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1.
Medicine (Baltimore) ; 99(10): e19411, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150091

RESUMO

The effects of the intercondylar notch morphology on predicting anterior crucaite ligament (ACL) injury in males were unknown. We aimed to determine the risk factors of the intercondylar notch on ACL injury, and evaluate the predictive effects of the morphological parameters on ACL injury in males. Sixty-one patients with ACL injury and seventy-eight patients with intact ACLs were assigned to the case group and control group respectively. The notch width (NW), bicondylar width, notch width index (NWI), notch height (NH), notch cross-sectional area (CSA), notch angle (NA) and notch shape were obtained from the magnetic resonance images of male patients. Comparisons were performed between the case and control groups. Logistic regression model and the receiver operating characteristic curve were used to assess the predictive effects of these parameters on ACL injury. The NW, NWI, NH, CSA and NA in the case group were significantly smaller than those in the control group on the coronal magnetic resonance images. The NW and NWI were significantly smaller, while no significant differences of the NH and CSA were found between the 2 groups on the axial images. There was no significant difference in the notch shape between the 2 groups. The maximum value of area under the curve calculated by combining all relevant morphological parameters was 0.966. The ACL injury in males was associated with NW, NH, NWI, CSA, and NA. These were good indicators for predicting ACL injury in males.


Assuntos
Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Adolescente , Adulto , Osso e Ossos/diagnóstico por imagem , Estudos de Casos e Controles , Humanos , Escala de Gravidade do Ferimento , Articulação do Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Valor Preditivo dos Testes , Fatores de Risco , Sensibilidade e Especificidade , Adulto Jovem
2.
Medicine (Baltimore) ; 99(10): e19439, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150095

RESUMO

INTRODUCTION: Immune checkpoint inhibitors (ICIs) represent an important advance in the treatment of melanoma. ICIs may induce autoimmune phenomena caused by concurrent activation of the immune system against normal cells. During the last years, cases of musculoskeletal side effects, especially immune-mediated arthritis (IA), have been increasingly reported. PATIENT CONCERNS: We present a 59-year-old woman, who was treated with pembrolizumab for a relapsed BRAF V600E mutated cutaneous malignant melanoma. The patient presented with right knee arthritis on week 30. DIAGNOSIS: The erythrocyte sedimentation rate and serum C-reactive protein levels were elevated, while rheumatoid factor and anti-cyclic citrullinated peptide antibodies were negative. Imaging confirmed the presence of fluid mainly in the suprapatellar bursa. Synovial fluid analysis revealed an inflammatory effusion, while other etiologies of inflammatory arthritis were excluded. INTERVENTIONS: Arthritis improved with an intra-articular injection of 8 mg dexamethasone. Twelve days later the arthritis relapsed in both knees, and although it was resistant to nonsteroidal anti-inflammatory treatment, it improved with systemic steroids. Tapering of methylprednisolone dose was feasible with the coadministration of leflunomide and subsequently hydroxychloroquine. OUTCOMES: Arthritis resolved and the patient is free of complications and disease activity 20 months after the initiation of the second line systemic treatment. CONCLUSIONS: We present an unusual case of IA associated with pembrolizumab treatment. The originality of the current report is based on the late occurrence, the monoarticular initial distribution, and uncommon location of IA at the knee.


Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Antineoplásicos Imunológicos/efeitos adversos , Artrite Reumatoide/diagnóstico , Melanoma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Artrite Reumatoide/induzido quimicamente , Diagnóstico Diferencial , Feminino , Humanos , Articulação do Joelho , Pessoa de Meia-Idade , Líquido Sinovial
3.
Medicine (Baltimore) ; 99(12): e19576, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32195969

RESUMO

RATIONALE: Tension band wiring is the most widely accepted technique for the treatment of patellar fractures but the technique is associated with common complications like wire migration, prominence, and breakage. To reduce these complications, we developed and propose a modified technique that has a superior biomechanical strength and a potential to reduce such postoperative complications. PATIENT CONCERNS: The patient presented with pain and mild swelling in his left knee after he slipped on the floor and fell on his left knee. He has no significant past medical or surgical history. The patient took the tension band wiring as the first choice because of the wide acceptance. But he worried about the complications. DIAGNOSES: X-ray showed a transverse fracture of the left patella with an inferior pole occult fracture. INTERVENTIONS: The patient was operated with a modified technique of the classic tension band wiring for patellar fractures. In our 4-step procedure, double tension cerclage wires were wrapped under the exposed ends of the Kirschner wires (K-wires) and the tendons in figure-of-8 fashion. The aim was to increase the biomechanical strength so that when one of the tension wires fail, the other one can hold the fragments together. OUTCOMES: The patient recovered very well and without any complications. The patient was followed-up for 1 year and the fracture has united very well, with satisfying knee range of motion. LESSONS: From this case study, we can detect the biomechanical advantages of our technique which can increase the stability of the fracture and that allows early functional exercise and additionally the micromotion at the fracture site has a beneficial effect of fracture union. Based on the perfect outcomes, our technique is worthy of clinical application.


