Cause Of Knee Pain Research Articles

Structural And Morphologic Maladaptation Underlies Patellar Tendinopathy Following ACL Injury

Anterior cruciate ligament (ACL) rupture is a prevalent sports injury associated with prolonged muscle weakness and atrophy. Patellofemoral pain is also common following ACL injury, but the direct impact of ACL injury on knee tendons has not been defined. Tendons are crucial for force transmission from muscle to bone, and the highly structured collagen network within tendon supports optimal load bearing and force transduction. With development of tendinopathy—a common cause of knee pain and restricted sports participation—normal tendon morphology shifts to a pathologic phenotype with altered collagen content and organization, which may contribute to impaired sports performance. PURPOSE: Determine if altered morphology representative of tendinopathy exists in patellar tendon after ACL injury. METHODS: Surgical ACL transection (ACL-T) was performed unilaterally on healthy adult mice (n=7). The patellar tendon was collected from injured and uninjured knees 7d after ACL-T and processed for morphological analysis. Immunohistochemical and histological techniques were used to assess collagen structure and abundance and tendon morphology. RESULTS: Collagen 1 content in the patellar tendon of the injured knee was significantly elevated by 78% at 7d after ACL-T (30.7 ± 3.3 pixels/μm2 vs. 17.2 ± 5.7 pixels/μm2; p=0.03). The collagen 3 to collagen 1 ratio was similarly higher in patellar tendon from the injured knee (0.09 ± 0.05 vs. 0.05 ± 0.04) but did not reach statistical significance. Densely packed collagen was 18% lower in the patellar tendon of the ACL-T injured knee (1.5 ± 0.3 pixels/μm2 vs. 1.8 ± 0.2 pixels/μm2; p=0.08). CONCLUSIONS: Collagen 1 content is starkly elevated in patellar tendon 7d after ACL-T in mice, consistent with tendinopathy. ACL injury was associated with reduced abundance of densely organized collagen, despite the elevated abundance of collagen 1. These findings are consistent with tendon pathology and may impair tendon loading capacity and force transduction. These data are the first to identify patellar tendon structural and morphologic maladaptation following ACL injury. Support: R01 AR072061

Patellofemoral Instability Part I: Evaluation and Nonsurgical Treatment

Patellofemoral instability (PFI) is a prevalent cause of knee pain and disability. It affects mostly young females with an incidence reported as high as 1 in 1,000. Risk factors for instability include trochlear dysplasia, patella alta, increased tibial tubercle-to-trochlear groove distance, abnormal patella lateral tilt, and coronal and torsional malalignment. Nonsurgical and surgical options for PFI can treat the underlying causes with varied success rates. The goal of this review series was to synthesize the current best practices into a concise, algorithmic approach. This article is the first in a two-part review on PFI, which focuses on the clinical and radiological evaluation, followed by nonsurgical management. The orthopaedic surgeon should be aware of the latest diagnostic protocol for PFI and its nonsurgical treatment options, their indications, and outcomes.

A case of mucoid hypertrophic degeneration of anterior cruciate ligament with ganglion cyst causing extension block treated with arthroscopic debridement of the cyst and partial debulking surgery

<p class="abstract"><span lang="EN-US">Mucoid degeneration of anterior cruciate ligament (ACL) is an uncommon cause of knee pain and restriction of movements. It uncommonly presents with a coexisting ACL ganglion cyst. Typically present between ages of 40-60 years, however, the true incidence and symptoms are variable. We present our experience with one such case with loss of knee extension treated with arthroscopic debulking. The patient regained both full range of motion and resolution of symptoms after the treatment.</span></p>

Association of eccentric quadriceps torque with pain, physical function, and extension lag in women with grade ≤ II knee osteoarthritis: An observational study.

