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Knee Exam

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13181. Polyethylene wear particles in synovial fluid after total knee arthroplasty. Full Text available with Trip Pro

Polyethylene wear particles in synovial fluid after total knee arthroplasty. The aims of the current study were to examine polyethylene particles in synovial fluid at an early stage, and to compare a newly introduced medial pivot total knee prosthesis with an established posterior-stabilized total knee prosthesis. Synovial fluid was obtained 1 year after knee arthroplasty from 17 patients with well-functioning prostheses (22 knees, 11 posterior-stabilized prostheses and 11 medial pivot

2003 Clinical Orthopaedics and Related Research

13182. Medial opening-wedge high tibial osteotomy with use of porous hydroxyapatite to treat medial compartment osteoarthritis of the knee. (Abstract)

Medial opening-wedge high tibial osteotomy with use of porous hydroxyapatite to treat medial compartment osteoarthritis of the knee. The aims of this study were to investigate the results of opening-wedge high tibial valgus osteotomy in patients with medial compartment osteoarthritis of the knee and to examine the usefulness of hydroxyapatite wedges as the supporting material.Medial opening-wedge osteotomy was performed in twenty-one osteoarthritic knees in eighteen patients who had a mean age (...) by altering the direction of wedge insertion. The goal was to achieve a final standing alignment of 10 degrees of anatomical valgus angulation.All patients had pain relief and improvement in walking ability after the osteotomy. The mean knee and function scores of the American Knee Society were 60.2 +/- 5.3 and 48.1 +/- 10.4 points, respectively, before the osteotomy and 94.3 +/- 7.3 and 93.1 +/- 9.8 points, respectively, at the time of the final follow-up. Limb alignment, expressed as the standing

2003 The Journal of Bone and Joint Surgery. American Volume

13183. Diagnosis and treatment of posterolateral knee injuries. (Abstract)

full length anteroposterior radiographs, taken with the patient standing, to assess for varus alignment in patients with chronic injuries and high field (1.5 tesla or higher) magnetic resonance imaging with specific posterolateral knee sectioning. A physical examination that includes the external rotation recurvation test, varus stress test at 30 degrees, dial test at 30 degrees and 90 degrees, posterolateral drawer test, reverse pivot shift, and an assessment for a varus thrust gait are essential (...) developed. Improved education of clinicians as to the proper diagnosis of posterolateral knee injuries is necessary because a large number of these injuries still are missed on initial examinations. In addition, additional research into the most optimal posterolateral knee reconstruction techniques and outcome studies are needed to improve the treatment of this debilitating knee injury.

2002 Clinical Orthopaedics and Related Research

13184. Joint proprioception before and after total knee arthroplasty. (Abstract)

Joint proprioception before and after total knee arthroplasty. To investigate the effects of total knee arthroplasty on joint proprioception, the absolute angular error of the knee in 38 consecutive patients before and after total knee arthroplasty for osteoarthritis and in 23 age-matched control subjects were examined. Varus and valgus laxity of the knee and muscle strengths of the thigh were measured using appropriate instruments. There were no significant differences in absolute angular (...) error before and after total knee arthroplasty, independent of retaining or substituting the posterior cruciate ligament. The absolute angular error of the knee with a normal appearing anterior cruciate ligament was larger than that with a missing anterior cruciate ligament before total knee arthroplasty and decreased significantly after surgery. The absolute angular error correlated with the varus and valgus laxity of the knee, but did not correlate with the strength of thigh muscles after total

2002 Clinical Orthopaedics and Related Research

13185. Revision total knee replacement ligament balancing for deformity. (Abstract)

Revision total knee replacement ligament balancing for deformity. Ligament balancing in revision settings requires attention to flexion-extension gap balancing and adjusting the asymmetry of the gaps. The tension-stress examination must be understood and done. The shortcomings of ligament tightening procedures have been experienced. Standard concave-side releases may be done, with attention given to the maintenance of adequate vascularity to the subjacent bone. However, frequently exact (...) flexion space may provide the opportunity for subluxation of the intercondylar peg of a varus-valgus constrained prosthesis. Although quadriceps tension may hold the tibia up and control the flexion space, this mechanism of stabilization will fail if the patient's knee regains substantial range of motion.

