The effect of foot posture on static balance, ankle and knee proprioception in 18-to-25-year-old female student: a cross-sectional study.

BACKGROUND & PURPOSE: Afferent input from the sole affects postural stability. Cutaneous reflexes from the foot are important to posture and gait. Lower-limb afferents alone provide enough information to maintain upright stance and are critical in perceiving postural sway. Altered feedback from propreoceptive receptors alters gait and patterns of muscle activation. The position and posture of the foot and ankle may also play an important role in proprioceptive input.Therefore, the current research aims to compare static balance and ankle and knee proprioception in people with and without flexible flatfeet. METHODOLOGY: 91 female students between the ages of 18 and 25 voluntarily participated in this study, of which 24 were in the flexible flatfoot group and 67 were in the regular foot group after evaluating the longitudinal arch of the foot. The position sense of ankle and knee joints were measured using the active reconstruction test of the ankle and knee angle; Static balance was measured using the Sharpened Romberg test. Data were non-normally distributed. Accordingly, non-parametric tests were applied. The Kruskal-Wallis test was applied to compare differences between groups in variables. RESULT: Kruskal-Wallis test showed a significant difference between two groups of flat feet and normal feet in the variables of static balance and position sense of ankle plantarflexion, ankle dorsiflexion, and knee flexion (p ≤ 0.05). A significant correlation was found between static balance and sense of ankle and knee position in the group with normal feet. The analysis of the regression line also showed that ankle and knee position sense could predict the static balance score in the regular foot group (ankle dorsiflexion position sense 17% (R2 = 0.17), ankle plantarflexion position sense 17% (R2 = 0.17) and knee flexion position sense 46% (R2 = 0.46) explain of changes in static balance). DISCUSSION & CONCLUSION: Flexible flatfoot soles can cause loss of balance and sense of joint position; therefore, according to this preliminary study, clinicians must be aware and should take into account this possible deficit in the management of these patients.

Are patients with preoperative synovitis suitable for unicompartmental knee arthroplasty? Magnetic resonance imaging evidence from a retrospective cohort study.

BACKGROUND: The use of unicompartmental knee arthroplasty (UKA) in patients with preoperative synovitis is controversial. This study aimed to investigate the association between synovitis detected by magnetic resonance imaging (MRI) and prognosis after UKA. METHODS: Synovitis was graded using the MRI Osteoarthritis Knee Score criteria based on preoperative MRI findings of 132 UKAs performed between June 2020 and August 2021. The Knee Society Knee Score (KS-KS) and the Knee Society Function Score were collected preoperatively and 1 year postoperatively. The relationship between synovitis and the changes in the Knee Society score was analyzed using logistic regression. RESULTS: Univariate logistic regression showed that patients with higher preoperative synovitis scores (odds ratio (OR) = 1.925, 95% confidence interval (CI): 1.482-2.500, P < 0.001) had higher KS-KS changes. After adjusting for confounding variables, synovitis was proven to be an independent factor for KS-KS improvement after UKA in multivariate logistic regression (OR = 1.814, 95% CI: 1.354-2.430, P < 0.001). Before UKA, patients with synovitis had lower pain scores (PS) than patients without synovitis (95% CI: -17.159 - -11.160, t = -9.347, P < 0.001). There was no difference in PS between the two groups after UKA (95% CI: -6.559 - 0.345, t = -1.782, P = 0.077). CONCLUSIONS: Patients with synovitis can achieve good improvement of pain symptoms, and the efficacy is not inferior to that of non-synovitis patients after UKA.

[Hyaluronic acid in the treatment of osteoarthritis of various localization: A review].

