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This question is pertaining to a human knee joint model. What settings can be used.
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Yeah same problem for me and then I landed here on search and seeing answer by lfeanyi kalu which I already did and I was unable to solve.
But decreasing the element size of my file from 50 - 40 mm I solved my problem.
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Application of Wharton Jelly (containing gel-like collagens, and exosomes from mesenchymal stem cell) extracted from the Umbilical Cord, mainly for the knee joint, osteoarthritis, burn wound, gun wound, and more. Now we have to find methods to measure the Strength, Flexibility, Cushioning, Covering, Compressibility and Response to Friction and Shear of the Wharton Jelly extracted from the Umbilical Cord? (We are not necessarily doing all of those).
The purposes are keeping minimally manipulated, in order to get similar function for the extracted Wharton Jelly for the injured or damaged tissues. By now we only need to measure the extracted Wharton Jelly. Our Wharton Jelly and Wharton Jelly pad are ready, I would like to ask for help that if there are experts who have facilities and methods conducting and measuring the biophysical properties of Strength, Flexibility, Cushioning, Covering, Compressibility, and Response to Friction and Shear of the Wharton Jelly extracted from the Umbilical Cord?
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my job aim to improve the properties of knee joint replacement and increase its life
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you can improve the wear resistance of UHMWPE in knee joint replacement by adding any metal nanotubes.
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Can someone provide me some journal links regarding use of 3D printed orthosis in osteoarthritis knee joints?
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Excellent mid-term follow-up for a new 3D-printed cementless total knee arthroplasty
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Dose any one tell me please which the best material to use for athletics prosthetics for legs under knee joint?
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Carbon fiber composite material which is flexible as well as strong enough to withstand high impact during athletic activities
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Tissue processing techniques in particular..
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Hi Muhammad,
1. Have you placed the bone in fixative (10% Neutral Buffered Formalin or 4% PFA)?
2. Decal in 10% Formic acid
3. Tissue processor protocol for bone
I have a few questions to ask you before I give you specific details.
Please contact me: tina.vanmeter@gmail.com
Regards,
Tina
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I am starting to work on knee joint pain and see articles using paw withdrawal test to evaluate hyperalgesia occuring in the knee? Just curious why stimulating the hind paws instead of the knee to assess pain sensitivity. Much appreciate your inputs. Thank you very much.
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Pain can be induced by abnormal excitability of the pain pathways of the nervous system (peripheral and central). For this reason, the assessment of paw removal is performed in animal models of knee pain.
DOI: 10.1111/1756-185X.13450
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I have to do a simulation on a knee joint during alpine skiing in a certain position, I have never done such a complex simulation. I was thinking to design it on SolidWorks and then imported into Abaqus in order to get data of the stresses. Could anyone give me some advice?
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you can also use it in Ansys Workbench. In the" transient structural" part. the software has advanced tools to model you problem easily.
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Rupture of the anterior cruciate ligament (ACL) is the most common traumatic knee injury in active adults. ACL tears (ACLt) tend to occur during activities including sudden acceleration and deceleration, rapid changes of direction, jumping and landing tasks, where rapid and unanticipated movement responses of the medial and lateral hamstring muscles are necessary to stabilize the knee joint and successfully counteract the extreme load forces generated (McLean et al. 2010; Smith et al. 2012). During these movements, numerous muscle actions occur with differing co-contraction strategies required to stabalize the joint.
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Sensorimotor rehabilitation includes rehab tools targeting neural and muscular components. It may include electrotherapy, manual therapy, and strenghening regimes. Balance, coordination, and muscle performance are three different things, requiring different therapeutic protocols. In Hungary, rehabilitation after ACLt is a 4 months managment program, that includes various different protocols; starting from low impact exercises to high impact balance training. The asked question need to be specified with more clarity to have a more specific answer.
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What the concentration variation of synovial fluid in knee joint in different stages of osteoarthritis?
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Zaheer, you need to rephrase your question to clarify what exactly concentration of what?
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Hi all,
I have been collecting cross-sections of a mouse knee joint, and I keep seeing some differently coloured, yellowish tissue on the anterior side of the joint, but I'm not too sure what this is?
Please refer to the attached optical scan of one of my sections and let me know if you have any insight.
Thanks in advance,
Jordan
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I think it is most likely a large blood vessel cut longitudinally which is still filled with erythrocytes. See uploaded image.
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Physiotherapy and exercise show short-term improvements in physical function. I would like to know particularly cycling exercise for treatment.
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Cycling after a total knee replacement can improve range of motion. This exercise is often included in physical therapy after TKR, as early as the first week after surgery.
Early on, the seat can be raised to limit the amount of bending required. You might only be able to do partial revolutions at first, and this is normal. As motion improves, the seat can gradually be lowered.
Cycling for range of motion is performed slowly, pausing at the top to stretch into bending, and at the bottom of the revolution to stretch into extension — a straight-knee position. During the range of motion phase, there is no added resistance on the bike.
Avid exercisers may be accustomed to moderate to high-intensity workouts. However, for patients who have recently undergone a total knee replacement, it is important not to over-exert initially.
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I have a tissue that causes arthritis with MIA.
Usually everyone uses Cryo or Paraffin section for knee joint.
What's the difference?
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Better have paraffin embedded and decalcinatef tissues. It gives you opportunity to use this tissue in future. For example for immunohistochemistry, ISH or just additional histochemical stains
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Why VMO is the first muscle to undergo disuse atrophy following any knee joint pathological or traumatic condition?
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Yes sir, some say it's due to embryological development. But I am searching for confirm ans. Thank you Sir
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Knee joint and ankle joint are crucial joints of human beings.
Using different foot ware which joint effects more
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Due to the multiple joint construct of the ankle it is the ankle. It is not only the effect on the ankle joint but the syndesmosis as well. The position of the ankle joint has a more direct effect on the syndesmosis and the subtalar joints than the knee does on the ankle and the hip. Shoe gear in any of the 3 planes affects the ankle whereas it is predominately only the frontal plant that affects the knee.
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how to increase the strength of the knee joint for male and female
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Dear Enas,
I think that it is important to evaluate the goals of your patients/athletes in the beginning of your treatment. This will show you the level and the needs of your clients. After this evaluation, I suggest to build up a training plan which is i) functional and ii) progressive, always having the final goal in mind.
