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La artrosis de rodilla grado 1 es un problema frecuente a escala mundial. La fisioterapia se presenta como una alternativa prometedora para el tratamiento conservador de esta patología, ya que reduce eficazmente la artralgia. Objetivo. Describir la eficacia de los ejercicios terapéuticos para aliviar el dolor en la artrosis de rodilla grado I. Metodología. Se trata de una revisión sistemática, que abarcó una búsqueda exhaustiva en varias bases de datos como Pubmed, Scielo y Elsevier. Los criterios de búsqueda incluyeron ensayos de control aleatorios, experimentales y cuasiexperimentales realizados entre los años 2017 y 2023. Resultados. De un total de 82 documentos se excluyeron 40 al ser estudios secundarios. Posteriormente, se excluyeron 21 estudios adicionales debido a la escasa relación entre las variables del estudio y a su falta de disponibilidad. Finalmente, se seleccionaron 21 artículos que cumplieron con los criterios de evaluación de calidad metodológica mediante la escala CRF-QS. Para evaluar el dolor, la rigidez, la funcionalidad y la calidad de vida, se utilizaron escalas como EVA, NPRS, WOMAC y OXFORD. Los ejercicios isocinéticos resultaron ser los más efectivos, ya que demostraron un aumento de la fuerza y el grosor del cartílago articular, lo que resultó en una disminución de las puntuaciones de EVA de 8,05 a 3,75. Conclusión. El ejercicio terapéutico supervisado centrado en el fortalecimiento de las extremidades inferiores ha demostrado ser una alternativa efectiva para el tratamiento conservador de la artrosis de rodilla grado I. Este enfoque alivia eficazmente el dolor, mejora la calidad de vida e incluso puede detener la progresión de la enfermedad.
Grade 1 knee osteoarthritis is a common problem worldwide. Physiotherapy is presented as a promising alternative for the conservative treatment of this pathology, since it effectively reduces arthralgia. Aim. To describe the effectiveness of therapeutic exercises to relieve pain in grade I knee osteoarthritis. Methodology. This is a systematic review, which included an exhaustive search in several databases such as Pubmed, Scielo and Elsevier. Search criteria included randomized, experimental and quasi-experimental control trials conducted between the years 2017 and 2023. Results. Of a total of 82 documents, 40 were excluded as they were secondary studies. Subsequently, 21 additional studies were excluded due to poor relationships between study variables and lack of availability. Finally, 21 articles were selected that met the methodological quality evaluation criteria using the CRF-QS scale. To evaluate pain, stiffness, functionality and quality of life, scales such as VAS, NPRS, WOMAC and OXFORD were used. Isokinetic exercises were found to be the most effective, demonstrating an increase in articular cartilage strength and thickness, resulting in a decrease in VAS scores from 8.05 to 3.75. Conclusion. Supervised therapeutic exercise focused on strengthening the lower extremities has been shown to be an effective alternative to the conservative treatment of grade I knee osteoarthritis. This approach effectively relieves pain, improves quality of life, and may even stop the progression of osteoarthritis. disease.
A osteoartrite do joelho grau 1 é um problema comum em todo o mundo. A fisioterapia apresenta-se como uma alternativa promissora para o tratamento conservador desta patologia, uma vez que reduz eficazmente a artralgia. Mirar. Descrever a eficácia dos exercícios terapêuticos no alívio da dor na osteoartrite de joelho grau I. Metodologia. Trata-se de uma revisão sistemática, que incluiu uma busca exaustiva em diversas bases de dados como Pubmed, Scielo e Elsevier. Os critérios de pesquisa incluíram ensaios de controle randomizados, experimentais e quase-experimentais realizados entre os anos de 2017 e 2023. Resultados. De um total de 82 documentos, 40 foram excluídos por se tratarem de estudos secundários. Posteriormente, 21 estudos adicionais foram excluídos devido às más relações entre as variáveis do estudo e à falta de disponibilidade. Por fim, foram selecionados 21 artigos que atenderam aos critérios de avaliação da qualidade metodológica pela escala CRF-QS. Para avaliar dor, rigidez, funcionalidade e qualidade de vida foram utilizadas escalas como VAS, NPRS, WOMAC e OXFORD. Os exercícios isocinéticos foram considerados os mais eficazes, demonstrando um aumento na força e espessura da cartilagem articular, resultando em uma diminuição nos escores VAS de 8,05 para 3,75. Conclusão. O exercício terapêutico supervisionado focado no fortalecimento das extremidades inferiores tem se mostrado uma alternativa eficaz ao tratamento conservador da osteoartrite do joelho grau I. Esta abordagem alivia eficazmente a dor, melhora a qualidade de vida e pode até interromper a progressão da osteoartrite.
الموضوعات
Osteoarthritis, Kneeالملخص
Objective: the aim of this study was to evaluate the quality of life between patients who have already undergone the TKA surgery and those who have not. Methodology: 118 patients [60 undergoing TKA (G1) and the remaining 58 awaiting the procedure (G2)] answered questions about QoL using the WOMAC and SF-36 protocols. The comparison was performed using the chi-square test and Student's t-test, with a significance level of 0.05. Results: with regard to clinical aspects, there was a higher level of pain in Group G2, as well as greater frequency in the use of medications, especially for pain relief. In the QoL evaluation, significant difference was observed in all the domains of the generic questionnaire SF-36 and in WOMAC, estando a capacidade functional do G2 reduzida e abaixo do nível observado nos pacientes do G1. Conclusion: patients with advanced knee arthrosis who underwent TKA, compared to those who did not undergo the procedure, had better quality of life in all domains assessed by both the general SF-36 questionnaire and the WOMAC questionnaire.
