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1.
J Orthop Sci ; 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32173180

RESUMO

BACKGROUND: The locomotive syndrome risk test was developed to quantify the decrease in mobility among adults, which could eventually lead to disability. The purpose of this study was to establish reference values for the locomotive syndrome risk test for adults and investigate the influence of age and sex. METHODS: We analyzed 8681 independent community dwellers (3607 men, 5074 women). Data pertaining to locomotive syndrome risk test (the two-step test, the stand-up test, and the 25-question geriatric locomotive function scale [GLFS-25]) scores were collected from seven administrative areas of Japan. RESULTS: The reference values of the three test scores were generated and all three test scores gradually decreased among young-to-middle-aged individuals and rapidly decreased in individuals aged over 60 years. The stand-up test score began decreasing significantly from the age of 30 years. The trajectories of decrease in the two-step test score with age was slightly different between men and women especially among the middle-aged individuals. The two physical test scores were more sensitive to aging than the self-reported test score. CONCLUSION: The reference values generated in this study could be employed to determine whether an individual has mobility comparable to independent community dwellers of the same age and sex.

2.
J Orthop Sci ; 2020 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-31955959

RESUMO

BACKGROUND: Lower extremity alignment is an important variable with respect to the development and progression of knee osteoarthritis. It is very essential for the preoperative planning of realignment surgeries such as total knee arthroplasty and high tibial osteotomy. Nevertheless, there have been no reports comparing 3D lower extremity alignment between weight-bearing upright and non-weight-bearing horizontal states in osteoarthritic knees in the same subject. Therefore, we determined whether the alignment of the lower extremity in the weight-bearing upright state differed from that in the non-weight-bearing horizontal or supine position in patients with knee osteoarthritis. METHODS: Adduction-abduction, flexion-extension, and rotational angle of osteoarthritic knees were assessed in weight-bearing upright and non-weight-bearing supine positions. Knee alignment in the supine position was determined from preoperative computed tomography data. In the weight-bearing upright state, alignment was determined using a technique that utilized 2D-3D image-matching with biplanar computed radiography and 3D bone models of the complete lower extremity rebuilt using computed tomography-based information. RESULTS: We assessed 81 limbs from osteoarthritic knee patients (74 women, 7 men; mean age 75.3 years, range 59-86 years). In the coronal plane, there were varus deformities in both the supine and standing positions, while there was flexion in both the supine upright state and position at the sagittal plane. In the axial plane, the rotation of the tibia to the femur was neutral in the supine position and internal in the upright state. CONCLUSION: Patient position significantly affects lower extremity alignment in osteoarthritic knees. This study provides important data regarding the preoperative evaluation of realignment surgery in total knee arthroplasty and high tibial osteotomy. We believe that these results are an important contribution to the knowledge regarding knee osteoarthritis.

3.
J Orthop Sci ; 25(1): 173-177, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30928034

RESUMO

BACKGROUND: In first-time acute traumatic patellar dislocations, numerous anatomic and clinical factors are complicatedly associated and should be comprehensively considered for the optimal management of conservative or surgical intervention. The purpose of this study was to establish a scoring system, using a concept that is not complicated and easily used in clinic. METHODS: Of 131 first-time acute traumatic patellar dislocations, 81 patients (51 females, 30 males) with an average age of 19.6 (95%CI, 17.5-21.6) years and an average follow-up duration of 17.1 (95% CI, 12.3-21.9) months, who underwent conservative treatment after first-time dislocations, were reviewed. Based on the odds ratios applying logistic regression analysis, the scoring system was established. RESULTS: The scoring system (total: 10 points) had simple composition of age <20 (2 points), sports injury (1 points), hemarthrosis (1 points), and image findings of a bony fragment (3 points), lateral shift of the patella (1 points), and trochlear dysplasia (2 points). A threshold score of 6.5 was determined using the area under receiver operating characteristic curve of 0.893 (p < 0.0001). In logistic regression analysis, a score of ≥7 was shown to be a dominant factor for recurrence (OR = 27.1, p < 0.0001). Furthermore, the association between the score and recurrence risk was as follows: a score of ≤4 = low risk (1/21 cases, 5%); a score of 5-7 = medium risk (13/27 cases, 48%); a score of ≥8 = high risk (30/33 cases, 91%). CONCLUSIONS: Based on the simple scoring system, patients who scored ≥8 were considered suitable for surgical treatment because of the high rate of recurrence, whereas those who scored ≤4 were considered suitable for conservative treatment because of the low rate of recurrence.

