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1.
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
2.
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
3.
Medicine (Baltimore) ; 100(6): e24141, 2021 Feb 12.
Artigo em Inglês | MEDLINE | ID: mdl-33578519

RESUMO

BACKGROUND: The global neo-coronary pneumonia epidemic has increased the workload of healthcare institutions in various countries and directly affected the physical and psychological recovery of the vast majority of patients requiring hospitalization in China. We anticipate that post-total knee arthroplasty kinesiophobia may have an impact on patients' postoperative pain scores, knee function, and ability to care for themselves in daily life. The purpose of this study is to conduct a micro-video intervention via WeChat to verify the impact of this method on the rapid recovery of patients with kinesiophobia after total knee arthroplasty during neo-coronary pneumonia. METHODS: Using convenience sampling method, 78 patients with kinesiophobia after artificial total knee arthroplasty who met the exclusion criteria were selected and randomly grouped, with the control group receiving routine off-line instruction and the intervention group receiving micro-video intervention, and the changes in the relevant indexes of the two groups of patients at different time points on postoperative day 1, 3 and 7 were recorded and analyzed. RESULTS: There were no statistical differences in the scores of kinesiophobia, pain, knee flexion mobility (ROM) and ability to take care of daily life between the two groups on the first postoperative day (P > .05). On postoperative day 3 and 7, there were statistical differences in Tampa Scale for kinesiophobia, pain, activities of daily living scale score and ROM between the two groups (P < .01), and the first time of getting out of bed between the two groups (P < .05), and by repeated-measures ANOVA, there were statistically significant time points, groups and interaction effects of the outcome indicators between the 2 groups (P < .01), indicating that the intervention group reconstructed the patients' postoperative kinesiophobiaand hyperactivity. The level of pain awareness facilitates the patient's acquisition of the correct functional exercises to make them change their misbehavior. CONCLUSIONS: WeChat micro-video can reduce the fear of movement score and pain score in patients with kinesiophobia after unilateral total knee arthroplasty, shorten the first time out of bed, and improve their joint mobility and daily living ability. ETHICS: This study has passed the ethical review of the hospital where it was conducted and has been filed, Ethics Approval Number: 20181203-01.


Assuntos
Artroplastia do Joelho/psicologia , Transtornos Fóbicos/psicologia , Pneumonia/epidemiologia , Atividades Cotidianas , Idoso , Artroplastia do Joelho/efeitos adversos , /diagnóstico , Estudos de Casos e Controles , China/epidemiologia , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/diagnóstico , Dor Pós-Operatória/psicologia , Pneumonia/virologia , Período Pós-Operatório , Estudos Prospectivos , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Reabilitação/métodos , Reabilitação/psicologia , Comunicação por Videoconferência/instrumentação , Comunicação por Videoconferência/estatística & dados numéricos
4.
Bone Joint J ; 103-B(2): 329-337, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517740

RESUMO

AIMS: A comprehensive classification for coronal lower limb alignment with predictive capabilities for knee balance would be beneficial in total knee arthroplasty (TKA). This paper describes the Coronal Plane Alignment of the Knee (CPAK) classification and examines its utility in preoperative soft tissue balance prediction, comparing kinematic alignment (KA) to mechanical alignment (MA). METHODS: A radiological analysis of 500 healthy and 500 osteoarthritic (OA) knees was used to assess the applicability of the CPAK classification. CPAK comprises nine phenotypes based on the arithmetic HKA (aHKA) that estimates constitutional limb alignment and joint line obliquity (JLO). Intraoperative balance was compared within each phenotype in a cohort of 138 computer-assisted TKAs randomized to KA or MA. Primary outcomes included descriptive analyses of healthy and OA groups per CPAK type, and comparison of balance at 10° of flexion within each type. Secondary outcomes assessed balance at 45° and 90° and bone recuts required to achieve final knee balance within each CPAK type. RESULTS: There was similar frequency distribution between healthy and arthritic groups across all CPAK types. The most common categories were Type II (39.2% healthy vs 32.2% OA), Type I (26.4% healthy vs 19.4% OA) and Type V (15.4% healthy vs 14.6% OA). CPAK Types VII, VIII, and IX were rare in both populations. Across all CPAK types, a greater proportion of KA TKAs achieved optimal balance compared to MA. This effect was largest, and statistically significant, in CPAK Types I (100% KA vs 15% MA; p < 0.001), Type II (78% KA vs 46% MA; p = 0.018). and Type IV (89% KA vs 0% MA; p < 0.001). CONCLUSION: CPAK is a pragmatic, comprehensive classification for coronal knee alignment, based on constitutional alignment and JLO, that can be used in healthy and arthritic knees. CPAK identifies which knee phenotypes may benefit most from KA when optimization of soft tissue balance is prioritized. Further, it will allow for consistency of reporting in future studies. Cite this article: Bone Joint J 2021;103-B(2):329-337.


