Search Results (759)

Focal chondral defects of the knee are a common cause of pain and functional limitation in active individuals and may predispose to early degenerative joint changes. Given the limited regenerative capacity of hyaline cartilage, biologically based surgical strategies have emerged to promote tissue repair and restore joint function. This narrative review critically examines current treatment approaches that rely on autologous cell sources and scaffold-supported regeneration. Particular emphasis is placed on techniques that stimulate endogenous repair or support chondrocyte-based tissue restoration through the use of autologous biomaterial constructs. The influence of lesion morphology, joint biomechanics, and patient-specific variables on treatment selection is discussed in detail, focusing on the differences between tibiofemoral and patellofemoral involvement. Biologically driven approaches have shown promising mid- to long-term outcomes in selected patients, and are increasingly favoured over traditional methods in specific clinical scenarios. However, the literature remains limited by heterogeneity in study design, follow-up duration, and outcome measures. This review aims to provide an evidence-based, morphology-informed framework to support the clinical decision-making process in the management of knee cartilage defects. Full article

Total knee replacement (TKR) is a common procedure for pain relief and restoration of the mobility of the knee joint in patients with severe knee joint problems. Despite this, some patients still suffer from stiffness, instability, or pain caused by soft tissue imbalance, malalignment, or implant-related issues. Previously, surgeons have had to use their experience and visual judgment to balance the knee, which has resulted in variability of outcomes. Smart knee implants are addressing these issues by using sensor technology to provide real-time feedback on joint motion, pressure distribution, and loading forces. This enables more accurate intra-operative adjustment, enhancing implant positioning and soft tissue balance and eliminating post-operative adjustment. These implants also enable post-operative monitoring, simplifying the ability to have more effective individualized rehabilitation programs directed at optimizing patient mobility and minimizing complications. While the patient pool for smart knee implantation remains not commonly documented, it was found in a study that 83.6% of the patients would opt to have the monitoring device implemented, and nearly 90% find reassurance in monitoring their healing indicators. As the number of knee replacements is likely to rise due to aging populations and the rising prevalence of joint disease, smart implants are a welcome development in orthopedics, optimizing long-term success and patient satisfaction. Smart knee implants are built with embedded sensors such as force, motion, temperature, and pressure detectors placed within the implant structure. These sensors provide real-time data during surgery and recovery, allowing earlier detection of complications and supporting tailored rehabilitation. The design aims to improve outcomes through better monitoring and personalized care. Full article

Background: Fear of falling (FOF) is a significant concern among older adults, especially after total knee arthroplasty (TKA). FOF can limit daily activities, reduce quality of life, and hinder recovery. This study aimed to investigate the prevalence, severity, and impacts of FOF in patients undergoing TKA and identify factors contributing to increased FOF. Methods: A prospective observational study was conducted at King Abdulaziz Medical City in Riyadh, Saudi Arabia, from April 2024 to December 2024. This study included 52 participants aged 20 to 75 years who had undergone primary TKA. Data were collected at two time points: after TKA and at three months post-surgery. The Short Falls Efficacy Scale-International (SFES-I) was used to assess the severity of FOF, and the Short Form 36 (SF-36) was used to measure the quality of life. Descriptive statistics, t-tests, and logistic regression were used for analysis. Results: This study included 52 participants (mean age: 63.77 ± 6.65 years; 82.7% female). Post-TKA, all participants exhibited high FOF (mean SFES-I score: 56.75 ± 8.30). After three months, the mean SFES-I score decreased significantly to 49.04 ± 12.45 (t = 4.408, p < 0.05). Post-TKA, SF-36 showed significant improvements in the physical function, role of physical limitations, bodily pain, vitality, social function, role of emotional limitations, and mental health subdomains. Bilateral total knee arthroplasty, body mass index, and some SF-36 subcomponents—such as general health, vitality, and role of emotional limitations—were identified as factors leading to increased FOF. Conclusions: FOF remains prevalent and severe in TKA patients, even at three months post-surgery, affecting rehabilitation outcomes. Early identification and tailored interventions for FOF should be considered essential components of comprehensive TKA recovery programs. Full article

