Applied Sciences

Editorial

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2 pages, 167 KiB

Open AccessEditorial

Special Issue on Biomechanical and Biomedical Factors of Knee Osteoarthritis

by Hanatsu Nagano

Appl. Sci. 2022, 12(22), 11807; https://doi.org/10.3390/app122211807 - 20 Nov 2022

Cited by 1 | Viewed by 1211

Abstract

Knee osteoarthritis (OA) is a prevalent condition with up to 30–40% lifetime risk [...] Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

Research

Jump to: Editorial, Review, Other

21 pages, 7472 KiB

Open AccessArticle

A Computer-Assisted Approach Regarding the Optimization of the Geometrical Planning of Medial Opening Wedge High Tibial Osteotomy

by Ileana Ioana Cofaru, Mihaela Oleksik, Nicolae Florin Cofaru, Andrei Horia Branescu, Adrian Haşegan, Mihai Dan Roman, Sorin Radu Fleaca and Robert Daniel Dobrotă

Appl. Sci. 2022, 12(13), 6636; https://doi.org/10.3390/app12136636 - 30 Jun 2022

Cited by 2 | Viewed by 1679

Abstract

Opening wedge high tibial osteotomy (OWHTO) is a surgical procedure often used to eliminate the effects of knee osteoarthritis, a disease that is becoming more widespread worldwide. Optimizing the geometric planning of this operation is a very important preparatory step for the success [...] Read more.

Opening wedge high tibial osteotomy (OWHTO) is a surgical procedure often used to eliminate the effects of knee osteoarthritis, a disease that is becoming more widespread worldwide. Optimizing the geometric planning of this operation is a very important preparatory step for the success of the intervention and rapid postoperative recovery. This optimization is performed in two main directions. The first direction evaluates the intraoperative behavior of the tibia during the osteotomy by optimizing four geometric parameters that characterize geometric planning. The second direction aims at a postoperative evaluation of the flat tibia-osteosynthesis assembly taking into account the optimal position on the medial–lateral articular line through which the corrected mechanical axis of the tongue passes and implicitly offloads the transfer from the medial area to the side of the knee. The research methods used are exclusively computer-assisted such as: computer-aided design (hereinafter CAD) for geometric modeling of the tibia taking into account the real bone structure, the finite element method (hereinafter FEM) for performing numerical analyses and design of the experiment (hereinafter DOE) for the design of the research. The results obtained are eloquent and clearly presented and can be important elements for orthopedic doctors at the geometric planning stage of the OWHTO. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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17 pages, 2947 KiB

Open AccessArticle

Unjumbling Procedure in the Algorithmic Analysis of Biomechanical Torques Induced by Electrical Stimulation: Case Study of the Lower Limb

by Matthew J. Taylor, Ché Fornusek, Philip de Chazal and Andrew J. Ruys

Appl. Sci. 2022, 12(11), 5711; https://doi.org/10.3390/app12115711 - 3 Jun 2022

Viewed by 1586

Abstract

Functional Electrical Stimulation (FES) uses electrical pulses to cause muscles to contract synthetically. When muscles contract due to stimulation, torques are produced around joints attached to the muscle. It is important to understand torques being produced, for reasons such as safety and indirect [...] Read more.

Functional Electrical Stimulation (FES) uses electrical pulses to cause muscles to contract synthetically. When muscles contract due to stimulation, torques are produced around joints attached to the muscle. It is important to understand torques being produced, for reasons such as safety and indirect fatigue measurement. Given the translatability of FES devices into the home for therapy, having ways to non-invasively measure muscle responses to stimulation is essential for understanding and diagnosing the biomechanical response of the human body. Here, we present data from a stimulation experiment examining knee joint torques (KJTs) arising when quadriceps are subjected to electrical stimulation. A novel algorithm for computing and summarizing KJT data into a series of simplified parameters was developed using MATLAB software. From this, we draw some conclusions about the effect of changing the stimulation duty cycle on the resultant KJT. We believe this method will provide researchers with a tool to measure torque in a semi-automated, convenient fashion. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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15 pages, 3898 KiB

Open AccessArticle

Computational Wear Prediction of TKR with Flatback Deformity during Gait

by Hye Kyeong Lee, Sung Min Kim and Hong Seok Lim

Appl. Sci. 2022, 12(7), 3698; https://doi.org/10.3390/app12073698 - 6 Apr 2022

Cited by 6 | Viewed by 2119

Abstract

Loss of lumbar lordosis in flatback patients leads to changes in the walking mechanism like knee flexion. Such variations in flatback patients are predicted to alter the characteristics of total knee replacement (TKR) contact, so their TKR will show different wear characteristics with [...] Read more.

Loss of lumbar lordosis in flatback patients leads to changes in the walking mechanism like knee flexion. Such variations in flatback patients are predicted to alter the characteristics of total knee replacement (TKR) contact, so their TKR will show different wear characteristics with a normal gait. However, the relevant study is limited to predicting the wear depth of TKR for normal gait mechanisms or collecting and analyzing kinematic data on flatback gait mechanisms. The objective of this study was to compare wear in TKR of flatback patients with people without flatback syndrome. The main difference between the normal gait mechanism and the flat back gait mechanism is the knee flexion remain section and the tendency to change the vertical force acting on the knee. Thus, in this paper, A finite element-based computational wear simulation for the gait cycle using kinematic data for normal gait and flat gait were performed, and substituting the derived contact pressure and slip distance into the Archard formula, a proven wear model, wear depth was predicted. The FE analysis results show that the wear volume in flatback patients is greater. The results obtained can provide guidance on the TKR design to minimize wear on the knee implant for flatback patients. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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12 pages, 5898 KiB

Open AccessArticle

Central vs. Peripheral Vision during a Singe-Leg Drop Jump: Implications of Dynamics and Patellofemoral Joint Stress

by Junyoung Ko, Kyeongtak Song, Hoon Kim, Sae Yong Lee and Jihong Park

Appl. Sci. 2022, 12(5), 2599; https://doi.org/10.3390/app12052599 - 2 Mar 2022

Cited by 2 | Viewed by 2643

Abstract

Landing on a single-leg without receiving direct visual information (e.g., not looking at the ground) may increase the risk of injury. We examined whether visual focus contributed to the changing lower-extremity dynamics and patellofemoral joint stress during a single-leg drop jump task. Twenty [...] Read more.