Best regards
Erich
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As a P.T., focused and interested on orthopedics (such as, back, knee, shoulder, etc., pain and dysfunctions), my main concern is: how cognition and the capacity to search and obtain information, and convert it to knowledge, can affect our patients pain and rehabilitation, specially in low income areas?
Thinking about focusing on (regarding future researches):
- Health literacy
- Metacognition
- Information/knowledge sharing
- Group therapy intervention/prevention
Are those topics of interest? If "yes", which groups and researchers should i dig deeper to get the foundations?
Any suggestions are more than welcome
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Your welcome. Good Luck
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I have placed a Kinect(v2) at sagittal plane of a subject walking on a treadmill. Kinect(v2) provides 3D positional data (i.e x,y, and z column) (skeletal data) for all 25 number of joints. We know that not all joints of our body have 3 degrees of freedom (dof). But Kinect is giving 3D positional data for knee joint also which actually have 1 dof only.
My question is: do x,y, and z data of Kinect (placed at sagittal plane of a subject) represent the frontal, transverse, and sagittal plane data of a human body respectively? If it is not, then how to convert Kinect coordinate system data to body coordinate system data?
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I have rat knee joints that have been fixed in 4% PFA. I stored them in 70% ethanol before decalcification, and then placed them back into 70% ethanol after decalcification before I could paraffin embed them. If I did not rinse the tissues for a prolonged period of time in distilled water both before and after the decalcification, will this affect the IHC results? I have done IHC before with the same tissues, stored in 70% ethanol for a prolonged period, but I cannot recall whether I rinsed them overnight in water before and after the decal. It needs to be noted that these tissues should already have Alexa Fluor 647 fluorescence within immune cells.
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Most likely it will not affect. Since sections goes thru lot of washings.
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Dear sir,
This is tinku naik, pursuing my bachelors in mechanical engineering.
I have mailed to sujatha madam for internship. But, she didn't respond.
I have keen eagerness to work with you.
please can you provide me a possible internship !
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This is not the appropriate medium for such personal request. Please contact the person directly.
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Hello, for my final year project i'm required to produce a finite element analysis on abaqus of the human knee joint. Im starting off by producing an FEA on a simplified CAD model but unfortunately ive been receiving the following error: "Time increment required is less than the minimum specified" and "Too many increments needed to complete the step" after decreasing the minimum increment size.
I would really appreciate if someone could help me get over this problem. I've attached my CAE file.
Thank you
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So I looked at the model and found the following problems:
Your units are probably wrong: You give density as 1600 (probably in kg/m^3), but your geometric unit seems to be millimeter so your units are not consistent.
You should specifiy NLGEOM=ON in a contact problem unless you do small sliding
The displacement bc on the top is strange: You apply it so some points (or a RP? or both?)and then do some kind of kinematic coupling to transfer it to other points. And then in step 3 you add a concentrated load to the RP?
The BC on the tibia is wrong - you should not specify a bc on a contact surface, but on the bottom surface, I suppose.
It is also very wasteful to start with such alarge gap between the parts.
Also note that you are dealing with a Hertzian contact (sphere with a plane), this requires a much finer mesh to be resolved correctly.
Since I could not really make sense of your three loading steps. I deactivated them and changed the model so that the first step runs (was fun, actually). Hope you can take it from there.
PS: Please also note that if you actually want to model a knee joint, you will have to account for synovial fluid, cartilage etc., which will be very difficult to model (and to get material parameters for...)
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One of the most critical steps in knee ACL Reconstruction is the anatomic placement of the femoral tunnel – the so-called ACL Femoral Anatomic Footprint. This could lead to tunnel misplacement – the main reason for ACL revision surgery.
The femoral native ACL attachment site is described as an oval-shaped divided into two bundles: the anteromedial (AM) and the posterolateral (PL) bundles.
Several theories and methods have been described to a proper tunnel positioning such as 10 o’clock position (right knee) and 2 o’clock position (left knee) - in a single bundle technique or the use of intraoperative fluoroscopy.
The most accurate anatomic landmark for arthroscopic ACL reconstruction is the native ACL remnant.
The Lateral Intercondylar Ridge (LIR)/”Resident´s Ridge" defines the upper border of the ACL and the ACL femoral drilling should aim for the Lateral Bifurcate Ridge, which divides the AM and PL bundle fibers.
However, cross-sectional area of the PL and AM bundles is variable from patient-to-patient, the location of the Lateral Bifurcate Ridge, when present, does not necessarily represent the true center of the ACL femoral attachment site.
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AM
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i want to knew the last improvement of knee joint replacement
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Without a radical rethink (bio materials etc.) there are only really a handful of things that can make a difference as things stand:
  • materials - improving fixation and wear; primarily Improving survival
  • design / geometry - improving the shape of implants; likely to manifest in improved functional outcomes.
  • procedural technology - improving the positioning and reproducibility of the procedure.
  • Patient selection vs implant / procedure choice.
They are clearly all linked however the last one is perhaps most intrinsically linked with all three of the first point. With the increased use of robotics patient and implant selection could shift as people access procedures that surgeons were perhaps unwilling / unable to perform with manual instrumentation.
Just my opinion!
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Synovial fluid was already collected from knee joint and firboblast cells were cultured from the collected synovial fluid. What will be the control of synovial fibroblast cells of rheumatoid patient?
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OA SF fibroblasts can be one controls esp if you are evaluating inflammation pathways.
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hello, I've got a question about Vicon motion analysis system. it seems we have a problem with reported angles of each joint. I've already taken a look at the manual, but the methods of calculating the angles doesn't seem to be same as what we see in reported exported data. for example the angle of Valgus in knee joint is supposed to have negative values; but the system reports it as positive values, same as Varus! so both Varus and Valgus data are positive. if you know what is the problem here, i would be happy to see your solution ;)
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Have you checked the coordinate system orientation? It can the responsible for showing negative curves instead positive…
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I need to isolate RNA from Articular cartilage.
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Dear Amaresh,
When I had to do it, I use a stereoscopic microscope and forceps and scalpels to clean up the cartilage.
I'd rather focus on the femurs as the tibial plateau is flater than in the femur.
You can actually see the difference between the cartilage (smooth) and the bone which will contain the marrow (red) and present a structure a little more crumbly/spongy. You can then remove carefully the bone from the articular cartilage with the scalpel.
