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PubMed1997

Osteoarthritis of the knee in retired, elite Australian Rules footballers.

OBJECTIVE: To determine the functional and radiological status of knee joints of retired Australian Rules footballers compared with those of active community members. DESIGN: Retrospective cohort study. PARTICIPANTS: Fifty retired elite footballers aged 34-85 years (mean, 53.7 years; SD, 11.4) from four AFL clubs and 50 age-matched controls (35-79 years; mean, 55.7 years; SD, 12.4) who had played no contact sport since their teenage years. MAIN OUTCOME MEASURES: Severity of knee functional osteoarthritis as determined by a questionnaire, and assessment of osteoarthritis by posteroanterior weight-bearing radiographs taken of both knees of each participant in 45-degree flexion. RESULTS: After adjusting for age, height, weight and body mass index, footballers had a significantly greater prevalence (P < 0.0001) and severity (P < 0.05) of functional and radiological osteoarthritis than controls. Footballers with a history of intraarticular ligamentous and/or meniscal injury (Group 1) had a greater risk of functional osteoarthritis (P = 0.002) and radiological (P = 0.067) osteoarthritis than those with a history of collateral ligament injury or no injury (Group 2). Compared with controls, the odds of developing moderate to severe levels of functional and radiological osteoarthritis were 6.9 times (95% CI, 1.6-29.7; P = 0.01) and 105.0 times (95% CI, 11.8-931.8; P < 0.0001), respectively, those in Group 1 footballers and 3.6 times (95% CI, 0.8-16.2; P = 0.10) and 17.7 times (95% CI, 2.2-146.2; P = 0.0075), respectively, those in Group 2 footballers. CONCLUSIONS: Elite Australian Rules footballers have a significant risk of both functional and radiological osteoarthritis, and a history of intra-articular ligament or meniscal injury increases this risk.

Activities of Daily Living↗
PubMed2006

Arthroscopy of the subtalar joint and arthroscopic subtalar arthrodesis.

Subtalar arthroscopy has become a valuable adjunct to the tools used in lower extremity surgery. For the past 25 years, ankle arthroscopy has been in vogue for treating a variety of conditions. Subtalar arthroscopy has more treatment limitations and is more technically difficult to perform than ankle arthroscopy because of the anatomic confines and structure of the subtalar joint. Most procedures are performed on the posterior aspect of the subtalar joint. The subtalar joint is composed of three articulations (posterior, middle, and anterior facets) and is surrounded by a variety of intra-articular and extra-articular ligaments, whose anatomy must be fully understood before attempting this procedure. Subtalar arthroscopy may be indicated for diagnostic purposes and for débridement of synovial impingement syndromes in the sinus tarsi. It may be used to examine loose bodies or osteochondral lesions, to address fractures of the lateral process of the talus, and to evaluate subtalar instability to determine appropriate stabilization methods. Arthroscopic subtalar arthrodesis also has gained credibility over the past 10 years as an acceptable surgical procedure. Arthroscopic evaluation of subtalar instability is useful in planning the appropriate stabilization. Subtalar arthroscopy is usually performed with the patient in the lateral decubitus position without traction. Anterior and posterior portals as well as an accessory anterior portal are usually necessary to perform all of the above procedures. Because of the limited confines of the joint, care must be taken to prevent any articular cartilage damage. When performing subtalar arthroscopy in conjunction with ankle arthroscopy, the subtalar arthroscopy should be performed first to avoid excessive extravasation from the ankle arthroscopy, which could obscure entry to the subtalar joint. Complications of subtalar arthroscopy are similar to those encountered in ankle arthroscopy, such as damage to the sural and superficial peroneal nerves.

Arthrodesis↗
PubMed2005

MR imaging evaluation of the postoperative knee: ligaments, menisci, and articular cartilage.

