Quality of Non-Surgical and Non-Pharmacological Knee Osteoarthritis Care in the Maritimes.

Objectives: To evaluate the quality and types of care individuals with mild-to-moderate knee osteoarthritis receive in the Canadian Maritime provinces, and determine associations with demographic, social, and patient-reported factors.

Methods: Individuals with knee osteoarthritis were invited to complete a healthcare quality survey based on the British Columbia Osteoarthritis (BC OA) survey. The cross-sectional descriptive observational survey assessed four healthcare quality indicators: advice to exercise, advice to lose weight, assessment of ambulatory function, and assessment of non-ambulatory function.

Association Between Knee Joint Muscle Activation and Knee Joint Moment Patterns During Walking in Moderate Medial Compartment Knee Osteoarthritis: Implications for Secondary Prevention.

Objective: To determine associations between knee moment features linked to osteoarthritis (OA) progression, gait muscle activation patterns, and strength.

Design: Cross-sectional secondary analysis.

Setting: Gait laboratory.

Baseline Gait Muscle Activation Patterns Differ for Osteoarthritis Patients Who Undergo Total Knee Arthroplasty Five to Eight Years Later From Those Who Do Not.

Objective: To determine if baseline quadriceps and hamstrings muscle activity patterns differed between those with medial-compartment knee osteoarthritis (OA) who advanced to total knee arthroplasty (TKA) and those who did not advance to TKA, and to examine associations between features extracted from principal component analysis (PCA) and discrete measures.

Methods: Surface electromyograms of the vastus lateralis and medialis, rectus femoris, and lateral and medial hamstrings during walking were collected from 54 individuals with knee OA. Amplitude and temporal characteristics from PCA, co-contraction indices (CCI) for lateral and medial muscle pairs, and root mean square (RMS) amplitudes for early, mid, late, and overall stance were calculated from electromyographic waveforms.

Longitudinal evidence links joint level mechanics and muscle activation patterns to 3-year medial joint space narrowing.

Background: It is currently not known if there are different mechanical factors involved in accelerated rates of knee osteoarthritis structural progression. Data regarding the role of the transverse plane moment along with the contributions to joint loading from muscle activity, a primary contributor to the joint loading environment, is not well represented in the current literature on knee OA radiographic progression. The objective of this study was to understand if a 3-year end point corroborates what has been shown for longer term radiographic progression or provides more insight into factors that may be implicated in more accelerated radiographic progression than those shown previously.

Reductions in Perceived Injustice are Associated With Reductions in Disability and Depressive Symptoms After Total Knee Arthroplasty.

Introduction: Perceptions of injustice have been associated with problematic recovery outcomes in individuals with a wide range of debilitating pain conditions. It has been suggested that, in patients with chronic pain, perceptions of injustice might arise in response to experiences characterized by illness-related pain severity, depressive symptoms, and disability. If symptoms severity and disability are important contributors to perceived injustice (PI), it follows that interventions that yield reductions in symptom severity and disability should also contribute to reductions in perceptions of injustice.

Asymptomatic and symptomatic individuals with the same radiographic evidence of knee osteoarthritis walk with different knee moments and muscle activity.

There is an established discordance between the structural joint damage and clinical symptoms of knee osteoarthritis; however, there has been little investigation into the differences in joint level biomechanics and muscle activation patterns during gait between symptomatic and asymptomatic individuals with the same radiographic evidence of osteoarthritis. The objective of this study was to examine three-dimensional knee joint biomechanics and muscle activation differences during gait between asymptomatic and symptomatic individuals with radiographic knee osteoarthritis. A total of 54 asymptomatic and 59 symptomatic individuals with a Kellgren-Lawrence osteoarthritis radiographic grade of 2 underwent a comprehensive gait analysis to examine differences in the magnitude and patterns of the knee flexion angle, three-dimensional net resultant moments, and electromyography of the quadriceps, hamstrings, and gastrocnemii during over ground walking between the two groups.

Osteochondral Biopsy Analysis Demonstrates That BST-CarGel Treatment Improves Structural and Cellular Characteristics of Cartilage Repair Tissue Compared With Microfracture.

Objective: The efficacy and safety of BST-CarGel, a chitosan-based medical device for cartilage repair, was compared with microfracture alone at 1 year during a multicenter randomized controlled trial (RCT) in the knee. The quality of repair tissue of osteochondral biopsies collected from a subset of patients was compared using blinded histological assessments.