Assuntos
Fios Ortopédicos/normas , Traumatismos do Joelho/cirurgia , Patela/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Fios Ortopédicos/efeitos adversos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Humanos , Articulação do Joelho/patologia , Masculino , Pessoa de Meia-Idade , Patela/diagnóstico por imagem , Patela/patologia , Radiografia/métodos , Resultado do Tratamento
4.
Acta Chir Orthop Traumatol Cech ; 87(1): 17-23, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-32131966

RESUMO

INTRODUCTION The anterior cruciate ligament (ACL) reconstruction is a tried and tested method in treating knee joint instability which brings valuable results in an acceptable time frame. In the long-term follow-up, however, a higher risk of knee osteoarthritis development is described. One of the possible reasons is considered to be the abnormal kinematics of the operated knee. The purpose of our study was to determine the degree to which the ACL reconstruction helps restore the correct gait cycle compared to the healthy limb. MATERIAL AND METHODS The study included patients after the ACL reconstruction performed in the period from 1 January 2016 to 31 March 2018. With the use of strict criteria, 11 patients were selected for kinematic analysis, who underwent examinations in a gait laboratory and were also evaluated using the Tegner and Lysholm rating systems and the IKDC (International Knee Documentation Committee) knee score, namely preoperatively and at 6 and 12 months postoperatively. The kinematic assessment of gait was carried out using the Vicon MX system with the placement of reflexive markers in line with the Plug-In Gait model. RESULTS The clinical outcomes (namely the score according to Tegner, Lysholm as well as the IKDC) during the first year postoperatively showed a major improvement in knee function and the achievement of the pre-injury activity level. The kinematic analysis revealed lower knee extension at the stance phase and lower overall range of motion of the limb with the injured ACL compared to the healthy limb. The follow-up evaluation at 6 and 12 months postoperatively showed a persisting between-limbs difference in knee extension, whereas the range of motion gradually improved during the year. CONCLUSIONS Although our study confirmed that the ACL reconstruction is an efficient method to treat knee joint instability, it also indicated that even at one year after the ACL reconstruction, the kinematics of the operated knee was not fully restored to the level of the heathy knee. The persisting limb-difference in gait kinematics could contribute to the gradual development of degenerative changes in the operated knee joint. Key words: anterior cruciate ligament deficiency, anterior cruciate ligament reconstruction, knee kinematics during gait, knee osteoarthritis.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Articulação do Joelho , Fenômenos Biomecânicos , Seguimentos , Marcha , Humanos , Articulação do Joelho/fisiologia , Resultado do Tratamento
5.
Sichuan Da Xue Xue Bao Yi Xue Ban ; 51(2): 185-192, 2020 Mar.
Artigo em Chinês | MEDLINE | ID: mdl-32220186

RESUMO

Objective: To investigate the effect and mechanism of static progressive stretching (SPS) in different durations on traumatic knee contracture in rats. Methods: Seventy male Wistar rats were randomly divided into three groups, including surgical modeling group ( n=50), control group (CON, no surgery, no treatment, n=10) and trauma without immobilization group (TRA, no treatment, n=10). The knee contracture model was established, and 50 surgical modeling rats were randomly divided into five groups including static progressive stretching treatment for 20 minutes group (S20 min, n=10), treatment for 30 minutes group (S30 min, n=10), treatment for 40 minutes group (S40 min, n=10), untreatment group (UNT, no SPS, n=10) and modeling group (MOD, n=10, euthanized after immobilization for histological staining and Western blot). Individuals in the S20 min, S30 min, and S40 min groups were anesthetized and submitted to SPS. One treatment session took place every other day. A total of 8 sessions were given till the final treatment session on the day 16. On the day 0, 8, and 16 of intervention, the range of joint motion (ROM) and gait analysis were measured and compared. After the ROM measurements and gait analysis, the rats were euthanized on the day 16 and the samples were stained with HE and Masson methods. The changes of pathological organization were observed. Western blot was used to detect the expressions of transforming growth factor-ß1 (TGF-ß1) and interleukin-6 (IL-6). Results: ① ROM:the ROM of S30 min group recovered similar to that of the S20 min and S40 min groups after 8 days of treatment ( P>0.05), and was the best among all the surgical modeling groups after 16 d of treatment ( P<0.05). The ROM of S20 min, S30 min and S40 min groups significantly improved on the day 8 and day 16 comparing with that on day 0 ( P<0.01). ② Gait analysis: the stands in the S30min group improved best on the day 8 and day 16 ( P<0.05) , and better than that on day 0 ( P<0.05). The stride length of the S30 min group progressed similar to that of the S40 min group on the day 8 ( P>0.05), and there was no difference among three groups on the day 16 ( P>0.05). The stride length of the S30 min group appeared to recover more quickly on the day 8 ( P<0.05), and those of S20 min and UNT groups recovered significantly on the day 16 ( P<0.05). In addition, the swings in the S30 min group improved best ( P<0.05), and it appeared to recover better on the day 16 ( P<0.05). There was no statistical difference in terms of the swing speed among the four surgical modeling groups on the day 8 ( P>0.05). The swing speed of the S30min group increased most than those of the other three groups ( P<0.05), and it was much better on the day 8 and day 16 comparing with that on the day 0 ( P<0.05 ). ③ HE and Masson staining: the fibrosis and inflammation of the S30min group were significantly suppressed comparing to the other groups on the day 16. ④ Western blot: The protein expression levels of TGF-ß1 and IL-6 were significantly lower than those in the other intervention groups including the S20 min, S40 min and UNT groups on the day 16 ( P<0.05). Conclusion: Static progressive stretching treatment for 30 min could significantly improve the traumatic knee contracture in rats. The mechanism may be that the SPS decreased the expressions of TGF-ß1 and IL-6, reduced the adhesion and inflammation of joint capsule. Therefore it relieved the pain and increased the joint mobility by reconstructing the structure of the capsule and suppressing the fibrotic changes.