4.
Artigo em Inglês | MEDLINE | ID: mdl-31853619

RESUMO

PURPOSE: To test the hypothesis that an inclined articular surface on the medial proximal tibia is aligned more parallel to the ground in three-dimensional (3D) space under weight-bearing (WB) conditions (parallel phenomenon) than under non-WB (NWB) conditions in healthy and varus osteoarthritic knees. METHODS: We examined 55 healthy knees (26 women, 29 men; mean age, 70 ± 6 years) and 108 varus osteoarthritic knees (66 women, 16 men; mean age, 74 ± 7 years). For the evaluation under WB conditions, a 3D assessment system was used on biplanar long-leg radiographs and 3D bone models using a 3D-to-2D image registration technique. In addition, the least square method was used to determine the approximation plane. The angles between the normal vector for the approximation plane of an articular surface on the medial proximal tibia and each axis of the tibial or world coordinate system were calculated. RESULTS: Morphologically, the inclination of the approximation plane was steeper in osteoarthritic knees than in healthy knees (p < 0.0001). The approximation plane was aligned more parallel to the ground under WB conditions than under NWB conditions in healthy (p < 0.0001) and osteoarthritic knees (p < 0.0001). CONCLUSIONS: The parallel phenomenon in the medial proximal tibia was confirmed for healthy and varus osteoarthritic knees. The medial proximal tibia plays an important role in the parallel phenomenon, assumingly associated with varus alignment and varus thrust. The inclination of the medial proximal tibia may become a new parameter for imaging investigations. LEVEL OF EVIDENCE: III.

5.
J Exp Orthop ; 6(1): 14, 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30923977

RESUMO

BACKGROUND: The inclination of the medial compartment of the proximal tibia (MCT) is assumed to be a critical factor for varus alignment in advanced knee osteoarthritis (OA). This study was aimed at investigating; (1) whether the inclination of MCT is aligned parallel to the ground under weight-bearing (WB) conditions; (2) whether this is associated with the change in alignment and the relative position between the bones; and (3) whether the tibia or femur mainly contributes to the changes. METHODS: We examined 102 knees (84 women, 18 men; mean 75 years). A three-dimensional (3D) assessment system was applied on biplanar whole lower extremity radiographies using 3D-to-2D image registration technique. The evaluation parameters were 1) MCT angle, 2) femorotibial angle (FTA), 3) medial-lateral femoral location to the tibia (M-L femoral location), 4) WB line passing point, and 5) tibial position to WB line (tibial position) and 6) femoral postion to WB line (femoral position). Each parameter was evaluated in non-WB and WB conditions, and the differences (Δ-parameters). RESULTS: MCT angle in the world coordinate system was larger than that in the tibial coordinate system (p <  0.0001). ΔMCT angle was correlated with ΔFTA (p = 0.002) and ΔM-L femoral location (p = 0.004). The tibial position was the more dominant factor for ΔMCT angle (p = 0.001), ΔFTA (p <  0.0001), and ΔWB line passing point (p <  0.0001) . CONCLUSIONS: The inclination in MCT was aligned parallel to the ground under WB conditions (tibial parallel phenomenon). The parallel phenomenon was associated with the change of alignment and the relative position between the bones in the coronal plane. These phenomena were produced mainly by the tibia, not the femur. LEVEL OF EVIDENCE: Level IV.

6.
Surg Radiol Anat ; 41(1): 25-28, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30377754

RESUMO

PURPOSE: The purpose of this study is to clarify the morphological characteristics of the lateral talocalcaneal ligament (LTCL). METHODS: This study examined 100 legs from 54 Japanese cadavers. The LTCL was classified into three types: Type I, the LTCL branches from the calcaneofibular ligament (CFL); Type II, the LTCL is independent of the CFL and runs parallel to the calcaneus; and Type III, the LTCL is absent. The morphological features measured were fiber bundle length, fiber bundle width, and fiber bundle thickness. RESULTS: The LTCL was classified as Type I in 18 feet (18%), Type II in 24 feet (24%), and Type III in 58 feet (58%). All LTCLs were associated with the anterior talofibular ligament at the talus. There was no significant difference in morphological characteristics by Type for each ligament. CONCLUSIONS: The LTCL was similar to the CFL in terms of fiber bundle width and fiber bundle thickness.