Objetivo: o objetivo deste estudo foi avaliar a qualidade de vida entre pacientes que já se submeteram à cirurgia de ATJ e aqueles que ainda não passaram pelo procedimento. Metodologia: 118 pacientes [60 submetidos à ATJ (G1) e os 58 restantes aguardando o procedimento (G2)] responderam perguntas sobre QV usando os protocolos WOMAC e SF-36. A comparação foi realizada usando o teste qui-quadrado e o teste t de Student, com um nível de significância de 0,05. Resultados: em relação aos aspectos clínicos, houve um maior nível de dor no Grupo G2, bem como maior frequência no uso de medicamentos, especialmente para alívio da dor. Na avaliação da QV, foi observada diferença significativa em todos os domínios do questionário genérico SF-36 e no WOMAC, estando a capacidade funcional do G2 reduzida e abaixo do nível observado nos pacientes do G1. Conclusão: pacientes com artrose avançada de joelho que se submeteram à ATJ, em comparação com aqueles que não passaram pelo procedimento, apresentaram melhor qualidade de vida em todos os domínios avaliados tanto pelo questionário geral SF-36 quanto pelo questionário WOMAC.
الموضوعات
Humans , Male , Femaleالملخص
OBJECTIVE@#To explore effect of nerve growth factor (NGF) antibody on knee osteoarthritis (KOA) pain model was evaluated by in vitro model.@*METHODS@#Thirty male SPF rats aged 28-week-old were divided into blank group (10 rats with anesthesia only). The other 20 rats were with monoiodoacetate (MIA) on the right knee joint to establish pain model of OA, and were randomly divided into control group (injected intraperitoneal injection of normal saline) and treatment group (injected anti-NGF) intraperitoneal after successful modeling, and 10 rats in each group. All rats were received retrograde injection of fluorogold (FG) into the right knee joint. Gait was assessed using catwalk gait analysis system before treatment, 1 and 2 weeks after treatment. Three weeks after treatment, right dorsal root ganglia (DRG) were excised on L4-L6 level, immunostained for calcitonin gene-related peptide (CGRP), and the number of DRGS was counted.@*RESULTS@#In terms of gait analysis using cat track system, duty cycle, swing speed and print area ratio in control and treatment group were significantly reduced compared with blank group (P<0.05). Compared with control group, duty cycle and swing speed of treatment group were significantly improved (P<0.05), and there was no significant difference in print area ratio between treatment group and blank group (P>0.05). The number of FG-labeled DRG neurons in control group was significantly higher than that in treatment group and blank group (P<0.05). The expression of CGRP in control group was up-regulated, and differences were statistically significant compared with treatment group (P<0.05).@*CONCLUSION@#Intraperitoneal injection of anti-NGF antibody inhibited gait injury and upregulation of CGRP in DRG neurons. The results suggest that anti-nerve growth factor therapy may be of value in treating knee pain. NGF may be an important target for the treatment of knee OA pain.
الموضوعات
Aged , Animals , Male , Rats , Calcitonin Gene-Related Peptide/metabolism , Disease Models, Animal , Ganglia, Spinal/metabolism , Knee Joint , Nerve Growth Factor/therapeutic use , Osteoarthritis, Knee/drug therapy , Pain/metabolism , Rats, Sprague-Dawley , Antibodies/therapeutic useالملخص
ObjectiveThis study aims to explore the potential mechanism of Danggui Niantongtang in treating knee osteoarthritis （KOA） by regulating the intestinal flora through 16S rDNA analysis. MethodThirty-six C57BL/6J mice were subjected to anterior cruciate ligament transection （ACLT） to establish a KOA model and were randomly divided into the sham surgery group， model group， low-dose Danggui Niantongtang group （0.819 g·kg-1）， medium-dose Danggui Niantongtang group （1.638 g·kg-1）， high-dose Danggui Niantongtang group （3.276 g·kg-1）， and Meloxicam group （0.975 mg·kg-1）， with 6 mice in each group. Except for the treatment groups， the sham surgery group and model group were given normal saline by gavage. After 4 weeks of continuous intervention， feces and intact knee joints of the mice were collected. Hematoxylin-eosin （HE） staining and Safranin O-Fast Green staining were performed to observe the pathological changes in knee joint tissue morphology. The 16S rDNA sequencing was used to analyze changes in the abundance and diversity of intestinal microorganisms before and after treatment， along with corresponding functional predictions. ResultHigh-dose Danggui Niantongtang and Meloxicam significantly relieved pain symptoms in KOA mice， improved the disorder of joint structure， maintained the integrity of knee articular cartilage， increased the expression of type Ⅱ collagen alpha 1 （Col2a1） in articular cartilage， and decreased the expression of matrix metalloproteinase-13 （MMP-13）. The results of 16S rDNA sequencing showed that high-dose Danggui Niantongtang could adjust the abundance and structure of intestinal microbial species. Compared with the sham surgery group， the abundance of Proteobacteria， Actinobacteria， Ruminococcus， and Bacteroides was significantly increased in the model group （P<0.05）， while in the Danggui Niantongtang group， the abundance of these four flora was significantly reduced compared with the model group. Compared with the sham surgery group， the abundance of Verrucomicrobia， Oscillospira， and Akkermansia was significantly decreased in the model group （P<0.05）， while in the Danggui Niantongtang groups， the abundance of these three flora was significantly increased compared with the model group （P<0.05）. Functional pathway prediction of differential genera revealed that species differences among groups mainly involved metabolic pathways with high abundance associated with biosynthesis and precursors， as well as energy production， including amino acid biosynthesis， nucleotide and nucleoside biosynthesis， cofactors， prosthetic groups， electron carriers， and vitamin biosynthesis. ConclusionDanggui Niantongtang can effectively protect articular cartilage and delay the progression of KOA， possibly by regulating the structure of the intestinal flora， promoting probiotics， and inhibiting the growth of harmful pathogenic bacteria.
