Autologe Knochen-Knorpel-Transplantation

In cases of chondral or osteochondral lesions, the autologous transfer of cartilage-bone cylinders is the only technique to provide hyaline cartilage at the defect site of weight-bearing joints such as the knee, ankle, hip, or even the elbow. The technique described is used for full-thickness cartilage defects or osteochondral lesions. Donor cylinders are harvested from knee areas in the anterolateral or medial trochlea with less contact pressure and transplanted to the lesion in the weight-bearing zone. Different technical approaches are described to achieve congruent joint surfaces by many small cylinders, the so-called mosaicplasty, or single cylinders of larger diameter. It has been shown that there is frequent and secure bony integration, but there is no ingrowth of cartilage itself. In some cases there are signs of cartilage degeneration in the graft. The clinical evaluation showed good to excellent results, especially at knee and ankle joints. Thus, the OATS is a reliable and reproducible technique for treatment of focal chondral and osteochondral lesions in weight-bearing joints.     

Surgical correction of leg alignment in unilateral knee osteoarthrosis reduces the load on the hip and knee joint bilaterally

Seventeen patients with strictly unilateral medial knee osteoarthrosis that justified surgical treatment constituted the study group. No patient had any symptoms from the hip or ankle joints or from the other knee. Eight patients were operated with high tibial osteotomy and nine were operated with unicompartmental prosthetic replacement (Brigham model). The forces and the external moment about the hip, knee, and ankle joints of the involved and uninvolved leg were calculated before and 1 year after corrective surgery and compared to the external moment in 10 normal controls. Clinical examinations was performed and the hip-knee-ankle angle in the involved leg was determined from whole-leg weightbearing radiographs before and 1 year after surgery. The external moments about the hip, knee, and ankle joints and the knee moment arms at mid-stance in the frontal plane during gait were determined with a Kistler force plate and a videorecording system. All patients improved clinically after surgery. The mean hip-knee-ankle angle changed from 11 degrees of varus to 0 degrees. In the uninvolved leg the mid-stance adduction moments about the hip and knee joints were significantly increased compared to normal subjects in the control group before surgery, but reduced to a normal level 1 year after surgery. This reduction was mainly due to a significant reduction of the medially directed force. The moments about the ankle joints were not found to be changed by the knee deformity or by the corrective surgery. RELEVANCE: This study demonstrates that a varus malalignment in the osteoarthrotic knee is accompanied by increased load about the uninvolved hip and knee joint. One might expect a more rapid progression of degenerative changes in joint cartilage as a consequence of such increased load. The reduced load after surgical correction of leg alignment might be beneficial to patients with osteoarthrosis of their hip and knee joints.     

铅球运动员主要关节等速肌力配布特征

背景：目前,国内外利用等速仪器针对铅球运动主要环节肌肉力量特征方面研究的文献较少。目的：查找铅球运动员不同速度下各主要环节肌力配布特征和存在的不足。方法：利用德国ISOMED2000等速肌力测试系统,对第十一届全运会男子铅球冠军膝关节、髋关节、腰背环节和肩关节进行慢速60（°）/s和快速180（°）/s等速测试。结果与结论：1膝关节慢速左右侧屈伸肌比值为25.6%、39.4%,快速屈伸肌比值为28.5%、29.8%,屈肌群肌力较小。2髋关节在快、慢速时,右侧伸肌群分别为左侧的2.11和1.87倍,屈肌群为1.25和1.64倍,右髋非常显著性大于左髋。3腰背环节慢速屈伸肌比值为93.3%,快速测试屈伸肌比值为84.3%。4肩关节自然位屈伸,慢速屈伸肌力右肩分别为左肩的1.27和1.34倍,快速为左肩的1.40和1.92倍。5各环节根据人体模型相对质量按膝关节为基准膝、髋、躯干、肩为1∶2.38∶3.30∶0.70。结果表明：1膝关节屈伸肌群绝对肌力、快速屈肌群肌力均较弱,肌群配备不合理。2躯干肌力在右侧最大力量伸肌群、左右侧快速伸肌群非常薄弱,增加腰背肌力伸肌训练,特别是慢速和快速肌肉力量和伸展性训练。3右侧各环节伸肌群薄弱,加强右肩伸肌群的绝对肌肉力量。     