Assuntos
Calcâneo/anatomia & histologia , Ligamentos Laterais do Tornozelo/anatomia & histologia , Articulação Talocalcânea/anatomia & histologia , Tálus/anatomia & histologia , Idoso , Variação Anatômica , Cadáver , Feminino , Humanos , Japão , Masculino
7.
J Orthop Sci ; 24(3): 514-520, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30591399

RESUMO

INTRODUCTION: The Knee Injury and Osteoarthritis Outcomes Survey (KOOS) has been translated into 50 languages worldwide. These translations have adhered to guidelines for cross cultural adaptation of health surveys. However, after release of the Japanese KOOS (JKOOS) we discovered the JKOOS was not fully culturally relevant to Japanese patients. Therefore, we undertook the development and validation of the JKOOS+. METHODS: We completed this project in 2 phases across 9 hospitals. In Phase 1, 187 surgically naïve patients with knee pain were asked about activities limited by their knee pain. An expert panel reconciled these activities against existing KOOS items to identify novel items. In Phase 2, 241 surgically naïve patients with knee pain were administered the Japanese Oxford Knee Survey, JKOOS, and these novel items. An iterative Rasch analysis was used to test item fit of these novel items within the KOOS Activities of Daily Living (ADL) domain and a potential new domain. Unidimensionality was assessed using principle component analysis. Internal consistency (Cronbach's alpha) and external validity (Spearman's Correlations) were assessed for Japanese ADL (J-ADL) and the novel domain. RESULTS: Phase 1 identified 4 activities relevant to Japanese knee patients: sitting seiza, using a Japanese toilet, climbing hills, and getting on/off a bus/train. In Phase 2, climbing hills and bus/train were well fit in JADL. Seiza and using a Japanese toilet were not well fit in J-ADL, yet both require deep knee flexion so a knee flexion (KF) domain was constructed by considering all KOOS items that require knee flexion using an iterative Rasch model. An 8 item KF domain emerged. Both J-ADL and KF were deemed to be unidimensional with high internal consistency (Cronbach's alpha >0.92) and external validity (Spearman Correlations 0.723-0.929). CONCLUSIONS: We have successfully developed and validated JKOOS+, a more culturally relevant knee survey for Japanese patients.


Assuntos
Atividades Cotidianas , Comparação Transcultural , Osteoartrite do Joelho/cirurgia , Avaliação de Resultados da Assistência ao Paciente , Recuperação de Função Fisiológica/fisiologia , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Japão , Idioma , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Qualidade de Vida , Reprodutibilidade dos Testes , Traduções
8.
PLoS One ; 13(9): e0202488, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30208059

RESUMO

INTRODUCTION: Posterior tibial slope (PTS) and sagittal alignment are important factors in the etiology of knee osteoarthritis and knee surgery. Clinically, sagittal alignment, which indicates flexion contracture of the knee, contributes to knee function in weight-bearing (WB) conditions. PTS and sagittal alignment under WB conditions in varus osteoarthritic knees are presumed to affect each other, but their association remains unclear. In this study, we aimed to clarify the association. MATERIAL AND METHODS: In total, 140 osteoarthritic varus knees were investigated. Under WB conditions, a three-dimensional (3D) alignment assessment system was applied via biplanar long-leg X-rays, using 3D-to-2D image registration technique. The evaluation parameters were as follows: 1) 3D mechanical flexion angle (3DMFA) in regards to sagittal alignment, 2) passing point in the WB line (PP), and 3) medial and lateral PTS. RESULTS: The medial and lateral PTS showed a positive correlation with 3DMFA and PP, respectively (medial PTS-3DMFA, p = 0.001; medial PTS-PP, p < 0.0001; lateral PTS-3DMFA, p < 0.0001; lateral PTS-PP, p = 0.002). The flexion contracture group with 3DMFA >5° demonstrated greater PTS than non-flexion contracture group (medial PTS, p = 0.006; lateral PTS, p = 0.006). CONCLUSIONS: Both medial and lateral PTS were correlated with sagittal alignment under WB conditions and were larger in the flexion contracture group. This finding can explain the function to take the load articular surface parallel to the ground for holding the balance in WB conditions in the sagittal plane for osteoarthritic knees. Moreover, surgeons may be required to decrease the PTS during knee arthroplasty to restore full extension in knees of patients with fixed flexion contracture.


Assuntos
Osteoartrite do Joelho/fisiopatologia , Tíbia/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imageamento Tridimensional , Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Equilíbrio Postural , Amplitude de Movimento Articular , Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Suporte de Carga
9.
Artigo em Inglês | MEDLINE | ID: mdl-29255915

RESUMO

The author would like to correct the errors in the publication of the original article. The corrected detail is given below for your reading.

