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Journal of Orthopaedic Surgery and... Dec 2022The management of chondral defects of the patellofemoral joint is debated, and definitive evidence is lacking. This study systematically updated and summarised the... (Review)
Review
BACKGROUND
The management of chondral defects of the patellofemoral joint is debated, and definitive evidence is lacking. This study systematically updated and summarised the current literature on the surgical management of isolated chondral defects of the patellofemoral joint, discussing techniques, outcome, pitfalls, and new frontiers.
METHODS
This systematic review was conducted according to the 2020 PRISMA statement. In August 2022, PubMed, Web of Science, Google Scholar, and Embase databases were accessed with no time constrain. All the clinical studies investigating the surgical management of chondral defects of the patellofemoral joint were retrieved. Articles which reported data on patients with advanced to severe osteoarthritis were not eligible. Only studies with a minimum 24 months follow-up were considered. Studies which mixed results of patellofemoral and tibiofemoral joints were not considered.
RESULTS
Data from 10 studies (692 procedures) were retrieved. The mean follow-up was 46.9 ± 18.2 months. The mean age of the patients was 34.0 ± 6.1 years, and the mean BMI was 25.9 ± 0.8 kg/m. The mean duration of symptoms before the index surgery was 81.0 ± 24.0 months. The mean defect size was 3.8 ± 0.8 cm. All the PROMs improved from baseline to last follow-up: VAS 0-10 (P = 0.04), Tegner (P = 0.02), Lysholm (P = 0.03), and International Knee Documentation Committee (P = 0.03). The rate of hypertrophy was 5.6% (14 of 251), the rate of progression to total knee arthroplasty was 2.4% (2 of 83), the rate of revision was 16.9% (29 of 136), and the rate of failure was 13.0% (16 of 123).
CONCLUSION
Current surgical strategies may be effective to improve symptoms deriving from chondral defects of the patellofemoral joint. The limited and heterogeneous data included for analysis impact negatively the results of the present study. Further clinical studies are strongly required to define surgical indications and outcomes, and the most suitable technique.
Topics: Humans; Adult; Patellofemoral Joint; Cartilage Diseases; Knee Joint; Arthroplasty, Replacement, Knee; Patient Satisfaction; Cartilage, Articular; Transplantation, Autologous
PubMed: 36471319
DOI: 10.1186/s13018-022-03419-4 -
Sensors (Basel, Switzerland) Aug 2023The prevalence of musculoskeletal symptoms (MSS) like neck and back pain is high among open-surgery surgeons. Prolonged working in the same posture and unfavourable...
The prevalence of musculoskeletal symptoms (MSS) like neck and back pain is high among open-surgery surgeons. Prolonged working in the same posture and unfavourable postures are biomechanical risk factors for developing MSS. Ergonomic devices such as exoskeletons are possible solutions that can reduce muscle and joint load. To design effective exoskeletons for surgeons, one needs to quantify which neck and trunk postures are seen and how much support during actual surgery is required. Hence, this study aimed to establish the biomechanical profile of neck and trunk postures and neck and lumbar joint loads during open surgery (training). Eight surgical trainees volunteered to participate in this research. Neck and trunk segment orientations were recorded using an inertial measurement unit (IMU) system during open surgery (training). Neck and lumbar joint kinematics, joint moments and compression forces were computed using OpenSim modelling software and a musculoskeletal model. Histograms were used to illustrate the joint angle and load distribution of the neck and lumbar joints over time. During open surgery, the neck flexion angle was 71.6% of the total duration in the range of 10~40 degrees, and lumbar flexion was 68.9% of the duration in the range of 10~30 degrees. The normalized neck and lumbar flexion moments were 53.8% and 35.5% of the time in the range of 0.04~0.06 Nm/kg and 0.4~0.6 Nm/kg, respectively. Furthermore, the neck and lumbar compression forces were 32.9% and 38.2% of the time in the range of 2.0~2.5 N/kg and 15~20 N/kg, respectively. In contrast to exoskeletons used for heavy lifting tasks, exoskeletons designed for surgeons exhibit lower support torque requirements while additional degrees of freedom (DOF) are needed to accommodate combinations of neck and trunk postures.
