Acute knee MRI and x-ray pictures.

Great video presenting x-ray and MRI examination of an acute knee injury.
All rights reserved to the Radiology Channel.

Cartilage repair rehabilitation guidelines.

Dr Karen Hambly from the University of Kent shares her opinion on rehabilitation guidelines following knee cartilage repair in soccer players. The presentation was given at the 2012 Football Medicine Strategies for Knee Injuries Conference in London.

All rights resevered to the isokineticbologna.

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BJSM podcast: Acute knee examination.

Professor Mark Hutchinson shares his views on acute knee examination in this BJSM podcast. He addresses wide range of issues regarding diagnosis of acute knee involving anatomy, ACL testing, meniscus testing, patellar dislocation, neurovascular examination, timing of diagnosis, imaging, differentiation and other. Definitely worth listening if you want to improve your diagnostic skills.

Listen here 

All rights reserved to the British Journal of Sports Medicine.

Knee OA risk factors after ACL reconstruction.

Factors Involved in the Development of Osteoarthritis After Anterior Cruciate Ligament Surgery. 
Keays, S., Newcombe, P., Bullock-Saxton, J., Bullock, M. and Keays, A.  American Journal of Sports Medicine, 2010; 38, 455 – 463.
http://www.ncbi.nlm.nih.gov/pubmed/20051501

The most commonly affected joint by osteoarthritis is knee joint. Knee trauma has been associated with increased risk of knee OA development. ACL rupture and meniscal lesions are one of the most commonly suggested factors triggering the onset of OA. Some research findings report that half of the ACL – reconstructed knees will suffer from OA. Knowledge of the factors involved in the pathogenesis of this condition after ACL reconstruction could lead to improved preventive and therapeutic management. Thus, authors conducted this study to identify risk factors for knee OA development after ACL reconstruction.

Patient Profiling in Cartilage Regeneration.

Patient Profiling in Cartilage Regeneration. Prognostic Factors Determining Success of Treatment for Cartilage Defects.
Windt, T., Bekkers, J., Creemers, L., Dhert, W., Saris, D. American Journal of Sports Medicine; 2009, 37, 58 – 62.
www.ncbi.nlm.nih.gov/pubmed/19934438

Cartilage lesions are considered to be one of starting points for knee OA development. Cartilage injuries are usually treated with one of currently available surgical procedures. Treatment approach is usually dependent on patient’s history, patient’s expectation and preferences of the surgeon. The identification of patient characteristics that predict clinical outcome could be helpful in the development of patient-specific treatment strategies. Therefore, the aim of this study was to determine prognostic factors for knee articular cartilage lesion successful treatment.

Microfracture procedure for cartilage lesions - A systematic review.

Clinical Efficacy of the Microfracture Technique for Articular Cartilage Repair in the Knee. An Evidence – Based Systematic Analysis. 
Mithoefer, K., McAdams, T., Williams, R., Kreuz, P. and Mandelbaum, B. American Journal of Sports Medicine; 2009, 37, 2053 – 2063.
http://www.ncbi.nlm.nih.gov/pubmed/19251676 

Cartilage injuries affect a substantial part of patients who suffered knee trauma. Limited regenerative capabilities of articular cartilage makes treatment approach complicated and challenging. Several surgical procedures are currently available for clinicians including microfracture, autologous chondrocyte implantation, and osteochondral autograft and allograft transplantation. The arthroscopic microfracture technique is commonly used as a first-line option and frequently serves as the standard technique. Despite its widespread clinical use, no systematic evaluation of the clinical efficacy of the microfracture technique for cartilage repair in the knee is available. Thus, authors performed a comprehensive systematic analysis of the microfracture procedure with specific focus on its short and long-term clinical results.

Gender and sport as a risk factors for cartilage lesions in ACL - deficient knees.