10.
Knee Surg Sports Traumatol Arthrosc ; 26(10): 2891-2898, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29150745

RESUMO

PURPOSE: Abnormalities of lower extremity alignment (LEA) in recurrent patella dislocation (RPD) have been studied mostly by two-dimensional (2D) procedures leaving three-dimensional (3D) factors unknown. This study aimed to three-dimensionally examine risk factors for RPD in lower extremity alignment under the weight-bearing conditions. METHODS: The alignment of 21 limbs in 15 RPD subjects was compared to the alignment of 24 limbs of 12 healthy young control subjects by an our previously reported 2D-3D image-matching technique. The sagittal, coronal, and transverse alignment in full extension as well as the torsional position of the femur (anteversion) and tibia (tibial torsion) under weight-bearing standing conditions were assessed by our previously reported 3D technique. The correlations between lower extremity alignment and RPD were assessed using multiple logistic regression analysis. The difference of lower extremity alignment in RPD between under the weight-bearing conditions and under the non-weight-bearing conditions was assessed. RESULTS: In the sagittal and coronal planes, there was no relationship (statistically or by clinically important difference) between lower extremity alignment angle and RPD. However, in the transverse plane, increased external tibial rotation [odds ratio (OR) 1.819; 95% confidence interval (CI) 1.282-2.581], increased femoral anteversion (OR 1.183; 95% CI 1.029-1.360), and increased external tibial torsion (OR 0.880; 95% CI 0.782-0.991) were all correlated with RPD. The tibia was more rotated relative to femur at the knee joint in the RPD group under the weight-bearing conditions compared to under the non-weight-bearing conditions (p < 0.05). CONCLUSIONS: This study showed that during weight-bearing, alignment parameters in the transverse plane related to the risk of RPD, while in the sagittal and coronal plane alignment parameters did not correlate with RPD. The clinical importance of this study is that the 3D measurements more directly, precisely, and sensitively detect rotational parameters associated with RPD and hence predict risk of RPD. LEVEL OF EVIDENCE: III.


Assuntos
Imageamento Tridimensional , Articulação do Joelho/fisiopatologia , Patela/fisiopatologia , Luxação Patelar/diagnóstico , Adolescente , Adulto , Estudos de Casos e Controles , Feminino , Fêmur , Humanos , Extremidade Inferior , Masculino , Postura , Recidiva , Fatores de Risco , Rotação , Tíbia , Suporte de Carga , Adulto Jovem
11.
Knee Surg Sports Traumatol Arthrosc ; 26(9): 2607-2614, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28447140

RESUMO

PURPOSE: The purpose of this study was to investigate the causal relationship between quadriceps muscle strength and radiographic knee osteoarthritis (OA) in a longitudinal study. METHODS: The present study included 976 knees from 488 subjects who participated in both the 5th (2007) and 7th (2013) surveys of the Matsudai Knee Osteoarthritis Survey. Bilateral quadriceps strengths of each subject were measured using the quadriceps training machine (QTM-05F, Alcare Co., Ltd., Tokyo, Japan). Additionally, weight-bearing standing knee radiographs were obtained, and knee OA was graded according to the Kellgren-Lawrence classification system. The relationships between quadriceps strength and the incidence and progression of radiographic knee OA were assessed using multiple logistic regression analysis. RESULTS: After adjusting for age and body mass index (BMI), both female and male knees in the lowest quantile of quadriceps strength had higher risk of the incidence of radiographic knee OA compared with the highest quantile of quadriceps strength (women: OR 2.414, 95% CI 1.098-5.311; men: OR 2.774, 95% CI 1.053-7.309). In contrast, after adjusting for age, BMI and femorotibial angle, both female and male knees in the lowest quantile compared with the highest quantile of quadriceps strength did not differ in risk of the progression of radiographic knee OA (women: OR 1.040, 95% CI 0.386-2.802; men: OR 2.814, 95% CI 0.532-14.898). CONCLUSION: Quadriceps muscle weakness was related to increased risk of the incidence of radiographic knee OA, but not its progression, in both women and men. Therefore, the clinically important finding of this study is that, in both women and men, maintaining higher quadriceps muscle strength may be one of the most effective prevention methods for incident radiographic knee OA. LEVEL OF EVIDENCE: II.