Landing on a single-leg without receiving direct visual information (e.g., not looking at the ground) may increase the risk of injury. We examined whether visual focus contributed to the changing lower-extremity dynamics and patellofemoral joint stress during a single-leg drop jump task. Twenty healthy volunteers visited the laboratory for three separate sessions. During each session, participants randomly performed either of two types of a single-leg drop jump task from a 30 cm high wooden box. Subsequently, participants looked at the landing spot (central vision condition) or kept their heads up (peripheral vision condition) when performing the task. Sagittal and frontal plane lower-extremity joint angles and joint moments (in the ankle, knee, and hip), including the vertical ground reaction force, and patellofemoral joint stress during the first landing phase (from initial contact to peak knee flexion) were compared. Greater ankle inversion and hip adduction were observed when landing with the peripheral vision condition. However, the magnitudes were negligeable (Cohen’s d effect size <0.35). No statistical difference was observed in other comparisons. Landing on a single-leg from a 30 cm height without receiving full visual attention (peripheral vision condition) does not increase the risk of lower-extremity traumatic and overuse injuries. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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16 pages, 3246 KiB

Open AccessArticle

Geometrical Planning of the Medial Opening Wedge High Tibial Osteotomy—An Experimental Approach

by Nicolae Florin Cofaru, Valentin Oleksik, Ileana Ioana Cofaru, Carmen Mihaela Simion, Mihai Dan Roman, Ioana Codruta Lebada and Sorin Radu Fleaca

Appl. Sci. 2022, 12(5), 2475; https://doi.org/10.3390/app12052475 - 27 Feb 2022

Cited by 2 | Viewed by 4360

Abstract

This article presents an experimental approach to the geometrical planning of the medial opening wedge high tibial osteotomy surgery which, as it is known, is an efficient surgical strategy quite widely used in treating knee osteoarthritis. While most of the published papers focus [...] Read more.

This article presents an experimental approach to the geometrical planning of the medial opening wedge high tibial osteotomy surgery which, as it is known, is an efficient surgical strategy quite widely used in treating knee osteoarthritis. While most of the published papers focus on analyzing this surgery from a medical point of view, we suggest a postoperative experimental evaluation of the intervention from a biomechanical point of view. The geometrical planning and, more specifically, the determination of the point of intersection between the corrected mechanical axis and the medial-lateral articular line of the knee, is a problem quite often debated in literature. This paper aims to experimentally investigate the behavior of the tibia with an open wedge osteotomy fixed with a locking plate, TomoFix (DE Puy Synthes), taking into account two positions of the mechanical axis of the leg on the width of the tibial plateau, measured from medial to lateral at 50% and 62.5% (Fujisawa point), respectively. The variations of the force relative to the deformation, strains, and displacements resulting from the progressive loading of the tibial plateau are studied. The research results reveal that using the Fujisawa point is better for conducting the correction not only for medical reasons, but also from a mechanical point of view. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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8 pages, 1105 KiB

Open AccessArticle

Effect of an Innovative Biofeedback Insole on Patient Rehabilitation after Total Knee Arthroplasty

by Gianluca Castellarin, Michele Merlini, Giulia Bettinelli, Raffaella Riso, Edoardo Bori and Bernardo Innocenti

Appl. Sci. 2022, 12(5), 2456; https://doi.org/10.3390/app12052456 - 26 Feb 2022

Cited by 4 | Viewed by 2398

Abstract

Partial weight bearing is fundamental to rehabilitation in the early stages following lower limb surgery. However, it remains debated as to how to properly achieve partial weight bearing while avoiding complications from excessive or premature load. Of the devices currently on the market, [...] Read more.

Partial weight bearing is fundamental to rehabilitation in the early stages following lower limb surgery. However, it remains debated as to how to properly achieve partial weight bearing while avoiding complications from excessive or premature load. Of the devices currently on the market, instrumented insoles coupled with force-sensitive resistors (FSRs) are among the best options in today’s clinical practice. Still, although several of these systems have been developed in the last few years, only some have been validated, leaving insufficient information on their application in rehabilitation after total knee replacement (TKR). To address this research gap, we evaluated the performance of an innovative biofeedback insole system featuring an extremely low response time for real-time force feedback. We randomly recruited 30 patients who underwent total knee arthroplasty. All patients used the new programmable insole for partial weight bearing per post-operative rehabilitation protocol. Our results confirm their inability to perform a correct gait with low partial weight bearing (<30–50% of their bodyweight). Partial weight bearing with a correct gait in the post-operative period is not obtainable without a measuring system. This new biofeedback insole is thus one of the most indicated and can improve rehabilitation compliance, therefore allowing continual patient monitoring for faster discharge and fast-track rehabilitation. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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16 pages, 6922 KiB

Open AccessArticle

Biomechanical Analysis of Staples for Epiphysiodesis

by Karel Frydrýšek, Daniel Čepica, Tomáš Halo, Ondřej Skoupý, Leopold Pleva, Roman Madeja, Jana Pometlová, Monika Losertová, Jan Koutecký, Pavel Michal, Vojtěch Havlas, Šimon Kraus, Dominik Ďurica, Kateřina Peterek Dědková, Marek Pagáč, Pavel Krpec and Paweł Osemlak

Appl. Sci. 2022, 12(2), 614; https://doi.org/10.3390/app12020614 - 9 Jan 2022

Cited by 5 | Viewed by 5497

Abstract

Limb asymmetry can, and often does, cause various health problems. Blount bone staples (clips) are used to correct such uneven growth. This article analyzes the performance of a biomechanical staple during bone (tibia) growth arrest. The staples considered in this study were made [...] Read more.

Limb asymmetry can, and often does, cause various health problems. Blount bone staples (clips) are used to correct such uneven growth. This article analyzes the performance of a biomechanical staple during bone (tibia) growth arrest. The staples considered in this study were made of 1.4441 stainless steel, the model of tibia consisted of two materials representing corticalis and spongiosis. Hooke’s law was used for modeling materials’ behaviors for finite element analysis (FEA). The maxima of stress and total staple displacement were evaluated using the finite element method and verification of the results, along with the determination of the maximum loading (growing) force that the staples are capable of withstanding, was performed experimentally. The presented method can be used to determine the safety and usability of staples for bone growth arrest. According to our results, the design of Blount staples considered in this paper is safe and suitable for orthopedic treatment. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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14 pages, 2157 KiB

Open AccessArticle

Estimation of Tibiofemoral and Patellofemoral Joint Forces during Squatting and Kneeling

by Ulrich Glitsch, Kai Heinrich and Rolf Peter Ellegast

Appl. Sci. 2022, 12(1), 255; https://doi.org/10.3390/app12010255 - 28 Dec 2021

Cited by 1 | Viewed by 4307

Abstract

This study examined the differences of knee joint forces between lowering to, or rising from squat, and typical final postures of squatting and kneeling. A biomechanical model of the lower limb was configured considering large knee flexion angles, multiple floor contact points, and [...] Read more.

