Displaying publications 1 - 20 of 200 in total

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  1. Teoh YX, Othmani A, Lai KW, Goh SL, Usman J
    Comput Methods Programs Biomed, 2023 Dec;242:107807.
    PMID: 37778138 DOI: 10.1016/j.cmpb.2023.107807
    BACKGROUND AND OBJECTIVE: Knee osteoarthritis (OA) is a debilitating musculoskeletal disorder that causes functional disability. Automatic knee OA diagnosis has great potential of enabling timely and early intervention, that can potentially reverse the degenerative process of knee OA. Yet, it is a tedious task, concerning the heterogeneity of the disorder. Most of the proposed techniques demonstrated single OA diagnostic task widely based on Kellgren Lawrence (KL) standard, a composite score of only a few imaging features (i.e. osteophytes, joint space narrowing and subchondral bone changes). However, only one key disease pattern was tackled. The KL standard fails to represent disease pattern of individual OA features, particularly osteophytes, joint-space narrowing, and pain intensity that play a fundamental role in OA manifestation. In this study, we aim to develop a multitask model using convolutional neural network (CNN) feature extractors and machine learning classifiers to detect nine important OA features: KL grade, knee osteophytes (both knee, medial fibular: OSFM, medial tibial: OSTM, lateral fibular: OSFL, and lateral tibial: OSTL), joint-space narrowing (medial: JSM, and lateral: JSL), and patient-reported pain intensity from plain radiography.

    METHODS: We proposed a new feature extraction method by replacing fully-connected layer with global average pooling (GAP) layer. A comparative analysis was conducted to compare the efficacy of 16 different convolutional neural network (CNN) feature extractors and three machine learning classifiers.

    RESULTS: Experimental results revealed the potential of CNN feature extractors in conducting multitask diagnosis. Optimal model consisted of VGG16-GAP feature extractor and KNN classifier. This model not only outperformed the other tested models, it also outperformed the state-of-art methods with higher balanced accuracy, higher Cohen's kappa, higher F1, and lower mean squared error (MSE) in seven OA features prediction.

    CONCLUSIONS: The proposed model demonstrates pain prediction on plain radiographs, as well as eight OA-related bony features. Future work should focus on exploring additional potential radiological manifestations of OA and their relation to therapeutic interventions.

    Matched MeSH terms: Knee Joint
  2. Daneshjoo A, Abu Osman NA, Sahebozamani M, Yusof A
    PLoS One, 2015;10(11):e0143323.
    PMID: 26599336 DOI: 10.1371/journal.pone.0143323
    PURPOSE: Running at high speed and sudden change in direction or activity stresses the knee. Surprisingly, not many studies have investigated the effects of sprinting on knee's kinetics and kinematics of soccer players. Hence, this study is aimed to investigate indices of injury risk factors of jumping-landing maneuvers performed immediately after sprinting in male soccer players.

    METHODS: Twenty-three collegiate male soccer players (22.1±1.7 years) were tested in four conditions; vertical jump (VJ), vertical jump immediately after slow running (VJSR), vertical jump immediately after sprinting (VJFR) and double horizontal jump immediately after sprinting (HJFR). The kinematics and kinetics data were measured using Vicon motion analyzer (100Hz) and two Kistler force platforms (1000Hz), respectively.

    RESULTS: For knee flexion joint angle, (p = 0.014, η = 0.15) and knee valgus moment (p = 0.001, η = 0.71) differences between condition in the landing phase were found. For knee valgus joint angle, a main effect between legs in the jumping phase was found (p = 0.006, η = 0.31), which suggests bilateral deficit existed between the right and left lower limbs.

    CONCLUSION: In brief, the important findings were greater knee valgus moment and less knee flexion joint angle proceeding sprint (HJFR & VJFR) rather than no sprint condition (VJ) present an increased risk for knee injuries. These results seem to suggest that running and sudden subsequent jumping-landing activity experienced during playing soccer may negatively change the knee valgus moment. Thus, sprinting preceding a jump task may increase knee risk factors such as moment and knee flexion joint angle.