Knee osteoarthritis (OA) is a prevalent disabling disease among women and quadriceps weakness is attributed to one of the causes of knee pain (KP) and disability. The study aimed to test the correlation of eccentric quadriceps torque (EQT) with 2 subscales of the reduced WOMAC questionnaire (KP and physical function) and extension lag range of motion (ROM) at the knee joint in osteoarthritic women.A cross-sectional design was used. A total of 70 patients (mean age 41.1 years) who had grade I or II knee OA participated in the study. The pearson correlation coefficient was used to test the correlation between the EQT and 2 subscales of the reduced WOMAC questionnaire and extension lag ROM.EQT presented a significant moderate negative correlation with pain (r = –0.489, P < .001) and physical function (r = –0.425, P < .001), and low positive correlation with available ROM (R = 0.349, P < .001).KP, physical function, and extension lag in the early stages of knee OA in women are associated with EQT. Therefore, designing a rehabilitation program that has eccentric quadriceps strengthening exercises may improve KP and physical activities, but more randomized controlled trials are needed to verify this.

Tibial Tubercle Osteotomy With Anteriorization and Distalization for Treatment of Patellar Instability With Patella Alta

Patellofemoral instability is a common cause of knee pain that can lead to long-standing pain, chondral injury, recurrent dislocations, and degenerative changes if not treated appropriately. Tibial tubercle osteotomy is indicated when there is anatomy predisposing to patellar maltracking and instability, namely abnormal patellar height or tibial tubercle location. In this Technical Note, we describe a technique for tibial tubercle anteriorization and distalization as part of the overall treatment algorithm for patellar instability with associated patella alta. This method of tibial tubercle osteotomy reliably produces anterior and distal translation of the patella to correct patellar height and decrease contact pressure across the patellofemoral joint.

Osgood-Schlatter disease: a review of current diagnosis and management

Osgood-Schlatter disease is a common cause of knee pain in children and adolescents, particularly in those who participate in sports. Repetitive force during athletic activities, along with changes that happen during a growth spurt, result in the development of traction apophysitis. Because of its typical presentation, the diagnosis is usually made clinically. The disorder generally resolves with skeletal maturity, and most patients respond to conservative therapy. Surgery can be considered in recalcitrant cases. Several approaches of surgical intervention have been proposed; each approach has its advantages and disadvantages.

Osgood-Schlatter Disease in youth elite football: Minimal time-loss and no association with clinical and ultrasonographic factors

BackgroundOsgood-Schlatter Disease is the most common cause of knee pain in youth. Scientific research in youth elite football is limited. ObjectivesTo assess clinical and ultrasonographic factors associated with Osgood-Schlatter Disease and calculate point prevalence of clinical diagnosis and time-loss in youth elite male football. Study designNested case-control study and cross-sectional prevalence study; Level of evidence: 3. MethodsWe obtained data during the pre-season periodic health evaluation. Osgood-Schlatter Disease diagnosis was defined as (1) athlete-reported anterior knee pain and (2) clinical confirmation by pain provocation at the tibial tuberosity. Time-loss was defined as inability to participate in team training and/or competition.For the nested-case control study, we examined clinical and ultrasonographic factors in the U13 to U16 teams. We matched on calendar-age. The clinical factors were: self-reported history of Sever's disease, growth measures, leg muscles flexibility and strength and ultrasonographic bone maturity stages according to Ehrenborg, For the cross-sectional study, we included players of the U13 to U19 teams to calculate the point prevalence. ResultsThe case-control study consisted 30 players and the cross-sectional study 127 players. Previous Sever's disease was strongly associated with Osgood-Schlatter Disease (OR = 16.8; p = 0.02; 95% CI = 1.6–174.5). None of the other clinical or ultrasonographic factors were associated. The point prevalence was 17% and 80% had no time-loss despite presence of clinical symptoms. ConclusionConsidering the 16.8OR, previous Sever's disease indicates a strong association with Osgood-Schlatter Disease. Although generally suggested, growth velocity and bone maturity are not associated in an age-matched comparison.

