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Morphometric Analysis of the Menisci of the Knee Joint in South Indian Human Fetuses
Murlimanju,B. V; Nair,Narga; Pai,Shakuntala R; Pai,Mangala M; Gupta,Chandni; Kumar,Vishal; Pulakunta,Thejodhar;
International Journal of Morphology , 2010, DOI: 10.4067/S0717-95022010000400029
Abstract: the morphometrical data related to the menisci of the adults have been reported by few authors and that of the fetuses have not been reported. the aims of the present study were to analyse the external circumference thickness, the width, peripheral and inner border lengths, and the distance between anterior and posterior horns of the fetal menisci and to compare the meniscal dimensions with that of the adult meniscal parameters which are available in the literature. the menisci from 106 knee joints of the formalin fixed south indian fetuses which were obtained from the anatomy department were analysed. the fetuses which had musculoskeletal anomalies were excluded from the study. a vernier caliper of 0.02 mm accuracy and a non elastic cotton thread were used for the morphometry. after comparing the meniscal dimensions of the present study with the adult meniscus parameters, we established that the fetal parameters of the meniscus are entirely different from the adults. these differences are may be due to the mesenchymal differentiation or variability of the vasculature early in embryonic life. we believe that our study will provide support to the fetal anatomy, concerning surgical procedures and arthroscopy of the knee joint. since the morphometric studies of the fetal menisci are not reported, this study may be considered new and needs to be studied further with different groups of fetuses from various stages of intrauterine development. this study is important not only for orthopedic surgeons, but also for morphologists and embryologists.
Influence of bi- and tri-compartmental knee arthroplasty on the kinematics of the knee joint
Markus Wünschel, JiaHsuan Lo, Torsten Dilger, Nikolaus Wülker, Otto Müller
BMC Musculoskeletal Disorders , 2011, DOI: 10.1186/1471-2474-12-29
Abstract: No in vitro data is available to biomechanically evaluate the ability of the anterior cruciate ligament (ACL) to maintain knee joint kinematics after bicruciate-retaining bi-compartmental knee arthroplasty (BKA).Therefore, the objective of the current study was to investigate the kinematics of the natural knee joint, before and after installing bicruciate-retaining BKA and posterior cruciate retaining total knee arthroplasty. Specifically, we incorporated a dynamic knee simulator to simulate weight-bearing flexions on cadaveric knee specimen before and after surgical manipulations.In this cadaveric study we investigated rotational and translational tibiofemoral kinematics during simulated weight-bearing flexions of the intact knee, after bi-compartmental knee arthroplasty (BKA+), after resecting the ACL in BKA (BKA-), and after posterior cruciate retaining total knee arthroplasty (TKA).Rotation of BKA+ is closest to the intact knee joint, whereas TKA shows significant differences from 30 to 90 degree of flexion. Within the tested flexion range (15 to 90 degree of flexion), there was no significant difference in the anterior-posterior translation among intact, BKA+, and TKA knees. Resecting the ACL in BKA leads to a significant anterior tibial translation.BKA with intact cruciate ligaments resembles rotation and translation of the natural knee during a simulated weight-bearing flexion. It is a suitable treatment option for medial and patellofemoral osteoarthritis with advantages in rotational characteristics compared to TKA.Unicondylar knee Arthroplasty (UKA) is a well established treatment option for osteoarthritis of either medial or less often lateral knee joint compartment. Advantages include the minimal surgical exposure and the intact cruciate ligaments. It also provides the possibility to switch to a total knee arthroplasty (TKA) later, even though UKA conversion to TKA has been shown to be associated with poorer clinical outcome compared to primary TKA [1]. S
Synovial Neuronal Changes in Knee Joint Osteoarthritis  [PDF]
Haq Nawaz, Masood Umer, Shahryar Noordin, Bo Christer Bertilson, Jian Li, Aisha Siddiqah Ahmed, Mahmood Ahmed
Open Journal of Rheumatology and Autoimmune Diseases (OJRA) , 2016, DOI: 10.4236/ojra.2016.62005
Abstract: Purpose: The purpose is to study whether pain and inflammation in knee joint osteoarthritis (OA) are associated with local synovial neuronal changes. Methods: Synovial biopsies were harvested from the medial and lateral knee compartments from OA patients undergoing total joint replacement surgery. All patients had predominant pain at the medial joint compartment. Pain and knee joint function were evaluated by knee society score (KSS). Synovial inflammation was analyzed by histopathological analysis and expression of growth associated protein-43 (GAP-43), sensory (SP, CGRP) and autonomic (NPY, VIP, TH) neuropeptides was studied by single and double immunohistochemistry techniques. Results: We observed reduced KSS and increased inflammatory score in synovial membrane of medial knee compartment. A significant increase in GAP-43 [P = 0.001], SP [P = 0.05], CGRP [P = 0.05] and TH [P = 0.05] expression was observed and SP, CGRP and NPY were found to be co-existed predominantly with GAP-43 in synovial membrane collected from medial compared to the lateral knee compartment. Conclusions: Regenerating nerve fibers containing sensory and autonomic neuropeptides are associated with pain and inflammation in knee joint OA.
