A Comprehensive Review of Current Management Trends in Medial Compartment Arthritis of the Knee Joint.

Medial compartment arthritis of the knee joint presents a significant clinical challenge, with diverse management options ranging from nonsurgical interventions to various surgical procedures. This comprehensive review synthesizes current evidence on the management trends in medial compartment arthritis, highlighting both nonsurgical approaches such as physical therapy, pharmacological interventions, and intra-articular injections as well as surgical interventions, including arthroscopic debridement, high tibial osteotomy, and knee arthroplasty. Through a comparative analysis of efficacy, complication rates, and patient outcomes, this review underscores the importance of tailoring treatment strategies to individual patient characteristics and preferences. Furthermore, emerging techniques and technologies promise to advance the field, necessitating ongoing research efforts to refine treatment algorithms and establish standardized guidelines. By adopting a multidisciplinary approach and integrating evidence-based practices, clinicians can optimize the management of medial compartment arthritis and enhance patient care outcomes.

Pediatric Synovial Osteochondromatosis of the Knee with Leg Length Discrepancy: A Case Report.

Introduction: Synovial chondromatosis (SC) is very rare among children. We are aware of no reports of patients with SC accompanied by leg length discrepancy (LLD). Case Report: We describe a case of synovial osteochondromatosis of a 7-year-old boy complicated by LLD. We performed epiphysiodesis of the distal femur and arthroscopic resection of loose bodies and total synovectomy. Three years after surgery, LLD had been corrected and there was no sign of recurrence. Conclusion: Physicians should be aware of synovial osteochondromatosis complicated by LLD in childhood and take radiographs of the whole length of lower legs when this condition is suspected.

Comparison of knee joint and temporomandibular joint development in pig embryos.

Although the knee joint (KNJ) and temporomandibular joint (TMJ) all belong to the synovial joint, there are many differences in developmental origin, joint structure and articular cartilage type. Studies of joint development in embryos have been performed, mainly using poultry and rodents. However, KNJ and TMJ in poultry and rodents differ from those in humans in several ways. Very little work has been done on the embryonic development of KNJ and TMJ in large mammals. Several studies have shown that pigs are ideal animals for embryonic development research. Embryonic day 30 (E30), E35, E45, E55, E75, E90, Postnatal day 0 (P0) and Postnatal day 30 (P30) embryos/fetuses from the pigs were used for this study. The results showed that KNJ develops earlier than TMJ. Only one mesenchymal condensate of KNJ is formed on E30, while two mesenchymal condensates of TMJ are present on E35. All structures of KNJ and TMJ were formed on E45. The growth plate of KNJ begins to develop on E45 and becomes more pronounced from E55 to P30. From E75 to E90, more and more vascular-rich cartilage canals form in the cartilage regions of both joints. The cartilaginous canal of the TMJ divides the condyle into sections along the longitudinal axis of the condyle. This arrangement of cartilaginous canal was not found in the KNJ. The chondrification of KNJ precedes that of TMJ. Ossification of the knee condyle occurs gradually from the middle to the periphery, while that of the TMJ occurs gradually from the base of the mandibular condyle. In the KNJ, the ossification of the articular condyle is evident from P0 to P30, and the growth plate is completely formed on P30. In the TMJ, the cartilage layer of condyle becomes thinner from P0 to P30. There is no growth plate formation in TMJ during its entire development. There is no growth plate formation in the TMJ throughout its development. The condyle may be the developmental center of the TMJ. The chondrocytes and hypertrophic chondrocytes of the growth plate are densely arranged. The condylar chondrocytes of TMJ are scattered, while the hypertrophic chondrocytes are arranged. Embryonic development of KNJ and TMJ in pigs is an important bridge for translating the results of rodent studies to medical applications.

Diagnostic accuracy of a novel ultrasound imaging index for knee osteoarthritis: Evaluation of sensitivity, specificity, and predictive values.

