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Huber S, Mitterer JA, Vallant SM, Simon S, Hanak-Hammerl F, Schwarz GM, Klasan A, Hofstaetter JG. Gender-specific distribution of knee morphology according to CPAK and functional phenotype classification: analysis of 8739 osteoarthritic knees prior to total knee arthroplasty using artificial intelligence. Knee Surg Sports Traumatol Arthrosc 2023; 31:4220-4230. [PMID: 37286901 DOI: 10.1007/s00167-023-07459-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/13/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE Osteoarthritis of the knee is commonly associated with malalignment of the lower limb. Recent classifications, as the Coronal Plane Alignment of the Knee (CPAK) and Functional Phenotype classification, describe the bony knee morphology in addition to the overall limb alignment. Data on distribution of these classifications is not sufficient in large populations. The aim of this study was to analyse the preoperative knee morphology with regard to the aforementioned classifications in long leg radiographs prior to total knee arthroplasty surgery using Artificial Intelligence. METHODS The cohort comprised 8739 preoperative long leg radiographs of 7456 patients of all total knee arthroplasty surgeries between 2009 and 2021 from our institutional database. The automated measurements were performed with the validated Artificial Intelligence software LAMA (ImageBiopsy Lab, Vienna) and included standardized axes and angles [hip-knee-ankle angle (HKA), mechanical lateral distal femur angle (mLDFA), mechanical medial proximal tibia angle (mMPTA), mechanical axis deviation (MAD), anatomic mechanic axis deviation (AMA) and joint line convergence angle (JLCA)]. CPAK and functional phenotype classifications were performed and all measurements were analysed for gender, age, and body mass index (BMI) within these subgroups. RESULTS Varus alignment was more common in men (m: 2008, 68.5%; f: 2953, 50.8%) while neutral (m: 578, 19.7%; f: 1357, 23.4%) and valgus (m: 345, 11.8%; f: 1498, 25.8%) alignment was more common in women. The most common morphotypes according to CPAK classification were CPAK Type I (2454; 28.1%), Type II (2383; 27.3%), and Type III (1830; 20.9%). An apex proximal joint line (CPAK Type VII, VIII and IX) was only found in 1.3% of all cases (n = 121). In men, CPAK Type I (1136; 38.8%) and CPAK Type II (799; 27.3%) were the most common types and women were spread more equally between CPAK Type I (1318; 22.7%), Type II (1584; 27.3%) and Type III (1494; 25.7%) (p < 0.001). The most common combination of femur and tibia types was NEUmLDFA0°,NEUmMPTA0° (m: 514, 17.5%; f: 1004, 17.3%), but men showed femoral varus more often. Patients with a higher BMI showed a significantly lower age at surgery (R2 = 0.09, p < 0.001). There were significant differences between men and women for all radiographic parameters (p < 0.001). CONCLUSION Distribution in knee morphology with gender-specific differences highlights the wide range in osteoarthritic knees, characterized by CPAK and phenotype classification and may influence future surgical planning. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Stephanie Huber
- Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna Speising, Speisinger Straße 109, 1130, Vienna, Austria
- Center for Anatomy and Cell Biology, Medical University Vienna Speising, Währinger Straße 13, 1090, Vienna, Austria
| | - Jennyfer A Mitterer
- Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna Speising, Speisinger Straße 109, 1130, Vienna, Austria
| | - Sascha M Vallant
- Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna Speising, Speisinger Straße 109, 1130, Vienna, Austria
| | - Sebastian Simon
- Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna Speising, Speisinger Straße 109, 1130, Vienna, Austria
- 2nd Department, Orthopedic Hospital Vienna Speising, Speisinger Straße 109, 1130, Vienna, Austria
| | - Florian Hanak-Hammerl
- Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna Speising, Speisinger Straße 109, 1130, Vienna, Austria
| | - Gilbert M Schwarz
- Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna Speising, Speisinger Straße 109, 1130, Vienna, Austria
- Center for Anatomy and Cell Biology, Medical University Vienna Speising, Währinger Straße 13, 1090, Vienna, Austria
- Department of Orthopedics and Trauma-Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Antonio Klasan
- Department of Orthopedics and Trauma-Surgery, AUVA Trauma Hospital Graz, Göstinger Straße 26, 8020, Graz, Austria
- Johannes Kepler University Linz, Altenberger Strasse 69, 4040, Linz, Austria
| | - Jochen G Hofstaetter
- Michael Ogon Laboratory for Orthopedic Research, Orthopedic Hospital Vienna Speising, Speisinger Straße 109, 1130, Vienna, Austria.
