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Age distribution of 193 patients with knee osteoarthritis who underwent primary total knee replacement ( TKR ) surgery. The proportions of diseased compartments are divided into two groups: medial compartment only and other compartments
Source publication
The objective of this study was to assess, with knee radiography, joint space narrowing (JSN) and its relationship to meniscal tears, anterior cruciate ligament (ACL) ruptures, articular cartilage erosion, and duration of pain in patients with knee osteoarthritis.
A total of 140 patients who had knee osteoarthritis and underwent primary total knee...
Context in source publication
Context 1
... 193 patients who had a diagnosis of osteoarthritis of the knee and underwent primary TKR, 140 (72.5%) patients had unicompartmental medial tibiofemoral osteoarthritis (Fig. 1), 70 of the right knee and 70 of the left. Women presented with indications for a TKR at a younger age than men (mean, 69.4 vs 72.6 years; Table 1). Women had a higher BMI than men, but the difference was not significant. The duration of knee pain was similar for both sexes. There were 123 (87.9%) meniscal tears, 58 (41.4%) partial (insufficient or attenuated ACL fibers) and 10 (7.1%) complete ACL ruptures, and 115 out of 134 (85.8%) patients with moderate to severe cartilage erosion of the tibiofemoral joints. The unicompartmental medial tibiofemoral osteoarthritis was categorized as JSN grade 1 in 10.0% (14), grade 2 in 45.7% (64), and grade 3 in 44.3% (62). Ignoring all other factor effects, we noted that the presence of meniscal tears was correlated with a higher grade of JSN (OR 6.00, 95% CI 1.29 – 27.96 for grade 2 vs grade 1; Table 2). A longer duration of knee pain (per year of increase in knee pain) increased the risk of a higher JSN grade (OR 1.25, 95% CI 1.01 – 1.53 for grade 3 vs grade 1). ACL ruptures and grade of cartilage erosion of the tibiofemoral joints did not show any clear relationship with the severity of JSN grade. No statistical differences in age, sex, or BMI were observed among JSN ...
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Purpose:
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Citations
... Although articular cartilage itself is not visible on X-rays, insufficient repair may lead to a decreased cartilage thickness, causing the two bones of a joint to appear much closer together than normal on an X-ray. This is called joint space narrowing, and is an important sign for clinically meaningful osteoarthritis (Chan et al. 2008). ...
Background
Musculoskeletal injuries are a common occurrence in sport. The goal of sport injury epidemiology is to study these injuries at a population level to inform their prevention and treatment.
Main body
This review provides an overview of musculoskeletal sport injuries and the musculoskeletal system from a biological and epidemiologic perspective, including injury mechanism, categorizations and types of sport injuries, healing, and subsequent injuries. It is meant to provide a concise introductory substantive background of musculoskeletal sport injuries for epidemiologists who may not have formal training in the underlying anatomy and pathophysiology.
Conclusion
An understanding of sport injuries is important for researchers in sport injury epidemiology when determining how to best define and assess their research questions and measures.
... X-ray revealed that around 37% of patients over 60 s years of age had KOA [3]. Joint space narrowing (JSN) is highly correlated with chronic knee osteoarthritis as well as meniscal tears [4]. Quadriceps weakness could increase the load on the knee joint. ...
BACKGROUND: Hamstring shortening altered joint reaction forces during activities of daily living (ADL), causing knee pain. Moreover, weak quadriceps may negatively distribute the compressive and shear forces at the knee joint. PURPOSE: The study examined the effect of adding hamstring stretching to quadriceps strengthening exercises on joint space narrowing (JSN), medial joint space width (mJSW), and physical abilities in patients with knee osteoarthritis (KOA). METHODS: A total of 42 osteoarthritis patients, aged from 50 to 65 years, were randomized and assigned into 2 groups: the study and the control groups. Quadriceps strengthening exercises were given to both groups, while static hamstring stretching was applied to only the study group. Patients of both groups were screened with a weight-bearing x-ray beam to investigate the JSN, mJSW, and functional abilities measured in the WOMAC scale. The Outcomes were evaluated at the baseline and immediately after 6 weeks of treatment. RESULTS: The mJSW improved in the study group (p< 0.001) compared to the control group (p= 0.07). The OARSI JSN was enhanced significantly in both groups, but in favor of the study group (p< 0.001) over the control group (p= 0.046). Both MVIC and total score of WOMAC were significantly improved in both groups (p< 0.001). CONCLUSION: Adding static hamstring stretching to quadriceps strengthening exercises provided a substantial effect on mJSW, JSN, and functional abilities in KOA patients.
