Activity-related Knee Pain Research Articles

Multi-centre Modified Delphi Exercise to Identify Candidate Items for Classifying Early-Stage Symptomatic Knee Osteoarthritis

To generate a list of candidate items potentially useful for discriminating individuals with Early-stage Symptomatic Knee Osteoarthritis (EsSKOA) from those with other conditions and from established osteoarthritis (OA), and to reduce this list based on expert consensus. We conducted a three-round online international modified Delphi exercise with OA clinicians and researchers ("OA experts"). In Round 1, participants reviewed 84 candidate items and nominated additional item(s) potentially useful for EsSKOA classification; those nominated by ≥3 participants were added. In Round 2, participants rated perceived usefulness of 108 items (1 [not at all useful] to 9 [extremely useful]). In Round 3, participants could revise their ratings after reviewing Round 2 group median and quartiles. Following Round 3, we retained items with a median usefulness score >5 and ≥33.3% of participants categorized the item as useful (7 to 9), overall and in subgroup analysis by clinician field. There were 128 participants in Round 1 and 113 (88%) completed all rounds. We retained 77 items that spanned multiple domains (demographics, symptoms, physical exam, performance-based measures, imaging, laboratory investigations, and gross inspection/arthroscopy). Highly rated items included (median usefulness score): prior knee joint injury (8), diagnosis of OA in a different joint (7), and activity-related knee pain (7). The interquartile range was most often 3. We identified 77 items that OA experts consider potentially useful for EsSKOA classification. The results highlight experts' uncertainty around item usefulness. Next, candidate items will be further assessed and reduced using data-driven and multicriteria decision analysis methods.

Impact of Specific Bioactive Collagen Peptides on Joint Discomforts in the Lower Extremity during Daily Activities: A Randomized Controlled Trial.

The intake of specific collagen peptides (SCPs) has been shown to decrease activity-related knee pain in young, physically active adults. This trial investigated the effect of a 12-week SCP supplementation in a wider age range of healthy men and women over 18 years with functional knee and hip pain during daily activities. A total of 182 participants were randomly assigned to receive either 5 g of specific collagen peptides (CP-G) or a placebo (P-G). Pain at rest and during various daily activities were assessed at baseline and after 12 weeks by a physician and participants using a 10-point numeric rating scale (NRS). The intake of 5 g SCP over 12 weeks significantly reduced pain at rest (p = 0.018) and during walking (p = 0.032) according to the physician's evaluation. Participants in the CP-G also reported significantly less pain when climbing stairs (p = 0.040) and when kneeling down (p < 0.001) compared to the P-G. Additionally, after 12 weeks, restrictions when squatting were significantly lower in the CP-G compared with the P-G (p = 0.014). The daily intake of 5 g of SCP seems to benefit healthy adults with hip and knee joint discomforts by reducing pain during daily activities.

Distal Femoral Stress Fractures Has High Operation Rates in Adolescent and Young Adult Athletes.

Although stress fractures of the distal femur are rare, symptoms can overlap with other peri-articular knee pathology, delaying diagnosis. Untreated stress fractures have the potential to progress into completed fractures with a higher likelihood for requiring surgery and longer recovery times in otherwise healthy adolescents and young adults. This case series represents the largest cohort of adolescent athletes with distal femoral stress fractures who presented with activity-related knee pain. Patients treated nonoperatively and operatively for metaphyseal distal femur stress fractures at a tertiary referral center over a four-year period were retrospectively identified from the medical record. Eight patients (mean age 16.8y; range 14 to 22y; 87.5% male; mean body mass index [BMI] 20.9) with a total of 10 distal femur stress fractures were identified. All patients were involved in competitive sports or military training. There was an average of 3.8 encounters with a medical provider between presentation with activity-related knee pain and diagnosis with distal femur stress fracture. All except 1 patient (87.5%) were initially incorrectly diagnosed with another type of peri-articular knee pathology. Six stress fractures (60%) were treated conservatively with protected weight bearing, activity modification, and gradual return to activity. Four completed stress fractures (40%) required operative fixation-3 healed uneventfully, while 1 had an asymptomatic delayed union. Vitamin D insufficiency (<30ng/mL) was identified in 7 of 8 patients (87.5%) and 3 patients (37.5%) had an underweight BMI (<18.5). The mean clinical follow-up was 13.1 weeks (range, 2.8 to 32.0wk). High clinical suspicion for distal femoral stress fractures is needed to avoid misdiagnosis or delayed diagnosis in young, active individuals with activity-related knee pain refractory to conservative management. In this patient population, activity-related knee pain recalcitrant to activity modification, rest, and physical therapy warrants further workup with magnetic resonance imaging and orthopaedic evaluation. Though rare, misdiagnosis can result in catastrophic fractures with prolonged rehabilitation needs. An open line of communication and streamlined access for referral between primary care providers and orthopaedic surgeons is critical in preventing misdiagnosis and delayed treatment. Furthermore, the treatment of concomitant metabolic disorders and nutritional deficiency should not be neglected when treating distal femoral stress fractures. Level-IV (case series).