This study examined the differences of knee joint forces between lowering to, or rising from squat, and typical final postures of squatting and kneeling. A biomechanical model of the lower limb was configured considering large knee flexion angles, multiple floor contact points, and the soft tissue contact between the thigh and calf. Inverse dynamics were used to determine muscle and compressive joint forces in the tibiofemoral and patellofemoral joints. Data were obtained from a group of 13 male subjects by means of 3D motion capturing, two force plates, a pressure-sensitive pad, and electromyography. During lowering into the kneeling/squatting positions and rising from them, the model exhibited the anticipated high maximum forces of 2.6 ± 0.39 body weight (BW) and 3.4 ± 0.56 BW in the tibiofemoral and patellofemoral joints. Upon attainment of the static terminal squatting and kneeling positions, the forces fell considerably, remaining within a range of between 0.5 and 0.7 BW for the tibiofemoral joint and 0.9 to 1.1 BW for the patellofemoral joint. The differences of the knee joint forces between the final postures of squatting and kneeling remained on average below 0.25 BW and were significant only for the tibiofemoral joint force. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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19 pages, 2201 KiB

Open AccessArticle

Associations of Urinary Collagen II Neoepitope C2C with Total Knee Replacement Outcomes: Is OA a Systemic Disease in Rapidly Progressive Cases?

by Liisa Kuhi, Ann E. Tamm, Jaanika Kumm, Kristel Järv, Aare Märtson, Agu O. Tamm and Kalle Kisand

Appl. Sci. 2022, 12(1), 164; https://doi.org/10.3390/app12010164 - 24 Dec 2021

Cited by 4 | Viewed by 2575

Abstract

The objective of this study was to investigate the dynamics of the urinary collagen type II C-terminal cleavage neoepitope (uC2C) before and after total knee replacement (TKR) in rapid knee OA progressors. C2C in the urine was measured by IBEX-uC2C assay in 86 [...] Read more.

The objective of this study was to investigate the dynamics of the urinary collagen type II C-terminal cleavage neoepitope (uC2C) before and after total knee replacement (TKR) in rapid knee OA progressors. C2C in the urine was measured by IBEX-uC2C assay in 86 patients (mean age: 59.9 years) with symptomatic knee OA (kOA) undergoing TKR, assessed before surgery and 3 and 12 months after. The patients’ condition was determined by self-assessment questionnaires, by lower limb performance tests, and by radiography. In the preoperative period, the uC2C level was significantly higher in females than in males, and was associated with the radiographic severity of kOA. A weak correlation between the C2C and knee pain was observed in the whole group and in males, but not in females. The individual dynamics of uC2C after TKR were heterogenic. In general, uC2C increased three months after TKR, but fell to the preoperative level after 12 months. A higher preoperative uC2C implied the tendency to diminish as a result of TKR, and vice versa. TKR did not stop the degradation of Coll2 in the tissues in the majority of cases. The pre-TKR uC2C predicts the postoperative uC2C level. The uC2C dynamic seems to be sex-specific, so it could be considered a prospective pre- and post-TKR biomarker for progressive kOA. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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10 pages, 19496 KiB

Open AccessArticle

Healthy Knee Kinematic Phenotypes Identification Based on a Clustering Data Analysis

by Neila Mezghani, Rayan Soltana, Youssef Ouakrim, Alix Cagnin, Alexandre Fuentes, Nicola Hagemeister and Pascal-André Vendittoli

Appl. Sci. 2021, 11(24), 12054; https://doi.org/10.3390/app112412054 - 17 Dec 2021

Cited by 4 | Viewed by 2580

Abstract

The purpose of this study is to identify healthy phenotypes in knee kinematics based on clustering data analysis. Our analysis uses the 3D knee kinematics curves, namely, flexion/extension, abduction/adduction, and tibial internal/external rotation, measured via a KneeKG™ system during a gait task. We [...] Read more.

The purpose of this study is to identify healthy phenotypes in knee kinematics based on clustering data analysis. Our analysis uses the 3D knee kinematics curves, namely, flexion/extension, abduction/adduction, and tibial internal/external rotation, measured via a KneeKG™ system during a gait task. We investigated two data representation approaches that are based on the joint analysis of the three dimensions. The first is a global approach that is considered a concatenation of the kinematic data without any dimensionality reduction. The second is a local approach that is considered a set of 69 biomechanical parameters of interest extracted from the 3D kinematic curves. The data representations are followed by a clustering process, based on the BIRCH (balanced iterative reducing and clustering using hierarchies) discriminant model, to separate 3D knee kinematics into homogeneous groups or clusters. Phenotypes were obtained by averaging those groups. We validated the clusters using inter-cluster correlation and statistical hypothesis tests. The simulation results showed that the global approach is more efficient, and it allows the identification of three descriptive 3D kinematic phenotypes within a healthy knee population. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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8 pages, 5123 KiB

Open AccessArticle

Correlation of Kinematics and Kinetics of Changing Sagittal Plane Body Position during Landing and the Risk of Non-Contact Anterior Cruciate Ligament Injury

by Mahgolzahra Kamari, Randeep Rakwal, Takuya Yoshida, Satoru Tanigawa and Seita Kuki

Appl. Sci. 2021, 11(17), 7773; https://doi.org/10.3390/app11177773 - 24 Aug 2021

Cited by 2 | Viewed by 2228

Abstract

Anterior cruciate ligament (ACL) injury is one of the most common knee injuries that negatively affect athletes’ future performance and return to play. The purpose of this study was to examine the correlation of kinematics and kinetics of changing sagittal plane body position [...] Read more.