PURPOSE: We aimed to develop and validate a new ultrasonography (US) index for the diagnosis of primary medial-type knee osteoarthritis (OA). METHODS: In total, 156 patients (203 limbs) underwent standing knee radiography and the US for suspected knee OA. Total osteophyte height (TOH) and distance between bones (DBB) aided diagnosis. Logistic regression identified optimal cutoff values. Thresholds from logistic regression informed recipient operating characteristic curve (ROC) analysis, balancing sensitivity and specificity. These thresholds were then applied in the differential thermal analysis (DTA) to construct a 2 × 2 table. RESULTS: The TOH-DBB index showed that a DBB of 5.6 mm or less was required to diagnose primary medial-type knee arthropathy. The results in the 2 × 2 table were 41 true-positive (TP), 10 false negative (FN), 22 true-negative (TN), and 7 false positive (FP). A DBB of 5.6 mm or less and TOH of 4.7 mm or more were necessary to diagnose severe deformity. The results in the 2 × 2 table were 10 TP, 4 FN, 23 TN, and 4 FP. CONCLUSION: The TOH-DBB index was confirmed to capture changes in primary medial-type knee OA across various stages.

CPAK classification detect the real knee joint apex position in less than half of the knees.

PURPOSE: Accurate assessment of the knee joint line is essential for surgeries involving the knee. The knee joint line obliquity (KJLO) is a radiological measurement that evaluates the position of the knee joint relative to the ground and is frequently used in preoperative planning and clinical follow-up. On the other hand, coronal plane alignment of the knee (CPAK) classifications assesses the joint line as the summation of the medial proximal tibial angle (MPTA) and mechanical lateral distal femoral angle (mLDFA). The purpose of this study is to determine the concordance of these two measurement techniques. METHODS: This cross-sectional study evaluated the long-leg standing radiographs (LSRs) of 164 healthy knees. The extremity KJLO and CPAK classification JLO were measured twice by two observers at 8-week intervals. The knee joint line apex positions (proximal, neutral and distal) of the two measurement techniques are compared (concordance or discordant). The intraobserver and interobserver reliability were examined using the intraclass correlation coefficient (ICC). Possible causes of the discordant were evaluated with univariate and multivariate logistic regression analysis. RESULTS: CPAK classification detected the KJLO apex position in 70 extremities (42.7%) only. Subgroups CPAK JLO detected 13.6% of the proximal apex, 20.4% of the neutral, and 90.7% of the distal apex (p < 0.01). Upon multivariate logistic regression analysis, the variable KJLO apex position (proximal, neutral vs. distal, odds ratio (OR) = 10.291, 95% confidence interval [CI] = 2.225-25.656, and (p < 0.01) was determined as a risk factor for discordant. CONCLUSION: The CPAK JLO measurement technique can be misleading in defining the KJLO apex position and the concordance between them is less than 50%. It has a high tendency to misleadingly predict proximal and neutral apex positions, which can potentially have negative implications for assessing the joint line. LEVEL OF EVIDENCE: Level I.

Reconstruction of 3D knee MRI using deep learning and compressed sensing: a validation study on healthy volunteers.