Comparing an Expanded Versus Brief Telehealth Physical Therapist Intervention for Knee Osteoarthritis: Study Protocol for the Delaware PEAK Randomized Controlled Trial.

The purpose of this study is to investigate whether a remotely delivered physical therapist intervention increases physical activity (PA) over 12weeks, compared with existing web-based resources, in adults with knee osteoarthritis (OA). This will be a single-center, randomized controlled trial with 2 parallel arms: (1) the Expanded Intervention (Delaware PEAK [Physical Exercise and Activity for Knee osteoarthritis]), which includes five 45- to 60-minute video conference-based sessions of supervised exercise (strengthening exercises, step goals) that are remotely delivered over 12weeks by a physical therapist; or (2) the Brief Intervention (control group), a website that includes prerecorded videos directing participants to web-based resources for strengthening, PA, and pain management for knee OA that are freely available. The trial will enroll 100 participants who meet the National Institute for Health and Care Excellence OA clinical criteria (≥45years old, have activity-related knee pain, and have no morning stiffness or it lasts ≤30minutes), reside in the contiguous United States (excluding Alaska and Hawaii), and are seeking to be more physically active. Outcomes include PA (time in moderate-to-vigorous and light PA, steps per day), sedentary behaviors, treatment beliefs, and self-efficacy for exercise. Our primary outcome is moderate-to-vigorous PA. Outcomes will be measured at baseline, 12weeks, and 24weeks. This protocol focuses on the remote delivery of physical therapy via telehealth to adults with knee OA and comes at a critical time, because the burden of inactivity is of particular concern in this population. If successful, the findings of this work will provide strong support for the broad implementation of Delaware PEAK, highlight the utility of telehealth in physical therapy, and address the critical need to utilize exercise to manage adults with knee OA through physical therapists.

Focal Periphyseal Edema (FOPE) Zone: A Possible Cause of Unexplained Knee Pain In Adolescents. A Case Report and Literature Review.

Focal periphyseal edema (FOPE) is a recently described condition seen on Magnetic Resonance Imaging (MRI) scans of adolescent patients in relation to knee pain. Since its description in 2011, and proposal as a possible reason for adolescent knee pain, few case series have been published. We report a case of an adolescent male with activity-related knee pain and FOPE finding on MRI scan of his knee. On reviewing medical literature we found nine case series reported with regards to FOPE zone. We have reviewed the demographic and clinical characteristics of the reported cases. With this report we aim to bring more awareness about this condition amongst orthopedic surgeons.

Patient experiences with physiotherapy for knee osteoarthritis in Australia—a qualitative study

ObjectivePhysiotherapists commonly provide non-surgical care for people with knee osteoarthritis (OA). It is unknown if patients are receiving high-quality physiotherapy care for their knee OA. This study aimed to explore...

"I've been to physical therapy before, but not for the knees." A qualitative study exploring barriers and facilitators to physical therapy utilization for knee osteoarthritis.

Physical therapy (PT) is recommended to reduce pain and improve function. However, only 10%-15% of adults with knee osteoarthritis (OA) use PT in the United States. The purpose of this study was to explore patient-reported barriers and facilitators to PT utilization for knee OA, to understand why PT is underutilized. Qualitative descriptive study using semi-structured interviews was conducted, that is, one-on-one phone interviews with adults from local community centers. Participants were eligible if they were fluent in English and self-reported knee OA (1) over 45 years of age, (2) have activity-related knee pain, and (3) have no morning stiffness or morning stiffness in the knee(s) for ≤30 min. Interviews were audio-recorded and transcribed. To identify barriers and facilitators to PT utilization for knee OA, a coding framework, thematic analysis, and a constant comparative approach were used. Of 22 participants with health insurance and who participated, 59% were considering PT, 23% refused PT, and 18% used PT for knee OA. Themes identified as either barriers or facilitators for participants were (1) previous experience with PT, (2) physician referral, (3) beliefs about treatment efficacy before and after knee replacement surgery, (4) insurance coverage, and (5) preference to avoid surgery. A previous positive encounter with PT and a physician referral may facilitate PT utilization for adults with knee OA. Knowledge about and access to PT services were not identified as barriers related to PT utilization. Further research is necessary to confirm findings in a broader group of adults with knee OA.