Anterior cruciate ligament (ACL) injury is one of the most common knee injuries that negatively affect athletes’ future performance and return to play. The purpose of this study was to examine the correlation of kinematics and kinetics of changing sagittal plane body position during landing and the risk of non-contact ACL injury. Seven university female (age 19.57

\pm

0.79 y, height 164.21

\pm

8.11 m, weight 60.43

\pm

5.99 kg) athletes playing soccer and handball, and with

\geq

two years of training volunteered for this research. Three trunk positions: Lean Forward Landing (LFL), Self-selected Landing (SSL), and Upright Landing (URL)—via double/single-leg landing—were captured by a high-speed VICON motion capture system. A 3 × 2 two-way within-subjects ANOVA and Multiple Bonferroni corrected pairwise were used to test for condition (LFL, SSL, URL) and task (single/double-leg) effects (p

\leq

0.05

). The findings indicated that landing with a deeper knee flexion angle (LFL) would lead to smaller impact forces when compared to upright landing. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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13 pages, 1891 KiB

Open AccessArticle

Kinect Azure–Based Accurate Measurement of Dynamic Valgus Position of the Knee—A Corrigible Predisposing Factor of Osteoarthritis

by Ádám Uhlár, Mira Ambrus, Márton Kékesi, Eszter Fodor, László Grand, Gergely Szathmáry, Kristóf Rácz and Zsombor Lacza

Appl. Sci. 2021, 11(12), 5536; https://doi.org/10.3390/app11125536 - 15 Jun 2021

Cited by 16 | Viewed by 4603

Abstract

(1) Dynamic knee valgus is a predisposing factor for anterior cruciate ligament rupture and osteoarthritis. The single-leg squat (SLS) test is a widely used movement pattern test in clinical practice that helps to assess the risk of lower-limb injury. We aimed to quantify [...] Read more.

(1) Dynamic knee valgus is a predisposing factor for anterior cruciate ligament rupture and osteoarthritis. The single-leg squat (SLS) test is a widely used movement pattern test in clinical practice that helps to assess the risk of lower-limb injury. We aimed to quantify the SLS test using a marker-less optical system. (2) Kinect validity and accuracy during SLS were established by marker-based OptiTrack and MVN Xsens motion capture systems. Then, 22 individuals with moderate knee symptoms during sports activities (Tegner > 4, Lysholm > 60) performed SLS, and this was recorded and analyzed with a Kinect Azure camera and the Dynaknee software. (3) An optical sensor coupled to an artificial-intelligence-based joint recognition algorithm gave a comparable result to traditional marker-based motion capture devices. The dynamic valgus sign quantified by the Q-angle at the lowest point of the squat is highly dependent on squat depth, which severely limits its comparability among subjects. In contrast, the medio-lateral shift of the knee midpoint at a fixed squat depth, expressed in the percentage of lower limb length, is more suitable to quantify dynamic valgus and compare values among individual patients. (4) The current study identified a new and reliable way of evaluating dynamic valgus of the knee joint by measuring the medial shift of the knee-over-foot at a standardized squat depth. Using a marker-less optical system widens the possibilities of evaluating lower limb functional instabilities for medical professionals. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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11 pages, 1067 KiB

Open AccessFeature PaperArticle

Training and Detraining Effects of a Rehabilitation Program with or without Electro-Cryotherapy in Patients with Anterior Knee Pain: A Randomized Trial

by Yuyeon Roh and Jihong Park

Appl. Sci. 2021, 11(11), 4812; https://doi.org/10.3390/app11114812 - 24 May 2021

Cited by 1 | Viewed by 2429

Abstract

We investigated the effect of ten-sessions (with or without receiving modalities) of training and 4-weeks of detraining in individuals with anterior knee pain (AKP). Thirty patients with AKP (19 males; 11 females; pain duration: 46 months) were randomly assigned to either a rehabilitation [...] Read more.

We investigated the effect of ten-sessions (with or without receiving modalities) of training and 4-weeks of detraining in individuals with anterior knee pain (AKP). Thirty patients with AKP (19 males; 11 females; pain duration: 46 months) were randomly assigned to either a rehabilitation program (with or without pre-exercise modality). Quadriceps (strength, activation, power, and endurance) and self-reported functions (pain perception and functional outcomes) were recorded pre- and post-rehabilitation and detraining (4-weeks). The application of electro-cryotherapy did not produce a summative effect on quadriceps or self-reported functions (condition × time: F_2,56 < 2.27, p > 0.11 for all tests). Regardless of the modality application (time effect), quadriceps (strength: 12%, p = 0.06; power: 20%, p = 0.006; endurance: 13%, p = 0.0002) and self-reported (pain perception during daily activities: −70%, p < 0.0001; at least: −44%, p = 0.04; at worst: −43%, p < 0.0001; functional outcome scores: 13%, p = 0.0003) functions improved after ten sessions of rehabilitation. The improved values were maintained after 4-weeks of detraining, but functional outcome scores showed an 8% further increase (p = 0.02). Regardless of electro-cryotherapy application prior to voluntary exercises at each session, quadriceps and self-reported function improved after ten sessions of rehabilitation for AKP. Improved functioning lasted throughout a 4-week detraining period. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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12 pages, 7779 KiB

Open AccessArticle

Bone Marrow Aspirate Concentrate Is More Effective Than Hyaluronic Acid and Autologous Conditioned Serum in the Treatment of Knee Osteoarthritis: A Retrospective Study of 505 Consecutive Patients

by Mohsen Hussein, Carola F. van Eck and Nevenka Kregar Velikonja

Appl. Sci. 2021, 11(7), 2932; https://doi.org/10.3390/app11072932 - 25 Mar 2021

Cited by 3 | Viewed by 3425

Abstract

The aim of this study was to evaluate and compare the effectiveness of three different intra-articular injective treatments: hyaluronic acid (HA), autologous conditioned serum (ACS) and bone marrow aspirate concentrate (BMAC) for the treatment of knee osteoarthritis (OA). A Level III retrospective comparative [...] Read more.

The aim of this study was to evaluate and compare the effectiveness of three different intra-articular injective treatments: hyaluronic acid (HA), autologous conditioned serum (ACS) and bone marrow aspirate concentrate (BMAC) for the treatment of knee osteoarthritis (OA). A Level III retrospective comparative clinical study was performed on 505 consecutive patients treated with HA (n = 171), ACS (n = 222) or BMAC (n = 112) for knee OA. The mean patient age was 52 ± 13 years; 54.5% were males. Collected data included patient demographics, symptoms, visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and radiographic classification of osteoarthritis grade using plain radiographs and advanced imaging. Clinical outcome was assessed at 3 and 12 months post treatment. Significant improvement in VAS and WOMAC was seen for all three treatments at the 3-month follow-up. At 12 months, VAS was improved in all three treatment groups, yet only BMAC sustained the improved WOMAC even in patients with more severe degenerative changes. This study shows that BMAC is more effective than HA and ACS in the treatment of symptomatic knee OA, especially in the patients with more severe degenerative changes. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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12 pages, 678 KiB

Open AccessArticle

Postural Stability and Proprioception Abnormalities in Patients with Knee Osteoarthritis

by Luciana Labanca, Giuseppe Barone, Stefano Zaffagnini, Laura Bragonzoni and Maria Grazia Benedetti

Appl. Sci. 2021, 11(4), 1469; https://doi.org/10.3390/app11041469 - 5 Feb 2021

Cited by 9 | Viewed by 3466

Abstract

Knee osteoarthritis (OA) leads to the damage of all joint components, with consequent proprioceptive impairment leading to a decline in balance and an increase in the risk of falls. This study was aimed at assessing postural stability and proprioception in patients with knee [...] Read more.

