Abstract
The source of osteoarthritic (OA) knee pain is perplexing. Bone marrow Lesions (BMLs) and the Infrapatellar Fat Pad (IPFP) are hypothesized to cause symptoms in this patient population. With escalating costs for OA treatment, physiotherapy could be an inexpensive option for managing OA knee pain. The aim of this study was to examine the Magnetic Resonance Imaging (MRI) of OA knee pain patients, pre and post, a specific physiotherapy program to determine if there were any changes in patellar position, IPFP volume and appearance as well as BMLs. The study included 12 patients with radiological evidence of tibio-femoral, patello-femoral or tri-compartmental OA. 1.5 T MRIs were obtained pre and 4 months post 6 physiotherapy sessions. MRI comparisons were made for changes in (a) IPFP oedema signal b) patellar alignment c) IPFP depth, area and perimeter and d) cyst presence or size in the subspinous tibial bone marrow and subchondral bone marrow. After treatment, both pain scores and IPFP signal reduced in all subjects. The patella was 1.7 mm higher (p=0.004), 1.2 mm more medial (patellar drift, p=0.0001) and 2° more varus (patellar roll, p=0.001). No consistent pattern was found in distribution, size or intensity in BMLs. IPFP oedema seems to be associated with increased pain in knee OA.
Highlights
Worldwide, arthritis is a major cause of long-term disability, costing governments billions of dollars annually in both direct and indirect costs [1,2,3,4,5,6]
Before commencing the physiotherapy program most patients were unable to participate in sport and the quality of life measures were low
Three months after the completion of physical therapy, with pain resolved and tape no longer required, MRI shows maintenance of improved alignment at both the patello-femoral and tibia-femoral articulations, with (i) patellar height significantly increased from the pre-treatment baseline due to improved resting quadriceps tone, and (ii) persistent lengthening and apparent thinning of the myxoid ACL that shows the lateral tibial condyle has maintained its corrected position
Summary
Arthritis is a major cause of long-term disability, costing governments billions of dollars annually in both direct (health care) and indirect (loss of income and early retirement) costs [1,2,3,4,5,6]. A recent study by Guermazi et al [19] involving 710 participants of more than 50 years age found that, 89% had structural abnormalities on MRI consistent with OA, only 29% complained of pain. The most common abnormalities were osteophytes (74%) followed by bone marrow lesions (52%). These authors concluded that most middle aged and elderly people with “normal” knee X-rays have degenerative tibiofemoral joint lesions on MRI regardless of the presence or absence of pain. Javaid et al [13] found that the presence of bone marrow lesions (BMLs), in the non-weight bearing, subspinous tibial region of asymptomatic, radiographically normal knees, predicted the development of pain 15 months later
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