Joint capsule collagen. Analysis by the study of intra-articular pressure during joint distension. Measurements in the knees of control subjects and patients with rheumatoid arthritis and Ehlers-Danlos syndrome.

Steer, G; Jayson, M. I. V.; Dixon, A. St. J.; Beighton, Peter

doi:10.1136/ard.30.5.481

Cited by 7 publications

(5 citation statements)

References 8 publications

(7 reference statements)

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“…Steer et al previously reported the slope changing section, which is toe region, where the elasticity changes during knee joint distension using a dextrose/sodium chloride solution in experimental setup. 27 In our study, V ph1 , was significantly reduced in knees with effusion (6.15 ± 5.46 ml) compared to those without (13.50 ± 10.09 ml). In Figure S2A, raw data from two contrasting knees demonstrated that knee #27 (with suprapatellar effusion) had a much shorter initial flat phase than that of knee #4 (without suprapatellar effusion)…”

Section: Early Strain In the Presence Of Supra-patellar Effusionsupporting

confidence: 49%

“…In this study, we initially decided to stop the procedure if pending rupture signs or pain complaints emerged, but the average injected volume was much less (approximately 52 ml) than normal joint volume, and the knee was in its resting state without muscle contraction, so the synovium could be preserved without rupture. We observed bulging of the meniscofemoral recess at the medial knee under the deep medial collateral ligament, which are normally closed as potential spaces, so we presumed that the various bursae and recesses in the knee joint 26 were stretched at the same time (Figure 4).…”

Section: Discussionmentioning

confidence: 96%

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Intra‐articular pressure characteristics of the knee joint: An exploratory study

Lee

Kim

Chung

2021

Journal Orthopaedic Research

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Inflammation-predominant osteoarthritis is an important clinical type of osteoarthritis, with synovitis suggested as its distinct pathophysiology. We investigated whether the synovium's mechanical properties in knees differed by osteoarthritis and other clinical parameters through retrospectively analyzing intra-articular pressure-volume characteristics. We analyzed 60 knees that were administered intra-articular corticosteroids while undergoing pressure monitoring. McMurray's test, pain complaints at end-range knee flexion, Kellgren-Lawrence classification from standing anteroposterior radiographs, and suprapatellar effusion from ultrasound constituted clinical parameters.Pressure-volume profiles-phasic changes in pressure by volume infusion, the volume of Phase 1-the potential volume of the synovial space, the pressure at 45 ml infusionintra-articular pressure at a standardized volume, and the slope of Phase 2-synovial stiffness were compared with clinical parameters. All graphs were biphasic. Knees with suprapatellar effusion or radiologically definite osteoarthritis (Kellgren-Lawrence grade ≥2), had a lower Phase 1 volume. Knees with definite radiographic osteoarthritis also showed higher pressures at 45 ml and Phase 2 slopes (171.11 ± 94.35 mmHg and 5.08 ± 3.07 mmHg/ml, respectively) than those without (101.88 ± 58.12 mmHg and 2.84 ± 1.27 mmHg/ml, respectively). The Phase 2 slope was higher for knees with positive provocative tests than in those with negative provocative tests, although not statistically significant. The synovium stretched earlier in knees with effusion or radiologically definite osteoarthritis. Intra-articular pressure and synovial stiffness were significantly higher in patients with radiologically definite osteoarthritis. The synovium's mechanical characteristics are altered by osteoarthritis of the knee joint. Intra-articular pressure characteristics could be utilized for synovial evaluation clinically.

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Section: Early Strain In the Presence Of Supra-patellar Effusionsupporting

confidence: 49%

Section: Discussionmentioning

confidence: 96%

Intra‐articular pressure characteristics of the knee joint: An exploratory study

Lee

Kim

Chung

2021

Journal Orthopaedic Research

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“…This phase ofthe pressure-volume curve can be explained by the structural integrity and changes, in the form of molecular reorientation, which determine the pressure response to a further rise in volume. Steer et al (1971) have suggested that once the capsule is stretched collagen fibres become reoriented and start to bear some of the strain and it is this which may produce the observed increase in elastance at high intra-articular volumes and pressures. It should be stressed that 'joint capsule wall' is not a single discrete structure, but includes synovial interstitium (including its lymph and blood vessels), ligaments, and connective tissue envelope sealing the joint.…”

Section: Discussionmentioning

confidence: 99%

“…Pressure-volume relationships have been described in studies on abnormal human knees carried out by Caughey & Bywaters (1963), Jayson & Dixon (1970a), Steer, Jayson, Dixon & Beighton (1971) and Myers and Palmer (1972), and in animals by McCarty, Phelps & Pyenson (1966). O'Driscoll, Kumar & Salter (1983), Knight & Levick (1981, 1982a, b, 1983 and Jayson & Dixon (1970c) have investigated several aspects of the relationship between pressure and volume in the normal knee joints 418 JOINT ELASTANCE -PRESSURE-VOLUME of rabbits and man.…”

Section: Introductionmentioning

confidence: 99%

Pressure‐volume relationships and elastance in the knee joint of the dog.