The surgical management of knee injuries has increased in recent years. Postoperative magnetic resonance (MR) imaging of the knee following surgical intervention serves an important role in the diagnostic evaluation of patients with recurrent or residual symptoms following surgical intervention. MR imaging additionally assists in the noninvasive documentation of temporal changes at the surgical site potentially reflective of procedural success, or failure. Background understanding of the common surgical procedures performed, their normal postoperative MR imaging appearance, and imaging features of potential procedural complications are essential in the accurate evaluation of patients following prior knee surgery. The focus of the following article is to review the clinical and MR imaging features of the postoperative knee following prior surgical treatment of ligamentous, meniscal, and articular cartilage injuries of the joint.

Cartilage, Articular↗
PubMed1991

Intrinsic innervation of the rat knee joint articular capsule and ligaments.

In spite of the practical importance of having a detailed knowledge of knee joint innervation to understand the pathophysiologic aspects, little information is now available concerning the density and pattern of the nerve fibres which are distributed to it. The present study has been designed to investigate the density and distribution of nerve fibres and receptor corpuscles in the knee joint articular capsule, cruciate and collateral ligaments in the rat, using the acetylcholinesterase (AChE) histochemical in toto staining technique. The investigation was performed on male Wistar rats of 3 months of age, some of which had been treated with capsaicin to deplete their afferent 'C' fibres of their content of neuropeptides. AChE-positive nerve fibres and different types of receptor corpuscle endings were found within articular capsule and ligaments. The highest density of AChE-positive nerve fibres was noticeable in the fibular collateral ligament followed by the tibial collateral ligament, the posterior cruciate ligament, the anterior cruciate ligament and the articular capsule. In the articular capsule the number of type I endings was higher than in the ligaments. The opposite is true for the other type of receptor corpuscles found as well as for nerve endings. Capsaicin treatment significantly reduced the density of AChE-positive nerve fibres in knee joint ligaments but did not affect nerve fibres in the articular capsule. Moreover, it caused the disappearance of some kind of receptor corpuscles within the collateral and cruciate ligaments. The above data collectively suggest that the AChE in toto staining technique may represent a good method for investigating joint innervation and that a significant percentage of nerve fibres supplying knee joint ligaments is represented by C fibre afferents.

Acetylcholinesterase↗
PubMed1980

Functional articulation of some hominoid foot bones: implications for the Olduvai (hominid 8) foot.

Previous observations on twelve fossil foot bones (Olduvai 8: Day and Napier, '64) together with multivariate morphometric studies of one of them, the talus (Day and Wood, '68) suggested human-like bipedality for this foot. Subsequent studies showed the conclusions on the talus to be wrong: The fossil talus, as defined by eight measures, does not resemble that of man but is reminiscent of those of creatures known (extant--orangutans) or believed (extinct--some fossil apes and monkeys) to be arboreal in habitus (Oxnard '72; Lisowski, et al., '74, '76). A reassessment of the entire Olduvai 8 foot is therefore necessary to answer the problem posed by a foot that has a non-human talus with, apparently, a human arched pattern of the remaining tarsal and metatarsal bones. The dry bones of a series of feet of extant hominoids have been rearticulated and are found to be close to the actual relationships presented by dissected specimens in which ligaments, articular cartilages and soft tissues are present. Similar rearticulation applied to casts of the individual Olduvai foot bones produces a structure that is not arched in the same manner as the human foot; it displays features that ally it more closely with the feet of various apes. Sections of casts of the already rearticulated Olduvai foot (from both the Wenner Gren Foundation and the Kenya National Museums) show that the human-like appearance of the original rearticulation is due to a series of incorrect osteological alignments. Although casts do not permit study of surface features, the dimensions of the casts are sufficiently accurate to permit rearticulation in this manner. It is thus clear, a) that the Olduvai foot is not adated for bipedality in the manner of man, and b) that it displays features in which it resembles the feet of arboreal creatures. Such anatomical characters as relate to bipedality in the fossil suggest usage as in an arboreal species that also walks bipedally with flattened arches (like a chimpanzee or gorilla) rather than with the high arches of man.