Prevalence of Patellofemoral Pain Syndrome Among Sports Sciences Students In Lahore

Patellofemoral pain syndrome is characterized by severe pain around the knee cap during physical activities. Many researches have been done to describe the causes of PFP and it is found that it is multifactorial in nature. It is suggested that Patellofemoral pain can persist for many years and can cause decline in sports participation. Muscular imbalance and over activity are major causes of knee pain in Sports related PFP .Multiple management strategies are used in the intervention protocol of PFP however, more research is required to find potential causes of knee pain and its management in sport sciences. Objective: The aim of this study is to find out prevalence of Patellofemoral Pain Syndrome among Sports Sciences students in Lahore. Methods: This is an observational study; cross sectional survey with 306 estimated sample size 288 participants were respondents but remaining 18 were non respondents and data is collected from students of sports sciences department in mentioned universities using Kujala Scoring questionnaire. Data is entered and analyzed using SPSS version 21. Results: The results shows that age of participants were between 19 to 25 years. Number of male(62.15%) participants were more than female(37.85%) participants .prevalence of PFP among sports sciences students is 63.54%( N=183) with mild or no symptoms of anterior knee pain, 26.74%(N=77) with moderate symptoms and 9.72% (N=28) with severe symptoms of Patellofemoral pain syndrome. Conclusion: According to the results we concluded that there are mild or no symptoms of Patellofemoral Pain Syndrome in 63.54 % Sports Sciences Students in Lahore,26.74 % Sport Sciences Students have moderate symptoms of Anterior Knee joint Pain and 9.72% Sports Sciences Students have severe Symptoms Of Patellofemoral Pain Syndrome

A Case of Chronic Deep Infrapatellar Bursitis Complicated by Patellar Tendinopathy and its Evaluation With Musculoskeletal Ultrasound

Knee pain is a very common complaint in routine physiatry and orthopedic practice. While bursitis is a well-known and common cause of knee pain, deep infrapatellar bursa (DIPB) involvement is relatively less common. Inflammation of DIPB occurs commonly due to either direct trauma or overuse, but other rare causes have also been reported in the literature including infection, juvenile idiopathic arthritis, gout, and juvenile ankylosing spondylitis. We report a case of chronic inflammation of DIPB caused by direct trauma and associated with patellar tendinopathy. Additionally, we describe the characteristic findings on musculoskeletal ultrasonography (MSK-USG). For ultrasound evaluation, the patient should lie supine with the knee slightly flexed. Deep infrapatellar bursitis can be seen as an anechoic fluid-filled structure immediately posterior to the distal patellar tendon and anterior to the tibial tuberosity. While MRI can confirm the diagnosis of bursitis, MSK-USG can be quick, highly sensitive, and is able to confirm the diagnosis as well as to detect dynamic changes in the patellar tendon and adjacent structures. USG can also help in the treatment by guiding corticosteroid injection into the bursa. Activity modification and eccentric exercises play an important role in the rehabilitation program in these cases.

Bracing for the Patellofemoral Joint.

Patellofemoral disorders are common causes of knee pain that result in frequent visitations to musculoskeletal care clinics. Patellar tendinopathy, patellar instability and patellar maltracking, and pain are some of the most common pathologies resulting in patellofemoral dysfunction. For each of these diagnoses, there are unique orthoses and braces available, some of which are uniquely designed to address the pathology involved. While the spectrum of patellofemoral disorders is wide ranging and can often be challenging to treat, bracing frequently plays a large role in the overall treatment algorithm. In this article, we summarized the current literature and treatment recommendations related to the most common types of patellar braces. We performed a thorough review of randomized controlled trials and up to date literature to reach well-informed conclusions on current best practice regarding the uses of patellar braces for patellofemoral disorders.

Rate of force development in the quadriceps of individuals with severe knee osteoarthritis: A preliminary cross-sectional study.