BACKGROUND: To investigate the potential of combining compressed sensing (CS) and artificial intelligence (AI), in particular deep learning (DL), for accelerating three-dimensional (3D) magnetic resonance imaging (MRI) sequences of the knee. METHODS: Twenty healthy volunteers were examined using a 3-T scanner with a fat-saturated 3D proton density sequence with four different acceleration levels (10, 13, 15, and 17). All sequences were accelerated with CS and reconstructed using the conventional and a new DL-based algorithm (CS-AI). Subjective image quality was evaluated by two blinded readers using seven criteria on a 5-point-Likert-scale (overall impression, artifacts, delineation of the anterior cruciate ligament, posterior cruciate ligament, menisci, cartilage, and bone). Using mixed models, all CS-AI sequences were compared to the clinical standard (sense sequence with an acceleration factor of 2) and CS sequences with the same acceleration factor. RESULTS: 3D sequences reconstructed with CS-AI achieved significantly better values for subjective image quality compared to sequences reconstructed with CS with the same acceleration factor (p ≤ 0.001). The images reconstructed with CS-AI showed that tenfold acceleration may be feasible without significant loss of quality when compared to the reference sequence (p ≥ 0.999). CONCLUSIONS: For 3-T 3D-MRI of the knee, a DL-based algorithm allowed for additional acceleration of acquisition times compared to the conventional approach. This study, however, is limited by its small sample size and inclusion of only healthy volunteers, indicating the need for further research with a more diverse and larger sample. TRIAL REGISTRATION: DRKS00024156. RELEVANCE STATEMENT: Using a DL-based algorithm, 54% faster image acquisition (178 s versus 384 s) for 3D-sequences may be possible for 3-T MRI of the knee. KEY POINTS: • Combination of compressed sensing and DL improved image quality and allows for significant acceleration of 3D knee MRI. • DL-based algorithm achieved better subjective image quality than conventional compressed sensing. • For 3D knee MRI at 3 T, 54% faster image acquisition may be possible.

Combined Anterior Cruciate Ligament Reconstruction (ACLR) and Lateral Extra-articular Tenodesis through the Modified Lemaire Technique versus Isolated ACLR: A Meta-analysis of Clinical Outcomes.

Objective Lateral extra-articular tenodesis (LET) has been proposed to resolve rotatory instability following anterior cruciate ligament reconstruction (ACLR). The present meta-analysis aimed to compare the clinical outcomes of ACLR and ACLR with LET using the modified Lemaire technique. Materials and Methods We performed a meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) staement. The literature search was performed on the PubMed, EBSCOHost, Scopus, ScienceDirect, and WileyOnline databases. The data extracted from the studies included were the study characteristics, the failure rate (graft or clinical failure) as the primary outcome, and the functional score as the secondary outcome. Comparisons were made between the patients who underwent isolated ACLR (ACLR group) and those submitted to ACLR and LET through the modified Lemaire technique (ACLR + LET group). Results A total of 5 studies including 797 patients were evaluated. The ACLR + LET group presented a lower risk of failure and lower rate of rerupture than the ACLR group (risk ratio [RR] = 0.44; 95% confidence interval [95%CI]: 0.26 to 0.75; I 2 = 9%; p = 0.003). The ACLR + LET group presented higher scores on the Knee Injury and Osteoarthritis Outcome Score (KOOS) regarding the following outcomes: pain, activities of daily living (ADL), sports, and quality of life (QOL), with mean differences of 0.20 (95%CI: 0.10 to 0.30; I 2 = 0%; p < 0.0001), -0.20 (95%CI: -0.26 to -0.13; I 2 = 0%; p < 0.00001), 0.20 (95%CI: 0.02 to 0.38; I 2 = 0%; p = 0.03), and 0.50 (95%CI: 0.29 to 0.71; I 2 = 0%; p < 0.00001) respectively when compared with the ACLR group. Conclusion Adding LET through the modified Lemaire technique to ACLR may improve knee stability because of the lower rate of graft rerupture and the superiority in terms of clinical outcomes. Level of Evidence I.

The Influence of Tunnel Parameters and Graft Inclination Angle on Clinical and Radiological Outcome at Long-term Follow-up after Arthroscopic Anterior Cruciate Ligament Reconstruction.