Autologous therapies are currently being studied to determine if they can modulate the course of knee osteoarthritis symptoms and/or disease progression. One potential therapeutic target is the polarization of pro-inflammatory M1 macrophages to pro-healing M2 macrophages. The autologous therapy, Autologous Protein Solution (APS), was incubated with donor-matched human peripheral-derived macrophages for 10 days. M1 pro-inflammatory macrophages were determined by the percentage of CD80+ and M2 pro-healing macrophages were determined by CD68+ and CD163+ by epifluorescent microscopy. To determine clinical effectiveness, an APS-specific minimal clinically important improvement (MCII) using an anchor-based method was calculated in a randomized controlled trial of APS (n = 46) and then applied to a real-world registry study (n = 78) to determine the percentage of pain responders. Compared to control media, APS statistically increased the percentage of M2 macrophages and decreased the percentage of M1 macrophages, while platelet-poor plasma had no effect on polarization. In the randomized controlled trial (RCT), the MCII at the 12-month follow-up visit was calculated as 2.0 points on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale and 7.5 points on the WOMAC function scale. Applying this MCII to the real-world registry data, 62.5% of patients met the MCII with an average of 4.7 ± 2.5 points of improvement in pain. Autologous therapies can influence macrophage polarization and have demonstrated clinical effectiveness in a real-world patient setting. Full article

In this report of two cases, we describe two patients with spinal involvement of gout. The first case involved a 67-year-old female who presented to the emergency department with a one-week history of weakness in both the upper and lower limbs, despite no prior history of gout. Cervical spine MRI revealed spinal cord compression at the C4 level from a posterior lesion. During surgery, chalky white deposits consistent with gouty tophi were observed in the ligamentum flavum within the epidural space at C4. These intraoperative findings correlated with elevated serum uric acid levels. The second case concerned a 68-year-old male who presented with a five-day history of right lower limb pain along with bilateral knee discomfort. Radiologic and laboratory evaluations revealed elevated inflammatory markers, negatively birefringent crystals in knee joint aspirate, spondylodiscitis at the L5-S1 level, and a right-sided synovial cyst at the T10–T11 level causing spinal cord compression. Following the initiation of anti-gout therapy, the patient experienced significant clinical improvement, normalization of inflammatory markers, and radiologic resolution of the thoracic synovial cyst. Full article

Background: Knee osteoarthritis (KOA) is a prevalent degenerative joint disease that can greatly affect quality of life in middle-aged and elderly individuals. Nutritional supplements are increasingly used for KOA due to their low risk, but direct comparative evidence on their efficacy and safety remains scarce. This study aimed to systematically compare the effectiveness and safety of seven common nutritional supplements for KOA. Methods: A systematic review and network meta-analysis were conducted following PRISMA guidelines. Embase, PubMed, and the Cochrane Library were searched through December 2024 for randomized controlled trials (RCTs) evaluating use of eggshell membrane, vitamin D, Boswellia, curcumin, ginger, krill oil, or collagen, versus placebo, in adults with KOA. Primary outcomes included changes in scores for WOMAC pain, stiffness and function, and pain visual analog scale (VAS). Adverse events were also assessed. Bayesian network meta-analyses estimated ranking probabilities for each intervention. Results: In total, 39 RCTs (42 studies; 4599 patients) were included. Compared with placebo, Boswellia showed significant improvements in WOMAC pain (mean difference [MD] = 10.58, 95% CI: 6.45 to 14.78, p < 0.05), stiffness (MD = 9.47, 95% CI: 6.39 254 to 12.74, p < 0.05), function (MD = 14.00, 95% CI: 7.74 to 20.21, p < 0.05), and VAS pain (MD = 17.26, 95% CI: 8.06 to 26.52, p < 0.05). Curcumin, collagen, ginger, and krill oil also demonstrated benefits in some outcomes. No supplement was associated with increased adverse events compared to placebo. Bayesian rankings indicated Boswellia had the highest probability of being most effective for pain and stiffness, with krill oil and curcumin showing potential for function improvement. Conclusions: Nutritional supplements, particularly Boswellia, appear to be effective and well-tolerated for improving KOA symptoms and function. These results suggest that certain supplements may be useful as part of non-pharmacological KOA management. However, further large-scale, well-designed randomized controlled trials (RCTs) are needed to confirm these findings, particularly those that include more standardized dosages and formulations, as well as to evaluate their long-term efficacy. Full article