Effect of Gender and Sports on the Risk of Full-Thickness Articular Cartilage Lesions in Anterior Cruciate Ligament -Injured Knees : A Nationwide Cohort Study From Sweden and Norway of 15 783 Patients.
Røtterud, J., Sivertsen, E., Forssblad, M., Engebretsen, L. and Årøen, A. American Journal of Sports Medicine; 2011, 39, 1387 – 1394. 
www.ajs.sagepub.com/content/39/7/1387.abstract

Knee injuries commonly result in substantial damage to articular and periarticular structures including ACL tear, meniscal and cartilage lesions. ACL rupture has been shown to be associated with increased risk of OA development, both in professional and recreational sports participants. ACL ruptures rarely occur in isolation and cartilage and meniscal lesions are often present at the time of injury. It has been reported that meniscal and cartilage injuries are strong predictors of later degenerative changes in ACL-deficient knees. Thus, identification of cartilage/meniscal lesions risk factors plays a crucial role in improving prevention and treatment. Therefore, authors decided to conduct this study on risk factors for cartilage lesions in ACL-injured knees.

Factors which increase the risk of meniscus/cartilage lesions after ACL tear.

Are Meniscus and Cartilage Injuries Related to Time to Anterior Cruciate Ligament Reconstruction? 
Chhadia, A., Inacio, M., Maletis, G., Csintalan, R., Davis, B., Funahashi, T. American Journal of Sports Medicine, 2011, 39; 1894 – 1899.
http://www.ncbi.nlm.nih.gov/pubmed/21705649

ACL rupture results in knee instability which places articular structures, like meniscus and cartilage, at increased injury risk. It can be avoided with ACL reconstruction surgery which restores knee stability and allows subject to return to high-demand activities. Meniscus and cartilage lesions may occur at the time of ACL tear or may occur due to present instability (giving – way) episodes. This could indicate that late ACL reconstruction might be associated with increased amount of meniscal and/or cartilage lesions. However, research is somehow inconsistent. Therefore, authors decided to conduct this study with purpose of determining relationships between time to surgery, age, and gender with meniscus injury, cartilage injury, and combined meniscus and cartilage injury pattern.

Andrew Dawson on proprioception.

Andrew Dawson, a performance artist, presents an experience of one man's loss of proprioception. This is an interesting view, also relevant to knee joint as proprioception, by no means, plays a crucial role in knee functionality and knee injury prevention. 
All rights reserved to Andrew Dawson.

How runners might prevent overuse knee injuries?!

Walking knee biomechanics after matrix - induced ACI.

Knee biomechanics during walking gait following matrix – induced autologous chondrocyte implantation.

Ebert J, Lloyd D, Ackland T, Wood D. Clinical Biomechanics, 2010; 25, 1011 – 1017.

http://www.ncbi.nlm.nih.gov/pubmed/20692745

Matrix – induced autologous chondrocyte implantation (MACI) is a two – stage procedure with an initial arthroscopic harvest of healthy cartilage, isolation and expansion of chondrocytes ex-vivo, and subsequent re-implantation of cells into the chondral defect. Literature proves its positive effect on reducing pain and improving knee function, however still little is known how it influences walking gait and normal knee biomechanics. Therefore, authors analyzed knee joint kinematics and kinetics during walking in 61 patients following MACI, in combination with either conservative or accelerated post-operative WB rehabilitation. Evaluation was performed three, six and twelve months post – surgery in both groups and two matched, healthy control groups for comparison.

Return to sport after articular cartilage repair.

Return to Sports Participation after Articular Cartilage Repair in the Knee. Scientific evidence.

Mithoefer K, Hambly K, Della Villa S, Silvers H, Mandelbaum B. American Journal of Sports Medicine; 2009, 37, 167 – 176.

http://www.ncbi.nlm.nih.gov/pubmed/19861696

Knee articular cartilage injury is a common complaint among those participating in sport, both recreationally and as professionals. Rarely occurs in isolation, most often is associated with other injuries e.g.  ACL tear, meniscal lesion. Sports medicine physician are aware that repaired cartilage requires enough quality to withstand significant stresses related with high impact sports. Current cartilage repair techniques (microfracture, osteochondral autograft transfer, osteochondral allograft transplantation and autologous chondrocyte transplantation) are successful in reducing pain and improving knee function. Nevertheless, ability to return to sports activity is the most important outcome measure for the injured athlete. Mithoefer et al. systematically reviewed available literature on return to sports activity following knee cartilage repair and tried to determine influencing factors.