Topics: Lumbar Vertebrae; Joints; Posture; Lumbosacral Region; Neck; Biomechanical Phenomena
PubMed: 37571757
DOI: 10.3390/s23156974 -
Journal of Athletic Training Sep 2022Pediatric anterior cruciate ligament (ACL) injury rates are increasing and are highest in female adolescents. Complete ACL tears are typically surgically reconstructed,...
CONTEXT
Pediatric anterior cruciate ligament (ACL) injury rates are increasing and are highest in female adolescents. Complete ACL tears are typically surgically reconstructed, but few guidelines and very limited data exist regarding the need for surgical reconstruction or rehabilitation for partial ACL tears in skeletally immature patients.
OBJECTIVE
To evaluate the effects of partial (anteromedial bundle) and complete ACL transection on joint laxity and tissue forces under anterior and rotational loads in male and female stifle joints throughout skeletal growth in the porcine model.
DESIGN
Descriptive laboratory study.
SETTING
Laboratory.
PATIENTS OR OTHER PARTICIPANTS
We studied 60 male and female Yorkshire crossbreed pigs aged 1.5, 3, 4.5, 6, and 18 months (n = 6 pigs per age per sex).
MAIN OUTCOME MEASURE(S)
Joint laxity was measured in intact, anteromedial bundle-transected, and ACL-transected joints under applied anterior-posterior drawer and varus-valgus torque using a robotic testing system. Loading of the soft tissues in the stifle joint was measured under each condition.
RESULTS
Anterior-posterior joint laxity increased by 13% to 50% (P < .05) after anteromedial bundle transection and 75% to 178% (P < .05) after ACL transection. Destabilization after anteromedial bundle transection increased with age (P < .05) and was greater in late female than late male adolescents (P < .05). In anteromedial bundle-transected joints, the posterolateral bundle resisted the anterior load. In ACL-transected joints, the medial collateral ligament (MCL) contribution was largest, followed by the medial meniscus. The MCL contribution was larger and the medial meniscus contribution was smaller in male versus female specimens.
CONCLUSIONS
Partial ACL transection resulted in moderate increases in joint laxity, with the remaining bundle performing the primary ACL function. Destabilization due to partial ACL transection (anteromedial bundle) was largest in late adolescent joints, indicating that operative treatment should be considered in active, late-adolescent patients with this injury. Increased forces on the MCL and medial meniscus after ACL transection suggested that rehabilitation protocols may need to focus on protecting these tissues.
Topics: Male; Female; Humans; Animals; Swine; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament; Biomechanical Phenomena; Joint Instability; Knee Joint; Cadaver
PubMed: 34964874
DOI: 10.4085/1062-6050-565-21 -
Scientific Reports Nov 2022Stokes's equation in the fluid domain and Brinkman's equation in the porous media are combined in the current study which is designated by the Stokes-Brinkman coupling....
Stokes's equation in the fluid domain and Brinkman's equation in the porous media are combined in the current study which is designated by the Stokes-Brinkman coupling. The current paper gives a theoretical analysis of the Stokes-Brinkman coupling. It has been shown that such a model is a good match for the knee joint. A flow model has been investigated in order to get a better understanding of the convective diffusion of the viscous flow along the articular surfaces between the joints. The Beavers and Joseph slip conditions which are a specific boundary condition for the synovial fluid are used to solve the governing system of partial differential equations for the synovial fluid and the results are provided here. We develop formulas for the interfacial velocity for both flow through special slip condition and analyse the link between the slip parameters [Formula: see text] and [Formula: see text]. Thus, the damping force due to the porous medium naturally when we non-dimensionalize, some parameter which are controlling the structure like, [Formula: see text] and [Formula: see text]. Through the development of an analytical solution and numerical simulation (using the finite volume approach) it is hoped that the mechanisms of nutritional transport into the synovial joint will be better understood. According to the data the average concentration has a negative connection with both the axial distance and the duration spent in the experiment. Many graphs have been utilized to gain understanding into the problem's various characteristics including velocity and concentration, among others. Hyaluronate (HA) is considered to be present in porous cartilage surfaces and the viscosity of synovial fluid fluctuates in response to the amount of HA present.
