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Clinical Scenario: Ankle sprains are one of the most common injuries in athletics, and many lead to recurrent sprains, chronic ankle instability, and persistent symptoms. Treatment improvements are needed. Platelet-rich plasma (PRP) involves formulating autologous plasma with higher platelet concentration to be injected in the desired tissue. There is currently high-quality evidence supporting the use of PRP with lateral epicondylitis and knee osteoarthritis to accelerate the healing process and decrease pain. Clinical Question: Does the injection of PRP relieve pain faster and improve function compared with no injection or placebo in patients with a lateral ankle sprain? Summary of Key Findings: A computerized search yielded 191 studies; of these, 3 studies fit the inclusion and exclusion criteria. PRP injection reduces pain and increases function after lateral ankle sprain 5 to 8 weeks after intervention. Clinical Bottom Line: The use of PRP after lateral ankle sprain to decrease pain and increase function is supported with moderate evidence. Strength of Recommendation: Based on the Strength of Recommendation Taxonomy, evidence from the included studies is considered as level B, reflecting limited quality patient-oriented evidence. [ABSTRACT FROM AUTHOR]

Imbalanced joint load distribution across the tibiofemoral surface is a risk factor for osteoarthritic changes to this joint. Lateral wedge insoles, with and without arch support, are a form of biomechanical intervention that can redistribute tibiofemoral joint load, as estimated by external measures of knee load. The objective of this study was to examine the effect of these insoles on the internal joint contact characteristics of osteoarthritic knees during weightbearing. Fifteen adults with tibiofemoral osteoarthritis underwent magnetic resonance imaging of the affected knee, while standing under 3 insole conditions: flat control, lateral wedge alone, and lateral wedge with arch support. Images were processed, and the surface area and centroid location of joint contact were quantified separately for the medial and lateral tibiofemoral compartments. Medial contact surface area was increased with the 2 lateral wedge conditions compared with the control (P ≤.012). A more anterior contact centroid was observed in the medial compartment in the lateral wedge with arch support compared with the lateral wedge alone (P =.009). Significant changes in lateral compartment joint contact outcomes were not observed. These findings represent early insights into how loading at the tibiofemoral interface may be altered by lateral wedge insoles as a potential intervention for knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Individuals with knee osteoarthritis (KOA) and flat feet are more likely to experience increased pain and cartilage damage. This study aimed to investigate the knee kinetics, kinematics, pain, and physical function in individuals with moderate symptomatic KOA, in comparison to asymptomatic control participants. Thirty volunteers with moderate KOA (with flat feet n = 15, with normal feet n = 15) and 30 asymptomatic people (with flat feet n = 15, with normal feet n = 15) were evaluated. The knee adduction angular impulse, knee flexion moment, knee flexion angular impulse, and knee flexion angle were measured during level walking. The pain was assessed in patients with KOA. The study found that individuals with KOA had a significant increase in the knee adduction angular impulse compared with the asymptomatic people (P <.05). The KOA with flat feet group had significantly lower knee flexion moment, knee flexion angular impulse, and knee flexion angle values than the KOA with normal feet group (P <.05). Furthermore, the KOA with flat feet group had a higher pain score than the KOA with normal feet group. Individuals with osteoarthritis and flat feet had lower knee flexion moments which may indicate reduced knee force exerted through compensatory mechanisms. Despite this reduction, they reported significantly higher levels of pain compared with those without flat feet, a finding that warrants further investigation in future studies. [ABSTRACT FROM AUTHOR]

PURPOSE: The purpose of this study was to review the currently available systematic reviews and meta-analyses comparing kinematic alignment (KA) and mechanical alignment (MA). METHODS: A literature search was performed to obtain all systematic review and meta-analyses comparing KA to MA that included one or more randomised controlled trials. A total of 18 studies were obtained, three of which were systematic reviews without meta-analysis. Studies were evaluated based on their meta-analysis methodology, appropriate inclusion criteria, the use of correct definitions of each alignment technique, and risk of bias. RESULTS: These 18 studies included between 3 and 14 RCTs in each study. From the perspective of study design, the majority of papers had low risk of bias. In contrast, most of these reviews had technical issues pertaining to study inclusion in their meta-analyses that would potentially compromise their conclusions. These included mixing time points in the analysis, duplicate inclusion of patients in a meta-analysis, inclusion of studies with incorrect definitions of KA, inclusion of studies performed with restricted kinematic alignment with the KA group, and inappropriate combination of studies with bilateral total knee arthroplasty (TKA) with studies with unilateral TKA. CONCLUSIONS: The current literature is inadequate to determine if there is any advantage to KA compared to MA in TKA. Claims made in systematic reviews and meta-analyses on the subject must be carefully scrutinised based not only on risk of bias but also on the included study populations, the surgical methodology of each underlying study, and the authors understanding of the definitions of each alignment technique. LEVEL OF EVIDENCE: Level 1 based on this study being a systematic review with the inclusion of only systematic reviews and meta-analyses of randomised controlled trials.

We aimed to investigate the effects of delivering 3 gait retraining interventions (toe-in, toe-out, and placebo gait) on proxy measures of medial knee load (early- and late-stance peak knee adduction moment [KAM], KAM impulse, and varus thrust) in people with knee osteoarthritis, using a hybrid model of face-to-face and telehealth-delivered sessions over 5 months. This was an originally planned 3-arm randomized placebo-controlled clinical trial. However, during the 2021 COVID-19 outbreak and lockdown in Sydney, Australia, the study became a pilot randomized controlled trial with the remainder of interventions delivered via telehealth. Nine individuals with symptomatic medial knee osteoarthritis were allocated to receive either a toe-in, toe-out, or posture re-education (placebo) gait retraining intervention. Primary outcomes of early- and late-stance peak KAM, KAM impulse, and varus thrust were assessed at baseline and follow-up. Eight participants returned for their follow-up gait assessment. Participants in both active intervention groups (toe-in and toe-out) achieved foot progression angle changes at follow-up. Overall, knee biomechanics in the placebo group did not change at follow-up. It is possible to achieve biomechanical changes in individuals with medial knee osteoarthritis when delivering gait retraining interventions via a hybrid model of face-to-face and telehealth. [ABSTRACT FROM AUTHOR]

Background: Low-intensity resistance exercise therapy (LIRET) based on myofascial chains, applied to both affected and nonlocal joints, is an effective method for knee osteoarthritis (OA) rehabilitation. This study applied LIRET in a comparison of prevalues and postvalues of lower-limb tension in female patients with knee OA and asymptomatic participants. Methods: Twenty-four female participants with knee OA and 20 asymptomatic women took part in a 3-month long application of LIRET. Participants' ankle passive torque and ankle range of motion in the sagittal plane were assessed with an isokinetic dynamometer. The collected values were used to estimate the sagittal-plane lower-limb tension. Results: Compared with the asymptomatic group, participants with knee OA presented decreased maximum ankle dorsiflexion (P <.001), decreased ankle plantar flexion range (P =.023), ankle resting position more inclined to dorsiflexion (P =.017), increased ankle dorsiflexion stiffness (P =.005), and lower ankle plantar flexion stiffness (P =.034). After exercise intervention, the knee OA group self-reported less knee pain (P <.001), improved physical function (P <.001), increased maximum dorsiflexion (P =.021), and increased plantar flexion range (P <.001). While plantar flexion stiffness increased (P =.037), dorsiflexion stiffness decreased (P =.015) and ankle resting position moved toward dorsiflexion (P =.002). Results suggest possible decreased anterior leg tension and possible increased posterior leg tension in patients with knee OA. Conclusions: The results supported that knee OA patients present imbalanced myofascial tension of lower limbs. LIRET based on myofascial chains appears to decrease pain, and stiffness, and improve physical function of patients with knee OA and change their lower-limb tension. [ABSTRACT FROM AUTHOR]

BACKGROUND: MRI is important for the diagnosis of early knee osteoarthritis. MRI image recognition and intelligent segmentation of knee osteoarthritis using deep learning method is a hot topic in image diagnosis of artificial intelligence. OBJECTIVE: Through deep learning of MRI images of knee osteoarthritis, the segmentation of femur, tibia, patella, cartilage, meniscus, ligaments, muscles and effusion of knee can be automatically divided, and then volume of knee fluid and muscle content were measured. METHODS: 100 normal knee joints and 100 knee osteoarthritis patients were selected and randomly divided into training dataset (n=160), validation dataset (n=20), and test dataset (n=20) according to the ratio of 8:1:1. The Coarse-to-Fine sequential training method was used to train the 3D-UNET network deep learning model. A Coarse MRI segmentation model of the knee sagittal plane was trained first, and the rough segmentation results were used as a mask, and then the fine segmentation model was trained. The T1WI and T2WI images of the sagittal surface of the knee joint and the marking files of each structure were input, and DeepLab v3 was used to segment bone, cartilage, ligament, meniscus, muscle, and effusion of knee, and 3D reconstruction was finally displayed and automatic measurement results (muscle content and volume of knee fluid) were displayed to complete the deep learning application program. The MRI data of 26 normal subjects and 38 patients with knee osteoarthritis were screened for validation. RESULTS AND CONCLUSION: (1) The 26 normal subjects were selected, including 13 females and 13 males, with a mean age of (34.88±11.75) years old. The mean muscle content of the knee joint was (1 051 322.94±2 007 249.00) mL, the mean median was 631 165.21 mL, and the mean volume of effusion was (291.85±559.59) mL. The mean median was 0 mL. (2) There were 38 patients with knee osteoarthritis, including 30 females and 8 males. The mean age was (68.53±9.87) years old. The mean muscle content was (782 409.18±331 392.56) mL, the mean median was 689 105.66 mL, and the mean volume of effusion was (1 625.23±5 014.03) mL. The mean median was 178.72 mL. (3) There was no significant difference in muscle content between normal people and knee osteoarthritis patients. The volume of effusion in patients with knee osteoarthritis was higher than that in normal subjects, and the difference was significant (P < 0.05). (4) It is indicated that the intelligent segmentation of MRI images by deep learning can discard the defects of manual segmentation in the past. The more accuracy evaluation of knee osteoarthritis was necessary, and the image segmentation was processed more precisely in the future to improve the accuracy of the results. [ABSTRACT FROM AUTHOR]