Assuntos
Contratura , Articulação do Joelho/fisiopatologia , Exercícios de Alongamento Muscular , Animais , Fenômenos Biomecânicos , Contratura/terapia , Interleucina-6/metabolismo , Cápsula Articular , Masculino , Amplitude de Movimento Articular , Ratos , Ratos Wistar , Fator de Crescimento Transformador beta1/metabolismo
6.
Bone Joint J ; 102-B(3): 329-335, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114807

RESUMO

AIMS: Biopsy of the periprosthetic tissue is an important diagnostic tool for prosthetic joint infection (PJI) as it enables the detection of the responsible microorganism with its sensitivity to antibiotics. We aimed to investigate how often the bacteria identified in the tissue analysis differed between samples obtained from preoperative biopsy and intraoperative revision surgery in cases of late PJI; and whether there was a therapeutic consequence. METHODS: A total of 508 patients who required revision surgery of total hip arthroplasty (THA) (n = 231) or total knee arthroplasty (TKA) (n = 277) because of component loosening underwent biopsy before revision surgery. The tissue samples collected at biopsy and during revision surgery were analyzed according to the criteria of the Musculoskeletal Infection Society (MSIS). RESULTS: In total, 178 (113 THA, 65 TKA) were classified as infected. The biopsy procedure had a sensitivity of 93.8%, a specificity of 97.3%, a positive predictive value (PPV) of 94.9%, a negative predictive value (NPV) of 96.7%, and an accuracy of 96.1%. Of the 178 infected patients, 26 showed a difference in the detected bacteria from the biopsy and the revision surgery (14.6%). This difference required a change to antibiotic therapy in only two cases (1.1%). CONCLUSION: Biopsy is a useful tool to diagnose PJI, but there may be a difference in the detected bacteria between the biopsy and revision surgery. However, this did not affect the choice of antibiotic therapy in most cases, rendering the clinical relevance of this phenomenon as low. Cite this article: Bone Joint J 2020;102-B(3):329-335.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Biópsia/métodos , Diagnóstico Tardio , Infecções Relacionadas à Prótese/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Bactérias/isolamento & purificação , Feminino , Seguimentos , Articulação do Quadril/microbiologia , Articulação do Quadril/patologia , Articulação do Quadril/cirurgia , Prótese de Quadril/efeitos adversos , Prótese de Quadril/microbiologia , Humanos , Articulação do Joelho/microbiologia , Articulação do Joelho/patologia , Articulação do Joelho/cirurgia , Prótese do Joelho/efeitos adversos , Prótese do Joelho/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Relacionadas à Prótese/microbiologia , Reprodutibilidade dos Testes
7.
Bone Joint J ; 102-B(3): 276-279, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114811

RESUMO

Dissatisfaction following total knee arthroplasty is a well-documented phenomenon. Although many factors have been implicated, including modifiable and nonmodifiable patient factors, emphasis over the past decade has been on implant alignment and stability as both a cause of, and a solution to, this problem. Several alignment targets have evolved with a proliferation of techniques following the introduction of computer and robotic-assisted surgery. Mechanical alignment targets may achieve mechanically-sound alignment while ignoring the soft tissue envelope; kinematic alignment respects the soft tissue envelope while ignoring the mechanical environment. Functional alignment is proposed as a hybrid technique to allow mechanically-sound, soft tissue-friendly alignment targets to be identified and achieved. Cite this article: Bone Joint J 2020;102-B(3):276-279.


Assuntos
Artroplastia do Joelho/métodos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Amplitude de Movimento Articular/fisiologia , Procedimentos Cirúrgicos Robóticos/métodos , Humanos , Articulação do Joelho/fisiopatologia , Prótese do Joelho
8.
Bone Joint J ; 102-B(3): 336-344, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114816

RESUMO

AIMS: In the absence of an identified organism, single-stage revision is contraindicated in prosthetic joint infection (PJI). However, no studies have examined the use of intra-articular antibiotics in combination with single-stage revision in these cases. In this study, we present the results of single-stage revision using intra-articular antibiotic infusion for treating culture-negative (CN) PJI. METHODS: A retrospective analysis between 2009 and 2016 included 51 patients with CN PJI who underwent single-stage revision using intra-articular antibiotic infusion; these were compared with 192 culture-positive (CP) patients. CN patients were treated according to a protocol including intravenous vancomycin and a direct intra-articular infusion of imipenem and vancomycin alternately used in the morning and afternoon. In the CP patients, pathogen-sensitive intravenous (IV) antibiotics were administered for a mean of 16 days (12 to 21), and for resistant cases, additional intra-articular antibiotics were used. The infection healing rate, Harris Hip Score (HHS), and Hospital for Special Surgery (HSS) knee score were compared between CN and CP groups. RESULTS: Of 51 CN patients, 46 (90.2%) required no additional medical treatment for recurrent infection at a mean of 53.2 months (24 to 72) of follow-up. Impaired kidney function occurred in two patients, and one patient had a local skin rash. No significant difference in the infection control rate was observed between CN and CP PJIs (90.2% (46/51) versus 94.3% (181/192); p = 0.297). The HHS of the CN group showed no substantial difference from that of CP cases (79 versus 81; p = 0.359). However, the CN group showed a mean HSS inferior to that of the CP group (76 versus 80; p = 0.027). CONCLUSION: Single-stage revision with direct intra-articular antibiotic infusion can be effective in treating CN PJI, and can achieve an infection control rate similar to that in CP patients. However, in view of systemic toxicity, local adverse reactions, and higher costs, additional strong evidence is needed to verify these treatment regimens. Cite this article: Bone Joint J 2020;102-B(3):336-344.


