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1.
Zhongguo Zhen Jiu ; 41(3): 303-6, 2021 Mar 12.
Artigo em Chinês | MEDLINE | ID: mdl-33798314

RESUMO

OBJECTIVE: To observe the imaging features of focus of knee joint tendon in patients with knee osteoarthritis (KOA) by musculoskeletal ultrasound (MSUS) technique. METHODS: One hundred KOA patients and 100 healthy subjects were included. All the KOA patients were palpated by the sequence of foot yangming meridian, foot shaoyang meridian, foot taiyang meridian and foot three yin-meridians, and the focus of knee tendon and its frequency were recorded by MSUS technique. The top-5 focus of knee tendon of KOA patients and the corresponding focus of knee tendon of healthy subjects were selected as the observation sites to compare the differences of thickness of ligament and tendon soft tissue in the extension and flexion positions of the knee joint. RESULTS: The top-5 focus of knee tendon of KOA patients were located in medial inferior patella, medial tibial condyle, inferior patella, Zusanlici and Hedingci. The thickness of ligaments and tendons in extension and flexion positions in KOA patients were thicker than that in healthy subjects (P<0.05). CONCLUSION: The focus of knee joint tendon in KOA patients shows significantly thickened musculoskeletal imaging features.


Assuntos
Osteoartrite do Joelho , Voluntários Saudáveis , Humanos , Articulação do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/diagnóstico por imagem , Tendões/diagnóstico por imagem , Ultrassonografia
2.
Arthroscopy ; 37(4): 1192-1193, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33812522

RESUMO

Although most reports in the literature suggest that the knee anterolateral structures contribute to the anterolateral rotational stability of the knee, the extent of its contribution is still controversial. There are many dynamic structures that also affect the stability of the knee joint, including the iliotibial band and quadriceps muscle. Although not all of the dynamic structures surrounding the knee influence stability associated with the anterior cruciate ligament, we recommend that cadaveric, biomechanical analysis of the knee anterolateral ligament and related structures include tensioning of all knee dynamic structures to avoid potential biases.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Instabilidade Articular , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Cadáver , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , Amplitude de Movimento Articular
3.
Arthroscopy ; 37(4): 1212-1213, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33812524

RESUMO

Trochlear dysplasia is one of the primary morphologic abnormalities associated with patellar instability. Although qualitative classifications based on trochlear shape such as the Dejour classification exist, radiographic measurements to quantify the severity of trochlear dysplasia are numerous and varied. Each measurement addresses a different element of the complex and wide-ranging presentations that exist along a spectrum of abnormalities in trochlear morphology, and the reported reliability of such measurements are mixed. Overall, our understanding of trochlear dysplasia continues to evolve, and the ability to quantify the morphology of the trochlea, as well as its influence on patellar stability, remains a work in progress. Future directions include developing improved 3-dimensional descriptions of trochlear anatomy, as well as standardizing measurement methods and image slice selection, to better evaluate trochlear morphology in the assessment of patellar instability.


Assuntos
Instabilidade Articular , Articulação do Joelho , Fêmur/diagnóstico por imagem , Humanos , Instabilidade Articular/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Patela/diagnóstico por imagem , Reprodutibilidade dos Testes
4.
Arthroscopy ; 37(4): 1221-1222, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33812525

RESUMO

The timing between anterior cruciate ligament (ACL) injury and surgical treatment may determine secondary injuries and abnormal laxity. Specifically, a knee without a functioning ACL is more at risk of a future episode of instability and the development of injuries to other joint structures. Ultimately, this may result in degenerative joint disease. Associated medial or lateral meniscus, cartilage or multiligamentous lesions indicate earlier ACL reconstruction. In particular, the possibility of an effective meniscus repair is a key indicator for early surgery. Patient selection is the key to success of ACL surgery, and it is deeply linked to surgical timing. Also, in the case of athletic patients, professional or otherwise, surgery must be as performed early to allow a rapid recovery of activity.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Instabilidade Articular , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , Meniscos Tibiais/cirurgia
5.
Rev Med Liege ; 76(4): 262-267, 2021 Apr.
Artigo em Francês | MEDLINE | ID: mdl-33830690

RESUMO

Rotationplasty can be used as an alternative to amputation when conservative treatment is not possible, for example in malignant tumours of the knee. The principle of the operation is to rotate the lower leg through 180 ° after resection of the distal femur and in this way the ankle joint replaces the knee joint. This surgical technique, although complex, allows satisfactory carcinological resection with a functional outcome superior to amputation above the knee as well as a better quality-of-life. Patients do not develop phantom pain, neuroma or stump discomfort because it is not an amputation. In addition, they can actively control their knee and having proprioception and normal contact with the ground. This results in a coordinated, harmonious and elegant gait pattern similar to the normal population. Patients are more efficient in their activities of everyday life and sports. The major disadvantage is the particular aesthetic aspect and the psychological acceptance.


