Using 3D MRI Bone Shape to Predict Pre-Osteoarthritis of the Knee 2 Years After Anterior Cruciate Ligament Reconstruction.

BACKGROUND: Anterior cruciate ligament (ACL) injury increases risks for osteoarthritis (OA), a poorly modifiable and disabling condition. Joint changes of potentially reversible pre-OA have been described just 2 years after ACL reconstruction (ACLR) when early bone shape changes have also been reported. PURPOSE: This study evaluates relationships between interlimb differences in tibiofemoral bone shape derived from statistical shape modeling (SSM) of magnetic resonance imaging (MRI) and participant factors on patient-reported outcomes 2 years after unilateral ACLR. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: SSM-derived tibiofemoral bone shape and subchondral bone area were assessed from bilateral knee MRI scans of 72 participants with unilateral ACLR (mean age, 34 ± 11 years; 32 women) and compared with a reference cohort of 398 older individuals without OA (mean age, 50 ± 3 years; 213 women). Multivariable logistic regression models examined relationships between participant and surgical factors with interlimb differences in bone shapes or subchondral bone areas. Relationships between patient-reported outcomes and the interlimb differences in bone shape and subchondral area were examined using similar models. RESULTS: Bone shape scores and subchondral bone areas were greater (more OA-like) in ACLR knees than uninjured contralateral knees in every bone metric tested (P≤ .001). Interlimb differences in femur shape scores of participants with ACLR were 65% greater (P < .001) than those of the significantly older reference cohort. Taller height, medial meniscal tears, and decreasing age were associated with larger interlimb differences in shape scores and subchondral areas (P < .05). Bone-patellar tendon-bone (BPTB) autograft recipients demonstrated greater interlimb subchondral area differences compared with allograft recipients (P < .05). Interlimb differences for hamstring autograft recipients did not differ from those with BPTB or allograft. Greater interlimb differences in medial femur subchondral areas were associated with worse patient-reported Knee injury and Osteoarthritis Outcome Score Symptoms (R = 0.27; P = .040). CONCLUSION: Even in the absence of radiographic OA, just 2 years after unilateral ACLR patients showed greater bone shape scores and subchondral areas consistent with pre-OA in their ACLR knees. Furthermore, greater medial femur bone areas were weakly associated with worse symptoms. Patients who are younger, are taller, have meniscal tears, or have BPTB grafts may be at increased risk for bony asymmetries 2 years after ACLR.

Competitive Binding of Bilirubin and Fatty Acid on Serum Albumin Affects Wear of UHMWPE.

Total Joint Replacement (TJR) devices undergo standardized wear testing in mechanical simulators while submerged in a proteinaceous testing solution to mimic the environmental conditions of artificial joints in the human body. Typically, bovine calf serum is used to provide the required protein content. However, due to lot-to-lot variability, an undesirable variance in testing outcome is observed. Based on an earlier finding that yellowish-orange serum color saturation is associated with wear rate, we examined potential sources of this variability, by running a comparative wear test with bilirubin; hemin; and a fatty acid, oleic acid, in the lubricant. All these compounds readily bind to albumin, the most abundant protein in bovine serum. Ultrahigh molecular weight polyethylene (UHMWPE) pins were articulated against CoCrMo discs in a pin-on-disc tribometer, and the UHMWPE wear rates were compared between lubricants. We found that the addition of bilirubin increased wear by 121%, while hemin had a much weaker, insignificant effect. When added at the same molar ratio as bilirubin, the fatty acid tended to reduce wear. Additionally, there was a significant interaction with respect to bilirubin and hemin in that UHMWPE wear rate decreased with increasing fatty acid concentration. We believe the conformational change in albumin by binding bilirubin makes it more likely to form molecular bridges between UHMWPE and the metal counterface, thus increasing adhesive wear. However, fatty acids compete for binding sites on albumin, and can prevent this conformational change. Hence, the protein is stabilized, and the chance for albumin to form bridges is lowered. Ultimately, UHMWPE wear rate is driven by the competitive binding of bilirubin and fatty acid to albumin.

Unsupervised gait retraining using a wireless pressure-detecting shoe insole.