Prevalence and impact of knee osteoarthritis in runners

Purpose: The aim of this study was to investigate the prevalence and impact of knee osteoarthritis among recreational runners. Methods: This study is part of a randomized-controlled trial that investigated the effectiveness of an evidence-based online injury prevention program on running injuries, in preparation for a running event (from 5 km up to marathon) in recreational runners (N=2378). After registration, a baseline questionnaire informed on demographics, lifestyle characteristics, running characteristics and injury history. All participants received three follow-up questionnaires during the study period; two weeks before the running event they registered for, one day after the running event and one month after the running event. The follow-up questionnaires informed on running related injuries (RRIs) during follow-up. Participants that reported a new running related knee injury (RRKI) during the study period (N=277)were sent a knee-specific questionnaire after a mean of 16-months (range 11.7-18.6) follow-up. This questionnaire informed on the type of knee complaints, morning stiffness, activity related knee pain and self-reported diagnosis. In addition, the National Institute for Health and Care Excellence (NICE) guideline was followed to diagnose clinical knee osteoarthritis (OA).Participants were asked if they were recovered from their RRKI (yes/no) and time to recovery(weeks) was questioned. Information on medical consumption was obtained and all were asked whether the RRKI restricted their running in terms of running speed, duration and/or frequency. The subscales symptoms and sports of the Knee injury and Osteoarthritis Outcome Score (KOOS/100) and the Anterior Knee Pain Score (AKPS/100) were used to administer OA and patellofemoral specific outcomes at follow-up. T-tests and chi-square tests were used to describe differences between runners with and without knee OA. With cox regression analysis, the association between time-to-recovery and potential prognostic factors was determined. Results: Of the 277 runners that reported a new RRKI (11.6%) during follow-up, a total of 138 (49.8%) responded to the knee-specific follow-up questionnaire and were consequently included in the current study. Responders were on average significantly older (42.3 vs. 39.3 years, p=0.04). No other differences between responders and non-responders were observed. At baseline, study participants (N=138) were on average 42.3 (SD 12.2) years old, had an average BMI of 23.3 (SD 3.0) kg/m2 and the majority was male (59.4%). Participants trained on average 2.2 (SD 0.9) times a week, spend 2.6 (SD 1.5) hours a week on training with an average running speed of 6.0 (SD 0.9) min/km. At baseline, 36.2% of the participants reported an RRKI in the previous 12 months. At 16 month follow-up, 71.0% of the runners were recovered from their knee injury, with a mean recovery time of 10.5 (SD 9.9) weeks. Non-recovered participants had complaints for 54.4 (SD 4.8) weeks up to follow-up. Following self-diagnosis, most participants suffered from knee OA/degenerative meniscus lesions (23.2%)and iliotibial band syndrome (23.2%). Morning stiffness was reported by 26.0% of the participants. Following the NICE guidelines, 13.8% of the runners with incident knee injuries were diagnosed with knee OA at follow-up. Within the group of participants that had clinical knee OA following the NICE guideline, 5.1% was recovered and 35% was not-recovered from their knee injury (p<0.001). The presence of morning stiffness was associated with recovery rate (83.3% versus 36.1%, p<0.001). Runners with clinical knee OA had a significantly lower KOOS symptom score (65.3(20.0) vs 84.8(20.0), p<0.001) and AKPS (80.9(10.7) vs. 93.3(9.6), p<0.001) compared to runners with other types of RRKIs. Runners with a self-reported diagnosis of knee OA more frequently visited a health care professional (78.1% vs. 43.4%, p<0.001) compared to runners with other types of RRKIs, with especially a high percentage of visits to the physiotherapist (80%). The results of the COX regression for time to recovery shows that male sex (HR 1.90; 95%CI 1.17-3.09) was associated with a shorter time to recover from RRKIs, while participants diagnosed with knee OA following the NICE guideline (HR 0.18; 95%CI 0.06-0.53) had a longer time to recovery. Conclusions: Time-to-recovery from RRKIs is relatively long, which emphasizes the need for optimal treatment, education and injury prevention programs in recreational runners, especially in female runners. Furthermore, more knowledge on the impact of running with knee OA is important, given the high number of runners with knee OA symptoms and the longer time-to-recovery of RRKI in runners with knee OA.