Methods: The international RCT evaluated repair tissue quantity and quality by 3-dimensional quantitative magnetic resonance imaging as co-primary endpoints at 12 months.

Obesity is associated with higher absolute tibiofemoral contact and muscle forces during gait with and without knee osteoarthritis.

Background: Obesity is an important risk factor for knee osteoarthritis initiation and progression. However, it is unclear how obesity may directly affect the mechanical loading environment of the knee joint, initiating or progressing joint degeneration. The objective of this study was to investigate the interacting role of obesity and moderate knee osteoarthritis presence on tibiofemoral contact forces and muscle forces within the knee joint during walking gait.

Relationship between knee adduction moment patterns extracted using principal component analysis and discrete measures with different amplitude normalizations: Implications for knee osteoarthritis progression studies.

Background: Knee adduction moment discrete features (peaks and impulses) are commonly reported in knee osteoarthritis gait studies, but they do not necessarily capture loading patterns. Principal component analysis extracts dynamic patterns, but can be difficult to interpret. This methodological study determined relationships between external knee adduction moment discrete measures and principal component analysis features, and examined whether amplitude-normalization methods influenced differences in those with knee osteoarthritis who progressed to surgery versus those that did not.

Chondroinduction Is the Main Cartilage Repair Response to Microfracture and Microfracture With BST-CarGel: Results as Shown by ICRS-II Histological Scoring and a Novel Zonal Collagen Type Scoring Method of Human Clinical Biopsy Specimens.

Background: Current cartilage repair histological scoring systems are unable to explain the relationship between collagen type II deposition and overall repair quality.

Purpose/hypothesis: The purpose of this study was to develop a novel zonal collagen type (ZCT) 5-point scoring system to measure chondroinduction in human clinical biopsy specimens collected after marrow stimulation. The hypothesis was that the ZCT scores would correlate with the International Cartilage Repair Society-II (ICRS-II) overall histological repair assessment score and glycosaminoglycan (GAG) content.

BST-CarGel® Treatment Maintains Cartilage Repair Superiority over Microfracture at 5 Years in a Multicenter Randomized Controlled Trial.

Objective: The efficacy and safety of BST-CarGel®, a chitosan scaffold for cartilage repair was compared with microfracture alone at 1 year during a multicenter randomized controlled trial in the knee. This report was undertaken to investigate 5-year structural and clinical outcomes.

Design: The international randomized controlled trial enrolled 80 patients, aged 18 to 55 years, with grade III or IV focal lesions on the femoral condyles.

Three-dimensional biomechanical gait characteristics at baseline are associated with progression to total knee arthroplasty.

Objective: To determine if baseline 3-dimensional (3-D) biomechanical gait patterns differed between those patients with moderate knee osteoarthritis (OA) who progressed to total knee arthroplasty (TKA) and those that did not, and whether these differences had predictive value.

Methods: Fifty-four patients with knee OA had ground reaction forces and segment motions collected during gait. 3-D hip, knee, and ankle angles and moments were calculated over the gait cycle.

Novel scaffold-based BST-CarGel treatment results in superior cartilage repair compared with microfracture in a randomized controlled trial.

Background: Microfracture, the standard of care, is recognized to be an incomplete solution for cartilage damage. BST-CarGel, a chitosan-based medical device, is mixed with autologous whole blood and is applied to a microfractured cartilage lesion in which it physically stabilizes the clot and guides and enhances marrow-derived repair. An international, multicenter, randomized controlled trial was conducted to evaluate BST-CarGel treatment compared with microfracture alone in the repair of cartilage lesions in the knee.

Changes in knee joint muscle activation patterns during walking associated with increased structural severity in knee osteoarthritis.

Purpose: To determine whether alterations in knee joint muscle activation patterns during gait were related to structural severity determined by Kellgren-Lawrence (KL) radiographic grades, for those with a moderate knee OA classification.

Scope: Eighty-two individuals with knee OA, classified as moderate using a functional and clinical criterion were stratified on KL-grade (KL II, KL III and KL IV). Thirty-five asymptomatic individuals were matched for age and walking velocity.

Reliability of surface electromyographic recordings during walking in individuals with knee osteoarthritis.