Assuntos
Artroplastia do Joelho , Neoplasias Ósseas , Amputação , Fêmur/cirurgia , Humanos , Articulação do Joelho/cirurgia , Rotação
6.
BMJ Case Rep ; 14(3)2021 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-33653867

RESUMO

A previously healthy 53-year-old man was hospitalised for 12 days due to COVID-19 with shortness of breath. A few days after discharge from hospital, the patient developed fever and severe pain in several joints in the lower extremities. The pain was so severe that the patient was unable to stand on his feet. Synovial fluid from the right-side knee contained a high number of polynuclear cells and a few mononuclear cells. Microscopy, culture and PCR tests for bacterial infection were all negative. Furthermore, the patient tested negative for rheumatoid factor, anti-cyclic citrullinated peptide and human leukocyte antigen (HLA)-B27. Thus, the condition was compatible with reactive arthritis. The condition improved markedly after a few days' treatment with non-steroid anti-inflammatory drugs and prednisolone.


Assuntos
Anti-Inflamatórios não Esteroides/administração & dosagem , Artrite Reativa , Artrite , Prednisolona/administração & dosagem , Líquido Sinovial , Anti-Inflamatórios/administração & dosagem , Artralgia/diagnóstico , Artralgia/etiologia , Artrite/tratamento farmacológico , Artrite/etiologia , Artrite/fisiopatologia , Artrite Reativa/diagnóstico , Artrite Reativa/tratamento farmacológico , Artrite Reativa/fisiopatologia , Artrite Reativa/virologia , Artrite Reumatoide/diagnóstico , Autoanticorpos/análise , /fisiopatologia , Diagnóstico Diferencial , Humanos , Articulação do Joelho/diagnóstico por imagem , Extremidade Inferior/patologia , Masculino , Pessoa de Meia-Idade , Radiografia/métodos , Líquido Sinovial/citologia , Líquido Sinovial/imunologia , Resultado do Tratamento
7.
Sensors (Basel) ; 21(4)2021 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-33670561

RESUMO

Although the external knee adduction moment (KAM) during gait was shown to be a quantitative parameter of medial knee osteoarthritis (OA), it requires expensive equipment and a dedicated large space to measure. Therefore, it becomes a major reason to limit KAM measurement in a clinical environment. The purpose of this study was to estimate KAM using a single inertial measurement unit (IMU) during gait in patients with knee OA. A total of 22 medial knee OA patients (44 knee joints) performed conventional gait analysis using three-dimensional (3D) motion capture system. At the same time, we attached commercial IMUs to six body segments (sternum, pelvis, both thighs, and both shanks), and IMU signals during gait were recorded synchronized with the motion capture system. The peak-to-peak difference of acceleration in the lateral/medial axis immediately after heel contact was defined as the thrust acceleration (TA). We hypothesized that TA would represent the lateral thrust of the knee during the stance phase and correlate with the first peak of KAM. The relationship between the peak KAM and TA of pelvis (R = 0.52, p < 0.001), shanks (R = 0.57, p < 0.001) and thighs (R = 0.49, p = 0.001) showed a significant correlation. The root mean square error (RMSE) of linear regression models of pelvis, shanks, and thighs to estimate KAM were 0.082, 0.079, and 0.084 Nm/(kg·m), respectively. Our newly established parameter TA showed a moderate correlation with conventional KAM. The current study confirmed our hypothesis that a single IMU would predict conventional KAM during gait. Since KAM is known as an indicator for prognosis and severity of knee OA, this new parameter has the potential to become an accessible predictor for medial knee OA instead of KAM.


