1
|
Oğuzdoğan GY, Arslan FZ. Evaluation of Anatomical Variations with Morphological Measurements and Their Relationship to Meniscal Injury and Ligament Damage. J Knee Surg 2023; 36:1357-1364. [PMID: 36041483 DOI: 10.1055/a-1933-3592] [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: 02/07/2023]
Abstract
The purpose of this study was to reveal the anatomical risk factors for anterior and posterior cruciate ligament (ACL and PCL) injuries and menisci injury. We aim to investigate whether there are significant relationships between tibial tubercle-trochlear groove (TT-TG) distance, patella angle, trochlear sulcus angle (TSA), trochlear groove depth (TGD), medial and lateral trochlea length (MT and LT), MT/LT ratio, lateral patellar tilt angle (LPTA), patella-patellar tendon angle (P-PTA), quadriceps-patellar tendon angle (QPA), Insall-Salvati index (ISI), medial and lateral trochlear inclination (MTI and LTI) measurements and important common pathologies such as ACL, PCL, medial and lateral meniscal injuries (MM and LM), peripatellar fat pad edema, chondromalacia, and effusion. Thus, the mechanisms of injury will be better understood by revealing important anatomical variations for meniscus and ligament damage. Three hundred eighty patients with knee magnetic resonance imaging examination were included in this study. Our patients who underwent knee magnetic resonance imaging were divided into groups according to the presence of MM tear, LM tear, ACL tear, PCL tear, peripatellar fat pad edema, chondromalacia and effusion. TT-TG distance, patella angle, TSA, TGD, MT, LT, MT/LT ratio, LPTA, P-PTA, QPA, ISI, MTI, and LTI were measured. In patients with ACL tear, age, LT, ML/LT ratio, and QPA measurements were found to be significantly higher. There was no significant difference between the participants' LPTA value and the presence of ACL tear, MM and LM injury. MT and ML/LT ratio were found to be significantly lower in the group with MM tear (p <0.001). The TT-TG distance was found to be significantly lower in the group with LM tear. Increased age, LT, ML/LT ratio, and QPA are predisposed risk for ACL tear. Decreased MT and ML/LT ratio are among the risk factors for MM tear. The anatomical variations are associated with ligament and meniscal injury.
Collapse
Affiliation(s)
| | - Fatma Zeynep Arslan
- Department of Radiology, Basaksehir Cam and Sakura City Hospital, İstanbul, Turkey
| |
Collapse
|
2
|
Cho J, Yi J, Song Y, Kim YU. Assessment of patellar cartilage cross-sectional area in patients with lower grade chondromalacia patella. Medicine (Baltimore) 2023; 102:e34307. [PMID: 37603532 PMCID: PMC10443766 DOI: 10.1097/md.0000000000034307] [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: 05/23/2023] [Accepted: 06/20/2023] [Indexed: 08/23/2023] Open
Abstract
Chondromalacia patella (CMP) is abnormal softening of the cartilage of the underside the patella. It is a cause of anterior knee pain. Previous study has demonstrated that the patellar cartilage hypertrophy is correlated with early signs of CMP (Grade 1 or 2). However, no studies have investigated the clinical cutoff value of patella cartilage hypertrophy. Thus, we devised the patellar cartilage cross-sectional area (PCCSA) as a new predictive parameter for diagnosing the CMP. The purpose of this research was to compare MR measured PCCSA between CMP patients and gender matched healthy controls. The PCCSA samples were collected from 50 patients with CMP, and from 50 healthy controls who underwent knee MRI with no evidence of CMP. The T2-weighted turbo spin echo transverse MRI images were acquired. We measured the PCCSA on MRI using a PACS system. The PCCSA was measured on the axial angled sections through the whole images by drawing outlines. The average PCCSA was 104.28 ± 23.28 mm2 in the healthy controls and 134.09 ± 26.55 mm2 in the CMP group. CMP patients had significantly higher PCCSA (P < .001). Regarding the validity of PCCSA as predictors of CMP, Receiver Operating Characteristic curve analysis showed that the best cutoff point for the PCCSA was 116.24 mm2, with 72.0% sensitivity, 72.0% specificity, and the area under curve (AUC) of 0.79 (0.71-0.88). The PCCSA is a sensitive measurement parameter to predict low grade CMP. Thus, to evaluate CMP patients, the treating physician carefully inspect the PCCSA.