Knee osteoarthritis (OA) leads to the damage of all joint components, with consequent proprioceptive impairment leading to a decline in balance and an increase in the risk of falls. This study was aimed at assessing postural stability and proprioception in patients with knee OA, and the relation between the impairment in postural stability and proprioception with the severity of OA and functional performance. Thirty-eight patients with knee OA were recruited. OA severity was classified with the Kellgren–Lawrence score. Postural stability and proprioception were assessed in double- and single-limb stance, in open- and closed-eyes with an instrumented device. Functional performance was assessed using the Knee Score Society (KSS) and the Short Performance Physical Battery (SPPB). Relationships between variables were analyzed. Postural stability was reduced with respect to reference values in double-limb stance tests in all knee OA patients, while in single-stance only in females. Radiological OA severity, KSS-Functional score and SPPB were correlated with greater postural stability impairments in single-stance. Knee OA patients show decreased functional abilities and postural stability impairments. Proprioception seems to be impaired mostly in females. In conclusion, clinical management of patients with OA should include an ongoing assessment and training of proprioception and postural stability during rehabilitation. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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12 pages, 2029 KiB

Open AccessArticle

3D Kinematics and Decision Trees to Predict the Impact of a Physical Exercise Program on Knee Osteoarthritis Patients

by Marwa Mezghani, Nicola Hagemeister, Youssef Ouakrim, Alix Cagnin, Alexandre Fuentes and Neila Mezghani

Appl. Sci. 2021, 11(2), 834; https://doi.org/10.3390/app11020834 - 17 Jan 2021

Cited by 4 | Viewed by 2490

Abstract

Measuring knee biomechanics provides valuable clinical information for defining patient-specific treatment options, including patient-oriented physical exercise programs. It can be done by a knee kinesiography test measuring the three-dimensional rotation angles (3D kinematics) during walking, thus providing objective knowledge about knee function in [...] Read more.

Measuring knee biomechanics provides valuable clinical information for defining patient-specific treatment options, including patient-oriented physical exercise programs. It can be done by a knee kinesiography test measuring the three-dimensional rotation angles (3D kinematics) during walking, thus providing objective knowledge about knee function in dynamic and weight-bearing conditions. The purpose of this study was to assess whether 3D kinematics can be efficiently used to predict the impact of a physical exercise program on the condition of knee osteoarthritis (OA) patients. The prediction was based on 3D knee kinematic data, namely flexion/extension, adduction/abduction and external/internal rotation angles collected during a treadmill walking session at baseline. These measurements are quantifiable information suitable to develop automatic and objective methods for personalized computer-aided treatment systems. The dataset included 221 patients who followed a personalized therapeutic physical exercise program for 6 months and were then assigned to one of two classes, Improved condition (I) and not-Improved condition (nI). A 10% improvement in pain was needed at the 6-month follow-up compared to baseline to be in the improved group. The developed model was able to predict I and nI with 84.4% accuracy for men and 75.5% for women using a decision tree classifier trained with 3D knee kinematic data taken at baseline and a 10-fold validation procedure. The models showed that men with an impaired control of their varus thrust and a higher pain level at baseline, and women with a greater amplitude of internal tibia rotation were more likely to report improvements in their pain level after 6 months of exercises. Results support the effectiveness of decision trees and the relevance of 3D kinematic data to objectively predict knee OA patients’ response to a treatment consisting of a physical exercise program. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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12 pages, 2560 KiB

Open AccessArticle

Analysis of Proteoglycan Content and Biomechanical Properties in Arthritic and Arthritis-Free Menisci

by Johannes Pordzik, Anke Bernstein, Hermann O. Mayr, Sergio H. Latorre, Anastasija Maks, Hagen Schmal and Michael Seidenstuecker

Appl. Sci. 2020, 10(24), 9012; https://doi.org/10.3390/app10249012 - 17 Dec 2020

Cited by 3 | Viewed by 2593

Abstract

Studies on osteoarthritis of the knee have examined isolated aspects of the meniscus biomechanically and histologically, but not the difference between instantaneous modulus (IM) in healthy and diseased samples. The aim of this study is to investigate the difference in the biomechanical behavior [...] Read more.

Studies on osteoarthritis of the knee have examined isolated aspects of the meniscus biomechanically and histologically, but not the difference between instantaneous modulus (IM) in healthy and diseased samples. The aim of this study is to investigate the difference in the biomechanical behavior and proteoglycan content between arthritic and arthritis-free menisci. In addition, the relationship between the biomechanical behavior and proteoglycan content should be investigated. A novel indentation-based method was used, which allows the mapping of the entire meniscus, without damaging it for histological examinations. A total of 26 arthritic and 14 arthritis-free samples were examined in the present study. A Mach-1 Model V500css test machine was used for biomechanical testing. A position grid was placed over each sample allowing all measurements (indentation test and thickness measurements) to be taken at the same position. All sections were then graded for Safranin O staining intensity for proteoglycan content. The maximum applied load of our arthritic samples above the posterior horn was statistically significantly higher (p = 0.01) at 0.02 ± 0.02 N than the maximum applied load of the arthritis-free samples at 0.01 ± 0.01 N. The proteoglycan content of the meniscus, evaluated by the Safranin O score, correlated statistically significantly with the maximum applied load over the entire meniscus (p = 0.04, 95% CI: 0.06–0.71). The present study showed that in the final stage of gonarthritis, the attenuation behavior of the meniscus was significantly lower compared to the arthritis-free knee. The mapping of IM and histological examination of the meniscus showed a direct correlation between changes in proteoglycan content and altered mechanical properties of the meniscus in gonarthritis. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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20 pages, 4718 KiB

Open AccessArticle

Medial Opening Wedge High Tibial Osteotomy in Knee Osteoarthritis—A Biomechanical Approach

by Nicolae Florin Cofaru, Mihai Dan Roman, Ileana Ioana Cofaru, Valentin Stefan Oleksik and Sorin Radu Fleaca

Appl. Sci. 2020, 10(24), 8972; https://doi.org/10.3390/app10248972 - 16 Dec 2020

Cited by 12 | Viewed by 11428

Abstract

This paper provides an analysis from a biomechanical perspective of the medial opening wedge high tibial osteotomy surgery, a medical procedure commonly used in treating knee osteoarthritis. The aim of this research is to improve the analysed surgical strategy by establishing optimal values [...] Read more.

