Effect of sodium hyaluronate combined with rehabilitation training on knee joint injury caused by golf

BACKGROUND In high-intensity sports like golf,knee joints are prone to injury,leading to pain,limited mobility,and decreased quality of life.Traditional treatment methods typically involve rehabilitation exercises,but their effectiveness may be limited.In recent years,sodium hyaluronate has emerged as a widely used biomedical material in the treatment of joint diseases.AIM To explore the effect of sodium hyaluronate combined with rehabilitation training on pain degree,flexion range of motion and motor function of knee joint injured by golf.METHODS Eighty patients with knee joint injury caused by golf were randomly divided into control(group B)and observation group(group A).The group B was treated with rehabilitation training,and the group A was treated with sodium hyaluronate combined with rehabilitation training.The clinical efficacy,range of motion and function of knee joint,quality of life and inflammatory factors were compared.RESULTS The excellent and good rate of rehabilitation in the group A was raised than group B.At 6 weeks and 3 months after treatment,the range of motion of the two groups was raised than that before treatment,and that of the group A was raised than group B.After treatment,the scores of Lysholm and International Knee Documentation Committee(IKDC)in the group A were raised,and those in the group A were raised than group B.The VAS score of the two groups was reduced than that of the group B,and the SF-36 score of the group A was reduced than group B.The interleukin(IL)-1β,IL-8 and tumor necrosis factor-αin the two groups were reduced,and those in the group A were reduced than group B.CONCLUSION Sodium hyaluronate combined with rehabilitation training has a good clinical effect in the treatment of patients with knee joint injury caused by golf,which relieve pain,maintain knee joint function and improve patients'life quality.

Dental Treatment Using Quantum Mechanics for Knee Joint Pain

In clinical practice, dentists sometimes encounter phenomena that cannot be explained by modern western medical concepts;for example, the patient’s medical symptoms improve by bringing medicines or dentures close to the body. Although it seems difficult to completely elucidate the mechanism through modern western medicine, it can be explained using quantum mechanics. The quantum, the smallest unit of matter composition, exhibits wave-particle duality. The fact that symptoms can be improved simply by bringing dentures or medicines closer to the body indicates that the waves emitted by dentures or medicines interfere with the pathological waves emitted by the pathological site. Thus, the pathological waves are deformed and lead to a change in symptoms. In this way, quantum theory can explain phenomena that are difficult to elucidate in conventional medicine, which are encountered in clinical practice. So far, the author has presented a case of difficulty in raising the upper limb where the symptoms improved without the need for dentures in the mouth by adjusting the dentures outside the mouth. This time, the author would like to introduce a case which the patient’s knee pain improved by adjusting the dentures outside the mouth.

Formation process of extension knee joint contracture following external immobilization in rats

BACKGROUND Current research lacks a model of knee extension contracture in rats.AIM To elucidate the formation process of knee extension contracture.METHODS We developed a rat model using an aluminum external fixator.Sixty male Sprague-Dawley rats with mature bones were divided into the control group(n=6)and groups that had the left knee immobilized with an aluminum external fixator for 1,2,and 3 d,and 1,2,3,4,6,and 8 wk(n=6 in each group).The passive extension range of motion,histology,and expression of fibrosis-related proteins were compared between the control group and the immobilization groups.RESULTS Myogenic contracture progressed very quickly during the initial 2 wk of immobilization.After 2 wk,the contracture gradually changed from myogenic to arthrogenic.The arthrogenic contracture progressed slowly during the 1^(st) week,rapidly progressed until the 3^(rd) week,and then showed a steady progression until the 4^(rd) week.Histological analyses confirmed that the anterior joint capsule of the extended fixed knee became increasingly thicker over time.Correspondingly,the level of transforming growth factor beta 1(TGF-β1)and phosphorylated mothers against decapentaplegic homolog 2(p-Smad2)in the anterior joint capsule also increased with the immobilization time.Over time,the cross-sectional area of muscle fibers gradually decreased,while the amount of intermuscular collagen and TGF-β1,p-Smad2,and p-Smad3 was increased.Unexpectedly,the amount of intermuscular collagen and TGF-β1,p-Smad2,and p-Smad3 was decreased during the late stage of immobilization(6-8 wk).The myogenic contracture was stabilized after 2 wk of immobilization,whereas the arthrogenic contracture was stabilized after 3 wk of immobilization and completely stable in 4 wk.CONCLUSION This rat model may be a useful tool to study the etiology of joint contracture and establish therapeutic approaches.