The article discusses the treatment of osteoarthritis (OA), the prevalence of which is high, and according to some forecasts it will increase by 50% in the next 20 years. The authors emphasize the high comorbidity among patients suffering from OA and high cardiovascular and gastrointestinal risks with frequent use of NSAIDs, the volume of consumption of which is constantly increasing. Discussing recommendations for the treatment of patients with OA, the article focuses on the use of hyaluronic acid (HA) preparations in the treatment of OA. The mechanisms of anti-inflammatory and chondroprotective actions of HA in the joint, its effect on cartilage and synovial membrane are discussed. Attention is drawn to the fact that, despite more than 30 years of experience in the effective use of HA preparations in the treatment of OA, this procedure is still a subject of controversy among international professional communities. The article presents data from meta-analyses and systematic reviews confirming the effectiveness of the use of intra-articular management of HA preparations in OA of various localization (knee joints, hip joints, hand joints). In conclusion, the recommendations of the technical expert group established at the International Symposium on Intra-Articular Treatment are given to determine the criteria for the successful administration of HA in OA of various localizations, as well as predictors of success and non-success of therapy with HA drugs. The experts identified indications, contraindications for intra-articular administration of HA preparations, as well as conditions associated with an increased risk of therapy failure. In conclusion, the authors draw conclusions about the importance of using HA preparations for intra-articular administration for the treatment of OA, starting from the early stages, following the recommendations of experts.

A simplified relationship between the femoral trochlea and the femoral condyle: A sagittal MRI analysis by an ellipse-fitting approach.

We have introduced an ellipse-fitting approach to express the shapes of trochlea and condyle on magnetic resonance imaging (MRI) and to analyze their relationship. Fifty healthy right knees were sagittal-imaged by MRI at full extension. On the deepest trochlear groove slice, the articular surface was best-fitted by a circle. Based on the center of this circle, both the most prominent slices of the medial and lateral trochleae were best-fitted by ellipses. On the most distal slice of medial condyle, the articular surface was best-fitted by a horizontal ellipse. Based on the center of this ellipse, the lateral condyle was best-fitted by a rotational ellipse. The semimajor and semiminor axes of the trochlear ellipse and the condylar ellipse constituted a rectangle that represented the relationship between the trochlea and the condyle. The anteroposterior dimension (l) of this rectangle was 12.33 ± 1.41 mm, and the superoinferior dimension (w) was 7.21 ± 1.23 mm. The average tangent angle (θ) of the rectangle was 30.1° ± 2.6°. There were significant sex differences in l, w, and θ (all P ≤ 0.006), and all correlated significantly with the height of the subject (all P ≤ 0.001). The relationship between the femoral trochlea and the femoral condyle differed significantly between males and females, but this could have been a consequence of the significant correlation with subject height. Clin. Anat. 33:500-506, 2020. © 2019 Wiley Periodicals, Inc.

[Osteoarthrosis in the clinic of internal and occupational diseases: differential diagnostic aspects].

Osteoarthritis is a common pathology, which indicates the great medical and social significance of this disease. The article discusses the issues of pathogenesis, risk factors and diagnosis of professional and professionally caused osteoarthritis: the age of onset of the disease, the specifics of work, the localization of joint damage. Differential diagnosis issues are discussed.

[Combined application of physiotherapy and acupuncture in patients with knee osteoarthrosis]. / Sochetannoe primenenie fizioterapii i igloukalyvaniia v lechenii patsientov s osteoartrozom kolennykh sustavov.