This paper provides an analysis from a biomechanical perspective of the medial opening wedge high tibial osteotomy surgery, a medical procedure commonly used in treating knee osteoarthritis. The aim of this research is to improve the analysed surgical strategy by establishing optimal values for several very important parameters for the geometric planning of this type of surgical intervention. The research methods used are numerical and experimental. We used finite element, a numerical method used to study the intraoperative behavior of the CORA area for different positions of the initiation point of the cut of the osteotomy plane and for different correction angles. We also used an experimental method in order to determine the maximum force which causes the occurrence of cracks or microcracks in the CORA area. This helped us to determine the stresses, the maximum forces, and the force-displacement variations in the hinge area, elements that allowed us to identify the optimal geometric parameters for planning the surgery. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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12 pages, 1308 KiB

Open AccessArticle

by Hanatsu Nagano and Rezaul Begg

Appl. Sci. 2020, 10(24), 8881; https://doi.org/10.3390/app10248881 - 12 Dec 2020

Cited by 6 | Viewed by 3877

Abstract

The prevalence of knee osteoarthritis (OA) increases with ageing and this research aimed to identify gait adaptations that could reduce OA by investigating ageing effects on knee joint biomechanics. Participants were 24 healthy young males (18–35 yrs) and 14 healthy older males (60–75 [...] Read more.

The prevalence of knee osteoarthritis (OA) increases with ageing and this research aimed to identify gait adaptations that could reduce OA by investigating ageing effects on knee joint biomechanics. Participants were 24 healthy young males (18–35 yrs) and 14 healthy older males (60–75 yrs). Three-dimensional motion capture (Optotrak) and walkway-embedded force plates (AMTI) recorded their natural preferred-speed walking and the following parameters were computed: knee adduction moment, knee joint vertical force, foot contact angle, toe-out angle, foot centre of pressure displacement, time to foot flat, step length, step width and double support time. A 2 × 2 (age × limb) repeated measures mixed model analysis of variance design determined main effects and interactions. Pearson’s correlations between knee kinetic parameters and stride phase variables were also calculated. Both knee adduction moment and vertical joint force were larger in the older group. Relative to the young controls, older individuals showed a longer time to foot flat, less toe-out angle and wider steps. Correlation analysis suggested that reduced toe-out angle and increased step width were associated with lower knee adduction moment; furthermore, knee joint vertical force reduced with greater step length. Future research could focus on intervention strategies for managing excessive knee joint stresses to prevent the ageing-related development of knee OA. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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8 pages, 1335 KiB

Open AccessArticle

Gender Differences in Patellar Positions among the Korean Population

by Hyoung-Taek Hong, Yong-Gon Koh, Ji-Hoon Nam, Paul Shinil Kim, Yoon Hae Kwak and Kyoung-Tak Kang

Appl. Sci. 2020, 10(24), 8842; https://doi.org/10.3390/app10248842 - 10 Dec 2020

Cited by 4 | Viewed by 2271

Abstract

The various factors related to the morphometric characteristics of patella make it difficult to produce a standard interpretation of their respective values. A total of 1423 patients participated in this work. The distribution of Insall–Salvati ratios was investigated, and the upper and lower [...] Read more.

The various factors related to the morphometric characteristics of patella make it difficult to produce a standard interpretation of their respective values. A total of 1423 patients participated in this work. The distribution of Insall–Salvati ratios was investigated, and the upper and lower limits of two standard deviations were used to define the patellar alta and baja. An additional method was used, where 2.5% at each end of the distribution was defined as patellar alta and baja. Ratios in the females and males were 0.92 ± 0.14 and 0.87 ± 0.14, respectively. The ratios were considerably higher in females than in males (p < 0.05). Ratios defined for patellar alta and baja were 1.19 and 0.68 for females and 1.13 and 0.58 for males, respectively, when two standard deviations were used. Ratios defined for patellar alta and baja were 1.22 and 0.66 for females and 1.15 and 0.59 for males, respectively, when the extreme 2.5% method was used. No considerable differences in the patellar alta and baja were observed between the two methods. Patellar alta and baja were determined in ratios of more than 1.20 and less than 0.64, respectively. No significant differences in the patellar alta and baja were observed between the genders in the Korean population. Additionally, two standard deviations of the Insall–Salvati index are recommended for defining patellar alta and baja for the Korean population. However, we recommended analyzing the histogram distribution for the population, followed by an analysis of the patellar alta and baja. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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10 pages, 1084 KiB

Open AccessArticle

Energy Absorption Strategies in the Lower Extremities during Double-Leg Landings in Knee Valgus Alignment

by Akihiro Tamura, Kiyokazu Akasaka and Takahiro Otsudo

Appl. Sci. 2020, 10(23), 8742; https://doi.org/10.3390/app10238742 - 7 Dec 2020

Cited by 2 | Viewed by 3098

Abstract

Landing with the knee in a valgus position may alter energy absorption strategies in the lower extremities and increase mechanical stress on the knee joint. We compared the energy absorption strategies in the lower extremities during valgus and varus landings. Seventeen females were [...] Read more.