Collapse
Affiliation(s)
- Jaeho Cho
- Department of Anesthesiology and Pain Medicine, Comprehensive Pain Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jungmin Yi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| | - Yumin Song
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| |
Collapse
|
3
|
Sieroń D, Jabłońska I, Niemiec P, Lukoszek D, Szyluk K, Platzek I, Meusburger H, Delimpasis G, Christe A. Relationship between Outerbridge Scale and Chondropathy Femorotibial Joint in Relation to Gender and Age-The Use of 1.5T and 3.0T MRI Scanners. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111634. [PMID: 36422173 PMCID: PMC9697703 DOI: 10.3390/medicina58111634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/04/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022]
Abstract
Background and Objective: Magnetic resonance imaging (MRI) enables the effective evaluation of chondromalacia of the knee joint. Cartilage disease is affected by many factors, including gender, age, and body mass index (BMI). The aim of this study was to check the relationship between the severity of chondromalacia of the femoro-tibial joint and age, gender, and BMI assessed with 1.5T and 3.0T MRI scanners. Materials and Methods: The cross-observational study included 324 patients—159 (49%) females and 165 (51%) males aged 8−87 (45.1 ± 20.9). The BMI of study group was between 14.3 and 47.3 (27.7 ± 5.02). 1.5T and 3.0T MRI scanners were used in the study. The articular cartilage of the knee joint was assessed using the Outerbridge scale. Results: The age of the patients showed a significant correlation with Outerbrige for each compartment of the femorotibial joint (Spearman’s rank correlation rho: 0.69−0.74, p < 0.0001). A higher correlation between BMI and Outerbridge was noted in the femur medial (rho = 0.45, p < 0.001) and the tibia medial (rho = 0.43, p < 0.001) than in the femur lateral (rho = 0.29, p < 0.001) and the tibia lateral compartment (rho = 0.34, p < 0.001). Conclusions: The severity of chondromalacia significantly depends on age and BMI level, regardless of gender.
Collapse
Affiliation(s)
- Dominik Sieroń
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
- Correspondence:
| | - Izabella Jabłońska
- Recreation and Treatment Center “Glinik” 1, Wysowa-Zdrój 101 str, 38-316 Wysowa-Zdrój, Poland
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, Medyków 18 str, 40-752 Katowice, Poland
| | - Dawid Lukoszek
- Dawid Lukoszek Physiotherapy Osteopathy, 42-690 Hanusek, Poland
| | - Karol Szyluk
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
- Department of Orthopaedic and Trauma Surgery, District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 str, 41-940 Piekary Śląskie, Poland
| | - Ivan Platzek
- Department of Radiology, Dresden University Hospital, Fetscherstr. 74, 01307 Dresden, Germany
| | - Hugo Meusburger
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Georgios Delimpasis
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Andreas Christe
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| |
Collapse
|
4
|
QIN L, GUO C, ZHAO R, WANG T, WANG J, GUO Y, ZHANG W, HU T, CHEN X, ZHANG Q, ZHANG D, XU Y. Acupotomy inhibits aberrant formation of subchondral bone through regulating osteoprotegerin/receptor activator of nuclear factor-κB ligand pathway in rabbits with knee osteoarthritis induced by modified Videman method. J TRADIT CHIN MED 2022; 42:389-399. [PMID: 35610008 PMCID: PMC9924767 DOI: 10.19852/j.cnki.jtcm.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
OBJECTIVE To investigate the effects of acupotomy on inhibiting abnormal formation of subchondral bone in rabbits with knee osteoarthritis (KOA). METHODS A total of 24 New Zealand rabbits were randomly divided into four groups of 6 rabbits each [control, model, electroacupuncture (EA) and acupotomy]. Eighteen KOA model rabbits were established using a modified Videman method. Rabbits in EA and acupotomy groups received the intervention for 3 weeks. Then, the cartilage and subchondral bone unit were obtained and the histomorphological changes were recorded. Osteo-protegerin (OPG) and receptor activator of nuclear factor-κB ligand (RANKL) in subchondral bone were evaluated by Western blotting, real-time polymerase chain reaction and immunohistochemistry. RESULTS Compared with the model group, both the acupotomy and EA groups showed a significant decrease in the Lequesne index (both 0.01) and Mankin score ( 0.01, < 0.05). In addition, both EA and acupotomy groups had a higher expression of total articular cartilage (TAC) ( 0.05, < 0.01) and lower expression of articular calcified cartilage (ACC)/TAC ( 0.05, < 0.05) compared with the model group. The thickness of the subchondral bone plate in EA and acupotomy groups were decreased (both 0.01) compared to the model group. Moreover, trabecular bone volume (BV/TV), protein and relative expression of OPG and the ratio of OPG/RANKL in the subchondral bone of acupotomy group were decreased statistically significant, while these parameters were not significantly changed in the EA group compared with the model group. CONCLUSIONS In the rabbit model of KOA, acupotomy inhibits aberrant formation of subchondral bone by suppressing OPG/RANKL ratio as a potential therapy for KOA.