RATIONALE: Osteoarthrosis (OA) is one of the most common heterogeneous diseases. OA treatment is stopping the pain syndrome with the help of medical methods. Currently, there are no comprehensive programs, including a combination of physiotherapy and acupuncture, in the treatment of OA. AIM: The scientific justification and development of a comprehensive treatment for patients with OA of the knee joints (OAKJ) using transdermal electropharmstimulation (TEFS) and acupuncture in microacupuncture zones of the hand and foot. MATERIAL AND METHODS: We examined 210 patients with OAKJ who underwent outpatient treatment at LLC 'Sanatorium 'Zelenaya Roscha'', Republic of Bashkortostan (Ufa) in 2014-2017. Patients were divided into 3 groups at random. The groups were comparable by medical and demographic characteristics (gender, age), average duration and stage of the disease, and body mass index. The 1st group (comparison group) included 70 patients who were prescribed TEFS with a non-steroidal anti-inflammatory drug, combined with traditional drug treatment. In the 2nd group (main group) - 70 patients who underwent TEFS with a non-steroidal anti-inflammatory drug in combination with acupuncture in the microacupuncture zones of the hand and foot, as well as traditional drug therapy. In the 3rd group (control group) - 70 patients who received only drug therapy with a non-steroidal anti-inflammatory drug of 15 mg/day. Therapeutic efficacy was evaluated on the 4th, 7th, 11th, 11th and 12-15th days of treatment based on the timing of the relief of the pain syndrome, the dynamics of the clinical presentation of the disease, the visual analogue scale (VAS) for pain, the McGill pain questionnaire, tensoalgometry, electromyography of the thigh muscles, as well as changes in blood microcirculation in the knee joints on the 1st - 5th day of treatment. RESULTS: It was found that the combined use of TEFS and acupuncture in the microacupuncture zones of the hand and foot in patients with OAKJ relieves pain earlier than in the patients of the control group and the comparison group, and also leads to an increase in tensoalgometry, a decrease in VAS pain, and a decrease in the number of words-descriptors and sums of ranks, normalization of the amplitude of electric potentials and the frequency of muscle contractions of the thigh muscles, improvement of microcirculation of blood of the knee joints faster. CONCLUSION: The obtained results indicate the high efficiency of the combined use of TEFS and acupuncture in the microacupuncture zones of the hand and foot in the treatment of patients with OAKJ.

Pre-Clinical Testing of Microwave Radiometer and a Pilot Study on the Screening Inflammation of Knee Joints.

This article presents the pre-clinical evaluation of our custom-built, single-band microwave radiometer centered at 1.3 GHz for deep tissue thermometry, and a pilot study on volunteers for passive detection of inflammation in knee joints. The electromagnetic (EM) compatibility of the battery-operated radiometer for clinical use was assessed as per International Special Committee on Radio Interference (CISPR) 22 standard. The ability to detect inflammation in knee joints was assessed using a substrate integrated waveguide antenna connected to the radiometer. EM compatibility tests carried out in the laboratory indicated device immunity to intentional radiated interference up to -20 dBm injected power in the global system for mobile communication frequency band, and pre-compliance to CISPR 22 standard. Radiometer temperature measurements recorded at the lateral and medial aspects of both knees of 41 volunteers indicated mean temperature greater than 33°C for the diseased sites compared with the mean temperature of 28°C measured for the healthy sites. One-way analysis of variance statistics indicated significantly (P < 0.005) higher radiometer temperature at the diseased sites unlike the healthy sites. Thus, the EM pre-compliance of the device and the potential to measure deep tissue inflammation were demonstrated. Bioelectromagnetics. 2019;40:402-411. © 2019 Bioelectromagnetics Society.

[The use of the functional state of the joints for the estimation of the effectiveness of the application of oxygen/ozone therapy for the rehabilitative treatment of the patients suffering from knee arthritis]. / Funktsional'noe sostoianie sustavov kak kriterii otsenki éffektivnosti ispol'zovaniia ozonoterapii v vosstanovitel'nom lechenii bol'nykh gonartrozom.