Efficacy of specific bioactive collagen peptides in the treatment of joint pain

Efficacy of specific bioactive collagen peptides in the treatment of joint pain

The Inverted Discoid Meniscus Segment

Background: A flipped, or inverted, meniscus segment is easily visualized in the normal meniscus. However, an inverted discoid meniscus segment may be difficult to appreciate because the tear occurs more centrally and leaves more meniscal rim; thus, it may be undertreated if not addressed during arthroscopy. Purpose: To describe findings on clinical history, radiographs, MRI, and arthroscopy of a lateral discoid meniscus with an inverted segment and compare them with characteristics of a lateral discoid meniscus without an inverted segment. Study Design: Case-control study; Level of evidence, 3. Methods: Between 2009 and 2012, a retrospective series of 121 consecutive knee arthroscopies for symptomatic lateral discoid meniscus were reviewed for the presence of an inverted fragment. Chart review of clinical presentation, operative reports, radiographic images, and arthroscopic images was performed. Comparative analysis of the clinical presentation between lateral discoid menisci with an inverted segment and noninverted lateral discoid menisci was performed by use of Fisher exact test and Mann-Whitney test. Results: Nineteen patients with an inverted discoid meniscus segment (14 males, 5 females; average age, 15.0 years; range, 9.5-17.0 years) were compared with 102 patients with a noninverted discoid meniscus (53 males, 49 females; average age, 12.3 years; range, 5-17.0 years) (P = .011 for sex and P < .001 for age). All 19 discoid meniscus patients with an inverted segment had activity-related knee pain. Only 4 patients (21.0%) reported mechanical symptoms. Patients with an inverted discoid segment, compared with patients with discoid menisci without inverted segments, were more likely to have instability and effusion (P = .012 and P < .001, respectively). Eighteen discoid meniscus patients with an inverted segment (94.7%) had an injury, while only 41.2% of patients with noninverted symptomatic discoid menisci had an injury (P < .001). On MRI, an inverted discoid segment was seen as a horizontal longitudinal tear, a free fragment, or a double meniscus. During arthroscopy, the inverted discoid segment appeared normal, without a tear; upon probing, however, the inverted segment could be exposed. Conclusion: An inverted discoid segment occurs during adolescence, and it is more likely to occur in male patients and more likely to be associated with activity-related pain and injury compared with a noninverted symptomatic discoid meniscus. A discoid meniscus with an inverted segment does not have the standard radiographic and arthroscopic features normally associated with a discoid meniscus.

Juvenile Osteochondritis Dissecans of the Knee

Juvenile osteochondritis dissecans (jOCD) of the knee is a focal stress reaction to the subchondral bone that occurs in skeletally immature adolescent athletes. It is thought to be related to overuse and classically occurs at the posterolateral aspect of the medial femoral condyle. It presents with aching, activity-related knee pain, occurring bilaterally in 25% of cases. jOCD of the knee is best seen on intercondylar notch view (“tunnel”) radiographs, whereas magnetic resonance imaging is useful for determining lesion stability. Small, stable jOCD lesions are treated conservatively with activity modification possibly combined with immobilization and/or limitation of weight bearing. Operative intervention is reserved for stable lesions that do not heal after 6 to 9 months of conservative management, for large stable lesions in children approaching skeletal maturity, and for most unstable lesions. Arthroscopic retrograde transarticular drilling is our preferred treatment for stable lesions. Internal fixation is added for larger or unstable lesions. Damaged and unsalvageable jOCD lesions or displaced jOCD lesions devoid of subchondral bone are generally treated initially with debridement and abrasion arthroplasty (microfracture). Other cartilage repair techniques may be used for failures of the previously described treatment. Excellent short-term results have been reported with these techniques, although long-term data are lacking regarding the future development of osteoarthritis in this young patient population.