Depending what are your dowsntream application, you might want to do your dissection in a +4 PBS/FBS or PBS only.
At the end, it'll be important to rince off your explant to remove the eventual pieces of bones sticking to it.
Good luck!
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What are common pathologies of knee joint which can be diagnosed on Musculoskeletal Ultrasound, please share if you have any experience.
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hello, with ultrasound can study the entire pathology quadriceps patellar tendon patellar tendons distal hamstring collateral ligaments the hyaline cartilage of the femoral trochlea in partial form, recognize parameniscal cysts, periarticular ganglions and in any adjacent structure such as muscles, tendons, nerves such as perineural, adventitial of popliteal vessels, aneurysms of popliteal vessels. we can also evaluate with Doppler power technique the degree of vascularization or vascular flow of the evaluated structures and define if we are seeing an acute or chronic process. we easily recognize calcifications of soft tissues and their precise location.
we have limitations to osseous edema and all intraarticular lesions such as cruciate ligament injuries, chondromalacia osteochondral lesions, intraarticular free bodies, meniscal lesions, intraosseous ganglions, ganglions related to the cruciate ligaments, etc
I hope you can use the information
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I have been preparing 10% EDTA solution for decalcification of rat knee joints that I want to use for IHC, and have been using it for 2.5 weeks. However, even though the pH may only change by 0.2 units, I am wondering if it would be better to complete the process using 10% EDTA in PBS to provide a buffer. Would this affect the cell morphology of the tissue if I switch from water to PBS?
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PBS has the osmotic pressure of normal cells. If your tissue was in H2O this means at the beginning the buffer will be hypertonic, but in my experience it has no effect on whole mount embryos unlike hypotonic buffer which can lead to rips in the epithelium due to osmotic pressure. But if you want to be save you could always do an extra step with half volume old buffer, half new.
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For example, does an injection in ITB could be (or will be) be strongly uptaken into the knee joint or an injection for tennis elbow would be uptaken by the elbow joint???
What the capacity of corticosteroides to diffuse through membranes? I cannot find any manuscript in that regard.
cheers
@J
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Unless there is a defect in the joint capsule in the area of the injection or the needle is placed through the tendon into the joint, it is unlikely that an injection of anything, including a cortisone solution, would "seep" into the joint.
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Many physicians and physiotherapists advise their patients who have knee osteoarthritis whether in earlier stage or late and chronic stage to stop stair climbing and use lifts if available.
Is this logic suitable for all types of patients with knee osteoarthritis?
Is there any evidence or published article that discuss this issue?
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there is a mechanical association....
however it becomes relevant when there is a predisposing  factor like altered bio mechanics / .....
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We are determining what besides IRAP and A2M are responsible for the clinical effects of signaling cell transplantation in arthritic knee pain. 
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not yet
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Interpositional arthroplasty has gained in success and popularity in non load bearing joints in recent years. All of the joints that have had great success have been sheer force joints and not in load bearing joints. Any thoughts or experience in performing this procedure in load bearing joints as to integration of graft or graft breakdown due to loads. Is there any graft that is more durable with load than others?
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Yes the procedure went through IRB/ethical committee.  It isn't considered as experimental since it has been used extensively in the elbow, shoulder, first MPJ of the foot, and many other small joints.  We just don't have long term data as of yet in a load bearing joint but I will be doing a larger group of patients in a few years with the results that will either show it works for the long term or the timing to failure.  This is being done by several other surgeons in the US so hopefully we can make it a multicenter study for better data
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What are the reasons of knee cracking in young people who do not suffer from any symptoms? In particular, cracking that comes with normal activities.
Is this normal for such type of knee cracking? Should we treat this issue?
Any suggested article that explain this issue would be appreciated!
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Please let me know if this citation (and reference below) is useful to you.
“Why joints pop
Like nearly all the joints in your body, the knee joint is covered by a protective membrane containing synovial fluid. This fluid lubricates the joint, allowing it to move smoothly and easily.
Occasionally, tiny gas bubbles build up in this fluid. When the joint moves, the bubbles are released, causing the nearby ligaments to emit a snap or pop sound. The technical term for this phenomenon is crepitus, which also describes all grinding or crackling sounds and sensations in the body.
When to be concerned about joints popping
Most of the time, this popping and creaking of joints is harmless. However, crepitus is also a symptom of the joint degeneration that leads to osteoarthritis.
 You should worry about joint popping if:
•It's occurring frequently in one location
•It's accompanied by pain
•It's accompanied by joint swelling, tenderness, or stiffness
•You're also having pain as a result of prolonged joint movement, such as when walking
If you're experiencing pain when a joint pops or you have any other of the symptoms listed above, talk with your doctor. If your symptoms and test results indicate it, your doctor may diagnose osteoarthritis and start treatment. Treatments for osteoarthritis can ease pain, improve mobility, and slow disease progression—especially if it's caught early.”
Reference:
Dennis
Dennis Mazur
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I am researching cases of cricothyroid joint dislocation.I am seeking information  on etiology, management and surgical options.
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Excuse me but have no information about it.
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Hi All,
I am looking for various ways to analyse medio-lateral control of the knee joint during single-leg landing following a hop. There are few methods suggested by Roos et al. (2014). I would appreciate hearing some suggestions, on this, from the members of ResearchGate.
Roos PE, Button K, Sparkes V, van Deursen RWM. Altered biomechanical strategies and medio-lateral control of the knee represent incomplete recovery of individuals with injury during single leg hop. Journal of Biomechanics. 2014;47(3):675-80.
Thanks,
Ashok
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Thank you Dr. Bhattacharya for your suggestion. However, this study has analysed variables that are not specific to medio-lateral control of the knee during single-leg hop! Indeed, the aims of their study were different though.
Best regards,
Ashok
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Could anyone explain the reasons to supplement A2M to OA knee mainly because there is a lower concentration of A2M in SF than serum (plasma)? Why did the higher A2M in OA's SF (results shown in Fig. 1) not inhibit MMP-13 or other proteases? Perhaps the nature or properties of OA's A2M is/are different than those of normal A2M, and itself may be the problem?
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Though higher in concentration they are structurally different 
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I have made a mini-review about CMI and I want to interact with someone who have knowledge in this area. Be free to contact me; )
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Thank you very much Gustavo! 