Background: Knee osteoarthritis (OA) is a leading cause of disability, with current treatment options often falling short of providing satisfactory outcomes. Autologous-cultured adipose-derived mesenchymal stem cells (ADMSCs) and stromal vascular fractions (SVFs) have emerged as potential regenerative therapies. Methods: A comprehensive search was conducted among multiple databases for studies up to June 2023. The risk of bias was assessed in randomized and non-randomized studies, adhering to PRISMA guidelines. The study has been registered with PROSPERO (CRD 42023433160). Results: Our analysis encompassed 31 studies involving 1,406 patients, of which, 19 studies with 958 patients were included in a meta-analysis, examining both SVF and autologous-cultured ADMSC methods. Significant pain reduction was observed with autologous-cultured ADMSCs starting at 3 months (MD = −2.43, 95% CI, −3.99, −0.86), whereas significant pain mitigation in response to SVF therapy was found to start at 12 months (MD = −2.13, 95% CI, −3.06, −1.21). Both autologous-cultured ADMSCs and SVF provided significant improvement in knee function starting at 12 months (MD = −9.19, 95% CI, −12.48, −5.90 vs. MD = −9.09, 95% CI, −12.67, −5.51, respectively). We found no evidence of severe adverse events linked directly to ADMSC therapy. Conclusion: Autologous-cultured ADMSCs offer a promising alternative for more rapid pain relief in knee OA, with both ADMSCs and SVF demonstrating substantial long-term benefits in joint function and cartilage regeneration, in the absence of any severe ADMSC-related adverse events. [ABSTRACT FROM AUTHOR]

Background: Accurate measurement of the hip-knee-ankle (HKA) angle is essential for informed clinical decision-making in the management of knee osteoarthritis (OA). Knee OA is commonly associated with varus deformity, where the alignment of the knee shifts medially, leading to increased stress and deterioration of the medial compartment. The HKA angle, which quantifies this alignment, is a critical indicator of the severity of varus deformity and helps guide treatment strategies, including corrective surgeries. Current manual methods are labor-intensive, time-consuming, and prone to inter-observer variability. Developing an automated model for HKA angle measurement is challenging due to the elaborate process of generating handcrafted anatomical landmarks, which is more labor-intensive than the actual measurement. This study aims to develop a ResNet-based deep learning model that predicts the HKA angle without requiring explicit anatomical landmark annotations and to assess its accuracy and efficiency compared to conventional manual methods. Methods: We developed a deep learning model based on the variants of the ResNet architecture to process lower limb radiographs and predict HKA angles without explicit landmark annotations. The classification performance for the four stages of varus deformity (stage I: 0°–10°, stage II: 10°–20°, stage III: > 20°, others: genu valgum or normal alignment) was also evaluated. The model was trained and validated using a retrospective cohort of 300 knee OA patients (Kellgren-Lawrence grade 3 or higher), with horizontal flip augmentation applied to double the dataset to 600 samples, followed by fivefold cross-validation. An extended temporal validation was conducted on a separate cohort of 50 knee OA patients. The model's accuracy was assessed by calculating the mean absolute error between predicted and actual HKA angles. Additionally, the classification of varus deformity stages was conducted to evaluate the model's ability to provide clinically relevant categorizations. Time efficiency was compared between the automated model and manual measurements performed by an experienced orthopedic surgeon. Results: The ResNet-50 model achieved a bias of − 0.025° with a standard deviation of 1.422° in the retrospective cohort and a bias of − 0.008° with a standard deviation of 1.677° in the temporal validation cohort. Using the ResNet-152 model, it accurately classified the four stages of varus deformity with weighted F1-score of 0.878 and 0.859 in the retrospective and temporal validation cohorts, respectively. The automated model was 126.7 times faster than manual measurements, reducing the total time from 49.8 min to 23.6 sec for the temporal validation cohort. Conclusions: The proposed ResNet-based model provides an efficient and accurate method for measuring HKA angles and classifying varus deformity stages without the need for extensive landmark annotations. Its high accuracy and significant improvement in time efficiency make it a valuable tool for clinical practice, potentially enhancing decision-making and workflow efficiency in the management of knee OA. [ABSTRACT FROM AUTHOR]

This study aimed to analyze and predict various types of knee pain in knee osteoarthritis (KOA) patients based on Semi-Quantitative MRI Osteoarthritis Knee Score (SQ-MOAKS) features. The goal was to identify structural abnormalities in the knee joint associated with different types of pain, thereby aiding in the development of personalized treatment plans. Subjects were selected from the Osteoarthritis Initiative (OAI) database, including 297 patients who underwent both SQ-MOAKS assessment on knee MRI images and WOMAC knee pain assessment. Univariate and multivariate logistic regression analyses were used for feature selection, followed by the construction of multi-risk factor models and corresponding nomograms for each pain type. The predictive values of the models were evaluated using ROC curves and related metrics (AUC, accuracy, sensitivity, specificity), and the DeLong test was used to assess the significance of differences between various ROCs and AUCs. Significant associations were found between specific SQ-MOAKS features and different types of knee pain. Bone marrow lesions (BML) and cartilage morphology (CM) features were crucial in predicting the walking pain and rest pain, while osteophytes (OS) were more associated with nocturnal pain and pain during stair climbing. The models demonstrated high predictive accuracy, particularly for walking pain and rest pain. This study demonstrated that SQ-MOAKS features could effectively predict different types of knee pain, revealing the structural basis of knee pain in KOA patients. These results prompted the use of SQ-MOAKS in developing personalized treatment strategies, enhancing clinical decision-making, and improving patient quality of life. [ABSTRACT FROM AUTHOR]

BackgroundObjectiveMethodsResultsConclusionVarus thrust (VT) is a frequently reported abnormal gait pattern in patients with medial knee osteoarthritis (KOA). VT is important to prevent KOA progression. However, there is no consensus on the relationship between VT and foot alignment and flexibility, although it has been reported that patients with KOA have pronated foot.In this study, we examined the relationship between VT, foot alignment, and flexibility in patients with KOA.Twenty patients with unilateral KOA were included in this study (mean age: 71.5 ± 4.7 years). KOA severity ranged from grade III (8 patients) to grade IV (12 patients) based on the Kellgren-Lawrence classification. Gait analysis using inertial sensors was performed to determine the difference between the VT of KOA side and the contralateral side without symptoms. The correlations between VT, foot alignment, and flexibility were also analyzed.VT was significantly greater on the side with KOA than on the contralateral side without KOA (d = 1.09, p = .002). VT was not significantly correlated with foot alignment but was significantly correlated with the arch stiffness index, which indicates foot flexibility (r = 0.642, p = .003).This study suggests that foot flexibility may play a more significant role than foot alignment in addressing VT in patients with KOA. When performing physical therapy for VT, evaluating foot flexibility in addition to foot alignment may help reduce this condition. Further studies with larger sample sizes and more detailed statistical analyses are needed to validate these findings. [ABSTRACT FROM AUTHOR]

BACKGROUND: For early knee osteoarthritis in which total knee arthroplasty fails to achieve satisfactory results, high tibial osteotomy that has been found to promote regeneration of damaged cartilage and alleviate symptoms in patients is considered a classic knee-preserving procedure. OBJECTIVE: To review and discuss the effectiveness, mechanism, and application prospects of high tibial osteotomy in stimulating cartilage regeneration in knee osteoarthritis and to provide a theoretical basis for the use of high tibial osteotomy in the treatment of knee osteoarthritis. METHODS: A computerized search was conducted in PubMed, Web of Science, CNKI and WanFang databases for relevant literature published from 2013 to 2023. The search terms used were “knee osteoarthritis, high tibial osteotomy, limb alignment, chondrocytes, biomechanics, intra-articular” in both English and Chinese. Finally, 75 articles were included for review. RESULTS AND CONCLUSION: High tibial osteotomy correcting the lower limb alignment has been found to be effective in alleviating symptoms and potentially delaying or preventing the need for total knee arthroplasty. This is an important aspect of orthopedic step-down treatment in knee osteoarthritis. Maintaining a normal mechanical microenvironment is crucial for the proper functioning and maintenance of chondrocyte phenotype. Abnormal mechanical signals can be converted into intracellular chemical signals through mechanosensors like primary cilia, integrins, cytoskeleton and nucleoskeleton, resulting in disruptions to the balance of matrix metabolism and regulation of inflammatory responses. Chondrocytes after abnormal stress action still have the potential to revert to a normal phenotype under appropriate stress; correction of the mechanical microenvironment by high tibial osteotomy leads to spontaneous cartilage repair and remission of synovial inflammation. The combination of high tibial osteotomy and cartilage regeneration strategy holds promising prospects for patients with early knee osteoarthritis who are not candidates for total knee arthroplasty. [ABSTRACT FROM AUTHOR]

BACKGROUND: Platelet-rich fibrin (PRF) is a second generation platelet concentrate with the advantages of simple operation, no anticoagulant, and high bioactivity, which has been applied in the fields of trauma repair, bone defect repair, and tendon soft tissue repair, and has been proved to have a certain tissue repair-promoting effect. OBJECTIVE: To study the repair effect of PRF on articular cartilage tissue in rats with knee osteoarthritis. METHODS: Thirty-six Sprague-Dawley rats were randomly divided into normal group, model group, and PRF group, with 12 rats in each group. Rats in the normal group did not undergo any treatment. In the model group, animal models of knee osteoarthritis were prepared and rat models were then given physiological saline into the joint cavity once a week after surgery. Rat models of knee osteoarthritis were also prepared in the PRF group, and autologous PRF was injected into the joint cavity once a week after surgery. After 5 weeks of continuous treatment, tissue samples were taken. Hematoxylin-eosin staining was used to observe the morphology of cartilage tissue. Tunel staining was used to detect chondrocyte apoptosis, ELISA was used to detect inflammatory factor levels. Western blot and RT-PCR were used to detect Bcl-2, Bax, and Caspase-3 expression in protein and mRNA levels, respectively. RESULTS AND CONCLUSION: The model group had severe cartilage tissue damage, while the PRF group had significantly improved cartilage tissue morphology compared with the model group. The model group had more apoptotic chondrocytes. Compared with the model group, the mean absorbance of Tunel positive staining in the PRF group significantly decreased (P < 0.01). The levels of interleukin-1β, interleukin-6 and tumor necrosis factor-α were significantly increased in the model group and PRF group compared with the normal group (P < 0.01) and were significantly decreased in the PRF group compared with the model group (P < 0.01). The relative expressions of Bax and Caspase-3 at protein and mRNA levels were significantly increased in the model group and PRF group compared with the normal group (P < 0.01), while the relative expressions of Bcl-2 at protein and mRNA were significantly decreased (P < 0.01). Compared with the model group, the relative expression of Bax and Caspase-3 at protein and mRNA levels were significantly decreased in the PRF group (P < 0.01), while the relative expressions of Bcl-2 at protein and mRNA levels were significantly increased (P < 0.01). To conclude, PRF can inhibit chondrocyte apoptosis by inhibiting the expression of pro-inflammatory factors, thereby promoting cartilage tissue repair in knee osteoarthritis rats. [ABSTRACT FROM AUTHOR]