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ObjectiveTo observe the effects of Xibining （XBN） and adipose stem cell exosome （ADSC-Exos） in the cases of separate or joint application on cartilage degeneration and mitochondrial autophagy and explore its mechanism of action to improve knee osteoarthritis （KOA）. MethodSD rats were divided into a sham operation group （sham group）， a model group， an ADSC-Exos group （Exos group）， an XBN group， and an ADSC-Exos+XBN group （Exos+XBN group）. KOA model was established by using anterior cruciate ligament transection （ACLT）. The pain sensitivity status of rats was evaluated， and the degeneration degree of the knee joint and cartilage tissue was detected by Micro-CT and pathological staining. The expression of p62 and LC3B was observed by immunofluorescence， and the serum levels of TNF-α， IL-1β， IL-6， and IL-15 in rats were detected by ELISA. The Western blot was used to detect the protein expression levels of MMP-3， MMP-13， ADAMTS5， ColⅡ， TIMP， ACAN， PINK1， Parkin， p62， and LC3A/B. ResultCompared with the sham group， rats in the model group showed decreased cold-stimulated foot-shrinkage thresholds and mechanical pain sensitivity thresholds， varying degrees of abrasion and loss of cartilage tissue， degeneration of cartilage tissue， elevated serum IL-1β， IL-6， IL-15， and TNF-α levels （P<0.01）， and increased protein expression of MMP-3， MMP-13， and ADAMTS5 in cartilage tissue. In addition， the protein expression of ColⅡ， TIMP1， and ACAN was decreased （P<0.01）. Compared with the model group， rats in each treatment group showed higher cold-stimulated foot-shrinkage thresholds and mechanical pain sensitivity thresholds， reduced cartilage tissue degeneration， lower serum levels of IL-1β， IL-6， IL-15， and TNF-α （P<0.05，P<0.01）， decreased protein expression of MMP-3， MMP-13， and ADAMTS5， and higher protein expression of Cold， TIMP1， and ACAN in cartilage tissue （P<0.05，P<0.01）. Moreover， the changes were the most obvious in the Exos+XBN group. ConclusionBoth ADSCs-Exos and XBN can increase the level of mitochondrial autophagy in chondrocytes and delay cartilage tissue degeneration by promoting the expression of the PINK1/Parkin signaling pathway， and the combination of the two can enhance the therapeutic effect.
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Objective To observe the effect of different synovial cell secretions on chondrocytes after LPS-induced inflammation,and to explore the mechanism of two synovial cell secretions causing cartilage damage in the progres-sion of KOA disease.Methods Two kinds of synovial cells were co-cultured at 1∶4 and LPS-induced inflamma-tion.The supernatant and exocrine were extracted,and then the normal and LPS-induced inflammation were extrac-ted.The human cartilage tissue obtained during the operation was isolated and cultured into chondrocytes,which were divided into five groups:the first group was added with FLS secretion,the second group was added with nor-mal FLS secretion,the third group was added with secretion after co-culture of two kinds of synovial cells,the fourth group was added with inflammatory MLS secretion,and the fifth group was added with inflammatory FLS se-cretion.CCK-8 was used to detect the viability of chondrocytes in each group.TNF-α,IL-1β,IL-6 level in the su-pernatant of chondrocytes in each group was detected by ELISA.The protein expression of TLR4,NF-κB,IkK,IκB,ADAMTS5 in chondrocytes of each group was detected by Western blot method.Results CCK-8 showed that the activity of chondrocytes in the three groups of inflammatory secretions decreased compared with the secretions from normal synovial cells(P＜0.05);ELISA showed TNF-α,IL-1 β,IL-6 level in the supernatant of group Ⅲ,Ⅳ and V was higher than that of group Ⅰ and Ⅱ(P＜0.05),TNF-α,IL-1 β,IL-6 level in group Ⅲ was higher than that in group Ⅳ but lower than that in group Ⅴ(P＜0.05).Western blot showed the protein expression of TLR4,NF-κB,IkK,IκB,ADAMTS5 in chondrocytes of group Ⅲ,Ⅳ and Ⅴ was higher than that in group Ⅰ and Ⅱ(P＜0.05),the protein expression of TLR4,NF-κB,IkK,IκB,ADAMTS5 in group Ⅲ was higher than that in group Ⅳbut lower than that in group Ⅴ(P＜0.05).Conclusion Two kinds of synovial cell-derived secretions after LPS-induced inflammation can regulate cartilage TLRs/NF-κB signal pathway,causing cartilage inflammation.The in-flammatory effect of MLS secretion is stronger than that of FLS secretion,but the inflammatory effect of MLS secre-tion under two co-cultures is weaker than that of MLS secretion alone.
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Objective To explore the application effect of new improved 3D printing individualized guidance(3D psi)in total knee arthroplasty(TKA)for knee osteoarthritis(KOA).Methods A total of 100 patients with KOA in 920th Hospital of Joint Logistics Support Force,PLA from January 2021 to January 2022 were selected,and were divided into 2 groups of 50 patients each using the randomized numerical table method.The control group was treated with conventional TKA,and the study group was treated with new improved 3D psi assisted TKA.The operation conditions,postoperative rehabilitation,complications,prosthesis component position deviation,knee range of motion(ROM),lower limb force line parameters[coronal distal femoral mechanical axis lateral angle(mldfa),lower limb mechanical axis angle(HKA)],gait parameters(percentage of support time,stride,pace),knee function(HSS score),quality of life(AIMS2 score)were observed.Results Com-pared with control group,the amount of intraoperative and postoperative blood loss and drainage volume 2 days after operation were less in the study group,and the operation time and hospital stay were shorter(P<0.05).The deviations of LTC Angle,FFC Angle,HKA Angle,LFC Angle and FTC Angle in the study group were smaller than those in the control group(P<0.05).At 3 months,6 months and 12 months after surgery,the percentage of knee ROM,supporting time,stride length and walking speed of the research group were higher than those of the control group,while the coronal-position mLDFA and HKA were lower than those of the control group(P<0.05).The proportion of WBC and PMN in joint fluid at 3 months,6 months and 12 months after surgery was lower than that in control group(P<0.05).The HSS score of the study group was higher than that of the control group at 3 months,6 months and 12 months after operation,and the AIMS2 score was lower than that of the control group(P<0.05).There was no statistically significant difference in the incidence of complications between the study group and the control group(P>0.05).Conclusion The new improved 3D PSI-assisted TKA treatment of KOA can optimize the surgical situation,improve operating accuracy,improve the patient's lower limb alignment,promote limb function recovery,help improve the quality of life,and has high safety.