Assuntos
Força Muscular/fisiologia , Osteoartrite do Joelho/etiologia , Músculo Quadríceps/fisiologia , Idoso , Índice de Massa Corporal , Progressão da Doença , Feminino , Humanos , Incidência , Japão/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/epidemiologia , Radiografia , Fatores de Risco , Inquéritos e Questionários , Suporte de Carga
12.
J Orthop Sci ; 23(1): 151-155, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28947242

RESUMO

BACKGROUND: Studies on the epidemiology of pediatric fractures have been scarce in recent years although fractures are very common in childhood. Boys have a higher incidence of fractures than girls. Currently, societal trends have seemed to influence the difference in activity patterns between boys and girls, but the sex difference regarding longitudinal changes in fracture incidence is not well known. METHODS: We analyzed the school accident report in Niigata city, Japan and compared the incidence of fractures in elementary and junior high school students and the sex-related risk ratio between two 9-year periods separated by 20 years from their start and end points (1999-2007 and 1979-1987). RESULTS: The study included 383,273 students from 1999 to 2007 and 561,109 students from 1979 to 1987. Comparing these periods, the fracture incidence increased significantly by 2.4 times in boys vs 2.1 times in girls from elementary school and by 2.2 times in boys vs 2.9 times in girls from junior high school (all p ï¼œ 0.001). The sex-related risk ratio of boys to girls increased significantly from 1.47 to 1.64 in elementary school students. In contrast, it decreased significantly from 3.29 to 2.52 in junior high school students and the change was markedly significant because of the drastic increase in fracture incidence in junior high school girls. CONCLUSIONS: The reasons proposed for the increase in schoolchildren's fractures were an improvement in diagnosis owing to social background and increased participation in sports activities despite the general decline in children's physical fitness and exercise ability. In junior high school girls, in particular, there was an increase in fracture risk due to increased participation in sports activities.


Assuntos
Traumatismos em Atletas/epidemiologia , Fraturas Ósseas/epidemiologia , Aptidão Física/fisiologia , Serviços de Saúde Escolar/tendências , Instituições Acadêmicas , Adolescente , Criança , Estudos Transversais , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/terapia , Humanos , Incidência , Japão/epidemiologia , Estudos Longitudinais , Masculino , Medição de Risco , Distribuição por Sexo
13.
J Orthop Sci ; 22(4): 765-770, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28408156

RESUMO

BACKGROUND: Quadriceps muscle strength reference value of normal individuals in Japan is necessary to quantitatively evaluate functional deterioration of locomotive organs. Therefore, we established a reference value by using the Locomo Scan, a new device that measures knee extension muscle strength. METHODS: We measured knee extension muscle strength with the Locomo Scan in 3617 individuals (1692 men, 1925 women, 20-89 years; mean age. 50.7 years) by implementing our own 49 measurement events in 20 prefectures. RESULTS: The means of maximum knee extension muscle strength for men (women) in each age group were as follows: 20s, 546 (475) N; 30s. 552 (475) N; 40s, 534 (450) N; 50s, 507 (442) N; 60s, 471 (405) N; 70s, 385 (340) N; and 80s, 359 (267) N. No significant differences were found from the 20s to 40s age groups, but older groups had significantly decreased knee extension muscle strength with age for both sexes. CONCLUSIONS: We established reference values for quadriceps muscle strength with the Locomo Scan as an index for functional deterioration of locomotive organs based on a large-scale sample.


Assuntos
Força Muscular/fisiologia , Músculo Quadríceps/fisiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Japão , Articulação do Joelho/fisiologia , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Valores de Referência , Fatores Sexuais , Adulto Jovem
14.
J Orthop Sci ; 22(3): 501-505, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28139346

RESUMO

INTRODUCTION: The relative torsional angle of the distal tibia is dependent on a deformity of the proximal tibia, and it is a commonly used torsional parameter to describe deformities of the tibia; however, this parameter cannot show the location and direction of the torsional deformity in the entire tibia. This study aimed to identify the detailed deformity in the entire tibia via a coordinate system based on the diaphysis of the tibia by comparing varus osteoarthritic knees to healthy knees. METHODS: In total, 61 limbs in 58 healthy subjects (age: 54 ± 18 years) and 55 limbs in 50 varus osteoarthritis (OA) subjects (age: 72 ± 7 years) were evaluated. The original coordinate system based on anatomic points only from the tibial diaphysis was established. The evaluation parameters were 1) the relative torsion in the distal tibia to the proximal tibia, 2) the proximal tibial torsion relative to the tibial diaphysis, and 3) the distal tibial torsion relative to the tibial diaphysis. RESULTS: The relative torsion in the distal tibia to the proximal tibia showed external torsion in both groups, while the external torsion was lower in the OA group than in the healthy group (p < 0.0001). The proximal tibial torsion relative to the tibial diaphysis had a higher external torsion in the OA group (p = 0.012), and the distal tibial torsion relative to the tibial diaphysis had a higher internal torsion in the OA group (p = 0.004) in comparison to the healthy group. CONCLUSION: The reverse torsional deformity, showing a higher external torsion in the proximal tibia and a higher internal torsion in the distal tibia, occurred independently in the OA group in comparison to the healthy group. Clinically, this finding may prove to be a pathogenic factor in varus osteoarthritic knees. LEVEL OF EVIDENCE: Level Ⅲ.