BACKGROUND: In recent years, epidemiological studies have shown that sleep patterns are risk factors for osteoarthritis, but the causal relationship between sleep characteristics and osteoarthritis remains unknown. OBJECTIVE: To investigate the causal relationship between seven sleep phenotypes and osteoarthritis, thereby providing a theoretical foundation for clinical prevention and intervention of osteoarthritis. METHODS: Seven sleep-related features, namely sleep duration, wake-up time, daytime napping, morning/evening preference, snoring, insomnia, and hypersomnia, were selected from published genome-wide association studies. Instrumental variables for these sleep-related features were extracted. Instrumental variables for knee osteoarthritis and hip osteoarthritis were obtained from publicly available genome-wide association studies. Causal relationships between sleep characteristics and outcome risks were evaluated using two-sample and multivariable Mendelian randomization analyses. The inverse variance weighted method was employed as the primary Mendelian randomization approach. Various methods, including weighted median, weighted mode, Mendelian randomization-Egger regression, Mendelian randomization pleiotropy-residual sum and outlier, were utilized to detect and correct for the presence of pleiotropy. RESULTS AND CONCLUSION: The results of the inverse variance-weighted method in the two-sample Mendelian randomization study revealed a detrimental causal association between the duration of sleep and the incidence risk of knee osteoarthritis [odds ratio (OR)=0.621, 95% confidence interval (CI): 0.470-0.822, P=0.001]. Concurrently, insomnia displayed a positive causal connection with hip osteoarthritis risk (OR=2.016, 95% CI: 1.249-3.254, P=0.005). Sensitivity analysis affirmed the robustness of these causal relationships, and Mendelian randomization-Egger intercept analysis found no evidence of potential horizontal pleiotropy (knee osteoarthritis: P=0.468, hip osteoarthritis: P=0.551). Moreover, the results from the multivariable Mendelian randomization analysis showed that the causal association between insomnia and hip osteoarthritis lacked statistical significance (P=0.715). In contrast, sleep duration exhibited a direct negative causal relationship with the incidence risk of knee osteoarthritis (OR=0.526, 95% CI: 0.336-0.824, P=0.005). Reverse Mendelian randomization analysis indicated that knee osteoarthritis did not influence sleep duration (P=0.757). These findings indicate a negative correlation between sleep duration and incidence risk of knee osteoarthritis, suggesting that correcting insufficient sleep might mitigate the incidence risk of knee osteoarthritis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Acupotomy is effective in the treatment of knee osteoarthritis, but its mechanism is not very clear. OBJECTIVE: To observe the effect of acupotomy on the apoptosis of knee chondrocytes in knee osteoarthritis rats based on osteoclast associated receptor (OSCAR)-tumor necrosis factor-associated apoptosis-inducing ligand (TRAIL)-osteoprotetin (OPG) pathway. METHODS: Twenty-seven Sprague-Dawley rats were randomly divided into normal group (n=9), model group (n=9) and acupotomy group (n=9). Rats in the normal group were routinely housed without any treatment. Animal models of knee osteoarthritis were established by knee injection of papain. Acupotomy intervention was performed 1 week after modeling, once a week for a total of three times. Relevant tests were performed at the end of the intervention. RESULTS AND CONCLUSION: The Lequesne MG behavioral scores of rats in the model group were elevated compared with the normal group (P < 0.01), while the Lequesne MG behavioral scores of rats in the acupotomy group were decreased compared with the model group (P < 0.01). Hematoxylin-eosin staining results showed that compared with the normal group, the cartilage surface of the rat’s knee joints in the model group was worn and uneven and the chondrocytes were swollen, ruptured, reduced in number, and arranged disorderly; while the cartilage surface of the rat’s knee joints in the acupotomy group was relatively smooth, and the chondrocytes were high in number and arranged in an orderly manner, with the structure basically clear. Immunohistochemical staining results showed that compared with the normal group, the positive expressions of OSCAR and TRAIL were increased in the model group (P < 0.01), while the positive expression of OPG was decreased (P < 0.01). Compared with the model group, the positive expressions of OSCAR and TRAIL in the acupotomy group were decreased (P < 0.01), while the positive expression of OPG was increased (P < 0.01). TUNEL staining results showed that compared with the normal group, the number of apoptotic cells in the model group were increased (P < 0.01); compared with the model group, the number of apoptotic cells in the acupotomy group decreased (P < 0.01). RT-qRCR and western blot results showed that compared with the normal group, the protein expressions of OSCAR, TRAIL and Bax in the model group were increased (P < 0.01), and the protein expressions of OPG and Bcl-2 were decreased (P < 0.01); compared with the model group, the protein expressions of OSCAR, TRAIL, and Bax in the acupotomy group were decreased (P < 0.01), and the protein expressions of OPG and Bcl-2 were increased (P < 0.01). To conclude, acupotomy can reduce cartilage injury of the knee joint in rats with knee osteoarthritis, which may be related to the blockage of mitochondrial pathway apoptotic signaling release by the OSCAR-TRAIL-OPG pathway. [ABSTRACT FROM AUTHOR]

BACKGROUND: Knee osteoarthritis is a common clinical degenerative joint disease characterized by chronic inflammation and oxidative stress. Resveratrol has anti-inflammatory and anti-oxidative stress biological effects, and therefore it can be used symptomatically and expected to provide a new strategy for the treatment of knee osteoarthritis. OBJECTIVE: To investigate the therapeutic effect and mechanism of resveratrol on knee osteoarthritis in rats through the silence information regulator 1 (SIRT1)/forkhead transcription factor O1 (FOXO1) pathway. METHODS: Forty Sprague-Dawley rats were randomly divided into control group, model group, low-dose resveratrol group, and high-dose resveratrol group, with 10 rats in each group. Knee osteoarthritis models were established in the model group, low-dose resveratrol group, and high-dose resveratrol group. A mixture of 4% papain solution and 0.3 mol/L cysteine solution (1:1 for 0.5 hours; 20 μL) was injected at 1, 4, and 7 days after modeling. Rats in the low-dose and high-dose resveratrol groups were injected with 25 and 100 mg/kg resveratrol through the articular cavity at 1 day after successful modeling, while those in the control and model groups were injected with equivalent volume of physiological saline through the articular cavity. After 28 days of treatment, the maximum knee joint activity was measured; the levels of oxidative stress indicators and inflammatory factors in the synovial fluid of the knee joint were analyzed by radioimmunoassay and ELISA; the content of collagen fibers in the knee joint was analyzed by safranin O-fast green staining; the degree of arthritic lesions was analyzed using the Mankin histological score; and the levels of SIRT1 and FOXO1 in the knee joint were detected by western blot assay. RESULTS AND CONCLUSION: Compared with the model group, the maximum knee flexion and extension angles of rats significantly increased in the low-dose and high-dose resveratrol groups, and were significantly higher in the high-dose group than the low-dose group (P < 0.05). Compared with the model group, the levels of superoxide dismutase and glutathione peroxidase in the knee joint fluid of rats significantly increased in the low-dose and high-dose resveratrol groups. The level of malondialdehyde significantly decreased in both resveratrol groups, and the level in the high-dose resveratrol group was significantly better than that in the low-dose resveratrol group (P < 0.05). Compared with the model group, the low-dose and high-dose resveratrol groups showed a significant decrease in the levels of interleukin 1β, interleukin 6 and tumor necrosis factor α in the knee joint fluid of rats, and the levels of these inflammatory factors were significantly lower in the high-dose resveratrol group than the low-dose resveratrol group (P < 0.05). Compared with the model group, the content of collagen fibers in the knee joint was significantly increased in both resveratrol groups, and the high-dose resveratrol group showed a higher content of collagen fibers than the low-dose resveratrol group (P < 0.05). Compared with the model group, the expression level of SIRT1 in the knee joints of rats significantly increased in both resveratrol groups, while the level of acetylated FOXO1 significantly decreased (P < 0.05). The magnitude of changes was significantly better in the high-dose group than the low-dose group. To conclude, resveratrol significantly improves the levels of oxidative stress and inflammatory factors in the joint fluid of rats with knee osteoarthritis and alleviates arthritic symptoms in a dose-dependent manner, possibly through the SIRT1/FOXO1 pathway. [ABSTRACT FROM AUTHOR]

