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Knee Exam

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13161. Total knee arthroplasty in patients with diastrophic dysplasia. (Abstract)

February 1992 and March 2000, twenty-one primary total knee arthroplasties were performed on fourteen consecutive patients with severe osteoarthritis due to diastrophic dysplasia. The patients were followed prospectively with clinical examinations, determination of the Hungerford knee scores, and radiographs. Preoperatively, ten knees had chronic dislocation of the patella. The mean duration of follow-up was 3.4 years.The mean Hungerford knee pain and total scores improved from 5.8 points and 46 points (...) preoperatively to 50 points and 83 points, respectively, at the final follow-up examination (p < 0.001 for both comparisons). Two knees required a distal femoral corrective osteotomy because of metaphyseal angulation. None of the total knee arthroplasties had to be revised during the follow-up period. Six complications were recorded.Total knee arthroplasty substantially improved the function of patients with diastrophic dysplasia. Additional peripatellar procedures were commonly needed, and complications

2003 The Journal of Bone and Joint Surgery. American Volume

13162. Extraarticular abrasive wear in cemented and cementless total knee arthroplasty. (Abstract)

Extraarticular abrasive wear in cemented and cementless total knee arthroplasty. In this study, we examine the contributions of periprosthetic impingement to a seldom recognized source of PE damage resulting in gouging, abrasion, and severe localized damage in cemented and cementless total knee replacement. One hundred sixty two tibial components of 34 different designs in a retrieval collection were examined. The presence and location of abrasive wear to the nonarticulating edges of the insert (...) were measured, with representative specimens examined using SEM. Significant abrasive wear was observed in 35% of the retrievals with cemented femoral components and 25% from noncemented components. Within the group of worn inserts, abrasive scars were seen with a frequency of 75% on the extreme medial edge, 20% on the extreme lateral edge, 26% on the posteromedial edge, and 16% on the posterolateral edge. The role of extraarticular impingement in this damage mode was confirmed by examination

2003 Clinical Orthopaedics and Related Research

13163. The kinematics of fixed- and mobile-bearing total knee arthroplasty. (Abstract)

The kinematics of fixed- and mobile-bearing total knee arthroplasty. The success of any total knee arthroplasty (TKA) is influenced by a complex interaction between component geometry and the surrounding soft tissues. The objective of this study was to investigate posterior femoral translation and tibial rotation in a single design posterior-stabilized TKA offering fixed- and mobile-bearing tibial components. Specifically, we examined whether mobile-bearing TKA restores normal knee translation (...) and rotation better than fixed-bearing TKA design. Eleven human knee specimens retrieved postmortem were tested using a robotic system. The translation and rotation of the intact and reconstructed knees were compared. The data indicate that for all knees, posterior femoral translation occurs along the passive path and under muscle loading conditions. Furthermore, increasing flexion angle corresponded with increased internal tibial rotation. Femoral translation and tibial rotation for fixed- and mobile

2003 Clinical Orthopaedics and Related Research

13164. Investigation of the collagen fibril distribution in the medial collateral ligament in a rat knee model. (Abstract)

Investigation of the collagen fibril distribution in the medial collateral ligament in a rat knee model. This study compared the collagen fibril diameter distribution among six anatomical sites of the rat medial collateral ligament (MCL). Ultrathin MCL sections from 4 male Sprague-Dawley rats were examined electron microscopically. With an automated quantitation method, 41,638 fibrils were measured and compared among the periphery and core regions of the femoral, middle, and tibial portions

2003 Connective Tissue Research

13165. Reliability of a quantification imaging system using magnetic resonance images to measure cartilage thickness and volume in human normal and osteoarthritic knees. (Abstract)

), (2) determining the differences between the readings of the same image made by different readers (between-reader agreement), and (3) determining the differences between the cartilage volume readings obtained from two MR images of the same knee image acquired a few hours apart (patient positioning reliability).Forty-eight MR examinations of the knee from normal subjects, patients with different stages of symptomatic knee osteoarthritis (OA), and a subset of duplicate images were independently (...) Reliability of a quantification imaging system using magnetic resonance images to measure cartilage thickness and volume in human normal and osteoarthritic knees. The aim of this study was to evaluate the reliability of a software tool that assesses knee cartilage volumes using magnetic resonance (MR) images. The objectives were to assess measurement reliability by: (1) determining the differences between readings of the same image made by the same reader 2 weeks apart (test-retest reliability