Adult↗
PubMed1981

[Medical opinion about injuries in the foot area (author's transl)].

One-seventh of all fractures concerns the foot, excluding the malleolus, and injuries of the lower leg and knee are also followed by disturbances in the foot. One-third of the foot injuries lead to a 30% disability. Some of the lesions are often undiagnosed (ligaments, articular cartilage, subtotal luxations of the talus or calcaneus, fractures and luxations of the cuneiform bones I and II and tarsal bones I--III, additional foreign bodies in the metatarsus). For expert opinion anamnesis, complaints, objective findings, and functional state are important. X-ray pictures in two or three directions or tomograms are needed for differential diagnosis. Knowledge of the laws and of jurisdiction is required to form an opinion.

Disability Evaluation↗
PubMed1993

Cartilage destruction and osteophytes in instability-induced murine osteoarthritis: role of TGF beta in osteophyte formation?

Osteoarthritis is characterized by focal cartilage destruction and marked formation of osteophytes. We have investigated the possible relationship between site specific occurrence of cartilage damage and osteophytes in the collagenase induced murine osteoarthritis model. The degree of instability of the joint correlated with the amount of cartilage loss. Moreover, cartilage damage in the medial tibial plateau correlated only strongly with the osteophyte at the medial plateau, whereas a similar, site directed trend was noted for lateral damage and lateral osteophytes. A separate study with intraarticular injection of TGF beta 1 in normal murine knee joints revealed that this factor can induce osteophytes at characteristic sites, suggesting a role of endogenous TGF beta in this phenomenon.

Animals↗
PubMed2006

[Fracture of the tibial head].

Fractures of the tibial head are severe injuries, characterized by enormous variety. Fractures can be classified into fractures of the tibial plateau, luxation fractures, and comminuted fractures. Due to the mechanism of injury luxation fractures are frequently associated with lesions of the menisci and intra- and extra-articular ligaments. Multiple factors can be etiologic for post-traumatic gonarthrosis: nonanatomic reduction of the joint surface, malalignment, and unaddressed associated injuries. Therefore in addition to diagnostic steps such as X-ray, CT scan, and MRI a sophisticated therapeutic regime is necessary. In cases with severely damaged soft tissue or unstable patients, the fracture should initially be reduced and fixed with an external fixator and the definite fixation should be performed in a second setting. Arthroscopically assisted treatment is reserved for fractures of the tibial eminence, crack fractures, and impression fractures. Comminuted and bilateral fractures can be addressed via different incisions. New locking plates with angular stability allow avoidance of bilateral plating in most situations. In specific cases such as compound fractures and for patients with low compliance, a hybrid fixator may be a well-chosen alternative.

Arthroscopy↗
PubMed2000

Reconstruction of rabbit Achilles tendon with three bioabsorbable materials: histological and biomechanical studies.

This study investigated whether three biodegradable materials, poly-N-acetyl-D-glucosamine (chitin), poly-epsilon-caprolactone (p-CL), polylactic acid (PLA), and chitin/p-CL composite could be used as scaffold implants in the reconstruction of extra-articular ligaments or tendons. Braided artificial tendons made from these materials were soaked in phosphate-buffered saline or implanted in the subcutaneous tissue of 31 Japanese white rabbits and then subjected to load at failure testing. There was no significant loss of load at failure when chitin tendons were soaked in saline for 26 weeks, but a rapid decrease occurred in vivo. The other two types of tendons showed significant loss of strength after 26 weeks both in vitro and in vivo. Another 111 rabbits were used to assess Achilles tendon reconstruction with the braided tendon implants. The tendon regeneration process was assessed macroscopically, histologically, immunohistochemically, and mechanically (maximum load at failure). Chitin showed more rapid degradation than the other materials on histological examination. There was good formation of fibrous tissue composed of type I and type III collagen around the chitin, PLA, and chitin/p-CL fibers in comparison with p-CL fibers, but chitin tendons showed more rapid loss of strength after implantation. Both PLA and the chitin/p-CL composite tendons had good initial strength and showed increased ingrowth of fibrous tissue, suggesting that these materials are promising as artificial tendons.