Background: While measuring meniscal extrusion quantitatively is an early risk factor for knee osteoarthritis (KOA), the biomechanics involved in this process are not well understood. This study aimed to investigate the effects of varying degrees of medial and lateral meniscal extrusion and their material softening on knee osteoarthritis progression. Methods: Finite element analysis (FEA) was utilized to simulate varying degrees of meniscal extrusion (1–5 mm) in 72 knee joint models, representing progressive meniscal degeneration and material softening due to injury. Changes in von Mises stress of the cartilage and menisci and the load distribution on the tibial plateau's meniscus and cartilage were studied under balanced standing posture in both healthy and injured knees, and statistical analysis was performed using Spearman correlation. Results: Compared to healthy knees, peak stress in medial compartment tissues increased by over 40% with 4 mm of medial meniscus extrusion, and in lateral compartment tissues with 2 mm of lateral meniscus extrusion. Meniscus extrusion reduced the contact load between the meniscus and femoral cartilage but increased it between the tibial and femoral cartilages, with a maximum increase up to fivefold. Spearman correlation analysis indicated that meniscal extrusion significantly affected peak stress and contact loads in the respective knee compartment (p < 0.001), with a lesser impact on the opposite compartment. Notably, medial meniscal extrusion also significantly increased peak stress in the lateral tibial cartilage (p < 0.05). Conclusions: The quantitative analysis revealed that meniscal extrusion significantly affected the biomechanics of soft tissues within the same compartment, with limited impact on the opposite side. Specifically, Medial extrusion beyond 4 mm significantly affected the biomechanics of the medial compartment, while lateral extrusion over 2 mm had a similar impact on the lateral compartment. Meniscal softening, without altering joint contact characteristics, primarily affected the biomechanics of the meniscus itself, with minimal impact on other soft tissues. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence Patients undergoing total knee arthroplasty (TKA) with prior knee cartilage surgery have unclear outcomes in the literature. This study compared outcomes after TKA in patients with or without prior knee cartilage surgery, and we hypothesized there would be equivocal outcomes between groups.A retrospective matched case–control study was conducted on patients from our institution who underwent ipsilateral cartilage procedure(s) and TKA (cases) or TKA alone (controls) from 2000 to 2022. Cartilage procedures included Autologous Chondrocyte Implantation (ACI), Osteochondral Allograft (OCA) and Microfracture (MFx). Matching was performed in 1:3 (case:control) ratio for age, sex, body mass index, Charlson Comorbidity Index, pre‐TKA Kellgren–Lawrence osteoarthritis grade and follow‐up for knee injury and osteoarthritis outcome score for joint replacement (KOOS‐JR). Mann–Whitney U and χ2 analyses were conducted, with significance being a p < 0.05. A priori power analysis required 29 patients per cohort to reach a clinically detectable difference of 11 for KOOS‐JR.Forty‐three cases (one ACI, eight OCA and 34 MFx) and 129 controls were included after matching, with no significant demographic differences. Cases underwent TKA after cartilage surgery at a mean of 4.6 years. No significant differences existed between cases and controls for the preoperative KOOS‐JR (45.2 vs. 47.8; p = 0.353), postoperative KOOS‐JR (69.8 vs. 69.9; p = 0.974) or Delta KOOS‐JR (30.4 vs. 26.0; p = 0.387). No significant differences existed for 90‐day readmission rates (4.7% vs. 2.3%; p = 0.600) or revision TKA rates (11.6% vs. 5.4%; p = 0.177).Patients with and without prior cartilage surgery experience similar functional outcomes, readmission rates and revision rates after TKA on the same knee. Patients who are candidates for TKA with a history of cartilage surgery may be counselled that their surgical history on that knee does not convey the risk of worse functional outcomes.Level III case–control study. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusions Level of Evidence Using time‐driven activity‐based costing (TDABC), we sought to compare the total facility costs, comprising supply and personnel costs during the episode of care for the index procedure, in patients with isolated medial compartmental knee osteoarthritis (OA) undergoing unicompartmental knee arthroplasty (UKA) versus total knee arthroplasty (TKA).We conducted a retrospective analysis of 100 UKAs and 100 TKAs from 2019 to 2022. From a larger sample of 4899 TKAs and 137 UKAs, patients with isolated medial OA (Kellgren–Lawrence Grade <2 in other compartments) were radiographically identified. Demographic data included age, sex and body mass index, with comorbidities controlled using the Charlson comorbidity index. Facility costs were calculated using TDABC and standardized in cost units (CUs), a metric for comparing costs across procedures. Multiple regression analysis was used to assess the independent effect of TKA versus UKA on facility costs.TKA patients had similar operative times (TKA vs. UKA: 1.01×, p = 0.783) and supply costs (1.00×, p = 0.866), where ‘x’ denotes the relative cost ratio. However, TKA was associated with higher personnel costs (260.0 vs. 222.5 CUs [1.17×], p < 0.001) and total facility costs, both including (706.3 vs. 667.5 CUs [1.06×], p = 0.007) and excluding implants (353.8 vs. 312.5 CUs [1.13×], p < 0.001). Adjusted for demographics and comorbidities, TKA had increased facility costs, including (32.2 CUs, 95% confidence interval [CI]: 2.9–61.5, p = 0.031) and excluding implants (37.8 CUs, 95% CI: 15.2–60.3, p = 0.001).TDABC analysis revealed higher total facility costs for the index procedure in TKA, suggesting UKA may be a cost‐saving alternative for isolated medial compartment knee OA.Level III, retrospective comparative study. [ABSTRACT FROM AUTHOR]

Optimal ligament balance is crucial for successful total knee arthroplasty (TKA), which is a standard procedure for managing end-stage knee osteoarthritis. However, the reported values of ligament balance vary due to different methodologies and population differences, which requires further studies. This study aimed to investigate the varus-valgus ligament balance in healthy knees of Japanese individuals and its relationship with lower limb alignment. The studyanalyzed64 knees from 33 healthy young adults using stress radiographs to measure varus-valgus laxity. The mechanical hip-knee-ankle angle, medial proximal tibial angle, and lateral distal femoral angles were determined using digital long-leg radiographs. Varus and valgus laxities were compared, and the relationship between ligament balance and alignment parameters was analyzed. Mean varus laxity (3.6°± 1.3°) was significantly greater than mean valgus laxity(2.9°± 1.0°) (p<0.0001). No significant association was observed between ligament balance and alignment parameters. Healthy knees of Japanese individuals exhibited slightly greater varus laxity (0.7°) than valgus laxity, with no correlation observed between ligament balance and lower limb alignment. The finding underscores the importance of recognizing alignment diversity while noting that alignment does not influence ligament balance; this is particularly relevant in modern TKA techniques focusing on patient-specific joint and ligament reconstructions. The study's findings could help formulate strategies benefiting knee osteoarthritis management. [ABSTRACT FROM AUTHOR]

Diclofenac etalhyaluronate (DF‐HA) sustained diclofenac release with the effects of hyaluronic acid (HA), offering long‐term analgesia in osteoarthritis. In this study, the effects of DF‐HA on pain improvement and osteoarthritis were evaluated in a rat knee monoiodoacetate‐induced osteoarthritis model compared to HA. Eight rats per group had been injected with monoiodoacetate (2.0 mg) or saline in the right knee for 4 weeks and were injected with either DF‐HA (1.25 mg/kg; 0.5 mg), HA (0.5 mg), vehicle which was a substrate without DF‐HA (50 μL), or saline and followed for 4 weeks. Mechanical plantar skin sensitivity was assessed weekly using the von Frey assay. Osteoarthritis changes were monitored with Larsen scores via CT imaging at every 2 weeks. The articular cartilage was analyzed using OARSI scores through H&E, Safranin‐O staining at 8 weeks. The percentage of Iba‐1 positive microglia in the spinal dorsal horn and of FG + CGRP‐labeled cells among FG‐positive cells in the dorsal root ganglion were evaluated by immunohistochemical staining. TNF‐α and IL‐6 mRNA expression levels in the knee synovium were evaluated by PCR. The DF‐HA showed significantly improved pain hypersensitivity compared with the HA at 6–8 weeks. The percentage of Iba‐1‐positive microglia was significantly lower than that in the vehicle and the percentage of FG + CGRP/FG was significantly lower than that in the HA. OARSI scores did not differ among treatment groups, Larsen scores indicated lower in the DF‐HA than in the vehicle. DF‐HA was as effective as HA in joint protection and significantly improved inflammatory pain compared to HA. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONThis study aimed to translate the Simple Knee Value (SKV) into Thai and evaluate its psychometric properties as a single-question assessment tool.The SKV was translated into Thai according to international guidelines. Psychometric properties were assessed in adults aged 18–50 years with patellofemoral pain. Participants completed questionnaires at baseline, 2 weeks, and 2 months.Seventy-six patients with patellofemoral pain (mean age 36.8 ± 8.3 years, 56.6% female) participated in this prospective cohort study. SKV scores were moderately correlated with those of the Knee Injury and Osteoarthritis Outcome Score–Patellofemoral Subscale (KOOS-PF) and the Anterior Knee Pain Scale (AKPS). The test-retest reliability was high, with an intraclass correlation coefficient of 0.79 (95% confidence interval: 0.65–0.88). The SKV change scores effectively differentiated between improved and unimproved patients, with a minimal important change of 12.5 points.The SKV demonstrated acceptable psychometric properties for assessing patellofemoral pain in young to middle-aged adults. This single-question patient-reported outcome measure is simple and easy to use in daily clinical practice and can serve as an adjunctive assessment tool in patellofemoral pain research.Patient-reported outcome measures are essential for assessing patients with patellofemoral pain and determining their symptoms, clinical progression, and treatment outcomes.The Simple Knee Value (SKV) employs the Single Assessment Numeric Evaluation (SANE) method, in which patients are asked to assess their affected knee’s function as a percentage of normal knee function.This study demonstrated that the Thai version of the SKV is a valid, reliable, and responsive tool for evaluating patellofemoral pain in young to middle-aged adults.Patient-reported outcome measures are essential for assessing patients with patellofemoral pain and determining their symptoms, clinical progression, and treatment outcomes.The Simple Knee Value (SKV) employs the Single Assessment Numeric Evaluation (SANE) method, in which patients are asked to assess their affected knee’s function as a percentage of normal knee function.This study demonstrated that the Thai version of the SKV is a valid, reliable, and responsive tool for evaluating patellofemoral pain in young to middle-aged adults. [ABSTRACT FROM AUTHOR]

Individuals with anterior cruciate ligament reconstruction (ACLR) exhibit less knee kinematic variability while walking than uninjured controls, associated with deleterious changes in cartilage composition linked to an increased risk for early knee osteoarthritis (KOA). It is unknown whether less knee kinematic variability is also associated with worse knee-related patient-reported outcomes (PROs) consistent with KOA development. This study examined associations between kinematic variability during gait and PROs in individuals post-ACLR. Gait kinematics and the Knee Injury and Osteoarthritis Outcome Score (KOOS) were collected from 45 participants 6-months post-ACLR (67% Females; 21.45 ± 4.56 years). Overground gait biomechanics using 3D motion capture were collected, and knee kinematics were extracted for post-processing. Sample entropy (SampEn) was used to calculate knee kinematic variability. Pearson’s product-moment correlations were conducted to determine the associations between SampEn and KOOS sub-scores. Additionally, independent samples t-tests were performed to evaluate potential differences in SampEn outcomes between individuals with and without clinically relevant symptoms (defined in the introduction). Less sagittal plane kinematic variability is associated with greater pain (r = 0.37, p = 0.01) and symptoms (r = 0.32, p = 0.03). Symptomatic participants demonstrated less sagittal plane knee kinematic variability compared to asymptomatic participants (p = 0.01). The findings suggest less variable gait patterns 6-months post-ACLR may be linked to KOA-related symptoms. [ABSTRACT FROM AUTHOR]