BACKGROUND: In the recent years, the ever increasing tendency toward the growth in the prevalence of degenerative-dystrophic articular diseases has been observed especially among the young subjects and the middle-aged people. The enhanced economic burden of treating the patients with this condition on the public health care system frequently comes not only from chronic pathology of the joints but also from the development of concomitant disorders which dictates the necessity of the search for the new methods for the management of such patients. AIM: The objective of the present study was the optimization of the treatment of the patients presenting with stage I-II gonarthrosis by the para-articular application of oxygen/ozone therapy at the early stages of knee arthritis and the evaluation of the clinical effectiveness of this approach. MATERIAL AND METHODS: A total of 89 patients suffering from I-II sg gonarthrosis were recruited for the participation in the study. They included 67.2% of men and 32.8% of women. The age of the patients varied from 33 to 54 (mean 42±5) years, the duration of the disease averaged 4±1.2 years. All the patients were randomly divided into two groups: matched for the age, gender, the duration and severity of the disease, and the methods of its treatment. The main group was comprised of 45 patients whereas the group of comparison consisted of 44 patients. The generally accepted therapeutic modalities were used to treat the patients of both groups. Those included in the main group (n=45) additionally received para-articular oxygen/ozone therapy applied to the affected knee at a permanent ozone concentration of 8 gr/l (the injection area 15-20 sq.cm), main group n=45). The results of the treatment were evaluated within 1 and 6 months after the onset of therapy. RESULTS: The application of the up-to-date methods of oxygen/ozone therapy in the combination with the universally-accepted drug-based treatments for the patients of the main group resulted in the significant (p<0.01) improvement of the indicators of the biomechanical activity of the knee joints in comparison with that achieved by means of the generic drug-based treatment alone. DISCUSSION: The results of the present study give evidence of the feasibility of application of oxygen/ozone therapy for the treatment of degenerative-dystrophic articular diseases of the knees. The positive dynamics of the indicators of the functional activity of the knee joints, intensity and duration of the pain syndrome as well as the reduction of the period of the temporary incapacity for work associated with exacerbation of knee arthrosis suggests the high clinical and economic effectiveness of the para-articular application of oxygen/ozone therapy. CONCLUSIONS: The present study has demonstrated the expediency and effectiveness of the application of oxygen/ozone therapy during exacerbation of stage І-ІІ knee arthritis as evaluated based on the WOMAC index, VAS, and Lyshom scale within one and six months after the onset of the treatment. The resulting reduction in the number of days of temporary incapacity for work in the patients suffering from knee arthritis gives evidence of the clinical and economic validity of the proposed method of the combined treatment of this condition based on the application of oxygen/ozone therapy.

[INTERNATIONAL CLASSIFICATION OF FUNCTIONING, DISABILITY AND HEALTH AS A MODERN TOOL FOR ASSESSING QUALITY REHABILITATION OF PATIENTS].

The article used the methods of assessment of knee function, structure and functional activity in elderly patients with osteoarthritis to represent in terms of the ICF structure and subsequent evaluation of the rehabilitation patient profile and effectiveness of medical rehabilitation of patients with osteoarthritis of the knee. It is shown that the inclusion in the program of rehabilitation of older patients with osteoarthritis of the knee EHF-IR therapy provides a more pronounced clinical effect. An analysis of the profile of the rehabilitation of patients shows positive dynamics of all three components of the assessment of the rehabilitated patients (function, structure, activity). The data confirm the possibility of using the ICF in its use as a criterion for the scientific evaluation of the effectiveness of rehabilitation of patients with osteoarthritis.

Obesity, metabolic abnormality, and knee osteoarthritis: a cross-sectional study in Korean women.

BACKGROUND: This study aimed to analyze the association between knee osteoarthritis and four body size phenotypes defined by the presence or absence of metabolic abnormality and obesity. MEHODS: This was a cross-sectional study using data from 1,549 female participants of the Fifth Korean National Health and Nutrition Examination Survey. Knee osteoarthritis was defined as a Kellgren-Lawrence grade of ≥ 2. Metabolically abnormal state was defined as presence of more than one abnormality among five metabolic risk factors. Obesity was defined using body mass index. Participants were grouped into one of the four body size phenotypes: metabolically healthy normal weight (MHNW), metabolically abnormal but normal weight (MANW), metabolically healthy obesity (MHO), and metabolically abnormal obesity (MAO). RESULTS: The distribution of each body size phenotype was as follows: MHNW 54.7%, MANW 30.7%, MHO 4.3%, and MAO 10.3%. Prevalence of symptomatic knee osteoarthritis was higher in MANW than in MHNW, and in MAO than in MHO. In multivariable analysis, the association between symptomatic knee osteoarthritis and the body size phenotypes was as follows (OR [95% CI]): MHNW 1.00 (reference), MANW 1.54 (1.15-2.07), MHO 1.61 (0.83-3.13), and MAO 3.47 (2.35-5.14). CONCLUSIONS: Obesity showed closest association with knee osteoarthritis when accompanied by metabolic abnormality.