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BACKGROUND:Circular RNAs(circRNAs)play important roles in a variety of diseases or tumors,and recent findings have revealed that circRNAs are abnormally expressed in knee osteoarthritis and are involved in disease progression through microRNA/mRNA regulation. OBJECTIVE:To investigate the effect of circRNA WD repeat containing protein 1(circ-BRWD1)/miR-488-3p/DNA methyltransferase 3A(DNMT3A)on the proliferation and apoptosis of chondrocytes in knee osteoarthritis. METHODS:Real-time fluorescence quantitative PCR was performed to detect the expression of circ-BRWD1,miR-488-3p,DNMT3A in knee osteoarthritis chondrocytes.Cells were divided into si-NC group,si-circ-BRWD1 group,vector group,circ-BRWD1 group,si-circ-BRWD1+anti-miR-NC group,si-circ-BRWD1+anti-miR-488-3p group,miR-NC group,miR-488-3p group,anti-miR-NC group,anti-miR-488-3p group,miR-488-3p+vector group,miR 488-3p+DNMT3A group.Real-time fluorescence quantitative PCR was used to detect circ-BRWD1,miR-488-3p,DNMT3A expression,MTT and flow cytometry assay were used to detect cell proliferation and apoptosis.Western blot assay was used to detect DNMT3A and proliferation/apoptosis-related protein expression.Dual luciferase reporter assay was used to Dual luciferase reporter assay to detect the targeting relationship of circ-BRWD1 with miR-488-3p and miR-488-3p with DNMT3A. RESULTS AND CONCLUSION:circ-BRWD1 and DNMT3A were highly expressed and miR-488-3p was lowly expressed in knee osteoarthritis chondrocytes compared with normal chondrocytes.Knockdown of circ-BRWD1 or overexpression of miR-488-3p inhibited proliferation and induced apoptosis in knee osteoarthritis chondrocytes.circ-BRWD1 targeted negative regulation of miR-488-3p and inhibition of miR-488-3p reversed the effect of circ-BRWD1 knockdown on chondrocyte proliferation and apoptosis in knee osteoarthritis.miR-488-3p targeted negative regulation of DNMT3A and upregulation of DNMT3A reversed the effect of miR-488-3p overexpression on chondrocyte proliferation and apoptosis in knee osteoarthritis.circ-BRWD1 could regulate the expression of DNMT3A by regulating miR-488-3p.To conclude,knockdown of circ-BRWD1 inhibits chondrocyte proliferation and induces apoptosis in knee osteoarthritis,and the mechanism of action may be related to the regulation of miR-488-3p/DNMT3A axis.
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OBJECTIVE:Knee adduction moment and knee adduction angular impulse enlargement is the main biomechanical risk factor of knee osteoarthritis.According to the survey,a change in the foot progression angle could effectively change the motion mode of patients with knee osteoarthritis.However,the impact of toe-in and toe-out on knee adduction moment and knee adduction angular impulse in young and elderly patients did not reach a consensus.Therefore,this study comprehensively discussed the effect of foot progression angle on knee adduction moment and knee adduction angular impulse in different populations through meta-analysis and provided a reference for the treatment of knee osteoarthritis. METHODS:By June 2022,searches were conducted on Web of Science,EBSCO,PubMed and CNKI databases using"foot progression angle,knee adduction moment,knee adduction angular impulse,gait"as Chinese and English search terms.Self-controlled randomized controlled studies analyzing the effects of toe-in and toe-out on knee adduction moment bimodality and knee adduction angular impulse were included.The cochrane bias risk assessment tool was utilized to make a quality evaluation of the literature.Stata 15.1 software was used for subgroup analysis to determine the effect of foot progression angle on knee adduction moment and knee adduction angular impulse.Meta-regression analysis was used to further determine characteristics of outcome indicators(knee adduction moment,knee adduction angular impulse)changing with foot progression angle. RESULTS:(1)A total of 15 self-control trials and 2 randomized controlled trials(455 subjects)were included in the meta-analysis.All of the included articles were of medium to high quality.(2)The meta-analysis results showed that the toe-in gait could reduce the first peak of knee adduction moment(SMD=-0.380,95%CI:-0.710 to-0.060,P=0.022)and knee adduction angular impulse(SMD=-1.470,95%CI:-2.160 to-0.770,P<0.001)in young patients.The toe-out gait reduced the second peak of knee adduction moment(SMD=-0.720,95%CI:-1.010 to-1.440,P<0.001)in young patients.In addition,toe-in gait could reduce the first peak of knee adduction moment in elder patients(SMD=-0.550,95%CI:-0.800 to-0.300,P<0.001),but increase the second peak knee adduction moment of elderly(SMD=0.280,95%CI:-0.010 to 0.560,P=0.047).The toe-out gait could decrease the second peak knee adduction moment in this population(SMD=-0.510,95%CI:-0.830 to-0.190,P=0.002).(3)Meta-regression showed that the greater the toe-out in elderly patients,the lower the second peak knee adduction moment. CONCLUSION:(1)Toe-in reduced the first peak knee adduction moment and knee adduction angular impulse in young knee osteoarthritis patients aged 18 to 34 years.Since knee adduction moment and knee adduction angular impulse were associated with medial knee loading and knee osteoarthritis incidence,toe-in gait intervention may be a suitable rehabilitation strategy for young patients.(2)Toe-in increased the second peak of knee adduction moment in older knee osteoarthritis patients over 60 years of age,which may exacerbate knee osteoarthritis in this population.However,the second peak of knee adduction moment during walking in this population decreases as the toe-out increases,contributing to a reduction in medial knee loading,suggesting that older patients may consider using toe-out gait during walking.