Collapse
Affiliation(s)
- Luxue QIN
- 1 School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Changqing GUO
- 1 School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
- Prof. GUO Changqing, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China. ,Telephone: +86-10-64286687
| | - Ruili ZHAO
- 2 the First People's Hospital of Dongcheng District, Beijing 100050, China
| | - Tong WANG
- 1 School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Junmei WANG
- 1 School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Yan GUO
- 3 Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
| | - Wei ZHANG
- 4 the Third Affiliated Hospital of Beijing Universality of Chinese Medicine, Beijing 100029, China
| | - Tingyao HU
- 1 School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Xilin CHEN
- 1 School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Qian ZHANG
- 1 School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Dian ZHANG
- 1 School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Yue XU
- 1 School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| |
Collapse
|
5
|
Atici A, Bahadir Ulger FE, Akpinar P, Illeez OG, Geler Kulcu D, Unlu Ozkan F, Aktas I. Poor Accuracy of Clinical Diagnosis in Pes Anserine Tendinitis Bursitis Syndrome. Indian J Orthop 2021; 56:116-124. [PMID: 35070151 PMCID: PMC8748597 DOI: 10.1007/s43465-021-00424-3] [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: 12/26/2020] [Accepted: 05/12/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To investigate the characteristics of the patients who are clinically diagnosed with pes anserine tendinitis bursitis syndrome (PATBS), and to determine the sensitivity and specificity of clinical diagnose based on magnetic resonance imaging (MRI). METHODS Included in this cross-sectional clinical study were 156 patients who were evaluated based on the clinical presence or absence of PATBS. All patients underwent Q-angle measurement, knee osteoarthritis (OA) grading according to the Kellgren-Lawrence classification, and medial joint space measurement, and their cartilage thickness, and any periarticular and intraarticular knee pathologies were recorded from an assessment of knee MRIs. RESULTS Of the total, 64 cases (41%) were diagnosed clinically with PATBS and 92 (59%) were not. There was no difference in the Q angles of the two groups (p > 0.05), while the medial joint spaces were significantly lower in the PATBS patients (p < 0.05). There were no significant differences between the two groups in an MRI assessment of meniscus and ligament lesions, chondromalacia patella, cyst, bursitis, effusion and synovial pathologies (p > 0.05). The sensitivity and specificity of the PATBS clinical diagnoses relative to the MRI findings were determined as 41.2% and 59.5%, respectively. CONCLUSION The medial joint space was found to be significantly lower in patients with PATBS, while there was no difference in any other knee pathologies between the two groups. The sensitivity and specificity of a PATBS clinical diagnosis were found to be low, and so it was concluded that clinical PATBS diagnoses may be inaccurate, particularly in the presence of such invasive therapies as injection, and that diagnoses based on imaging methods would be more accurate.
Collapse
Affiliation(s)
- Arzu Atici
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Icerenkoy, 34752 Istanbul, Turkey
| | - Fatma Esra Bahadir Ulger
- Department of Radiology, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Pinar Akpinar
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Icerenkoy, 34752 Istanbul, Turkey
| | - Ozge Gulsum Illeez
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Icerenkoy, 34752 Istanbul, Turkey
| | - Duygu Geler Kulcu
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Feyza Unlu Ozkan
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Icerenkoy, 34752 Istanbul, Turkey
| | - Ilknur Aktas
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Icerenkoy, 34752 Istanbul, Turkey
| |
Collapse
|
6
|
Abate M, Di Carlo L, Di Iorio A, Salini V. Baker's Cyst with Knee Osteoarthritis: Clinical and Therapeutic Implications. Med Princ Pract 2021; 30:585-591. [PMID: 34348320 PMCID: PMC8739941 DOI: 10.1159/000518792] [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: 12/20/2020] [Accepted: 07/23/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Several symptoms are common to knee osteoarthritis and Baker's cyst. To what extent each condition contributes to the patient's discomfort is still a matter of debate. The aim of the present study was twofold: first, to compare the burden of symptoms in patients with isolated knee osteoarthritis and patients with knee osteoarthritis associated with Baker's cyst; second, to assess the outcomes after conservative treatments. SUBJECT AND METHODS Patients suffering from monolateral idiopathic knee osteoarthritis were enrolled. Demographic, anthropometric and clinical data (KOOS scale) were collected. Ultrasound evaluation was performed according to standard protocols. On the basis of the clinical presentation different therapeutic options were used (fluid withdrawal, hyaluronic acid and/or steroids injections). RESULTS One-hundred and thirty patients were included in the study (97 with isolated knee osteoarthritis, 33 with knee osteoarthritis and Baker's cyst). In basal conditions, lower scores in KOOS sub-scales were observed in patients with knee osteoarthritis associated with Baker's cyst and in patients with effusion compared with patients without effusion. At 3 months after therapy significant higher scores were observed in both groups. At 6 months the scores were unchanged in the patients without Baker's cyst, but worsened in those with Baker's cyst. CONCLUSIONS The study shows that Baker's cysts associated with knee osteoarthritis contribute to the burden of symptoms. The conservative treatment of both conditions allows significant improvements, but in the medium term (6 months) the efficacy of the therapy declines in patients with knee osteoarthritis associated with Baker's cyst.