Knee osteoarthritis (KOA) is a leading cause of knee pain and disability due to irreversible cartilage degeneration. Previous studies have not identified modifiable risk factors for KOA. In this preliminary cross-sectional study, we aimed to test the following hypotheses: individuals with severe KOA would have a significantly lower quadriceps rate of force development (RFD) than individuals with early KOA, and the decrease in quadriceps RFD would be greater than the decrease in maximum quadriceps strength in individuals with severe KOA. The maximum isometric strength of the quadriceps was assessed in individuals with mild (Kellgren and Lawrence [K&L] grade 1-2) and severe KOA (K&L grade 3-4) using a handheld dynamometer. The RFD was analyzed at 200 ms from torque onset and normalized to the body mass and maximum voluntary isometric contraction torque. To test whether the quadriceps RFD was lowered and whether the lower in the quadriceps RFD was greater than the lower in maximum quadriceps strength in individuals with severe knee OA, the Mann-Whitney U-test and analysis of covariance were performed, respectively. The effect size (ES) based on Hedges' g with a 95% confidence interval (CI) was calculated for the quadriceps RFD and maximum quadriceps strength. Sixty-six participants were analyzed. Individuals with severe KOA displayed significantly lower quadriceps RFD (p = 0.009), the lower being greater than the lower in maximum quadriceps strength (between-group difference, ES: 0.88, -1.07 vs. 0.06, -0.22). Our results suggest that a decreased quadriceps RFD is a modifiable risk factor for progressive KOA. Our finding could help in the early detection and prevention of severe KOA.

Current Concepts in the Management of Patellofemoral Pain Syndrome

IntroductionPatellofemoral pain syndrome (PFPS) is one of the leading causes of knee pain, manifesting itself during daily life activities. This study presents a review on PFPS treatment modalities. Materials and methodsState of the art review on the treatment of PFPS with grades of recommendation. Active and passive conservative interventions are reviewed, as well as surgical alternatives. ResultsHip and lower-limb muscle strengthening and stretching are active interventions that provide long-lasting benefits. Passive interventions include patellofemoral joint bracing, kinesiotaping and foot orthoses, and are considered useful coadjuvants to active interventions, with quick relief for patients but usually in the short term. Surgical treatment is only recommended in a small subset of patients with specific anatomic abnormalities in the patellofemoral joint. DiscussionConservative treatment remains as the mainstream in the management of patellofemoral pain syndrome. Level of EvidenceIV, Clinical Review.

The correlation between clinical and radiological severity of osteoarthritis of the knee.

Introduction: Primary osteoarthritis (OA) is a common cause of knee pain. Appropriate management of knee OA is based on clinical and radiological findings. Pain, deformity, and functional impairments are major clinical factors considered along with radiological findings when making management decisions. Differences in management strategies might exist due to clinical and radiological factors. This study aims at finding possible associations between clinical and radiological observations. Methods: A prospective cross-sectional study of 52 patients with primary osteoarthritis of the knee managed conservatively at a tertiary hospital arthroplasty clinic was conducted for three months. English speaking patients with primary OA were identified and included in this study. Pain and functional impairment were assessed using Wong-Baker Faces pain scale, The Knee Society Score (KSS), and Western Ontario and McMaster Osteoarthritis Index (WOMAC). The Body Mass Index (BMI) of all participants was measured. Standard two views plain radiographs were used for radiographic grading of the OA. Anonymized radiographs were presented to two senior consultant orthopaedic surgeons who graded the OA using Kellgren and Lawrence (KL) and Ahlbäck classification systems. The severity of the functional impairment and pain score was then compared to the radiological grading. Results: The average age of our participants was 63 ± 9 years. Their average BMI was 34.9 ± 8.4 kg/m2, median self-reported pain, total WOMAC, and pain WOMAC scores were 8, 60, and 13, respectively. We observed no significant correlation between BMI and pain scores. Inter-rater reliability for KL and Ahlbäck grading was strong. There was no significant correlation between WOMAC scores and the radiological grades. Conclusion: There was no correlation between pain and functional scores, patient factors and radiological severity of OA of the knee.

Validation of knee osteoarthritis case identification algorithms in a large electronic health record database