    Matched MeSH terms: Knee Joint/physiology
  3. Merican AM, Amis AA
    J Bone Joint Surg Br, 2008 Apr;90(4):527-34.
    PMID: 18378934 DOI: 10.1302/0301-620X.90B4.20085
    Anatomical descriptions of the lateral retinaculum have been published, but the attachments, name or even existence of its tissue bands and layers are ill-defined. We have examined 35 specimens of the knee. The deep fascia is the most superficial layer and the joint capsule is the deepest. The intermediate layer is the most substantial and consists of derivatives of the iliotibial band and the quadriceps aponeurosis. The longitudinal fibres of the iliotibial band merge with those of the quadriceps aponeurosis adjacent to the patella. These longitudinal fibres are reinforced by superficial arciform fibres and on the deep aspect by transverse fibres of the iliotibial band. The latter are dense and provide attachment of the iliotibial band to the patella and the tendon of vastus lateralis obliquus. Our study identifies two important new findings which are a constant connection of the deep fascia to the quadriceps tendon superior and lateral to the patella, and, a connection of the deeper transverse fibres to the tendon of vastus lateralis obliquus.
    Matched MeSH terms: Knee Joint/anatomy & histology*
  4. Harwant S, Borhan TA, Sivakumar S, Jeevanan J
    Med J Malaysia, 2001 Mar;56(1):98-9.
    PMID: 11503306
    A case report of a missed appendicitis presenting with abdominal wall necrotising fasciitis which extended up to the right knee. This subcutaneous collection in the prepatella region of the right knee presented as a crepitus and mimicked an intraarticular pathology.
    Matched MeSH terms: Knee Joint*
  5. Siong FT, Kim TW, Kim SC, Lee ES, Jaffar MSA, Lee YS
    J Arthroplasty, 2020 02;35(2):380-387.
    PMID: 31587980 DOI: 10.1016/j.arth.2019.09.005
    BACKGROUND: The aims of this study were to (1) describe our functional stepwise multiple needle puncturing (MNP) technique as the final step in medial ligament balancing during total knee arthroplasty (TKA) and (2) evaluate whether this technique can provide sufficient medial release with safety.

    METHODS: A total of 137 patients with 212 consecutive knees who underwent TKAs with or without functional stepwise MNP of superficial medial collateral ligament was recruited in this prospective cohort. Eighty-one patients with 129 knees who performed serial stress radiographs were enrolled in the final assessment. Superficial medial collateral ligament was punctured selectively (anteriorly or posteriorly or both) and sequentially depending on the site and degree of tightness. Mediolateral stability was assessed using serial stress radiographs and comparison was performed between the MNP and the non-MNP groups at postoperative 6 months and 1 year. Clinical outcomes were also evaluated between 2 groups.

    RESULTS: Fifty-five TKAs required additional stepwise MNP (anterior needling 19, posterior needling 3, both anterior and posterior needling 33). Preoperative hip-knee-ankle angle and the difference in varus-valgus stress angle showed significant difference between the MNP and the non-MNP groups, respectively (P = .009, P = .037). However, there was no significant difference when comparing the varus-valgus stress angle between the MNP and the non-MNP groups during serial assessment. Clinical outcomes including range of motion also showed no significant differences between the 2 groups.

    CONCLUSION: Functional medial ligament balancing with stepwise MNP can provide sufficient medial release with safety in TKA with varus aligned knee without clinical deterioration or complication such as instability.

    LEVEL OF EVIDENCE: Level II, Prospective cohort study.