2003 Osteoarthritis and Cartilage

13166. Joint space width of the tibiofemoral and of the patellofemoral joint in chronic knee pain with or without radiographic osteoarthritis: a 2-year follow-up. (Abstract)

of a prospective study of early OA the signal knee in 55 people, 28 men and 27 women (aged 41-57 years, median 50), with chronic knee pain at inclusion was examined with a 2-year interval (median 25 months, range 21-30). The MJS of the TF joint was measured using a flexed PA view in weightbearing and the MJS of the PF joint using an axial view in standing.The MJS of the TF joint decreased medially by 0.056+/-0.44mm (n.s.) and increased laterally by 0.080+/-0.51mm (n.s.) during the time of observation. In knees (...) as well as in a subgroup of these knees without osteophytes. The radiographic examinations and the MJS measurements were reproducible.

2003 Osteoarthritis and Cartilage

13167. Reliability of the Ahlbäck classification of knee osteoarthritis. (Abstract)

Reliability of the Ahlbäck classification of knee osteoarthritis. The aim of the study was to assess the inter-observer reliability and intra-observer reproducibility of the Ahlbäck radiographic classification for knee osteoarthritis (OA).Ninety-six knee radiographs of patients with clinical signs of arthritis were evaluated and classified into five grades of Ahlbäck classification by three observers with different experience. The evaluation was repeated after 1 month. The inter- and intra (...) classification, as routinely applied, should not be used in orthopaedic surgery without the support of clinical and/or arthroscopic examinations, because of its poor reliability.

2003 Osteoarthritis and Cartilage

13168. The association of cartilage volume with knee pain. (Abstract)

The association of cartilage volume with knee pain. Whilst the characteristic pathologic feature of OA is the loss of hyaline cartilage, prior studies have demonstrated a poor relationship between severity of reported knee pain and degree of radiographic change. The aim of this study was to examine the association between knee symptoms and MRI cartilage volume.A cross-sectional study was performed to assess the association between knee symptoms and MRI cartilage volume in an unselected (...) , community based population. The subjects were 133 postmenopausal females. The subjects had a T2-weighted fat saturated sagittal gradient-echo MRI performed of their right knee. Femoral, tibial and patella cartilage volumes were measured using three-dimensional (3D) Slicer, a software that facilitates semi-automatic segmentation, generation of 3D surface models and quantitative analysis. Qualitative data relating to symptoms, stiffness, pain, physical dysfunction and the quality of life using the WOMAC

2003 Osteoarthritis and Cartilage

13169. In vivo contrast-enhanced micro MR-imaging of experimental osteoarthritis in the rabbit knee joint at 7.1T1. (Abstract)

In vivo contrast-enhanced micro MR-imaging of experimental osteoarthritis in the rabbit knee joint at 7.1T1. In this longitudinal MR study the early stages of joint pathology in two surgically-induced rabbit models of osteoarthritis (OA) were monitored by in vivo contrast-enhanced MRI at 7.1T. Qualitative and quantitative MR data were compared with macroscopic and microscopic findings.Scanning of mature, male New Zealand White rabbits (N=12) was performed before surgery, and at 2, 4, and 8 (...) weeks after unilateral transection of the anterior cruciate ligament (ACLT), medial meniscectomy (ME), or sham operation. MR-images were simultaneously obtained of both knee joints after intravenous injection of Magnevist. We implemented a 2D T1-weighted (T1w) coronal, fat-saturated gradientecho protocol (68 x 138 microm2, slice thickness 1 mm). Additionally, consecutive 3D gradientecho images were obtained from two sham-operated and two rabbits of the ME group (234 x 273 x 234 microm(3)). ACLT

2003 Osteoarthritis and Cartilage

13170. The natural history of emergent osteoarthritis of the knee in women. (Abstract)

The natural history of emergent osteoarthritis of the knee in women. We assessed the probability that mid-aged women with a Kellgren and Lawrence (K-L) score of 1 are likely to progress to a score of 2 or regress to a score of zero at a second time point, 2-3 years later.Osteoarthritis (OA) of measurements (weight-bearing X-rays and interviews) were undertaken in women from the Southeast Michigan population who were > or =40 years of age, and who participated in both the 1995 and 1998 (...) measurements (N=679).Of the 17.1 % of women with a 1995 K-L score of 1 in their right knee, 37.1% had a K-L score of 1 in 1998 while 32.8 % had a score of > or =2 and 30.2% had a score of zero. For 26.0% of women, the score progressed by at least one unit over the 2.5 year period whereas scores for only 7.0% of women regressed in the same time period. Women who had a K-L score of 1 in the right knee in 1995 were 2.5 times more likely to have a K-L score of 1 in 1998 (95% CI=1.6-3.8); and were 2.2 times

