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The relationship between medial knee osteoarthritis and gait parameters of foot
100
Abstracts / Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology 9 (2017) 59e124
Taiwan; 2 Department of Graduate Institute of Biomedical Electronics And Bioinformatics, National Taiwan University, Taiwan; 3 Department of Orthopedic Surgery, National Taiwan University Hospital, Taiwan; 4 Department of Computer Science And Information Engineering, National Taiwan University, Taiwan Knee osteoarthritis is the most common type of arthritis in the general population particularly happens in the elderly. The symptoms of knee osteoarthritis include knee pain, swelling, decreased of range of motion to patients, Cartilage abnormalities are primary features of osteoarthritis. The X-ray is the most common radiological examination for diagnosis of knee osteoarthritis, but the radiographs diagnosis has limitations and few information of cartilage condition and other soft tissue. The ultrasound examination can be used for measurement of joint cartilage, detection of cartilage abnormalities and inflammation in the knee joint. In this study, an automatic computer-aided method for quantitation of knee cartilage thickness using ultrasound images was developed to assist the physicians in evaluating the severity of cartilage wear which represents the severity of knee osteoarthritis. The proposed computer-aided quantitative assessment system was developed for automatic identification of cartilage area and measurement of cartilage thickness by using ultrasound images. After ultrasound images are acquired, the cartilage area were segmented from these images by Markov random field (MRF) models. For segmented cartilage area, the delineation of cartilage boundary was marked automatically by spline interpolation algorithm and superficial and deep boundaries were smoothed for preparation of marks for measurement positions. The thickness of femoral trochlea cartilage was measured by the proposed automatic computer-aided system. The three positions of measurement were done automatically at the lateral condyle (LC), the intercondylar area (IA), and the medial condyle (MC) respectively. The collected cases included 80 knee ultrasound images from 10 males and 12 females. The difference of cartilage thickness between the proposed computer-aided system and direct measure by the orthopedist was 16.12% at IA, 15.02% at LC, and 15.33% at MC respectively. The accuracy of the proposed CAD system in cartilage measurement was 84.51%. In conclusion, the proposed automatic computer-aided system can provide the quick, inexpensive, and accurate additional information of knee cartilage identification and thickness measurement for the physicians to evaluate the severity of osteoarthritis. Keywords: osteoarthriti, knee cartilage, cartilage thicknes, ultrasound, computer-aided
Knee - Cartilage/Celltherapy EP-017 LIMITATION OF IN SITU ARTHROSCOPIC FIXATION FOR STABLE OSTEOCHONDRITIS DISSECANS OF THE KNEE Masakazu Ishikawa, Masakazu Ishikawa, Atsuo Nakamae, Tomoyuki Nakasa, Seiju Hayashi, Norifumi Suga, Masahiro Yoshikawa, Mitsuo Ochi, Nobuo Adachi. Department of Orthopaedic Surgery, Hiroshima University, Japan Introduction: There are various surgical treatment options for juvenile osteochondritis dissecans (OCD) of the knee, such as multiple drilling, fixation and cell-based therapy. For arthroscopically stable lesion, in situ arthroscopic fixation is more desirable approach compared to the open arthrotomy due to less surgical morbidity and faster recovery. However, its efficacy still remains unclear. Methods: The 97 consecutive patients with 111 affected knees surgically treated at our hospital were evaluated by retrospectively collected data. Subsequently, patients who underwent in situ arthroscopic fixation for arthroscopically stable lesions were grouped for further analysis. Arthroscopic lesion stability was graded according to the grading system, as described by Guhl, from the surgical description of each lesion and the grade I and II were defined as “stable” lesions. Clinical outcomes were evaluated by Lysholm score at the final office visit and were classified as complete failure if the patient had a revision surgery due to deterioration of lesion. Compared to clinical results, the lesion stability was also evaluated with MRI grading system, as described by Dipaola et al, in preoperative images retrospectively. As demonstrated in arthroscopic grading, the
grade I and II lesions were defined as “stable” and more than III as “unstable”. Results: There were 12 lesions in 12 patients with open physis treated with in situ arthroscopic fixation using bioabsorbable pins. In this population, Lysholm score was significantly improved from 77.3 ± 11.2 to 99.0 ± 3.2 in 9 cases (follow-up period: 23.0 ± 11.2 months, p¼0.002), however, we found 3 revision cases. Interestingly, of these revision cases, all lesions were graded as “unstable”, i.e. grade III, by MRI grading system. Conclusions: From our study, the failure rate was 25% for in situ arthroscopic fixation for stable OCD lesion of the knee. We strongly suggest that if the lesion presents unstable status from MRI findings even if it is stable arthroscopically, we should not choose in situ arthroscopic fixation for the patient to prevent a potential risk of revision surgery. Keywords: osteochondritis dissecans, stable lesion, in situ arthroscopic fixation