Shock-wave impact on the knee joint affected with osteoarthritis and after arthroplasty

Degenerative diseases significantly reduce the quality of human life.Non-invasive treatments are used in the initial stages of osteoarthritis(OA).Total knee arthroplasty is used in the late stages of osteoarthritis of the knee joint.Non-invasive methods based on mechanical action are also used for the rehabilitation of a patient after arthroplasty.This paper presents numerical models of the knee joint with degenerative OA changes and arthroplasty.Using these models,a computational study was made of the influence of the intensity of shock-wave exposure on the conditioning for the regeneration of bone and cartilage tissues.Based on the modeling results,it was found that in the knee joint with degenerative OA changes,conditions for the regeneration of cartilage and meniscus tissues were fulfilled under medium and highintensity loading.Under high-intensity loading(up to 0.9 m J/mm^(2)),the stress level was significantly below the ultimate value required for fracture.At knee arthroplasty,the conditions for bone tissue regeneration around the tibia component are fulfilled only under high-intensity loading.

The Knee Joint Design and Control of Above-knee Intelligent Bionic Leg Based on Magneto-rheological Damper

The above-knee intelligent bionic leg is very helpful to amputees in the area of rehabilitation medicine. This paper first introduces the functional demand of the above-knee prosthesis design. Then, the advantages of the four-bar link mechanism and the magneto-rheological （MR） damper are analyzed in detail. The fixed position of the MR damper is optimized and a virtual prototype of knee joint is given. In the end, the system model of kinematics, dynamics, and controller are given and a control experiment is performed. The control experiment indicates that the intelligent bionic leg with multi-axis knee is able to realize gait tracking of the amputee＇s healthy leg based on semi-active control of the MR damper.

Stem cell application for osteoarthritis in the knee joint: A minireview

Knee osteoarthritis is a chronic, indolent disease that will affect an ever increasing number of patients, especially the elderly and the obese. It is characterized by degeneration of the cartilage substance inside the knee which leads to pain, stiffness and tenderness. By some estimations in 2030, only in the United States, this medical condition will burden 67 million people. While conventional treatments like physiotherapy or drugs offer temporary relief of clinical symptoms, restoration of normal cartilage function has been difficult to achieve. Moreover, in severe cases of knee osteoarthritis total knee replacement may be required. Total knee replacements come together with high effort and costs and are not always successful. The aim of this review is to outline the latest advances in stem cell therapy for knee osteoarthritis as well as highlight some of the advantages of stem cell therapy over traditional approaches aimed at restoration of cartilage function in the knee. In addition to the latest advances in the field, challenges associated with stem cell therapy regarding knee cartilage regeneration and chondrogenesis in vitro and in vivo are also outlined and analyzed. Furthermore, based on their critical assessment of the present academic literature the authors of this review share their vision about the future of stem cell applications in the treatment of knee osteoarthritis.

Expression of mu-opioid receptors in human chronic inflamed knee joint synovium tissue

Objective: To examine the changes of mu-opioid receptors (MORs) expression in human chronic inflamed knee joint synovium tissue. Methods:Knee joint synovium tissues were taken from 21 patients with chronic arthritis (inflamed group) and 6 fresh bodies with normal knee joints (control group). And the expression of MORs was detected by using immunohistochemistry. flow cytometry(FCM) and reverse-transcription polymerase chain reaction (RT-PCR). Results: The expression of MORs in the inflamed group was significantly higher than that in the normal group by using the 3 techniques(P<0. 05). Conclusion: Chronic inflammation enhances the up-regulation of MORs in human knee joint synovium tissue.

THREE-DIMENSIONAL FINITE ELEMENT SIMULATION OF TOTAL KNEE JOINT IN GAIT CYCLE

Based on CT scanning pictures from a volunteer＇s knee joint, a three-dimensional finite element model of the healthy human knee joint is constructed including complete femur, tibia, fibular, patellar and the main cartilage and ligaments. This model was validated using experimental and numerical results obtained from other authors. The pressure distribution of contact surfaces of knee joint are calculated and analyzed under the load action of ‘heel strike＇, ‘single limb stance＇ and ‘toe-off＇. The results of the gait cycle are that the contact areas of medial cartilage are larger than that of lateral cartilage; the contact force and contact areas would grow larger with the load increasing; the pressure of lateral meniscus is steady, relative to the significant variation of peak pressure in medial meniscus; and the peak value of contact pressure on all components are usually found at about 4570 of the gait cycle.