Joint and systemic distribution of dialysis amyloid

Deposition of beta 2-microglobulin amyloid in the joints of dialysis patients is common and begins early in the course of treatment, but its pathogenic significance in the production of dialysis arthropathy is uncertain. The joints (hip, knee, shoulder, elbow, wrist, cervical and lumbar spine, sacroiliac joint) and systemic tissues of 19 autopsied patients who had undergone haemodialysis for between 6 and 231 months were examined histopathologically for the presence of beta 2-microglobulin amyloid; it was present in all joints examined, including those unassociated with radiological changes and those of patients who had been on haemodialysis alone for only 24 months. Osteoarticular beta 2-microglobulin amyloid deposits were also found in patients who had been treated mainly by continuous ambulatory peritoneal dialysis. Systemic amyloid deposition was only seen in patients who had been haemodialysed for more than 13 years and consisted of sparse tiny deposits in blood vessel walls.     

Injections of joints and soft tissue: Part II. Guidelines for specific joints

Sterile technique is recommended for corticosteroid injection of joints and soft tissue. For joint aspiration, a slightly larger needle than that used for injection may be of benefit. Corticosteroid injection is followed by pain relief if the appropriate structure is treated. This article describes the technique used for aspiration and injection of specific structures, including the joints of the fingers and toes, wrist, elbow, shoulder, hip and knee.     

三梯杠康复练功器治疗脑血管病关节废用综合征

目的：观察脑血管病恢复期后遗症期不同程度的肢体关节废用综合征患者应用 Ｔ Ｗ Ｚ－ １ 型三梯杠多功能练功器进行康复治疗性训练的疗效。方法：选择患者１５０ 例,脑血栓形成８６ 例,脑出血６４ 例,病程４２ 天～１ 年半,恢复期５４ 例,后遗症期９６ 例。采用患肢与健肢的正常运动轴位作对照。结果：有效率：肩关节８２ ．６ ％ 、肘关节９３ ．１ ％ 、腕关节８６ ．７ ％ 、髋关节７６ ．５ ％ 、膝关节８５ ．７ ％ 、踝关节９４ ．７ ％ 。总有效率８８ ％ （ Ｐ＜ ０ ．０１） 。疗程平均８２ ．４９ 天。结论：三梯杠多功能练功器是肢体偏废关节废用综合征功能康复较理想的治疗性训练器械。     

2011北美放射年会关节影像学研究进展

2011年度北美放射年会（RSNA）共有骨天节系统影像学研究文章457篇,其中关节影像学研究文章达118篇,髋、膝、踝、肩等大关节周围韧带、肌腱损伤及关节软骨方面研究较多,以MRI为主,其中关节软骨研究主要集中于应用MRI新技术对损伤后软骨改变、软骨修复等进行定性和定量研究。四肢末端小关节及关节微结构研究相对较少,主要为MRI与MR关节造影对比研究。作者对以上方面进行简要综述,以期对今后关节影像学研究提供帮助。     

Osteoarticular tuberculosis: current diagnosis and treatment

Tuberculous synovitis frequently presents as a monoarthritis of weight-bearing joints such as the hip, knee, or ankle. Owing to its low incidence in developed countries, the diagnosis is often delayed for months to years. Early diagnosis with a synovial biopsy permits prompt antituberculous therapy and substantially improves the prospect of preservation of joint structure and function. Initial treatment typically includes combination therapy with four drugs (isoniazid, rifampin, pyrazinamide, and streptomycin or ethambutol) because of the frequency of isoniazid resistance. Antimicrobial therapy should be of at least 9 months' duration, longer in immunocompromised hosts. Partial synovectomy and other surgical procedures should be restricted to joints with severe cartilage destruction, large abscesses, joint deformity, multiple drug resistance, or atypical mycobacteria.     