Objective To study the influence of various tunnel parameters and graft inclination angle (GIA) on the clinical and radiological outcome after anterior cruciate ligament reconstruction (ACLR) at long-term follow-up. Methods In this retrospective study, 80 patients with isolated anterior cruciate ligament (ACL) injury treated by single bundle ACLR using bone patellar tendon bone (BPTB) and hamstring (HT) autografts were evaluated clinically and radiologically at their long-term follow-up. The study population were divided into two groups based on ideal and nonideal tunnel parameters as well as ideal and nonideal GIA. The various tunnel parameters and GIA were interpreted with clinical and radiological outcome at long-term follow-up. Results Eighty patients, 36 (45%) using BPTB and 44 (55%) using HT autografts, were available to complete the study. Patients with ideal coronal tibial tunnel angle (CTTA) and coronal femoral tunnel angle (CFTA) show superior clinical outcome (pivot shift test) than nonideal CTTA and CFTA, which was found to be statistically significant ( p -value < 0.038 and 0.024, respectively). Similarly, patients with ideal coronal tibial tunnel position (CTTP) show superior clinical outcome (International Knee Documentation Committee - IKDC objective) over nonideal CTTP ( p -value < 0.017). All other tunnel parameters and GIA were not found to have influence on clinical outcome. None of the tunnel parameters have influenced osteoarthritis (OA) change. There was no progression of OA change in the study population at long-term follow-up after ACLR. Conclusion Ideal coronal tunnel parameters produced a better clinical outcome at long-term follow-up after ACLR. There was no progression of OA change at long-term follow-up after isolated ACLR.

Prehabilitation: A proactive approach to enhancing outcomes in joint replacement surgery.

Prehabilitation is an emerging proactive and preventive approach to healthcare that focuses on preparing individuals for upcoming medical interventions or procedures. It aims to optimize physical and mental health before the planned medical and surgical interventions. By integrating exercise, psychological support, and lifestyle modifications, prehabilitation empowers individuals to face medical interventions with increased resilience and a higher likelihood of successful outcomes. Prehabilitation helps patients build strength and endurance, which can enhance their ability to withstand the physical stress of surgery and contribute to faster recovery. It plays a crucial role in optimizing outcomes for patients undergoing joint replacement surgery, by enhancing postoperative recovery, reducing complications, and improving the overall quality of life for patients. As the field of orthopaedics continues to evolve, the integration of prehabilitation into standard care protocols has the potential to redefine the landscape of joint replacement surgeries, ultimately improving patient outcomes, and hence more research is required from diverse population groups from developed and developing countries to collate required data and formulate evidence-based clinical guidelines.

Platelet-rich Plasma as Effectiveness in the Treatment of Osteoarthrosis of the Knee in a Tertiary Care Center.

Introduction: Osteoarthrosis (OA) is a condition that develops slowly but eventually causes considerable morbidity. Many medical specialties have employed platelet-rich plasma (PRP) since it is the best autologous biological blood-derived product, can be exogenously supplied to tissues, and releases high concentrations of platelet-derived growth factors to promote tendon, bone, and wound healing. This prospective research aims to clinically assess the effectiveness of PRP injection therapy for treating knee osteoarthrosis. Materials and Methods: A clinical prospective study was conducted at a tertiary care center for a period of a year. Subjects older than 50 years were selected for both genders who had a symptomatic primary knee OA. PRP is administered to and evaluated in 80 patients with knee osteoarthrosis. Using the VAS and WOMAC questionnaire tools, primary data was collected. The observations were compared using the appropriate statistical tools while considering significance at 95%. Results: Eighty-four subjects participated in the study till the end of the study period of 3 months. All study participants filled out questionnaires before injection, eight weeks after injection, and 12 weeks after. The obtained scores for the WOMAC and the VAS were compared, and it was observed that after 12 weeks, the WOMAC scores lowered from 77 to 33 (P < 0.001) and the VAS scores lowered to 6 to 1.5 (P < 0.001) and these alterations were significant. Conclusion: According to the most recent research, PRP therapy is a less expensive and more straightforward therapeutic option for the management of knee pain in patients who have OA, and it has also improved patients' ability to participate in everyday activities.

Functional and union outcome of combined column tibial plateau fracture treated with hybrid external fixator.