The Effect of Ligament Modeling Technique on Knee Joint Kinematics: A Finite Element Study  [PDF]
Ata M. Kiapour, Vikas Kaul, Ali Kiapour, Carmen E. Quatman, Samuel C. Wordeman, Timothy E. Hewett, Constantine K. Demetropoulos, Vijay K. Goel
Applied Mathematics (AM) , 2013, DOI: 10.4236/am.2013.45A011

Finite element (FE) analysis has become an increasingly popular technique in the study of human joint biomechanics, as it allows for detailed analysis of the joint/tissue behavior under complex, clinically relevant loading conditions. A wide variety of modeling techniques have been utilized to model knee joint ligaments. However, the effect of a selected constitutive model to simulate the ligaments on knee kinematics remains unclear. The purpose of the current study was to determine the effect of two most common techniques utilized to model knee ligaments on joint kinematics under functional loading conditions. We hypothesized that anatomic representations of the knee ligaments with anisotropic hyperelastic properties will result in more realistic kinematics. A previously developed, extensively validated anatomic FE model of the knee developed from a healthy, young female athlete was used. FE models with 3D anatomic and simplified uniaxial representations of main knee ligaments were used to simulate four functional loading conditions. Model predictions of tibiofemoral joint kinematics were compared to experimental measures. Results demonstrated the ability of the anatomic representation of the knee ligaments (3D geometry along with anisotropic hyperelastic material) in more physiologic prediction of the human knee motion with strong correlation (r 0.9 for all comparisons) and minimum deviation (0.9° RMSE 2.29°) from experimental findings. In contrast, non-physiologic uniaxial elastic representation of the ligaments resulted in lower correlations (r 0.6 for all comparisons) and substantially higher deviation (2.6° RMSE

Analysis of Force Transmission by a Knee Loading Device from Skin and Soft Tissue to Knee Joint Elements  [PDF]
Samson Rayi, Hiroki Yokata, Sohel Anwar
Journal of Biomedical Science and Engineering (JBiSE) , 2019, DOI: 10.4236/jbise.2019.126025
Abstract: Dynamic loading to a knee joint is considered to be an effective modality for enhancing the healing of long bones and cartilage that are subject to ailments like fractures, osteoarthritis, etc. We developed a knee loading device and tested it for force application. The device applies forces on the skin, whereas force transmitted to the knee joint elements is directly responsible for promoting the healing of bone and cartilage. However, it is not well understood how loads on the skin are transmitted to the cartilage, ligaments, and bone. Based on a CAD model of a human knee joint, we conducted a finite element analysis (FEA) for force transmission from the skin and soft tissue to a knee joint. In this study, 3D models of human knee joint elements were assembled in an FEA software package (SIMSOLID). A wide range of forces was applied to the skin with different thickness in order to obtain approximate force values transmitted from the skin to the joint elements. The maximum Von Mises stress and displacement distributions were estimated for different components of the knee joint. The results demonstrate that the high load bearing areas were located on the posterior portion of the cartilage. This prediction can be used to improve the design of the knee loading device.