Joint pain

Stiff and painful joints commonly accompany aging and sometimes occur in younger persons. Too often, the pain is attributed to arthritis without giving adequate consideration to soft-tissue joint disease. Dr Baum discusses disorders of the bursae and tendons that often cause pain in the knee, hip, and shoulder. Included are tips on history taking and physical examination, as well as a discussion of treatment methods.     

Differences in hip–knee joint coupling during gait after anterior cruciate ligament reconstruction

BackgroundAfter anterior cruciate ligament injury, patients have increased risk for developing degenerative osteoarthritis, potentially due to the kinematic changes that persist after surgical reconstruction. Current research only describes single joint kinematic differences rather than the way in which two joints behave concurrently, termed joint coupling. The purpose of this study was to compare knee motion relative to hip motion in anterior cruciate ligament reconstructed and healthy limbs during walking and jogging.MethodsThirty-seven recreationally active volunteers (22 reconstructed, 15 healthy) walked and jogged at 4.83 km/h and 9.66 km/h respectively. Vector coding methods were used to calculate stride-to-stride variability, magnitude, and vector angle of 6 joint couples during walking and jogging: hip frontal–knee frontal planes, hip frontal–knee sagittal, hip frontal–knee transverse, hip sagittal–knee frontal, hip sagittal–knee transverse, and hip transverse–knee frontal planes.FindingsThe hip sagittal–knee frontal and hip sagittal–knee transverse joint couples had decreased variability during mid-stance, and all other couples had increased variability during the stance phase in the reconstructed group. The reconstructed group had decreased magnitude of joint excursion in the hip frontal–knee sagittal couple during all phases of gait during walking. Vector angles of the hip frontal–knee transverse couple increased in the reconstructed group during the loading, middle, and terminal stance phases, and swing phase of gait during walking.InterpretationThe increased variability and decreased magnitude of joint excursion indicate that movement patterns were less consistent during walking gait despite employing a more constrained system during movement in the reconstructed limb compared to healthy controls.     

Sit-to-stand at different periods of pregnancy

OBJECTIVE: This study was performed to determine the biomechanics of chair rising by pregnant women. DESIGN: Relative body joint position and ground reaction forces were measured by a motion analysis system and one force plate. BACKGROUND: Physiological and psychological changes during pregnancy impose postural demands and limit the performance of daily living activities such as rising from sitting to standing position. METHODS: Twenty-four pregnant women, divided into three groups, were studied performing sit-to-stand transition from an armless and adjustable chair. By kinematic and kinetic analysis, the angles and moments of hip, knee and ankle joints were investigated. RESULTS: The chair height has great influence on knee joint and hip joint moments, but less on ankle joints. In the third trimester for all chair heights, because of a marked increase in abdominal depth, the maximum hip moment is significantly less than that in first trimester, while the maximum knee moment is significantly larger. Pregnant women in third trimester produced larger knee moment during sit-to-stand transition from lower chair height. CONCLUSIONS:The mechanism of sit-to-stand is affected by the physical changes of pregnant women at different periods of pregnancy, e.g. increased loading of knee joint and decreased hip joint moment, especially in the last trimester period of pregnancy.     