- 2nd Department, Orthopedic Hospital Vienna Speising, Speisinger Straße 109, 1130, Vienna, Austria.
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Ołowiana E, Selkow N, Laudner K, Puciato D, Bączkowicz D. Vibroarthrographic analysis of patellofemoral joint arthrokinematics during squats with increasing external loads. BMC Sports Sci Med Rehabil 2020; 12:51. [PMID: 32874592 PMCID: PMC7457288 DOI: 10.1186/s13102-020-00201-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/24/2020] [Indexed: 12/20/2022]
Abstract
Background The patellofemoral joint (PFJ) provides extremely low kinetic friction, which results in optimal arthrokinematic motion quality. Previous research showed that these friction-reducing properties may be diminished due to the increase in articular contact forces. However, this phenomenon has not been analyzed in vivo during functional daily-living activities. The aim of this study was the vibroarthrographic assessment of changes in PFJ arthrokinematics during squats with variated loads. Methods 114 knees from 57 asymptomatic subjects (23 females and 34 males) whose ages ranged from 19 to 26 years were enrolled in this study. Participants were asked to perform 3 trials: 4 repetitions of bodyweight squats (L0), 4 repetitions of 10 kg barbell back loaded squats (L10), 4 repetitions of 20 kg barbell back loaded squats (L20). During the unloaded and loaded (L10, L20) squats, vibroarthrographic signals were collected using an accelerometer placed on the patella and were described by the following parameters: variation of mean square (VMS), mean range (R4), and power spectral density for frequency of 50–250 Hz (P1) and 250–450 Hz (P2). Results Obtained results showed that the lowest values were noted in the unloaded condition and that the increased applied loads had a significant concomitant increase in all the aforementioned parameters bilaterally (p < 0.05). Conclusion This phenomenon indicates that the application of increasing knee loads during squats corresponds to higher intensity of vibroacoustic emission, which might be related to higher contact stress and kinetic friction as well as diminished arthrokinematic motion quality.
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Affiliation(s)
- Ewelina Ołowiana
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Prószkowska 76, PL-45-578 Opole, Poland
| | - Noelle Selkow
- Illinois State University, School of Kinesiology and Recreation, Normal, IL USA
| | - Kevin Laudner
- Beth El College of Nursing and Health Sciences, University of Colorado, Colorado Springs, CO USA
| | - Daniel Puciato
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Prószkowska 76, PL-45-578 Opole, Poland
| | - Dawid Bączkowicz
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Prószkowska 76, PL-45-578 Opole, Poland
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Analysis of patellofemoral arthrokinematic motion quality in open and closed kinetic chains using vibroarthrography. BMC Musculoskelet Disord 2019; 20:48. [PMID: 30704430 PMCID: PMC6357468 DOI: 10.1186/s12891-019-2429-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 01/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background Knee movements performed in open (OKC) and closed (CKC) kinetic chains generate various patterns of muscle activities and especially distinct contact stresses in the patellofemoral joint (PFJ). In contrast to these features, the arthrokinematic motion quality (AMQ) of the PFJ has not been compared between mentioned conditions. In this study we performed vibroarthrographic analysis of AMQ in movements performed in OKC and CKC, in healthy subjects and individuals with chondromalacia patellae, to assess which of the test conditions is more efficient in differentiation between healthy and deteriorated joints. Moreover, our analysis will broaden the knowledge related to behavior of normal and pathological synovial joints during motion with and without weight bearing. It is an essential issue, due to the recently observed significant interest in comparing potential benefits and limitations of CKC and OKC exercises as they relate to lower extremity rehabilitation. Methods 100 subjects (62 healthy controls and 38 subjects with PFJ chondromalacia) were enrolled. During repeated knee flexion/extension motions performed in OKC (in a sitting position) and CKC (sit-to-stand movements), the vibroarthrographic signals were collected using an accelerometer and described by variability (VMS), amplitude (R4), and spectral power in 50–250 Hz (P1) and 250–450 Hz (P2) bands. Results Significant differences in VMS [V], R4 [V], P1 [V2/Hz] and P2 [V2/Hz] between OKC and CKC were found (0.0001, 0.969. 0.800 0.041 vs 0.013, 3.973, 6.790, 0.768, respectively, P < 0.001). Moreover, in both analyzed load-related conditions the subjects with chondromalacia were characterized by significantly higher values of all parameters, when compared to controls (P < 0.001), with effect size values over 0.6. Conclusions We showed that motion of the physiological, unloaded PFJ articular surfaces in OKC is nearly vibrationless, which corresponds with optimal AMQ of PFJ, while loaded movements in CKC are characterized by a higher vibroacoustic emission level. Moreover, chondral lesions should be considered as an increased friction-related, aggravating factor of AMQ, which is critical in CKC movements under load. Nonetheless, OKC and CKC conditions are characterized by large effect sizes, and provide an efficient test frame for differentiating physiological knees and joints with chondral lesions.