Impacts of Segond Fractures on Anterior Cruciate Ligament Reconstruction Outcomes.

INTRODUCTION: Segond fractures, characterized by avulsion injuries at the lateral tibial condyle's anterolateral structure (ALS) attachment, often coincide with anterior cruciate ligament (ACL) injuries, potentially leading to knee instability. However, the influence of Segond fractures on knee stability after ACL reconstruction remains uncertain. Despite documented ALS reconstructions, there is a lack of consensus regarding the assessment of ALS failure and the criteria for surgical interventions. This study aimed to determine if Segond fracture presence impacts ACL reconstruction outcomes, utilizing patient-reported subjective assessments and healthcare providers' objective evaluations. MATERIALS AND METHODS: This retrospective study encompassed 639 patients (328 males, 311 females; mean age 26.9 years) who underwent ACL reconstruction, with a follow-up of at least one year. Subjects were divided into two groups: Segond fractures diagnosed through radiographic findings (Group S+, n = 17) and no Segond fractures (Group S-, n = 622). Clinical evaluation included the 36-item Short Form Survey (SF-36), Lysholm score, visual analog scale (VAS) for knee pain, knee injury and osteoarthritis outcome score (KOOS), and knee instability assessment via Telos SE (Telos Japan, Tokyo, Japan). Statistical comparisons were performed between the two groups. RESULTS: At the final follow-up, all SF-36 subscales improved in all eight subscales compared to before surgery, reaching national standard scores; no significant inter-group differences were evident. Lysholm scores were 93.0 ± 12.1 (Group S+) and 91.7 ± 10.9 (Group S-) (P = 0.62), VAS for knee pain was 10.0 ± 18.0 (Group S+) and 11.9 ± 16.9 (Group S-) (P = 0.62), total KOOS was 89.0 ± 17.4 (Group S+) and 90.7 ± 9.9 (Group S-) (P = 0.39), and anterior tibial translation differences were 2.8 ± 3.0 mm (Group S+) and 2.7 ± 2.9 mm (Group S-) (P = 0.73). All these values represent postoperative measurements. No significant discrepancies existed between groups across evaluation methods. CONCLUSIONS: This study's results suggest that Segond fractures have minimal impact on clinical ACL reconstruction outcomes, as assessed through both patient-reported subjective evaluations and objective healthcare provider evaluations. Segond fractures' significance in postoperative outcomes questions the necessity of ALS reconstruction.

Qualitative and Quantitative Evaluation of Morpho-Metabolic Changes in Bone Cartilage Complex of Knee Joint in Osteoarthritis Using Simultaneous 18F-NaF PET/MRI-A Pilot Study.