Achilles Tendon↗
PubMed2006

A multiaxial force-sensing implantable tibial prosthesis.

Accurate in vivo measurement of tibiofemoral forces is important in total knee arthroplasty. These forces determine polyethylene stresses and cold-flow, stress distribution in the implant, and stress transfer to the underlying implant bone interface. Theoretic estimates of tibiofemoral forces have varied widely depending on the mathematical models used. The six degrees of freedom of motion, complex articular surface topography, changing joint-contact position, intra- and extra-articular ligaments, number of muscles crossing the knee joint, and the presence of the patellofemoral joint contribute to the difficulty in developing reliable models of the knee. A prototype instrumented total knee replacement tibial prosthesis was designed, manufactured, and tested. This prosthesis accurately measured all six components of tibial forces (R2>0.997). The prosthesis was also instrumented with an internal microtransmitter for wireless data transmission. Remote powering of the sealed implanted electronics was achieved using magnetic coil induction. This device can be used to validate existing models of the knee that estimate these forces or to develop more accurate models. In conjunction with kinematic data, accurate tibiofemoral force data may be used to design more effective knee-testing rigs and wear simulators. Additional uses are intraoperative measurement of forces to determine soft-tissue balancing and to evaluate the effects of rehabilitation, external bracing, and athletic activities, and activities of daily living.

Humans↗
PubMed1984

The role of arthroscopy in the management of knee injuries in the athlete.

The athlete who has an acute knee injury requires early diagnosis and treatment, an accurate estimate of the extent of the injury and the time required for rehabilitation, and an ultimate prognosis for function. Arthroscopic evaluation is extremely useful in these persons because it allows an accurate early diagnosis of injuries to the menisci, cruciate ligaments, articular cartilage, joint capsule, and synovium. Early diagnosis allows selection of the treatment modalities that will permit the most rapid return of the athlete to sports activities in the minimal amount of time. The concept of temporizing rather than early diagnosis is not a viable technique in the athlete. A review of 63 bucket-handle tears of the medial meniscus which were treated arthroscopically revealed a rapid return to function. Athletic endeavors could be performed competitively an average of 4 weeks after arthroscopic treatment. Arthroscopy is a valuable agent in the evaluation and management of acute knee injuries in athletes. An aggressive program of diagnosis should be pursued.

Arthroscopy↗
PubMed1996

Expression of biglycan, decorin and fibromodulin in the hypertrophic phase of experimental osteoarthritis.

This study sought to assess the relative levels of the mRNAs of the core proteins of the small proteoglycans (PGs) biglycan, decorin and fibromodulin in the hypertrophic phase of the early osteoarthritis (OA) that follows joint injury. Experimental OA was induced in eight dogs by transection of the anterior cruciate ligament. Articular cartilage was harvested from each joint, the total RNA was extracted and the concentration of DNA in the cartilage was measured. The relative levels of mRNA for biglycan, decorin and fibromodulin were assessed by northern blot analyses. An increase in cartilage mass with no increase in DNA concentration confirmed that the joints were in the hypertrophic phase that follows joint injury. The total RNA per microgram of DNA was increased 2.5 times. Compared with control cartilage, the mRNA levels in osteoarthritic cartilage, when normalized to the concentration of DNA, were increased 3.9 times for biglycan, 1.2 times for decorin and 2.4 times for fibromodulin. Because these small PGs affect collagen fibrillogenesis in vitro, their discoordinate metabolism may contribute to the abnormal collagen formation and deposition that occurs in OA and to the ultimate failure of the articular cartilage.

Animals↗
PubMed1996

Efficacy of sparfloxacin and autoradiographic diffusion pattern of [14C]Sparfloxacin in experimental Staphylococcus aureus joint prosthesis infection.