BACKGROUND: The knee adduction moment (KAM) is a surrogate measure of mediolateral distribution of loads across the knee joint and is correlated with progression and severity of knee osteoarthritis (OA). Existing biomechanical approaches for unloading the arthritic medial knee compartment vary in their effectiveness in reducing KAM. This study employed a completely wireless, pressure-detecting shoe insole capable of generating auditory feedback via a smartphone. RESEARCH QUESTION: To investigate whether auditory cues from a smartphone can prompt subjects to adjust their gait pattern and reduce KAM. METHODS: Nineteen healthy subjects underwent gait training inside the lab (Phase 1) and received auditory cues during mid- and terminal stance to medialize their foot COP (center-of-pressure). This initial training period was continued unsupervised while walking around campus (Phase 2). RESULTS: After Phase 1, subjects reduced their KAM by 20.6% (p = 0. 001), a finding similar to a previous study that used a wired, lab-based insole system. After further unsupervised training outside the lab during Phase 2, subjects were able to execute the newly learned gait pattern without auditory feedback still showing a KAM reduction of 17.2% (p < 0.001). Although, speed at Phase 2 was lower than at baseline (p = 0.013), this reduction had little effect on KAM (r = 0.297, p = 0.216). In addition, the adduction angular impulse was reduced (p = 0.001), despite the slower speed. SIGNIFICANCE: Together, these results suggest that the wireless insole is a promising tool for gait retraining to lower the KAM and will be implemented in a home-based clinical trial of gait retraining for subjects with knee OA.

CT-based morphometric analysis of the occipital condyle: focus on occipital condyle screw insertion.

OBJECTIVE The segmental occipital condyle screw (OCS) is an alternative fixation technique in occipitocervical fusion. A thorough morphological study of the occipital condyle (OC) is critical for OCS placement. The authors set out to introduce a more precise CT-based method for morphometric analysis of the OC as it pertains to the placement of the segmental OCS, and they describe a novel preoperative simulation method for screw placement. Two new clinically relevant parameters, the height available for the OCS and the warning depth, are proposed. METHODS CT data sets from 27 fresh-frozen human cadaveric occipitocervical spines were used. All measurements were performed using a commercially available 3D reconstruction software package. The length, width, and sagittal angle of the condyle were measured in the axial plane at the base of the OC. The height of the OC and the height available for the segmental OCS were measured in the reconstructed oblique sagittal plane, fitting the ideal trajectory of the OCS recommended in the literature. The placement of a 3.5-mm-diameter screw that had the longest length of bicortical purchase was simulated into the OC in the oblique sagittal plane, with the screw path not being blocked by the occiput and not violating the hypoglossal canal cranially or the atlantooccipital joint caudally. The length of the simulated screw was recorded. The warning depth was measured as the shortest distance from the entry point of the screw to the posterior border of the hypoglossal canal. RESULTS The mean length and width of the OC were found to be larger in males: 22.2 ± 1.7 mm and 12.1 ± 1.0 mm, respectively, overall (p < 0.0001 for both). The mean sagittal angle was 28.0° ± 4.9°. The height available for the OCS was significantly less than the height of the OC (6.2 ± 1.3 mm vs 9.4 ± 1.5 mm, p < 0.0001). The mean screw length (19.3 ± 1.9 mm) also presented significant sex-related differences: male greater than female (p = 0.0002). The mean warning depth was 7.5 ± 1.7 mm. In 7.4% of the samples, although the height of the OC was viable, the height available for the OCS was less than 4.5 mm, thus making screw placement impractical. For these cases, a new preoperative simulation method of the OCS placement was proposed. In 92.6% of the samples that could accommodate a 3.5-mm-diameter screw, 24.0% showed that the entry point of the simulated screw was covered by a small part of the C-1 posterosuperior joint rim. CONCLUSIONS The placement of the segmental OCS is feasible in most cases, but a thorough preoperative radiological analysis is essential and cannot be understated. The height available for the OCS is a more clinically relevant and precise parameter than the height of the OC to enable proper screw placement. The warning depth may be helpful for the placement of the OCS.