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I am requesting your kind assistance in proper steps in harvesting, decalcifying and embedding the knee joint samples, assuming that sectioning and histological staining of the knee samples are similar with other kinds of tissue. Thank you. 
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For LM use 10% tetrasodiumEDTA to decalcify after fixation with Bouin's fluid.  Embed in paraffin.  For EM use my protocol in the paper by Warshawsky and Moore, that is enclosed. HW
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I'm mostly interested in whether X-ray or MRI was used, whether operated or contralateral knee was measured and which parameters were considered.
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Hi
Usually MRI images are considered for meniscus implant sizing for better precision. These articles may help you,
Thanks and regards,
Mamatha
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For the lubrication of the knee of an artificial leg surrogate we chose a grease based lubrication. In order to tell how good this one is compared to real joint fluid we want to do a comparative test. The joint fluid can be gained from pigs. What we don't know is, if the joint fluid changes its properties due to air contact, decomposition (how fast?) or missing nutrition (as it’s not in a living body anymore).
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It shouldn't change its viscosity due to air.  However, i think the concern is more that the amount you get makes testing difficult.  Also you need to be careful that the surface tension does not affect your measurement.
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i need a good paper about equations of predictions of 1RM in knee extension, but many articles have a wrongstatistical analysis, so i need you're help.
thanks in advance
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Dear Jeferson
Hope this article may help you.
Arthritis Care Res (Hoboken). 2011 Feb;63(2):216-22. doi: 10.1002/acr.20368.
Predicting maximal strength of quadriceps from submaximal performance in individuals with knee joint osteoarthritis.
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Hi everyone,
I'm currently doing a series of mechanical test in healthy porcine joints. I usually do these tests within hours after hogs are slaughtered. I'd like to quickly induce degeneration on the soft tissues (articular cartilage, tibial cartilage and menisci) by injecting chemicals on the joints.
Any suggestions regarding which chemicals can be used to induce degeneration within 48 hrs after injection?
Thanks!
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We used trypsin to degrade cartilage. Usually put a small sample into 0.1 mg/ml trypsin solution more than 8 hours. but you might use higher concentration trypsin.
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Specifically with regard to knee, hip and/or lower back pain.
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One relavent RCT from the PubMed:
Hashemi, M., Jalili, P., Mennati, S., Koosha, A., Rohanifar, R., Madadi, F., Sajad, S. & Taheri, F. (2015). The Effects of Prolotherapy With Hypertonic Dextrose Versus Prolozone (Intraarticular Ozone) in Patients With Knee Osteoarthritis. Anesthesiology and pain medicine, 5(5).
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In Germany, some arthroscopic procedures such as debridement, joint lavage and others will not be reimbursed by the public health care system starting in April 2016. Nevertheless, the definition of osteoarthritis of the knee joint remains unclear and is not exactly defined. From a clinical point of view, what is your best available clinical definition of osteoarthritis ? 
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This is a great discussion and also very informative. Allow me to add on this my humble views.
The definition of the word "Osteoarthritis" to start with creates some controversy on each own. It is a combination of mainly two words deriving from Greek (Ostoun=οστουν= Bone and Arthrosis = αρθρωσις = joint) and an ending (-itis=-ιτις)which is commonly used in Greek again for something infectious. In Osteoarthritis there is no infection. For this reason the ending -itis it is questioned and another ending -osis (-ωσης) was chosen as more appropriate. Despite this as -itis in some cases is liberally used for inflammation and in OA there is an inflamed joint then the original word can be used as well.
The role of Arthroscopy and OA.
Early '90 one of the pioneers in the study, the pathology, and the recreation of the articular cartilage, George Bentley, had said in one of his lectures at the instructional courses that "if we had available operating time to perform arthroscopic wash-outs of knees the course of the articular cartilage's changes in the knee joint may be different, and the need of total knee arthroplasty may be altered".
That was also the time when the number of "diagnostic arthroscopies" increased, not because of the above statement but also because of the use and the availability of the arthroscope to all "hands".
This increased the waiting lists of all hospitals and put pressure to managers who had to control them. The MRI started to be more available to all and the diagnosis with the use of the arthroscope it was thought that was not necessary and the risks of such procedure were higher that the MRI. This was taken by the insurances and they slowly stopped funding the "diagnostic arthroscopies".
The new though way which is used and it is possible to lead to acceptance from the insurances is "Staging of the Knee Degeneration" to define the exact prosthesis which could be chosen or define another way of treatment for the diseased articular cartilage.
Clinical definition of OA must be based on the clinical signs of OA. Pain (frequency, severity, effect on life), Stiffness, Deformity, Limitations of day living, Functional problems, Joint appearance etc. Oxford scoring, for example, can give answers to this. 
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Relative involvement of different muscles in the postural changes and maintaining balancing needs to assessed, This will help us in creating the assessment of postural imbalances in normal individuals which can cause undue overload on few other joints like knee joint which would lead to  development of OA. Thus preventive measures can be adopted through postural training!
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Dear Kumar,
I sent to you two papers which I like very much! It's Winter's papers and I believe that you will can find a real responses of your question.   
In addition look also the classic book :
- Winter, D (1990) Biomechanics of human movement. New York: John Wiley. 
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it is said that the most Knee OA is age related:  wear and tear due to daily joint use causes some damage to the knee joint which is not followed by the repair process. Sp
what is the  physiological pathway which is protecting the knee joint in normal people? and what is the pathophysiological pathway which leads to damage of cartilage in the knee Joint in knee OA? 
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Cause Osteoarthritis is complex and multifactorial. It is a result of problems that deriving from the morphology of the cartilage and the mechanical properties of it, as well as changes in the biochemistry of the area.
Few factors that are described as causes of OA are
Anatomical abnormalities
Trauma (either major fractures or microfractures as result of repeated low degree trauma)
Loss of joint stability
Abnormal loading due to alteration of the weight bearing axis
Meniscal surgery (medial meniscectomy almost doubles the incidence of OA)
Altered kinetics of the knee
Gait modification.
Repetitive increase load in a particular area of the knee
Inflammatory factors (increase of them)
Increase of activities of the immune system in the joint environment
Metabolic disorders
Obesity.
In females if they have 6 or more pregnancies.
Vitamin D deficiency (about 2.5 times more OA)
and so on.
All mechanical problems influence the Proteoglycans and all inflammatory problems increase the Proteolytic Enzymes.