Synovial Neuronal Changes in Knee Joint Osteoarthritis

Purpose: The purpose is to study whether pain and inflammation in knee joint osteoarthritis (OA) are associated with local synovial neuronal changes. Methods: Synovial biopsies were harvested from the medial and lateral knee compartments from OA patients undergoing total joint replacement surgery. All patients had predominant pain at the medial joint compartment. Pain and knee joint function were evaluated by knee society score (KSS). Synovial inflammation was analyzed by histopathological analysis and expression of growth associated protein-43 (GAP-43), sensory (SP, CGRP) and autonomic (NPY, VIP, TH) neuropeptides was studied by single and double immunohistochemistry techniques. Results: We observed reduced KSS and increased inflammatory score in synovial membrane of medial knee compartment. A significant increase in GAP-43 [P = 0.001], SP [P = 0.05], CGRP [P = 0.05] and TH [P = 0.05] expression was observed and SP, CGRP and NPY were found to be co-existed predominantly with GAP-43 in synovial membrane collected from medial compared to the lateral knee compartment. Conclusions: Regenerating nerve fibers containing sensory and autonomic neuropeptides are associated with pain and inflammation in knee joint OA.

Anatomy of the anterolateral ligament of the knee joint

Despite remarkable improvements in clinical outcomes after anterior cruciate ligament reconstruction,the residual rotational instability of knee joints remains a major concern.The anterolateral ligament(ALL)has recently gained attention as a distinct ligamentous structure on the anterolateral aspect of the knee joint.Numerous studies investigated the anatomy,function,and biomechanics of ALL to establish its potential role as a stabilizer for anterolateral rotational instability.However,controversies regarding its existence,prevalence,and femoral and tibial insertions need to be addressed.According to a recent consensus,ALL exists as a distinct ligamentous structure on the anterolateral aspect of the knee joint,with some anatomic variations.The aim of this article was to review the updated anatomy of ALL and present the most accepted findings among the existing controversies.Generally,ALL originates slightly proximal and posterior to the lateral epicondyle of the distal femur and has an anteroinferior course toward the tibial insertion between the tip of the fibular head and Gerdy’s tubercle below the lateral tibial plateau.

IL-1B,IL-6 and TNF-a change of experimental knee joint degeneration model and effect of local loosening therapy

Objective To observe IL-1B,IL-6 and TNF-a level change of the joint fluid in the experimental knee joint degeneration and the effect of the local loosening therapy.Methods Thirty rabbits were divided into 3 groups at random:ten in the normal contrast group,ten in the blank model group and ten in the loosening therapy group to observe the IL-1B,IL-6 and TNF-a change of the joint fluid before and after the treatment in each group.Result IL-1B,IL-6 and TNF-a level in the blank model group was obviously higher than that in the normal group.(P<0.05).IL-1B,IL-6 and TNF-a level in the treatment group was obviously lower than that in the normal group.(P<0.05).Conclusions 1)IL-1B,IL-6 and TNF-a level of the joint fluid in the blank model group was obviously higher than that in the normal group.2)Loosening soft tissues of the knees can improve IL-1B,IL-6 and TNF-a level of the joint fluid.

A Case Report of Synovial Osteochondromatosis of the Knee Joint with neither Calcification nor a Synovial Lesion on Imaging

Synovial osteochondromatosis is a rare, benign condition of unknown etiology in which the synovium undergoes metaplasia, leading to cartilaginous nodules that ultimately break free, mineralize, and even ossify. The most commonly involved joint is the knee. Typically, radiographs can be diagnostic and mineralized nodules are pathognomonic. In as many as one-third of cases, however, no calcification or ossification of the cartilage occurs in the early stage of the disease because mineralization is time-dependent. In such cases, gadolinium-enhanced MRI can be useful. Unmineralized nodules are typically peripherally enhanced because they are attached to and derive a vascular supply from the synovium. We experienced an unmineralized case of synovial osteochondromatosis of the right knee joint, in which imaging diagnosis was difficult. Neither calcification nor ossification was observed, but all nodules were released from the synovium as loose bodies and there was no vascular supply. Therefore, MRI did not show a typical appearance. These findings suggest that synovial osteochondromatosis should be considered as a differential diagnosis in a case in which unmineralized loose bodies without a synovial lesion are found in an imaging examination.