Assuntos
Artroplastia do Joelho , Mau Alinhamento Ósseo/classificação , Articulação do Joelho/patologia , Osteoartrite do Joelho/cirurgia , Assistência Perioperatória/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/métodos , Fenômenos Biomecânicos , Mau Alinhamento Ósseo/complicações , Mau Alinhamento Ósseo/diagnóstico , Mau Alinhamento Ósseo/fisiopatologia , Estudos de Casos e Controles , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/patologia , Osteoartrite do Joelho/fisiopatologia , Equilíbrio Postural , Estudos Prospectivos , Resultado do Tratamento
5.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541981

RESUMO

Hoffa fractures are unstable intra-articular fractures of the femoral condyle that occur in the coronal plane.Insufficient anatomical reduction and internal fixation may lead to non-union or malunion. A 39-year-old man was involved in a traffic accident while riding a motorcycle and was diagnosed with left Hoffa fracture and avulsion fracture of the femoral attachment of the medial collateral ligament. Open reduction and internal fixation were performed 5 days after injury. The patient experienced intermittent knee pain, joint contracture and deformity, and attended our hospital for further treatment 18 months after surgery. CT revealed depression and malunion of the posterior aspect of the lateral femoral condyle, and weight-bearing X-ray showed valgus deformity due to malunion. Distal femoral osteotomy (DFO) was performed and good functional and radiographic results were obtained. This report suggests that DFO is a reasonable treatment for young patients suffering from malalignment due to malunited Hoffa fracture.


Assuntos
Fixação Interna de Fraturas , Fraturas Mal-Unidas/diagnóstico por imagem , Geno Valgo/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Osteotomia , Adulto , Feminino , Geno Valgo/diagnóstico , Humanos , Fraturas Intra-Articulares/diagnóstico por imagem , Masculino , Redução Aberta , Radiografia , Tomografia Computadorizada por Raios X
6.
Phys Ther Sport ; 47: 185-192, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33321266

RESUMO

OBJECTIVE: Describe a consecutive cohort of people with a non-surgically treated ACL injury and evaluate correlations between functional performance and patient reported outcome measures (PROMs). DESIGN: Cross-sectional. PARTICIPANTS: Sixty-eight individuals (38 males, 18-45 years old) 2-5 years after ACL injury. MAIN OUTCOME MEASURES: Tegner Activity Scale, International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Anterior Cruciate Ligament Return to Sport after Injury scale (ACL-RSI) and ACL-Quality of Life (ACL-QoL) were completed. Functional performance was assessed using 4 hop tests and a squat test. RESULTS: Mean IKDC-SKF score was 72 ± 17 and mean LSI on performance tests were above 90%. Tegner Activity Scale was reduced from median 8 pre-injury to 5 at follow up. Satisfaction with activity level was median 7 on a 10-point ordinal scale. Correlations were moderate to strong (r = 0.552-0.856) between PROMs, negligible to weak (r = 0.003-0.403) between performance tests and PROMs and negligible to moderate (r = 0.142-0.683) between performance tests. CONCLUSION: Functional performance had negligible or weak correlation to PROMs, which indicates the need for multi-modal assessment strategies. Activity level was reduced 2-5 years after a non-surgically treated ACL injury, but most patients were able to resume physical activity at a sufficient level to maintain health and displayed symmetrical functional performance. LEVEL OF EVIDENCE: Retrospective cohort study, Level III.