Background Articular cartilage (AC) loss and deterioration, as well as bone remodeling, are all symptoms of osteoarthritis (OA). As a result, an ideal imaging technique for researching OA is required, which must be sensitive to both soft tissue and bone health. Objective The aim of this study was to assess the potential of simultaneous 18F sodium fluoride (18F-NaF) positron emission tomography/magnetic resonance imaging (PET/MRI) to identify as well as classify osseous metabolic abnormalities in knee OA and to see if degenerative changes in the cartilage and bone on MRI might be correlated with subchondral 18F-NaF uptake on PET. Methods Sixteen (32 knees) volunteers with no past history of knee injury, with or without pain, were enrolled for the research from January to July 2021. The images of both knees were taken utilizing an molecular magnetic resonance (mMR) body matrix coil on a simultaneous PET/MRI biograph mMR. The acquisition was conducted after 45 minutes of intravenous infusion of 18F-NaF 185-370 MBq (5-10 mCi) over one PET bed for 40 minutes, while MRI sequences were performed simultaneously. Results All pathologies showed significantly higher maximum standardized uptake value (SUV max ) than the background. Thirty-four subchondral magic spots were identified on 18F-NaF PET without any structural alteration on MRI. Bone marrow lesions (BMLs) and osteophytes with higher MRI osteoarthritis knee score (MOAKS) score showed higher 18F-NaF uptake (grade1˂grade2˂grade3). BMLs had corresponding AC degeneration. There was discordance between grade 1 osteophytes (86.6%), sclerosis (53.7%) and grade 1 BML in cruciate ligament insertion site (91.66%); they did not have high uptake of 18F-NaF. In case of cartilage, there was significant difference between AC grades and average subchondral SUV max and T2* relaxometry (grade0˂grade1˂grade2˂grade3˂grade4). BMLs are much more metabolically active than other pathologies, while sclerosis is the least. We also found that the subchondral uptake was statistically increased in the areas of pathology: Conclusion 18F-NaF PET/MRI was able to detect knee abnormalities unseen on MRI alone and simultaneously assessed metabolic and structural markers of knee OA across multiple tissues in the joint. Thus, it is a promising tool for detection of early metabolic changes in OA.

Congenital Absence of Patella: A Case Report.

Congenital absence of patella is a rare orthopedic condition characterized by an underdeveloped or complete lack of patella. This condition is very rare in isolation and is usually accompanied by other genetic syndromes. The prevalence is difficult to estimate as very few cases of this condition have been reported worldwide. Here, we report a case of congenital bilateral absence of patella in an 18-month-old female child who came with a chief complaint of inability to stand and walk without support, with hyperextension at the knee joint with no other associated abnormalities. The patient was started with active and resisted physiotherapy sessions that alleviated the condition of our patient.

Investigating Risk Factors and Magnetic Resonance Imaging (MRI)-Based Grading of Subchondral Incomplete Fracture (SIF) of Medial Femoral Condyle.

BACKGROUND: Subchondral insufficiency fractures (SIF) of the knee joint are prevalent in osteoporosis patients over the age of 55. Early diagnosis of SIF fracture of the medial femoral condyle is crucial for delaying disease progression, early therapy, and potential disease reversal. Magnetic resonance imaging (MRI) is useful in detecting SIF, which is often undetectable on initial radiographs. This study aimed at developing a grading system for subchondral insufficiency fractures (SIF) based on MRI to predict outcomes and evaluate risk factors. METHODS: In this study, MRI was used to examine SIF risk variables in the medial condyle of the femur to help clinicians diagnose, treat, and delay the condition. A total of 386 patients with SIF from 2019 to 2021 were retrospectively analyzed and divided into 106 patients in the disease group and 280 patients in the control group according to whether they had SIF. The lesion site, meniscus, ligament, and other parameters were evaluated and compared. At the same time, a grading system was introduced to stratify and statistically analyze the size of the lesion area, the degree of bone marrow edema (BME), meniscus tears, and other parameters in the patients. RESULTS: Most SIF were low-grade (LG) fractures, and the predictors of LG and high-grade (HG) fractures included heel tear (P =0.031), degree of medial malleolus degeneration (P < 0.001), advanced age (P < 0.001), and lesion size (P < 0.001). The prognostic factors that showed significant differences between the two groups included age (P =0.027), gender (P =0.005), side (P =0.005), medial tibial plateau injury (P < 0.0001), femoral medullary bone marrow edema (P < 0.0001), medial tibial plateau bone marrow edema (P < 0.0001), meniscus body partial injury (P =0.016), heel tear (P =0.001), anterior cruciate ligament injury (P =0.002), and medial collateral ligament injury (P < 0.0001). CONCLUSION: This current study proposed an MRI-based grading system for inferior condylar fractures of the femur, in which HG inferior condylar fractures are associated with severe medial malleolus degeneration, advanced age, lesion size (correlation), and meniscus heel tears.