Expression changes and clinical significance of TLR-4 and IL-1β in serum and knee joint fluid of patients with knee osteoarthritis

Objective:To investigate the expression changes and clinical significance of Toll-like receptor-4(TLR-4)and interleukin-1β(IL-1β)in the serum and knee joint fluid in patients with knee osteoarthritis(KOA).Methods:From June 2017 to December 2018,220 cases of patients with KOA who were admitted in Department of Orthopedics of the Third Affiliated Hospital of Inner Mongolia Medical University(“our hospital”for short)were selected as the observation group.According to the severity of KOA,they were divided into the mild subgroup(n=98),the moderate subgroup(n=80)and the severe subgroup(n=42).In addition,60 cases of volunteers who received the physical examination in Health Medical Center of our hospital were selected as the control group.The levels of TLR-4 and IL-1βin the serum and knee joint fluid were detected by enzyme-linked immunosorbent assay,in order to analyze the correlation of TLR-4 and IL-1βlevels with the severity of KOA.Results:The levels of TLR-4 and IL-1βin the serum and knee joint fluid of the observation group were significantly higher than those of the control group,and the differences were statistically significant(all p<.05).The levels of TLR-4 and IL-1βin the serum and knee joint fluid of the severe subgroup were significantly higher than those of the mild subgroup and the moderate subgroup,and the levels of TLR-4 and IL-1βin the serum and knee joint fluid of the moderate subgroup were higher than those of the mild group.The differences were statistically significant(all p<.05).The levels of TLR-4 and IL-1βin the serum and knee joint fluid were positively correlated to the severity of KOA(r=.706,.729,.741,.715,all p<.05);in the serum,the level of TLR-4 was positively correlated to the level of IL-1β(r=.720,p<.05);in the joint fluid,the level of TLR-4 was positively correlated to the level of IL-1β(r=.736,p<.05).Conclusions:The levels of TLR-4 and IL-1βin the serum and knee joint fluid of KOA patients are abnormally increased,which is closely related with the severity of KOA.It can be used for clinical prediction,diagnosis and treatment of KOA.

Yersinia enterocolitica Infection of a Prosthetic Knee Joint.Case Report and Review of the Literature on Deep Sited Infections Caused by Y.enterocolitica

Prosthetic joint infection is a rare manifestation of Yersinia enterocolitica. We report a case of a patient presenting with fever and a purulent infection in his prosthetic knee joint caused by Y. enterocolitica. He had been operated in 1990 for arthrosis of the right knee. Re-operation was performed in 2007 for loosening of the prosthesis. Seven months later, following progressively increasing knee pain, he became acutely febrile and a purulent knee joint infection was diagnosed. Y. enterocolitica was isolated from the joint fluid. Serum antibodies against Y. enterocolitica were also positive. He was treated with debridement, replacement of the liner component of the prosthesis and a long course of intravenous antimicrobial therapy. The infection was thought to be in a chronic suppressive state. The final outcome after all therapy was good.

Evaluating the effects of pain and disorders of the knee joint on knee extension strength and daily life activities in the female elderly

This study aimed at examining the differences in leg strength and activities of daily living (ADL) ability among groups with various knee problems. The subjects consisted of 328 elderly females who were classified into three groups: those without knee pain or a knee disorder, those with knee pain, and those with a knee disorder. The subjects took a knee extension strength test and an ADL survey. Knee extension strength and ADL scores (total score and each domain score of the motions of locomotion, posture change, stability, and manipulation) were selected as the evaluation parameters. The knee extension strength, total ADL score and each domain score of the motions of locomotion, posture change, and stability ranged from low to high in the following order: the group with a knee disorder, the group with knee pain, and the group without pain or a knee disorder. Moreover, manipulation scores were significantly inferior in the group with a knee disorder compared with the other two groups. In conclusion, the female elderly with knee pain or a knee disorder have inferior knee extension strength and ADL with respect to the motions of locomotion, posture change and stability. In addition, with regard toknee extension strength with respect to theabove three motions, the elderly with a knee disorder have inferior scores when compared with the elderly who have only knee pain;thus, they find it difficult to perform activities involving the knee joints.