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BACKGROUND:There are many treatment methods for knee osteoarthritis,among which electroacupuncture,as an important non-drug treatment,is effective in the treatment of knee osteoarthritis,but its exact mechanism is not clear. OBJECTIVE:Effect of electroacupuncture on the expression of p53 and P21 in articular cartilage and subchondral bone of aged rats with knee osteoarthritis. METHODS:Eight 6-month-old male Sprague-Dawley rats were included in the young group and sixteen 24-month-old male Sprague-Dawley rats were randomly divided into old group(n=8)and electroacupuncture group(n=8).The rats in the electroacupuncture group received electroacupuncture stimulation once a day,5 days a week,for 8 continuous weeks,and the other two groups did not do any treatment.Eight weeks later,the level of type Ⅱ collagen C-terminal peptide in peripheral blood was detected by ELISA,the morphology of left knee cartilage and subchondral bone was observed by safranin O-fast green staining,the degree of knee cartilage degeneration was evaluated by modified Mankin's score,the microstructure of left knee cartilage and subchondral bone was detected by micro-CT,and the expression levels of matrix metalloproteinase 13,P53,P21 Mrna and protein were detected by RT-PCR and western blot respectively. RESULTS AND CONCLUSION:Compared with the young group,the level of C-terminal peptide of type Ⅱ collagen in the peripheral blood was increased in the old group(P<0.05).The micro-CT results showed that the bone volume fraction,bone mineral density and the number of bone trabeculae were decreased in the old group compared with the young group(P<0.05),while the trabecular separation increased(P<0.05).Safranin O-fast green staining showed that in the old group,the surface layer of cartilage was uneven with fissures,the morphology of chondrocytes was irregular and stained unevenly,the boundary between the cartilage and subchondral bone was blurred,and the matrix loss was serious.The Mankin's score was higher in the old group than the young group(P<0.05).The expression of matrix metalloproteinase 13,P53,P21 at Mrna and protein levels increased in the old group compared with the young group(P<0.05).Compared with the old group,electroacupuncture decreased the level of C-terminal peptide of type Ⅱ collagen(P<0.05),increased the bone volume fraction,bone mineral density and the number of bone trabeculae(P<0.05),and decreased the trabecular separation(P<0.05).Safranin O-fast green staining showed that in the electroacupuncture group,the surface of cartilage was smooth and red staining was uniform,and the cell morphology and structure were between the young group and the old group.Following electroacupuncture treatment,the Mankin's score(P<0.05),matrix metalloproteinase 13 and P21 Mrna expression(P<0.05),and matrix metalloproteinase 13 and P53 protein expression decreased(P<0.05),while there was a decreasing trend of P53 Mrna and P21 protein expression,but with no statistical significance(P>0.05).To conclude,electroacupuncture may delay articular cartilage degeneration and subchondral osteoporosis in aged rats by inhibiting the expression of P53 and P21,so as to protect joints and delay joint aging.
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BACKGROUND:Previous studies have shown that knee joint moment changes in patients with knee osteoarthritis,but there are few reports on the correlation of moment changes with knee extensor muscle strength and gait spatiotemporal parameters. OBJECTIVE:To explore the correlation of knee extensor muscle strength and gait spatiotemporal parameters with peak knee flexion moment and knee adduction moment in female patients with knee osteoarthritis. METHODS:Twenty knee osteoarthritis female patients with single knee disease hospitalized in Guizhou Hospital,Beijing Jishuitan Hospital from February to August 2022 were selected as the knee osteoarthritis group,and an additional 20 healthy females without musculoskeletal disease were selected as the control group.The knee extensor force at 60(°)/s was measured with the Biodex isokinetic instrument.The gait spatiotemporal parameters and peak knee flexion moment and knee adduction moment were collected with the Italian BTS infrared motion capture system and force measuring platform.Pearson correlation analysis was used to explore the correlation of muscle strength and gait spatiotemporal parameters with peak knee adduction moment and knee flexion moment,and the variables significantly related to knee joint moment were further included in the multiple stepwise regression analysis. RESULTS AND CONCLUSION:(1)Compared with the control group,the knee osteoarthritis group had significantly lower knee extensor force,step speed,step frequency,step length,step width,peak knee adduction moment and knee flexion moment at 60(°)/s(P<0.05).(2)Pearson correlation analysis showed that the 60(°)/s centripetal extensor force,step speed,step frequency and step length were positively correlated with the peak knee flexion moment,and negatively correlated with the peak knee adduction moment,with a statistically significant difference(P<0.05).(3)The results of multiple stepwise regression showed that step speed and 60(°)/s knee extensor force were the strongest predictors of peak knee flexion moment,and the total R2 value of the two factors was 0.426,indicating that 42.6%of the total variance of this parameter could be explained.Step length and 60(°)/s centripetal extensor force were the strongest predictors of peak knee adduction moment.The total R2 value of the two factors was 0.602,indicating that 60.2%of the total variance of this parameter could be explained.(4)It is concluded that knee extensor strength,step speed and step length are the main variables affecting peak knee adduction moment and knee flexion moment.Therefore,these variables can be used for clinical gait monitoring and guidance to change knee joint load during knee osteoarthritis rehabilitation.
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BACKGROUND:High tibial osteotomy results in massive blood loss during the perioperative period.Tranexamic acid can effectively reduce perioperative blood loss.However,the method of tranexamic acid application has not been unified. OBJECTIVE:To investigate the effect and safety of different methods of tranexamic acid on perioperative blood loss in the high tibial osteotomy. METHODS:A total of 160 patients who underwent primary unilateral high tibial osteotomy in the Binzhou Medical University Hospital from January 2019 to December 2021,including 69 males and 91 females,were randomly divided into four groups(n=40 per group).Among them,40 patients were given an intravenous infusion of saline containing 2 g tranexamic acid 10 minutes before tourniquet release(venous group);40 patients were given an intravenous infusion of 1 g tranexamic acid and 1 g tranexamic acid was injected through a drainage tube after the closure of the incision(combined group);40 patients were given 2 g tranexamic acid infusion into drainage tube after the closure of the incision(perfusion group);an additional 40 patients were given an intravenous infusion of the same amount of normal saline(blank group).The general information was compared among the four groups of patients.The hemoglobin,hematocrit,intraoperative blood loss,drainage volume,blood transfusion rate,incision complication,and the incidence of deep vein thrombosis were recorded on days 1,3 and 5 after operation in the four groups.The total blood loss and hidden blood loss were calculated. RESULTS AND CONCLUSION:(1)There was no statistically significant difference in general information among the four groups.(2)No significant difference was found in intraoperative blood loss among the four groups.(3)The maximum decreased values of hemoglobin and hematocrit on days 1,3 and 5 after operation,drainage volume,total blood loss and hidden blood loss were all ranked as the combined group<venous group<perfusion group<blank group.(4)The postoperative blood transfusion rate of the blank group was significantly higher than that of the other three groups,and there was no significant difference in the postoperative blood transfusion rate among the combined group,the venous group and the perfusion group.(5)There was no significant difference in the incidence of venous thrombosis and incision complications among the four groups.(6)It is indicated that the application of tranexamic acid in high tibial osteotomy can reduce perioperative bleeding and postoperative blood transfusion rate,and the effect of intravenous infusion combined with drainage tube perfusion is better,which does not increase the incidence of venous thrombosis and incision complications.
