Gait cycle time variability in patients with knee osteoarthritis and its possible associating factors.

[Purpose] Knee osteoarthritis can alter gait variability; however, few studies have investigated the associating factors with gait cycle time variability. The first objective was to compare gait cycle variability between female patients with knee osteoarthritis and healthy elderly females and to determine gait characteristics in patients with knee osteoarthritis. The second objective was to identify the associating factors with gait cycle time variability. [Participants and Methods] The participants included 24 female patients diagnosed with knee osteoarthritis and 12 healthy elderly females. Gait cycle variability (coefficient of variation of gait cycle time), knee extension range of motion, knee extension strength, 5-m walk test, Timed Up & Go Test, and Western Ontario and McMaster Universities Osteoarthritis Index were measured. All assessment results were compared between the knee osteoarthritis and healthy groups. [Results] Gait cycle time variability was significantly higher in the knee osteoarthritis group than in the healthy group. Further, it showed a significant positive correlation with the 5-m walk test and the Western Ontario and McMaster Universities Osteoarthritis Index. [Conclusion] Patients with knee osteoarthritis presented greater gait cycle variability than that of healthy individuals. Therefore, rehabilitation to improve gait variability might enhance the quality of life of patients with knee osteoarthritis.

Utility of delayed gadolinium-enhanced MRI (dGEMRIC) for qualitative evaluation of articular cartilage of patellofemoral joint.

Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) was used for the measurement of relative proteoglycan depletion of articular cartilage in the patellofemoral (PF) joint following a proprietary protocol, which was compared with the X-ray images, proton density weighted MR images (PDWI) and arthroscopic findings. The study examined 30 knees. The ages ranged from 16 to 74 (average 40.3) years. The Gd-DTPA(2-)containing contrast medium was used in a single dose. The subjects were made to exercise the knee joint for 10 min; and MR images were taken 2 h after intravenous injection of contrast medium. T1-calculated images were produced and the region of interest (ROI) was set as follows. (1) ROI1: entire articular cartilage in a slice through the center of the patella. (2) ROI2: low signal region in T1-calculated images, which were set in a blind fashion by two observers. (3) ROI3: articular cartilage on one side that includes ROI2 where low signal region were detected (medial or lateral). ROI3 was set to examine the contrast of ROI2 with surrounding articular cartilage. The average T1 values of ROI1 was 393.5+/-33.6 ms for radiographic grade 0 and 361.3+/-11.1 ms for grade I, which showed a significant difference (P=0.036). The T1 value of ROI2 was 351.6+/-28.2 ms for grade I, 361.9+/-38.3 ms for grade II, 362.1+/-67.7 ms for grade III, and 297.8+/-54.1 ms for grade IV according to arthroscopic Outerbridge classification. All cases, that demonstrated decrease of T1 values on dGEMRIC (ROI2), showed abnormal arthroscopic or direct viewing findings. The ratio (ROI3/ROI2) in cases of only slight damage classified as Outerbridge grade I (6 cases) was an average of 1.04+/-0.02 and was 1.0 or greater in all cases, thereby indicating well-defined contrast with the surrounding cartilage. The diagnosis of damage in articular cartilage was possible in all 16 cases with radiographic K-L grade I on dGEMRIC, while the intensity changes were not found in 10 of 16 cases on PDWI. The dGEMRIC with a single-dose would be useful on a diagnosis of the area demonstrating early relative proteoglycan depletion in the articular cartilage of the PF joint prior to any discernible changes in the subchondral bone on X-ray images and exceeds to plain MR images for examining deterioration of articular cartilage.

Anterior cruciate ligament reconstruction using the double bundle method.

Clinical results of our reconstruction technique for anterior cruciate ligament using the double bundle, i.e., the combination of bone-tendon-bone (BTB) from the patellar tendon and semitendinosus tendon (ST), were evaluated. BTB was fixed in the tunnels produced on the isometric points on the tibia and femur, and ST, on the tibial tunnel through the same route as BTB. Throughout the observation period, no patients developed pain, limited range of motion, and/or instability of the operated knee. All patients were able to return to previous sports activities within 12 months. No apparent changes occurred on the reconstructed ligament. In 4 of 14 patients, knee stability was quantitatively examined, and a good result was obtained. The double bundle was found to be a useful method for patients who require physiologically more durable reconstruction.