A Knee Assessment In 3D In Movement Combined With Artificial Intelligence
At any given time, Millions of Americans are dealing with knee pain. Osteoarthritis (OA), the most common form of joint disease, is a problematic condition weighing down both patients and the healthcare system. Centers for Disease Control and Prevention reported in 2016 that 13.9% of adults aged 25 and older in the US are affected with OA. OA accounts for 21.7 million medical care visits in the USA alone. Healthcare professionals and the healthcare system are seeking solutions to overcome the current situation and the expected concomitant increase in the economic burden of this disease:
$ 13.2 billion USD spent annually on health and safety (2016)
The costs associated with hip and knee arthroplasty is more than $ 49.3 billion USD. (Experts predict an increase of 673 % through 2030 growing to 3.5 million surgeries annually)
Overuse of MRI is associated with USD $ 20 billion to $ 50 billion unsupported expenses
When considering the co-morbidities associated with OA, average cost to treat a patient is between 1.5 and 2.6 times higher
For the last 30 years, there has been a lack in technological progress to assess knee pain and define the proper care pathway. Current issues in treating knee patients include the lack of correlation between their symptoms and diagnostic imaging results, e.g. MRI and X-ray, leading to an empirical approach and a process of elimination in trying to identify and manage the causes of the pain.
It is well recognized that joint function is directly linked with symptoms and the development & progression of knee pathologies. For example, a varus thrust, a knee mechanical deficiency, leads to a 4X increase in the risk of knee OA progression. However, mechanical markers are difficult and sometimes impossible to be detected with the eye (observation) and cannot be documented objectively. To date, no clinical diagnostic aid has been made available for healthcare professionals to adequately investigate knee function and specific knee mechanical markers known to be linked with knee osteoarthritis progression, ligament injuries & instabilities and anterior knee pain.
There is a need for objective and quantifiable data of the knee in motion and in a weight-bearing condition that documents the presence of functional deficiencies, like the Electrocardiogram does for the heart…
The ‘Knee Kinesiography’ assessment is now available for doctors to obtain objective and quantifiable data on knee functional deficiencies to better manage their patients. As a gait lab in a box, the KneeKG system is used in the clinical setting to accurately assess the knee in 3D and dynamically in a weight-bearing condition. Artificial intelligence is used to compute the data and immediately highlight functional deficiencies linked to patients’ symptoms that the doctor should address.
Emovi (emovi.ca) is Transforming Knee Care – Eliminating the pain for Patients and Providers with KneeKG.
KneeKG is the first 3D High-Tech Dynamic Knee Assessment that enables a Knee Kinesiography test in clinic and serves as the ultimate and best quality measurement tool to (i) help quickly diagnose pathologic patterns (ii) then develop a focused treatment strategy to restore optimal knee function, and (iii) document outcomes, i.e. the clinical benefits of the treatment regimen.
About Knee Pain
The knee comprises the tibia, fibula, femur and the patella that are articulating thanks to the proper function of ligaments, muscles and cartilages. The major causes of knee pain in younger patients are trauma or overuse, which is typically a result of activity or sports. In most of the patients older than 40 years old, knee pain is caused by the wear and tear in the joint.
Knee pain can lead to limping due to discomfort, difficulty in walking or completing functional tasks (i.e. climbing stairs, kneeling, etc.), locking of knee, redness, swelling and inability to extend knee.
With the growing incidence of sports injuries, prevalence of knee osteoarthritis and demand for treatment options are factors driving the growth of global knee pain management market. Advancements in technology and development in joint replacements are believed to play a crucial role in the growth of global knee pain management market over the forecast period.
The primary cause of knee pain consultation is associated with knee osteoarthritis / loss of / injuries in cartilage of knee. Cartilage is semi- hard tissue that is responsible to cover the end of bones. The cartilages associated with knee are the medial meniscus and lateral meniscus.
Anterior Knee Pain is the second leading cause of knee pain consultation. The causes for anterior knee pain are multifactorial. These include overuse injuries of the extensor apparatus (tendonitis, insertional tendinosis), patellar instability, chondral and osteochondral damage. The patellofemoral pain syndrome (PFPS) is a common cause for “anterior knee pain” and mainly affects young adults without any structural changes such as increased Q-angle or significant pathological changes in articular cartilage. Therefore, PFPS is a diagnosis of exclusion. Clinical manifestations include crepitus and functional deficit. PFPS symptoms cause many athletes to limit their sportive activities. According to some authors, the PFPS will eventually lead to osteoarthritis. The pathogenesis of PFPS is multifactorial with various functional disorders of the lower extremity to be involved.