... Moreover, SM with KOA had a reduction in the narrowest medial tibiofemoral joint space compared to SM without KOA: A common radiological finding of KOA. 42 Although the medial tibiofemoral compartment was not more significantly impacted in SM with KOA, a significant difference in the percentage of patellofemoral degeneration in SM with KOA compared to those without KOA (patellofemoral OC ≥ 1; KOA: 100% versus non-KOA: 57.1%, P = .03) was observed, although patellofemoral joint space did not differ between SM with versus without KOA, suggesting the medial tibiofemoral compartment may not be the most vulnerable to initial degeneration in the lower LL population. ...
Introduction
Knee osteoarthritis (KOA) is a primary source of long-term disability and decreased quality of life (QoL) in service members (SM) with lower limb loss (LL); however, it remains difficult to preemptively identify and mitigate the progression of KOA and KOA-related symptoms. The objective of this study was to explore a comprehensive cross-sectional evaluation, at the baseline of a prospective study, for characterizing KOA in SM with traumatic LL.
Materials and Methods
Thirty-eight male SM with traumatic unilateral LL (23 transtibial and 15 transfemoral), 9.5 ± 5.9 years post-injury, were cross-sectionally evaluated at initial enrollment into a prospective, longitudinal study utilizing a comprehensive evaluation to characterize knee joint health, functionality, and QoL in SM with LL. Presences of medial, lateral, and/or patellofemoral articular degeneration within the contralateral knee were identified via magnetic resonance imaging(for medically eligible SM; Kellgren–Lawrence Grade [n = 32]; and Outerbridge classification [OC; n = 22]). Tri-planar trunk and pelvic motions, knee kinetics, along with temporospatial parameters, were quantified via full-body gait evaluation and inverse dynamics. Concentrations of 26 protein biomarkers of osteochondral tissue degradation and inflammatory activity were identified via serum immunoassays. Physical function, knee symptoms, and QoL were collected via several patient reported outcome measures.
Results
KOA was identified in 12 of 32 (37.5%; KL ≥ 1) SM with LL; however, 16 of 22 SM presented with patellofemoral degeneration (72.7%; OC ≥ 1). Service members with versus without KOA had a 26% reduction in the narrowest medial tibiofemoral joint space. Biomechanically, SM with versus without KOA walked with a 24% wider stride width and with a negative correlation between peak knee adduction moments and minimal medial tibiofemoral joint space. Physiologically, SM with versus without KOA exhibited elevated concentrations of pro-inflammatory biomarker interleukin-7 (+180%), collagen breakdown markers collagen II cleavage (+44%), and lower concentrations of hyaluronic acid (−73%) and bone resorption biomarker N-telopeptide of Type 1 Collagen (−49%). Lastly, there was a negative correlation between patient-reported contralateral knee pain severity and patient-reported functionality and QoL.
Conclusions
While 37.5% of SM with LL had KOA at the tibiofemoral joint (KL ≥ 1), 72.7% of SM had the presence of patellofemoral degeneration (OC ≥ 1). These findings demonstrate that the patellofemoral joint may be more susceptible to degeneration than the medial tibiofemoral compartment following traumatic LL.
... However, representing only an indirect measure for cartilage thickness, JSW measurements can be influenced significantly by positioning, acquisition errors, focal cartilage degeneration, and changes in other joint tissues. 6,7 The meniscus, in particular, has been shown substantially to impact radiographic JSW measurements. 8,9 A more recent method is the direct measurement of articular cartilage thickness on magnetic resonance imaging (MRI) scans. ...