Assuntos
Lesões do Ligamento Cruzado Anterior/psicologia , Lesões do Ligamento Cruzado Anterior/terapia , Medidas de Resultados Relatados pelo Paciente , Desempenho Físico Funcional , Adolescente , Adulto , Traumatismos em Atletas/fisiopatologia , Traumatismos em Atletas/terapia , Estudos Transversais , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Volta ao Esporte , Adulto Jovem
7.
Phys Ther Sport ; 48: 26-34, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33352395

RESUMO

OBJECTIVES: The purpose of this study was to identify prospectively the anatomical and functional intrinsic risk factors for lateral ankle sprain (LAS) in adolescent athletes participating in team sports. DESIGN: A prospective cohort study. SETTING: University research laboratory. PARTICIPANTS: A total of 152 adolescent male athletes (age: 14.45 ± 2.96 years; height: 165.63 ± 15.33 cm; weight: 55.60 ± 16.56 kg; body mass index: 19.97 ± 3.58 kg/m2) participated in this study. MAIN OUTCOME MEASURES: The participants were assessed during the preseason for previous ankle sprain history, navicular drop, tibia vara, Q angle, tibia torsion, knee recurvatum, and ankle ROM. LASs were prospectively recorded and diagnosed for two consecutive seasons (20 months). RESULTS: Previous ankle sprain history (odds ratio [OR] = 60.911, p < 0.001), increased navicular drop (OR = 1.767, p < 0.001), and knee recurvatum (OR = 1.881, p = 0.002) were positively associated with the incidence of LAS. The receiver operating characteristic (ROC) analyses revealed the predictive potentials of previous ankle sprain history (the area under the ROC [AUROC] = 0.706, p < 0.001), navicular drop (AUROC = 0.906, p < 0.001), and knee recurvatum (AUROC = 0.724, p < 0.001). CONCLUSION: Athletes with previous ankle sprain history, knee recurvatum, and especially navicular drop may have a greater risk of LAS injury. The data from this study can help therapists and trainers to identify people with a higher risk of LAS.


Assuntos
Traumatismos do Tornozelo/epidemiologia , Atletas , Entorses e Distensões/epidemiologia , Adolescente , Traumatismos do Tornozelo/fisiopatologia , Articulação do Tornozelo/fisiopatologia , Criança , Estudos de Coortes , Humanos , Incidência , Articulação do Joelho/fisiopatologia , Masculino , Estudos Prospectivos , Amplitude de Movimento Articular , Fatores de Risco , Entorses e Distensões/fisiopatologia , Tíbia/fisiopatologia
8.
Phys Ther Sport ; 48: 35-42, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33352396

RESUMO

OBJECTIVE: To compare self-report and functional outcomes between participants with anterior cruciate ligament reconstruction (ACLR) with age and activity matched controls. DESIGN: Cross-sectional study. SETTING: University laboratory-based study. PARTICIPANTS: Twenty-five participants (30.8 ± 9.7 years; 13 women), two to ten years post anterior cruciate ligament reconstruction; 24 controls (31.0 ± 10 years, 13 women). MAIN OUTCOME MEASURES: Knee Osteoarthritis and Injury Outcome Score (KOOS), Tegner, Marx Activity and Fear of Re-injury scales, and SF-12; isokinetic quadriceps and hamstring peak torque and single-leg hop distance. RESULTS: There were no between-groups differences for the Tegner and the Marx Activity Scales. The ACLR group had lower KOOS dimensions (p < 0.001), SF-12 Physical Component Scores (p = 0.008), and higher Fear of Reinjury Scores (<0.001) than the controls. No significant differences were found for physical performance measures between the ACLR and the control groups. Significant between-side differences for the ACLR group were evident for concentric quadriceps (p < 0.001) and concentric hamstring peak torque (p = 0.002), and hop distance (p < 0.001). CONCLUSION: Knee-specific symptoms and function, activity and quality of life were lower, and fear of re-injury was higher for participants with ACLR than controls. Side-to-side thigh muscle strength and hop distance deficits were evident for the ACLR group.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Joelho/fisiopatologia , Qualidade de Vida , Adulto , Estudos Transversais , Feminino , Músculos Isquiossurais/fisiopatologia , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Força Muscular , Medidas de Resultados Relatados pelo Paciente , Desempenho Físico Funcional , Músculo Quadríceps/fisiopatologia , Autorrelato , Coxa da Perna/fisiopatologia , Torque , Adulto Jovem
9.
Phys Ther Sport ; 48: 54-59, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33373903