Accuracy Verification of Four-Dimensional CT Analysis of Knee Joint Movements: A Pilot Study Using a Knee Joint Model and Motion-Capture System.

Objective This study aimed to use the optical motion-capture method to verify the accuracy of four-dimensional computed tomography (4D-CT) analysis of knee joint movement. Methods One static CT and three 4D-CT examinations of the knee joint model were obtained. The knee joint model was passively moved in the CT gantry during 4D-CT acquisitions. 4D-CT and static CT examinations were matched to perform 3D-3D registration. An optical-motion capture system recorded the position-posture of the knee joint model simultaneously with the 4D-CT acquisitions. Reference axes (X, Y, and Z directions) were defined based on static CT and applied to 4D-CT and the optical-motion capture system. Using the position-posture of the motion capture system as a reference standard, the position-posture measurements using 4D-CT were compared to these values, and the accuracy of the 4D-CT analysis of knee joint movements was quantitatively assessed. Results The position-posture measurements obtained from 4D-CT showed a similar tendency to those obtained from the motion-capture system. In the femorotibial joint, the difference in the spatial orientation between the two measurements was 0.7 mm in the X direction, 0.9 mm in the Y direction, and 2.8 mm in the Z direction. The difference in angle was 1.9° in the varus/valgus direction, 1.1° in the internal/external rotation, and 1.8° in extension/flexion. In the patellofemoral joint, the difference between the two measurements was 0.9 mm in the X direction, 1.3 mm in the Y direction, and 1.2 mm in the Z direction. The difference in angle was 0.9° for varus/valgus, 1.1° for internal/external rotation, and 1.3° for extension/flexion. Conclusions 4D-CT with 3D-3D registration could record the position-posture of knee joint movements with an error of less than 3 mm and less than 2° when compared with the highly accurate optical-motion capture system. Knee joint movement analysis using 4D-CT with 3D-3D registration showed excellent accuracy for in vivo applications.

Synovial Chondromatosis in a Rural Healthcare Setting.

Synovial chondromatosis is a rare, benign, and metaplastic cause of joint swelling resulting in the formation of cartilaginous nodules in the joint space. It is usually an oligoarticular disorder of large joints that typically manifests in the third to fifth decade of life. Synovial chondromatosis can be primary or secondary depending on whether an underlying etiology can be identified. Diagnosis can be made using imaging studies of the affected joint and confirmed on histopathology. Management of synovial chondromatosis can be done arthroscopically or surgically. We present a case of a 23-year-old male who presented with a long history of right knee pain, swelling, and limitation in range of motion. An X-ray of the knee showed multiple intra-articular and soft tissue calcifications. Due to the limitations of our setting, we proceeded with an open biopsy. During arthrotomy, clear straw-colored fluid with multiple nodules of varied sizes was found. A google image search helped put us in the direction of the diagnosis of synovial chondromatosis. We did a complete evacuation of loose bodies and a biopsy of synovium, which confirmed the diagnosis. The rarity of synovial chondromatosis results in a delay in the diagnosis. With the thoughtful application of resources and surgical principles, synovial chondromatosis can be safely and effectively managed in resource-limited settings.

Dissociation of a Medial Pivot Polyethylene in a Kinematically Aligned Total Knee Arthroplasty.

An 81-year-old male patient who underwent a Medacta GMK sphere kinematically aligned (KA) total knee arthroplasty (TKA) for end-stage knee osteoarthritis presented with a dislocated medial pivot (MP) tibia polyethylene (PE) insert on routine six-week postoperative x-rays. The patient presented asymptomatic with a normal range of motion. Dissociation of a fixed-bearing (FB) PE implant is an uncommon complication after TKA. There are only a few cases reported in the literature. We report for the first time a case of non-traumatic dissociation of MP PE from the tibial baseplate in a KA TKA in an asymptomatic patient but identified on routine postoperative radiographs.