Obesity is found to increase the Leptin within the joint which is influencing the chondrocytes.
These are part of the Causes leading to Osteoarthritis and mentioned here in brief.
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I am doing Ph.D in the biomechanics of knee joint.
After referring to the paper,"Makris, E. A., Hadidi, P., & Athanasiou, K. A. (2011). The knee meniscus: structure–function, pathophysiology, current repair techniques, and prospects for regeneration. Biomaterials, 32(30), 7411-7431.", I understood how to represent the forces on the knee meniscus during standing.
Now how would it change when the knee is in flexion..let us say 15 degree??
Also how would the forces act after 30% meniscectomy?
Can anyone share any research papers explaining the above.
I am looking forward to your answers. Thank you.
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I agree completely with Tserenchimed but if it will be necessary to take the meniscus as "fixed property" you have to add this to the limitations of your study. To help you though, there is the potential argument that in a fixed chosen angle there is the possibility that the meniscus is "fixed" in the taken position (although there will be some micro motion).
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There may be altered joint arthrokinematics and other mechanical issue of an adjacent structure, which may contribute to lateral knee pain. So, what will be the best physiotherapy management?
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Hi Peter,
Very informative..... Thanks a lot.
Warm regards,
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A 16 year old football player suffered a knee dislocation. LCL/ACL/PCL tear and lateral meniscus tear. A neurolysis of the peroneal nerve was performed during LCL reconstruction, but patient still has a foot drop without any activation yet. EMG is suppose to be performed this week. I was wondering if anyone had any good research or expertise on time frame of the peroneal nerve? Any help or other information would be appreciated. 
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Early on what I have found is that utilizing a 2 pad placement with Russian E-stim 2,500 hz 50 pps pulse rate 300 usec width and 4 sec on 12 sec off with a 0.5 sec ramp time for 4 min over the peroneal longus brevus and then over the anterior tibialis each followed by rest for 4 min and then again on for 4 min. Having the patient perform  Active Assistive (with e-stim and/or assistance from the P.T. or towel) to perform Ankle eversion, and then ofcourse move the pads and perform AAROM ankle DF this has helped tremondously. If you have a sEMG unit that is in sync with the e-stim unit with setting and adjusting the threshold for the sEMG to trigger the e-stim that has also worked very well. Or if you have a patterned e-stim unit, I have found that that has worked with  excellent results within one session and very excellent results within 3-5 sessions.  I hope this helps.
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I am doing Finite element analysis of knee joint to investigate the effects of meniscectomies on  knee biomechanics
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Partial: when a part of the meniscus is removed (anterior or posterior horn or middle part of the body or part of the whole length of  the meniscus mainly at the white zone, for example after removal of a bucket handle tear)
Subtotal: when the removed part of the meniscus is near to the red zone and involves the whole length
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I wonder why the jigs used to size the femur have varying degrees of external rotation angles 3-9 degrees attached to them when we know that we need cut at angle of 3 degree external rotation. How do we measure the external rotation with jigs when we have a lateral or medial posterior condyle wear?
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Dear Karthick,
Rotation of the femoral component during total knee arthroplasty (TKA) is to achieve the following:
1) A rectangular flexion gap
2) Optimum patellofemoral tracking
Keeping in mind your question, it is important to know that the following discussion is assuming that the reference axis is the posterior condylar line/ axis (PCA) and the surgeon uses measured resection philosophy (and not gap balancing) during TKA.
Although, it is true that 3 degrees external rotation (ER) is commonly used during TKA, it would be incorrect to presume that only 3 degrees ER is required. The following will elucidate why 3 degrees ER is commonly used. 
Anatomical studies have shown that the mean medial proximal tibial angle is 87 degrees (3 degrees lesser than 90). During TKA, we aim to put the tibial component perpendicular to the tibial mechanical axis (90 degrees; i.e; 3 degrees additional to its natural alignment). Three degrees ER of the femoral component is hence required to rectangularize the flexion gap. If that is not done, we will have a trapezoidal flexion gap. This results in eccentric loading of the insert and patellar maltracking. Thus due to anatomical variations, 3 degrees ER may not be applicable to all. It is likely that after setting 3 degrees ER on the jig, the surgeon may observe that the rotation is inadequate and may opt for greater (or sometimes lesser) rotation. It should also be noted that, the femoral component rotation only seldom affects the size of the femoral component. Hence, the sizing and ER of femoral component must be viewed separately as such.
To answer second part of the question, if the femoral condyles are worn, one can use the transepicondylar axis or the Whiteside's line to determine rotation. If those landmarks are obscured too, one can use the linea aspera to determine femoral component rotation (as it is sometimes done during revision TKA). If you are using a jig that is based on PCA, you can remove the foot pedals that sit on the posterior condyles (usually detachable). Most systems will have inbuilt or additional attachments to the jig to aid reference the rotation off the epicondyles or Whiteside's line. If not, you can always ask the implant rep to arrange one for you.
Hope that helps.
Kind regards,
Sid
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We are looking for a publication that supports or refutes this question (see attached article by White) that shows that weight-bearing on a varus OA knee causes a large varus deformity but does not describe that the varus could be more apparent than real due to ER of the femur on the tibia.
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I have the impression that in varus knee deformity the tibia is rotating externally so the defect is mainly on the posteromedial aspect of the tibial plateaux. This can be demonstrated as extreme varus angle in AP views. Usually the femora condyle is OK. Literature supporting this
Takashi Tsujimoto and  Yoshinori Kadoya (2013). Rotational Deformity After Total Knee Arthroplasty for Varus Osteoarthritis of the Knee. Bone Joint Journal . 95-B  SUPP 34,  562
Shuichi Matsuda , Hiromasa Miura, Ryuji Nagamine, Taro Mawatari, Masami Tokunaga, Ryotaro Nabeyama, Yukihide Iwamoto (2004). Anatomical analysis of the femoral condyle in normal and osteoarthritic knees. Journal of Orthopaedic Research 22, 104-109.
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I am trying to track the nerve growth in the knee joint by 3-D diagnostic imaging technique. Can any one help me on this issue?
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difusion mr sequence called PSIF from siemens. that s a neurography study.
this sequence is nerve selective
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like the knee Joint theree is a provocation of the periferal nerve around the Joint.