Assuntos
Imageamento Tridimensional , Articulação do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/diagnóstico por imagem , Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Anormalidade Torcional/etiologia , Idoso , Diáfises/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Fatores de Tempo , Anormalidade Torcional/diagnóstico
15.
Knee Surg Sports Traumatol Arthrosc ; 25(2): 468-476, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-27262696

RESUMO

PURPOSE: To characterize femoral deformities and determine sex differences in varus knee osteoarthritis (OA), femoral morphology and limb alignment were evaluated by using three-dimensional (3D) assessment, comparing healthy, elderly volunteers with osteoarthritic knees. METHODS: A total of 178 lower limbs of 169 subjects with knee osteoarthritis (136 women, 33 men; mean age 74.9 ± 5.2 years) and 80 lower limbs of 45 healthy, elderly subjects (24 women, 21 men; mean age 65 ± 4.9 years) were examined. A 3D extremity alignment assessment system was used to examine the subjects under weight-bearing conditions on biplanar long-leg radiographs using a 3D-to-2D image registration technique. The evaluation parameters were (1) femoral bowing in the coronal plane, (2) femoral bowing in the sagittal plane, (3) femoral neck anteversion, (4) hip-knee-ankle angle, and (5) femoral torsion. RESULTS: Higher femoral lateral bowing and slightly higher femoral internal torsion in the proximal diaphysis were observed in women with OA compared with healthy subjects. No difference in the higher varus malalignment, no alteration in the femoral anterior bowing, and no difference in the lower femoral neck anteversion were found between men and women when comparing healthy and OA subjects. CONCLUSIONS: The higher femoral lateral bowing and slightly higher femoral internal torsion in the proximal diaphysis in women are possibly a structural adaptation to mechanical use. The clinical significance is that the femoral deformities and the sex differences in knee OA have the potential to improve the understanding of the aetiology of primary varus knee OA. LEVEL OF EVIDENCE: IV.


Assuntos
Fêmur/fisiopatologia , Imageamento Tridimensional , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Articulação do Tornozelo , Mau Alinhamento Ósseo/etiologia , Feminino , Colo do Fêmur , Humanos , Articulação do Joelho/fisiopatologia , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Radiografia , Fatores Sexuais , Suporte de Carga
16.
J Orthop Sci ; 21(4): 463-468, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27151074

RESUMO

BACKGROUND: Knee osteoarthritis (OA) is a multifactorial disease that is affected by mechanical factors. The aim of present study was to investigate the association between multiple mechanical factors and medial knee OA in a large epidemiological cohort. METHODS: Six hundred and ninety-nine subjects (323 males and 376 females), participating in the Matsudai Knee Osteoarthritis Survey 2010, were included. Twelve mechanical factors were selected and their association with the radiographic grade of knee OA, the Western Ontario and McMaster University Index (WOMAC) pain score, and the WOMAC function score was evaluated. RESULTS: A logistic regression analysis identified varus thrust to be associated with the radiographic grade of knee OA in males (OR: 1.876, 95% CI: 1.332-2.663) and females (2.61, 1.922-3.542), the WOMAC pain score in males (1.997, 1.463-2.672), and the WOMAC function score in females (1.449, 1.12-1.874). Quadriceps muscle strength was associated with the radiographic OA grade in males (0.605, 0.399-0.917) and females (0.636, 0.469-0.863), the WOMAC pain score in females (0.537, 0.445-0.789), and the WOMAC function score in males (0.581, 0.44-0.766). The knee flexion angle was also associated with the radiographic OA grade in males (0.344, 0.19-0.621) and females (0.121, 0.022-0.653), and the WOMAC pain score in males (0.287, 0.156-0.53) and females (0.537, 0.336-0.859). Obesity was associated with the radiographic OA grade in males (1.543, 1.041-2.287) and females (1.589, 1.176-2.146), the WOMAC pain score in female (2.017, 1.517-2.68). Femolo-tibial angle had no significant association with the radiographic knee OA grade or with the WOMAC pain and function scores. CONCLUSION: Among patients with medial knee OA, dynamic mechanical factors, such as varus thrust, quadriceps muscle strength, and range of motion were more likely to be associated with the radiographic grade of knee OA and to be the WOMAC pain and function scores, compared to static mechanical factors.