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BACKGROUND:Previous studies have confirmed that the new compound cottonrose hibiscus leaf gel plaster has a good effect in the treatment of acute soft tissue swelling. OBJECTIVE:To observe the clinical efficacy of compound cottonrose hibiscus leaf gel plaster in the treatment of synovitis of the knee joint. METHODS:Seventy-two patients with knee synovitis were selected from Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from December 2019 to May 2021.These patients were randomly divided into a trial group and a control group,with 36 cases in each group.The trial group was treated with compound cottonrose hibiscus leaf gel plaster,once a day,12 hours each time,while the control group was treated with Diclofenac Diethylamine Emulgel,twice a day.After 28 days of treatment,visual analog scale score,WOMAC Osteoarthritis Index score,quality of life score(SF-36),thickness of knee synovium and comprehensive curative effect were compared between the two groups. RESULTS AND CONCLUSION:(1)Visual analog scale scores after treatment were lower than those before treatment(P<0.05).Visual analog scale scores in the trial group after 7,14 and 28 days of treatment were lower than those in the control group(P<0.05).The WOMAC Osteoarthritis Index scores of the two groups after treatment were lower than those before treatment(P<0.05),and the WOMAC Osteoarthritis Index scores in the trial group after 7,14 and 28 days of treatment were lower than those in the control group(P<0.05).(3)The SF-36 quality of life score in the two groups after 28 days of treatment was higher than that before treatment(P<0.05).SF-36 quality of life score in the trial group after 28 days of treatment was higher than that in the control group(P<0.05).(4)After 28 days of treatment,the thickness of knee synovium in the trial group was less than that in the control group(P<0.05),and the effective rate in the trial group was higher than that in the control group(P<0.05).(5)These findings indicate that compared with Diclofenac Diethylamine Emulgel,the compound cottonrose hibiscus leaf gel plaster can better relieve knee pain,enhance knee joint function,reduce synovial hyperplasia,and elevate the overall quality of life of patients.
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BACKGROUND:Low to moderate intensity aerobic exercise can help protect knee cartilage.Long-chain non-coding RNAs are crucial for gene regulation.Among them,HOTAIR can activate numerous transcriptional co-repressors to repress the activation of certain genes. OBJECTIVE:To detect the expression levels of HOX transcript antisense RNA(HOTAIR)and other related factors in chondrocytes of high fat-fed mice and after low to moderate intensity exercise intervention,and to investigate their role in cartilage injury and sports rehabilitation. METHODS:Thirty C57BL/6 male mice were randomly divided into control group(normal feeding),high fat feeding group and high fat feeding plus treadmill exercise group,with 10 mice in each group.The mice in the high fat feeding plus treadmill exercise group were subjected to an 8-week low to middle intensity treadmill exercise,and the mice in the other two groups were caged.During this period,body mass was weighed every week on Sunday.After the 8-week exercise,both lower extremities of mice were taken,and the knee joint was scanned using Micro CT to make a 3D femoral condyle image to obtain relevant parameters.Hematoxylin-eosin and safranin O-fast green staining of the knee joint were performed for Mankin and Osteoarthritis Research Society International(OARSI)scoring.RT-PCR was performed to detect the mRNA levels of cartilage metabolic indicators and lipid metabolism indicators,including type II collagen,matrix metalloproteinase 13,interleukin 1,low-density lipoprotein receptor-related protein 5,HOTAIR and its downstream factor lysine specific demethylase 1. RESULTS AND CONCLUSION:The body mass of high fat-fed mice were higher than that of the control group(P<0.01),and the body mass of the high fat feeding plus treadmill exercise group was lower than that of the high fat feeding group(P<0.05).The connectivity density of high fat-fed mice was higher than that of the control group(P<0.01).Mankin and OARSI scores of the high fat feeding were higher than those of the control group(P<0.01)and high fat feeding plus treadmill exercise group(P<0.05).The mRNA level of type II collagen was higher in the control group than the high fat feeding plus treadmill exercise group(P<0.05)and high fat feeding group(P<0.01)as well as higher in the high fat feeding plus treadmill exercise group than the high fat feeding group(P<0.01).The mRNA levels of matrix metalloproteinase 13,interleukin 1,low-density lipoprotein receptor-related protein 5,HOTAIR and lysine specific demethylase 1 were higher in the high fat feed group than the control group and high fat feeding plus treadmill exercise group(P<0.01).To conclude,high fat feeding can increase the bone substance of the femoral condyle,lead to knee cartilage wear,and cause chondrocyte metabolism disorder.HOTAIR is highly expressed in this process.An 8-week low to middle intensity treadmill exercise can reduce body mass,alleviate knee cartilage wear,improve chondrocyte function and down-regulate HOTAIR expression in mice.
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BACKGROUND:Knee osteoarthritis is a common disease in middle-aged and elderly people.It is a kind of disease that seriously affects the quality of life of patients and even has the risk of disability.Therefore,the pathogenesis and treatment of knee osteoarthritis have become the focus of research.In Chinese medicine,knee osteoarthritis is often treated as"biness,"which is closely related to"biness"caused by blood stasis and blood vessels blocking collaterals in the theory of"blood stasis"in traditional Chinese medicine.Iron overload is a kind of pathological state caused by iron metabolism disorder,which highly coincides with the pathogenic characteristics and clinical manifestations of the"blood stasis"theory of traditional Chinese medicine,and is a risk factor that promotes the development of knee osteoarthritis. OBJECTIVE:Based on the"blood stasis"theory,to summarize the effects of iron overload on cartilage metabolism and subchondral bone reconstruction,to lay a new theoretical foundation for the treatment of knee osteoarthritis with traditional Chinese medicine,and to explore the therapeutic effect of traditional Chinese medicine for promoting blood circulation after interfering with bone tissue. METHODS:CNKI,WanFang database,PubMed and Web of Science databases were searched for relevant literature.The Chinese search terms were"ferroptosis,iron,iron overload,osteoarthritis,blood stasis"and the English search terms were"ferroptosis,iron,iron overload,osteoarthritis,TCM."In the end,76 articles were included for further review. RESULTS AND CONCLUSION:First of all,we explored the potential of the"blood stasis"theory in treating knee osteoarthritis,and found that"blood stasis"is a crucial part in the progress of knee osteoarthritis,indicating that the"blood stasis"theory is the key to the treatment of knee osteoarthritis in traditional Chinese medicine.Secondly,"blood stasis"and iron overload have a high degree of similarity in pathogenic factors,clinical manifestations,and pathogenic characteristics,suggesting the possibility of"blood stasis"theory in treating iron overload.This finding reminds us that iron overload may be an important mechanistic basis for the"blood stasis"theory in the treatment of knee osteoarthritis.The extracts of blood-activating drugs can relieve iron overload and treat knee osteoarthritis,but the specific mechanism is still unclear.Therefore,we believe that the relationship between"blood stasis"theory and iron overload and related mechanisms are important research directions for knee osteoarthritis in the future.The related mechanism of"blood stasis"theory to alleviate iron overload and then treat knee osteoarthritis also provides a theoretical basis for the modernization of traditional Chinese medicine,such as the development of new drugs and innovative usage,and has certain guiding significance for clinical practice.