Effects of methods of descending stairs forwards versus backwards on knee joint force in patients with osteoarthritis of the knee: a clinical controlled study
Masaki Hasegawa, Takaaki Chin, Sadaaki Oki, Shusaku Kanai, Koji Shimatani, Tomoaki Shimada
Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology , 2010, DOI: 10.1186/1758-2555-2-14
Abstract: Using a three-dimensional motion analysis system, we investigated lower extremity joint angles, joint moments, joint force of the support leg in forward and backward descending movements on stairs, and joint force of the leading leg at landing in 7 female patients with osteoarthritis of the knee.Compared with the forward descending movement, knee joint angle, joint moment and joint force of the support leg all decreased in the backward descending movement. Joint force of the leading leg at landing was also reduced in the backward descending movement. In addition, we confirmed that the center of body mass was mainly controlled by the knee and ankle joints in the forward descending movement, and by the hip joint in the backward descending movement.Since it has been reported that knee flexion angle and extensor muscle strength are decreased in patients with osteoarthritis of the knee, we believe that backward descending movement is an effective method to use the hip joint to compensate for these functional defects. In addition, due to the decreased knee joint force both in the leading and support legs in backward descending movement, the effectiveness of compensatory motion for pain control and knee joint protection was also suggested.Patients with osteoarthritis of the knee (OA patients) have limitations in motion in various daily activities due to functional defects, which include pain, reduced range of motion and decreased strength of the muscles surrounding the knee joint [1-3]. In particular, motions requiring deep flexion of the knee joint are commonly limited, and ascending and descending movements often become challenging [4]. Compared with the ascending movement, far greater muscle contraction is needed to control forward motion of the body when descending stairs due to an increased knee joint flexion angle [5].Although OA patients are advised to avoid ascending and descending stairs, learning a safe and comfortable method of using stairs is still important si
The Relationship between Incorrect Restoration of the Joint Line and Lateral Knee Pain in Patients Undergoing Total Knee Arthroplasty  [PDF]
Cetin Isik, Uygar Dasar, Mesut Tahta, Nurdan Cay, Ramazan Akmese, Derya Isik, Murat Bozkurt
Open Journal of Rheumatology and Autoimmune Diseases (OJRA) , 2014, DOI: 10.4236/ojra.2014.43020

Aim: In this study, the relationship between the change in the joint line and lateral knee pain was evaluated after primary total knee arthroplasty. Material and method: Between 2005 and 2012, patients who underwent primary total knee arthroplasty were included in the study. Patients having “cruciate retaining total knee arthroplasty” and with a change of the joint line ≥8 mm and patients having “posterior stabilized total knee arthroplasty” and with a change of the joint line ≥5 mm were selected as the study group (group 1, n = 32). A total of 47 patients having similar demographic characteristics with the study group and the joint line changing below the predetermined level or remaining unchanged were included as the control group (group 2). The 2 groups were compared according to the presence of knee pain, the localization and spread of the pain, iliotibial band, tension and pain in the patellar tendon and quadriceps tendon, front knee pain during squatting, VAS pain score, OBER test positivity, Knee Society knee and function score, and general patient satisfaction. Results: There were statistically significant more lateral knee pain (p < 0.001), OBER test positivity (p < 0.001) and iliotibial band tension (p < 0.001) in group 1 compared to group 2. However, there were no statistically significant differences between the 2 groups regarding rest pain (p = 0.855), pain during squatting (p = 0.761), exertional pain (p = 0.322), pain in the patellar tendon (p = 0.643) and quadriceps tendon (p = 0.873), Knee Society knee (p = 0.954) and function (p = 0.955) scores, and general satisfaction (p = 0.968). Conclusion: In total knee prosthesis operations, distal displacement of the joint line can result in lateral knee pain and iliotibial band tension. However, considering the results of total knee arthroplasty our findings have showed that this condition has no effect on knee functions and patient satisfaction.

Meat consumption and risk of primary hip and knee joint replacement due to osteoarthritis: a prospective cohort study
Yuanyuan Wang, Julie Simpson, Anita E Wluka, Dallas R English, Graham G Giles, Stephen Graves, Flavia M Cicuttini
BMC Musculoskeletal Disorders , 2011, DOI: 10.1186/1471-2474-12-17
Abstract: Eligible 35,331 participants were selected from the Melbourne Collaborative Cohort Study recruited during 1990-1994. Consumption of fresh red meat, processed meat, chicken, and fish was assessed using a food frequency questionnaire. Primary hip and knee replacement for osteoarthritis during 2001-2005 was determined by linking the cohort records to the Australian National Joint Replacement Registry.There was a negative dose-response relationship between fresh red meat consumption and the risk of hip replacement (hazard ratio (HR) 0.94 per increase in intake of one time/week, 95% confidence interval (CI) 0.89-0.98). In contrast, there was no association with knee replacement risk (HR 0.98, 95% CI 0.94-1.02). Consumption of processed meat, chicken and fish were not associated with risk of hip or knee replacement.A high level consumption of fresh red meat was