Assuntos
Artrite Infecciosa/tratamento farmacológico , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Imipenem/administração & dosagem , Cuidados Pós-Operatórios/métodos , Infecções Relacionadas à Prótese/tratamento farmacológico , Vancomicina/administração & dosagem , Antibacterianos/administração & dosagem , Bactérias/isolamento & purificação , Relação Dose-Resposta a Droga , Quimioterapia Combinada , Feminino , Seguimentos , Articulação do Quadril , Humanos , Injeções Intra-Articulares , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
9.
Bone Joint J ; 102-B(3): 301-309, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32114823

RESUMO

AIMS: Although knee osteoarthritis (OA) is diagnosed and monitored radiologically, actual full-thickness cartilage loss (FTCL) has rarely been correlated with radiological classification. This study aims to analyze which classification system correlates best with FTCL and to assess their reliability. METHODS: A prospective study of 300 consecutive patients undergoing unilateral total knee arthroplasty (TKA) for OA (mean age 69 years (44 to 91; standard deviation (SD) 9.5), 178 (59%) female). Two blinded examiners independently graded preoperative radiographs using five common systems: Kellgren-Lawrence (KL); International Knee Documentation Committee (IKDC); Fairbank; Brandt; and Ahlbäck. Interobserver agreement was assessed using the intraclass correlation coefficient (ICC). Intraoperatively, anterior cruciate ligament (ACL) status and the presence of FTCL in 16 regions of interest were recorded. Radiological classification and FTCL were correlated using the Spearman correlation coefficient. RESULTS: Knees had a mean of 6.8 regions of FTCL (SD 3.1), most common medially. The commonest patterns of FTCL were medial ± patellofemoral (143/300, 48%) and tricompartmental (89/300, 30%). ACL status was associated with pattern of FTCL (p = 0.023). All radiological classification systems demonstrated moderate ICC, but this was highest for the IKDC: whole knee 0.68 (95% confidence interval (CI) 0.60 to 0.74); medial compartment 0.84 (95% CI 0.80 to 0.87); and lateral compartment 0.79 (95% CI 0.73 to 0.83). Correlation with actual FTCL was strongest for Ahlbäck (Spearman rho 0.27 to 0.39) and KL (0.30 to 0.33) systems, although all systems demonstrated medium correlation. The Ahlbäck score was the most discriminating in severe knee OA. Osteophyte presence in the medial compartment had high positive predictive value (PPV) for FTCL, but not in the lateral compartment. CONCLUSION: The Ahlbäck and KL systems had the highest correlation with confirmed cartilage loss at TKA. However, the IKDC system displayed the best interobserver reliability, with favourable correlation with FTCL in medial and lateral compartments, although it was less discriminating in more severe disease. Cite this article: Bone Joint J 2020;102-B(3):301-309.


Assuntos
Cartilagem Articular/diagnóstico por imagem , Articulação do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/classificação , Radiografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho , Feminino , Seguimentos , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico , Osteoartrite do Joelho/cirurgia , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
10.
Zhen Ci Yan Jiu ; 45(1): 57-61, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-32144910

RESUMO

OBJECTIVE: The present study is to investigate the characteristic distribution of primary pain points and referred pain areas in patients with knee-joint pain diseases, therefore revealing the correlation between the myofascial trigger point and acupoint sensitization. METHODS: A total of 483 patients (320 men and 163 women, 36 to 72 years in age) with knee-joint pain recruited from 4 clinical centers were observed from July, 2017 to April, 2019 in the present study. The areas of primary and referred pain in these patients were detected by thumb-pressing and marked on human anatomic atlas. RESULTS: Of the 483 enrolled participants, 336 had lesion sites or tender points around the injured knee joint, and 147 with myofascial pain syndrome showed referred pain spots (zones) in the knee joint area. In 105 patients with patellar tendonitis, epiphysitis of the tibial tubero-sity, or quadriceps tendonitis, the pain area was mainly distributed in the anterior region of the knee. In 76 patients with medial collateral ligament injury, medial meniscal lesion, goose foot bursitis or semimembranosus ending-point inflammation, the pain points mainly occurred in the medial area of the knee. In 127 patients with lateral collateral ligament, lateral meniscus lesion, iliotibial band tendonitis, popliteus or triceps tendinitis, the pain spots were found in the lateral region of the knee. In 28 patients with posterior cruciate ligament injury or popliteal fossa tendonitis, the local pain was found to be at the back of the knee. Referred pain areas were normally detected in the lateral femoral muscles (43 cases), anterior femoral muscles (39 cases), adductor group of femur (26 cases), posterior popliteal fossa muscles group (15 cases), hamstrings (13 cases) and medial leg (11 cases).. CONCLUSION: The primary pain areas or spots of the knee injury mainly distribute around the joint, whereas those of each muscle group lesion are often located in their respective skeletal muscle. Most of the referred pain areas often occur in the distal end of skeletal muscle and around the knee joint. Primary myofascial trigger points may be considered to be an indicator of acupoint sensitization.