Topics: Humans; Porosity; Viscosity; Computer Simulation; Knee Joint; Synovial Fluid
PubMed: 36348000
DOI: 10.1038/s41598-022-23402-7 -
Scientific Reports Jul 2022The knowledge gap regarding the topography and anatomy of the dromedary's carpal joint must be bridged to improve diagnostic and treatment procedures such as...
The knowledge gap regarding the topography and anatomy of the dromedary's carpal joint must be bridged to improve diagnostic and treatment procedures such as ultrasonography, arthrocentesis, and arthroscopy. Thirty-five distal forelimbs were harvested from 21 dromedaries and studied through gross dissection, casting, ultrasonography, and computerized tomography. Representative three-dimensional models of the joint cavities, recesses, and pouches were obtained using various casting agents. The safety and feasibility of different arthrocentesis approaches were evaluated. This study provides a detailed description of dorsally located joint recesses and palmarly located joint pouches. The dorsomedial and dorsolateral approach is recommended for arthroscopy and arthrocentesis of the radiocarpal and intercarpal joint when the carpus is flexed. However, caution must be exercised during these approaches to prevent needle injury to the articulating cartilage. Caution is necessary to prevent the formation of inadvertent communication between the dorsally located tendon sheaths and joint cavities. Arthrocentesis via the lateral approach to the lateropalmar pouch is the most favourable approach for the radiocarpal joint. A subtendinous synovial bursa was found between the lateropalmar pouch of the radiocarpal joint and the extensor carpi ulnaris muscle. The subtendinous synovial bursa must be considered during the lateral arthrocentesis approach. The palmar approach is not recommended for arthrocentesis due to the high risk of injury to nerves, veins, and arteries located palmarly.
Topics: Animals; Arthrocentesis; Camelus; Carpal Joints; Forelimb; Wrist Joint
PubMed: 35896772
DOI: 10.1038/s41598-022-16801-3 -
Scientific Reports Oct 2023Irrespective of the exceptional adaptation of dromedaries to harsh environmental conditions, they remain highly susceptible to joint lameness resulting from a range of...
Irrespective of the exceptional adaptation of dromedaries to harsh environmental conditions, they remain highly susceptible to joint lameness resulting from a range of diverse factors and conditions. The joints most often affected by traumatic osteoarthritis in dromedaries are the metacarpophalangeal and metatarsophalangeal joints. A comprehensive understanding of joint anatomy and topography of the dromedary is required to perform arthrocentesis correctly on affected joints. Forty-two distal limbs were taken from 28 camels and studied by gross dissection, casting, ultrasonography, and computed tomography (CT). Representative three-dimensional models of the joint cavities, recesses, and pouches were obtained using different casting agents. This study provides a detailed description of dorsally, axially, and abaxially positioned joint recesses, as well as palmar/plantar positioned joint pouches. The safety and feasibility of the different arthrocentesis approaches were evaluated. The traditional dorsal arthrocentesis approach of the metacarpophalangeal, metatarsophalangeal, proximal interphalangeal, and distal interphalangeal joints, has limitations due to the risk of damaging the tendon structures and articular cartilage, which can lead to joint degeneration. A lateral arthrocentesis approach via the proximal palmar/plantar pouches of the metacarpophalangeal/metatarsophalangeal and proximal interphalangeal joints is recommended. This approach eliminates the potential needle injury to the articulating joint cartilage and other surrounding joint structures, such as tendons, blood vessels, and nerves.
Topics: Animals; Camelus; Arthrocentesis; Forelimb; Joints; Cartilage, Articular; Metatarsophalangeal Joint
PubMed: 37833397
DOI: 10.1038/s41598-023-44391-1 -
Arthritis Research & Therapy Oct 2022X-ray images are commonly used to assess the bone destruction of rheumatoid arthritis. The purpose of this study is to propose an automatic-bone-destruction-evaluation...