Nade¹,

Newbold²

1984

The Journal of Physiology

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SUMMARY1. This study has investigated changes in intra-articular hydrostatic pressure in the knee joints of normal dogs in response to continuous and stepwise infusions of fluids. The relationship between pressure and volume in the joint was examined over the pressure range of -8 to +50 mmHg, and also at much higher pressures often associated with joint disease or injury. The effects of joint angle and dog weight on the pressure-volume relationship and on elastance of the dogs' knees were also examined.2. With liquid paraffin B.P. the pressure was found to increase more with each unit volume infused at subatmospheric pressures than at pressures around atmospheric, and increased more again at higher pressures. The pressure-volume curve with saline infusions was affected by egress of fluid from the joint at supra-atmospheric pressure. Above + 5 mmHg the rise in pressure per unit volume infused was less than that for paraffin at the same volume.3. Elastance and compliance of the normal joint capsule were calculated from the pressure-volume data. Elastance was high at subatmospheric pressures, decreased rapidly as atmospheric pressure was approached and rose as a linear function of pressure above 12 mmHg.4. The biphasic shape ofthe elastance-pressure curve is discussed, and explanations for the shape are suggested.5. After intra-articular pressure in the knee was raised by infusion of paraffin oil the joint was moved through the range of positions from 125 deg extension to 50 deg flexion. Intra-articular pressure did not change across the range 125-110 deg. However, increasing the angle of flexion from 110 to 50 deg resulted in a rise in pressure which became steeper for each volume increment.6. Increasing intra-articular fluid volume caused a decrease in the total range of movement of the joint.7. The pressure-volume curves measured at extended angles of 110, 125 and 140 deg, where the starting pressures were subatmospheric, were the same. At flexed joint positions of 80 and 50 deg, where the starting pressures were supra-atmospheric, the pressure-volume curves became steeper with greater flexion. * Authors names are in alphabetical order.14 pHY 357S. NADE AND P. J. NEWBOLD 8. Elastance of the joint tissues increased with flexion. The elastance at each joint angle depended also on the volume or pressure.9. Significant differences were found to exist between pressure-volume curves for three groups of animals of different weight. Curves were steeper in small animals.10. Acrylic casts of the knee joint space were constructed at 90 and 40 deg of flexion to demonstrate channels of communication between anterior and posterior regions. The anterior compartment provided two-thirds of the total surface area.

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“…Chronic pain has been estimated to occur in up to 85%-90% of patients with EDS, with several studies reporting lower healthrelated quality-of-life measures not only in healthy controls but also in patients with rheumatoid arthritis [7][8][9][10][11][12]. These findings are thought to be in part due to hypermobility and laxity around the joints, leading to instability and early arthritis [11,[13][14][15][16]. The characteristics of hypermobility and laxity in patients with EDS must be accounted for when planning to perform THA, which relies on the soft tissues for stability.…”

Section: Discussionmentioning

confidence: 99%

Primary Total Hip Arthroplasty in Patients With Ehlers-Danlos Syndrome: A Retrospective Matched-Cohort Study

Guier¹,

Shi²,

Ledford³

et al. 2020

Arthroplasty Today

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Background: Ehlers-Danlos syndromes (EDSs) are connective-tissue disorders resulting in joint laxity. Soft-tissue stability is a concern in these patients when they undergo total hip arthroplasty (THA). Our purpose was to compare THAs in the population with EDS with a matched control undergoing THA for osteoarthritis. Methods: Thirteen patients with EDS underwent THA from 1997 to 2017. Matching was 1:3 with a control group of patients who underwent THA for osteoarthritis. Matching was based on the gender, age, and length of follow-up. Results: We found no difference in demographics or postoperative Harris Hip Scores between the cohorts (P > .05). Two patients (15.4%) with EDS and 2 patients (5.1%) in the control group suffered a dislocation. We found no difference in the reoperation or revision rate between the groups (P ¼ .28). Conclusions: Patients with EDS have a significant improvement in postoperative Harris Hip Scores after THA. These patients also have a high dislocation rate after surgery, and alternative approaches and technologies such as dual-mobility components should be considered to reduce the rate of dislocation in this population.

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Joint capsule collagen. Analysis by the study of intra-articular pressure during joint distension. Measurements in the knees of control subjects and patients with rheumatoid arthritis and Ehlers-Danlos syndrome.

Cited by 7 publications

References 8 publications

Intra‐articular pressure characteristics of the knee joint: An exploratory study

Intra‐articular pressure characteristics of the knee joint: An exploratory study

Pressure‐volume relationships and elastance in the knee joint of the dog.

Primary Total Hip Arthroplasty in Patients With Ehlers-Danlos Syndrome: A Retrospective Matched-Cohort Study

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