Background: Seiza, a traditional sitting posture requiring deep ankle plantarflexion and knee flexion, often becomes difficult after ankle fracture surgery because of restricted mobility. Increased stiffness of the tibialis anterior (TA) muscle, particularly in its deep and superficial fibres, may limit plantarflexion and affect functional recovery. This study aimed to investigate the relationship between TA muscle stiffness, assessed using shear wave elastography (SWE), and the ability to assume the seiza posture after ankle fracture surgery. We also sought to determine whether the stiffness in the deep or superficial TA fibres was more strongly correlated with seiza ability. Methods: In this cross-sectional study, 38 patients who underwent open reduction and internal fixation for ankle fractures were evaluated 3 months postoperatively. Seiza ability was assessed using the ankle plantarflexion angle and heel–buttock distance. The shear moduli of the superficial and deep TA fibres were measured using SWE. Ankle range of motion, muscle strength, and self-reported seiza pain were also measured. Multiple linear regression was used to identify the predictors of seiza performance. Results: The shear moduli of both deep (β = −0.454, p < 0.001) and superficial (β = −0.339, p = 0.017) TA fibres independently predicted ankle plantarflexion angle during seiza (adjusted R², 0.624). Pain during seiza was significantly associated with reduced plantarflexion, whereas muscle strength was not a significant predictor. Conclusions: TA muscle stiffness, especially in the deep fibres, was significantly associated with limited postoperative seiza performance. Targeted interventions that reduce deep TA stiffness may enhance functional outcomes. Full article

Total knee arthroplasty is an extensive orthopedic surgery for patients with severe cases of osteoarthritis. This surgery restores the range of motion in the knee joint and allows for pain-free movement. Advancements in medical techniques used in the surgical zone and implant technology, as well as the management of operations and administration for around two decades prior, have hugely improved surgical outcomes for patients. In this study, advancements in TKA were examined through exploring aspects such as robotic surgery, new implants and materials, minimally invasive surgery, and post-surgery rehabilitation. This paper entails a review of the peer-reviewed literature published between 2005 and 2025 in the PubMed and Google Scholar databases. For predictors, we incorporated clinical relevance together with methodological soundness and relation to review questions to select relevant research articles. We used the PRISMA flowchart to illustrate the article selection system in its entirety. Since robotic surgical and navigation systems have been implemented, surgical accuracy has improved, there is an increased possibility of ensuring alignment, and the use of cementless and 3D-printed implants has increased, offering durable long-term fixation features. The trend in the current literature is that minimally invasive knee surgery (MIS) techniques reduce permanent pain after surgery and length of hospital stays for patients, though the long-term impact still needs to be established. There is various evidence outlining that the enhanced recovery after surgery (ERAS) protocols show positive results in terms of functional recovery and patient satisfaction. The integration of these new advancements enhances TKA surgeries and translates them into ‘need of patient’ procedures, ensuring improved results and increases in patient satisfaction. The aim of this study was to perform a comprehensive analysis of the existing literature regarding TKA advancement studies to identify current gaps and problems. Full article

Quadricep weakness is frequently observed in patients following anterior cruciate ligament (ACL) injury or in those with knee osteoarthritis, often contributing to functional impairments and persistent symptoms. While high-intensity resistance training has been shown to effectively improve muscle strength, its application may be limited in certain populations due to pain or the risk of surgical complications. In recent years, blood flow restriction (BFR) training has emerged as a promising alternative. Growing evidence indicates that low-load BFR exercise can significantly improve muscle strength, induce hypertrophy, and enhance knee function, with outcomes comparable to those of high-intensity resistance training. When implemented using appropriate protocols, BFR training appears to be a safe and efficacious rehabilitation strategy for individuals with knee pathology. Full article

Spontaneous quadriceps tendon rupture is a very rare occurrence, notably for bilateral simultaneous ruptures. Its occurrence is commonly linked to an underlying condition that may weaken the tendons leading to rupture. We report the case of a 68-year-old Caucasian male afflicted with long-term gout who presented a bilateral simultaneous quadriceps tendon rupture (BSQTR). We showcase the clinical presentation, the surgical intervention, rehabilitation program, dynamic sonographic monitoring, and home-based rehabilitation techniques of this injury, which aimed to improve activities of daily living (ADL) and quality of life (QoL). The patient was included in a 9-week post-surgical rehabilitation program and a home-based rehabilitation program with subsequent pain management and gait reacquisition. The outcome measures included right and left knee active range of motion (AROM), pain intensity measured on Visual Analogue Scale (VAS), functioning measured through ADL score, and gait assessment on Functional Ambulation Categories (FAC). All endpoints were measured at different time points, scoring significant improvement at discharge compared to baseline (e.g., AROM increased from 0 degrees to 95 degrees, while VAS decreased from 7 to 1, ADL score increased from 6 to 10, and FAC increased from 1 to 5). Moreover, some of these outcomes continued to improve after discharge, and the effects of home-based rehabilitation program and a single hip joint manipulation were assessed at 6-month follow-up. Musculoskeletal ultrasound findings showed mature tendon structure, consistent dynamic glide, and no scarring. Full article