BACKGROUND
X-ray images are commonly used to assess the bone destruction of rheumatoid arthritis. The purpose of this study is to propose an automatic-bone-destruction-evaluation system fully utilizing deep neural networks (DNN). This system detects all target joints of the modified Sharp/van der Heijde score (SHS) from a hand X-ray image. It then classifies every target joint as intact (SHS = 0) or non-intact (SHS ≥ 1).
METHODS
We used 226 hand X-ray images of 40 rheumatoid arthritis patients. As for detection, we used a DNN model called DeepLabCut. As for classification, we built four classification models that classify the detected joint as intact or non-intact. The first model classifies each joint independently, whereas the second model does it while comparing the same contralateral joint. The third model compares the same joint group (e.g., the proximal interphalangeal joints) of one hand and the fourth model compares the same joint group of both hands. We evaluated DeepLabCut's detection performance and classification models' performances. The classification models' performances were compared to three orthopedic surgeons.
RESULTS
Detection rates for all the target joints were 98.0% and 97.3% for erosion and joint space narrowing (JSN). Among the four classification models, the model that compares the same contralateral joint showed the best F-measure (0.70, 0.81) and area under the curve of the precision-recall curve (PR-AUC) (0.73, 0.85) regarding erosion and JSN. As for erosion, the F-measure and PR-AUC of this model were better than the best of the orthopedic surgeons.
CONCLUSIONS
The proposed system was useful. All the target joints were detected with high accuracy. The classification model that compared the same contralateral joint showed better performance than the orthopedic surgeons regarding erosion.
Topics: Arthritis, Rheumatoid; Deep Learning; Disease Progression; Humans; Joints; Radiography; Severity of Illness Index
PubMed: 36192761
DOI: 10.1186/s13075-022-02914-7 -
PloS One 2021In joint action literature it is often assumed that acting together is driven by pervasive and automatic process of co-representation, that is, representing the...
In joint action literature it is often assumed that acting together is driven by pervasive and automatic process of co-representation, that is, representing the co-actor's part of the task in addition to one's own. Much of this research employs joint stimulus-response compatibility tasks varying the stimuli employed or the physical and social relations between participants. In this study we test the robustness of co-representation effects by focusing instead on variation in response modality. Specifically, we implement a mouse-tracking version of a Joint Simon Task in which participants respond by producing continuous movements with a computer mouse rather than pushing discrete buttons. We have three key findings. First, in a replication of an earlier study we show that in a classical individual Simon Task movement trajectories show greater curvature on incongruent trials, paralleling longer response times. Second, this effect largely disappears in a Go-NoGo Simon Task, in which participants respond to only one of the cues and refrain from responding to the other. Third, contrary to previous studies that use button pressing responses, we observe no overall effect in the joint variants of the task. However, we also detect a notable diversity in movement strategies adopted by the participants, with some participants showing the effect on the individual level. Our study casts doubt on the pervasiveness of co-representation, highlights the usefulness of mouse-tracking methodology and emphasizes the need for looking at individual variation in task performance.
Topics: Adult; Arm; Choice Behavior; Female; Humans; Joints; Movement; Neuropsychological Tests; Psychomotor Performance; Reaction Time; Young Adult
PubMed: 34965256
DOI: 10.1371/journal.pone.0261735 -
Calcified Tissue International Apr 2023Hereditary hemochromatosis (HH) causes unbalanced iron deposition in many organs including the joints leading to severe cartilage loss and bone damage in the...