RESUMO

OBJECTIVES: The purpose was to compare body composition, cardiorespiratory fitness, and physical activity (PA) engagement between women with ACLR and healthy controls. DESIGN: Cross-sectional study. SETTING: University laboratory. PARTICIPANTS: Ten women with ACLR (time since surgery = 33.0 ± 18.3 months; age = 21.4 ± 3.8 years) and 10 healthy women (age = 21.9 ± 3.1 years) matched based on age (±2 years) and Tegner Activity Level (±2) participated. MAIN OUTCOME MEASURES: Body fat percentage (%BF) was estimated using air displacement plethysmography, cardiorespiratory fitness was assessed via a graded cycle test, and PA was assessed using accelerometers worn for 7 days. Groups were compared using Mann-Whitney U tests. Time (minutes/week) spent in moderate-to-vigorous PA and step count (steps/day) were compared between groups using a one-way ANCOVA with 7-day total wear time as the only covariate. Statistical significance was established a priori as α ≤ 0.05. RESULTS: Women with ACLR had significantly higher %BF than controls (ACLR = 32.7 ± 6.7%, healthy = 22.6 ± 4.9%; p < 0.01) and participated in less steps per day (ACLR = 6650 ± 3227 steps/day, healthy = 9361 ± 2626 steps/day; p = 0.02). CONCLUSIONS: There may be persistent negative effects on body composition and PA engagement for women following ACLR. Low PA and high %BF have adverse consequences for premature mortality and morbidity; therefore, it is crucial to assess these characteristics and determine interventions to maintain PA and healthy body composition following ACLR.


Assuntos
Reconstrução do Ligamento Cruzado Anterior , Composição Corporal , Aptidão Cardiorrespiratória , Exercício Físico , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/cirurgia , Estudos Transversais , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Escore de Lysholm para Joelho , Adulto Jovem
10.
Phys Ther Sport ; 48: 60-66, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33373904

RESUMO

OBJECTIVES: To compare trunk and knee biomechanics of women with and without patellofemoral pain (PFP) and knee crepitus during stair ascent. DESIGN: Cross-sectional. SETTING: Laboratory-based study. PARTICIPANTS: 29 women with PFP and knee crepitus (PFPCrepitus); 28 women with PFP and no knee crepitus (PFPNOCrepitus); 17 pain-free women with knee crepitus (Pain-freeCrepitus); and 29 pain-free women without knee crepitus (Pain-freeNOCrepitus). MAIN OUTCOME MEASURES: Peak trunk flexion, peak knee flexion, mean knee angular velocity, knee extensor moment at peak knee flexion, peak and impulse of the knee extensor moment. RESULTS: PFPCrepitus group performed the stair ascent task with reduced peak knee flexion compared to Pain-freeCrepitus (p = 0.04; Effect size = -0.85) and Pain-freeNOCrepitus (p = 0.03; Effect size = -0.75). No significant differences among groups were found for peak trunk flexion (p = 0.979), knee angular velocity (p = 0.420), knee extensor moment at peak knee flexion (p = 0.933), peak (p = 0.290) and impulse (p = 0.122) of the knee extensor moment. CONCLUSION: Women with concomitant PFP and knee crepitus demonstrated reduced knee flexion during stair ascent, but no significant differences for trunk flexion and knee extensor moment variables were found.


