Plain radiography in the degenerate knee. A case for change.
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We took posteroanterior weight-bearing radiographs, both with the joint fully extended and in 30 degrees of flexion, in a consecutive series of 50 knees in 37 patients referred for the primary assessment of pain and/or stiffness. These radiographs were reported 'blind' both by an orthopaedic surgeon and a radiologist. Direct measurement of the joint space, together with grading of the severity of erosion according to the Ahlback criteria, was undertaken. Any other abnormality present was also documented. The radiographs of the knees in 30 degrees of flexion consistently showed more advanced erosion in both the medial (p = 0.001) and the lateral (p = 0.0001) tibiofemoral compartments, when compared with those of knees in full extension. The Ahlback classification of 25 joints was altered, in some cases by several grades, by the flexed position of the joint. In every case in which another abnormality was identified on the radiograph in full extension, it was also noted on that of the knee in 30 degrees of flexion. In a further four cases, additional pathology could only be seen in the flexed knee. Every patient was able to complete the radiological examination without difficulty. Our study supports the adoption of a weight-bearing view in 30 degrees of flexion as the standard posteroanterior radiograph for the assessment of tibiofemoral osteoarthritis in patients over 50 years of age. (+info)
The popliteofibular ligament. An anatomical study of the posterolateral corner of the knee.
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We designed an experimental study to prove the existence of the popliteofibular ligament (PFL) and to define its role in providing static stability of the knee. We also examined the contribution of the lateral collateral ligament (LCL). We found this ligament to be present in all eight human cadaver knees examined. These specimens were mounted on a specially designed rig and subjected to posterior, varus and external rotational forces. We used the technique of selective sectioning of ligaments and measured the displacement with a constant force applied, before and after its division. We recorded the displacement in primary posterior translation, coupled external rotation, primary varus angulation and primary external rotation. Statistical analysis using the standard error of the mean by plotting 95% confidence intervals, was used to evaluate the results. The PFL had a significant role in preventing excessive posterior translation and varus angulation, and in restricting excessive primary and coupled external rotation. Isolated section of the belly of popliteus did not cause significant posterolateral instability of the knee. The LCL was also seen to act as a primary restraint against varus angulation and secondary restraint against external rotation and posterior displacement. Our findings showed that in knees with isolated disruption of the PFL stability was restored when it was reconstructed. However in knees in which the LCL was also disrupted, isolated reconstruction of the PFL did not restore stability. (+info)
Changes in transmission in the pathway of heteronymous spinal recurrent inhibition from soleus to quadriceps motor neurons during movement in man.
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H reflexes were induced in the human quadriceps muscle by electrical stimulation of the femoral nerve. The reflexes were conditioned by prior stimulation of the inferior soleus nerve. The conditioning stimulus produced an inhibition of long duration (>20 ms). The threshold of this inhibition was at zero soleus motor discharge and the inhibition scaled with soleus motor discharge. It was concluded that the inhibition was a heteronymous recurrent inhibition of quadriceps motor neurons mediated by Renshaw cells which had been activated by soleus motor neuron discharge. This recurrent inhibition declined during voluntary tonic contraction of the quadriceps, falling to zero at around one-third of maximum voluntary contraction. Antagonist contraction and weak co-contraction of the quadriceps and its antagonists did not lead to any significant change in recurrent inhibition. It is concluded that motor commands descending from the brain reduce heteronymous recurrent inhibition during isolated quadriceps muscle contraction, but to a much lesser extent during co-contraction. No evidence was obtained for any descending facilitation of heteronymous recurrent inhibition. (+info)
Sonographic evaluation of the posterior cruciate ligament in amputated specimens and normal subjects.
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The purpose of this study was to define the sonographic appearance and echogenicity of the normal posterior cruciate ligament. We examined the posterior cruciate ligament of five amputated specimens and five normal subjects using a 10 MHz linear array transducer. One K-wire was inserted into the substance of the posterior cruciate ligament of the amputated knee specimens to verify the location of the ligament on the sonogram. Various angles of insonation were used to examine the echogenicity of the posterior cruciate ligament. The results showed that the in situ posterior cruciate ligament appeared as a hypoechoic band relative to the surrounding tissue on sonograms, but it appeared hyperechoic when it was isolated and immersed in a water bath. The specific spatial orientation of the posterior cruciate ligament and anisotropy phenomenon contributed to the hypoechogenicity of the posterior cruciate ligament in situ on sonogram. (+info)
Effects of nalidixic acid on hamster knee cartilage morphology and synovial fluid composition.