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Nsir H, Szychlinska MA, Cardile V, Graziano ACE, Avola R, Esafi H, Bendini A, Zarouk M, Loreto C, Rapisarda V, Castrogiovanni P, Musumeci G. RETRACTED: Polar and apolar extra virgin olive oil and leaf extracts as a promising anti-inflammatory natural treatment for osteoarthritis. Acta Histochem 2017; 119:407-416. [PMID: 28461019 DOI: 10.1016/j.acthis.2017.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/23/2017] [Accepted: 04/24/2017] [Indexed: 01/27/2023]
Abstract
This article has been retracted: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/our-business/policies/article-withdrawal).
This article has been retracted at the request of the Authors. An anonymous reader made the authors aware of potential errors in the presentation and the experimental design for the Western blot data in Figure 3. Upon thorough investigation the authors concluded that in fact, in addition to an honest error (wrong image selected for inclusion into the article), the experimental design was not state-of-the-art in that the loading controls were run on parallel gels rather than on the gels to be probed for iNOS and collagen II. Therefore, in order to avoid any potentially wrong conclusions, the authors decided to retract the article, to confirm the data in a separate series of experiments and to submit the manuscript again after proper confirmation of the results and conclusions. The authors thank the anonymous reader, who spotted this error, and apologize for any inconvenience caused.
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Affiliation(s)
- Houda Nsir
- Biotechnology Laboratory of Olive Tree, Centre of Biotechnology of BorjCedreya, University of Carthage, Tunisia.
| | - Marta Anna Szychlinska
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Italy.
| | - Venera Cardile
- Department of Biomedical and Biotechnological Sciences, Physiology Section, School of Medicine, University of Catania, Italy.
| | - Adriana Carol Eleonora Graziano
- Department of Biomedical and Biotechnological Sciences, Physiology Section, School of Medicine, University of Catania, Italy.
| | - Rosanna Avola
- Department of Biomedical and Biotechnological Sciences, Physiology Section, School of Medicine, University of Catania, Italy.
| | - Hanen Esafi
- Biotechnology Laboratory of Olive Tree, Centre of Biotechnology of BorjCedreya, University of Carthage, Tunisia.
| | - Alessandra Bendini
- Department of Agricultural and Food Sciences, Alma Mater Studiorum-University of Bologna, p.zza Goindanich 60, 47521 Cesena (FC), Italy.
| | - Mokhtar Zarouk
- Biotechnology Laboratory of Olive Tree, Centre of Biotechnology of BorjCedreya, Tunisia.
| | - Carla Loreto
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Italy.
| | - Venerando Rapisarda
- Department of Clinical and Experimental Medicine, Occupational Medicine, University of Catania, Catania, Italy.
| | - Paola Castrogiovanni
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Italy.
| | - Giuseppe Musumeci
- Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section, School of Medicine, University of Catania, Italy; Department of Health, Institut des Etudes Universitaries, UniPoliSI, Veyras, Switzerland.
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