Background and Objectives: Meniscal pathologies are common abnormalities of the knee joint and a frequent cause of knee pain. Prompt and accurate diagnosis is essential to ensure appropriate treatment. Ultrasonography is increasingly used due to its accessibility, cost- and time-efficiency, and capacity for dynamic assessment. This study aimed to evaluate the usefulness of ultrasonography in identifying specific types of meniscal tears and to assess their frequency of occurrence. Materials and Methods: A retrospective study was conducted to assess the frequency and sonographic appearance of various meniscal pathologies. The study population included all patients who underwent ultrasonographic examination of the knee in our clinic over one year for various indications (n = 430). Archived ultrasound images were retrospectively reviewed and analyzed. Results: Meniscal pathologies were identified in 134 patients. The findings included 95 cases of degenerative lesions (70.9%), 18 meniscal cyst-related pathologies (13.4%), 8 complex tears (6.0%), 5 flap tears (3.7%), 3 vertical pericapsular tears (2.2%), 3 partial thickness tears (2.2%), and 2 bucket-handle-type tears (1.5%). Each lesion type was characterized and illustrated through representative ultrasound images. Conclusions: Ultrasound imaging of meniscal pathology offers a valuable diagnostic option. By characterizing and visually documenting different meniscal lesions, this study highlights the practical potential of ultrasonography in routine clinical settings. These findings may enhance diagnostic accuracy and guide more targeted management strategies. Moreover, the results contribute to the expanding body of research on musculoskeletal ultrasonography and may encourage broader adoption of ultrasound in orthopedic diagnostics. Full article

Background/Objectives: Total knee arthroplasty (TKA) is commonly associated with postoperative muscle atrophy and weakness, while traditional rehabilitation is often limited by pain and patient compliance. Passive blood flow restriction (pBFR) training may offer a safe, low-threshold method to attenuate muscle loss in this early phase. This pilot study examined the feasibility, safety, and early effects of pBFR initiated during hospitalization on muscle mass, swelling, and functional recovery after TKA. Methods: In a prospective, single-blinded trial, 26 patients undergoing primary or aseptic revision TKA were randomized to either a control group (CON: sham BFR at 20 mmHg) or intervention group (INT: pBFR at 80% limb occlusion pressure). Both groups received 50 min daily in-hospital rehabilitation sessions for five consecutive days. Outcomes, including lean muscle mass (DXA), thigh/knee circumference, 6 min walk test (6 MWT), handgrip strength, and patient-reported outcomes, were assessed preoperatively and at discharge, six weeks, and three months postoperatively. Linear mixed models with Bonferroni correction were applied. Results: The INT group showed significant preservation of thigh circumference (p = 0.002), reduced knee swelling (p < 0.001), and maintenance of lean muscle mass (p < 0.01), compared with CON, which exhibited significant declines. Functional performance improved faster in INT (e.g., 6 MWT increase at T3: +23.7%, p < 0.001; CON: −7.2%, n.s.). Quality of life improved in both groups, with greater gains in INT (p < 0.05). No adverse events were reported. Conclusions: Initiating pBFR training on the first postoperative day is feasible, safe, and effective in preserving muscle mass and reducing swelling after TKA. These findings extend prior BFR research by demonstrating its applicability in older, surgical populations. Further research is warranted to evaluate its integration with standard rehabilitation programs and long-term functional benefits. Full article