Assuntos
Pontos de Acupuntura , Pontos-Gatilho , Adulto , Idoso , Feminino , Fêmur , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Tíbia
11.
Zhen Ci Yan Jiu ; 45(2): 105-10, 2020 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-32144919

RESUMO

OBJECTIVE: To investigate the effect of warm acupuncture on chondrocyte cytoskeleton protein Rho associa-ted protein kinase (ROCK)/ monopherine domain kinase 1 (LIMK1)/Cofilin signaling of synovial tissue of the knee-joint in knee osteoarthritis (KOA) rats, so as to explore its mechanisms underlying improvement of KOA. METHODS: One hundred-twenty SD rats (half male and half female) were randomly divided into 5 groups: normal control, model, acupuncture, moxibustion and warm acupuncture, with 24 rats in each group. The KOA model was established by injection of 4% Papain (0.25 mL/kg) into the right knee cavity on day 1, 3 and 7. Rats in the acupuncture, moxibustion and warm acupuncture groups were treated with manual acupuncture, moxibustion and warm acupuncture stimulation of "Neixiyan"(EX-LE4), "Waixiyan"(EX-LE5) and "Zusanli"(ST36), respectively for 20 min, once a day for 21 days. The volume of the right knee-joint was measured by using drainage method and its width measured using a vernier caliper. The histopathological changes of the right knee cartilage were observed after H.E. stain, and scored (0 to 14 points) with reference to Markin's methods. The expression levels of ROCK, Cofilin, phospho-Cofilin, LIMK1 and phospho-LIMK1 proteins of the right knee synovial tissue were detected by Western blot. RESULTS: After modeling, the width and the volume since day 6 of the right knee-joint and Markin score of the cartilage, as well as the expression levels of ROCK, phospho-Cofilin, and phospho-LIMK1 proteins were significantly increased in the model group in contrast to the normal control group (P<0.05,P<0.01). Following the interventions, the width and the volume since day 12 of the right knee-joint and Markin score of the cartilage, as well as the expression levels of ROCK, phospho-Cofilin, and phospho-LIMK1 proteins were reversed in the three treatment groups (P<0.05). The effect of warm acupuncture was significantly superior to that of both simple acupuncture and simple moxibustion in decreasing the width and the volume since day 15 of the right knee-joint and Markin score of the cartilage, as well as in down-regulating the expression levels of ROCK, phospho-Cofilin and phospho-LIMK1 proteins (P<0.05). No significant differences were found between the acupuncture and moxibustion groups in deceasing all the aforementioned indexes (P>0.05).. CONCLUSION: Acupuncture, moxibustion and warm acupuncture can reduce arthritic injury in KOA rats, which is closely associated with their effects in down-regulating the expression of chondrocyte cytoskeletal proteins ROCK, phospho-Cofilin and phospho-LIMK1. The efficacy of warm acupuncture is evidently superior to that of simple acupuncture and simple moxibustion.


Assuntos
Terapia por Acupuntura , Moxibustão , Osteoartrite do Joelho , Animais , Feminino , Articulação do Joelho , Masculino , Ratos , Ratos Sprague-Dawley
12.
J Frailty Aging ; 9(1): 30-36, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32150211

RESUMO

BACKGROUND: The mobility of older adults is limited by the compounding effects of vascular health conditions, or vascular risk burden. However, little is known about the role of neuromuscular attributes among those in which vascular risk burden contributes to mobility limitations. OBJECTIVE: We investigated (1) the relationship between the absence/presence of type 2 diabetes, hypertension, and/or obesity and mobility measures and neuromuscular attributes, and (2) whether the association between vascular risk burden and mobility is mediated by lower limb neuromuscular attributes. DESIGN: Cross-sectional analysis of baseline data from 430 older adults within the Boston RISE Study. MEASUREMENTS: Measures of mobility were the Short Physical Performance Battery, habitual gait speed, and functional mobility as measured by the Late Life Function Instrument. We also evaluated lower limb neuromuscular attributes, namely leg strength, leg velocity, trunk extensor muscle endurance, knee and ankle range of motion, and sensory loss. RESULTS: Participants self-reported the presence of None (n=93), One (n=179), Two (n=114), or Three (n=44) of the following conditions: diabetes, hypertension, and obesity. Multivariable regression models indicated that those with a greater vascular risk burden had worse performance on the Short Physical Performance Battery (p=0.01), slower gait speed (p=0.0003) and lower Basic and Advanced Late Life Function Instrument scores (p<0.003). These associations were independent of multiple covariates. Vascular risk burden was also found to be negatively associated with leg strength (p=0.0002) and knee flexion range of motion (p<0.0001) and an associated non-significant trend was observed with leg velocity (p=0.06). In addition, the association between vascular risk burden and mobility outcomes were found to be partially mediated by leg strength, leg velocity, and knee flexion range of motion. CONCLUSIONS: Among older adults with vascular risk burden and mobility problems, neuromuscular impairments in attributes such as leg strength, leg velocity, and knee range of motion may need to be treatment priorities.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Hipertensão/epidemiologia , Limitação da Mobilidade , Força Muscular/fisiologia , Obesidade/epidemiologia , Idoso , Estudos Transversais , Humanos , Articulação do Joelho/fisiologia , Perna (Membro)/fisiologia , Amplitude de Movimento Articular/fisiologia , Fatores de Risco
13.
Orthop Clin North Am ; 51(2): 169-176, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32138855