Objective: To determine the combined column tibial plateau fracture treated with a hybrid external fixator in terms of knee functionality, union outcome and complications. METHODS: The quasi-experimental study was conducted at the Department of Orthopaedic Surgery, Mayo Hospital, Lahore, Pakistan, from July 5, 2019, to December 31, 2021, and comprised patients of either gender aged 20-50 years who presented with 2-column or 3-column fractures of proximal tibia classified according to the 3-column classification system after being diagnosed using radiographs and three-dimensional computed tomography scan. Knee function, union and complications, like neural, vascular, infection, delayed union, nonunion, malunion and implant failure, were evaluated. The Knee Society Score was used to assess knee function, and modified Rasmussen score for the union, while complications were assessed clinically on the 2nd, 6th, 12th, 16th, 24th, 36th weeks and one year post-operatively. Data was analysed using SPSS 26. RESULTS: Of the 113 patients, 91(80.53%) were males and 22(19.47%) were females. The overall mean age was 35.56±9.00 years. From the 12th week to the 24th week 45(39.83%) patients had good and 59(52.21%) patients had excellent functional outcomes. Union outcome in the 16th and 24th week was good in 57(50.44%) patients and excellent in 47(41.59%) patients. No neurovascular injury was observed. Superficial pin tract infection was observed in 21(18.6%) cases that healed with wound debridement and antibiotics. No delayed union, malunion and implant failure was observed. CONCLUSIONS: Good to excellent functional and union outcomes with minimum complications were observed with the hybrid external fixator.

The Relationship of Open- and Closed-Kinetic-Chain Rate of Force Development With Jump Performance Following Anterior Cruciate Ligament Reconstruction.

PURPOSE: To determine between-limbs differences in isometric rate of force development (RFD) measured during open- (OKC) and closed-kinetic-chain (CKC) strength testing and establish which method had the strongest relationship to single-leg vertical-jump performance and knee mechanics after anterior cruciate ligament (ACL) reconstruction. METHODS: Subjects (n = 19) 1 to 5 years from ACL reconstruction performed isometric knee extensions (OKC), unilateral isometric midthigh pulls (CKC), and single-leg vertical jumps on the ACL-involved and -noninvolved limbs. Between-limbs differences were assessed using paired t tests, and the relationship between RFD, jump performance, and knee mechanics was assessed using correlation coefficients (r; P ≤ .05). RESULTS: There were significant between-limbs differences in OKC RFD (P = .008, d = -0.69) but not CKC RFD. OKC RFD in the ACL-involved limb had a strong association with jump height (r = .64, P = .003), knee-joint power (r = .72, P < .001), and peak knee-flexion angle (r = .72, P = .001). CKC RFD in the ACL-involved limb had a strong association with jump height (r = .65, P = .004) and knee-joint power (r = .67, P = .002) but not peak knee-flexion angle (r = .40, P = .09). CONCLUSIONS: While both OKC and CKC RFD were strongly related to jump performance and knee-joint power, OKC RFD was able to detect between-limbs RFD asymmetries and was strongly related to knee-joint kinematics. These findings indicate that isometric knee extension may be optimal for assessing RFD after ACL reconstruction.

Expression of Chondrogenic Potential Markers in Cultured Chondrocytes from the Human Knee Joint.

OBJECTIVES: While substantial progress has been made in engineering cartilaginous constructs for animal models, further research is needed to translate these methodologies for human applications. Evidence suggests that cultured autologous chondrocytes undergo changes in phenotype and gene expression, thereby affecting their proliferation and differentiation capacity. This study was designed to evaluate the expression of chondrogenic markers in cultured human articular chondrocytes from passages 3 (P3) and 7 (P7), beyond the current clinical recommendation of P3. METHODS: Cultured autologous chondrocytes were passaged from P3 up to P7, and quantitative polymerase chain reaction (qPCR) was used to assess mRNA expression of chondrogenic markers, including collagen type I (COLI), collagen type II (COLII), aggrecan (AGG), bone morphogenetic protein 4 (BMP4), transcription factor SOX-9 (SOX9), proteoglycan 4 (PGR4), and transformation-related protein 53 (p53), between P3 and P7. RESULTS: Except for AGG, no significant differences were found in the expression of markers between passages, suggesting the maintenance of chondrogenic potential in cultured chondrocytes. Differential expression identified between SOX9 and PGR4, as well as between COLI and SOX9, indicates that differences in chondrogenic markers are present between age groups and sexes, respectively. CONCLUSIONS: Overall, expression profiles of younger and male chondrocytes exhibit conversion of mature cartilage characteristics compared to their counterparts, with signs of dedifferentiation and loss of phenotype within-group passaging. These results may have implications in guiding the use of higher passaged chondrocytes for engineering constructs and provide a foundation for clinical recommendations surrounding the repair and treatment of articular cartilage pathology in both sexes.

