak contact stress and increased contact area after graft implantation. MR scans at 3-6 months showed decreased T1ρ values in tibial articular cartilage, suggesting an increase in proteoglycan content or concomitant decrease in water content. Prolongation of T2 values was found primarily within the central, cartilage-cartilage contact region of the tibial plateau suggested disruption of the collagen network. Minimal differences were found in cartilage thickness over the short time frame of this preliminary study. With longer clinical follow-up, our platform of clinical tests can be used to better understand the patient-specific mechanical factors that are related to increased risk of OA after meniscus injury and surgery. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:600-611, 2017.
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Affiliation(s)
- Suzanne A Maher
- Tissue Engineering Regeneration and Repair Program, Hospital for Special Surgery, 535 East 70th Street, New York, 10021
| | - Hongsheng Wang
- Tissue Engineering Regeneration and Repair Program, Hospital for Special Surgery, 535 East 70th Street, New York, 10021
| | - Matthew F Koff
- Magnetic Resonance Imaging Laboratory, Hospital for Special Surgery, 535 East 70th Street, New York, 10021
| | - Nicole Belkin
- Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, 10021
| | - Hollis G Potter
- Magnetic Resonance Imaging Laboratory, Hospital for Special Surgery, 535 East 70th Street, New York, 10021
| | - Scott A Rodeo
- Tissue Engineering Regeneration and Repair Program, Hospital for Special Surgery, 535 East 70th Street, New York, 10021.,Sports Medicine and Shoulder Service, Hospital for Special Surgery, 535 East 70th Street, New York, 10021
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19
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Shimomura K, Rothrauff BB, Tuan RS. Region-Specific Effect of the Decellularized Meniscus Extracellular Matrix on Mesenchymal Stem Cell-Based Meniscus Tissue Engineering. Am J Sports Med 2017; 45:604-611. [PMID: 27895039 DOI: 10.1177/0363546516674184] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The meniscus is the most commonly injured knee structure, and surgical repair is often ineffective. Tissue engineering-based repair or regeneration may provide a needed solution. Decellularized, tissue-derived extracellular matrices (ECMs) have received attention for their potential use as tissue-engineered scaffolds. In considering meniscus-derived ECMs (mECMs) for meniscus tissue engineering, it is noteworthy that the inner and outer regions of the meniscus have different structural and biochemical features, potentially directing the differentiation of cells toward region-specific phenotypes. PURPOSE To investigate the applicability of mECMs for meniscus tissue engineering by specifically comparing region-dependent effects of mECMs on 3-dimensional constructs seeded with human bone marrow mesenchymal stem cells (hBMSCs). STUDY DESIGN Controlled laboratory study. METHODS Bovine menisci were divided into inner and outer halves and were minced, treated with Triton X-100 and DNase, and extracted with urea. Then, hBMSCs (1 × 106 cells/mL) were encapsulated in a photo-cross-linked 10% polyethylene glycol diacrylate scaffold containing mECMs (60 μg/mL) derived from either the inner or outer meniscus, with an ECM-free scaffold as a control. The cell-seeded constructs were cultured with chondrogenic medium containing recombinant human transforming growth factor β3 (TGF-β3) and were analyzed for expression of meniscus-associated genes as well as for the collagen (hydroxyproline) and glycosaminoglycan content as a function of time. RESULTS Decellularization was verified by the absence of 4',6-diamidino-2-phenylindole (DAPI)-stained cell nuclei and a reduction in the DNA content. Quantitative real-time polymerase chain reaction showed that collagen type I expression was significantly higher in the outer mECM group than in the other groups, while collagen type II and aggrecan expression was highest in the inner mECM group. The collagen (hydroxyproline) content was highest in the outer mECM group, while the glycosaminoglycan content was higher in both the inner and outer mECM groups compared with the control group. CONCLUSION These results showed that the inner mECM enhances the fibrocartilaginous differentiation of hBMSCs, while the outer mECM promotes a more fibroblastic phenotype. Our findings support the feasibility of fabricating bioactive scaffolds using region-specific mECM preparations for meniscus tissue engineering. CLINICAL RELEVANCE This is the first report to demonstrate the feasibility of applying region-specific mECMs for the engineering of meniscus implants capable of reproducing the biphasic, anatomic, and biochemical characteristics of the meniscus, features that should contribute to the feasibility of their clinical application.