Assuntos
Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/fisiopatologia , Idoso , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Força Muscular , Osteoartrite do Joelho/diagnóstico por imagem , Medição da Dor , Amplitude de Movimento Articular , Índice de Gravidade de Doença , Inquéritos e Questionários , Suporte de Carga
17.
J Orthop Sci ; 21(2): 166-71, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26778626

RESUMO

BACKGROUND: Relationship malalignment of the knee and the onset of knee OA are unclear. Moreover, it has not been clarified whether malalignment of the knee affects the morphological change of the proximal tibia. The purpose of current study was to investigate whether varus knee alignment and morphological change of the proximal medial tibia influence the onset of medial knee OA and to clarify the relationship between them. METHODS: The subjects comprised 736 knees from 390 women that went under both the first survey in 1979 and the fourth survey in 2000 in the Matsudai district in Niigata Prefecture in Japan. None of the subjects demonstrated radiographic knee OA at the first survey. OA was graded according to the Kellgren-Lawrence classification and the subjects were divided according to the OA grades in the forth survey into the 3 groups (non-OA, early OA, and advanced OA). Age, BMI, Femorotibial angle (FTA), the tibial plateau angle and medial tibial cortical bone thickness (MTCBT) were measured. We performed multivariate logistic regression analysis using the stepwise method to identified the risk factors regarding onset of knee OA and calculated the odds ratio (OR) and 95% confidence intervals (95% CI). RESULTS: Advanced OA had a significantly higher OR compared to non-OA in 1979 with the tibial plateau angle (OR: 1.15) and MTCBT (OR: 2.11). And also advanced OA had a significantly higher OR compared to early-OA in 1979 with the tibial plateau angle (OR: 1.17) and MTCBT (OR: 1.62). CONCLUSIONS: In the advanced OA, varus alignment of the proximal tibia had already existed before the onset of knee OA. In addition, we thought that varus alignment due to the proximal tibia had influenced the morphologic alterations of proximal medial tibia.


Assuntos
Mau Alinhamento Ósseo/complicações , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/etiologia , Radiografia/métodos , Inquéritos e Questionários , Tíbia/diagnóstico por imagem , Adulto , Idoso , Mau Alinhamento Ósseo/epidemiologia , Mau Alinhamento Ósseo/fisiopatologia , Progressão da Doença , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Articulação do Joelho/diagnóstico por imagem , Pessoa de Meia-Idade , Razão de Chances , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/epidemiologia , Estudos Retrospectivos , Fatores de Risco
18.
J Orthop Sci ; 21(2): 159-65, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26714666

RESUMO

BACKGROUND: Anterior cruciate ligament (ACL) injury often leads to symptoms of instability, which may cause meniscus injury, osteochondral lesions, and degenerative changes. For thorough evaluation of the effects of abnormal motion of ACL-deficient (ACLD) knees on the meniscus and articular cartilage, it is necessary to assess tibiofemoral motion in the medial and lateral compartments separately. Our aim was to determine if in vivo three-dimensional (3D) dynamic motion of ACLD knees differs from that of contralateral uninjured knees by assessing knee motion in the medial and lateral compartments respectively. METHODS: A total of 22 patients with an isolated ACL-injured knee were examined. 3D to two-dimensional registration was used to determine 3D knee motion during squatting from full knee extension to full flexion for both ACLD and contralateral uninjured knees. The knee motion was evaluated by the movement of the geometric center axis of the femur projected onto the tibial axial plane. RESULTS: In ACLD knees the lateral femoral condyle was located significantly more posteriorly during nearly full extension than in contralateral uninjured knees. The range of anteroposterior translation of the medial femoral condyle was significantly greater than those of contralateral uninjured knees. Almost all of the contralateral uninjured knees demonstrated medial pivot motion, while the ACLD knees showed higher variance. CONCLUSIONS: The ACLD knees exhibited a motion pattern different from those of contralateral uninjured knees with higher variance. During nearly full extension of the ACLD knees, the lateral femoral condyle translated posteriorly and the screw-home movement seemed to be impaired. The ACL might have an important role in maintaining normal knee function, especially during the early flexion phase. The larger range of anteroposterior translation of the medial femoral condyle in ACLD knees may be associated with a risk of secondary meniscal injury and degenerative change in the articular cartilage. LEVEL OF EVIDENCE: Level IV.