Assuntos
Articulação do Joelho/fisiopatologia , Síndrome da Dor Patelofemoral/fisiopatologia , Subida de Escada , Tronco/fisiopatologia , Adulto , Fenômenos Biomecânicos , Estudos Transversais , Feminino , Humanos , Articulação Patelofemoral/fisiopatologia , Amplitude de Movimento Articular , Adulto Jovem
11.
Methods Mol Biol ; 2230: 91-103, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33197010

RESUMO

Given the prevalence and the scope of the personal and societal burden of osteoarthritis (OA), investigators continue to be deeply interested in understanding the pathogenic basis of disease and developing novel disease modifying OA therapies. Because joint trauma/injury is considered a leading predisposing factor in the development of OA, and since posttraumatic OA is one of the most common forms of OA in general, large animal and rodent models of knee injury that accurately recapitulate the OA disease process have become increasingly widespread over the past decade. To enable study in the context of defined genetic backgrounds, investigative teams have developed standardized protocols for injuring the mouse knee that aim to induce a reproducible degenerative process both in terms of severity and temporal pacing of disease progression. The destabilization of the medial meniscus (DMM) is one of the most commonly employed surgical procedure in rodents that reproducibly models posttraumatic OA and allows for the study of disease progression from initiation to end-stage disease. The description provided here sets the stage for both inexperienced and established investigators to employ the DMM procedure, or other similar surgical destabilization methods, to initiate the development of posttraumatic OA in the mouse. Successful application of this method provides a preclinical platform to study the mechanisms driving the pathogenesis of posttraumatic OA and for testing therapeutic strategies to treat it.


Assuntos
Cartilagem Articular/crescimento & desenvolvimento , Traumatismos do Joelho/cirurgia , Meniscos Tibiais/cirurgia , Osteoartrite/cirurgia , Animais , Modelos Animais de Doenças , Progressão da Doença , Humanos , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Meniscos Tibiais/fisiopatologia , Camundongos , Osteoartrite/fisiopatologia
12.
J Orthop Surg Res ; 15(1): 603, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33308249

RESUMO

BACKGROUND: Although several reference axes have been established for determining femoral rotational alignment during total knee arthroplasty (TKA), the most accurate axis is undetermined. This study determines the relationship between the posterior cortical axis (PCA) and the trochlear anterior line (TAL) of the femur in relation to the epicondylar axis. METHODS: A total of 341 patients who underwent TKA for osteoarthritis were enrolled. Patients who had undergone previous bony surgery or replacement that might have changed the femoral geometry were excluded. Finally, 336 patients (200 females and 136 males) were included in the study. The angles between the transepicondylar axis (TEA) and TAL and TEA and the femoral PCA (FPCA) were evaluated. We also assessed whether there was any significant differences in variance and gender in these two angles. Student's t tests were used to determine the significance of coronal alignment and any gender-based differences. The variances between the TAL/TEA and FPCA/TEA angles were compared using F tests. RESULTS: The FPCA was externally rotated by 2.6° ± 3.6°, and the trochlear anterior line was internally rotated by 5.2° ± 5.5°, relative to the TEA. Gender-based differences were observed in the comparisons between anatomical references and TEA. CONCLUSIONS: The FPCA is a more conservative landmark than the TAL for intraoperative or postoperative approximation of the TEA. When conventional reference axes, such as the posterior condylar axis and the anteroposterior axis, are inaccurate, surgeons can refer to this alternative reference. These findings demonstrate that the FPCA may be useful for determining the rotational alignment of the femoral component before and during TKA.