Knee - Cartilage/Celltherapy EP-029 THE RELATIONSHIP BETWEEN MEDIAL KNEE OSTEOARTHRITIS AND GAIT PARAMETERS OF FOOT Hung-Maan Lee 1, 3, Bojain Lin 2, 3, Ming-Fa Hsieh 3. 1 Department of Public Health Bureau, Hualien County, Taiwan; 2 Department of Orthopaedics, Taoyuan Armed Forces General Hospital, Taiwan; 3 Department of Biomedical Engineering, Chung Yuan Christian University, Taiwan The purpose of this study is to build a model to predict knee osteoarthritis using foot pressure and gait parameters. 30 patients with medial knee osteoarthritis were enrolled to the experiment group while 35 nonsymptomatic healthy individuals were enrolled to the control group. The present study used the optical foot pressure measurement system to collect the path of the center of foot pressure in the gait cycle, to measure the travel time and offset angle of plantar pressure changes between gait cycle, and to estimate the static pressure of the plantar six districts along with the measurement of other clinical parameters and information. The results show that the mid-stance phase time of the left foot of osteoarthritis patients (0.20 seconds) is significantly longer than that of the control group (0.12 seconds), and yet the mid-stance phase time of the right foot of osteoarthritis patients (0.19 seconds) is also significantly longer than that of the control group (0.15 seconds). The individuals in the control (healthy group) prefer early toe-off in terminal stage of gait cycle and the toes used less force to finish the gait cycle. The progression of the center of foot pressure in the control group is biased toward the big toe, while that of the osteoarthritis group tends to be biased toward the second toe. At the terminal stage of gait cycle, the metatarsal head stress distribution of osteoarthritis group tends to move to big toe, and the individuals in the control group tends to move to fifth toe. The independent-samples ttest compared the means of pressure of six regions of plantar area between two groups. It was found that the left foot medial longitudinal arch area, the lateral heel region and the inner heel region of the control group are significant different. Using the principal component analysis, the midstance phase period, body mass index and center of pressure excursion index variables were included for logistic regression model. The analysis resulted in 90% of the positive predictive logistic regression and a negative predictive value of 88.6% indicating that the static and dynamic plantar pressure variables are statistically different between two groups. Therefore, it is concluded that the optic foot pressure measuring system combined with physical measurements of body height and weight measurements can predict whether the individual is bearing medial knee osteoarthritis or not. Keywords: Osteoarthritis, foot pressure, Gait parameter
Knee - Cartilage/Celltherapy EP-060 ENHANCING HUMAN MESENCHYMAL REGENERATION OF OCD DEFECTS
STEM
CELLS
FOR
THE
Hui Hoi Po James, Hui Hoi Po James. Department of Orthopaedic Surgery, National University Hospital Singapore, Singapore
Abstracts / Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology 9 (2017) 59e124
Taiwan; 2 Department of Graduate Institute of Biomedical Electronics And Bioinformatics, National Taiwan University, Taiwan; 3 Department of Orthopedic Surgery, National Taiwan University Hospital, Taiwan; 4 Department of Computer Science And Information Engineering, National Taiwan University, Taiwan Knee osteoarthritis is the most common type of arthritis in the general population particularly happens in the elderly. The symptoms of knee osteoarthritis include knee pain, swelling, decreased of range of motion to patients, Cartilage abnormalities are primary features of osteoarthritis. The X-ray is the most common radiological examination for diagnosis of knee osteoarthritis, but the radiographs diagnosis has limitations and few information of cartilage condition and other soft tissue. The ultrasound examination can be used for measurement of joint cartilage, detection of cartilage abnormalities and inflammation in the knee joint. In this study, an automatic computer-aided method for quantitation of knee cartilage thickness using ultrasound images was developed to assist the physicians in evaluating the severity of cartilage wear which represents the severity of knee osteoarthritis. The proposed computer-aided quantitative assessment system was developed for automatic identification of cartilage area and measurement of cartilage thickness by using ultrasound images. After ultrasound images are acquired, the cartilage area were segmented from these images by Markov random field (MRF) models. For segmented cartilage area, the delineation of cartilage boundary was marked automatically by spline interpolation algorithm and superficial and deep boundaries were smoothed for preparation of marks for measurement positions. The thickness of femoral trochlea cartilage was measured by the proposed automatic computer-aided system. The three positions of measurement were done automatically at the lateral condyle (LC), the intercondylar area (IA), and the medial condyle (MC) respectively. The collected cases included 80 knee ultrasound images from 10 males and 12 females. The difference of cartilage thickness between the proposed computer-aided system and direct measure by the orthopedist was 16.12% at IA, 15.02% at LC, and 15.33% at MC respectively. The accuracy of the proposed CAD system in cartilage measurement was 84.51%. In conclusion, the proposed automatic computer-aided system can provide the quick, inexpensive, and accurate additional information of knee cartilage identification and thickness measurement for the physicians to evaluate the severity of osteoarthritis. Keywords: osteoarthriti, knee cartilage, cartilage thicknes, ultrasound, computer-aided