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Anaesthetic nerve block is more commonly associated with Sensory neuropathy ( most common complication). It is regularly done for shoulder arthroscopy for post operative pain control
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Recently was stuck in preparing a proposal for including an outcome measure following ACLR.Just felt 1RM could be an valid tool,but it remains to be a topic of debate.Even though isokinetic measures and hand held dynamometry continues to surface off late in recent studies,still 1RM.... can it be a vital and a simple tool in orthopaedic research.
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Patient oppinion
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I want to know the relation of severity with the specific clinical findings of crepitus sound.
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An interesting question. Years back I started my career with this question.  We tried to record the sound from the joint using a microphone attached to the knee - an experiment not entirely successful. 
Crepitus apparently has no direct relationship to knee OA. It frequently decreases when a knee becomes inflamed or has fluid in the joint, a common occupancy as knee OA becomes more severe. 
Best best in can be an early sign of OA if it is present. 
Siddharth Das 
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3.8% citrate chelates Calcium less than EDTA. One can use 0.5ml citrate in 8ml to get adequate anticoagulation rather than the usual 1.0ml resulting in less dilution and less calcium that needs to be added to reverse the citrate chelation effect
It is possibly reasonable to assume that PRP injected into skin will not need activation with calcium because of the diluting effect of extracellular fluid but what is the effect in the joint cavity? The cavity is enclosed so the PRP cannot escape. If the platelets are not activated immediately this is not necessarily bad? but my gut feeling is that the PRP will soon be activated with both the dilution of the citrate and the mechanical trauma.
Any thoughts?
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I think there are several problems with using heparin with little or no advantage
  1. Heparin binds to receptors on the platelets thus potentially changing platelet physiology, whereas Citrate is well established as a safe anticoagulant working by  chelating the free calcium, and is easily reversible by the addition of more calcium.
  2. heparin increases the sensitivity of platelets to activation and causes platelet aggregation. Whether this is significant or not in the clinical situation where the PRP is being reinjected within minutes has yet to be ascertained.
  3. There have been cases of contaminated heparin and so if one were to use heparin tubes it would be important to ascertain the origins of the heparin used.
Because citrate uprates glycloysis in the platelets there is over several hours an increased rate of spontaneous activation which is reduced if ACD-A anticoagulant is used. I have a separate question here on whether there is any significant difference in the spontaneous activation rates between pure citrate and ACD-A for periods less than 60mins. Nobody has yet offered any concrete evidence either way but there is the suggestion that on a theoretical basis ACD-A could be preferred. 
Another question (also asked here) is how much citrate is necessary to achieve anticoagulation. The present protocols are based on historical blood bank requirements where the blood should remain anticogulated for 3-4 weeks. In reality the amount of citrate can be significantly reduced to 0.5ml 3.8% citrate in 8.5ml blood without any coagulation at several days, thus potentially decreasing the increased activation related to uprated glycolysis.
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I want to know which area's of medial and lateral meniscus have good blood supply because of it's healing. Some part's of meniscus have good blood supply, some don't. I hope that you could help me.
Thank you!
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 Vascularization of the meniscus arrive from the adjacent joint capsule. In the adult blood vessels are present only in a peripheral rim close to the joint capsule. The ligamentous anterior and posterior horns are completely vascularized regardless of age.
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I'm looking for several different studies and their results to see if there's any improvement in therapy. I want to know more about application in the knee joint.
Thank you!
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The intraarticular injections of corticosroids use are extremely rare. It may be used in chronic synovitis, rheumatoid arthritis. Frequent intra-articular use of corticosteroids leads to the degeneration of cartilage.
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In some patients we observe an oblique joint line (i.e. in cases of a femoral valgus which is compensated by a tibial varus deformity) even though the overall alignment of the affected leg is straight. Does anybody know papers on the biomechanical influence of an oblique joint line in such patients ?
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Panayot is right here: if the femur is valgus and the tibia varus the ligaments and cartilage in the medial compartment of the knee are overloaded under weight and that destined for alteration.
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The mice are Prx1CreER ; mT/mG. My goal is to take knee joints from these mice and make sections that demonstrate autoflourescing protein. Previous attempts have ended with my slices looking ragged, so I am trying to ascertain where my previous protocols went wrong.
My lab has a general protocol that I will follow, but I want to see if it works as well for an adult mouse as it would a younger mouse:   Fixate in 10% formalin for 3 days, and decalc. in formic acid for 2 weeks. This will be followed by processing and paraffin wax blocking.
Thank you very much!
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Instead of the formic acid it may be better to decalcify in EDTA solution.  10% EDTA with a few changes over 2 weeks is perhaps gentler than formic acid.  EDTA is difficult to get into solution, so start with dH2O and EDTA slowly until it dissolves.  When the solution becomes cloudy add NaOH pellets slowly until it clears.  Keep repeating the process until you have added all of the EDTA.
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Does anyone know exercises or passive techniques to restore knee extension in early acl postoperative rehabilitation without giving too much strain on the new graft? In my clinical practice I often manage patients with incomplete extension (PROM) and I'm in doubt how to manage this problem in the best way. What do you do in your clinical practice? Is there any literature about this topic? In particular I'm interested in early rehab after acl reconstruction with semitendinosus-gracilis autograft, p.o. weeks 1st to 6th.
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Dear Daniel and dear Anibarn, thak you so much for your answers. Indeed I think passive PROM is the best way to reach full extension avoiding any risk of excessive anterior tibial traslation. I agree that prone lying stretching is probably not a very comfortable method for patients (even for surgical sutures and edema) but it's probably the most effective and sure one. Perhaps a pillow under patients thigh can improve tibial posterior traslation. 
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I am particularly interested in the range of motion of knee, hip and foot. The purpose is to have an easy way to find potential exercises for a dynamic RSA(x-ray) study.
To specify, I need the actual motion coordinates, or at least motion ranges, of e.g. the knee during squat, step-up etc.
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Dear Christian This book describes the entire physiology of joint movements , with plans and vectors.
Enjoy
Kapandji. The Physiology of the Joints
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I am trying to find out level of cartilage destroying enzymes which is associated with crepitus sound with pain.
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Crepitation suggests sever chondromalacia (gr II and III). I have no experience with the measuring the level of destroying enzymes.
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I am working on building a humanoid bot and we need some help in this regard.
Please suggest any papers or links to go through.