Assuntos
Articulação do Joelho , Osteoartrite do Joelho , Fenômenos Biomecânicos , Feminino , Marcha , Humanos , Joelho , Masculino , Osteoartrite do Joelho/diagnóstico , Caminhada , Dispositivos Eletrônicos Vestíveis
8.
Dtsch Arztebl Int ; 118(4): 49-55, 2021 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-33759745

RESUMO

BACKGROUND: We address the question whether professional soccer players with and without macroinjury of the knee joint are at an elevated risk for knee osteoarthritis. METHODS: A systematic review with meta-analyses was conducted. The study protocol was prospectively registered (registration number CRD42019137139). The MEDLINE, EMBASE, and Web of Science databases were searched for relevant publications; in addition, forward searching was performed, and the listed references were considered. All steps of the process were undertaken independently by two reviewers, and any discordances were resolved by consensus. For all publications whose full text was included, the methods used were critically evaluated. The quality of the evidence was judged using the GRADE criteria. RESULTS: The pooled odds ratio for objectively ascertained osteoarthrosis of the knee was 2.25 (95% confidence interval [1.41-3.61], I2 = 71%). When only radiologically ascertained knee osteoarthrosis was considered, the odds ratio was 3.98 [1.34; 11.83], I2 = 58%). The pooled risk estimator in studies in which knee joint macroinjury was excluded was 2.81 ([1.25; 6.32], I2 = 71%). CONCLUSION: A marked association was found between soccer playing and knee osteoarthritis in male professional soccer players. For female professional soccer players, the risk of knee osteoarthritis could not be assessed because of the lack of data. Knee injuries seem to play an important role in the development of knee osteoarthritis in professional soccer players.


Assuntos
Traumatismos do Joelho , Osteoartrite do Joelho , Futebol , Feminino , Humanos , Traumatismos do Joelho/epidemiologia , Articulação do Joelho , Masculino , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/epidemiologia
9.
Int J Mol Sci ; 22(4)2021 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-33671471

RESUMO

Understanding the causality of the post-traumatic osteoarthritis (PTOA) disease process of the knee joint is important for diagnosing early disease and developing new and effective preventions or treatments. The aim of this review was to provide detailed clinical data on inflammatory and other biomarkers obtained from patients after acute knee trauma in order to (i) present a timeline of events that occur in the acute, subacute, and chronic post-traumatic phases and in PTOA, and (ii) to identify key factors present in the synovial fluid, serum/plasma and urine, leading to PTOA of the knee in 23-50% of individuals who had acute knee trauma. In this context, we additionally discuss methods of simulating knee trauma and inflammation in in vivo, ex vivo articular cartilage explant and in vitro chondrocyte models, and answer whether these models are representative of the clinical inflammatory stages following knee trauma. Moreover, we compare the pro-inflammatory cytokine concentrations used in such models and demonstrate that, compared to concentrations in the synovial fluid after knee trauma, they are exceedingly high. We then used the Bradford Hill Framework to present evidence that TNF-α and IL-6 cytokines are causal factors, while IL-1ß and IL-17 are credible factors in inducing knee PTOA disease progresssion. Lastly, we discuss beneficial infrastructure for future studies to dissect the role of local vs. systemic inflammation in PTOA progression with an emphasis on early disease.


Assuntos
Biomarcadores/metabolismo , Articulação do Joelho/patologia , Modelos Biológicos , Osteoartrite/etiologia , Osteoartrite/patologia , Ferimentos e Lesões/complicações , Ensaios Clínicos como Assunto , Humanos
10.
Medicine (Baltimore) ; 100(12): e23794, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761628

RESUMO

ABSTRACT: Diffuse pigmented villonodular synovitis (PVNS) of knee is a rare benign disease that has a destructive clinical course. Synovectomy and adjuvant radiotherapy (RT) have been reported as treatment options but literatures reporting functional outcomes were sparse. This study aimed to evaluate the long-term functional outcomes and disease control among treatment modalities through the 22 years of experience.A single-center database was searched for patients who received synovectomy of knee with the pathologic diagnosis of PVNS. General data, treatment modalities, and recurrent status were retrospectively collected from medical records. Functional outcomes were evaluated by Western Ontario and McMaster Universities Osteoarthritis Index through phone interviews by an independent orthopedist.From January 1995 to December 2017, 24 patients with diffuse PVNS of knee were identified, including 19 receiving open synovectomy (OP) and 5 undergoing arthroscopic surgery. Adjuvant RT was performed on 14 patients with a median dose of 35 Gy (range 20-40 Gy). After median follow up of 6 years, recurrences were recorded in 10 cases. The recurrence rate was significantly lower in the OP + RT group than the OP group (8.3% vs 57.1%, P = .038). Among those with preserved knee joints, there was no significant difference in the Western Ontario and McMaster Universities Osteoarthritis Index score and stiffness score between patients in the OP + RT and OP groups.For patients with diffuse PVNS of knee, the addition of moderate-dose adjuvant RT following OP provided excellent local control while maintaining good joint function with limited treatment-related morbidity. Our study emphasized the importance of moderate dose RT in diffuse PVNS of knee joint.