Objective: Lower socioeconomic status (SES) is a risk factor for poorer pain-related outcomes. Further, the neighborhood environments of disadvantaged communities can create a milieu of increased stress and deprivation that adversely affects pain-related and other health outcomes. Socioenvironmental variables such as the Area Deprivation Index, which ranks neighborhoods based on socioeconomic factors could be used to capture environmental aspects associated with poor pain outcomes. However, it is unclear whether the ADI could be used as a risk assessment tool in addition to individual-level SES. Methods: The current study investigated whether neighborhood-level disadvantage impacts knee pain-related outcomes above sociodemographic measures. Participants were 188 community-dwelling adults who self-identified as non-Hispanic Black or non-Hispanic White and reported knee pain. Area Deprivation Index (ADI; measure of neighborhood-level disadvantage) state deciles were derived for each participant. Participants reported educational attainment and annual household income as measures of SES, and completed several measures of pain and function: Short-form McGill Pain Questionnaire, Western Ontario and McMaster Universities Osteoarthritis Index, and Graded Chronic Pain Scale were completed, and movement-evoked pain was assessed following the Short Physical Performance Battery. Hierarchical linear regression analyses were used to assess whether environmental and sociodemographic measures (i.e., ADI 80/20 [80% least disadvantaged and 20% most disadvantaged]; education/income, race) were associated with pain-related clinical outcomes. Results: Living in the most deprived neighborhood was associated with poorer clinical knee pain-related outcomes compared to living in less deprived neighborhoods (ps < 0.05). Study site, age, BMI, education, and income explained 11.3–28.5% of the variance across all of the individual pain-related outcomes. However, the ADI accounted for 2.5–4.2% additional variance across multiple pain-related outcomes. Conclusion: The ADI accounted for a significant amount of variance in pain-related outcomes beyond the control variables including education and income. Further, the effect of ADI was similar to or higher than the effect of age and BMI. While the effect of neighborhood environment was modest, a neighborhood-level socioenvironmental variable like ADI might be used by clinicians and researchers to improve the characterization of patients' risk profile for chronic pain outcomes. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of the flexion angle of a femoral prosthesis on the postoperative clinical outcome of patients with knee osteoarthritis who are undergoing unicompartmental knee arthroplasty. Methods: Patients were divided into three groups according to the flexion angle of the femoral prosthesis following unicompartmental knee arthroplasty. Group A comprised patients with a flexion angle of the femur prosthesis of less than 5°, Group B included those with a flexion angle of 5° to 10°, and Group C consisted of patients with a flexion angle of the femur prosthesis greater than 10°. The basic clinical data, visual analog scale (VAS) score, Hospital for Special Surgery (HSS) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and knee range of motion (ROM) were subjected to statistical analysis and comparison between the groups. Results: No significant differences were observed in the basic data of the patients in each group. The ROM and VAS scores for the knee in the first month following unicompartmental knee arthroplasty in groups B and C were significantly greater than those in group A. The HSS scores for the knee joint in Group B indicated superior outcomes in the initial postoperative month and the third postoperative month, as evidenced by the WOMAC scores, which demonstrated a statistically significant difference between Group B and the other two groups within the six-month postoperative period. Conclusion: The short-term recovery of patients in Group B was the fastest. These results provide a new reference for the installation of femoral prostheses in unicompartmental knee arthroplasty. [ABSTRACT FROM AUTHOR]

Non-invasive assessment of joint status using acoustic emissions (AE) is a growing research area that has the potential to translate into clinical practice. The purpose of this study is to investigate the correlation of the knee's AE with measures of proprioception, self-assessment, and performance, as it can be hypothesised that, AE parameters will correlate with joint function metrics due to AE being recorded during interaction of the articular surfaces. Threshold to detect passive motion (TTDPM), Knee Osteoarthritis Outcome Scores (KOOS) and 5 times sit-to-stand test (5STS) were collected from 51 participant. Knee AE were recorded during cycling with 30 and 60 rpm cadences using two sensors in different frequency ranges and three modes of AE event detection. Weak (0.297, p = 0.048) to moderate (0.475, p = 0.001) Spearman's correlations were observed between longer 5STS time and AE parameters (i.e. higher median absolute energy, signal strength, longer AE event rise time and duration). Similarly, AE parameters shown correlation with lower KOOS, especially in the "Function in Sports and Recreation" and "Activities of Daily Living" subscales with correlation coefficients for higher median amplitude up to 0.441, p = 0.001 and 0.403, p = 0.004, respectively. The correlation with the TTDPM was not detected for most of the AE parameters. Additionally, a lower frequency sensor and 60 rpm cadence AE recordings showed higher correlations. Considering that this study included subjects from the general population and the number of participants with KOOS <70 was relatively small, higher correlations might be expected for clinically confirmed OA cases. Additionally, different ICCs might be expected for alternative signal parameters and proprioception assessment methods. Overall, the study confirms that AE monitoring offers an additional modality of joint assessment that reflects interaction between cartilage surfaces and can complement orthopaedic diagnostics, especially in the context of remote monitoring, drug testing, and rehabilitation. [ABSTRACT FROM AUTHOR]

Background: Focal cartilage lesions (FCLs) are frequently found during knee arthroscopies and may impair quality of life (QoL) significantly. Several treatment options with good short-term results are available, but the natural history without any treatment is largely unknown. The aim of this study was to evaluate patient-reported outcome measures (PROMs), the need for subsequent cartilage surgery, and the risk of treatment failure 20 years after diagnosis of an FCL in the knee. Methods: Patients undergoing any knee arthroscopy for an FCL between 1999 and 2012 in 6 major Norwegian hospitals were identified. Inclusion criteria were an arthroscopically classified FCL in the knee, patient age of ≥18 years at surgery, and any preoperative PROM. Exclusion criteria were lesions representing knee osteoarthritis or "kissing lesions" at surgery. Demographic data, later knee surgery, and PROMs were collected by questionnaire. Regression models were used to adjust for and evaluate the factors impacting the long-term PROMs and risk factors for treatment failure (defined as knee arthroplasty, osteotomy, or a Knee injury and Osteoarthritis Outcome Score-Quality of Life [KOOS QoL] subscore of <50). Results: Of the 553 eligible patients, 322 evaluated patients (328 knees) were included and analyzed. The mean follow-up was 19.1 years, and the mean age at index FCL surgery was 36.8 years (95% confidence interval [CI], 35.6 to 38.0 years). The patients without knee arthroplasty or osteotomy had significantly better mean PROMs (pain, Lysholm, and KOOS) at the time of final follow-up than preoperatively. At the time of follow-up, 17.7% of the knees had undergone subsequent cartilage surgery. Nearly 50% of the patients had treatment failure, and the main risk factors were a body mass index of ≥25 kg/m2 (odds ratio [OR] for overweight patients, 2.0 [95% CI, 1.1 to 3.6]), >1 FCL (OR, 1.9 [CI, 1.1 to 3.3]), a full-thickness lesion (OR, 2.5 [95% CI, 1.3 to 5.0]), and a lower level of education (OR, 1.8 [95% Cl, 1.1 to 2.8]). Autologous chondrocyte implantation (ACI) was associated with significantly higher KOOS QoL, by 17.5 (95% CI, 3.2 to 31.7) points, and a lower risk of treatment failure compared with no cartilage treatment, microfracture, or mosaicplasty. Conclusions: After a mean follow-up of 19 years, patients with an FCL who did not require a subsequent knee arthroplasty had significantly higher PROM scores than preoperatively. Nonsurgical treatment of FCLs had results equal to those of the surgical FCL treatments except for ACI, which was associated with a better KOOS and lower risk of treatment failure. Full-thickness lesions, >1 FCL, a lower level of education, and a greater BMI were the main risk factors associated with poorer results. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusions Level of Evidence Due to a lack of consensus regarding effective treatment options in young patients, the indications of meniscal allograft transplantation (MAT) have widened to include those with substantial cartilage disease. The aim of this study was to report the long‐term patient‐reported outcome measures (PROMs) and allograft survival rates for patients with substantial cartilage disease.A review of the prospectively maintained database was performed. Patients with International Cartilage Repair Society 3b or above cartilage grading in either their femur or tibia were classified as having substantial cartilage disease. Postoperative International Knee Documentation Committee, Tegner, Knee Injury and Osteoarthritis Outcome Score and Lysholm were compared between those with and without substantial cartilage disease. Kaplan–Meir analysis was used to assess the survival rates. Survival was defined as revision or removal of allograft or conversion to arthroplasty.Data from 422 patients were included in the analysis with 129 patients found to have full‐thickness chondral lesions and 281 patients without full‐thickness chondral lesions. The mean follow‐up was 6.33 (SD 3.48) years for the cohort. The mean age for the entire cohort was 30 (SD 9.23). Patients in substantial cartilage disease group underwent meniscal transplantation at an older age (32 [standard deviation {SD} 8.47] years vs. 29 [SD 9.35] years [p < 0.001]). There was no significant difference in PROMs between the two groups up to 10 years postoperatively (p > 0.05). The substantial cartilage disease group had significantly lower survival rates compared to those without (80.62% vs. 94.32%).MAT in the context of substantial cartilage disease was associated with an improvement in PROMs up to 10 years with no difference to the group without substantial cartilage disease. The PROMs in combination with the long‐term survival rates in this study can be used to counsel patients preoperatively.Level IV. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence The purpose of this study was to compare the incidence of knee osteoarthritis (OA) between the anatomic single‐bundle (SB) and anatomic double‐bundle (DB) anterior cruciate ligament (ACL) reconstruction technique after 5‐year follow‐up (FU). Secondary objectives were to compare patient‐reported outcome measures (PROMs), clinical examination, activity level, functional tests and graft failures between the two groups.The study was a secondary analysis after 5‐year FU of a randomized controlled trial (RCT) (Clinical Trials NCT01033188). One hundred and twenty patients between 18 and 40 years were randomized to either anatomic SB or anatomic DB reconstruction. The Kellgren–Lawrence (KL) classification grade ≥2 and the Osteoarthritis Research Society International (OARSI) atlas criteria score ≥2 were used for defining OA. Additionally, PROMs were obtained and clinical examinations of the knees were performed. Finally, the number of patients experiencing graft failure in each group was recorded.Radiographic imaging was performed in 39 patients in the SB group and in 37 patients in the DB group. Four patients (10%) in the SB group and two (5%) in the DB group developed osteoarthritis according to the KL classification (p = 0.28). Five (13%) in the SB group and three (8%) in the DB group developed osteoarthritis according to the OARSI atlas criteria (p = 0.59; difference 5.0% [95% confidence interval, CI: −0.10 to 0.20]). There were no significant differences in the PROMs, clinical examinations, activity levels, or functional tests when comparing the two groups. Of initially 62 SB patients, 14 (23%) experienced graft failure compared to 4 (7%) of the 58 DB patients (p = 0.015; difference 0.016 [95% CI: 0.03–0.29]).At 5‐year FU, there were no significant differences in the incidence of OA, PROMS, or other clinical findings comparing the anatomic DB to anatomic SB ACL reconstructed patients. There were fewer graft failures among patients treated with anatomic DB ACL reconstruction.II. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusion The gait analysis of patients after surgery for tumors around the knee joint relies on the use of a three‐dimensional motion capture system. However, obtaining long‐term, free‐standing, real‐world gait data with three‐dimensional gait analysis is challenging. In this study, we utilized a portable gait analyzer to collect gait data from patients who underwent rotating hinge knee megaprosthesis (RHK) and total knee arthroplasty (TKA), this study aims to compare via gait analysis patients who underwent megaprosthesis with patients with TKA.A retrospective study was conducted on eight patients with knee bone tumors (RHK group) and ten patients with knee osteoarthritis who underwent standard TKA (TKA group) from January 2018 to January 2022. Gait analysis, was conducted using the Intelligent Device for Energy Expenditure and Activity (IDEEA), and the results were compared with those of a healthy control group. The lower limb alignment of the RHK and TKA groups was evaluated, and the KSS scores of the two groups were collected and compared. Energy consumption during a 20‐m walk was measured and compared among the RHK, TKA, and healthy control groups using one‐way ANOVA. Paired t‐tests were used to compare the operated and nonoperated limbs within groups.All patients exhibited slower walking speeds and cadence than the healthy control participants (p < 0.01), While no significant differences were found between the RHK and TKA groups. The single support time (521.15 ± 94.56 ms) of the RHK‐operated limb was significantly shorter than that of the nonoperated limb (576.53 ± 77.40 ms, p = 0.004). The pulling acceleration of the RHK group (0.71 ± 0.27 G) was lower than that of the TKA group (1.04 ± 0.31 G, p = 0.029). The push‐off angle in the RHK group (24.91° ± 10.91°) was significantly greater than that in the TKA group (10.64° ± 5.41°, p = 0.007). The RHK group showed significant differences between the operated and nonoperated limbs in terms of swing power, ground impact, footfall, and push‐off. The RHK (0.03 ± 0.01 kcal/min/kg) and TKA (0.029 ± 0.01 kcal/min/kg) groups had significantly greater energy expenditures than did the healthy control group (0.02 ± 0.00 kcal/min/kg, p < 0.05). The comparison of HKA angles and KSS scores between the TKA and RHK groups showed statistically significant differences.A portable gait analyzer appears to be suitable for evaluating the effects of RHK. RHK patients demonstrate more pronounced gait abnormalities than TKA patients, reflected in greater energy expenditure, implying reduced walking efficiency. This suggests the need for increased energy expenditure in RHK patients to compensate for abnormal knee joint conditions during walking and maintain body balance. [ABSTRACT FROM AUTHOR]