Gait Analysis of Knee Joint Walking Based on Image Processing.

BACKGROUND: With the in-depth development of assistive treatment devices, the application of artificial knee joints in the rehabilitation of amputees is becoming increasingly mature. The length of residual limbs and muscle strength of patients have individual differences, and the current artificial knee joint lacks certain adaptability in the personalized rehabilitation of patients. PURPOSE: In order to deeply analyze the impact of different types of artificial knee joints on the walking function of unilateral thigh amputees, improve the performance of artificial knee joints, and enhance the rehabilitation effect of patients, this article combines image processing technology to conduct in-depth research on the walking gait analysis of different artificial knee joints of unilateral thigh amputees. METHODS: This article divides patients into two groups: the experimental group consists of patients with single leg amputation, and the control group consists of patients with different prostheses. An image processing system is constructed using universal video and computer hardware, and relevant technologies are used to recognize and track landmarks; Furthermore, image processing technology was used to analyze the gait of different groups of patients. Finally, by analyzing the different psychological reactions of amputees, corresponding treatment plans were developed. RESULTS: Different prostheses worn by amputees have brought varying degrees of convenience to life to a certain extent. The walking stability of wearing hydraulic single axis prosthetic joints is only 79%, and the gait elegance is relatively low. The walking stability of wearing intelligent artificial joints is as high as 96%. Elegant gait is basically in good condition. CONCLUSION: Image processing technology helps doctors and rehabilitation practitioners better understand the gait characteristics and rehabilitation progress of patients wearing different artificial knee joints, providing objective basis for personalized rehabilitation of patients.

Comparative evaluation of functional outcome and pain relief after pulsed radiofrequency of the saphenous nerve within and distal to the adductor canal in medial compartment knee osteoarthritis: A randomized double-blind trial.

Background and Aims: Pulsed radiofrequency (PRF) of the saphenous nerve (SN) has shown effective pain relief in knee pain because of knee osteoarthritis (KOA). The adductor canal (AC) contains other sensory nerves innervating the medial part of the knee joint apart from SN. We compared the PRF of SN within and outside the AC for their quality and duration of pain relief in knee osteoarthritis of the medial compartment (KOA-MC). Material and Methods: We conducted a randomized prospective study in 60 patients with anteromedial knee pain because of KOA-MC. Patients in group A received PRF-SN, and those in group B received PRF-AC. The primary objectives were comparison of pain by Visual Analog Scale (VAS) scores and changes in quality of daily living by Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and OXFORD knee scores. The secondary objectives were comparison of analgesic requirements using Medicine Quantification Scale (MQS) scores and block-related complications. Intra-group comparison was performed by analysis of variance. Inter-group normally distributed data were assessed by Student's t-test, non-normally distributed and ordinal data were assessed by Mann-Whitney U-test, and categorical data were assessed by Chi-square test. A P value of <0.05 was considered significant. Results: VAS scores were significantly lower in Gr-B at 12 weeks. The WOMAC scores and OXFORD scores at 4, 8, 12, and 24 weeks were significantly lower in Gr-B compared to Gr-A. Conclusion: The PRF-AC provides better pain relief and functional outcome than PRF-SN; however, duration of pain relief was not significantly different.

The Impact of Different Regions of Interest on Shear Wave Elastography Assessment of the Meniscus in the Knee Joint.