Assuntos
Artroscopia/efeitos adversos , Recidiva Local de Neoplasia/epidemiologia , Sinovectomia/métodos , Sinovite Pigmentada Vilonodular/terapia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Radioterapia Adjuvante/efeitos adversos , Amplitude de Movimento Articular , Sinovectomia/efeitos adversos , Sinovite Pigmentada Vilonodular/epidemiologia , Sinovite Pigmentada Vilonodular/patologia , Resultado do Tratamento , Adulto Jovem
11.
J Biomed Nanotechnol ; 17(2): 242-252, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-33785095

RESUMO

Sericin, a silk protein, has a high potential for use as an extracellular matrix in tissue engineering applications. In this study, novel gelatin (GEL) and silk sericin (SS) were incorporated with a polyvinyl alcohol) PVA hydrogel nanocomposite (GEL-SS-PVA) scaffold that can be applied to repair cartilage. Glutaraldehyde was used as a cross-linking agent, with hydrochloric acid acting as an initiator. The microstructure characteristics of the obtained GEL-SS and GEL-SS-PVA scaffolds were also examined using FTIR and XRD spectra and their enhanced thermal stability was assessed by TGA. The blended GEL-SS and GEL-SS-PVA scaffolds were confirmed by SEM analysis to be highly porous with optimum pore sizes of 172 and 58 µm, respectively. Smaller pore sizes and improved uniformity were observed as the concentration of PVA in the GEL-SS-PVA scaffold increased. PVA decreased the tensile strength and elongation of the membranes but increased the modulus. Swelling studies showed high swellability and complete degradation in the presence of phosphate-buffered saline. Cytocompatibility of the GEL-SS-PVA scaffolds showed that these had the highest potential to promote cell proliferation as evaluated with standard microscopy using L929 fibroblasts. The prepared GEL-SS composite scaffold incorporated with the PVA hydrogel was implanted in full-thickness articular cartilage defects in rats. The repair effect of cartilage defects was observed and evaluated among the GEL-SS-PVA, GEL-SS, and control operation groups. The defects were almost completely repaired after 14 weeks in the GEL-SS-PVA group, thereby indicating that the GEL-SS-PVA composite had a favorable effect on articular cartilage defects in rat knee joint repair.


Assuntos
Cartilagem Articular , Nanocompostos , Sericinas , Animais , Gelatina , Hidrogéis , Articulação do Joelho , Álcool de Polivinil , Ratos , Seda , Engenharia Tecidual , Tecidos Suporte
12.
Zhongguo Gu Shang ; 34(3): 269-74, 2021 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-33787174

RESUMO

OBJECTIVE: To compare the clinical outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction (ACLR) with a tibialis anterior allograft (TAA)versus hamstring tendon autograft (HTA) after 10 years follow-up. METHODS: A clinical data of 107 patients who underwent arthroscopic ACLR with a single bundle tendon between March 2007 and March 2010 was retrospectively analyzed. Among the patients, 48 patients were reconstructed with a tibialis anterior allograft (TAA group), including 26 males and 22 females, ranging in age from 16 to 38 years, with a mean of 27.2±6.2 years;59 patients were reconstructed with a hamstring tendon autograft (HTA group), including 31 males and 28 females, ranging in age from 16 to 40 years, with a mean of 28.0±7.6 years. The preoperative tibial anterior displacement and knee joint function, as well as knee joint stability, tibial anterior displacement and knee joint function at 10 years after operation were observed. Lachman test was used to evaluate the forward joint stability and pivot shift test to evaluate the rotational stability of the knee;KT-2000 side-to-side difference (SSD) was used to measure tibial anterior displacement;International Knee Documentation Committee(IKDC) score and Lysholm score were used to evaluate knee function. RESULTS: The incisions of both groups were healed by first intention, and no early complications occurred after operation. All patients were followed-up 10 to 13 years, the mean time was 11.7 years. There was no graft failure were found during the follow up period. The KT-2000 SSD of the TAA group and the HTA group at ten years after operation were 1.9±0.7 and 1.8±0.6 respectively, which were significantly improved than 8.8±0.9 and 8.6±1.0 preoperatively(P<0.05), but there were no significant difference between the two groups(P>0.05). The total Lysholm score of the TAA group and the HTA group at ten years after operation were 90.4±4.4 and 90.7±3.4 respectively, which were significantly improved than 51.4±13.3 and 51.2±14.6 preoperatively(P<0.05), but there were no significant difference between the two groups(P>0.05). The total IKDC score of the TAA group and the HTA group at ten years after operation were 91.5±4.1 and 90.9±3.2 respectively, which were significantly improved than 45.8±12.2 and 47.0±14.5 preoperatively(P<0.05), but there were no significant difference between the two groups(P>0.05). No significant difference were found between the two groups in Lachman test and pivot shift test at 10 years after operation (P>0.05). CONCLUSION: The TAA and HTA have equal long term effect in ACL reconstruction, doctors and patients can choose the graft according to the actual situation.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Tendões dos Músculos Isquiotibiais , Adolescente , Adulto , Aloenxertos , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Artroscopia , Autoenxertos , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
13.
Zhen Ci Yan Jiu ; 46(2): 123-8, 2021 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-33788433