Hereditary hemochromatosis (HH) causes unbalanced iron deposition in many organs including the joints leading to severe cartilage loss and bone damage in the metacarpophalangeal joints (MCPJ). High-resolution peripheral quantitative computed tomography (HR-pQCT) and its joint space width (JSW) quantification algorithm quantifies in vivo 3D joint morphology. We therefore aimed to (i) determine feasibility and performance of the JSW algorithm in HH, (ii) quantify joint space morphology, and (iii) investigate the relationship between morphological and clinical parameters in HH. Here, we performed an exploratory study on 24 HH patients and sex- and age-matched controls using HR-pQCT imaging of MCPJ. Mineralized bone structure was automatically segmented from the grayscale image data and periosteal surface bone masks and joint space masks were generated. Mean, minimal, and maximal joint space width (JSW; JSW.MIN; JSW.MAX), JSW heterogeneity (JSW.SD), JSW asymmetry (JSW.AS), and joint space volume (JSV) were computed. Demographics and, for HH patients, disease-specific parameters were recorded. Segmentation of JS was very good with 79.7% of MCPJs successfully segmented at first attempt and 20.3% requiring semi-manual correction. HH men showed larger JSV at all MCPs (+ 25.4% < JSV < + 41.8%, p < 0.05), larger JSW.MAX at MCP 3-4 (+ 14%, 0.006 < p < 0.062), and wider JSW (+ 13%, p = 0.043) at MCP 4 relative to HH women. Compared to controls, both HH men and HH women showed larger JSW.AS and smaller JSW.MIN at all MCP levels, reaching significance for HH men at MCP 2 and 3 (JSW.AS: + 323% < JSW.AS < + 359%, 0.020 < p < 0.043; JSW.MIN: - 216% < JSW.MIN < - 225%, p < 0.043), and for women at MCP 3 (JSW.AS: + 180%, p = 0.025; JSW.MIN: - 41.8%, p = 0.022). Time since HH diagnosis was correlated positively with MCP 4 JSW.AS and JSW.SD (0.463 < ρ < 0.499, p < 0.040), and the number of phlebotomies since diagnosis was correlated with JSW.SD at all MCPs (0.432 < ρ < 0.535, p < 0.050). HR-pQCT-based JSW quantification in MCPJ of HH patients is feasible, performs well even in narrow JS, and allows to define the microstructural joint burden of HH.
Topics: Male; Humans; Female; Hemochromatosis; Hand Joints; Metacarpophalangeal Joint; Tomography, X-Ray Computed; Algorithms
PubMed: 36738308
DOI: 10.1007/s00223-022-01050-3 -
Disease Models & Mechanisms Apr 2021Fetal activity in utero is a normal part of pregnancy and reduced or absent movement can lead to long-term skeletal defects, such as Fetal Akinesia Deformation Sequence,...
Fetal activity in utero is a normal part of pregnancy and reduced or absent movement can lead to long-term skeletal defects, such as Fetal Akinesia Deformation Sequence, joint dysplasia and arthrogryposis. A variety of animal models with decreased or absent embryonic movements show a consistent set of developmental defects, providing insight into the aetiology of congenital skeletal abnormalities. At developing joints, defects include reduced joint interzones with frequent fusion of cartilaginous skeletal rudiments across the joint. At the spine, defects include shortening and a spectrum of curvature deformations. An important question, with relevance to possible therapeutic interventions for human conditions, is the capacity for recovery with resumption of movement following short-term immobilisation. Here, we use the well-established chick model to compare the effects of sustained immobilisation from embryonic day (E)4-10 to two different recovery scenarios: (1) natural recovery from E6 until E10 and (2) the addition of hyperactive movement stimulation during the recovery period. We demonstrate partial recovery of movement and partial recovery of joint development under both recovery conditions, but no improvement in spine defects. The joints examined (elbow, hip and knee) showed better recovery in hindlimb than forelimb, with hyperactive mobility leading to greater recovery in the knee and hip. The hip joint showed the best recovery with improved rudiment separation, tissue organisation and commencement of cavitation. This work demonstrates that movement post paralysis can partially recover specific aspects of joint development, which could inform therapeutic approaches to ameliorate the effects of human fetal immobility. This article has an associated First Person interview with the first author of the paper.
Topics: Animals; Bone Development; Chick Embryo; Embryo, Nonmammalian; Extremities; Joints; Movement; Paralysis
PubMed: 33771841
DOI: 10.1242/dmm.048913