Assuntos
Artroplastia do Joelho/métodos , Fêmur/cirurgia , Articulação do Joelho/cirurgia , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Idoso , Feminino , Fêmur/fisiopatologia , Humanos , Articulação do Joelho/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Amplitude de Movimento Articular , República da Coreia , Rotação , Caracteres Sexuais
13.
Tech Vasc Interv Radiol ; 23(4): 100706, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308582

RESUMO

Knee osteoarthritis, a chronic degenerative condition, can be a debilitating and limiting process with affected patients presenting with symptoms such as pain, restrictive range of motion, and swelling. This condition commonly afflicts millions of people with a higher incidence among the elderly that results from chronic mechanical repetitive loading. The treatment of pain generating conditions such as arthritis in large joints is complex requiring interventions of varying focuses such as weight loss, anti-inflammatory medications, corticosteroid, hyaluronic and viscosupplementation injections, and prescription opioids. A gap in the treatment options of this ailment currently exists between short term pain solutions and surgical approaches such as total knee arthroplasty that may offer longer pain relief. Cooled radiofrequency ablation is an emerging technique that offers a minimally invasive alternative for treating knee pain with a clinical relevance in patients who are not surgical candidates due to coexistent medical comorbidities or those who are undesiring of surgery. This procedure uses radiofrequency ablation that blocks genicular nerves from transmitting knee pain signals to the brain. Further research will allow the application of this technique to treat other sensory nerves in large joints such as the hip and shoulder.


Assuntos
Artralgia/cirurgia , Denervação , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Manejo da Dor , Ablação por Radiofrequência , Radiografia Intervencionista , Artralgia/diagnóstico por imagem , Artralgia/fisiopatologia , Denervação/efeitos adversos , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Manejo da Dor/efeitos adversos , Complicações Pós-Operatórias/etiologia , Ablação por Radiofrequência/efeitos adversos , Radiografia Intervencionista/efeitos adversos , Fatores de Risco , Resultado do Tratamento
14.
PLoS One ; 15(12): e0241117, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33326434

RESUMO

Deafferentation and weight offloading can increase brain and spinal motor neuron excitability, respectively. End-effector gait robots (EEGRs) can blend these effects with stereotyped movement-induced neuroplasticity. The authors aimed to evaluate the usefulness of EEGRs as a postoperative neuro-muscular rehabilitation tool. This prospective randomized controlled trial included patients who had undergone unilateral total knee arthroplasty (TKA). Patients were randomly allocated into two groups: one using a 200-step rehabilitation program in an EEGR or the other using a walker on a floor (WF) three times a day for five weekdays. The two groups were compared by electrophysiological and biomechanical methods. Since there were no more enrollments due to funding issues, interim analysis was performed. Twelve patients were assigned to the EEGR group and eight patients were assigned to the WF group. Although the muscle volume of the quadriceps and hamstring did not differ between the two groups, the normalized peak torque of the operated knee flexors (11.28 ± 16.04 Nm/kg) was improved in the EEGR group compared to that of the operated knee flexors in the WF group (4.25 ± 14.26 Nm/kg) (p = 0.04). The normalized compound motor action potentials of the vastus medialis (VM) and biceps femoris (BF) were improved in the EEGR group (p < 0.05). However, the normalized real-time peak amplitude and total, mean area under the curve of VM were decreased during rehabilitation in the EEGR group (p < 0.05). No significant differences were found between operated and non-operated knees in the EEGR group. Five-day EEGR-assisted rehabilitation induced strengthening in the knee flexors and the muscular reactivation of the BF and VM after TKA, while reducing the real-time use of the VM. This observation may suggest the feasibility of this technique: EEGR modulated the neuronal system of the patients rather than training their muscles. However, because the study was underpowered, all of the findings should be interpreted with the utmost caution.