RESUMO

OBJECTIVE: To observe the effect of warm needle with moxibustion (WNM) on morphological changes of articular cartilage and subchondral bone tissues in knee osteoarthritis (KOA) rabbits, so as to explore whether WNM intervention can delay the development of KOA. METHODS: Forty male New Zealand rabbits were randomly divided into blank control, model, WNM and medication (Alendronate sodium) groups, with 10 rabbits in each group. A KOA model was established by immobilizing the right hind limb of rabbits with orthopedic casting tape for 6 weeks. The rabbits of the WNM group received WNM stimulation at "Neixiyan"(EX-LE4) "Waixiyan"(ST35) and "Heding"(EX-LE2) for 15 min, once a day for 4 weeks and those of the medication group received gavage of Alendronate sodium (150 µg·kg-1·d-1) once a day for 4 weeks. X-ray examination and magnetic resonance imaging (MRI) scanning were performed to observe the structure of the knee joints. Outcomes of X-ray examination were used to assess the degree of bone hyperplasia and joint space stenosis which were scaled according to Kellgren and Lawrence (K-L) standards, and those of MRI used to evaluate the degree of cartilage damage and bone marrow edema degrees which were respectively scored according to Recht scaling standards and semi-quantitative whole-organ MRI score (WORMS). Histopathological changes (degeneration degrees) of the articular cartilage were observed after H.E. staining, and given Mankin score. The ultrastructure of the cartilage surface and chondrocytes was observed by scanning electron microscopy (SEM) and transmission electron microscopy (TEM), respectively. RESULTS: Compared with the blank control group, the K-L grade, Recht grade, WORMS and Mankin score of the model group were significantly increased (P<0.05,P<0.01). After the intervention and in comparison with the model group, the K-L grade, Recht grade, WORMS and Mankin score of both WNM and medication groups were significantly decreased (P<0.05,P<0.01). Results of SEM showed severe defect, bulge and uneven surface of the cartilage with irregular growth and regeneration, and those of TEM showed degeneration and swelling of chondrocytes, margination of endonuclear chromatin, reduction in the number of organelles with disordered arrangement, extreme expansion of endoplasmic reticulum with detachment of the ribosome, unclear mitochondria, and disordered distribution of collagen fibers in the extracellular matrix in the model group, which was relatively milder in both the WNM and medication groups. Compared with the medication group, the Mankin score in the WNM group was evidently lower (P<0.05). CONCLUSION: WNM can effectively slow down the degeneration of cartilage and subchondral bone of KOA rabbits, delay the development of KOA.


Assuntos
Cartilagem Articular , Moxibustão , Osteoartrite do Joelho , Animais , Osso e Ossos , Articulação do Joelho , Masculino , Osteoartrite do Joelho/terapia , Coelhos
14.
Zhen Ci Yan Jiu ; 46(2): 129-35, 2021 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-33788434