The effects of domestic mechanical knee joints on pelvic motion in transfemoral amputees.

PURPOSE: Pelvic asymmetry in the sagittal and horizontal planes among prosthesis users is related to the strength of the abdominal and back muscles. Considering that lumbosacral pathologies and pain in long-term transfemoral prosthesis users can cause asymmetric pelvic motion, it is necessary to investigate pelvic asymmetry caused by prosthetic components. The aim was to compare the gait symmetry of the pelvis of active transfemoral amputees using different types of prosthetic knee joints (Non-microprocessor-controlled prostheses (NMCPs) and microprocessor-controlled prostheses (MCP) knees). METHODS: The two patient groups comprised eight transfemoral amputees: four patients had NMCP joints (Turkish products), and four patients had MCP knees. The reference group consisted of ten normal volunteers. In this work, the 3-D motion of the pelvis, hip, knee and ankle was assessed using the VICON system. RESULTS: The results revealed that during stance, the kinematics of pelvic movement in the amputee group differed from those of the control group in terms of the total excursion anterior pelvic tilt (APT) and maximum and minimum degrees of APT (p < .05). We evaluated the graphics of the NMCP and MCP knee joints and found that the prosthesis-side APT was closer to that of the control group during the stance phase among the NMCP users, while the APT of the MCP users was closer to that of the control group during the swing phase. CONCLUSION: The investigated MCP benefitted the patients considerably. The NMCP did not provide as much walking as the MCP but produced less APT.Implications for RehabilitationThe MCP may not provide symmetrical pelvic motion during all phases of the gait cycle. In transfemoral amputees using MCP, focusing on pelvis in walking training will contribute to pre-prosthetic and post-prosthetics rehabilitation.The NMCP knee joint may be closer in terms of APT.

Implications of Anti-Inflammatory Nature of Exosomes in Knee Arthritis.

Exosomes are extracellular vesicles (EVs) released from cells that are a part of many biological and pathological processes, especially in intercellular communication. These vesicles are involved cell signaling, influence tissue and immune response, and serve as biomarkers for diseases. Most interesting are the exosomes that are released from mesenchymal stem cells (MSCs) for inflammation in joint diseases. Preliminary studies have demonstrated the advantages of using EVs rather than MSCs for cell free therapy. Research on exosomes have shown promising results as biomarkers for tracking the pathogenesis and prognosis of inflammatory arthritis. Therapeutically, animal studies have demonstrated immunosuppression, reversing inflammation, increasing chondrocyte proliferation, and drug delivery properties. The field of exosomes continues to develop and more basic science and clinical studies with safety and efficacy studies are needed.

The Ethnic and Geographical Distribution of Fabella: A Systematic Review and Meta-Analysis of 34,733 Knees.

INTRODUCTION: The primary studies demonstrated that fabellar prevalence (FP) varied with ethnic and geographical distribution. Osteoarthritis (OA) and age-related degeneration have a significant association with FP. The prevalence of OA worldwide was doubled with life expectancy. Increased life expectancy has increased exposure to OA and age-related degeneration which could be a possible reason for the rise of FP. The analysis was conducted to provide insight about FP in respect to geographical, ethnic, sex, and laterality distribution. METHODOLOGY: Eighty-six studies were included which have data from 34,733 knee joints. Fifty radiological studies were consisting of 27,293 knees and 36 cadaveric studies had the data of 7,440 knees of dissected specimens, respectively. The prevalence, Odds, and rate ratios were calculated for aging, osteoarthritis, and ethnic variation.  Results: The worldwide FP was 25% (95% CI, 0.22, 0.28). The prevalence of fabella was found to be higher in cadaveric studies (32%) than radiological studies (19%) with significant heterogeneity. The FP was 16-18% till 1950 which was doubled by 2020 (35%). The FP in OA knee was 51% which was thrice of baseline.