RESUMO

There is a broad variation of implantation rates, indications, and types of prostheses used for hip and knee joint replacement procedures among different countries. The establishment of national joint registers has improved knowledge and quality of data related to joint implantation. Comparing reports of different national registries is crucial to determine potential variations in practices among surgeons and arthroplasty centers and to identify topics for future analysis. In this report, data from these registries in addition to manufacturer reports were used to evaluate procedure volumes and implants utilization trends of primary and revision total hip and knee replacement around the world.


Assuntos
Artrite/cirurgia , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/estatística & dados numéricos , Articulação do Quadril/cirurgia , Humanos , Internacionalidade , Articulação do Joelho/cirurgia
14.
Zhongguo Gu Shang ; 33(1): 4-10, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-32115917

RESUMO

OBJECTIVE: To compare the clinical effect of proximal fibular osteotomy (PFO) and single condyle replacement (UKA) in the treatment of knee osteoarthritis of different severity. METHODS: From June 2015 to September 2017, 53 patients with knee osteoarthritis were analyzed retrospectively. According to the operation mode, they were divided into PFO group (26 cases) and UKA group (27 cases) . According to Kellygren-Lawrence imaging classification standard:PFO group, 5 cases of gradeⅡ, 11 cases of grade Ⅲ, 10 cases of grade Ⅳ; UKA group, 7 cases of gradeⅡ, 9 cases of grade Ⅲ, 11 cases of grade Ⅳ. The amount of intraoperative bleeding, operation time and postoperative hospital stay were compared between the two groups. The patients were followed up regularly in the outpatient clinic before operation, 3 months after operation and 1 year after operation. The WOMAC score and the angle of tibiofemoral angle at each time point in the same group were compared, and the OMAC score and the angle of tibiofemoral angle at each time between the two groups were compared. RESULTS: Fifty-three patients were followed up for 12 to 24 (16.6±4.8) months. Compared with UKA group, PFO group had less intraoperative bleeding, shorter operative time and shorter postoperative hospital stay (P<0.05) . The scores of pain, stiffness and body function in UKA group were better than those in PFO group (P<0.05) . After 3 months and 1 year, the WOMAC index in PFO group was significantly improved (P<0.05) ; after 3 months and 1 year, the WOMAC index in UKA group was significantly better than that in PFO group (P<0.05) ; after 3 months, the WOMAC index in PFO group was significantly better than that in UKA group (P<0.05) . The tibiofemoral angle of gradeⅡand Ⅲ patients in both groups decreased gradually (P<0.05) ; the tibiofemoral angle of grade Ⅳ patients in UKA group was smaller than that of grade Ⅳ patients in PFO group (P<0.05) . CONCLUSION: Compared with UKA, PFO has the advantages of small trauma, fast recovery and low cost. The curative effect of PFO is equal to or more than UKA in the patients with gradeⅡand Ⅲ knee osteoarthritis. It is an alternative surgical method for the treatment of knee osteoarthritis.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Humanos , Articulação do Joelho , Osteoartrite do Joelho/cirurgia , Osteotomia , Estudos Retrospectivos , Resultado do Tratamento
15.
Zhongguo Gu Shang ; 33(1): 11-4, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-32115918

RESUMO

OBJECTIVE: To explore the clinical effect of patellofemoral joint replacement in the treatment of patellofemoral arthritis. METHODS: From July 2013 to June 2017, 35 patients with 42 knees underwent patellofemoral arthroplasty, including 34 females and 1 male, aged 45 to 70 (55.0±8.2) years old, with a course of 6 to 36 (13.7±2.5) months. Before and at the end of the follow-up, the patients were assessed with Oxford knee score, satisfaction with the operation was assessed at the end of the follow-up. In addition, X-ray films of the front and side of the knee joint and axial films of the patella were taken to assess whether the prosthesis was loose, and complications such as hematoma and joint infection were recorded. RESULTS: Forty-two knees of 35 patients were followed up for 18 to 65 (35.0±7.2) months, and the operation time was (56.2±8.7) min. Oxford knee joint score increased from preoperative 28.14±0.36 to 37.19±0.47 at the end of the follow-up (P<0.05) . The score of pain items increased from preoperative 10.12±0.26 to 15.83±0.30 at the end of the follow-up, and the score of functional items increased from preoperative 18.02±0.13 to 21.36±0.23 at the end of the follow-up (P<0.05) , there was statistical significance (P <0.05) . In one case, there was wound suture reaction in the early postoperative period, which was improved after debridement; in the other case, there was swelling around the wound 5 weeks after operation, which was improved after antibiotic treatment; in one case, there was tear at the suture of quadriceps femoris muscle at 1 month after operation, which was improved after re suture; no loosening of prosthesis was found. CONCLUSION: The second generation of patellofemoral arthroplasty for the treatment of simple severe patellofemoral arthritis has satisfactory early clinical effect and few complications, but the indication of operation should be strictly grasped. For severe cases, CT scan of knee joint can be used to customize the patellofemoral prosthesis, so as to reduce postoperative complications and improve the clinical effect.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Articulação Patelofemoral , Adulto , Feminino , Seguimentos , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Resultado do Tratamento
16.
Zhongguo Gu Shang ; 33(1): 15-20, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-32115919