Knee - Cartilage/Celltherapy EP-017 LIMITATION OF IN SITU ARTHROSCOPIC FIXATION FOR STABLE OSTEOCHONDRITIS DISSECANS OF THE KNEE Masakazu Ishikawa, Masakazu Ishikawa, Atsuo Nakamae, Tomoyuki Nakasa, Seiju Hayashi, Norifumi Suga, Masahiro Yoshikawa, Mitsuo Ochi, Nobuo Adachi. Department of Orthopaedic Surgery, Hiroshima University, Japan Introduction: There are various surgical treatment options for juvenile osteochondritis dissecans (OCD) of the knee, such as multiple drilling, fixation and cell-based therapy. For arthroscopically stable lesion, in situ arthroscopic fixation is more desirable approach compared to the open arthrotomy due to less surgical morbidity and faster recovery. However, its efficacy still remains unclear. Methods: The 97 consecutive patients with 111 affected knees surgically treated at our hospital were evaluated by retrospectively collected data. Subsequently, patients who underwent in situ arthroscopic fixation for arthroscopically stable lesions were grouped for further analysis. Arthroscopic lesion stability was graded according to the grading system, as described by Guhl, from the surgical description of each lesion and the grade I and II were defined as “stable” lesions. Clinical outcomes were evaluated by Lysholm score at the final office visit and were classified as complete failure if the patient had a revision surgery due to deterioration of lesion. Compared to clinical results, the lesion stability was also evaluated with MRI grading system, as described by Dipaola et al, in preoperative images retrospectively. As demonstrated in arthroscopic grading, the
grade I and II lesions were defined as “stable” and more than III as “unstable”. Results: There were 12 lesions in 12 patients with open physis treated with in situ arthroscopic fixation using bioabsorbable pins. In this population, Lysholm score was significantly improved from 77.3 ± 11.2 to 99.0 ± 3.2 in 9 cases (follow-up period: 23.0 ± 11.2 months, p¼0.002), however, we found 3 revision cases. Interestingly, of these revision cases, all lesions were graded as “unstable”, i.e. grade III, by MRI grading system. Conclusions: From our study, the failure rate was 25% for in situ arthroscopic fixation for stable OCD lesion of the knee. We strongly suggest that if the lesion presents unstable status from MRI findings even if it is stable arthroscopically, we should not choose in situ arthroscopic fixation for the patient to prevent a potential risk of revision surgery. Keywords: osteochondritis dissecans, stable lesion, in situ arthroscopic fixation
Knee - Cartilage/Celltherapy EP-029 THE RELATIONSHIP BETWEEN MEDIAL KNEE OSTEOARTHRITIS AND GAIT PARAMETERS OF FOOT Hung-Maan Lee 1, 3, Bojain Lin 2, 3, Ming-Fa Hsieh 3. 1 Department of Public Health Bureau, Hualien County, Taiwan; 2 Department of Orthopaedics, Taoyuan Armed Forces General Hospital, Taiwan; 3 Department of Biomedical Engineering, Chung Yuan Christian University, Taiwan The purpose of this study is to build a model to predict knee osteoarthritis using foot pressure and gait parameters. 30 patients with medial knee osteoarthritis were enrolled to the experiment group while 35 nonsymptomatic healthy individuals were enrolled to the control group. The present study used the optical foot pressure measurement system to collect the path of the center of foot pressure in the gait cycle, to measure the travel time and offset angle of plantar pressure changes between gait cycle, and to estimate the static pressure of the plantar six districts along with the measurement of other clinical parameters and information. The results show that the mid-stance phase time of the left foot of osteoarthritis patients (0.20 seconds) is significantly longer than that of the control group (0.12 seconds), and yet the mid-stance phase time of the right foot of osteoarthritis patients (0.19 seconds) is also significantly longer than that of the control group (0.15 seconds). The individuals in the control (healthy group) prefer early toe-off in terminal stage of gait cycle and the toes used less force to finish the gait cycle. The progression of the center of foot pressure in the control group is biased toward the big toe, while that of the osteoarthritis group tends to be biased toward the second toe. At the terminal stage of gait cycle, the metatarsal head stress distribution of osteoarthritis group tends to move to big toe, and the individuals in the control group tends to move to fifth toe. The independent-samples ttest compared the means of pressure of six regions of plantar area between two groups. It was found that the left foot medial longitudinal arch area, the lateral heel region and the inner heel region of the control group are significant different. Using the principal component analysis, the midstance phase period, body mass index and center of pressure excursion index variables were included for logistic regression model. The analysis resulted in 90% of the positive predictive logistic regression and a negative predictive value of 88.6% indicating that the static and dynamic plantar pressure variables are statistically different between two groups. Therefore, it is concluded that the optic foot pressure measuring system combined with physical measurements of body height and weight measurements can predict whether the individual is bearing medial knee osteoarthritis or not. Keywords: Osteoarthritis, foot pressure, Gait parameter
Knee - Cartilage/Celltherapy EP-060 ENHANCING HUMAN MESENCHYMAL REGENERATION OF OCD DEFECTS
STEM
CELLS
FOR
THE
Hui Hoi Po James, Hui Hoi Po James. Department of Orthopaedic Surgery, National University Hospital Singapore, Singapore