    Matched MeSH terms: Knee Joint/surgery
  6. Yeak RDK, Yap YY, Nizlan NM
    JNMA J Nepal Med Assoc, 2020 Dec 31;58(232):1083-1085.
    PMID: 34506395 DOI: 10.31729/jnma.5224
    Quadriceps tendon rupture usually occurs in adults and is rare in children. A six-year-old boy was playing at home and had a fall. He was unable to extend his right knee but there was no gap felt over the patella tendon or quadriceps. He was first seen by a family doctor and presented late to the surgeon three months after the injury. Radiographs and ultrasound were performed. The magnetic resonance imaging confirmed the findings of partial quadriceps tear. The patient was put in a cylinder case with the knee in extension for two months. Six months post-injury, he regained full range of motion without any complications. We present an unusual case of partial quadriceps tear in an otherwise healthy six-year-old boy that was treated successfully despite a delayed presentation. Besides a high index of suspicion, magnetic resonance imaging is a good modality to detect partial quadriceps tear in children.
    Matched MeSH terms: Knee Joint/surgery
  7. Yap YT, Gouwanda D, Gopalai AA, Chong YZ
    Med Biol Eng Comput, 2021 Mar;59(3):711-720.
    PMID: 33625670 DOI: 10.1007/s11517-021-02337-7
    Asymmetrical stiff knee gait is a mechanical pathology that can disrupt lower extremity muscle coordination. A better understanding of this condition can help identify potential complications. This study proposes the use of dynamic musculoskeletal modelling simulation to investigate the effect of induced mechanical perturbation on the kneeand to examine the muscle behaviour without invasive technique. Thirty-eight healthy participants were recruited. Asymmetrical gait was simulated using knee brace. Knee joint angle, joint moment and knee flexor and extensor muscle forces were computed using OpenSim. Differences inmuscle force between normal and abnormal conditions were investigated using ANOVA and Tukey-Kramer multiple comparison test.The results revealed that braced knee experienced limited range of motion with smaller flexion moment occuring at late swing phase. Significant differences were found in all flexormuscle forces and in several extensor muscle forces (p<0.05). Normal knee produced larger flexor muscle force than braced knee. Braced knee generated the largest extensor muscle force at early swing phase. In summary, musculoskeletal modelling simulation can be a computational tool to map and detect the differences between normal and asymmetrical gaits.
    Matched MeSH terms: Knee Joint*
  8. Hussin MS, Fernandez J, Ramezani M, Kumar P, Kelly PA
    Comput Methods Biomech Biomed Engin, 2020 Mar;23(4):143-154.
    PMID: 31928215 DOI: 10.1080/10255842.2019.1709118
    Osteoarthritis (OA) is a commonly occurring cartilage degenerative disease. The end stage treatment is Total Knee Arthroplasty (TKA), which can be costly in terms of initial surgery, but also in terms of revision knee arthroplasty, which is quite often required. A novel conceptual knee implant has been proposed to function as a reducer of stress across the joint surface, to extend the period of time before TKA becomes necessary. The objective of this paper is to develop a computational model which can be used to assess the wear arising at the implant articulating surfaces. Experimental wear coefficients were determined from physical testing, the results of which were verified using a semi-analytical model. Experimental results were incorporated into an anatomically correct computational model of the knee and implant. The wear-rate predicted for the implant was 27.74 mm3 per million cycles (MC) and the wear depth predicted was 1.085 mm/MC. Whereas the wear-rate is comparable to that seen in conventional knee implants, the wear depth is significantly higher than for conventional knee prostheses, and indicates that, in order to be viable, wear-rates should be reduced in some way, perhaps by using low-wear polymers.
    Matched MeSH terms: Knee Joint/surgery
  9. Robinson MA, Sharir R, Rafeeuddin R, Vanrenterghem J, Donnelly CJ
    Sports Biomech, 2023 Jan;22(1):80-90.
    PMID: 33947315 DOI: 10.1080/14763141.2021.1903981