2002 Clinical Orthopaedics and Related Research

13186. High-energy fractures of the tibial plateau. Knee function after longer follow-up. (Abstract)

patients (twenty knees) returned specifically for the study, at which time they completed an Iowa Knee Score questionnaire and a Short Form-36 (SF-36) general health survey, a physical examination was performed, and weight-bearing radiographs were made. The results of the SF-36 evaluations for fourteen patients and the Knee Scores for twelve were compared with those obtained five years previously, at two to four years after the injury.After healing, no patient required a secondary reconstructive (...) High-energy fractures of the tibial plateau. Knee function after longer follow-up. Studies of the long-term outcomes of treatment of fractures of the tibial plateau have included wide mixtures of fracture types and mostly low-energy split and split-depression fractures. The long-term results of treatment of high-energy intra-articular proximal tibial fractures are unknown. The purpose of this study was to assess the function of the knee and the development of arthrosis at a minimum of five

2002 The Journal of Bone and Joint Surgery. American Volume

13187. Activated PMNs lead to oxidative stress on chondrocytes: a study of swine knees. (Abstract)

Activated PMNs lead to oxidative stress on chondrocytes: a study of swine knees. Using an in vitro model, based on primary cultured chondrocytes, we examined possible oxidative injury caused by activated polymorphonuclear neutrophil granulocytes (PMNs), which are thought to be part of the pathomechanism of hemarthrosis. Chondrocytes were isolated from swine knee joints and divided into three groups. Pure chondrocytes acted as the control population (group I). PMNs from the systemic circulation

2003 Acta Orthopaedica Scandinavica

13188. Outcome of calf deep-vein thrombosis after total knee arthroplasty. (Abstract)

Outcome of calf deep-vein thrombosis after total knee arthroplasty. We investigated the outcome of deep-vein thrombosis (DVT) in the calf after total knee arthroplasty (TKA) in 48 patients (45 women and three men) by clinical assessment and venographic study between three and four years after surgery. The mean age of the patients was 67.2 +/- 7.7 years (52 to 85) and the mean follow-up was 42.6 +/- 2.7 months (38 to 48). The diagnosis was osteoarthritis in 47 patients and rheumatoid arthritis (...) in one patient. There were 44 calf thrombi, four popliteal thrombi but no thrombi in the femoral or iliac regions. Of the 48 patients, 24 were clinically symptomatic and 24 were asymptomatic. Clinical examination was carried out on 41 patients, of whom 37 underwent ascending venography. Seven were evaluated by telephone interview. No patient had the symptoms or signs of recurrent DVT, venous insufficiency in the affected leg, or a history of pulmonary embolism. No patient had been treated

2003 The Journal of Bone and Joint Surgery British Volume

13189. Risk factors for clinically relevant pulmonary embolism and deep venous thrombosis in patients undergoing primary hip or knee arthroplasty. (Abstract)

Risk factors for clinically relevant pulmonary embolism and deep venous thrombosis in patients undergoing primary hip or knee arthroplasty. Prevention of thromboembolic complications after elective lower extremity arthroplasty has increasingly relied on routine thromboprophylaxis in all patients. Not all patients are at equal risk, however, and prophylaxis is not devoid of complications. The aim of this study was to examine the risk factors for clinically relevant pulmonary embolism and deep (...) venous thrombosis after elective primary hip or knee arthroplasty in a large patient population.During the 10-yr study period, 116 of 9,791 patients undergoing primary hip or knee arthroplasty at the authors' institution who experienced pulmonary embolism or deep venous thrombosis within 30 days of surgery were matched at a 1:1 ratio with patients undergoing the same surgery with the same surgeon who did not experience an adverse event. Medical records were reviewed, with data abstracted using