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BACKGROUND:Knee osteoarthritis is a degenerative disease caused by multiple factors.Its pathogenesis is complex and still unclear.Chinese medicine in the treatment of knee osteoarthritis is fruitful,and in-depth study of Chinese medicine in the treatment of knee osteoarthritis is of great significance. OBJECTIVE:To review the progress of Chinese medicine monomers and compounds in the treatment of knee osteoarthritis and to provide ideas and reference for the effective prevention and treatment of knee osteoarthritis. METHODS:CNKI,WanFang,VIP,PubMed,MEDLINE,Nature,and Cochrane databases were retrieved for relevant literature published from database inception to 2022.The keywords were"knee osteoarthritis,cartilage damage,traditional Chinese medicine,Chinese herbal compound,treatment"in Chinese and English.Duplicates and obsolete non-referenced literature were excluded,and a total of 62 standard papers were included for further review. RESULTS AND CONCLUSION:Some of the pathogeneses of knee osteoarthritis include immune inflammatory response,chondrocyte autophagy and apoptosis,vascular endothelial growth factor level and biomechanical imbalance.The mechanisms by which traditional Chinese medicine treats knee osteoarthritis mainly focus on regulating inflammatory factor levels,chondrocyte autophagy and apoptosis,and vascular endothelial growth factor level and improving cartilage performance,so as to delay the occurrence and development of knee osteoarthritis.
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BACKGROUND:For the patients who have undergone unicompartmental knee arthroplasty,although the surgical effect is clear,there is still a lack of effective quantitative evaluation tools,and it is necessary to further explore the early postoperative gait and stability changes. OBJECTIVE:To investigate the changes in gait and stability before and after unicompartmental knee arthroplasty. METHODS:From May 2021 to May 2022,30 patients aged(63.80±9.31)years who planned to perform unilateral unicompartmental knee arthroplasty in the Department of Joint Surgery,Affiliated Hospital of Xuzhou Medical University were selected as the unicompartmental knee arthroplasty group.15 healthy elderly patients aged(61.28±8.60)years without a history of hip and knee pain and hip and knee joint dysfunction were recruited as the control group.Hospital for special surgery scores,stability parameters(center of pressure path length,95%confidence ellipse area)and gait parameters(pace,stride length,stride frequency,gait cycle,and the proportion of single support period)were recorded and compared in the control group and unicompartmental knee arthroplasty group before operation,1 and 3 months after operation. RESULTS AND CONCLUSION:(1)There was no significant difference in the step frequency between the patients 1 month after operation and those before operation in the unicompartmental knee arthroplasty group(P＞0.05).The stability of 1 month after operation was worse than that before operation,and other parameters of 1 month after operation were better than those before operation,and the difference was statistically significant(P＜0.05).(2)Hospital for special surgery score,gait and stability parameters at 3 months after operation were better than those before operation(P＜0.05).(3)Compared with the control group,the pace,stride length,stride frequency,and the proportion of single support period of the unicompartmental knee arthroplasty group were significantly lower before and 3 months after operation.Center of pressure path length,95%confidence ellipse area and gait cycle were greater in the unicompartmental knee arthroplasty group than those in the control group,with statistically significant differences(P＜0.05).(4)It is indicated that gait analysis is an effective means to quantitatively evaluate the rehabilitation status after unicompartmental knee arthroplasty.The early gait recovery after unicompartmental knee arthroplasty is good,but the gait frequency improvement is not obvious and the stability is poor 1 month after the operation.