Background
In knee osteoarthritis, radiographic joint space width (JSW) is frequently used as a surrogate marker for cartilage thickness; however, longitudinal changes in radiographic JSW have shown poor correlations with those of magnetic resonance imaging (MRI) cartilage thickness. There are fundamental differences between the techniques: radiographic JSW represents two-dimensional (2D), weight-bearing, bone-to-bone distance, while on MRI three-dimensional (3D) non-weight-bearing cartilage thickness is measured. In this exploratory study, computed tomography (CT) was included as a third technique, as it can measure bone-to-bone under non-weight-bearing conditions. The objective was to use CT to compare the impact of weight-bearing versus non-weight-bearing, as well as bone-to-bone JSW versus actual cartilage thickness, in the knee.
Methods
Osteoarthritis patients ( n = 20) who were treated with knee joint distraction were included. Weight-bearing radiographs, non-weight-bearing MRIs and CTs were acquired before and 2 years after treatment. The mean radiographic JSW and cartilage thickness of the most affected compartment were measured. From CT, the 3D median JSW was calculated and a 2D projectional image was rendered, positioned similarly and measured identically to the radiograph. Pearson correlations between the techniques were derived, both cross-sectionally and longitudinally.
Results
Fourteen patients could be analyzed. Cross-sectionally, all comparisons showed moderate to strong significant correlations (R = 0.43–0.81; all p < 0.05). Longitudinal changes over time were small; only the correlations between 2D CT and 3D CT (R = 0.65; p = 0.01) and 3D CT and MRI (R = 0.62; p = 0.02) were statistically significant.
Conclusion
The poor correlation between changes in radiographic JSW and MRI cartilage thickness appears primarily to result from the difference in weight-bearing, and less so from measuring bone-to-bone distance versus cartilage thickness.
... Importantly, we found that only the presence of osteoarthritis significantly increased the risk of pain. Osteoarthritis has been previously linked with pain in chronic knee instability (30), and progressive joint space narrowing has been found to correlate with prolonged duration of pain which is unrelated to ACL deficiency (31). Moreover, evidence is accumulating that meniscal tears do not directly cause pain but lead to cartilage damage, which will in turn lead to pain due to evolving osteoarthritis (32,33). ...
Background:
Anterior knee instability is usually encountered in the context of trauma, with the clinical examination and imaging focusing on anterior cruciate ligament (ACL) disruption. Limited data exist on magnetic resonance imaging (MRI) of acute anterior knee instability in the absence of recent trauma.
Purpose:
To provide the first comprehensive account of MRI findings in acute anterior knee laxity in the absence of acute trauma and to evaluate predictors of ACL integrity and pain.
Material and methods:
A total of 84 consecutive patients with non-traumatic knee instability were prospectively studied. Instability was assessed with Lachman's, pivot shift, and Lelli's tests. MRI findings were recorded, and ACL integrity was surgically confirmed in all 24 cases of MRI suggesting tear and in 21/60 cases of MRI suggesting no tear. Binary logistic regression models were used to identify predictors of ACL tears and pain, and Mann-Whitney U test served for comparisons between continuous variables. The study was approved by the institutional review board.
Results:
Osteoarthritis and notch bony outgrowth (NBO) were present in 44% and 42.9% of all knees, respectively. NBO did not correlate with osteoarthritis (P = 0.606). NBO (odds ratio [OR] = 4.157; P = 0.016) and ACL grafts (OR = 9.277; P = 0.01) predisposed to non-traumatic ACL tears (torn in 28.6% of total cases). Presence of osteoarthritis was predictive of pain (OR = 17.671; P < 0.001).
Conclusion:
We present a comprehensive analysis of MRI findings in clinically significant non-traumatic anterior instability, showing that NBO and ACL grafts predispose in non-traumatic ACL tears, whereas osteoarthritis is the only predictor of pain.
... Whether osteoporosis affects the progression of osteoarthritis of the knee remains controversial. However, the joint space narrowing may not be an ideal parameter to reflect the effect of osteoporosis on the OA knee progression because it can be affected by ligament laxity, meniscus injury, cartilage wearing and especially the weight bearing status [27][28][29][30][31]. The morphologic change of tibial plateau may be a better parameter which has less confounding factors to observe the effect of BMD on OA knee. ...