2003 Anesthesiology

13190. Gabapentin reduces the mechanosensitivity of fine afferent nerve fibres in normal and inflamed rat knee joints. (Abstract)

Gabapentin reduces the mechanosensitivity of fine afferent nerve fibres in normal and inflamed rat knee joints. The antiepileptic drug gabapentin has been shown to have an antihyperalgesic effect following central administration. This electrophysiological investigation examined whether peripherally administered gabapentin could modulate the mechanosensitivity of primary afferents innervating normal and kaolin/carrageenan inflamed rat knee joints. Close intraarterial injection of gabapentin (...) (0.01, 1 and 100mg/kg) dose-dependently reduced afferent firing rate in both normal and acutely inflamed rat knees in response to normal and hyper-rotation of the joint. Thus, in addition to its central mode of action, peripheral administration of gabapentin reduces nociception locally and this may prove to be beneficial in the treatment of various pain syndromes including inflammatory arthritis.

2003 Pain

13191. Expression of matrix metalloproteinases in articular cartilage of temporomandibular and knee joints of mice during growth, maturation, and aging. (Abstract)

Expression of matrix metalloproteinases in articular cartilage of temporomandibular and knee joints of mice during growth, maturation, and aging. This study examined the involvement of different matrix metalloproteinases (MMPs) in articular cartilage in the process of growth, maturation, and aging of mice, and compared the temporal changes in the expression of MMPs between temporomandibular joints (TMJ) and knee joints.Homogenates of intact tibial plateau, femoral condyle, and TMJ condyle (...) cartilages from animals of different ages were assessed for gelatinase (MMP-2 and MMP-9) activity by zymography. The messenger RNA (mRNA) expression of MMPs 1, 2, 3, 9, and 13 in tibial plateau cartilage was determined by semiquantitative reverse transcription-polymerase chain reaction, and immunohistochemistry was used to localize MMPs 2, 3, 9, and 13 in the knee joints and TMJ from mice of different ages.The pattern of gelatinase (MMP-2 and MMP-9) activity and their protein expression as well

2002 Arthritis and Rheumatism

13192. Association of interleukin-18 expression with enhanced levels of both interleukin-1beta and tumor necrosis factor alpha in knee synovial tissue of patients with rheumatoid arthritis. (Abstract)

Association of interleukin-18 expression with enhanced levels of both interleukin-1beta and tumor necrosis factor alpha in knee synovial tissue of patients with rheumatoid arthritis. To examine the expression patterns of interkeukin-18 (IL-18) in synovial biopsy tissue of patients with rheumatoid arthritis (RA), and to determine whether expression of this primary cytokine is related to the expression of other cytokines and adhesion molecules and related to the degree of joint (...) inflammation.Biopsy specimens of knee synovial tissue either without synovitis (n = 6) or with moderate or severe synovitis (n = 11 and n = 12, respectively) were obtained from 29 patients with active RA. Paraffin-embedded, snap-frozen sections were used for immunohistochemical detection of IL-18, tumor necrosis factor alpha (TNFalpha), IL-1beta, IL-12, and IL-17. Furthermore, adhesion molecules, such as intercellular adhesion molecule 1, vascular cell adhesion molecule 1, and E-selectin, and cell markers CD3

2003 Arthritis and Rheumatism

13193. Detection of radiographic joint space narrowing in subjects with knee osteoarthritis: longitudinal comparison of the metatarsophalangeal and semiflexed anteroposterior views. (Abstract)