    Multi-planar forces and moments are known to injure the anterior cruciate ligament (ACL). In ACL injury risk studies, however, the uni-planar frontal plane external knee abduction moment is frequently studied in isolation. This study aimed to determine if the frontal plane knee moment (KM-Y) could classify all individuals crossing a risk threshold compared to those classified by a multi-planar non-sagittal knee moment vector (KM-YZ). Recreationally active females completed three sports tasks-drop vertical jumps, single-leg drop vertical jumps and planned sidesteps. Peak knee abduction moments and peak non-sagittal resultant knee moments were obtained for each task, and a risk threshold of the sample mean plus 1.6 standard deviations was used for classification. A sensitivity analysis of the threshold from 1-2 standard deviations was also conducted. KM-Y did not identify all participants who crossed the risk threshold as the non-sagittal moment identified unique individuals. This result was consistent across tasks and threshold sensitivities. Analysing the peak uni-planar knee abduction moment alone is therefore likely overly reductionist, as this study demonstrates that a KM-YZ threshold identifies 'at risk' individuals that a KM-Y threshold does not. Multi-planar moment metrics such as KM-YZ may help facilitate the development of screening protocols across multiple tasks.
    Matched MeSH terms: Knee Joint*
  10. Yap YT, Gouwanda D, Gopalai AA, Chong YZ
    J Biomech Eng, 2023 Feb 01;145(2).
    PMID: 36082472 DOI: 10.1115/1.4055564
    Musculoskeletal modeling and simulation have been an emerging trend in human gait analysis. It allows the user to isolate certain biomechanical conditions and elucidate the dynamics of joints and muscles. This study used an open-source musculoskeletal modeling and simulation tool, opensim to investigate the biomechanical effect of knee brace. It collected gait data from thirty-eight participants and examined the gait spatio-temporal parameters, joint angles, and joint moments. Static optimization was performed to estimate the lower extremity muscle force. Statistical analysis was conducted to identify the difference between normal and braced gaits. The results demonstrated the feasibility of this method to investigate the interaction and coordination of lower extremity joints and muscles. The knee brace constrained the range of the motion of the knee during walking. It also changed the walking speed, step length, and stance-to-swing ratio. Several significant differences were found in the joint moments and muscle forces of the rectus femoris, gastrocnemius, soleus and tibialis anterior. Musculoskeletal modeling and simulation tool offers a less invasive and practical alternative to analyze human motion. It also provides a means to investigate the effect of medical devices such as knee brace, which can be potentially beneficial for the future design and development of such devices and for the derivation of future rehabilitation treatment to improve patient's gait.
    Matched MeSH terms: Knee Joint/physiology
  11. Li Z, Lin Z, Liu S, Yagi H, Zhang X, Yocum L, et al.
    Adv Sci (Weinh), 2022 Jul;9(21):e2105909.
    PMID: 35436042 DOI: 10.1002/advs.202105909
    Diseases of the knee joint such as osteoarthritis (OA) affect all joint elements. An in vitro human cell-derived microphysiological system capable of simulating intraarticular tissue crosstalk is desirable for studying etiologies/pathogenesis of joint diseases and testing potential therapeutics. Herein, a human mesenchymal stem cell-derived miniature joint system (miniJoint) is generated, in which engineered osteochondral complex, synovial-like fibrous tissue, and adipose tissue are integrated into a microfluidics-enabled bioreactor. This novel design facilitates different tissues communicating while still maintaining their respective phenotypes. The miniJoint exhibits physiologically relevant changes when exposed to interleukin-1β mediated inflammation, which are similar to observations in joint diseases in humans. The potential of the miniJoint in predicting in vivo efficacy of drug treatment is confirmed by testing the "therapeutic effect" of the nonsteroidal anti-inflammatory drug, naproxen, as well as four other potential disease-modifying OA drugs. The data demonstrate that the miniJoint recapitulates complex tissue interactions, thus providing a robust organ chip model for the study of joint pathology and the development of novel therapeutic interventions.
    Matched MeSH terms: Knee Joint/pathology
  12. Guo L, Li S, Xie S, Bian L, Shaharudin S
    Sci Rep, 2024 Feb 09;14(1):3310.
    PMID: 38331984 DOI: 10.1038/s41598-024-53853-z