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There is to little detail on the exact kinematics of the specific robot.
(0) you probably also know the trajectory of the center of mass of your robot and the corresponding orientation of the main body.  If not, you'll have to define a walking strategy, such as quasi-static walking (i.e. static balance at all time, and moving slowly) or using a zero-moment point strategy.
(1) if it is a typical 7 dof model of a leg ( 3 dof for the hip, 1 dof for the knee, 3 dof for the ankle ), then the foot trajectory does not give not enough information.  In such a case , you'll need to add additional information or add additional constraints.
(2) if the leg does not have redundant degrees of freedom and the trajectory of the main body is also known, this is a problem of inverse kinematics.  This can be solved using a velocity resolution strategy:  you write down the equations at velocity level:
J * q_dot = x_dot , where q_dot are the joint velocities and x_dot are the foot trajectories and J is a Jacobian.  At each time instant you numerically solve this equation in a least-squares way:
 q_dot = pinv(J) x_dot
where pinv is the pseudo-inverse.  (you can add term for movement in the null space, ie. movement of the joints that does not influence the foot).
(3) If dynamics are involved, you can use e.g. the whole body manipulation framework of Khatib.
Refs::
Khatib, Oussama, Luis Sentis, and Jae-Heung Park. "A unified framework for whole-body humanoid robot control with multiple constraints and contacts." European Robotics Symposium 2008. Springer Berlin Heidelberg, 2008.
Chiaverini, Stefano. "Singularity-robust task-priority redundancy resolution for real-time kinematic control of robot manipulators." Robotics and Automation, IEEE Transactions on 13.3 (1997): 398-410.
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Somebody proved that the ACL is a C shape through a cadaver study.  But it is not correct. I have to disprove that it is not either through staining or through any other technique. Please help me.
Thanks in advance.
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A very recent anatomical work confirms the shape of the ACL./ This work is submitted not yet published. It has been done on fresh specimens and confirms the "C" shaped attach on the tibia and a coma shaped attach on the femur. If you want check this result, just harvest fresh ACL after carefull removal of the synovial, stain it and study the structure.
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Pre-exposure may be in the form of a low-dose exposure or by a short fluoroscopy sequence. We want to know whether this is of great importance when new equipment is to be bought for skeletal radiology. Will the number of rejected images be less and thus the total dose (including the pre-exposure or fluoroscopy) to the patient decreased? thanks!
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Katie Clark would roll over in her grave to see fluoroscopy used to cover up incompetance by radiographers. Getting a true lateral knee or elbow X-ray is basic stuff. Who does lateral shoulders? Like Carla the Australian INstitute of Radiographers oppose fluoroscopy for these purposes and this is supported by the Colleges of Radiologists.
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I want to estimate the drug concentration in synovial fluid after topical application of drug on knee joint in rats. I have used the procedures like infusion of saline through one syringe and withdrawing from another, but it was more laborious and I am unable to perform experiment on more number of animals. As I am trying to perform another method of collection by flushing 100 µL of saline and withdrawing from same syringe, withdrawal was little difficult after flushing. Anyone tried this method ? Can you suggest any precautions need to be taken ?.
Thanks
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Demonstration of a novel technique to quantitatively assess
inflammatory mediators and cells in rat knee joints
Nicola J Barton*1, David A Stevens2, Jane P Hughes2, Adriano G Rossi3,
Iain P Chessell2, Alison J Reeve2 and Daniel S McQueen1
Journal of Inflammation 2007, 4:13
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 Pain is present on climbing and getting down stairs, also on sitting to standing when the knee joint is bearing more weight in middle range knee flexion. There was a history of using heeled shoes for two to three days since one month back after which these symptoms started. Also mild swelling without any pain present in the ankle and feet. There is no tenderness in the knee joint.
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Generally the presence of a Bakers cyst confirms that the patient has synovitis. This can be 1. Inflammatory cause 2. Traumatic/degenerative cause. Essentially from the History, it will be possible to determine if there are any other joints involved and whether there is a relevant past history or family history of inflammation. This can be followed through with a thorough examination and then blood tests for inflammatory arthropathy. If the cause is traumatic or degenerative, there will be synovitis as a result of intra-articular pathology such as meniscal tears or osteoarthritis, most commonly.This will be apparent on a careful clinical examination of the knee.  An xray is often the best initial investigation to begin with.
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I am condutcting research into contractures and I am going to be running finite element analysis of the knee joint. I need to find somewhere I can download CAD data/geometry of the entire lower leg (if possible) including ligaments, tendons and muscles. The structures I need to be included are: femur, tibia, fibula, medial and lateral menisci, gastrocnemius, biceps femoris and semitendinosus muscles and the associated tendons (since these are the structures I am focussing on).
I have been able to find geometry for the bones and patella tendon, but nothing with the hamstring tendons or any of the muscles. I need the entire bone geometry (not just a cut off bone as in many models) since I need to incorporate muscle insertions. Does anyone have any recommendations at all?
Thanks in advance for any help you can give me.
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Welcome!!!
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We receive such patients who refuse replacement surgery and expect a 100% recovery by PT Rx in terms of pain, function, gait and even joint space and deformity. We try counseling but they keep on complaining.
Do you face such problems? What's your opinion?
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Dear Dhara,
The ultimate goal of exercise in OA is to prevent or delay disability. An exercise program should incorporate elements to lessen pain during activity and to
increase or at least maintain joint range of motion, periarticular muscle strength, joint stability, and aerobic capacity or level of conditioning.
Exercise in OA should be adapted according to the presence and severity of pain.
In painful episodes:
- Isometric exercise or exercise in a non weight-bearing
(e.g., biking, rowing with adapted tools) or
- In a partial weight-bearing position (e.g., aquatic ex) should be recommended.
In painless (or at least less painful) periods:
- Exercise program may include progressive muscle performance exercises.
The above exercise programs may delay disability but does not help regenerationof the cartilage. Hence, it can't recover the actual joint pathology, so the final choise of treatment will remain joint reconstruction or replacement surgery untill we get a new line of treatment.
Regards
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In one of my recent surgeries on an obese female, the extension and flexion gaps (after the releases) were just sufficient enough for the largest insert (17.5) I had available. I was wondering what the options to tackle this situation would be if the gap was bigger.