RATIONALE AND OBJECTIVES: To investigate the impact of different regions of interest (ROI) on the assessment of shear wave elastography (SWE) in evaluating the meniscus of the knee joint. MATERIALS AND METHODS: After ethical approval, a total of 141 participants were enrolled in this prospective study from February to October 2023. SWE was utilized to evaluate the anterior horn of the lateral meniscus (LM) and medial meniscus (MM), using two different ROIs (ROI-Small and ROI-Trace) to measure the elastic mean value (Emean) and elastic maximum value (Emax). The differences in elasticity values between the normal menisci and torn menisci were compared, and the impact of different ROI selection methods on the diagnostic performance of elastic parameters in the torn menisci was assessed using receiver operating characteristic (ROC) curves. RESULTS: In Emean comparison, only MM in the tear group showed higher ROI-S than ROI-T. When comparing Emax, all ROI-T values were higher than the ROI-S values, and this difference was statistically significant. Different sizes of ROI did not significantly impact the diagnostic performance of Emean in LM and MM, nor the diagnostic effectiveness of Emax in LM. However, only the area under the curve (AUC) of MM for Emax in both ROI-S and ROI-T showed a statistically significant difference. CONCLUSION: The shear wave elasticity values and diagnostic performance may vary depending on the ROI settings. Therefore, it is recommended to use a 2 mm diameter ROI placed at the central position of the meniscus, with Emean as the elasticity index.

Comparing risk assessment methods for work-related musculoskeletal disorders with in vivo joint loads during manual materials handling.

The validity of observational methods in ergonomics is still challenging research. Criterion validity in terms of concurrent validity is the most commonly studied. However, studies comparing observational methods with biomechanical values are rare. Thus, the aim of this study is to compare the Ovako Working Posture Analysing System (OWAS) and the Rapid Entire Body Assessment (REBA) with in vivo load measurements at hip, spine, and knee during stoop and squat lifting of 14 participants. The results reveal that OWAS and REBA action levels (AL) can distinguish between different in vivo load measurements during manual lifting. However, the results also reveal that the same OWAS- and REBA-AL do not necessarily provide equal mean values of in vivo load measurements. For example, resultant contact force in the vertebral body replacement for squat lifting ranged from 57% body weight (%BW) in OWAS-AL1 to 138%BW in OWAS-AL3 compared to 46%BW in REBA-AL0 and 173%BW in REBA-AL3. Furthermore, the results suggest that the performed squat lifting techniques had a higher risk for work-related musculoskeletal disorders than the performed stoop lifting techniques.

Comparison of needle and conventional arthroscopy for visualisation of predefined anatomical structures of the knee joint: a feasibility study in human cadavers and patients.

BACKGROUND: In terms of the optics used for Knee arthroscopy, a large number of different endoscopes are currently available. However, the use of the 30° optics in knee arthroscopy has been established as the standard procedure for many years. As early as the 1990s, needle arthroscopy was occasionally used as a diagnostic tool. In addition to the development of conventional optics technology in terms of camera and resolution, needle arthroscopes are now available with chip-on-tip image sensor technology. To date, no study has compared the performance of this kind of needle arthroscopy versus standard arthroscopy in the clinical setting in terms of the visibility of anatomical landmarks. In this monocentric prospective feasibility study, our aim was to evaluate predefined anatomical landmarks of the knee joint using needle arthroscopy (0° optics) and conventional knee arthroscopy (30° optics) and compare their performance during knee surgery. METHODS: Examinations were performed on eight cadavers and seven patients who required elective knee arthroscopy. Two surgeons independently performed the examinations on these 15 knee joints, so that we were able to compare a total of 30 examinations. The focus was on the anatomical landmarks that could be visualized during a conventional diagnostic knee arthroscopy procedure. The quality of visibility was evaluated using a questionnaire. RESULTS: In summary, the average visibility for all the anatomic landmarks was rated 4.98/ 5 for the arthroscopy using 30° optics. For needle arthroscopy, an average score of 4.89/ 5 was obtained. Comparatively, the needle arthroscope showed slightly limited visibility of the retropatellar gliding surface in eight (4.5/ 5 vs. 5/ 5), medial rim of the patella in four (4.85/ 5 vs. 5/ 5), and suprapatellar recess in four (4.83/ 5 vs. 5/ 5) cases. Needle arthroscopy was slightly better at visualizing the posterior horn of the medial meniscus in four knee joints (4.9/ 5 vs. 4.85/ 5). CONCLUSION: Needle arthroscopy is a promising technology with advantages in terms of minimally invasive access and good visibility of anatomical landmarks. However, it also highlights some limitations, particularly in cases with challenging anatomy or the need for a wide field of view.