Analysis of the relative factors affecting the functional restoration of knee joint after the fracture of patella

Objective To explore the relative factors affecting the functional restoration of knee joint after the fracture of patella, and to anticipate the effect of middle-term and short-time rehabilitation therapy. Method 23 patients with limited flexion function of knee joint after the fracture of patella, accepted the routine rehabilitation treatment in out -patient service, and some of the patients adopted local heat therapy at the same time. The 13 factors have been selected for regression analysis step by step under the help of SPSS statistical software. Result The flexible degree of the knee joint before rehabilitation (X1), the non-smooth posterior edge of patella (X2), and the immobilization time of the joint (X3) are relative factors for the flexible degree of knee joint 1 month after rehabilitation (Y1) and the flexible degree of knee joint 3 months after rehabilitation (Y2), and Y1 can also be affected by whether surgery therapy or not (X4), (partial regression coefficient P< 0.05). The differences between theoretical mean and practical mean of Y1 and Y2 are 5.6% and 4.2% respectively in the 23 cases. Conclusion The flexible degree of the knee joint before rehabilitation, whether the posterior edge of patella is smooth or not, and the immobilization time of the joint are relative factors affecting the middle-term and short-term flexible function of knee joint after the fracture of patella, and short-term restoration can also be affected by whether surgery therapy or not. The effects of middle-term and short-term rehabilitation can be predicted by regression equation primarily.

Metastatic Rectal Adenocarcinoma of the Hip and Knee Joints: A Case Series

Two cases are presented of patients with a history of metastatic rectal adenocarcinoma presenting with a painful joint effusion. Both cases are potential examples of metastasis to periarticular bone with local infiltration to the synovium, which is one proposed mechanism of intrasynovial metastasis. While skeletal metastases are a relatively common occurrence in metastatic adenocarcinoma, intraarticular metastasis is extremely rare. These cases highlight the need to consider metastasis in the differential of joint swelling in the setting of a history of adenocarcinoma.

The Establishment of Three-Dimensional Model of Human Knee Joint

Objective: To discuss a method to establish a three-dimensional model of healthy human knee joint, which can be used for further knee joint biomechanics analysis and simulation. Methods: CT scan and medical image three-dimensional reconstruction software (Mimics) were used to obtain the knee joint three-dimensional finite element model (FEM) according to reverse engineering theory. Results: FEM of knee joint with complete bone structure was established by Mimics. Conclusion: Three-dimensional FEM was established according to CT images exports as IGES file. The model can be used for knee joint biomechanics finite element analysis to provide references and proposals for the clinical diagnoses of knee joint illness, and the design of artificial knee joint prosthesis.

Loose Body in the Knee Joint: A Case Report

Background: Loose bodies (LBs) within the knee joint are commonly encountered during clinical practice and are frequently observed during knee arthroscopy. The primary treatment involves the removal of loose bodies;however, their complete eradication is often challenging and may not address underlying diseases, leading to persistent symptoms and the risk of new loose body formation. Aim: This case report aims to present the findings and surgical management of a 52-year-old male with an unusually large osseous loose body in the knee joint and associated pathologies. Case Presentation: The patient, a 52-year-old male, experienced recurrent episodes of severe, sudden, and painful locking of the knee joint, leading to difficulties moving. A plain MRI study was conducted to evaluate the condition of the knee joint, which revealed various degenerative changes and the presence of a loose body. Subsequently, an arthroscopic examination was performed under general anesthesia, uncovering the presence of an abnormally large loose body, as well as other pathologies including chondropathy, meniscal degeneration, and Baker’s cyst. Conclusion: Loose bodies (LBs) in the knee joint pose significant challenges and may lead to debilitating symptoms. Timely diagnosis and appropriate surgical intervention are crucial for symptom relief and the prevention of further joint damage as arthroscopic excision. Comprehensive imaging has a vital role in guiding treatment decisions and optimizing patient outcomes. In this case, the removal of the loose body improved patient outcomes and helped prevent potential joint complications.