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In principle for the primary case you don't have such problems. The previous answer is correct to look at https://www.researchgate.net/go.Deref.html?url=http%3A%2F%2Fwww.orthobullets.com%2Frecon%2F5016%2Fsagittal-plane-gap-balancing.
But for this special situation a revision prosthesis is necessary .
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There are three main types of bone marrow stimulation in the literature; microfracture, abrasion chondroplasty, and drilling. Can anybody tell me why microfracture is overwhelmingly more popular than the other techniques? Does anybody have any references on the results of these different techniques? Or do you use other bone marrow stimulation techniques other than microfracture?
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I often prefer drilling with a 2.5 mm sheath pin at low speed. The defects which are not approachable by the pin, I use microfracture awl, for example most of the tibial defects.
Although it is advocated to keep them non weight bearing for 6-8 weeks, I however, start early weight bearing. I have, although, not performed a histopathology to see the quality of cartilage, a second look arthroscopy due to some other problem, in some patients showed filling of the defects with new cartilage like tissue.
My common indications these days for this procedure is to do it as a part of arthroscopic debridement in elderly patients for osteoarthrosis who are still not the candidates for arthroplasty due to various reasons. The results are satisfactory.
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Some experts say that up to 7 mm full thickness of longitudnal tears, and any length of partial thickness for longitudnal tears reaching to only one surface (femoral or tibial) can be left untouched.
I have always been wary about leaving them behind because I feel they are the trigger points for future extensions.
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Dear Ravi
The treatment of a meniscal injury will depend on its location, size, time of occurrence, age and level of sports activity of the patient. In my opinion, the treatment may be non-surgical for elderly patients with low functional demands and the remaining patients i performl arthroscopic surgery, even with minimal damage because I agree with you that this minimal lesion can evolve and cause more damage than it was
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I'm looking for information about the Q-Angle for my thesis.
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Dear Julie
Quadriceps angle (Q)
• It is the angle between the straight lines: 1) which pass through the patellar and tibial tuberosity and 2) the middle patella and the iliac crest Top Previous
• It is larger in women, since they have greater horizontal distance between iliac crest.
Limits for Men and Women
• Men: 11 to 17 degrees
• Women: 14 to 20 degrees
• Values ​​outside these limits are considered pathological burden and all structures involved joint (knee and hip).
These articles may be useful for you:
1) Biomed Tech (Berl). 2013 Sep 7
The Q-Angle and its Effect on Active Knee Joint Kinematics - a Simulation Study.
Asseln M, Eschweiler J, Zimmermann F, Radermacher K
2) J Orthop Res. 2001 Sep;19(5):834-40.
Q-angle influences tibiofemoral and patellofemoral kinematics.
Mizuno Y1, Kumagai M, Mattessich SM, Elias JJ, Ramrattan N, Cosgarea AJ, Chao EY
3) Does the change in Q angle magnitude in unilateral stance differ when comparing asymptomatic individuals to those with patellofemoral pain?
Herrington L.
Phys Ther Sport. 2013 May;14(2):94-7
4)The relationship between quadriceps angle and tibial tuberosity-trochlear groove distance in patients with patellar instability.
Cooney AD, Kazi Z, Caplan N, Newby M, St Clair Gibson A, Kader DF.
Knee Surg Sports Traumatol Arthrosc. 2012 Dec;20(12):2399-404
5) Normal Q-angle in an adult Nigerian population.
Omololu BB, Ogunlade OS, Gopaldasani VK.
Clin Orthop Relat Res. 2009 Aug;467(8):2073-6
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The extension ROM after TKR has been reported as a negative value, i.e. - 3.2 or -2 in some articles and in some other articles it has been reported as a positive value, i.e. 3.56 , 3.58 . What should we interpret? The authors have not mentioned anything.
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In case of reading the pioneers of total knee replacement as well as if you follow the scoring systems all values must be positive. Any hyper extension has to be reported as a positive value with the addition hyperextention. I am afraid that the confusion started when some health workers than surgeons started to publish their results and started to make negative markings. Following this some of the surgeons followed. So I will urge the authors of any paper to define clearly the ROM in the correct way either the value of their work will be diminished
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I am doing a meta analysis on TKR. There are so many outcomes measures (WOMAC, TUG,quadriceps lag etc) available. Which outcome measures will be the best predictor of the functional improvement?
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If I understand your question right ".. which outcome measure will be the best PREDICTOR of .. functional improvement.." you will have to consider the time axis: Outcome measure on dismission from the hospital, at 3 months follow-up, 12 months ... Talking about the early p.op. time as an inpatient, full extension is a powerfull predictor of good results 1 year pop. The quality of life tools (SF36, short form and others) in our hands are neither sensitive nor specific. Comparing quality of life in pts with calcaneal fractures, tibial head fractures, diverticulitis, HIV, osteoporosis and the life as a medical student, score values for med studs were lower than for HIV. Patients with a rural home do better than those in a city ' s apartment block. Otherwise the "usual clinical" scores - HSS, nontheless are inevitably to be used in any meta analysis.
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Anterior Cruciate Ligament (ACL) tears of the knee is a very common injury where it can be used different types of grafts to reconstruct a torn ACL such as: BTB (Bone- Patellar Tendon-Bone) autograft, hamstrings autograft, quadriceps tendon (QT) autograft or allografts to reconstruct the torn ligament. But which is your criteria to decide the ideal graft for you patient?
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The classic techniques (Hey Groves, Lindemann, Lange, etc) with preserved insertions of gracillis and/or semitendinosus give excellent results. Unfortunately, these surgical procedures are done through larger (sometimes multiple) incisions. That's why they are not so often used in favour of less invasive surgery with BTB.
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Varisation osteotomy is an established treatment for younger patient with arthritis of knee due to valgus malalignment. Since the majority of those deformities is located on the femur, supracondylar varisation osteotomy is indicated in the majority of the cases. Nevertheless, in some case in tibial deformities osteotomy of the proximal tibia can be performed. Is there an indication for double osteotomies in patients with a mixed type (femoral and tibial) deformity?
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Dear Gustavo, by doing it in the way of your recommendation, you will probably be right in the majority in the cases, but you will certainly not perform your correction at the site of the deformity in those with a femoral varus or a tibial valgus deformity ... my questions actually yielded on those patients with a severe mixed type (combined femoral and tibial) deformity ... in order to avoid an oblique joint line double osteotomy certainly seems an interesting option