2002 Osteoarthritis and Cartilage

13171. Serum cartilage oligomeric matrix protein and clinical signs and symptoms of potential pre-radiographic hip and knee pathology. (Abstract)

Serum cartilage oligomeric matrix protein and clinical signs and symptoms of potential pre-radiographic hip and knee pathology. To examine the cross-sectional relationship between serum cartilage oligomeric matrix protein (COMP) and hip and knee clinical signs and symptoms in a sample of adults without radiographic hip or knee osteoarthritis (OA).A total of 145 persons with available sera and no evidence of radiographic hip or knee OA (Kellgren-Lawrence grade 0) were randomly selected from (...) the Caucasian participants of the Johnston County Osteoarthritis Project. COMP was quantified by a competitive ELISA assay with a monoclonal antibody 17-C10. Hip and knee clinical signs and symptoms were assessed by physical examination and interview, and their associations with Ln COMP analysed with general linear models.After adjustment for age, gender, body mass index (BMI), and other symptomatic joints, mean Ln COMP was statistically significantly higher among persons with hip-related clinical signs (P

2002 Osteoarthritis and Cartilage

13172. Distribution of MR-detected cartilage defects of the patellofemoral joint in chronic knee pain. (Abstract)

41-58 years, mean 50 years) with chronic knee pain, with or without radiographically determined knee OA, was examined using MR imaging on a 1.0 T imager. Cartilage defects and the center of these defects in the PFJ were recorded.Cartilage defects were found more often in the patella (40 knees) than in the femoral trochlea (23 knees) (P<0.001) and were unevenly distributed in the patella (P<0.001), with most cartilage defects in the mid-patella.Since cartilage defects occur more commonly (...) Distribution of MR-detected cartilage defects of the patellofemoral joint in chronic knee pain. The aim of the study was to detect cartilage defects and determine the center of these defects in MR imaging of the patellofemoral joint (PFJ) in middle-aged people with chronic knee pain.In the format of a prospective study of early osteoarthritis (OA), this cross-sectional study of the signal knee (the most painful one at inclusion in the study in 1990) in 59 individuals, 30 women and 29 men (aged

2003 Osteoarthritis and Cartilage

13173. Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee. (Abstract)

Reliability and validity of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index in Italian patients with osteoarthritis of the knee. The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis (OA) Index is a tested questionnaire to assess symptoms and physical functional disability in patients with OA of the knee and the hip. We adapted the WOMAC for the Italian language and tested its metric properties in 304 patients with symptomatic OA of the knee.Three (...) correlations were found when comparing items measuring similar constructs, supporting the concepts of convergent construct validity. Very high correlations were also obtained between WOMAC scores and Lequesne OA algofunctional index. WOMAC physical function, but not WOMAC stiffness and pain subscales, was weakly associated with radiological OA severity (P=0.03). Also, WOMAC pain score was inversely correlated (P=0.01) with years of formal education. Examination of discriminant validity showed

2003 Osteoarthritis and Cartilage

13174. Rheology of joint fluid in total knee arthroplasty patients. Full Text available with Trip Pro

Rheology of joint fluid in total knee arthroplasty patients. While the properties of joint fluid may affect the tribology of joint replacement prostheses, the flow parameters of joint fluid have not yet been examined in the context of total knee arthroplasty (TKA). The objective of this study was to evaluate the flow properties of joint fluids in patients undergoing index TKA or revision TKA. We hypothesized that an alteration of the properties of joint fluid would result from TKA. The steady (...) undergoing TKA, spanning previously established "normal" and "diseased" ranges. Fluid obtained at index TKA was more likely to exhibit normal viscous properties than fluid obtained at revision TKA (p = 0.01). Other viscous parameters distinguished the two groups, but the difference did not reach statistical significance. Both groups exhibited degenerate flow properties when compared to synovial fluid from healthy individuals. Further examination of the connection between flow properties and the tribology

2002 Journal of Orthopaedic Research

13175. Vascular adaptation of intact joint stabilizing structures in the posterior cruciate ligament deficient rabbit knee. (Abstract)