Background/Objectives: Total knee arthroplasty (TKA) is an effective surgical intervention for end stage knee osteoarthritis in elderly patients, with emerging robotically assisted techniques aiming to enhance surgical precision and patient outcomes. This study aimed to compare medium-term balance and functional outcomes between robotically assisted and conventional manual TKA in community-dwelling elderly patients. Methods: This cross-sectional study included 50 elderly patients undergoing TKA, who were divided into robotically assisted (n = 25) and conventional manual (n = 25) groups. Demographic and clinical data, balance performance, and functional outcomes were compared at nearly 1.5 years postoperatively. Outcome measures included balance performance assessed by the Berg Balance Scale (BBS), pain via the Visual Analog Scale (VAS), knee function as measured by the Lysholm Knee Scoring Scale, quality of life using the Short Form-12 (SF-12), joint awareness as evaluated by the Forgotten Joint Score-12 (FJS-12), and surgical satisfaction. Results: The groups had similar demographic and clinical data regarding age, gender, follow-up duration, surgical time, and anesthesia type (p > 0.05). The robotically assisted group demonstrated better balance performance on the BBS (p = 0.043) and had a statistically shorter length of hospital stay (1.22 vs. 1.42 days; p = 0.005). However, no statistically significant differences were observed in VAS activity pain (p = 0.053), Lysholm Knee Scoring Scale (p = 0.117), SF-12 physical and mental scores (p = 0.174 and p = 0.879), FJS-12 (p = 0.760), and surgical satisfaction (p = 0.218). Conclusions: Robotically assisted TKA is associated with advantageous postoperative recovery, particularly in terms of balance performance, showing no clinical difference in other functional outcomes compared to the conventional manual technique. From a physical therapy perspective, these findings emphasize the importance of developing tailored and effective rehabilitation strategies in the medium term for functional recovery in the elderly population. Full article

Introduction: Knee osteoarthritis (OA) is defined by articular cartilage loss, increased discomfort, and functional restrictions. Changes in lifestyle, painkillers, intra-articular injections, and, as a last resort, surgery are all part of clinical therapy. In this setting, intra-articular injections of hyaluronic acid (HA) represent a relevant and diffused therapeutic option. Materials and Methods: A prospective observational study was performed from October 2024 to May 2025 in 70 patients with knee OA. HA was administered in three intra-articular injections and was followed up at 3 and 6 months from the last injection. Knee Injury and Osteoarthritis Outcome Score (KOOS) was evaluated as primary outcome measure; Visual Analogue Scale (VAS), time up and go test, six-minute walking test, general health assessment with 36-Item Short Form Health Survey (SF-36), Zung’s Self-Rating Anxiety Scale (Zung SAS), and Zung’s Self-Rating Depression Scale (Zung SDS) as secondary outcome measures. Results: We observed a statistically significant improvement in clinical scores at 3 months in both HA formulations compared to the control group. No relevant side effects were described during the study. Conclusion: Hyalubrix 30 mg/2 mL and DIART 1.8%/2 mL are two safe and effective therapeutic options to manage knee OA, offering benefits in pain control, functionality and emotional wellness. Full article

Background/Objectives: The importance of resistance training for functional recovery in Total Knee Arthroplasty (TKA) patients has been emphasized. Therefore, this systematic review and meta-analysis was conducted to analyze its effects on pain, muscle strength, and function in patients with TKA. Methods: The following databases were used: PubMed, Web of Science, the Cochrane Library, and Embase. Randomized controlled trials that administered resistance training to patients undergoing TKA and measured pain, strength, and function were included. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. Effect sizes were calculated using Hedges’ g and are presented as Standardized Mean Differences (SMDs) with 95% Confidence Intervals (CIs). Subgroup analyses were conducted to determine the effect size based on the type and duration of the intervention. Results: The study selection process resulted in the inclusion of seven studies comprising a total of 439 participants. The bias assessment found that three studies had a low risk of bias and four had some concerns. Resistance training was effective in improving pain (SMD: 0.84, 95% CI: 0.11; 1.57, I²: 89.6%), muscle strength (SMD: 1.03, 95% CI: 0.29; 1.77, I²: 83.1%), self-reported function (SMD: 1.58, 95% CI: 0.15; 3.01, I²: 93.1%), and performance-based function (SMD: 0.74, 95% CI: 0.38; 1.11, I²: 68.9%). Subgroup analysis revealed significant differences in pain, strength, and performance-based function by comparison group, performance-based function by intervention duration, and self-reported function by intervention type. Conclusions: Resistance training improves pain, muscle strength, and function in TKA patients. Additionally, resistance training appears particularly effective when implemented as a standalone intervention or for durations under 12 weeks. These findings suggest that the design of resistance training protocols should be considered in clinical practice. Full article