Assuntos
Artroplastia do Joelho/reabilitação , Osteoartrite do Joelho/reabilitação , Osteoartrite do Joelho/cirurgia , Robótica/instrumentação , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Terapia por Exercício , Feminino , Marcha , Humanos , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Movimento , Osteoartrite do Joelho/fisiopatologia , Estudos Prospectivos , Recuperação de Função Fisiológica , Robótica/métodos , Método Simples-Cego , Andadores , Suporte de Carga/fisiologia
16.
PLoS One ; 15(10): e0238486, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33031372

RESUMO

OBJECTIVE: We aim to propose a novel method of evaluating the degree of rhythmic irregularity during repetitive tasks in Parkinson's disease (PD) by using autocorrelation to extract serial perturbation in the periodicity of body part movements as recorded by objective devices. METHODS: We used publicly distributed sequential joint movement data recorded during a leg agility task or pronation-supination task. The sequences of body part trajectory were processed to extract their short-time autocorrelation (STACF) matrices; the sequences of single task conducted by participants were then divided into two clusters according to their similarity in terms of their STACF representation. The Unified Parkinson's Disease Rating Scale sub-score rated for each task was compared with cluster membership to obtain the area under the curve (AUC) to evaluate the discrimination performance of the clustering. We compared the AUC with those obtained from the clustering of the raw sequence or short-time Fourier transform (STFT). RESULTS: In classifying the pose estimator-based trajectory data of the knee during the leg agility task, the AUC was the highest when the STACF sequence was used for clustering instead of other types of sequences with up to 0.815, being comparable to the results reported in the original analysis of the data using an approach different from ours. In addition, in classifying another dataset of accelerometer-based trajectory data of the wrist during a pronation-supination task, the AUC was again highest up to 0.785 when clustering was performed using the STACF rather than other types of sequence. CONCLUSION: Our autocorrelation-based method achieved a fair performance in detecting sequences with irregular rhythm, suggesting that it might be used as another evaluation strategy that is potentially widely applicable to qualify the disordered rhythm of PD regardless of the kinds of task or the modality of devices, although further refinement is needed.


Assuntos
Doença de Parkinson/diagnóstico , Doença de Parkinson/fisiopatologia , Análise e Desempenho de Tarefas , Acelerometria , Área Sob a Curva , Fenômenos Biomecânicos , Análise por Conglomerados , Bases de Dados Factuais , Diagnóstico por Computador , Análise de Fourier , Humanos , Articulação do Joelho/fisiopatologia , Movimento/fisiologia , Doença de Parkinson/classificação , Pronação/fisiologia , Estudos Retrospectivos , Análise Espacial , Supinação/fisiologia
17.
J Vasc Interv Radiol ; 31(9): 1453-1458, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32868019

RESUMO

Ten patients with painful early-stage knee osteoarthritis underwent transcatheter arterial embolization of neoangiogenic branches from genicular arteries. At 12 months, 6 patients had responded to treatment according to study criteria. Median pain, function, and quality-of-life scores had improved by 15.4%, 21.3%, and 100%, respectively, for the 10 patients. Median 30-second chair stand test and 6-minute walk test scores had improved by 43% and 26%, respectively. No major adverse events occurred. Improvements following transcatheter arterial embolization provide evidence that embolization might be an effective treatment technique for people with early-stage knee osteoarthritis, although more rigorous evaluation is required.


Assuntos
Artralgia/terapia , Embolização Terapêutica , Articulação do Joelho/irrigação sanguínea , Neovascularização Patológica , Osteoartrite do Joelho/terapia , Idoso , Artralgia/diagnóstico , Artralgia/fisiopatologia , Fenômenos Biomecânicos , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/fisiopatologia , Projetos Piloto , Estudos Prospectivos , Qualidade de Vida , Recuperação de Função Fisiológica , Fatores de Tempo , Resultado do Tratamento
18.
Medicine (Baltimore) ; 99(35): e21672, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871881