Automated analysis of knee joint alignment using detailed angular values in long leg radiographs based on deep learning.

Malalignment in the lower limb structure occurs due to various causes. Accurately evaluating limb alignment in situations where malalignment needs correction is necessary. To create an automated support system to evaluate lower limb alignment by quantifying mechanical tibiofemoral angle (mTFA), mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA), and joint line convergence angle (JLCA) on full-length weight-bearing radiographs of both lower extremities. In this retrospective study, we analysed 404 radiographs from one hospital for algorithm development and testing and 30 radiographs from another hospital for external validation. The performance of segmentation algorithm was compared to that of manual segmentation using the dice similarity coefficient (DSC). The agreement of alignment parameters was assessed using the intraclass correlation coefficient (ICC) for internal and external validation. The time taken to load the data and measure the four alignment parameters was recorded. The segmentation algorithm demonstrated excellent agreement with human-annotated segmentation for all anatomical regions (average similarity: 89-97%). Internal validation yielded good to very good agreement for all the alignment parameters (ICC ranges: 0.7213-0.9865). Interobserver correlations between manual and automatic measurements in external validation were good to very good (ICC scores: 0.7126-0.9695). The computer-aided measurement was 3.44 times faster than was the manual measurement. Our deep learning-based automated measurement algorithm accurately quantified lower limb alignment from radiographs and was faster than manual measurement.

Are There Any Differences in the Healing Capacity between the Medial Collateral Ligament's (MCL) Proximal and Distal Parts in the Human Knee? Quantitative and Immunohistochemical Analysis of CD34, α-Smooth Muscle Actin (α-SMA), and Vascular Endothelial Growth Factor (VEGF) Expression Regarding the Epiligament (EL) Theory.

The human knee is a complex joint that comprises several ligaments, including the medial collateral ligament (MCL). The MCL provides stability to the knee and helps prevent its excessive inward movement. The MCL also has a thin layer of connective tissue known as the epiligament (EL), which adheres to the ligament. This unique feature has drawn attention in the field of ligament healing research, as it may have implications for the recovery process of MCL injuries. According to the EL theory, ligament regeneration relies heavily on the provision of cells, blood vessels, and molecules. The present study sought to compare the expression of vascular endothelial growth factor (VEGF), CD34, and α-smooth muscle actin (α-SMA) in healthy knees' proximal and distal MCL segments to better understand how these proteins affect ligament healing. By improving the EL theory, the current results could lead to more effective treatments for ligament injury. To conduct the present analysis, monoclonal antibodies were used against CD34, α-SMA, and VEGF to examine samples from 12 fresh knee joints' midsubstance MCLs. We identified a higher cell density in the EL than in the ligament connective tissue, with higher cell counts in the distal than in the proximal EL part. CD34 immunostaining was weak or absent in blood vessels and the EL, while α-SMA immunostaining was strongest in smooth muscle cells and the EL superficial layer. VEGF expression was mainly in the blood vessels' tunica media. The distal part showed more SMA-positive microscopy fields and higher cell density than the proximal part (4735 vs. 2680 cells/mm2). Our study identified CD34, α-SMA, and VEGF expression in the MCL EL, highlighting their critical role in ligament healing. Differences in α-SMA expression and cell numbers between the ligament's proximal and distal parts may explain different healing capacities, supporting the validity of the EL theory in ligament recovery.