osteoarthritis (OA) is unknown. The present study was undertaken to compare the metatarsophalangeal (MTP) view and the semiflexed anteroposterior (AP) view with respect to sensitivity to JSN in knee OA.In 49 subjects with definite knee OA, 2 MTP radiographs and 1 semiflexed AP radiograph were obtained at baseline. Each examination was repeated 14 months later. In MTP views, minimum JSW and the distance between the anterior and posterior margins of the medial tibial plateau (intermargin distance [IMD (...) ], an indicator of parallel alignment of the tibial plateau and the x-ray beam) were measured with a pair of calipers and a magnifying lens fitted with a graticule. JSW in semiflexed AP views was measured by digital image analysis.The mean of within-knee standard deviations of JSW in the baseline MTP examinations (n = 52 OA knees) was 0.24 mm (coefficient of variation 5.8%). Although IMDs in the 2 baseline MTP views were very highly correlated (+0.88), IMDs in the serial examinations were only moderately

2003 Arthritis and Rheumatism

13194. Measurement of radiographic joint space width in the tibiofemoral compartment of the osteoarthritic knee: comparison of standing anteroposterior and Lyon schuss views. (Abstract)

alignment were evaluated with respect to the reproducibility of JSW in repeated examinations (intraclass correlation coefficient [ICC]), the mean of within-knee standard deviations of repeated measurements (SD(m)), and the sensitivity to changes in JSW in serial radiographs (standardized response mean [SRM]).The performance of the new software, as assessed by the reproducibility of repeated measurements of minimum JSW on the same image, was excellent in both the standing AP (ICC = 0.98) and Lyon schuss (...) Measurement of radiographic joint space width in the tibiofemoral compartment of the osteoarthritic knee: comparison of standing anteroposterior and Lyon schuss views. To evaluate progression of joint space narrowing in radiographs of osteoarthritic (OA) knees imaged in both the standing anteroposterior (AP) and the Lyon schuss positions, using alternative methods to measure joint space width (JSW).Standing AP (extended view) and Lyon schuss (posteroanterior [PA] view, with 20-30 degrees

2003 Arthritis and Rheumatism

13195. The influence of alignment on risk of knee osteoarthritis progression according to baseline stage of disease. (Abstract)

at almost all stages of knee OA examined, the impact of varus or valgus malalignment on the odds of OA progression over the ensuing 18 months was greater in knees with moderate (K/L grade 3) OA at baseline, possibly due to greater joint vulnerability with some contribution from slightly more severe malalignment. (...) The influence of alignment on risk of knee osteoarthritis progression according to baseline stage of disease. Varus and valgus malalignment increase the risk of medial and lateral osteoarthritis (OA) progression, respectively. The impact of a mechanical factor such as alignment depends not only on the factor itself, but also on the state of the joint. The less-damaged joint of mild OA may be less vulnerable to malalignment effects than the more-damaged joint of moderate OA. Our goal

2002 Arthritis and Rheumatism

13196. Longitudinal analysis of cartilage atrophy in the knees of patients with spinal cord injury. (Abstract)

Longitudinal analysis of cartilage atrophy in the knees of patients with spinal cord injury. A previous cross-sectional study indicated that the morphology of patellar and tibial cartilage is subject to change after spinal cord injury (SCI). The aim of this study was to perform a longitudinal analysis of cartilage atrophy in all knee compartments, including the femoral condyles, in SCI patients over 12 months.The right knees of 9 patients with complete, traumatic SCI were examined shortly after (...) the injury (mean +/- SD 9 +/- 4 weeks) and at 6 and 12 months postinjury. Three-dimensional morphology of the patellar, tibial, and femoral cartilage (mean and maximum thickness, volume, and surface area) was determined from coronal and transversal magnetic resonance images (fat-suppressed gradient-echo sequences) using validated postprocessing techniques.The mean thickness of knee joint cartilage decreased significantly during the first 6 months after injury (range 5-7%; P < 0.05). The mean change at 12