Introduction: In the early postoperative period after total knee arthroplasty (TKA), joint range of motion (ROM) limitation and increased stiffness due to pain are commonly observed. Previous studies have reported that a single bout of foam rolling (FR) can acutely increase ROM and pain threshold on the contralateral (non-intervention) side in healthy participants. In this study, we aimed to expand this knowledge for TKA rehabilitation and investigated the acute effects of FR intervention on the non-operative side on ROM, stiffness, and pain of the operative side in postoperative patients within the first week after TKA. Materials and methods: The study employed a randomized crossover design: 20 patients (mean age 75.0 ± 7.8 years) in the first postoperative week after TKA were divided alternately into Roll_Break and Break_Roll groups in the order of prescription. In the Roll_Break group, after the initial evaluation, a 180-s (60-s × three sets) FR intervention using a roller massager by a physiotherapist for the knee extensors was performed on the contralateral side (non-operative side), followed by the measurement. Afterwards, after 180-s of supine at rest, the measurement was performed again (i.e., control phase). In the Break_Roll group, after the initial evaluation, each patient was placed in a seated resting position for 180-s, and then another measurement was performed (i.e., control phase). After this, the FR intervention was performed for 180-s, and then the measurement was performed again. The intensity of the FR intervention was set to the maximum intensity that did not cause pain. We measured pain using the visual analogue scale at rest and during the knee joint ROM measurements, knee joint active movement ROM, knee joint passive ROM, and stiffness during the knee joint active movement. Results: All outcome variables showed significant improvements after the FR intervention (intervention phase) when compared pre- to post-intervention, and significantly favourable effects were found compared to the control condition. Conclusion: The results showed significant improvements in ROM, pain, and stiffness of the operative side after the FR intervention on the non-operative side. For future therapy approaches for TKA patients, FR treatment of the non-operative side should be employed in the first weeks after surgery. [ABSTRACT FROM AUTHOR]

Background: This study aimed to study the effect of low-intensity muscle strength training on postoperative rehabilitation of patients with knee osteoarthritis over 55 years of age and the incidence of adverse events by a meta-analysis. Methods: We searched China National Knowledge Infrastructure (CNKI), WanFang, China Science and Technology Journal Database (VIP), PubMed, Web of science, and Embase databases for articles on the effect of low-intensity muscle strength training on the recovery of patients with knee arthritis. And meta-analysis combined effect was performed in R 4.2.2 software. Quantitative analysis and risk of bias were assessed by Begg's and Eegger's test. Results: Meta-analysis showed that the effect of low-intensity muscle strength training on postoperative knee range of motion in patients with knee arthritis was mean difference (MD) = 5.20, 95% CI=[4.00, 6.40], τ2 = 0.43, P = 0.34; the effect on postoperative muscle strength was standard mean difference (SMD) = 1.24, 95% CI=[0.86, 1.61], τ2 = 0.07, P < 0.01; the effect on postoperative knee joint score was MD = 5.88, 95%CI=[2.09, 9.67], τ2 = 16.60, P < 0.01; the effect on postoperative knee visual analogue scale (VAS) score was MD=-1.12, 95%CI =[-1.43, -0.81], τ2 = 0.09, P < 0.001; the effect on the incidence of adverse events was RR = 0.85, 95%CI= [0.52 1.39], τ2 = 0.79, P = 0.04. Conclusion: Low-intensity muscle strength training can improve the muscle strength of the affected limb and knee joint score, reduce the VAS score and the incidence of adverse events in patients with knee osteoarthritis over 55 years of age after surgery, but it has no effect on the postoperative knee range of motion, so it can be considered as appropriate in clinical selection. [ABSTRACT FROM AUTHOR]

Knee osteoarthritis (KOA) represents a well-documented degenerative arthropathy prevalent among the elderly population. KOA is a persistent condition, also referred to as progressive joint Disease, stemming from the continual deterioration of cartilage. Predominantly afflicting individuals aged 45 and above, this ailment is commonly labeled as a "wear and tear" joint disorder, targeting joints such as the knee, hand, hips, and spine. Osteoarthritis symptoms typically increase gradually, contributing to the deterioration of articular cartilage. Prominent indicators encompass pain, stiffness, tenderness, swelling, and the development of bone spurs. Diagnosis typically involves the utilization of Radiographic X-ray images, Magnetic Resonance Imaging (MRI), and Computed Tomography (CT) Scan by medical professionals and experts. However, this conventional approach is time-consuming, and also sometimes tedious for medical professionals. In order to address the limitation of time and expedite the diagnostic process, deep learning algorithms have been implemented in the medical field. In the present investigation, four pre-trained models, specifically CNN, AlexNet, ResNet34 and ResNet-50, were utilized to predict the severity of KOA. Further, a Deep stack ensemble technique was employed to achieve optimal performance resulting to the accuracy of 99.71%. [ABSTRACT FROM AUTHOR]

This study aimed to observe the characteristics of foot posture asymmetry and abnormal gait in patients with unilateral and bilateral knee osteoarthritis (KOA) and to explore the association between foot posture asymmetry, abnormal gait and the clinical symptoms and severity of KOA. Sixty patients with KOA were allocated as follows: unilateral group (UG; n = 30) and bilateral group (BG; n = 30). We accessed foot posture, foot posture asymmetry, gait and plantar pressure parameters and symmetry index, clinical symptom-related scores and disease severity, and investigated the relationship between these variables. The results showed that the overall percentage of asymmetry and severe asymmetry in foot posture were lower in BG than in UG. There was substantial asymmetry in many gait indicators within the two groups, but no significant differences were observed between the two groups. Moreover, foot posture asymmetry, multiple gait and plantar pressure parameters and symmetry indices were closely related to clinical symptoms and disease severity. In conclusion, both unilateral and bilateral KOA patients have foot posture asymmetry and gait asymmetry, but the foot posture asymmetry of the former is more severe than that of the latter. Intervention for this population should treat simultaneously both knee joints. The evaluation and monitoring of foot posture asymmetry, gait and plantar pressure parameters and symmetry indices can provide a more comprehensive and scientific basis for the prevention and treatment of KOA. [ABSTRACT FROM AUTHOR]

Humans have been shown to have biases when reading medical images, raising questions about whether humans are uniform in their disease gradings. Artificial intelligence (AI) tools trained on human-labeled data may have inherent human non-uniformity. In this study, we used a radiographic knee osteoarthritis external validation dataset of 50 patients and a six-year retrospective consecutive clinical cohort of 8,273 patients. An FDA-approved and CE-marked AI tool was tested for potential non-uniformity in Kellgren-Lawrence grades between the right and left sides of the images. We flipped the images horizontally so that a left knee looked like a right knee and vice versa. According to human review, the AI tool showed non-uniformity with 20–22% disagreements on the external validation dataset and 13.6% on the cohort. However, we found no evidence of a significant difference in the accuracy compared to senior radiologists on the external validation dataset, or age bias or sex bias on the cohort. AI non-uniformity can boost the evaluated performance against humans, but image areas with inferior performance should be investigated. [ABSTRACT FROM AUTHOR]