Vascular adaptation of intact joint stabilizing structures in the posterior cruciate ligament deficient rabbit knee. Loss of the posterior cruciate ligament (PCL) of the knee has a significant impact on joint stability and biomechanical function. Changes in joint biomechanics may result in mal-adaptive tissue degeneration and functional alteration of supporting ligaments. This study examines the effects of joint laxity on the vascular physiology of the intact anterior cruciate (ACL) and medial

2003 Journal of Orthopaedic Research

13176. Multipotent stromal cells derived from the infrapatellar fat pad of the knee. (Abstract)

Multipotent stromal cells derived from the infrapatellar fat pad of the knee. Tissue engineering approaches for promoting the repair of skeletal tissues have focused on cell-based therapies involving multipotent stromal cells. Recent studies have identified such cells in several tissues in the adult human, including skin, muscle, bone marrow, and subcutaneous fat. This study examined the hypothesis that the infrapatellar fat pad of the adult knee contains progenitor cells that have the ability

2003 Clinical Orthopaedics and Related Research

13177. The use of functional analysis in evaluating knee kinematics. (Abstract)

The use of functional analysis in evaluating knee kinematics. The importance of understanding the six-degrees-of-freedom kinematics of the knee during ambulatory activities was examined in the context of the function of total knee arthroplasty. Studies of knee kinematics during walking, stair climbing, and a deep flexion squat indicate that knee kinematics is activity-dependent. A comparative study of patients and healthy subjects during stair climbing indicates the importance of maintaining (...) the function of the posterior cruciate ligament. A second study used walking kinematics derived from patient testing as input to a wear simulator. There was increased wear relative to standard simulator input that was related to the slip velocity at the contact surface. Finally, results from a study of deep flexion indicate that substantial femoral rotation is required during deep flexion activities. The current study shows the importance of studying in vivo knee kinematics for future enhancement

2003 Clinical Orthopaedics and Related Research

13178. An analysis of rotating-platform total knee replacements. (Abstract)

An analysis of rotating-platform total knee replacements. Rotating-platform, mobile-bearing total knee replacements have been developed to improve knee kinematics, lower contact stresses on the polyethylene tibial component, minimize constraint, and allow implant self-alignment. The purpose of the current study was to examine some of these parameters. Gait studies during normal gait showed that the stance phase was associated with knee flexion between 8 degrees and 15 degrees. Contact area (...) studies have shown two types of rotating-platform total knee replacements, namely gait congruous (congruous only during the stance phase of gait) and totally congruous (congruous up to 90 degrees knee flexion) implants. Knee simulator studies have shown increased gravimetric wear with rotating-platform total knee replacements compared with their fixed-bearing counterparts. Rotate-only implants had less gravimetric wear than rotate and translate rotating-platform total knee replacements. Clinical

2003 Clinical Orthopaedics and Related Research

13179. Polyethylene damage on the nonarticular surface of modular total knee prostheses. (Abstract)

Polyethylene damage on the nonarticular surface of modular total knee prostheses. Modular tibial implants submitted for retrieval analysis were examined for evidence of cold flow, wear, or polyethylene failure. All retrieved components showed areas of cold flow and wear. Significant damage, defined as pitting, gouging, or delamination was observed in 77% of the retrieved implants. Cold flow deformation commonly was observed at the junction of the polyethylene and locking mechanisms or junction

2003 Clinical Orthopaedics and Related Research

13180. Femoral rollback after cruciate-retaining and stabilizing total knee arthroplasty. (Abstract)

Femoral rollback after cruciate-retaining and stabilizing total knee arthroplasty. Limited data comparing the kinematics of posterior cruciate ligament-retaining or substituting total knee arthroplasty with its own intact knee under identical loadings is available. In the current study, posterior femoral translation of the lateral and medial femoral condyles under unloaded conditions was examined for intact, cruciate-retaining, cruciate ligament-deficient cruciate-retaining and posterior (...) -substituting knee arthroplasties. Cruciate-retaining and substituting total knee arthroplasties behaved similarly to the cruciate-deficient cruciate-retaining total knee arthroplasty between 0 degrees and 30 degrees flexion. Beyond 30 degrees, the posterior cruciate-retaining arthroplasty showed a significant increase in posterior translation of both femoral condyles. The posterior cruciate-substituting arthroplasty only showed a significant increase in posterior femoral translation after 90 degrees

2003 Clinical Orthopaedics and Related Research

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