2003 Arthritis and Rheumatism

13197. Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year followup of meniscectomy with matched controls. (Abstract)

examined using standardized radiography and validated self-administered questionnaires. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to quantify knee-related symptoms, and the definition of a symptomatic knee was determined. We used 68 control subjects matched for age, sex, and body mass index to calculate the relative risks (RRs).Radiographic tibiofemoral osteoarthritis (OA) (Kellgren/Lawrence grade > or =2) was present in 66 index knees (43%), of which 39 (59%) were considered (...) Impact of type of meniscal tear on radiographic and symptomatic knee osteoarthritis: a sixteen-year followup of meniscectomy with matched controls. To investigate long-term radiographic and patient-relevant outcome of isolated limited meniscectomy with regard to type of meniscal tear and extent of surgical resection.We studied 155 patients with intact cruciate ligaments (mean +/- SD age 54 +/- 12 years) who had undergone meniscectomy an average of 16 +/- 1 years earlier. The patients were

2003 Arthritis and Rheumatism

13198. Development of radiographic changes of osteoarthritis in the "Chingford knee" reflects progression of disease or non-standardised positioning of the joint rather than incident disease. Full Text available with Trip Pro

radiographic examination.Subjects were 180 obese women, aged 45-64 years, with unilateral knee OA, based on the standing anteroposterior (AP) view. Subjects underwent a series of radiographic knee examinations: semiflexed AP, supine lateral, and Hughston (patellofemoral (PF)) views. Bony changes of OA were graded by consensus of two readers. Medial tibiofemoral joint space width was measured by digital image analysis. Knee pain was assessed by the WOMAC OA Index after washout of all OA pain drugs.Despite (...) Development of radiographic changes of osteoarthritis in the "Chingford knee" reflects progression of disease or non-standardised positioning of the joint rather than incident disease. To ascertain the extent to which the "Chingford knee" (that is, contralateral knee of the middle aged, obese, female patient with unilateral knee osteoarthritis (OA)) is a high risk radiographically normal joint as opposed to a knee in which radiographic changes of OA would have been apparent in a more extensive

2003 Annals of the Rheumatic Diseases

13199. Cytokine production in the infrapatellar fat pad: another source of cytokines in knee synovial fluids. Full Text available with Trip Pro

Cytokine production in the infrapatellar fat pad: another source of cytokines in knee synovial fluids. Recent studies have shown that adipose tissue is an endocrine organ that releases various cytokines.To investigate the production of growth factors and proinflammatory cytokines in infrapatellar fat pad specimens.Infrapatellar fat pad tissues were obtained from patients during knee surgery. Protein levels of basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF (...) ), tumour necrosis factor (TNF)alpha, and interleukin (IL)6 in homogenised tissues were measured by an enzyme immunoassay. Gene expressions for those cytokines were examined by reverse transcription-polymerase chain reaction (RT-PCR). Localisation of bFGF and VEGF was evaluated by immunohistochemistry and in situ hybridisation.Infrapatellar fat pads were found to contain various protein levels of bFGF, VEGF, TNF alpha, and IL6. Further, gene expressions for these cytokines were detected by RT-PCR

2003 Annals of the Rheumatic Diseases

13200. Arthrosonography of hip and knee joints in the follow up of juvenile rheumatoid arthritis. Full Text available with Trip Pro

Arthrosonography of hip and knee joints in the follow up of juvenile rheumatoid arthritis. To evaluate sensitivity of arthrosonography of hip and knee joints for monitoring disease activity in juvenile rheumatoid arthritis (JRA).Twenty eight patients with JRA with active disease at entry in 15 hips and 38 knee joints were followed up three times in intervals of 4-6 weeks. Sonographic, clinical, and laboratory findings were documented at the same time in clinically active and inactive disease (...) . As controls of the sonographic variables 10 children without a history of arthritis were examined by ultrasound.In active arthritis of the hip joint 19/31 (61%) examinations showed a pathological widening of the synovial joint space. There was no significant correlation between sonographic and clinical measures of disease activity in coxitis. Marked effusion within the suprapatellar pouch was seen in 87% and thickening of the synovial membrane in 92% of cases of active gonarthritis in patients with JRA

2003 Annals of the Rheumatic Diseases

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