RESUMO

OBJECTIVE: To observe the effect of "knot-loosing method" of acupotomy on morphological changes in knee osteoarthritis (KOA) rabbits, so as to provide experimental basis for clinical acupotomy treatment of KOA. METHODS: Male New Zealand rabbits were randomly divided into blank control, model and acupotomy groups, with 8 rabbits in each group. By using the modified Videman method, the left hindlimb was immobilized for 6 weeks with a plaster cast to replicate the KOA model. The knot-loosing manipulation of acupotomy was applied to "Hedingci" (located at the attachment of the positive upper margin of the quadriceps tendon and the patella),"Binneixia"(at "Neixiyan" [EX-LE4], the medial side of ligamentum patella), "Binwaixia" (at "Waixiyan" [ST35], the lateral side of patellar ligament), "Chengfeijian" (at the lateral collateral ligament of the knee in the la-teral joint space), "Weiyangci"(at the medial margin of the biceps femoris and the lateral side of the transverse striation), and "Yinlingci"(at the end-point of the medial tibia of the goose foot tendon), respectively, once a week for 4 times. One week after the last intervention, the left knee joint dysfunction severity (pain, maximum walking distance, and some activities of daily living) was evaluated by using modified Lequesne Index score. X-ray and magnetic resonance imaging(MRI)examinations were conducted to assess the articular space size, effusion and cartilage smoothness of the left knee for which the MRI Osteoarthritis Knee Score (MOAKS) was given according to their severity. The histopathologic changes of the cartilage of the left knee were observed by Hematoxylin-eosin (H.E.) staining and light microscope, which Mankin score was given. In addition, the surface of the cartilage was also examined by macroscopic observation. RESULTS: ①Following modeling, the Lequesne Index score, MOAKS, macroscopic observation score and Mankin score were significantly increased in the model group (P<0.05). X-ray and MRI imaging showed a narrower joint space, more effusion, rough cartilage surface; and H.E. staining displayed rough cartilage surface, and disordered arrangement and occasional clusters of the chondrocytes in the left knee joint. ②In comparison with the blank control group, the Lequesne Index, MOAKS, macroscopic observation and Mankin scores were significantly down-regulated in the acupo-tomy group (P<0.05). The abovementioned injury changes shown by X-ray, MRI, macroscopic and microscopic observations were relatively milder in the acupotomy group. CONCLUSION: Acupotomy loosing based on the "Jingjin theory" of traditional Chinese medicine can effectively improve the motor ability of knee joint and repair pathological changes of the cartilage in KOA rabbits.


Assuntos
Terapia por Acupuntura , Cartilagem Articular , Osteoartrite do Joelho , Atividades Cotidianas , Animais , Cartilagem , Humanos , Articulação do Joelho , Masculino , Osteoartrite do Joelho/terapia , Coelhos
15.
Medicine (Baltimore) ; 100(11): e24846, 2021 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-33725956

RESUMO

ABSTRACT: This research discussed clinical outcomes of anterior cruciate ligament reconstruction accompanied by conservative treatment for grade 2 medial collateral ligament injury, and comparison was performed between double-bundle and single-bundle anterior cruciate ligament reconstruction.Clinical information was retrospectively collected for 41 cases suffering anterior cruciate ligament injuries accompanied by grade 2 medial collateral ligament injuries. Within 14 days after their injuries 22 cases received single-bundle anterior cruciate ligament reconstruction (SB group), while 19 were treated with double-bundle medial collateral ligament reconstruction (DB group). Physical statuses were estimated based on International Knee Documentation Committee (IKDC) and Lysholm scores, Lachman, pivot shift and manual valgus test, and range of motion (ROM), while side-to-side difference was estimated through KT 2000 arthometer.Anterior cruciate ligament reconstruction accompanied by conservative treatment showed significantly improved anteroposterior, rotational and valgus stability, and IKDC and Lysholm scores (in comparison to pre-operative status, P < .05). Incidence of pivot shift was dramatically lower in DB group (2/19) than in SB group (7/22 and 2/22; P = .028). No substantial dissimilarity existed between DB and SB groups either in Lachman and valgus tests, KT 2000, ROM, IKDC, or Lysholm scores.Anterior cruciate ligament reconstruction accompanied by conservative treatment could achieve outstanding stability and functional manifestations for cases facing anterior cruciate ligament injury accompanied by grade 2 medial collateral ligament injury. Moreover, double-bundle anterior cruciate ligament reconstruction is superior to single-bundle operation in treating rotational instability of the knee.Level of evidence: Retrospective comparative study, Level III.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/métodos , Instabilidade Articular/cirurgia , Traumatismos do Joelho/cirurgia , Ligamento Colateral Médio do Joelho/lesões , Adolescente , Adulto , Feminino , Humanos , Instabilidade Articular/etiologia , Traumatismos do Joelho/complicações , Articulação do Joelho/fisiopatologia , Masculino , Ligamento Colateral Médio do Joelho/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
16.
Acta Chir Orthop Traumatol Cech ; 88(1): 39-44, 2021.
Artigo em Tcheco | MEDLINE | ID: mdl-33764866