RESUMO

BACKGROUND: Total knee arthroplasty (TKA) is known to be a painful orthopedic procedure and moderate to severe pain is common, especially immediately postoperatively and during active motion. The aim of the present study was to compare epidural analgesia (EA) and adductor canal block (ACB) techniques with regard to early period pain levels, need for additional opioids, and ambulation and functional scores in patients who had undergone primary TKA. METHODS: Approval for the study was granted by the Changji Branch of the First Affiliated Hospital of Xinjiang Medical University. Written informed consent will be obtained from all of the participants. Inclusion criteria included the following: planned unilateral TKA; spinal anesthesia; American Society of Anesthesiologists physical status classification score of I to III. Prospective assessment will be done for 100 patients who are scheduled for unilateral primary TKA surgery in our academic hospital by a single senior surgeon between August 2020 and December 2021. Patients were randomized to ACB treatment or EA treatment by a computer random number generator. The primary outcome was visual analog scale pain scores in the immediate postoperative period. Secondary outcomes included postoperative opioid use, length of hospital stay, activity level during physical therapy, and knee range of motion. Results were evaluated in a confidence interval of 95% and at a significance level of P < .05. CONCLUSIONS: We hypothesized that standard ACB would be as effective as EA for postoperative pain management following TKA. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5775).


Assuntos
Analgesia Epidural , Artroplastia do Joelho/efeitos adversos , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Dor Pós-Operatória/prevenção & controle , Humanos , Articulação do Joelho/fisiopatologia , Medição da Dor , Dor Pós-Operatória/etiologia , Amplitude de Movimento Articular
19.
Medicine (Baltimore) ; 99(35): e21749, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871895

RESUMO

BACKGROUND: Osteoarthritis is the most common form of arthritis, and is a major cause of disability and chronic pain in adults. However, there is very limited evidence in the scientific literature to support the effectiveness of extracorporeal shockwave therapy (ESWT) in human knee osteoarthritis. This retrospective study aimed to compare the efficacy of ESWT treatment with sham-ESWT on pain, walking speed, physical function, and adverse effects in knee osteoarthritis. METHODS: This study will be performed and reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist. We reviewed patients diagnosed with knee osteoarthritis at our academic center from 2016 to 2017. This retrospective cohort study was approved by the institutional review board in Ruijin Hospital. The primary outcome measure was pain on movement measured by a 100-cm visual analog scale. The secondary outcome measures included the Western Ontario and McMaster University Osteoarthritis Index, range of motion, and adverse effects. Statistical analysis was performed using Statistical Package for Social Sciences version 20.0 (IBM Corporation, Armonk, NY). A P-value of <.05 was defined as statistical significance. RESULTS: The hypothesis was that ESWT would be an effective treatment for improving pain and physical function in knee osteoarthritis to control symptoms. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5801).


Assuntos
Tratamento por Ondas de Choque Extracorpóreas , Osteoartrite do Joelho/terapia , Terapia por Exercício , Humanos , Articulação do Joelho/fisiopatologia , Estudos Observacionais como Assunto , Osteoartrite do Joelho/fisiopatologia , Medição da Dor , Amplitude de Movimento Articular , Projetos de Pesquisa , Estudos Retrospectivos
20.
PLoS One ; 15(8): e0236342, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32785226

RESUMO

Osteoarthritis (OA) constitutes a major and increasing burden on patients, health care systems and the broader society. It is estimated that around a quarter of the adult population is affected by OA in the knee and hip and that the prevalence of OA will increase over the coming decades largely due to aging and adverse life-style factors. Prevention and effective care are critical to manage the challenges posed by OA. Digital technologies offer opportunities to deliver cost-effective care for chronic diseases, including for OA. We report the results of a costing analysis of a new digital platform for delivering first-line care including disease information and physiotherapy to patients with OA and compare this with an existing face-to-face model of treatment. Both models are in accordance with National Treatment Guidelines in Sweden. The results show that overall the digital model costs around 25% of the existing face-to-face model of care. Based on existing evidence on the effects of these models, our findings also suggest that the digital platform offers a cost-effective alternative to the existing model of OA care. Depending on the extent to which the digital model substitutes for the existing model of care, significant resources can be saved.


Assuntos
Análise Custo-Benefício/economia , Osteoartrite do Quadril/economia , Osteoartrite do Joelho/economia , Idoso , Terapia por Exercício , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/epidemiologia , Osteoartrite do Quadril/terapia , Osteoartrite do Joelho/epidemiologia , Osteoartrite do Joelho/terapia , Suécia/epidemiologia
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