Detection of intra-articular pressure transmission between knees: a confirmation of the “internal hydraulic exoskeleton” system that protects articular cartilage from overloading


Prof. Pitkin, M.R. Dr. Tech. Sci. Tufts University, Boston, MA 02111, USA. Phone 617-636-7000, e-mail:

In the heading: Original researches

Year: 2020 Volume: 2 Journal number: 4 

Pages: 8-19

Article type: scientific and practical

UDC: 616.72-07

DOI: 10.26211/2658-4522-2020-2-4-8-19


Introduction. Overloading of articular cartilages is generally accepted as one of the main causes of the pathogenesis of osteoarthritis and related pathological conditions. Understandably, osteoarthritis is diagnosed more often in people who systematically experience excessive stress on their joints, whether occupationally, such as military personnel, or as a result of a primary health disorder like a unilateral amputation of the lower limb. What is surprising is why the rates of osteoarthritis aren’t higher in the rest of the population since, according to mechanical estimates, the contact pressures applied to cartilage in the norm approach the maximum loading strength of the cartilage tissue. It is necessary to understand and describe how cartilage can withstand such high pressures throughout a person’s life in order to improve prevention and treatment strategies for osteoarthritis and related diseases.

Aim. The article describes experiments that substantiate the hypothesis that intra-articular pressures are transmitted via newly identified physiological system. The system, called “internal hydraulic exoskeleton”, includes the periosteum, which covers almost the entire skeleton, synovial capsules, and subperiosteal synovial fluid.
Disturbances in its normal functioning leads to the dangerous overloading of joints and their further pathology. The article further discusses a possible approach to improving the prevention and rehabilitation of articular pathology by preserving the health of the IHE system.

Materials and methods. In our study on rabbits [1], in each of ten animals, we simultaneously measured the pressure in both knee joints of the hind limbs, one of which was passively flexed and extended, while the other was fixed with a plaster cast. In four rabbits, upon completion of the first experiment, a circular dissection of the periosteum was performed along the perimeter of the femur, 3 cm above the right knee joint. The joint was articulated anew, as in the first experiment, and the pressure in the articulated and immobilized joints were simultaneously measured.

Results. In the first experiment, the pressure in the immobile joint changed each time the pressure in the articulated joint changed. After dissection of the periosteum in the second experiment, the pressure in the immobilized joint did not change when the pressure in the articulated joint changed. Simultaneous measurements of venous blood pressure did not show a correlation with changes in hydrostatic pressure in the joints, suggesting that intra-articular pressure was transmitted through the space between the periosteum and the bone surface.

Discussion. The experiments suggest that the subperiosteal hydrostatic junction of the synovial joints forms a morphological network designed to redistribute and reduce pressure along the entire periosteum, protecting articular surfaces from excessive stresses, as evidenced by the free transmission of hydrostatic pressures that was arrested by the transection of the periosteum.

Conclusion. Preserving the health of the identified “internal hydraulic exoskeleton” system, including the application of the proposed method of physical exercises (Sanomechanics®), should be considered as a necessary condition for the successful prevention and treatment of joint pathology. Further multidisciplinary research is needed to establish the features of the morphology and physiology of this system.

Funding. This study was funded in part by Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH (grant number: R44HD057492).

Keywords: , , ,

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