RESUMO

PURPOSE OF THE STUDY Knee injuries accompanied by anterior cruciate ligament (ACL) tears can also result in rotational instability of the joint. Subsequent insufficient rotational stability after the ACL reconstruction can be a direct consequence also of injuries to lateral knee structures, specifically the anterolateral ligament (ALL). This residual postoperative rotational instability may be prevented by multiple surgical techniques. The purpose of this study was (1) to evaluate the knee stability in internal rotation after the "anatomical" single-bundle (SB) anterior cruciate ligament reconstruction together with ALL reconstruction compared to the double-bundle (DB) ACL reconstruction two years after surgery; (2) to compare the knee joint stability after the ACL and ALL reconstruction with the healthy contralateral knee joint. MATERIAL AND METHODS All the measurements were conducted by the computer navigation system. The study included 20 patients after the single-bundle ACL and ALL reconstruction and 20 patients after the double-bundle ACL reconstruction. The follow-up examination was carried out at 25 months after surgery on average (24 months at least). All measurements were performed in both the healthy and operated knee. Once the data necessary for navigation were determined, the patient remained in standing position with both feet firmly placed on the mat with intermalleolar distance of 20 cm. Then, at 30-degree flexion of the knee joints, the patient first performed the joint internal rotation by trunk torsion, followed by external rotation. Each measurement was repeated 3 times. A non-parametric t-test was used for statistical processing. RESULTS The mean internal rotation in the injured knee joint was 19.1 degrees preoperatively and 8.1 degrees postoperatively, while in the healthy knee it was 8.4 degrees. External rotation was not assessed. The reported internal rotation in the knees after DB ACL reconstruction was 9.2 degrees (p ≥ 0.05). DISCUSSION The double-bundle ACL reconstruction is a complex technique that can lead to many intraoperative and postoperative complications. Grafts harvested from both hamstrings can have an effect on the rotational stability of the joint. In order to restore the knee rotational stability with fewer potential complications, the method of choice can be the ACL reconstruction using the quadriceps femoris muscle graft and the ALL reconstruction using the gracilis muscle graft, leaving the semitendinosus tendon intact. CONCLUSIONS The obtained values reveal that the single-bundle ACL reconstruction in combination with ALL reconstruction results in the same internal rotational stability in the knee joint as the double-bundle ACL reconstruction. Similar joint rotational stability is observed in all the knee joints reconstructed with the use of these techniques and in the contralateral healthy knee joint. Key words: anterolateral ligament, anterior cruciate ligament, internal rotational stability, objective measurement.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Instabilidade Articular , Lesões do Ligamento Cruzado Anterior/cirurgia , Fenômenos Biomecânicos , Cadáver , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , Amplitude de Movimento Articular
17.
Acta Chir Orthop Traumatol Cech ; 88(1): 58-62, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33764869

RESUMO

PURPOSE OF THE STUDY To compare the early clinical results of patients who had anterior cruciate ligament (ACL) reconstruction with peroneus longus allograft versus hamstring tendon autograft. MATERIAL AND METHODS Forty patients who underwent ACL reconstruction were included in the study. Patients were grouped by their graft preference. Lachman and Pivot-shift tests were performed to the patients. Laxity was measured by KT-1000 arthrometer test with 15, 20 and 30 pound power. The maximum force values of nonoperated knee and the operated knee were recorded with Cybex II isokinetic dynamometer (HUMAC) and compared to each other. International Knee Documentation Committee (IKDC) form, modified Lysholm and Cincinnati evaluation forms were compared between two groups. RESULTS Twenty patients included into peroneus longus allograft (Group 1) and 20 patients were included into hamstring autograft group (Group 2). The mean age of patients Group 1 and 2 were 34.25 ± 6.73, and 29.6 ± 4.55, respectively. No significant difference was noted between two groups at modified Lysholm, Cincinati and IKDC scores (p > 0.01). There was no statistically significant difference between the Lachman and Pivot hift levels (p > 0.01). No significant difference was found in KT-1000 device measurements between groups according to the performed techniques (p > 0.01). There was no statistically significant difference between Cybex extension-flexion 60 /sec measurement and extension 240 /sec measurement of the patients (p > 0.01). DISCUSSION Allografts can be preferred because of the advantages, such as lack of donor site morbidity, short operative time, large graft, small incision, minimal scar, good cosmetic appearance, less postoperative pain, less movement restriction, and less arthrofibrosis. However, there are disadvantages, such as disease transmission, low biocompatibility, immune response, long recovery time, and high cost. Although it is difficult to compare the stability and functionality of allografts and autografts because of the differences in graft processing, fixation methods, and surgical techniques in studies, similar clinical results are reported in long-term follow-ups CONCLUSIONS Graft preference is dependent on surgical experience, patient age, activity status, comorbidities, presurgical status, and patient decision. Allograft ACL reconstruction is a good alternative to arthroscopic ACL reconstruction performed with hamstring tendon graft. Key words: anterior cruciate ligament, peroneus longus allograft, hamstring autograft, ACL reconstruction.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Tendões dos Músculos Isquiotibiais , Aloenxertos , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Articulação do Joelho/cirurgia , Transplante Autólogo , Resultado do Tratamento
18.
Zhonghua Yi Xue Za Zhi ; 101(11): 786-791, 2021 Mar 23.
Artigo em Chinês | MEDLINE | ID: mdl-33765719