Assuntos
Lesões do Ligamento Cruzado Anterior/fisiopatologia , Ligamento Cruzado Anterior/fisiopatologia , Fêmur/diagnóstico por imagem , Imageamento Tridimensional/métodos , Articulação do Joelho/fisiopatologia , Movimento/fisiologia , Amplitude de Movimento Articular/fisiologia , Adolescente , Adulto , Ligamento Cruzado Anterior/diagnóstico por imagem , Lesões do Ligamento Cruzado Anterior/diagnóstico , Fenômenos Biomecânicos , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
19.
Int J Sports Phys Ther ; 10(5): 592-601, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26491609

RESUMO

BACKGROUND: A smaller knee flexion angle and larger knee valgus angle during weight-bearing activities have been identified as risk factors for non-contact anterior cruciate ligament (ACL) injuries. To prevent such injuries, attention has been focused on the role of hip strength in knee motion control. However, gender differences in the relationship between hip strength and knee kinematics during weight-bearing activities in the frontal plane have not been evaluated. HYPOTHESIS/PURPOSE: The purpose of this study was to determine the influence of hip strength on knee kinematics in both genders during a single-legged landing task in the frontal plane. The hypotheses were that 1) subjects with a greater hip strength would demonstrate larger knee flexion and smaller knee valgus and internal rotation angles and 2) no gender differences would exist during the single-legged landing task. METHODS: Forty-three Japanese collegiate basketball players (20 males, 23 females) participated in this study. Three-dimensional motion analysis was used to evaluate knee kinematics during a single-legged medial drop landing (SML). A hand-held dynamometer was used to assess hip extensor (HEXT), abductor (HAB), and external rotator (in two positions: seated position [SHER] and prone [PHER]) isometric strength. Spearman rank correlation coefficients (ρ) were determined for correlations between hip strength and knee kinematics at initial contact (IC) and peak (PK) during SML (p < 0.05). RESULTS: Negative correlations were observed between the knee valgus angle at IC and HEXT (ρ = -0.48, p = 0.02), HAB (ρ = -0.46, p = 0.03) and PHER (ρ = -0.44, p = 0.04) strength in females. In addition, a significant positive correlation was observed between the knee flexion angle at PK and HEXT strength (ρ = 0.61, p = 0.004) in males. CONCLUSIONS: Significant correlations between hip strength and knee kinematics during SML were observed in both genders. Hip strength may, therefore, play an important role in knee motion control during sports activities, suggesting that increased hip strength may help to prevent non-contact ACL injuries in athletes of both genders. Moreover, gender-specific programs may be needed to control abnormal knee motion, as the influence of hip strength on knee kinematics may differ based on gender. LEVEL OF EVIDENCE: 3.

20.
Gait Posture ; 42(2): 127-32, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26002602

RESUMO

We recently developed a new method for three-dimensional evaluation of mechanical factors affecting knee joint in order to help identify factors that contribute to the progression of knee osteoarthritis (KOA). This study aimed to verify the clinical validity of our method by evaluating knee joint dynamics during gait. Subjects were 41 individuals (14 normal knees; 8 mild KOAs; 19 severe KOAs). The positions of skin markers attached to the body were captured during gait, and bi-planar X-ray images of the lower extremities were obtained in standing position. The positional relationship between the markers and femorotibial bones was determined from the X-ray images. Combining this relationship with gait capture allowed for the estimation of relative movement between femorotibial bones. We also calculated the point of intersection of loading axis of knee on the tibial proximal surface (LAK point) to analyze knee joint dynamics. Knee flexion range in subjects with severe KOA during gait was significantly smaller than that in those with normal knees (p=0.011), and knee adduction in those with severe KOA was significantly larger than in those with mild KOA (p<0.000). LAK point was locally loaded on the medial compartment of the tibial surface as KOA progressed, with LAK point of subjects with severe KOA rapidly shifting medially during loading response. Local loading and medial shear force were applied to the tibial surface during stance phase as medial KOA progressed. Our findings suggest that our method is useful for the quantitative evaluation of mechanical factors that affect KOA progression.


Assuntos
Marcha/fisiologia , Imageamento Tridimensional , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Análise Radioestereométrica , Tíbia/diagnóstico por imagem , Tíbia/fisiopatologia , Tomografia Computadorizada por Raios X , Suporte de Carga/fisiologia , Adulto , Idoso , Fenômenos Biomecânicos/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Postura/fisiologia , Valores de Referência , Adulto Jovem
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