Abstract Background Although varus inclination of the tibial plateau has increasingly been recognized as a major risk factor in the progression of Osteoarthritis of the knee (OA knee), little attention has been placed on the development of the varus inclination of the tibial plateau. Osteoporosis is a disease characterized by low bone mass and may increase the risk of a stress fracture in the proximal tibia. To date, risk factors for varus inclination of the tibial plateau are rarely reported. In this study, we investigated Bone Mineral Density (BMD) as a risk factor of varus inclination of the tibial plateau in postmenopausal women with advanced OA knee. Methods A total of 90 postmenopausal women with varus OA knee who had received a total knee arthroplasty in our department between January 2016 and December 2019 were reviewed. Certain factors may correlate to inclination of the tibial plateau (Medial Tibial Plateau Angle, MTPA), including age, operation side, Kellgren-Lawrence grade of OA knee, BMD, Body Mass Index (BMI), Lateral Distal Femur Angle (LDFA), lower extremity alignment (Hip-Knee-Ankle angle, HKAA), and history of both spinal compression fracture and hip fracture were collected and analyzed. Results Osteoporosis, lower extremity varus malalignment and age were significantly associated with varus inclination of the tibial plateau (MTPA) (P = 0.15, 0.013 and 0.033 respectively). For patients with a lower extremity varus malalignment (HKAA
... Previous studies revealed associations between 2D JSW and pain. [10][11][12] However, lower baseline minimum 2D JSW was not associated with physical performance measures, such as walking pace or repeat chair stand time. 12 One factor that may contribute to the lack of association with physical function is error in measurement of JSW due to bony overlap on plain radiography obscuring the edges of the joint margin. ...
Limitations of plain radiographs may contribute to poor sensitivity in the detection of knee osteoarthritis and poor correlation with pain and physical function. 3D joint space width, measured from weight bearing CT images, may yield a more accurate correlation with patients' symptoms. We assessed the cross‐sectional association between 3D joint space width and self‐reported pain and physical function. 528 knees (57% women) were analyzed from Multicenter Osteoarthritis Study participants. An upright weight bearing CT scanner was used to acquire bilateral, weight‐bearing fixed‐flexion images of the knees. A 3D dataset was reconstructed from cone beam projections and joint space width was calculated across the joint surface. The percentages of the apposed medial tibiofemoral joint surface with joint space width <2.0mm and <2.5mm respectively were calculated. Pain and physical function were measured using Western Ontario and McMaster Universities Osteoarthritis Index. Participants who reported greater pain severity tended to have a greater joint area with joint space width <2.0mm (p=.07 for the highest vs. the lowest tertile). Participants who reported greater functional limitations had a greater joint area with joint space width <2.0mm (p=.02 for the highest vs. the lowest tertile). There appears to be an association between the medial tibiofemoral area with joint space width <2.0mm and pain and physical function. This article is protected by copyright. All rights reserved.
... Однако критерии ACR обеспечивают лишь в 91 % чувствительность и в 86 % специфичность метода [47,57] для умеренно выраженного и терминального ГА. Таким образом, предложенные критерии не могут быть использованы на ранних стадиях ОА коленных суставов, когда предложенные рентгенологические симптомы отсутствуют [58,59,60]. С этих позиций перспективным представляется магнитно-резонансная диагностика гонартроза. ...
The paper discusses the etiology, pathogenesis, pathomorphology and pathophysiology of osteoarthritis of large joints from the perspective of evidencebased
medicine. The processes occurring in the tissues of the joints during the development of the pathological process at various stages are described
in detail; the features of diagnosis and treatment in sports medicine are described in detail. The characteristic of drugs used to treat osteoarthritis is
described, with a description of the positive effect and negative effect on particular organs and systems. A preparation Alflutop was comprehensively
analysed regarding its effectiveness in terms of safety and impact on the development of the pathological process. It was shown that Alflutop is a drug
of choice in the treatment of joint destruction.
... Тем не менее нельзя исклю-чить, что явные структурные изменения сустава вызывают более выраженные биомеханические нарушения и усили-вают негативное влияние механического стресса, испыты-ваемого пораженным суставом [29]. Взаимосвязь между выраженными рентгенологическими изменениями по K/L ииинтенсивностью суставной боли отмечена в ряде исследо-ваний [30,31]. Несомненно, значительное повреждение ткани сустава (которое косвенно отражает рентгенологиче-ская стадия) будет замедлять разрешение воспаления и ре-паративные процессы, а значит, негативно влиять на результаты лечения. ...