ABSTRACT:BackgroundMethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONOlder adults live with chronic conditions worldwide. The aim of this systematic review was to determine the effectiveness of physiotherapist-led (PT-led) tele-rehabilitation on various health outcomes.Six databases were searched. Eligible studies were randomized controlled trials that included older adults (≥65 years) who had ≥1 chronic condition, and evaluated tele-rehabilitation (e.g., video, telephone) that was PT-led or overseen. Screening and data extraction were performed in duplicate. Meta-analyses were performed where appropriate. Cochrane’s Risk of Bias 2.0 tool was used.Fifteen studies were included. A meta-analysis of studies of knee osteoarthritis demonstrated that tele-rehabilitation is more effective than usual care for functional mobility (MD= −2.72, 95% CI= −3.56, −1.88, p < 0.001), quadriceps strength (MD= 15.54, 95% CI= 10.14, 20.95, p < 0.001), pain (MD= −1.2, 95% CI= −2.09, −0.39, p = 0.004) and physical function (MD= −5.95, 95% CI= −8.32, −3.58, p < 0.001). No clear differences were found between tele-rehabilitation and usual care or comparator interventions for outcomes related to physical activity level, gait speed, mental health, and quality of life.PT-led tele-rehabilitation appears to be comparable to traditional methods at improving outcomes in older adults with various chronic conditions. However, high-quality trials are needed so future conclusions on the effectiveness of tele-rehabilitation can be made.CRD42023428048Physiotherapist-led tele-rehabilitation appears to be more effective than usual care related to functional mobility, quadriceps strength, self-reported pain and physical function for older adults living with knee osteoarthritis.No other significant differences were found indicating that either tele-rehabilitation or traditional methods of rehabilitation can be used by clinicians to improve health outcomes for older adults living with various chronic conditions.Clinicians should familiarize themselves with the available modes, user operations, and advantages of tele-rehabilitation so that tele-rehabilitation can be better incorporated into clinical practice.Physiotherapist-led tele-rehabilitation appears to be more effective than usual care related to functional mobility, quadriceps strength, self-reported pain and physical function for older adults living with knee osteoarthritis.No other significant differences were found indicating that either tele-rehabilitation or traditional methods of rehabilitation can be used by clinicians to improve health outcomes for older adults living with various chronic conditions.Clinicians should familiarize themselves with the available modes, user operations, and advantages of tele-rehabilitation so that tele-rehabilitation can be better incorporated into clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: Knee osteoarthritis (KOA) is a chronic degenerative bone metabolic disease that primarily affects older adults, leading to chronic pain and disability that affect patients' daily activities. Electroacupuncture (EA) is a commonly used method for the treatment of chronic pain in clinical practice. Previous studies indicate that the endocannabinoid system is involved in EA analgesia, but whether endocannabinopeptide VD-hemopressin (α) and RVD-hemopressin (α) derived from hemoglobin chains are involved in EA analgesia is unclear. Methods: RNA-seq technology was used to screen which genes involved in EA analgesia. The expression of hemoglobin α chain and 26S proteasome were determined by Western blotting. The level of VD-hemopressin (α) and RVD-hemopressin (α) were measured by UPLC-MS/MS. Microinjection VD-Hemopressin (α), RVD-Hemopressin (α) and 26S proteasome inhibitor MG-132 into vlPAG, then observe mechanical and thermal pain thresholds. Results: Therefore, we used RNA-seq to obtain differentially expressed genes Hba-a1 and Hba-a2 involved in EA analgesia in the periaqueductal gray (PAG), which were translated into the hemoglobin α chain. EA significantly increased the expression of the hemoglobin α chain and the level of hemopressin (α) and RVD-hemopressin (α). Microinjection of VD-hemopressin (α) and RVD-hemopressin (α) into the ventrolateral periaqueductal gray (vlPAG) mimicked the analgesic effect of EA, while CB1 receptor antagonist AM251 reversed this effect. EA significantly increased the expression of 26S proteasome in KOA mice. Microinjection of 26S proteasome inhibitor MG132 before EA prevented both the anti-allodynic effect and upregulation of the concentration of RVD-hemopressin (α) by EA treatment and upregulated the expression of the hemoglobin α chain. Discussion: Our data suggest that EA upregulated the concentration of VD-hemopressin (α) and RVD-hemopressin (α) through enhancement of the hemoglobin α chain degradation by 26S proteasome in the PAG, then activated the CB1 receptor, thereby exerting inhibition of chronic pain in a mouse model of KOA. These results provide new insights into the EA analgesic mechanisms and reveal possible targets for EA treatment of chronic pain. [ABSTRACT FROM AUTHOR]

Purpose: In total knee arthroplasty (TKA), asymmetric tibial components have been developed alongside symmetric tibial components to enhance bony coverage at the tibia. In primary TKA and revision TKA for patients with significant bone defects, augmentation is employed to fill the bone defect. However, there have been no reports on bony coverage of the tibial component of the revision system in the cases of bone defects. Therefore, we simulated bone defects using CT and compared the bony coverage of asymmetric and symmetric tibial components in the revision TKA system. Methods: This study included 45 patients (50 knees involved) with medial osteoarthritis. Preoperative CT scans were used to simulate placement using ZedKnee. Three models were evaluated: Persona Revision PCCK (Zimmer) for the asymmetric component, NexGen LCCK (Zimmer) for the symmetric component, and the ATTUNE revision system (Depuy-Synthes). A 130-mm stem extension was utilized. Augmentations of each thickness were placed to simulate bone defects of 5, 10, and 15 mm. The coverage, overhang, and underhang rates were measured for each slice and compared among the models. Results: In terms of coverage, the rate was greater for PCCK at 0 mm, and only ATTUNE exhibited a significantly lower coverage at 5 and 10 mm. There was no significant difference in coverage at 15 mm. At 0 mm, PCCK demonstrated less posterior underhangs. At 5 and 10 mm, PCCK showed less anterior overhang but more anterior underhang. At 15 mm, PCCK had a less anterior overhang, with an overhang in the posterior region but less underhang. When overhang and underhang were combined and compared, the asymmetric component generally yielded superior results. Conclusion: In the cases of bone defects, asymmetric components demonstrated reduced anterior overhang and decreased posterior underhang, resulting in greater bone coverage. This may contribute to improved long-term outcomes in the revision TKA system. [ABSTRACT FROM AUTHOR]

Researchers often use outcome-dependent sampling to study the exposure-outcome association. The case-control study is a widely used example of outcome-dependent sampling when the outcome is binary. When the outcome is ordinal, standard ordinal regression models generally produce biased coefficients when the sampling fractions depend on the values of the outcome variable. To address this problem, we studied the performance of survey-weighted ordinal regression models with weights inversely proportional to the sampling fractions. Through an extensive simulation study, we compared the performance of four ordinal regression models (SM: stereotype model; AC: adjacent-category logit model; CR: continuation-ratio logit model; and CM: cumulative logit model), with and without sampling weights under outcome-dependent sampling. We observed that when using weights, all four models produced estimates with negligible bias of all regression coefficients. Without weights, only stereotype model and adjacent-category logit model produced estimates with negligible to low bias for all coefficients except for the intercepts in all scenarios. In one scenario, the unweighted continuation-ratio logit model also produced estimates with low bias. The weighted stereotype model and adjacent-category logit model also produced estimates with lower relative root mean square errors compared to the unweighted models in most scenarios. In some of the scenarios with unevenly distributed categories, the weighted continuation-ratio logit model and cumulative logit model produced estimates with lower relative root mean square errors compared to the respective unweighted models. We used a study of knee osteoarthritis as an example. [ABSTRACT FROM AUTHOR]

Total knee arthroplasty (TKA) is an effective treatment to improve mobility in patients with severe knee osteoarthritis. However, some patients continue to have poor mobility after surgery. The preoperative identification of patients with poor mobility after TKA allows for better treatment selection and appropriate goal setting. The purpose of this study was to develop a clinical prediction rule (CPR) to predict mobility after TKA. This study included patients undergoing primary TKA. Predictors of outcome included patient characteristics, physical function, and psychological factors, which were measured preoperatively. The outcome measure was the Timed Up and Go test, which was measured at discharge. Patients with a score of ≥11 s were considered having a low-level of mobility. The classification and regression tree methodology of decision tree analysis was used for developing a CPR. Of the 101 cases (mean age, 72.2 years; 71.3 % female), 26 (25.7 %) were classified as low-mobility. Predictors were the modified Gait Efficacy Scale, age, knee pain on the operated side, knee extension range of motion on the non-operated side, and Somatic Focus, a subscale of the Tampa Scale for Kinesiophobia (short version). The model had a sensitivity of 50.0 %, a specificity of 98.7 %, a positive predictive value of 92.9 %, a positive likelihood ratio of 37.5, and an area under the receiver operating characteristic curve of 0.853. We have developed a CPR that, with some accuracy, predicts the mobility outcomes of patients after TKA. This CPR may be useful for predicting postoperative mobility and clinical goal setting. [ABSTRACT FROM AUTHOR]

The association between knee osteoarthritis (OA) and miRNAs has been widely reported. However, the utility of miRNAs as predictors of knee osteoarthritis (KOA) progression in longitudinal studies has not been reported. We aimed to identify circulating miRNAs (c-miRNAs) associated with KOA progression in the general population and to examine their potential use as predictors of KOA progression. In 2012 and 2018, 66 participants (128 knees) took part in a resident health check-up in the Yakumo study. If the KL classification progressed two or more levels, the patient was classified as having progressive OA. Quantitative real-time polymerase chain reaction was used to screen 21 c-miRNAs. The expression levels of those c-miRNAs were compared between the progressive OA group and non-progressive OA group using student-t-test. Logistic analysis was performed in c-miRNAs less than p < 0.10 in univariate analysis. The progressive OA group consisted of 78 knees. The results of the comparison between the progressive OA group and the non-progressive OA group showed that six c-miRNAs as follows; let7d (p = 0.030), c-miRNA-122 (p < 0.001), 150 (p = 0.070), 199 (p = 0.078), 21 (p = 0.016) and 320 (p = 0.093) were extracted as factors related to the progression of knee OA. In addition, logistic regression analysis identified c-miRNA-122 as an independent factor involved in the progression of knee osteoarthritis (odds ratio: 1.510, 95% confidence interval: 1.060–2.140, p = 0.023). The ROC curve showed by c-miRNA-122 for the progression of OA risk had an area under the curve of 0.702 (95% CI: 0.609–0.795). The threshold of c-miRNA-122 was −4.609. The expression level of c-miRNA-122 was associated with the risk of KOA progression in community dwelling Japanese people. [ABSTRACT FROM AUTHOR]

Objectives Osteoarthritis, a degenerative condition that results in significant morbidity, is typically managed with treatments aimed at symptom relief rather than addressing the underlying degeneration. Dapsone, recognized for its anti-inflammatory, antioxidant, antiexcitotoxic, and antiapoptotic properties, has demonstrated promising effects in various neurodegenerative diseases. This study explores the potential of dapsone to mitigate articular destruction, inflammation, and pain in rat models of osteoarthritis. Methods Osteoarthritis was induced in rats by injecting MIA into the right knee joint. Dapsone was then administered intraperitoneally at 5, 10, or 20 mg/kg every 2 days for 2 weeks. Behavioural tests were done on days 0, 7, and 14. On day 14, the articular cartilage was histologically analysed using H&E staining. Serum levels of NF-kB, IL-1β, and TNF-α were evaluated by ELISA. Results Dapsone effectively reduces pain, inflammation, and articular cartilage damage in osteoarthritis. Specifically, it improves mechanical allodynia and thermal hyperalgesia, reduces inflammatory markers (TNF-α, IL-1β, and NF-κB), and protects against cartilage destruction and chondrocyte loss, with the most significant effects at 20 mg/kg. Conclusions Dapsone effectively prevents pain, inflammation, and cartilage damage in osteoarthritis rats, suggesting its potential as a therapeutic option for managing osteoarthritis. [ABSTRACT FROM AUTHOR]

Osteoarthritis of the knee (KOA) is a degenerative disease that commonly affects middle-aged and elderly individuals, primarily characterized by cartilage degradation, subchondral bone remodeling, and synovial inflammation. It often result in chronic joint pain, physical function impairment, and even disability in patients. As society continues to age rapidly, this condition places an enormous burden on social economics. Currently, clinical treatment mainly involves symptomatic relief in the early stages and joint replacement in the advanced stages, with no effective method to delay the progression of KOA. In recent years, photobiomodulation therapy (PBMT) has garnered significant attention from researchers due to its painless, non-invasive, and safe therapeutic effects. PBMT enhances cellular energy levels and optimizes their state by stimulating ATP synthesis; it also improves blood flow conditions by adjusting hemodynamic status; modulates the levels of related cytokines to alleviate cellular inflammatory responses; and regulates the secretion of related enzymes to reduce cartilage degradation. This article outlines how PBMT treats KOA through these mechanisms, as well as its therapeutic effects and potential mechanisms in promoting cartilage regeneration, reducing synovial inflammation, and allevitating pain. [ABSTRACT FROM AUTHOR]