RESUMO

OBJECTIVE: To analyze the effect of computer navigation assisted total knee arthroplasty on intraoperative hemorrhage and postoperative joint function recovery in patients with knee osteoarthritis. METHODS: From February 2015 to December 2017, 65 patients with knee osteoarthritis treated by traditional total knee arthroplasty were retrospectively analyzed as the control group and 65 patients with knee osteoarthritis treated by total knee arthroplasty under computer navigation as the experimental group. Before operation, all patients showed red swelling pain of knee, pain of going up and down stairs, and pain and discomfort of waist when sitting up and standing up. All patients were treated with total knee arthroplasty. The control group was treated with traditional total knee arthroplasty, and the experimental group was treated with total knee arthroplasty under the computer navigation system. The operation related conditions of the two groups were recorded and compared including the operation time and hospitalization time; the changes of hemoglobin and hematocrit of the two groups were detected and compared before and 5 days after the operation; the blood loss of the two groups and the induced flow at each time point calculated and compared after the operation, and the perioperative allogeneic blood transfusion rate and average blood transfusion volume of the patients were recorded; The joint function scale (KSS) was used to evaluate the recovery of knee joint function before the operation, 6 and 18 months after the operation respectively and to record the incidence of postoperative infection, lower extremity venous thrombosis and other complications. RESULTS: All the patients were successfully operated and the prognosis of the wound was good. All the patients were followed up for an average of 18 months. The operation time of the experimental group was longer than that of the control group, and the hospitalization time was shorter than that of the control group (P <0.05) ; the KSS score of the two groups at each time point after operation was higher than that before operation, but the increasing range of the test group was higher than that of the control group (P<0.05) ; there was no significant difference between the two groups in the incidence of complications (P>0.05) . CONCLUSION: Under the guidance of computer navigation, total knee arthroplasty can prolong the operation time compared with single total knee arthroplasty, but it is more conducive to reduce perioperative blood loss, reduce the rate of postoperative allogeneic blood transfusion, ideal recovery of joint function, less complications, safety and reliability.


Assuntos
Artroplastia do Joelho , Perda Sanguínea Cirúrgica , Humanos , Articulação do Joelho , Osteoartrite do Joelho , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento
17.
Zhongguo Gu Shang ; 33(1): 71-5, 2020 Jan 25.
Artigo em Chinês | MEDLINE | ID: mdl-32115928

RESUMO

OBJECTIVE: To explore the effect of suture anchor combined with transverse drilling of patella to repair the fracture of the joint of bone and tendon of quadriceps femoris tendon. METHODS: From April 2016 to January 2018, 6 patients (8 knees) with complete rupture of the joint of the tendon and bone tendon of the quadriceps femoris were treated with the combination of anchor with wire and transverse drilling of the patella, including 5 males (7 knees) and 1 female, aged from 43 to 74 years with an average age of 53 years old. All the patients had pain in knee joint and could not extend the knee actively after trauma. X-ray, CT and MRI were performed on the knee joints, and it was clear that the joint of bone and tendon of quadriceps femoris tendon was completely broken. The X-ray of knee joint was reviewed regularly after operation, and Lysholm score was used to evaluate the function of knee joint. RESULTS: The average operation time of all patients was 60 minutes. Tourniquets were used during the operation, no drainage was placed after the operation, and no blood transfusion was performed in all patients. Six patients were followed up for 15 to 36 months with an average of 26 months. Lysholm score of 6 patients (8 knees) was 79 to 95 in the last follow-up with an average of 89 points. One of the patients with mandatory spondylitis developed infection and healed after 2 debridements. CONCLUSION: The suture structure of the joint of bone and tendon of quadriceps femoris tendon repaired with suture anchor and lateral drilling of patella is simple, reliable and effective.


Assuntos
Patela , Traumatismos dos Tendões , Adulto , Idoso , Fios Ortopédicos , Feminino , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Patela/cirurgia , Músculo Quadríceps , Traumatismos dos Tendões/cirurgia , Tendões
18.
Zhonghua Wai Ke Za Zhi ; 58(3): 203-208, 2020 Mar 01.
Artigo em Chinês | MEDLINE | ID: mdl-32187923