A method for the quantification of cartilage proteoglycan structures liberated to the synovial fluid during developing degenerative joint disease

An enzyme linked immunosorbent assay for the quantification of proteoglycans or proteoglycan fragments in biological fluids is presented. The assay has been used to determine concentrations of articular cartilage proteoglycans and/or fragments thereof in synovial fluid in early stages of osteoarthrosis. Osteoarthrosis was induced in one knee joint of nine German wire haired pointers by transection of the anterior cruciate ligament. All dogs developed osteoarthrosis in terms of macroscopic as well as microscopic criteria. Attempts were made to aspirate synovial fluid, prior to surgery and at various times in the postoperative period, from the joint operated on as well as from the contralateral joint. Concentrations of proteoglycans (fragments) of one type of aggregating proteoglycan were significantly higher in the synovial fluid samples from the joint operated on compared to the contralateral joint (p less than 0.001), while the difference observed when the other type of aggregating proteoglycan was used as the test antigen was less significant (p less than 0.05). The concentration of proteoglycans (fragments) in synovial fluid samples from joints operated on was significantly higher after the operation when compared with the preoperative concentration (p less than 0.001). No correction has been made for the increased dilution due to hydrops of the joints operated on.     

同种异体半关节移植重建肩膝关节21例报告

目的观察同种异体半关节移植重建肩膝关节的疗效及并发症.方法用同种异体半关节重建肿瘤切除后的骨关节21例;术后石膏托固定6周～3个月,抗炎治疗3个月,抗排异治疗6个月;随访时间2年～24.8年,平均10.5年.结果功能优良中16例(76.19%),差5例(23.81%);并发症种类多且发生率高.结论同种异体半关节移植重建肩膝关节不失为一种治疗骨肿瘤的有效手术.     

2012年北美放射学年会关节影像学研究进展

2012年度北美放射年会(RSNA)共有骨关节系统影像学研究论文约500余篇,其中关节影像学研究论文达200余篇,关于髋、膝、踝、肩、腕等关节软骨、周围韧带、肌腱损伤、关节病变术前评估及术后随访等方面研究较多,其中关节软骨研究主要集中于应用MRI新技术对损伤后软骨改变、软骨修复等进行定性和定量研究。对于四肢末端小关节及关节微结构研究相对较少,主要为诊断RA的新技术研究。此外,对关节US的研究较前增多。作者对以上方面进行简要综述,以期对今后关节影像学研究提供帮助。     

四肢关节结核的CT及MRI表现

目的:探讨外周大关节结核的CT、MRI表现及其鉴别诊断.方法:分析19例经病理证实或抗结核治疗效果显著的大关节结核的临床资料、CT和(或)MRI检查结果.结果:19例患者中,肘关节2例,踝关节3例,髋关节4例,肩关节4例,膝关节5例,腕关节1例.10例患者同时发现肺内结核,1例合并结核性胸膜炎,另外1例同时合并肺结核及...     

Role of infrapatellar fat pad in pathological process of knee osteoarthritis: Future applications in treatment

It has been found that obese people have a higher proportion in suffering from osteoarthritis (OA), not only in the weight-bearing joints like knee and hip joints, even in non-weight-bearing joints such as hand joints. One of the reasons is because the large amount of adipose tissue secretes some factors, which can promote the occurrence of arthritis. As an important structure of the knee joint, the infrapatellar fat pad (IPFP) is actually a piece of adipose tissue. The aim of this review is to offer a comprehensive view of the anatomy and physiological characteristics of IPFP and its relationship with the pathological process of OA, indicating the important function of IPFP in OA. At the same time, with the development of adipose derived stem cells in the treatment of OA, owing to its special advantages, the IPFP is becoming a kind of important, minimally invasive fat stem cell source, providing a new approach for the treatment of OA. We hope that this review will offer an overview of all published data regarding the IPFP and will indicate novel directions for future research.     

Radiologic signs of hip and knee joint degeneration. A potential source of iatrogenesis.

Bilateral x-ray films of hip joints in 326 and knee joints in 193 asymptomatic patients were analyzed to investigate the prevalence of abnormalities. Degenerative changes, if any, were classified according to severity. Bilateral degeneration of hip or knee joints was found in 20% of the subjects. Thus, caution must be exercised in interpreting radiologic signs of joint degeneration in the absence of clinical evidence.     

