Palaeopathology is about understanding what you are looking at and how it relates to actual clinical conditions. It is often only by having an awareness of the clinical condition that you can come to a diagnosis when viewing osteological features. Using examples from clinical photography, specifically orthopaedics, examples of pathology from the Anglo-Saxon cemetery in Little Chester, Derby and papers published, in many and varied journals, by Calvin Wells it is possible to see the importance of viewing palaeopathology from a clinician’s perspective. Population level analysis, for example the quantification of osteoarthritis (OA) in a particular area or cemetery, gives information about the frequency of occurrence of specific traits associated with OA. What it doesn’t do is give us a picture of actual diagnoses. Under a general category of OA of the knee you could have individuals with varus or valgus deformities, eburnation of the tibial plateau and femoral condyles and accompanying osteophytes through to variations in the patella-femoral joint e.g. subluxation, lateral patella maltracking and patella alta. Individual diagnoses though leading to short simple papers or a series of case studies can be equally valuable in understanding how our ancestors lived. Through looking at actual diagnoses we can link how people lived with specific increases or decreases in clinical conditions that could lead to ways of decreasing the impact of OA in modern populations.

1. The value of clinical knowledge
in understanding pathological
findings in Anglo-Saxons
David Bryson BSc(Anat) CertEd MIMI FRSB MCSFS
Senior Lecturer in Forensic Anthropology and Photography

2. Introduction
Anatomy
and Osteology
Clinical
knowledge of
orthopaedics
Photography
and visualisation

3. Lateral maltracking of patella
Male over 40yrs
Little Chester, Derby (Kinsley 2002)

4. Pathological findings
Eburnation and evidence of cog and groove lateral
facet of patella and lateral femoral condyle

5. Pathological findings
Eburnation and evidence of cog and groove lateral
facet of patella and lateral femoral condyle

6. Waldron T, 2001

7. Clinical examples: Skyline views of patella
Left
Lateral Maltracking
Right
Normal tracking

8. Biomechanics
0°

9. Biomechanics
45°

10. Biomechanics
90°

11. Patellofemoral pathologies
Patellar dislocation

12. Patellofemoral pathologies
Patellar dislocation

13. Patellofemoral pathologies
Patella altaNormal
Mann (1991) reported changes with pressure erosion of the femoral trochlea, patella
baja, and altered patellar surfaces.

14. Osteoarthritis of the knee joint
Wells, C. 1965

15. Pathological findings
Male, aged 30-40, showing marked osteoarthritis and eburnation of the
femoral condyles (Burgh Castle, Suffolk).

16. Pathological findings
“My impression is that it is not greatly dissimilar
from what is seen clinically today in comparable
populations of farm labourers. But in the ancient
peoples discussed here the onset of the
condition seems to have been earlier than is now
usual, and its progress may have been more
rapid”
(Wells, C. 1965 p103)

17. Pathological findings
Male, aged 50-60, Gross osteoarthritis without eburnation (Burgh Castle, Suffolk)
“The osteophytic reaction around the joint is however, much more gross than in
the former case.” Wells, C. 1965

18. Grading of localized articular cartilage changes
Stage I Fasciculation

19. Grading of localized articular cartilage changes
Stage II Fasciculation and fibrillation

20. Grading of localized articular cartilage changes
Stage III Erosion, arthritic phase

21. Clinical examples
Osteoarthritis of the knee: Close-up showing cracks in the cartilage and
remodelling of the joint surface at the margins of the joint.

22. Clinical examples
Unilateral osteoarthritis of the knee

25. Biomechanics: Joint movement
Valgus deformity due to osteoarthritis of the medial compartments of both
knees.

26. Biomechanics: Joint movement
Varus deformity due to fractured tibial plateau demonstrated
under anaesthesia.

27. Age and symptoms
• Lateral maltracking of the patella occurs at an
early age and continues throughout life.
• Osteoarthritis of the femoral condyle in
combination with the tibial plateau are
commonly associated with old age.
• Injuries resulting in changes can occur at any
time in life.
• Early onset OA is more likely due to
biomechanical changes or hereditary
differences.

28. Discussion: Recording of osteoarthritis
Evidence of symptoms and
significant features
Population level statistics

29. Evidence of symptoms and
significant features
Population level statistics
Diagnosis and or biomechanical
interpretation of features
Recording of osteoarthritis

30. Population statistics can cover up diagnoses
Waldron HA, 1991

31. Future research and directions
Personal directions
Comparing cartilaginous and bony changes visible
in OA knee from total knee replacements with the
bone once cartilage has been removed.
Preferably linked to pre-op locomotion studies.
Book in progress: Guide to Osteological
photography

32. References
Andriacchi, T.P. and Alexander, E.J., (2000) Studies of human locomotion: past,
present and future. Journal of biomechanics, 33(10), pp.1217-1224.
Kinsley, G. (2002) The Anglo-Saxon Cemetery. In: Sparey-Green, C. Excavations on
the south-eastern settlement of Little Chester, Derby, 1971-2. Derbyshire
Archaeological Journal 122: 84-121.
Mann, R.W., Roberts, C.A., Thomas, M.D. and Davy, D.T., (1991) Pressure erosion of
the femoral trochlea, patella baja, and altered patellar surfaces. American journal of
physical anthropology, 85(3), pp.321-327.
Rogers, J.M. Dieppe, P.A. (1993) Ridges and grooves on the bony surfaces of
osteoarthritic joints. Oseteoarthritis and Cartilage. 1(3): 167-170.
Waldron, H.A., (1991) Prevalence and distribution of osteoarthritis in a population from
Georgian and early Victorian London. Annals of the rheumatic diseases, 50(5), p.301-7.
Waldron, T. (2001) Shadows in the soil. Stroud: Tempus publishing. pp 87.
Wells, C., (1965) Diseases of the knee in Anglo-Saxons. Medical & Biological
Illustration, 15, p.100.

33. David Bryson
d.bryson@derby.ac.uk