    The digital healthcare (DH) system has recently emerged as an advanced rehabilitation approach that promotes rehabilitation training based on virtual reality (VR) and augmented reality (AR). The purpose of this meta-analysis study is to review and assess the impact of DH systems on pain and physical function among patients diagnosed with knee joint pain. Between January 2003 and September 2023, studies that met the listed inclusion criteria were gathered from Scopus, PubMed, Web of Science, and EBSCO databases. The analysis of standardized mean difference (SMD) was carried out with 95% confidence interval (95% CI) (PROSPERO registration number: CRD42023462538). Eight research papers were selected, which collectively involved 194 males and 279 females. The meta-analysis outcomes revealed that DH intervention significantly improved balance (SMD, 0.41 [0.12, 0.69], p knee joint range of motion (ROM) (SMD, 0.00 [- 0.76, 0.76], p = 1.00) and walking velocity (SMD, 0.04 [- 0.22, 0.29], p = 0.77) in patients with knee joint pain. The meta-analysis review conducted in this study revealed that DH intervention may potentially improve balance among the patients with knee joint pain. It may also alleviate the pain level particularly among OA patients.
    Matched MeSH terms: Knee Joint*
  13. Donnelly CJ, Weir G, Jackson C, Alderson J, Rafeeuddin R, Sharir R, et al.
    Sports Biomech, 2024 Mar;23(3):324-334.
    PMID: 33886425 DOI: 10.1080/14763141.2020.1860254
    Much inter-intra-tester kinematic and kinetic repeatability research exists, with a paucity investigating inter-laboratory equivalence. The objective of this research was to evaluate the inter-laboratory equivalence between time varying unplanned kinematics and moments of unplanned sidestepping (UnSS). Eight elite female athletes completed an established UnSS procedure motion capture laboratories in the UK and Australia. Three dimensional time varying unplanned sidestepping joint kinematics and moments were compared. Discrete variables were change of direction angles and velocity. Waveform data were compared using mean differences, 1D 95%CI and RMSE. Discrete variables were compared using 0D 95% CI. The mean differences and 95%CI for UnSS kinematics broadly supported equivalence between laboratories (RMSE≤5.1°). Excluding hip flexion/extension moments (RMSE = 1.04 Nm/kg), equivalence was also supported for time varying joint moments between laboratories (RMSE≤0.40 Nm/kg). Dependent variables typically used to characterise UnSS were also equivalent. When consistent experimental and modelling procedures are employed, consistent time varying UnSS lower limb joint kinematic and moment estimates between laboratories can be obtained. We therefore interpret these results as a support of equivalence, yet highlight the challenges of establishing between-laboratory experiments or data sharing, as well as establishing appropriate ranges of acceptable uncertainty. These findings are important for data sharing and multi-centre trials.
    Matched MeSH terms: Knee Joint*
  14. Arif M, Makundala V, Choon DSK
    Med J Malaysia, 2005 Jul;60 Suppl C:99-103.
    PMID: 16381292 MyJurnal
    We report on our early experiences with the Press Fit Condylar Rotating Platform (PFC-RP) total knee replacement prosthesis at University Malaya Medical Centre. This new prosthesis was introduced to Malaysia in 2001. It combines the rotating platform technology of Low Contact Stress (LCS) and the modularity of Press Fit Condylar (PFC) system. We performed 18 knee replacements using cruciate retaining prosthesis without patellar resurfacing in 10 patients and followed them up over a period of 16-month. A new operative strategy was developed to match the flexion and extension gaps. The pre- and post-operative assessments were made according to the American Knee Society Scores (AKSS). Post-operative pain relief, range of motion, knee score and functional score showed promising early results. The average knee rating improved from 28 to 91 (range 75-94). Average functional assessment improved from 26 to 82 (range 75-90). The radiographic assessments show correction of an average pre-operative varus of 140 to post-operative valgus of 50 (range 4-70). Early infection occurred in two knees. Both responded to aggressive debridement and antibiotics. Stiffness was encountered in one patient. There were no spinouts of the insert. We are satisfied that the implants are performing well at the one-year mark and will continue monitor this cohort.
    Matched MeSH terms: Knee Joint/physiopathology; Knee Joint/radiography; Knee Joint/surgery*
  15. Yunus MHM, Nordin A, Kamal H
    Medicina (Kaunas), 2020 Nov 16;56(11).
    PMID: 33207632 DOI: 10.3390/medicina56110614