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OBJECTIVE:There is no consensus on which sit-up strategy to adopt in knee osteoarthritis patients of different ages.Therefore,this study evaluated the biomechanical characteristics of sit-ups in knee osteoarthritis patients of different ages compared with healthy individuals by meta-analysis system and analyzed the sit-up movement patterns of patients of different ages to provide a reference for improving the sit-up function of patients. METHODS:By March 2023,observational studies of biomechanical characteristics of sitting up in patients with knee osteoarthritis and healthy population were retrieved on PubMed,Web of Science and CNKI.Subjects were required to be patients over 50 years of age with knee osteoarthritis who had Kellgren-Lawrence severity grading≥Ⅰ on knee imaging and who had regular knee pain.Subjects were analyzed by age(50-60 years vs.over 60 years)and severity(mild to moderate patients vs.severe patients)subgroups according to inclusion and exclusion criteria.Quality assessment was performed using the modified Down and black scale.Stata 16.0 software was used to perform subgroup analysis to determine the biomechanical characteristics of sitting up in patients with knee osteoarthritis of different ages and severities. RESULTS:A total of 14 randomized controlled trials(824 subjects)were included in the meta-analysis.The mean quality score of all included literature was 76.2,with a range of 66.7 to 86.7,all of which were of medium to high quality and representative.The included studies were of moderate to high quality and representative.Meta-analysis results found that(1)compared to healthy individuals,patients with knee osteoarthritis had longer total sitting up time(SMD=0.92,95%CI:0.76-1.09),P<0.001)and longer extension phase time(SMD=0.46,95%CI:0.18-0.74,P=0.001).Compared to mild to moderate patients,the total duration increased more significantly in severe patients(P<0.001)and the duration of the extension phase increased more significantly in patients over 60 years of age than in patients 50-60 years of age(P=0.001).(2)Compared to healthy individuals,patients with knee osteoarthritis had greater sitting-up trunk flexion motion range(SMD=0.64,95%CI:0.37-0.91,P<0.001);knee flexion motion range(SMD=-0.47,95%CI:-0.70 to-0.24,P<0.001)and ankle dorsiflexion motion range(SMD=-0.32,95%CI:-0.56 to-0.08,P=0.01)were smaller.And knee flexion motion range decreased more significantly in patients over 60 years of age than in patients 50-60 years of age(P<0.001).(3)The peak hip flexion moment(SMD=-0.57,95%CI:-0.83 to-0.31,P<0.001)and peak knee extension moment(SMD=-0.83,95%CI:-1.08 to-0.59,P<0.001)were smaller in patients with knee osteoarthritis. CONCLUSION:(1)Patients with knee osteoarthritis over the age of 60 years have a longer sit-up cushion and extension phase than patients aged 50 to 60 years.The increase in total sit-up duration was also more pronounced in patients with higher severity grades.The increased length of sitting up in patients with advanced age and knee osteoarthritis severity may increase the duration of cartilage loading,exacerbate knee pain symptoms,and increase the difficulty of sitting up in this population.(2)Patients with knee osteoarthritis exhibit limited knee and ankle flexion motion range.Knee mobility is more limited in patients over 60 years of age.(3)Patients with knee osteoarthritis have reduced peak hip flexion and knee extension moments,which may be a compensatory strategy for pain relief.
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BACKGROUND:Swimming is an important non-pharmacological treatment for knee osteoarthritis,which can effectively alleviate the disease.However,the effect and mechanism of swimming on senile knee osteoarthritis are still unclear. OBJECTIVE:To investigate the effect of swimming exercise on the articular cartilage of aged mice with knee osteoarthritis. METHODS:Six 3-month-old male C57BL/6 mice were selected as the young group,and twelve 18-month-old male C57BL/6 mice were randomized into the aged group and the swimming group,with six mice in each group.Mice in the swimming group received adaptive swimming for 1 week and formal swimming for 8 weeks.After the intervention,stride length analysis and sampling were performed in each group.The total number of leukocytes and lymphocytes in peripheral blood was detected by blood routine examinations.The morphology of the articular cartilage was observed by hematoxylin-eosin and safranin O-fast green staining.Chondrocyte counts and the modified Mankin's score were used to evaluate the degree of articular cartilage damage.The protein and mRNA expressions of type Ⅱ collagen,aggrecan and matrix metalloproteinase 13 in articular cartilage were detected by immunohistochemical staining and RT-qPCR. RESULTS AND CONCLUSION:Compared with the young group,the mice in the aged group showed significantly decreased stride length(P＜0.05),significantly increased numbers of peripheral leukocytes and lymphocytes(P＜0.05),significantly decreased count of chondrocytes(P＜0.05),significantly increased modified Mankin's score(P＜0.05),significantly decreased protein and mRNA expression of type Ⅱ collagen and aggreca(P＜0.05),and significantly increased matrix metalloproteinase 13 expression(P＜0.05).Moreover,hematoxylin-eosin and safranin O-fast green staining showed the uneven surface of the articular cartilage,abnormal chondrocytes,and proteoglycan loss in the aged group.Compared with the aged group,swimming exercise significantly improved the stride length of mice(P＜0.05),decreased the count of peripheral blood lymphocytes(P＜0.05),increased the count of chondrocytes(P＜0.05),decreased the modified Mankin's score(P＜0.05),increased the protein and mRNA expression of type Ⅱ collagen and aggrecan(P＜0.05),and decreased the expression of matrix metalloproteinase 13(P＜0.05).Hematoxylin-eosin and safranin O-fast green staining showed that the articular surface of mice in the swimming group was smooth,chondrocytes were normal,and proteoglycan loss was less.All these findings indicate that swimming exercise can reduce the number of inflammatory cells in the blood of aged mice,improve articular chondrocytes,matrix composition and cartilage tissue morphology;thus,it has a protective effect on the cartilage of aged mice with knee osteoarthritis.
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BACKGROUND:Unicompartmental knee arthroplasty can effectively treat severe unilateral knee osteoarthritis.It has been found that posterior tibial cortical fracture is prone to occur after unicompartmental knee arthroplasty.The fracture begins at the keel groove of tibial osteotomy.The tibial prosthesis riser length affects the biomechanical results of the knee joint after unicompartmental knee arthroplasty. OBJECTIVE:To investigate the effect of tibial prosthesis riser length on knee biomechanics in unicompartmental knee arthroplasty,and to find out the relationship between prosthesis riser length and anterior and posterior tibial diameters of patients. METHODS:Computed tomography image data and commonly used unicompartmental prostheses were selected from a 37-year-old healthy female with no history of knee disease.A natural knee joint model was established and a unicompartmental prosthesis model was built.Eight different lengths of tibial prosthesis risers were established,with a minimum length of 31 mm and a maximum length of 34.5 mm in 0.5 mm increments,for comparison with the commonly used hospital prosthesis riser length of 33.2 mm.The material of the femoral component and tibial disc was cobalt-chromium-molybdenum alloy,and the tibial spacer was ultra-high molecular weight polyethylene.The biomechanical changes of the knee joint were observed using finite element analysis software loaded with 1000 N over the femur. RESULTS AND CONCLUSION:(1)The tibial stress was minimal at a tibial prosthesis riser length of 33 mm;the anterior cruciate ligament stress was minimal;the lateral meniscus stress was minimal,and the femoral prosthesis stress was minimal.The remaining components were less stressful.(2)The subject's medial tibial plateau anterior-posterior diameter length was 53 mm,and by calculating the ratio,the optimal ratio of tibial prosthesis riser length to anterior-posterior tibial diameter should be about 62%.If it is lower than this value,aseptic loosening of the prosthesis may occur,and if it is higher than this value,fracture of the bone cortex at the anterior-posterior end of the tibia may occur.