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Quinolone-induced changes were studied in the knee joints of 4-wk-old female hamsters given intraperitoneal doses of either nalidixic acid (400 mg/kg body weight) or vehicle on days 0 and 1. After euthanasia on day 4, synovial fluid was collected for cytologic evaluation and for analysis of concentrations of hyaluronan, proteoglycans, total protein, and collagen as hydroxyproline. Slides of formalin-fixed decalcified tissues were stained with hematoxylin-eosin or safranin O for histologic scoring of lesion severity. Nine of 10 hamsters treated with nalidixic acid had fissures within articular cartilage of the femur and reduced safranin O staining of matrix indicative of loss of proteoglycans. Synovial membranes from affected joints, however, were not inflamed. Synovial fluid cell counts and cytomorphology were unaffected by treatment. In synovial fluid from 5 of 10 treated hamsters, proteoglycans were elevated by more than 2 SDs above the control group, and individual animal levels correlated with the histologic severity score (r2 = 0.36; p = 0.02). The hyaluronan content of the synovial fluid from treated hamsters was mildly but significantly elevated (p = 0.005), and the histologic severity score again correlated with individual animal levels (r2 = 0.42; p = 0.01). Hydroxyproline was unaffected by treatment. Although synovial fluid changes and histologic changes were correlated on a group basis, interanimal variability was significant and the magnitude of biochemical changes were far smaller than those that occur during inflammation. Changes in synovial fluid composition are not sufficiently robust to predict cartilage changes in individual animals. (+info)
External fixation in proximal tibial osteotomy: a comparison of three methods.
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During a period of 6 years (1990-1996), 154 patients with unilateral gonarthrosis underwent proximal tibial osteotomy using 3 different methods of external fixation: (1) closing wedge osteotomy and bilateral fixation; (2) closing wedge osteotomy with unilateral fixation, and (3) opening wedge osteotomy with unilateral fixation. The most common complications were pin-tract infection (25%), temporary nerve palsy (10%), and loss of alignment (17%). At least one complication developed in 33% of patients in this study, indicating that the use and technique of external fixation in proximal tibial osteotomy can be problematic. (+info)
Structural periodicity in human articular cartilage: comparison between magnetic resonance imaging and histological findings.
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OBJECTIVE: To relate the vertical striations visualized in the deeper layers of articular cartilage by Magnetic Resonance Imaging (MRI) to histological features. METHODS: Two knee joints recovered at post-mortem from males in their seventies with no history or visual evidence of joint disease were examined. MR images were obtained in a 4.7 T 400 mm-bore magnet, after which the knees were fixed, sectioned, and examined histologically. RESULTS: High resolution MR showed vertical high/low signal striations with a two to three-fold variation in signal intensity and a periodicity of 0.56 (+/-0.16 mm), most prominent in weight bearing areas. Histological sections revealed alternating light and dark staining areas with a periodicity of 1.01+/-0.54 mm in the lower zones of the cartilage, some, but not all of which clearly represented folding. Given that MR will only visualize vertical structures in cartilage aligned at 90 degrees, whereas histology will cut them at varying angles, it is likely that the vertical structures seen by each modality correspond, and that they represent structural heterogeneity in cartilage; perhaps the presence of plates of high collagen and proteoglycan content. CONCLUSION: The vertical striations seen routinely in the deep zones of hyaline articular cartilage on histological sections are not artefactual; they are likely to represent structural heterogeneity due to the presence of areas of high collagen and high proteoglycan content that exist in weight-bearing areas. This structural heterogeneity may be of great importance to the integrity and function of the cartilage. (+info)
Placement of intra-articular injections verified by mini air-arthrography.
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OBJECTIVE: To develop and assess a simple, inexpensive method for ascertaining the placement of intra-articular injections for knee osteoarthritis METHODS: During a one year period patients with "dry" osteoarthritis of the knee who received intra-articular therapy were tested by air-arthrography. Along with triamcinolone and lignocaine (lidocaine), 5 ml of air was injected into the joint. On subsequent lateral and anterior-posterior radiographs a correct placement was verified by a sharply defined shadow of air in the suprapatellar pouch, while extra-articular air was diffusely spread in the surrounding tissue. RESULTS: In 51 of 56 cases the injection was correctly placed. In the remaining five cases the injection was immediately repeated and positioned within the joint. No adverse events were seen that could be ascribed to the use of air during the study, although bleeding in the quadriceps was seen one week after an extra-articular injection. CONCLUSION: With mini-air arthrography, it is possible to test the placement of intra-articular injections in knee joints. The method is proposed as a learning tool as well as providing a means of quality assurance in studies involving intra-articular injections. (+info)