    Osteoarthritis (OA) is the most well-known degenerative disease among the geriatric and is a main cause of significant disability in daily living. It has a multifactorial etiology and is characterized by pathological changes in the knee joint structure including cartilage erosion, synovial inflammation, and subchondral sclerosis with osteophyte formation. To date, no efficient treatment is capable of altering the pathological progression of OA, and current therapy is broadly divided into pharmacological and nonpharmacological measures prior to surgical intervention. In this review, the significant risk factors and mediators, such as cytokines, proteolytic enzymes, and nitric oxide, that trigger the loss of the normal homeostasis and structural changes in the articular cartilage during the progression of OA are described. As the understanding of the mechanisms underlying OA improves, treatments are being developed that target specific mediators thought to promote the cartilage destruction that results from imbalanced catabolic and anabolic activity in the joint.
    Matched MeSH terms: Knee Joint
  16. Ewe, T.W., Ang, H.L., Chee, E.K., Ng, W.M.
    Malays Orthop J, 2009;3(2):24-28.
    MyJurnal
    Current available implants for total knee replacement are based on the mormphometry of the Caucasian knee. We believe there are significant morphometric differences in the Asian knee that will be relevant in future implant designs. Sixty-nine consecutive patients (80 knees) underwent computer navigated primary total knee arthroplasty. The anterior-posterior (AP) length, and the medial-lateral (ML) width of the distal femur, were analyzed, with respect to the final sizing details of four implants (femoral component) commonly used locally. The mean AP length was 59.9 (SD4.8) mm, and the mean ML width was 65.0 (SD 5.0) mm. The overall mean aspect ratio (ML/AP) was 1.09 (SD 0.07). The mean aspect ratio for females was 1.08 (SD 0.07). Both were smaller than the aspect ratio of the implants - which ranged from 1.11 to 1.13. All four implants tend to overhang at the medial-lateral width of the distal femur. This is more obvious in females. Future implant designs should provide more ML wdth sizes for a given AP length, in addition to gender differences, for this population.
    Matched MeSH terms: Knee Joint
  17. Yu, C.K., Wong, H.Y., Vivek, A.S., To, BC Se
    Malays Orthop J, 2008;2(1):23-27.
    MyJurnal
    Interlocking intramedullary nailing is suitable for comminuted femoral isthmus fractures, but for noncomminuted fractures its benefit over unlocked nailing is debatable. This study was undertaken to compare outcomes of interlocking nailing versus unlocked intramedullary nailing in such fractures. Ninety-three cases of noncomminuted femoral isthmus fractures (Winquist I and II) treated with interlocking nailing and unlocked nailing from 1 June 2004 to 1 June 2005 were reviewed; radiological and clinical union rates, bony alignment, complication and knee function were investigated. There was no statistical significant difference with regard to union rate, implant failure, infection and fracture alignment in both study groups. Open fixation with unlocked femoral nailing is technically less demanding and requires less operating time; additionally, there is no exposure to radiation and cost of the implant is cheaper. We therefore conclude that unlocked nailing is still useful for the management of non-comminute isthmus fractures of the femur.
    Matched MeSH terms: Knee Joint
  18. Nazri Mohd Yusof
    MyJurnal
    Gastrocnemius flap is the workhorse for wound coverage in the proximal
    tibia. It can be perform by general orthopaedic surgeon because it is done without the
    need of microscopic instrumentation. Its coverage can be extended to cover the knee
    and midshaft of tibia when skin overlying it is included in the flap. (Copied from article).
    Matched MeSH terms: Knee Joint
  19. Mohd Miswan MF, Latiff Alsagoff S, Muhamad Effendi F, Ibrahim MI
    Malays Fam Physician, 2019;14(2):26-28.
    PMID: 31827732
    Locked knee is an orthopaedic condition requiring urgent treatment. Although the condition can be diagnosed via history, physical examination and imaging studies, the cause of the mechanical obstruction may only be apparent during arthroscopic examination of the knee joint. It is known that imaging plays a role in evaluating the integrity of intra-articular structures, however in some atypical cases, imaging cannot identify the definitive cause of locked knee. Here we report on two cases of locked knee, due to uncommon conditions which were unobservable via normal imaging studies.
    Matched MeSH terms: Knee Joint
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