Collapse
Affiliation(s)
- Michele Abate
- Medical Facilities Delfino Pescara 1936, Pescara, Italy
- *Michele Abate,
| | | | - Angelo Di Iorio
- Department of Medicine and Science of Aging, University “G. d'Annunzio,”, Chieti Scalo, Italy
| | - Vincenzo Salini
- Division of Orthopedics and Traumatology, San Raffaele Hospital, Milan, Italy
| |
Collapse
|
7
|
Chen CPC, Hsu CC, Huang SC, Lin MY, Chen JL, Lin SY. The application of thermal oscillation method to augment the effectiveness of autologous platelet rich plasma in treating elderly patients with knee osteoarthritis. Exp Gerontol 2020; 142:111120. [PMID: 33091524 DOI: 10.1016/j.exger.2020.111120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/10/2020] [Accepted: 10/11/2020] [Indexed: 11/28/2022]
Abstract
Elderly patients with knee osteoarthritis (OA) are often troubled with joint soreness, swelling, weakness, and pain. Knee intra-articular (IA) injection of autologous platelet rich plasma (PRP) is one of the options that can be used in treating knee OA. However, there are doubts on the effect of PRP when used in treating elderly patients with moderate to severe degrees of knee OA. In this study, 47 elderly patients with moderate degree of knee OA combined with supra-patellar bursitis were recruited. Musculoskeletal ultrasound was used for accurate needle placement for the aspiration of bursa synovial fluid SF followed by PRP injections. In group 1, 23 patients received conventional liquid-form IA PRP injections. In group 2, 24 patients received IA injections of thermal oscillation prepared PRP injectants. It was discovered that when the liquid-form PRP was heated up to a temperature of 75 °C and simultaneously oscillated under 200 revolutions per minute (rpm) for 15 min, the end product became paste-form like and with a viscosity similar to that of an anti-cough syrup. Under incubation, the highest number of platelet-derived growth factor (PDGF) was obtained on the 8th day. At one month after the completion of PRP injections, group 2 patients revealed significant decreases in SF total protein concentrations, SF volumes, and Lequesne index values. Proteins associated with inflammation, such as apolipoprotein A-I, haptoglobin, immunoglobulin kappa chain, transferrin, and matrix metalloproteinase also decreased significantly. Therefore, the thermal oscillation preparation method can augment the effectiveness of autologous PRP in treating elderly patients with moderate knee OA. It may be recommended that the PRP injectant should be prepared first using the thermal oscillation method to increase its viscosity, enabling prolonged release of growth factors once it is injected into the knee joint.
Collapse
Affiliation(s)
- Carl P C Chen
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Guishan District, Taoyuan City, Taiwan.
| | - Chih-Chin Hsu
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Keelung and College of Medicine, Chang Gung University, Guishan District, Taoyuan City, Taiwan
| | - Shu-Chun Huang
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Guishan District, Taoyuan City, Taiwan
| | - Mu-Yun Lin
- Department of Medicine, College of Medicine, Chang Gung University, Guishan District, Taoyuan City, Taiwan
| | - Jean-Lon Chen
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Guishan District, Taoyuan City, Taiwan
| | - Shin-Yi Lin
- Department of Physical Medicine & Rehabilitation, Chang Gung Memorial Hospital at Linkou and College of Medicine, Chang Gung University, Guishan District, Taoyuan City, Taiwan
| |
Collapse
|