Using a new rabbit model of methicillin-susceptible Staphylococcus aureus knee prosthesis infection, we compared the efficacies of sparfloxacin (50 mg/kg of body weight subcutaneously, twice a day) and pefloxacin (50 mg/kg subcutaneously, twice a day). A partial knee replacement was performed with a silicone implant fitted into the intramedullary canal of the tibia, and 5 x 10(7) CFU of methicillin-susceptible S. aureus was injected into the knee. The 7-day treatment regimen was started 15 days later. The MICs and MBCs of sparfloxacin and pefloxacin were, respectively, 0.06 and 0.25 microgram/ml (MIC) and 0.25 and 1 microgram/ml (MBC). The peak levels of sparfloxacin and pefloxacin in serum were 3.6 and 21 micrograms/ml, respectively. Three weeks after the end of treatment, animals were sacrificed and tibias were removed, pulverized, and quantitatively cultured. In contrast to pefloxacin (3.61 +/- 1.64 log10 CFU/g of bone), sparfloxacin significantly reduced the bacterial density (2.12 +/- 1.1 log10 CFU/g of bone) (P = 0.01) in comparison with the level in controls (4.59 +/- 1.21 log10 CFU/g of bone), without selection of resistant variants. Sparfloxacin was significantly more effective than pefloxacin (P = 0.025). The autoradiographic pattern of [14C]sparfloxacin diffusion was studied in noninfected animals with prostheses and in infected animals 15 days after inoculation. Sixty minutes after completion of infusion of 250 microCi of [14C]sparfloxacin, in infected animals the highest levels of radioactivity were detected around the prosthesis, in femoral cartilage, and in articular ligaments. Radioactivity was slightly less intense in bone marrow and muscles and was very weak in compact bone. The distribution of sparfloxacin in uninfected rabbits was similar. Thus, sparfloxacin may represent a valid alternative therapy in these infections provided that it is carefully monitored for potential side effects.

Animals↗
PubMed1998

Efficacy of teicoplanin and autoradiographic diffusion pattern of [14C]teicoplanin in experimental Staphylococcus aureus infection of joint prostheses.

Prosthesis infections are difficult to cure. Infection with methicillin-resistant staphylococci is becoming more common in patients with orthopedic implants. Using a recently developed model of methicillin-resistant Staphylococcus aureus (MRSA) infection of a knee prosthesis, we compared the efficacies of teicoplanin and vancomycin. [14C]teicoplanin diffusion in this model was also studied by autoradiography. A partial knee replacement was performed with a silicone implant fitting into the intramedullary canal of the tibia, and 10(7) CFU of MRSA was injected into the knee. Treatment with teicoplanin or vancomycin (20 or 60 mg/kg of body weight, respectively, given intramuscularly twice daily) was started 7 days after inoculation and was continued for 7 days. The teicoplanin and vancomycin MICs for MRSA were 1 microg/ml. Mean peak and trough levels in serum were 39.1 and 23.5 microg/ml, respectively, for teicoplanin and 34.4 and 18.5 microg/ml, respectively, for vancomycin. Fifteen days after the end of therapy, the animals were killed and their tibias were removed, pulverized, and quantitatively cultured. Teicoplanin and vancomycin significantly reduced (P < 0. 05) the bacterial density (2.7 +/- 1.3 and 3.3 +/- 1.6 log10 CFU/g of bone, respectively) compared to those for the controls (5.04 +/- 1.4 log10 CFU/g of bone). The bacterial covents of teicoplanin- and vancomycin-treated rabbits were comparable. The [14C]teicoplanin autoradiographic diffusion patterns in rabbits with prostheses, two of which were uninfected and two of which were infected, were studied 15 days after inoculation. Sixty minutes after the end of an infusion of 250 microCi of [14C]teicoplanin, autoradiography showed that in the infected animals, the highest levels of radioactivity were located around the prosthesis and in the periosteum, bone marrow, and trabecular bone. Radioactivity was less intense in epiphyseal disk cartilage, femoral cartilage, articular ligaments, and muscles and was weak in compact bone. A similar distribution pattern was seen in uninfected rabbits. Thus, teicoplanin may represent an effective alternative therapy for the treatment of these infections.