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Affiliation(s)
- Kazunori Shimomura
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, Osaka, Japan.,Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Benjamin B Rothrauff
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Rocky S Tuan
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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20
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Osteoarthritis year in review 2016: mechanics. Osteoarthritis Cartilage 2017; 25:190-198. [PMID: 28100420 DOI: 10.1016/j.joca.2016.09.023] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/21/2016] [Accepted: 09/24/2016] [Indexed: 02/02/2023]
Abstract
Inappropriate biomechanics, namely wear-and-tear, has been long believed to be a main cause of osteoarthritis (OA). However, this view is now being re-evaluated, especially when examined alongside mechanobiology and new biomechanical studies. These are multiscale experimental and computational studies focussing on cell- and tissue-level mechanobiology through to organ- and whole-body-level biomechanics, which focuses on the biomechanical and biochemical environment of the joint tissues. This review examined papers from April 2015 to April 2016, with a focus on multiscale experimental and computational biomechanical studies of OA. Assessing the onset or progression of OA at organ- and whole-body-levels, gait analysis, medical imaging and neuromusculoskeletal modelling revealed the extent to which tissue damage changes the view of inappropriate biomechanics. Traditional gait analyses studies reported that conservative treatments can alter joint biomechanics, thereby improving pain and function experienced by those with OA. Results of animal models of OA were consistent with these human studies, showing interactions among bone, cartilage and meniscus biomechanics and the onset and/or progression OA. Going down size scales, experimental and computational studies probed the nanosize biomechanics of molecules, cells and extracellular matrix, and demonstrated how the interactions between biomechanics and morphology affect cartilage dynamic poroelastic behaviour and pathways to OA. Finally, integration of multiscale experimental data and computational models were proposed to predict cartilage extracellular matrix remodelling and the development of OA. Summarising, experimental and computational methods provided a nuanced biomechanical understanding of the sub-cellular, cellular, tissue, organ and whole-body mechanisms involved in OA.
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21
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Sole G, Pataky T, Tengman E, Häger C. Analysis of three-dimensional knee kinematics during stair descent two decades post-ACL rupture - Data revisited using statistical parametric mapping. J Electromyogr Kinesiol 2016; 32:44-50. [PMID: 28039768 DOI: 10.1016/j.jelekin.2016.12.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/22/2016] [Accepted: 12/15/2016] [Indexed: 12/11/2022] Open
Abstract
Changes in movement patterns following knee injuries have generally used analyses of pre-defined discrete event-related variables, whereas Statistical Parametric Mapping (SPM) assesses continuous data over time. We applied SPM to test differences for knee trajectories during stair descent between participants with past anterior cruciate ligament (ACL) rupture who underwent reconstruction or only physical therapy compared to healthy controls. Three-dimensional knee joint kinematics during stair descent were registered for 31 subjects with ACL reconstruction (ACLR), 36 subjects with ACL rupture managed with physical therapy only (ACLPT) (∼23years post-injury), and 32 uninjured controls. SPM was used to assess differences between groups for the entire three-component knee trajectory. A significant difference between the three groups was found for the first ∼10% of stance phase. Post-hoc analyses showed between-group differences when comparing the ACLPT to the control groups. Analyses of ACLPT versus control groups for individual vector components suggested a combination of less flexion at initial foot contact, and less adduction during weight acceptance (∼40% of stance). Altered knee kinematics were confirmed during weight acceptance of stair descent for the ACLPT group compared to controls, but not for ACLR group. Further exploration of the use of SPM and agreement with clinical gait assessment is warranted.
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Affiliation(s)
- Gisela Sole
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Box 56, Dunedin 9056, New Zealand.
| | - Todd Pataky
- Institute of Fiber Engineering, Department of Bioengineering, Shinshu University, Tokida 3-15-1, Ueda, Nagano 386-8567, Japan.
| | - Eva Tengman
- Institute of Fiber Engineering, Department of Bioengineering, Shinshu University, Tokida 3-15-1, Ueda, Nagano 386-8567, Japan.
| | - Charlotte Häger
- Dept. of Community Medicine and Rehabilitation, Section for Physical Therapy, Umeå University, SE-90187 Umeå, Sweden.