Landing with the knee in a valgus position may alter energy absorption strategies in the lower extremities and increase mechanical stress on the knee joint. We compared the energy absorption strategies in the lower extremities during valgus and varus landings. Seventeen females were divided into valgus and varus groups. Lower extremity kinetic data were obtained during drop jumps, using a three-dimensional motion analysis system. Negative mechanical work in the lower extremities were calculated during landing. The valgus group exhibited significantly more negative mechanical work at the knee, and less negative mechanical work at the hip, compared with the varus group. However, there was no difference in the negative mechanical work at the ankle between the two groups. Findings suggest that an increased valgus landing reduces the contribution of the hip to energy absorption and is associated with a reciprocal increased contribution by the knee. Hence a knee valgus landing position may be a key biomechanical factor that increases energy absorption in the knee, thereby increasing the risk of injury. Results further indicate that this can be prevented by adopting a knee varus position on landing, which facilitates absorption of the mechanical load at the hip, rather than at the knee. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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11 pages, 1309 KiB

Open AccessArticle

Manual Therapy Versus Closed Kinematic Exercises—The Influence on the Range of Movement in Patients with Knee Osteoarthritis: A Pilot Study

by Krystyna Hejdysz, Jagoda Goślińska, Agnieszka Wareńczak, Joanna Dudzińska, Ewa Adamczyk, Paweł Sip, Jarosław Gośliński, Piotr Owczarek, Adam Woźniak and Przemysław Lisiński

Appl. Sci. 2020, 10(23), 8605; https://doi.org/10.3390/app10238605 - 1 Dec 2020

Cited by 4 | Viewed by 3803

Abstract

Reduced range of motion is one of the main symptoms of knee osteoarthritis. These deficits are believed to have a negative impact on activities of daily living. The aim of the study was to examine how manual therapy and closed-chain kinematic exercises affect [...] Read more.

Reduced range of motion is one of the main symptoms of knee osteoarthritis. These deficits are believed to have a negative impact on activities of daily living. The aim of the study was to examine how manual therapy and closed-chain kinematic exercises affect the range of motion in patients with knee osteoarthritis. Sixty-six patients with knee osteoarthritis were recruited and divided into three groups: manual therapy group, exercise group, and control group. The following parameters were evaluated before and after 10 days of rehabilitation: the range of motion in the open and closed kinematic chain using Orthyo sensors, pain intensity using Visual Analogue Scale (VAS), and the subjective functional assessment in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). The results indicate an increase in the range of motion after manual therapy in the open chain test and an increase in the possible range of motion in the closed chain test in the exercise group. Both study groups showed significant improvement of WOMAC-assessed function and a significant decrease of VAS-assessed pain following rehabilitation. Manual therapy and exercise affect the range of motion in patients with knee osteoarthritis. When examining the range of motion, it is worth taking into account various biomechanical conditions. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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14 pages, 2951 KiB

Open AccessArticle

Short-Term Effects of Arthroscopic Microfracturation of Knee Chondral Defects in Osteoarthritis

by Przemysław Krakowski, Robert Karpiński, Ryszard Maciejewski, Józef Jonak and Andrzej Jurkiewicz

Appl. Sci. 2020, 10(23), 8312; https://doi.org/10.3390/app10238312 - 24 Nov 2020

Cited by 30 | Viewed by 2669

Abstract

Purpose: The purpose of this study was to estimate the effect of platelet-rich plasma (PRP) augmentation in microfractures of chondral lesions in elderly individuals. Methods: 29 patients with knee osteoarthritis were enrolled in the single-blinded randomized study. The study group consisted of 16 [...] Read more.

Purpose: The purpose of this study was to estimate the effect of platelet-rich plasma (PRP) augmentation in microfractures of chondral lesions in elderly individuals. Methods: 29 patients with knee osteoarthritis were enrolled in the single-blinded randomized study. The study group consisted of 16 patients and 13 were in the control group. All surgeries were performed in the same manner. The PRP injection was made in a dry arthroscopy directly over the microfractures. The evaluation was performed preoperatively on the 6th, 12th, and 24th week following the surgery. WOMAC and Lysholm questionnaires were utilized. Results: Microfracturation showed WOMAC improvement in the PRP group (p = 0.0012) and in the control group (p = 0.0042). No statistically significant differences between the two groups (p = 0.698) have been found. Clinical improvement was noted in the first six weeks after which the effect lasted. In addition, Lysholm score showed no significant differences at the end of the follow-up between both groups (p = 0.941). Conclusions: Arthroscopic microfracture improves motor function and reduces pain in patients over 50 years old. PRP augmentation of the procedure is safe, and can accelerate and prolong the therapeutic effect of treatment. Excellent effects of the procedure are observed in the first six weeks, after which the improvement lasts. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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19 pages, 1875 KiB

Open AccessArticle

Effects of Greenshell Mussel (Perna canaliculus) Intake on Pathological Markers of Multiple Phenotypes of Osteoarthritis in Rats

by Parkpoom Siriarchavatana, Marlena C. Kruger, Matthew R. Miller, Hong (Sabrina) Tian and Frances M. Wolber

Appl. Sci. 2020, 10(17), 6131; https://doi.org/10.3390/app10176131 - 3 Sep 2020

Cited by 5 | Viewed by 2969

Abstract

The prevalence of metabolic osteoarthritis has been increasing worldwide, particularly among women. The aim of this study was to investigate the effects of the New Zealand greenshell mussel (Perna canaliculus; GSM) on osteoarthritis (OA) prevention in a rat model. One-hundred-and-eight female [...] Read more.

The prevalence of metabolic osteoarthritis has been increasing worldwide, particularly among women. The aim of this study was to investigate the effects of the New Zealand greenshell mussel (Perna canaliculus; GSM) on osteoarthritis (OA) prevention in a rat model. One-hundred-and-eight female rats aged 12 weeks were divided into four test groups, containing 24 rats each, plus an additional control group. Each test group received one of the four experimental diets: normal control diet (ND), normal control diet supplemented with GSM (ND + GSM), high fat/high sugar diet (HFHS), or high fat/high sugar diet supplemented GSM (HFHS + GSM), for 36 weeks (end of the study). After 8 weeks on experimental diets, half of each group was subjected to ovariectomy (OVX) and the remaining half received a sham operation (ovaries left intact). The study evaluated body composition, bone mass, plasma cytokines, adipokines, HbA1c, CTX-II, and knee joint’s histopathology. HFHS diet and OVX significantly induced body weight gain and leptin production. OVX rats lost bone mineral density but increased adiponectin, HbA1C, and MCP-1. The OVX rats fed HFHS showed the highest Mankin scores. Importantly, inclusion of GSM reduced these pathological features. In conclusion, GSM might be beneficial in halting the progression of OA. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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12 pages, 1835 KiB

Open AccessArticle

Intra-Articular Bone Marrow Aspirate Concentrate Injection in Patients with Knee Osteoarthritis

by Gi Beom Kim, Jae-Do Kim, Young Choi, Chang Hyun Choi and Gun Woo Lee

Appl. Sci. 2020, 10(17), 5945; https://doi.org/10.3390/app10175945 - 27 Aug 2020

Cited by 5 | Viewed by 2941

Abstract

We aimed to evaluate the 5-year follow-up outcomes of an intra-articular bone marrow aspirate concentrate (BMAC) injection in patients with knee osteoarthritis. This is the first study to report the outcomes following BMAC injections over a 5-year follow-up period. Seventy knees of 37 [...] Read more.