Animals↗
PubMed1993

Acute haemarthrosis of the knee in athletes. A prospective study of 106 cases.

We made a prospective arthroscopic study of 106 skeletally mature male sportsmen with an average age of 28.35 years (16.8 to 44) who presented with an acute haemarthrosis of the knee due to sporting activities. We excluded those with patellar dislocations, radiographic bone injuries, extra-articular ligamentous lesions or a previous injury to the same joint. The anterior cruciate ligament (ACL) was intact in 35 patients, partially disrupted in 28 and completely ruptured in 43. In the patients with an ACL lesion, associated injuries included meniscal tears (17 patients), cartilaginous loose bodies (6), and minimal osteochondral fractures of the patella (2), the tibial plateau (3) or the femoral condyle (9). We found no age-related trend in the pattern of ACL injuries. Isolated injuries included one small osteochondral fracture of the patella, and one partial and one total disruption of the posterior cruciate ligament. Three patients had cartilaginous loose bodies, and no injury was detected in five. Acute traumatic haemarthrosis indicates a serious ligament injury until proved otherwise, and arthroscopy is needed to complement careful history and clinical examination. All cases with a tense effusion developing within 12 hours of injury should have an aspiration. If haemarthrosis is confirmed, urgent admission and arthroscopy are indicated.

Acute Disease↗
PubMed2006

Sonography of the acetabular labrum: visualization of labral injuries during intra-articular injections.

OBJECTIVE: The purpose of this series was to describe the improved conspicuity in the sonographic appearance of acetabular labral injuries during routine sonographically guided intra-articular injections. METHODS: Sonographic examinations of patients undergoing routine sonographically guided intra-articular hip injections were reviewed for evidence of labral injuries (n=21). Sonographic examinations were then correlated with magnetic resonance images of the ipsilateral hip when available (n=14). RESULTS: Before injection, 13 acetabular labra had linear or irregular hypoechoic clefts or fissures through the normally hyperechoic fibrocartilaginous labrum, thought to represent tears. Eight of the labra showed a more globular alteration in morphologic characteristics, with diffuse thickening and irregularity. During intra-articular injection, the visualized injected fluid outlined the labrum, yielding a "sonoarthrographic effect," providing a fluid interface along the labral boundaries, and confirming the presence of a tear by imbibition of injected material into the defect with a resultant subjective improvement in the labral injury. CONCLUSIONS: Evaluating the labrum after injection may improve visualization of labral injuries, as a result of greater labral conspicuity.

Acetabulum↗
PubMed2000

Vertebral stress of a cervical spine model under dynamic load.

The objective of this study is to develop cervical spine models that predict the stresses in each vertebra by taking account of the biodynamic characteristics of the neck. The loads and the moments at the head point (Occipital Condyle) used for the models were determined by the rigid body dynamic response of the head due to G-z acceleration. The experimental data used were collected from the biodynamic responses of human volunteers during an acceleration in the z direction on the drop tower facility at Armstrong Laboratory at Wright Patterson Air Force Base (WPAFB). Three finite element models were developed: an elastic local model, viscoelastic local model and complete viscoelastic model. I-DEAS software was used to create the solid models, the loadings and the boundary conditions. Then, ABAQUS finite element software was employed to solve the models, and thus the stresses on each vertebral level were determined. Beam elements with different properties were employed to simulate the ligaments, articular facets and muscles. The complete viscoelastic model was subjected to 11 cases of loadings ranging from 8 G-z to 20 G-z accelerations. The von Mises and Maximum Principal stress fields, which are good indicators of bone failure, were calculated for all the cases. The results indicated that the maximum stress in all cases increased as the magnitude of the acceleration increased. The stresses in the 10 to 12 G-z cases were comfortably below the injury threshold level. The majority of the maximum stresses occurred in C6 and C4 regions.

Biomechanical Phenomena↗