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Altered EMG patterns in diabetic neuropathic and not neuropathic patients during step ascending and descending. J Electromyogr Kinesiol 2016; 31:32-39. [PMID: 27632533 DOI: 10.1016/j.jelekin.2016.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/18/2016] [Accepted: 08/17/2016] [Indexed: 11/22/2022] Open
Abstract
Diabetic peripheral neuropathy (DPN) causes motor control alterations during daily life activities. Tripping during walking or stair climbing is the predominant cause of falls in the elderly subjects with DPN and without (NoDPN). Surface Electromyography (sEMG) has been shown to be a valid tool for detecting alterations of motor functions in subjects with DPN. This study aims at investigating the presence of functional alterations in diabetic subjects during stair climbing and at exploring the relationship between altered muscle activation and temporal parameter. Lower limb muscle activities, temporal parameters and speed were evaluated in 50 subjects (10 controls, 20 with DPN, 20 without DPN), while climbing up and down a stair, using sEMG, three-dimentional motion capture and force plates. Magnitude and timing of sEMG linear envelopes peaks were extracted. Level walking was used as reference condition for the comparison with step negotiation. sEMG, speed and temporal parameters revealed significant differences among all groups of patients. Results showed an association between earlier activation of lower limb muscles and reduced speed in subjects with DPN. Speed and temporal parameters significantly correlated with sEMG (p<0.05). The findings of this study are encouraging and could be used to improve rehabilitation programs aiming at reducing falls risk in diabetic subjects.
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Does meniscal pathology alter gait knee biomechanics and strength post-ACL reconstruction? Knee Surg Sports Traumatol Arthrosc 2016; 24:1501-9. [PMID: 26667152 DOI: 10.1007/s00167-015-3908-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 11/26/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE Individuals following anterior cruciate ligament reconstruction (ACLR) with concomitant meniscal pathology have a higher risk of developing knee osteoarthritis (OA) compared to those with isolated ACLR. Knee extensor weakness and altered dynamic knee joint biomechanics have been suggested to play a role in the development of knee OA following ACLR. This study investigated whether these factors differ in people following ACLR who have concomitant meniscal pathology compared to patients with isolated ACLR. METHODS Thirty-three patients with isolated ACLR and 34 patients with ACLR and meniscal pathology underwent strength and gait assessment 12-24 months post-operatively. Primary measures were peak isometric knee extensor torque and knee adduction moment (peak and impulse). Secondary measures included peak knee flexion moment and knee kinematics (sagittal and transverse). RESULTS There were no between-group differences in knee extensor strength [mean difference (95 % CI) 0.09 (-0.23 to 0.42) Nm/kg, n.s.], peak knee adduction moment [-0.02 (-0.54 to 0.49) Nm/(BW × HT) %, n.s.] or knee adduction moment impulse [0.01 (-0.15 to 0.17) Nm/(BW × HT) %, p = n.s.]. No between-group differences were found for any secondary measures. CONCLUSIONS No evidence was found to suggest that the higher prevalence of OA in patients with ACLR and meniscal pathology compared to patients with isolated ACLR is attributed to reduced knee muscle strength or altered knee joint biomechanics assessed 1-2 years post-surgery. Given that there is a higher incidence of knee OA in patients with concomitant meniscal pathology and ACLR, further investigation is needed so that population-specific rehabilitation protocols can be developed. LEVEL OF EVIDENCE III.
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Knee kinematics during stair descent 20 years following anterior cruciate ligament rupture with and without reconstruction. Clin Biomech (Bristol, Avon) 2016; 32:180-6. [PMID: 26690754 DOI: 10.1016/j.clinbiomech.2015.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 11/20/2015] [Accepted: 11/25/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Changes and asymmetries for walking gait have been explored extensively following injuries of anterior cruciate ligaments within ten years of injury or reconstruction. We examined longer term knee joint kinematics of reconstructed and non-reconstructed knees during stair descent compared to controls. METHODS Three-dimensional knee kinematics during stair descent were registered for 33 subjects with ACL reconstruction, 36 subjects with ACL rupture managed with physiotherapy only and 31 uninjured controls. Injured subjects were 23.5 (2.1) years following injury. Linear mixed models were used to compare temporal variables and knee kinematics during stance phase between groups and contralateral sides. FINDINGS Walking speed was slower for the both ACL-injured groups compared to controls and stance duration was longer for the injured than the uninjured sides of the physiotherapy-only group. Compared to controls, the physiotherapy-only group had significantly less adduction at initial foot contact of the injured and uninjured knees. The uninjured side of the physiotherapy-only group also had less flexion than controls at initial foot contact and during weight acceptance. Compared to the surgically-managed group, the injured sides of the physiotherapy-only groups had significantly less adduction at initial contact, peak adduction during weight acceptance, and peak flexion during propulsion. INTERPRETATION Independent of treatment, altered knee kinematics exist more than 20 years following ACL injury during stair descent. We suggest that future studies investigating short and long-term kinematic outcomes of ACL injury could evaluate stair descent with particular emphasis on weight acceptance of stance, and potential associations to perceived knee function.
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