Comparison between successful and failed sit-to-stand trials of a patient after traumatic brain injury

OBJECTIVE: To compare the peak whole-body center of mass (COM) velocities and joint angular contributions in successful and unsuccessful sit-to-stand (STS) trials in a subject with traumatic brain injury (TBI). DESIGN: Single-case study. SETTING: Motion research laboratory. PARTICIPANT: A 24-year-old man who was 3.5 years post-TBI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Peak horizontal and vertical velocities of the whole-body COM and peak angular velocities of the ankle, knee, hip, and shoulder joints. RESULTS: The peak whole-body COM vertical velocity was significantly lower in the unsuccessful STS trials. Angular velocities at the hip, knee, ankle, and shoulder joints in successful trials exceeded those in unsuccessful trials (P<.001). The subject's peak knee extension velocity was the single major predictor of the peak whole-body COM vertical velocity (r(2)=.90). Knee extension angular velocities greater than 3.25 radian/s were associated with successful STS trials. Knee extension angular velocities between 2.75 and 3.25 radian/s were associated with successful rising 50% of the time; the subject had no success in rising when velocities were less than 2.75 radian/s. CONCLUSIONS: For this subject, sit-back failures occurred in STS attempts characterized by peak whole-body COM vertical velocities that were lower than those generated in successful rising trials. These unsuccessful rising attempts were primarily the result of the subject's inability to generate sufficient knee extension angular velocity.     

Comparison of Postures According to Sitting Time with the Leg Crossed

[Purpose] The purpose of this study was to identify postural changes in adults who have adopted the habit of sitting with their legs crossed. [Subjects and Methods] The subjects were 232 adults in their 20s and 30s (84 males and 148 females). They were divided into 0-, 1-, 2-, and 3-hour or more groups by observing how much time per day they sat with their legs crossed while sitting on a chair. We measured the postural alignment of all the subjects in the sagittal plane and coronal plane. In the sagittal plane, distances from the line of gravity to the external auditory meatus, the shoulder joints, the knee joints, and the calcaneocuboid joint were measured. In the coronal plane, the shoulder inclination and the pelvic tilt were measured. [Results] The shoulder joints, the knee joints, and the calcaneocuboid joint did not show any significant differences, but the head was aligned further forward in the 3-hour group compared to the other groups. In the coronal plane, the acromion processes and the anterior superior iliac spines of the 3-hour group showed statistically significant differences than those of all of the other groups. [Conclusion] The results indicate that sitting with the legs crossed for longer than three hours per day may cause shoulder inclination, lateral pelvic tilt and forward head posture.     

The effects of ankle bracing on motion of the knee and the hip joint during trunk rotation tasks

BACKGROUND: The use of prophylactic ankle braces is common during athletic activities since the ankle is one of the most commonly injured joints. Past studies have focused on the effects of ankle braces on ankle movement restriction, preventing injuries, proprioception, balance and athletic performance. However, the influence of ankle restriction on other joints has not been studied. The constraint of ankle movement may lead to an increased loading on the knee joint, which could be a potential risk of knee injuries during athletic activities. The primary goal of the current study was to determine quantitatively the effect of an ankle brace on the knee axial rotation during two different trunk turning tasks. METHODS: Ten healthy subjects performed trunk turning movements while standing on one leg: turning sideways to catch a ball and turning sideways to touch a target with the shoulder. The tasks were performed with and without an ankle brace worn on the supporting leg. The trunk axial rotation in reference to the floor and three dimensional joint angular motions of the ankle, knee and hip were determined. FINDINGS: The use of an ankle brace resulted in reduced trunk axial rotation during the ball catching tasks, and increased knee axial rotation during the target touching tasks. INTERPRETATION: The results of this study showed that the effect of the ankle brace on the knee axial rotation depended on the context of the tasks performed. Under situations that required forceful trunk turning movement while standing on a single leg, the ankle braces may cause an increase in the knee axial rotation indicating higher risk of knee injury.