Objective Fecal metabonomics technique was used to investigate the potential mechanism of heat-sensitive moxibustion to treatment of knee osteoarthritis. Methods After replicating the model of knee osteoarthritis, the rabbits in the model group were randomly divided into model group and moxibustion group. At the same time, set up a blank group. After 14 days of intervention according to the subjects factors, the rabbits in the moxibustion group were divided into heat-sensitive moxibustion group (1) and non-heat-sensitive moxibustion group (≤ 1°C) according to the statistics of final temperature changes. The cartilage tissue was observed by HE staining, serum inflammatory factors were detected by ELISA, and fecal metabolites were detected by LC-MS. By multivariate statistical analysis, differential metabolites were screened and metabolic pathways were analyzed. Results After HE staining, the cartilage tissue of model group showed significant pathological changes compared with that of blank group. After the establishment of the model, the contents of IL-1 β and IL-6 in the model group were significantly higher than those in the blank group (P<0.001), while IL-10 decreased significantly (P<0.001). After treatment, compared with the model group, the contents of IL-1 β and IL-6 in the heat sensitive moxibustion group and non-heat sensitive moxibustion group decreased significantly (P<0.001), and the content of IL-10 increased significantly (P<0.001), while the decreasing trend of IL-1 β and IL-6 in the heat sensitive moxibustion group was better. 10 biomarkers and 11 metabolic pathways were determined to be closely related to KOA, such as steroid degradation, ovarian steroidogenesis, retinol metabolism and so on, among which steroid degradation was the most significant. Conclusion Heat-sensitive moxibustion being improved the inflammatory reaction of KΟΛ and exert the effect of anti-KOA, which may be related to the regulation of steroid degradation, ovarian steroidogenesis and retinol metabolism. [ABSTRACT FROM AUTHOR]

Objective To investigate the expression levels of tumor necrosis factor a (TNF-α), interleukins (ILs), matrix metalloproteinases (MMPs), and chitinase (YKL-40) in the knee joint fluid of patients with knee osteoarthritis (KOA), and their correlations with Kellgren-Lawrence (K-L) grade of knee imaging. Methods A total of 100 KOA patients undergoing the knee arthroplasty were enrolled and their knee joint fluid was extracted before the joint surgery. The expression levels of TNF-α, IL-1β, IL-6, IL-8, IL-15, and MMP-3, MMP-9, MMP-13, YKL-40 in the knee joint fluid were detected using cytometric bead array and ELISA, respectively. Patients were grouped according to the K-L scores. The independent influencing factors of KL-4 were determined by comparison between the two groups and binary logistic regression. Spearman method was used to analyze the correlations between the above molecules and K-L grades. Results Among 100 patients with KOA, 25 were males and 75 were females. The mean age was 64. 32 years and the mean course of the disease was 8. 98 years. There were 55 with KL-3 grade and 45 with KL-4 grade. TNF-α, IL-1β, MMP-13, and YKL-40 were highly expressed in KL-3, while IL-6, IL-8, IL-15, MMP-3, and MMP-9 were highly expressed in KL-4. IL-15 and MMP-9 were significantly different between the two groups (P < 0.05) . The result of univariate and multivariate logistic regression showed that IL-15 odds ratio (OR) = 1.575 95% confidence interval (CI): 1.286-1.929; P < 0.001 ] and MMP-9 ( OR = 1.032, 95% CI: 1.008-1.056, P = 0.01 ) were independent risk factors for the KL-4. IL-15 ( r = 0.22 P < 0.05 ) and MMP-9 r = 0.297 P < 0.05 ) were positively correlated with K-L grades. Conclusion The expressions of IL-15 and MMP-9 in the knee joint fluid of KOA patients are higher than that of KL-4 patients. IL-15 and MMP-9 are independent risk factors for the KL-4. There is a positive correlation between IL-15 and MMP-9 levels and the progression of radiographic K-L grades. IL-15 and MMP-9 may provide references for clinical evaluation and progression of this disease. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is a prevalent musculoskeletal disease affecting middle-aged and elderly individuals, with knee pain as a common complaint. Standard therapy approaches generally attempt to alleviate pain and inflammation, using various pharmacological and non-pharmacological options. However, the efficacy of these therapies in long-term tissue repair remains debated. As an alternative, regenerative medicine offers a promising strategy, with decreased adverse event rates and increasing evidence of safety and efficacy. This review will outline current advances in regenerative medicine for knee OA, emphasizing outpatient clinic-based therapies that use orthobiological and non-biological products. Different strategies based on orthobiologics are discussed as potential regenerative options for the management of knee OA. Cell-free therapies including platelet-rich plasma, autologous anti-inflammatories, exosomes, human placenta extract, and mitochondrial transplantation are discussed, focusing on their potential for cartilage regeneration. Additionally, cell-based therapies with regenerative properties including bone marrow aspirate concentrate, adipose stromal vascular fraction, microfat, nanofat, stem cell therapy, and genetically modified cells as part of orthobiologics, are being investigated. Also, this study is looking into non-biological approaches such as using gold-induced cytokines, extracorporeal shockwave therapy, and ozone therapy. The mechanisms of action, effectiveness, and clinical applications of each therapy are being explored, providing insights into their role in the management of knee OA. [ABSTRACT FROM AUTHOR]

Background/Objectives: The Star Excursion Balance Test (SEBT) is a simple and feasible tool for assessing dynamic balance in individuals with knee osteoarthritis (KOA). It has an advantage as it replicates dynamic balance better than other static balance tools. This study aims to determine how reliable SEBT is among people with end-stage KOA, as well as how responsive it is and how well it correlates with performance-based outcome measures after TKA. Methods: Patients on the waiting list for TKA performed SEBT in the anterior, posteromedial and posteriorlateral directions twice within 7 days. The measurements were repeated 6 and 12 months after TKA. The participants completed performance-based outcome measurements (PBOMs) and the Oxford Knee Score (OKS) before and after TKA to estimate correlation. Results: In all directions, the intraclass correlation coefficient range (ICC) was 0.998–0.993, and there were no significant differences between the test and re-test mean SEBT scores. The standard error of measurement (SEM) ranged from 0.37% to 0.68%, and the minimum detectable change (MDC) ranged from 1.02% to 1.89%. The post TKA SEBT results show significant improvement, with a large effect size. There were large-to-medium correlations between SEBT and PBOMs before and after TKA, while OKS correlated only before surgery. The magnitude of change in SEBT, PBOMs and OKS did not correlate. Conclusions: SEBT is an extremely reliable tool for assessing dynamic balance in all three directions of severe KOA patients. It is sensitive enough to detect balance changes at 6 and 12 months post TKA. SEBT cannot be used to reflect the change in functional outcome improvement after TKA. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is a degenerative joint disease with limited therapeutic options, where inflammation plays a critical role in disease progression. Extracellular vesicles (EV) derived from mesenchymal stromal cells (MSC) have shown potential as a therapeutic approach for OA by modulating inflammation and alleviating degenerative processes in the joint. This study evaluated the therapeutic effects for the treatment of OA of two types of EV—exosomes and matrix-bound nanovesicles (MBV)—both derived from the human umbilical cord MSC (UC-MSC) via differential ultracentrifugation. Different phenotypes of human monocyte-derived macrophages (MDM) were used to study the anti-inflammatory properties of EV in vitro, and the medial meniscectomy-induced rat model of knee osteoarthritis (MMx) was used in vivo. The study found that both EV reduced pro-inflammatory cytokines IL-6 and TNF-α in MDM. However, exosomes showed superior results, preserving the extracellular matrix (ECM) of hyaline cartilage, and reducing synovitis more effectively than MBVs. Additionally, exosomes downregulated inflammatory markers (TNF-α, iNOS) and increased Arg-1 expression in macrophages and synovial fibroblasts, indicating a stronger anti-inflammatory effect. These results suggest UC-MSC exosomes as a promising therapeutic option for OA, with the potential for modulating inflammation and promoting joint tissue regeneration. [ABSTRACT FROM AUTHOR]

Knee osteoarthritis (KOA) is a degenerative joint disease characterized by inflammation and cartilage degradation. The infrapatellar fat pad (IFP), located beneath the patella within the knee joint, serves as a key anatomical structure involved in cushioning and supporting the knee. It is also an active endocrine organ that secretes various bioactive substances, potentially influencing the local inflammatory environment and contributing to KOA pathogenesis. Netrin-4 (NTN4), a protein primarily known for its role in neuronal guidance, has been implicated in various non-neuronal functions, including inflammatory processes and tissue remodeling. This study aims to explore the involvement of NTN4 in KOA, focusing on its expression in the IFP and its potential impact on disease progression. This study involved 82 patients with radiographically confirmed KOA undergoing total knee arthroplasty (TKA). The correlation between NTN4 expression and OA pathology, including Kellgren–Lawrence (K/L) grades, was investigated. NTN4-expressing cells were identified in the stromal vascular fraction, including fibroblastic, hematopoietic, and endothelial cells of the IFP. To elucidate the molecular effects of NTN4, RNA sequencing (RNA-seq) was performed on fibroblastic cells treated with recombinant NTN4. Subsequent quantitative PCR (qPCR) was used to validate the RNA-seq findings. NTN4 expression was significantly elevated in the IFP of patients with advanced KOA (K/L grades 3 and 4) compared to those with early-stage disease (K/L grade 2). Higher NTN4 expression was found in fibroblastic cells, and RNA-seq analysis revealed upregulation of genes associated with pro-inflammatory pathways, including IL-17 and TNF-α signaling, and matrix degradation. Notably, genes including IL6, MMP1, CXCL1, and CXCL8 were significantly elevated, as confirmed by qPCR, indicating NTN4's role in promoting an inflammatory and catabolic environment. Our findings suggest that NTN4 plays a significant role in the pathogenesis of KOA by promoting inflammation and matrix degradation within the IFP. Although NTN4 expression was not directly correlated with clinical symptoms, its elevated expression in fibroblastic cells and influence on inflammatory and degradative pathways suggest a potential mechanism for exacerbating joint damage. Targeting NTN4 could offer a novel therapeutic approach to mitigating inflammation and slowing disease progression in KOA, ultimately improving patient outcomes. Further research is needed to clarify NTN4's specific roles and therapeutic potential in OA management. [ABSTRACT FROM AUTHOR]