RESUMO

Objective: To explore the short-term effectiveness of arthroscopic combined with dual-plane high tibial osteotomy in the treatment of anterior cruciate ligament injury combined with varus deformity of knee joint. Methods: A retrospective study was performed on 17 patients with anterior cruciate ligament injury combined with varus deformity of knee joint who underwent arthroscopic combined with dual-plane high tibial osteotomy at Department of Bone and Joint, the Affiliated Hospital of Southwest Medical University from January 2017 to June 2018.There were 11 males (11 knees) and 6 females (6 knees), aged 41.3 years (range: 32 to 49 years) .During the surgery, the weight bearing line of lower extremity was set to 62.5% position of the tibial plateau on coronal plane. The tibial slope was adjusted to the normal range on sagittal plane, and anterior cruciate ligament was reconstructed to improve the stability of knee joint.At final follow up, full length weight bearing X ray was used to evaluate the position of weight bearing line, femoral tibial angle and tibial slope pre- and post-operatively.The Lysholm scores, Hospital for Special Surgery score, Tegner knee activity scores and International Knee Documentation Committee (IKDC) scores were used to estimate knee joint function, while the Lachman test, KT-1000 side-to-side difference and pivot-shift test were used to estimate the knee joint stability. Results: The patients were followed up for 1.8 years(range:1.2 to 2.5 years). No complication such as infection, deep vein thrombosis, graft failure, nonunion or delayed union was observed.The weight bearing line was corrected from (28.48±2.24)% preoperatively to (57.43±1.02)% postoperatively (t=46.80, P=0.00) .The femoral tibial angle was improved from (172.31±3.37) ° preoperatively to (178.91±1.34) ° postoperatively(t=10.46, P=0.00). The tibial slope was decreased from (14.29±1.26) ° preoperatively to (9.31±0.79) ° postoperatively (t=24.59, P=0.00) . The KT-1000 side-to-side difference decreased from (7.95±1.19) mm preoperatively to (1.79±0.49)mm postoperatively(t=18.34, P=0.00). At the last follow-up, Lysholm score, Hospital for Special Surgery score, Tegner score, and the IKDC knee evaluation score of patients showed significant improvement from preoperative(P<0.05). Conclusion: Arthroscopic combined with dual-plane high tibial osteotomy can get a good short term efficacy in the treatment of anterior cruciate ligament injury combined with varus deformity of knee joint which can significantly improve the alignment of lower extremity and knee joint stability.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Artroscopia , Articulação do Joelho/cirurgia , Osteotomia , Adulto , Feminino , Humanos , Articulação do Joelho/anormalidades , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
19.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(3): 320-322, 2020 Mar 06.
Artigo em Chinês | MEDLINE | ID: mdl-32187939

RESUMO

From November to December of 2018, twenty 65-year-old or older women patients with knee osteoarthritis were recruited from the Department of Physical Therapy, the First Affiliated Hospital of Anhui Medical University. Meanwhile, twenty healthy 65-year-old or older women were recruited from the local community. The results showed that the knee contact angle of the patient group was more flexed (P=0.040), and the minimum angle of the knee joint increased (P=0.008) during the stance period compared to the healthy group. However, there was no significant difference in the maximum contact angle between the angle of hip and ankle joints. In addition, the tibialis anterior muscle of the patients was significantly smaller than the healthy group (P=0.023). Therefore, knee osteoarthritis could change the gait and muscle activity of older women, especially the knee joint.


Assuntos
Marcha , Articulação do Joelho/fisiopatologia , Músculo Esquelético/fisiopatologia , Osteoartrite do Joelho/fisiopatologia , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Amplitude de Movimento Articular/fisiologia
20.
Zhongguo Zhen Jiu ; 40(2): 142-6, 2020 Feb 12.
Artigo em Chinês | MEDLINE | ID: mdl-32100498

RESUMO

OBJECTIVE: To observe the effect of electroacupuncture (EA) on the rehabilitation of knee joint function after anterior cruciate ligament (ACL) reconstruction. METHODS: A total of 140 patients with ACL reconstruction were randomly divided into an observation group (58 cases recruited, 12 cases dropped out) and a control group (65 cases recruited, 5 cases dropped out). The patients in the control group were treated with routine rehabilitation treatment. The patients in the observation group, on the basis of the treatment in the control group, were treated with EA at Fengshi (GB 31), Futu (ST 32), Zusanli (ST 36), Shangjuxu (ST 37), Fenglong (ST 40), Xuanzhong (GB 39), Diji (SP 8) and Sanyinjiao (SP 6) on the affected side (2 Hz/100 Hz of dilatational wave, 2-5 mA). Each EA treatment lasted 20-30 min, twice a day for 7 days. The swelling degree (d), pain visual analogue scale (VAS), knee joint range of motion (ROM), scores of International Knee Documentation Committee (IKDC) subjective short form and scores of Lysholm were observed in the two groups 1 day, 1 month, 3 months, 6 months and 1 year after operation. RESULTS: One month and 3 months after operation, the swelling degree (d) and VAS scores in the observation group were lower than those in the control group (P<0.05); 6 months and 1 year after operation, there was no significant difference between the two groups on the swelling degree (d) and VAS scores (P>0.05). One month, 3 months, 6 months and 1 year after operation, the ROM of the knee joint in the observation group was higher than that in the control group (P<0.05), the IKDC score and Lysholm score were higher than those in the control group (P<0.05). Within one year, there were no relaxations, fractures and other related complications in the two groups. The pivot shift test, anterior drawer test and the Lachman test were all negative. CONCLUSION: EA combined with routine rehabilitation training could obviously reduce the pain of knee joint, improve the swelling degree, increase the ROM of knee joint, promote the functional recovery in patients with ACL reconstruction, which are superior to rehabilitation training alone.


Assuntos
Lesões do Ligamento Cruzado Anterior/reabilitação , Reconstrução do Ligamento Cruzado Anterior , Eletroacupuntura , Articulação do Joelho , Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Resultado do Tratamento
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