To determine test-retest reliability of a surface electromyographic protocol designed to measure knee joint muscle activation during walking in individuals with knee osteoarthritis (OA). Twenty-one individuals with moderate medial compartment knee OA completed two gait data collections separated by approximately 1month. Using a standardized protocol, surface electromyograms from rectus femoris plus lateral and medial sites for the gastrocnemii, vastii and hamstring muscles were recorded during walking.

Subchondral pre-solidified chitosan/blood implants elicit reproducible early osteochondral wound-repair responses including neutrophil and stromal cell chemotaxis, bone resorption and repair, enhanced repair tissue integration and delayed matrix deposition.

Background: In this study we evaluated a novel approach to guide the bone marrow-driven articular cartilage repair response in skeletally aged rabbits. We hypothesized that dispersed chitosan particles implanted close to the bone marrow degrade in situ in a molecular mass-dependent manner, and attract more stromal cells to the site in aged rabbits compared to the blood clot in untreated controls.

Methods: Three microdrill hole defects, 1.

Body mass index affects knee joint mechanics during gait differently with and without moderate knee osteoarthritis.

Objective: Obesity is a highly cited risk factor for knee osteoarthritis (OA), but its role in knee OA pathogenesis and progression is not as clear. Excess weight may contribute to an increased mechanical burden and altered dynamic movement and loading patterns at the knee. The objective of this study was to examine the interacting role of moderate knee OA disease presence and obesity on knee joint mechanics during gait.

Is there a dose response for valgus unloader brace usage on knee pain, function, and muscle strength?

Objective: To examine whether there was a dose response for valgus unloader brace wear on knee pain, function, and muscle strength in participants with medial compartment knee osteoarthritis.

Design: In this single-group study, participants with medial compartment knee osteoarthritis were followed for approximately 6 months.

Setting: Recruitment was conducted in the general community, and testing was performed at a university laboratory.

Neuromuscular alterations exist with knee osteoarthritis presence and severity despite walking velocity similarities.

Background: Neuromuscular strategies during walking in individuals with knee osteoarthritis are being explored for diagnostic information; however, isolating differences to disease progression is difficult given walking velocity decreases with osteoarthritis severity. This study investigated lower extremity electromyograms during walking in asymptomatic individuals and individuals with different severities of knee osteoarthritis who walked with similar self-selected velocities.

Methods: Muscle activity in lateral and medial gastrocnemius, vastus lateralis and medialis, rectus femoris and the lateral and medial hamstrings was monitored during self-selected walking in 230 subjects with asymptomatic knees, moderate and severe knee osteoarthritis.

Maximal voluntary isometric contraction exercises: a methodological investigation in moderate knee osteoarthritis.

Purpose: The objectives were, (i) to determine whether differences exist in relative activation amplitudes for participants with asymptomatic knees and participants with moderate medial compartment knee osteoarthritis during a series of maximal effort contractions and (ii) to determine whether maximum activations occurred on similar exercises for both groups.

Scope: Sixty-eight participants with asymptomatic knees and 68 participants with moderate medial compartment knee osteoarthritis completed eight standardized 3-s maximal voluntary isometric exercises. Maximal electromyographic amplitudes were identified for a 100 ms window from three quadriceps, two gastrocnemius and two hamstring muscle sites for each exercise.

Digital vascular mapping of the integument about the Achilles tendon.

Background: Soft-tissue coverage and vascularity likely play a vital role in the genesis of wound complications and infections during open Achilles tendon repair. Planning an appropriate surgical approach might decrease the prevalence of these complications.

Methods: Five adult cadavers underwent whole-body arterial perfusion with a mixture of lead oxide, gelatin, and water.

Double-bundle ACL reconstruction: how big is the learning curve?

The study aim was to determine whether an experienced ACL surgeon could convert from a single-bundle to a double-bundle technique with relative accuracy. We also wanted to determine whether there was a significant learning curve. Ten double-bundle ACL reconstruction procedures were carried out on suitable individuals.

Two to five year results of primary ACL reconstruction using doubled tibialis anterior allograft.

The aim of the study was to report the 2-5 year results of primary ACL reconstruction with doubled tibialis anterior allograft. Seventy-three patients who underwent primary ACL reconstruction with doubled tibialis anterior allografts with minimum 2 year follow-up were included in the study. Sixty-four patients were available for follow-up.