There are factors that can affect the effectiveness of treatment of osteoarthritis (OA). Aim to identify factors affecting the effectiveness of long - term analgesic therapy in OA. Materials and methods. The study included 6448 patients (70.9% female and 29.1% male), middle age 57.8±10.2 years, with severe pain [≥40 mm on the visual analog scale]. All patients received the preparation of avocado - soybean unsaponifiables (ASU) 300 mg/day. For pain relief at the beginning and during the study, the drug Ketoprofen lysine salt (KLS) 320 mg/day was used. The efficiency criterion was pain reduction ≥50% and satisfaction with treatment ≥4 on a 5-point scale. The influence of a number of factors on the result of treatment was evaluated. Results. For 3 months of treatment, the pain decreased from 63.7±12.0 to 14.2±11.7 mm VAS. The result was evaluated as "good" or "excellent" 81.7% of patients. Adverse reactions were rare. In total, a good response to therapy was noted in 87.4% of patients. Gender, body mass index ≥30 kg/m2, type 2 diabetes mellitus, poor effect of non - steroidal anti - inflammatory drugs (NSAIDs) and Symptomatic Slow-Acting Drugs in Osteoarthritis (SYSADOA) in history did not affect the result. The effect was lower in persons >65 years [odds ratio (OR) 0.418; 95% confidence interval (CI) 0.342-0.509, p2 by Kellgren-Lawrence (OR 0.556; 95% CI 0.298-0.738, p
... 3,21 The loss of hoop strain by MMPRTs leads to a physiological state equivalent to total meniscectomy and can accelerate the process of degenerative arthritis with meniscal extrusion. 11,15 Many studies have shown that MMPRTs are associated with osteoarthritis, but the most precipitating factor is unclear, 5,28 and debate about the associative factors and treatment strategy of MMPRTs is ongoing. 1,4,6,8,[18][19][20]26 Recently, 1 study 21 attempted to identify meniscal root tears according to tear morphology through an arthroscopic examination. ...
Background
Degenerative medial meniscus posterior root tears (MMPRTs) are reportedly associated with medial compartment osteoarthritis and meniscal extrusion with a displaced gap from the root insertion. However, degenerative MMPRTs have not yet been clearly classified according to arthroscopic findings.
Purpose
To classify degenerative MMPRTs according to the tear gap and to investigate how the classification could reflect the joint condition properly.
Study Design
Cohort study; Level of evidence, 3.
Methods
Patients who underwent arthroscopic surgery, performed by a single orthopaedic surgeon, for degenerative MMPRTs between August 2006 and February 2017 were included. MMPRTs were classified according to tear patterns observed during arthroscopic surgery (type 1, incomplete root tear; types 2-5, complete root tears), with each type further divided by the size of the tear gap, defined as the degree of tear displacement from the root (type 2, no gap or overlapped; type 3, gap of 1-3 mm; type 4, gap of 4-6 mm; type 5, gap of ≥7 mm). We compared preoperative factors, including the Kellgren-Lawrence (K-L) grade, absolute extrusion, relative percentage of extrusion (RPE), tear gap on magnetic resonance imaging (MRI), and mechanical alignment, as well as intraoperative factors, including chondral wear at surgery, between each MMPRT type.
Results
A total of 116 root tears were categorized according to this classification: type 1, 16.4% (19 knees); type 2, 9.5% (11 knees); type 3, 40.5% (47 knees); type 4, 25.0% (29 knees); and type 5, 8.6% (10 knees). Chondral wear of the medial femoral condyle (MFC) (P = .001), K-L grade (P = .001), meniscal extrusion (P = .001), and tear gap on MRI (P = .001) showed a tendency to increase with a higher tear type. Chondral wear (ρ for MFC = 0.388; ρ for MTP = 0.311), K-L grade (ρ = 0.390), and meniscal extrusion (ρ for absolute extrusion = 0.500; ρ for RPE = 0.451) showed a moderate correlation with tear type, whereas tear gap on MRI (ρ = 0.907) showed a strong correlation with tear type.
Conclusion
Our study introduces a new classification based on the tear gap that can concisely describe a degenerative MMPRT. The classification system demonstrated that a higher tear type (increasing displacement of the tear gap in arthroscopic surgery) is associated with higher meniscal extrusion, severe chondral wear, and greater severity of arthritis.