We aimed to evaluate the 5-year follow-up outcomes of an intra-articular bone marrow aspirate concentrate (BMAC) injection in patients with knee osteoarthritis. This is the first study to report the outcomes following BMAC injections over a 5-year follow-up period. Seventy knees of 37 patients, including 33 bilateral knees, were investigated. The primary outcome was the visual analogue scale (VAS) score for pain in the knee joint, and the secondary outcomes were the International Knee Documentation Committee score, the 36-Item Short Form Health Survey score, the Knee injury Osteoarthritis Outcome Score, Lysholm Knee Questionnaire/Tegner activity scale, BMAC injection-induced complications, and 5-year treatment success rate. The 5-year post-injection VAS scores (4.7 ± 0.5) were significantly lower than the preoperative scores (8.3 ± 1.2) (p = 0.01). Improvement in VAS scores was significantly greater in patients with Kellgren–Lawrence (K-L) Grade I or II than those in those with K-L Grade III or IV. Improvement in other clinical parameters and success rates were significantly low and the rates of secondary operation and failure were significantly higher in patients with K-L Grades III or IV. Intra-articular BMAC injections could be useful for managing patients with K-L Grades I or II osteoarthritis. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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13 pages, 2102 KiB

Open AccessReview

Developments in Smart Multi-Function Gait Assistive Devices for the Prevention and Treatment of Knee Osteoarthritis—A Literature Review

by Hanatsu Nagano, William Sparrow and Rezaul Begg

Appl. Sci. 2021, 11(22), 10947; https://doi.org/10.3390/app112210947 - 19 Nov 2021

Cited by 3 | Viewed by 4575

Abstract

Knee osteoarthritis (OA) is a degenerative condition that critically affects locomotor ability and quality of life and, the condition is particularly prevalent in the senior population. The current review presents a gait biomechanics conceptual framework for designing active knee orthoses to prevent and [...] Read more.

Knee osteoarthritis (OA) is a degenerative condition that critically affects locomotor ability and quality of life and, the condition is particularly prevalent in the senior population. The current review presents a gait biomechanics conceptual framework for designing active knee orthoses to prevent and remediate knee OA. Constant excessive loading diminishes knee joint articular cartilage and, therefore, measures to reduce kinetic stresses due to the fact of adduction moments and joint compression are an essential target for OA prevention. A powered orthosis enables torque generation to support knee joint motions and machine-learning-driven “smart systems” can optimise the magnitude and timing of joint actuator forces. Although further research is required, recent findings raise the possibility of exoskeleton-supported, non-surgical OA interventions, increasing the treatment options for this prevalent, painful and seriously debilitating disease. Combined with advances in regenerative medicine, such as stem cell implantation and manipulation of messenger ribonucleic acid (m-RNA) transcription, active knee orthoses can be designed to incorporate electro-magnetic stimulators to promote articular cartilage resynthesis. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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12 pages, 3059 KiB

Open AccessReview

Biomechanical Particularities in the Therapy of the Rheumatic Knee

by Christoph Biehl, Martin Heinrich, Lotta Biehl, Gero Knapp, Christian Heiss and Ulrich Thormann

Appl. Sci. 2020, 10(23), 8600; https://doi.org/10.3390/app10238600 - 1 Dec 2020

Cited by 3 | Viewed by 2528

Abstract

In rheumatoid arthritis, the joints of the lower extremities are almost always affected. This is most conspicuous in the knee joint. In rheumatics, inflammatory osteoarthritis manifests itself comparably earlier than in patients with osteoarthritis. The focus of attention was primarily on the synovia [...] Read more.

In rheumatoid arthritis, the joints of the lower extremities are almost always affected. This is most conspicuous in the knee joint. In rheumatics, inflammatory osteoarthritis manifests itself comparably earlier than in patients with osteoarthritis. The focus of attention was primarily on the synovia with its destruction process and secondary changes. Now, driven by experimental research, dendritic cells and fibroblasts and molecular features are moving into the clinician’s field of vision. Even in joints that appear to be in remission with no swelling or pain, the activity of these cells leads to changes in the capsule-ligaments. The complex deformities and instabilities caused by this, in conjunction with atrophy of the inter-articular musculature, have an impact on the activities of daily life (ADL). If these biomechanical aspects of the knee joint are not taken into account early on in therapy, the frequency of primary and secondary surgical treatment increases. The timely recognition of biomechanical pathologies and consistent treatment can contribute to improving the patient situation in addition to adequate medication therapy. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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8 pages, 6305 KiB

Open AccessCase Report

Bilateral Patella Cartilage Debridement and Exercise Rehabilitation for Chondromalacia and Plica Syndrome: A Case Report

by Jihong Park, Jingoo Kim and Bongseong Ko

Appl. Sci. 2021, 11(9), 4078; https://doi.org/10.3390/app11094078 - 29 Apr 2021

Cited by 1 | Viewed by 7563

Abstract

A 41-year-old active (exercising >600 min per week) male without a surgical history complained of nine years of intermittent bilateral anterior knee pain after physical activity. He was diagnosed with bilateral chondromalacia (grade IV chondrosis) with plica syndrome, for which he underwent bilateral [...] Read more.

A 41-year-old active (exercising >600 min per week) male without a surgical history complained of nine years of intermittent bilateral anterior knee pain after physical activity. He was diagnosed with bilateral chondromalacia (grade IV chondrosis) with plica syndrome, for which he underwent bilateral patella cartilage debridement with medial plica excision (additional removal of lateral retinaculum in the right knee). The patient then performed 12 weeks of an aggressive postoperative rehabilitation program. Each rehabilitation session consisted of disinhibitory modalities (sensory level of transcutaneous electrical stimulation and cryotherapy: focal knee joint cooling and cold-water immersion) and voluntary exercises (aerobic, resistance, and flexibility). During rehabilitation, pain perception, knee joint skin temperature and circumference, and functional outcome measures (Kujala anterior knee pain scale, International Knee Documentation Committee Score, and lower-extremity functional scale) were also recorded. While the patient’s pathology and surgical intervention were not extreme, progressions in the rehabilitation components and functional outcome measures in this clinical case could be used as a future reference for postoperative interventions. Additionally, surgery-induced inflammation seemed to last for four weeks. Full article

(This article belongs to the Special Issue Biomechanical and Biomedical Factors of Knee Osteoarthritis)

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