associated with a decreased risk of hip, but not knee, joint replacement for osteoarthritis. One possible mechanism to explain these differential associations may be via an effect of meat intake on bone strength and hip shape. Further confirmatory studies are warranted.Whilst the consumption of red meat is often recommended for its iron content [1], there is emerging evidence that red meat and processed meat are associated with carcinogenesis at several anatomic sites and increased mortality [2-5]. The mechanisms for these adverse effects are various but have been related to the constituent nutrients of red meat and methods of processing and cooking. Meat is a source of several multisite carcinogens including N-nitroso compounds, heterocyclic amines, and polycyclic aromatic hydrocarbons, some of which are formed during high-temperature cooking of meat [2]. Iron in red meat may increase oxidative damage and increase the formation of N-nitroso compounds [6]. Meat is also a major source of saturated fat which has been positively associated with cancer [7]. Current dietary recommendations are to consume small to modera
The associations between body and knee height measurements and knee joint structure in an asymptomatic cohort
Andrew J Teichtahl, Anita E Wluka, Boyd J Strauss, Yuanyuan Wang, Patricia Berry, Miranda Davies-Tuck, Flavia M Cicuttini
BMC Musculoskeletal Disorders , 2012, DOI: 10.1186/1471-2474-13-19
Abstract: 89 asymptomatic community-based adults aged 25-62 with no diagnosed history of knee arthropathy were recruited. Anthropometric data (knee height and body height) were obtained by standard protocol, while tibial cartilage volume and defects, as well as bone area were determined from magnetic resonance imaging. Static knee alignment was measured from the joint radiograph.All anthropometric height measures were associated with increasing compartmental tibial bone area (p ≤ 0.05). Although knee height was associated with tibial cartilage volume (e.g. β = 27 mm3 95% CI 7- 48; p = 0.009 for the medial compartment), these relationship no longer remained significant when knee height as a percentage of body height was analysed. Knee height as a percentage of body height was associated with a reduced risk of medial tibial cartilage defects (odds ratio 0.6; 95% confidence interval 0.4 - 1.0; p = 0.05).The association between increased anthropometric height measures and increased tibial bone area may reflect inherently larger bony structures. However the beneficial associations demonstrated with cartilage morphology suggest that an increased knee height may confer a beneficial biomechanical environment to the chondrocyte of asymptomatic adults.A novel and interesting measurement that may be related to knee joint structure is knee height. Although yet to be formally examined, the rationale for knee height being an important determinant of joint structure is based on the hypothesis that greater limb length imparts larger moments around the knee, producing more torque and subsequent joint loads.In the only study to have examined knee height, Hunter and colleagues (2005) demonstrated an increased prevalence of radiographic knee osteoarthritis (OA) in elderly Beijing residents with increased knee height [1]. This study comprised a population of Chinese aged 60 years or older and used radiographic disease as one of the measured end-points. Radiographic knee OA is heavily reliant on t
Effect of the Japanese herbal medicine, Boiogito, on the osteoarthritis of the knee with joint effusion
Tokifumi Majima, Masahiro Inoue, Yasuhiko Kasahara, Tomohiro Onodera, Daisuke Takahashi, Akio Minami
Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology , 2012, DOI: 10.1186/1758-2555-4-3
Abstract: Study was performed using 50 patients who were diagnosed with primary osteoarthritis of the knee with joint effusion. The patients were randomly assigned to two groups: one group (25 patients) using both loxoprofen (2-{4-[(2-oxocyclopentyl) methyl]} propanoic acid) and Boiogito and the other group (25 patients) using loxoprofen, and were evaluated during a 12 week observation period. The assessment parameters including knee scores in the Knee Society Rating System including Knee score and Functional scores, amount of joint effusion by joint puncture in clinically detected cases, the 36-items short form of the Medical Outcome Study Questionnaire (SF-36) as a measurement of health related quality of life were used.The knee scores based on the Knee Society Rating System were improved in both groups. The staircase climbing up and down ability in the Knee society rating system functional score was significantly improved in the group using Boiogito and loxoprofen compared to the loxoprofen group. In the evaluation using SF-36, significant improvements were found in the scores in both groups in physical functioning after 12 weeks. The amount of joint fluid was significantly decreased at 4, 8 and 12 weeks compared to pre-administration baseline in the group using Boiogito and loxoprofen. A side effect of Boiogito, dry mouth, was found in one case. The symptom was mild and improved immediately after discontinuation of administration.The results indicated that Boiogito have a possibility for a treatment modality for joint effusion with osteoarthritis of the knee.Osteoarthritis (OA) of the knee is a degenerative disease of the knee joints which significantly damages the functions of knee joints. The objective of its treatment is to decrease pain while attempting to maintain or increase the range of knee motion and to minimize disabilities in daily living. The majority of osteoarthritic patients visit the clinic with the complaint of pain. As clinical symptoms, joint effusion i
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