Sports activities can cause muscle strains, serious injuries to ligament, cartilage and tendinitis. Mild knee pain only causes hindrance to the daily life style whereas severe knee pains results in serious limitations to the movements. The knee ligaments connect the thigh bone to the lower leg bones and act as a binding element to hold the bones and provide stability to the knee. Ligament strains are one of the most common injuries in sports, affecting the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and medial collateral ligament (MCL).
Knee pain consultation post knee replacement and post ACL reconstruction are other leading causes of consultations.
1. About Knee osteoarthritis
Osteoarthritis (OA), the most common form of joint disease, and a progressively degenerative disease, is a key condition weighing down the healthcare system. It has been estimated that about 251 million people suffer from knee OA worldwide. Around 13% of women and 10% of men aged 60 and older have symptomatic knee Osteoarthritis. That prevalence is expected to increase in the forecast period due to increasing aging population and obesity. Per the Centers for Disease Control and Prevention report in 2016, 13.9% of adults aged 25 and older in the US are affected with OA. OA accounts for 21.7 million arthritis related visits to medical care in the USA alone.
Healthcare professionals and the healthcare system are seeking solutions to the expected concomitant increase in the economic burden of this disease:
$ 13.2 billion USD are spent annually on health and safety (2016);
The costs associated with hip and knee arthroplasty is more than $ 49.3 billion USD. (Experts predict an increase of 673 % through 2030 growing to 3.5 million operations annually)
Losses associated with the overuse of MRI is between USD $ 20 billion to $ 50 billion.
When considering the co-morbidities associated with osteoarthritis, average costs to treat a patient are between 1.5 and 2.6 times higher
2. About Knee Anterior Pain
“The incidence of “anterior knee pain” is high and with a prevalence of (2.2%) 22/1,000 people per year. Women are affected more than twice as often as men.
20% - 25% of all injured runners (3 million) suffer from PFPS = 600,000 – 750,000 injuries in the USA alone.
3. About Knee ligament injuries
The anterior cruciate ligament (ACL) is the most commonly injured knee ligament. In the United States, there are between 100,000 and 200,000 ACL ruptures per year. Data are limited by the absence of any standard surveillance mechanism for the general population. Registries exist for injuries sustained by United States college and high school athletes, but these account for a small percentage of the total number of injuries.
22% of all knee injuries (5,000,000) is knee instability= 1,100,000 in the USA
Up to 68% of patients have limited knee function / dissatisfaction post ACL reconstruction
4. About Residual Pain Post Surgery
(i) “Total knee arthroplasty (TKA) is a highly successful and cost-effective procedure to relieve pain, correct deformity, and improve function in patients with end-stage arthritis of the knee. However, patient dissatisfaction remains as high as 50%. Several factors contribute to dissatisfaction, including unmet expectations, functional limitations, and most commonly, residual pain. Residual pain after TKA is well documented. The incidence of anterior knee pain varies, but has been reported to be as high as 20%. One study reported that 10% of patients had persistent anterior knee pain at up to 10 years of follow-up. During later follow-up, an additional 10% had anterior knee pain. Finding a precise cause of anterior knee pain is a diagnostic challenge.” Caroline N. Park & al. Diagnostic Algorithm for Residual Pain After Total Knee Arthroplasty, Orthopaedics, March/April 2016 - Volume 39
(ii) Despite great advancements in surgical techniques for ACL reconstruction (ACLR), recent studies continue to document that up to 66% of people who had an ACLR have not returned to their level of knee functionality post ACL reconstruction and are not satisfied. Ardern CL and al. Satisfaction With Knee Function After Primary Anterior Cruciate Ligament Reconstruction Is Associated With Self-Efficacy, Quality of Life, and Returning to the Preinjury Physical Activity. Arthroscopy. 2016 Aug;32(8):1631-1638, 2016 Mar 24.
Patient dissatisfaction following primary ACLR can be divided into 3 general categories:
Postoperative complications (infection, loss of motion, patella fracture); and,
Comorbidities related to concomitant pathologic abnormalities (lower extremity malalignment, extensor mechanism dysfunction, donor site pain, meniscus loss, arthritis).
Recurrent instability is the most common cause for failed ACL surgery. Early failures (< 3 months) are usually related to loss of fixation and infection. Mid‐term failures (3 – 12 months) are often due to errors in surgical technique, aggressive physical therapy and unrecognized loss of secondary restraints. Late failures (> 12 months) are usually related to trauma (second injury).
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