RESUMO

Objective: To evaluate the effects of neuromuscular exercise therapy on joint stability of knee osteoarthritis (OA) patients. Methods: One hundred and ten patients with knee OA were enrolled in this ongoing prospective cohort study at Arthritis Clinic and Research Center, Peking University People's Hospital from September 2017 to October 2018. The treatment consisted of six-week neuromuscular exercise therapy. The participants were followed up at 6 weeks and 3 months after the therapy. The stability of the joint was evaluated by the index of knee joint stability (IKJS), which was extracted by a novel knee-aiming task combined with the multiscale entropy (MSE) analysis of the complexity of the light spot trajectories. The secondary outcomes were pain on the visual analogue scale (VAS, 0-100), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), quality of life on the Euro-quality of life-5 Dimensional (EQ-5D) VAS form, 30-second chair stand test and 40-meter walk test. One-way repeated measures ANOVA analysis was applied to compare the outcomes at baseline and 6 weeks and 3 months. Pearson partial analysis was used to investigate the correlation between the IKJS and the Kellgren-Lawrence (K/L) rate, pain and knee function. Results: Ninety-six participants ((65±8) years, 21 males, 75 females) completed 3-month follow-up. There was a significant improvement in IKJS at the 6-week visit compared with that at baseline (0.369, 95% confidence interval (CI) 0.241-0.496, P<0.001). The IKJS dropped at 3-month visit compared with 6-week visit, but was still better than that at baseline (0.178, 95%CI: 0.042-0.314, P=0.008). The correlation between IKJS and K/L rate, severity of pain, WOMAC or knee function was not significant (r=-0.131, -0.059, -0.231, 0.124, all P>0.05). There was improvement in pain VAS, WOMAC, EQ-5D-VAS, 30-second chair stand test and 40-meter walk test at 6 weeks and 3 months (all P<0.05). Conclusion: The neuromuscular exercise therapy is effective in improving the joint stability of the knee OA patients. However, the effect gradually diminished over time. In addition, neuromuscular exercise can help relieve pain, improve the function and quality of life in patients with knee OA.


Assuntos
Osteoartrite do Joelho , Exercício Físico , Terapia por Exercício , Feminino , Humanos , Articulação do Joelho , Masculino , Osteoartrite do Joelho/terapia , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
19.
Arthroscopy ; 37(3): 891-892, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33673969

RESUMO

Magnetic resonance imaging has been referred to as the gold standard diagnostic modality for meniscal pathology in the adult knee. However, there are multiple issues with reliance on magnetic resonance imaging for evaluating the meniscus in children. Diagnostic accuracy for meniscus pathology in children is not as high as with adults. Additionally, young children often cannot tolerate lying still for the study and require sedation, with a small but non-zero risk of anesthetic complication and risk motion artifact even with sedation. Ultrasound can be used to reliably diagnose a discoid lateral meniscus in a testing environment that is well tolerated by young children.


Assuntos
Meniscos Tibiais , Lesões do Menisco Tibial , Adulto , Criança , Pré-Escolar , Humanos , Articulação do Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética , Meniscos Tibiais/diagnóstico por imagem , Estudos Retrospectivos
20.
Arthroscopy ; 37(3): 901-902, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33673970

RESUMO

Adult stem cells have been isolated in bone marrow and adipose tissue. These mesenchymal stromal cells (MSCs) have the ability to differentiate into osteogenic, chondrogenic, and adipogenic cell lines. The study by Branch et al. has identified MSCs in the synovial fluid of the knee in patients after anterior cruciate ligament injury and in patients with osteoarthritis of the knee. When mixing synovial fluid with whole blood and using a commercially available platelet-rich plasma-processing system, the total number of MSCs doubled in both groups when compared with the cell count in synovial fluid only. However, it is not clear whether the MSCs in the processed synovium-whole blood mix include synovial MSCs versus MSCs from only the blood. In addition, cell counts were substantially lower when compared with the typical concentrations of MSCs in bone marrow aspirate. The clinical application is yet to be defined.


Assuntos
Plasma Rico em Plaquetas , Líquido Sinovial , Tecido Adiposo , Adulto , Medula Óssea , Células da Medula Óssea , Osso e Ossos , Diferenciação Celular , Condrogênese , Humanos , Articulação do Joelho , Sistemas Automatizados de Assistência Junto ao Leito , Membrana Sinovial
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