PurposeTo facilitate studies of knee osteoarthritis (OA) in large databases, case finding algorithms with high levels of diagnostic performance are needed. MethodsFrom a UK general practitioner (GP) practice derived database, we selected adults ages 40–90 years meeting algorithms that included various combinations of codes for knee OA or knee pain and imaging. The GP for each patient was mailed a questionnaire to assess the cause of knee pain and provide knee x-ray and/or MRI findings. We considered knee pain with x-ray and/or MRI findings consistent with OA the gold standard. We calculated positive predictive values (PPV) and sensitivity for case identification algorithms. ResultsOf 100 questionnaires sent, 93 were returned; we excluded 8 subjects who had other rheumatic disorders or total knee replacements. Among those with one code for OA, the PPV was 64% (95% CI ​= ​49%–79%) and it increased to 92% (95% CI ​= ​76%–100%) when two or more OA codes over six months were required. The increase in PPV was accompanied by a drop in sensitivity from 44% (95% CI ​= ​31%–57%) to 19% (95% CI ​= ​9%–30%). Use of one pain code yielded similar results to use of one OA code. Requiring two or more knee pain codes over six months yielded a PPV of 68% (95% CI ​= ​49%–88%) and sensitivity of 26% (95% CI ​= ​15%–38%). DiscussionA case identification algorithm requiring two or more knee OA codes yielded the highest PPV at the cost of reduced sensitivity. Tradeoffs between PPV and sensitivity will need to be weighed alongside study goals when selecting a case identification algorithm.

Outcomes After Surgical Excision of Knee Osteochondromas

Source: Wu M, Zheng ET, Anderson ME, et al Surgical treatment of solitary periarticular osteochondromas about the knee in pediatric and adolescent patients: complications and functional outcomes. J Bone Joint Surg Am. 2021;103(14):1276-1283; doi:10.2106/JBJS.20.00998Investigators from multiple institutions conducted a cohort study to assess outcomes in children after surgical excision of solitary knee osteochondromas (SKO). Patients ≤19 years old who underwent surgery for histology-confirmed SKO at the study hospital from 2003–2016 were included. Demographics and clinical features, such as SKO chief presenting symptom, type (sessile or pedunculated), and site (distal femur, proximal tibia, or proximal fibula), were abstracted from the medical record.The primary outcomes were major surgical complications and post-surgical functional outcomes. Major complications were obtained from the medical record and defined as Clavien-Dindo Grade III complications, such as recurrence-required surgical excision, deep wound infection, intraoperative vascular injury, and persistent pain. Post-surgical functional outcomes were assessed by administering 2 validated functional outcome measures (Pediatric International Knee Documentation Committee measure, or Pedi-IKDC, and Hospital for Special Surgery Pediatric Functional Activity Brief Scale, or Pedi-FABS) among those who could be reached by letter and/or telephone post-surgery. The Pedi-IKDC is scored from 0-100, and the Pedi-FABS is scored 0-30, with higher scores on each measure suggesting better functional ability. Investigators used multivariate regression to assess the association between demographic and clinical features with outcomes after adjusting for potential confounders.There were 264 patients included in analysis, 43% of whom provided post-surgical functional outcome data at a mean duration of follow-up of 5.8 years. Overall, most patients were male (58%), were athletes (81.4%), and had a chief presenting symptom of pain (90%). Most SKOs were pedunculated (65%) and were located in the distal femur (59%).There were 6 patients (2%) who had major complications, including 3 with recurrence requiring surgical excision. The mean Pedi-IKDC and Pedi-FABS scores were 97 and 16.7, respectively. The odds of a major complication were significantly lower in older children, pedunculated lesions, and lesions in the proximal tibia.The investigators conclude that surgical excision of SKOs was associated with infrequent major complications and good functional outcomes.Dr Hennrikus has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.A solitary osteochondroma is the most common benign bone tumor in children and adolescents.1 The tumor stems from a developmental disorder in the growth plate resulting in a metaphyseal bony projection with a cartilaginous cap. The tumor can be pedunculated or sessile.2 In approximately 15 % of cases, multiple tumors occur due to the autosomal dominant disorder, multiple hereditary exostoses.3As the child grows, the osteochondroma also grows. The osteochondroma can cause symptoms due to irritation of adjacent tendons, nerves, or arteries.4 In children and adolescents, surgical excision is indicated if symptoms such as pain, swelling, or snapping are present. In rare cases, if the osteochondroma has not been excised in childhood, malignant transformation as an adult can occur.5The current study is the largest consecutive series of patients from 1 institution investigating the peri-operative complications and functional outcomes following surgical excision of solitary knee osteochondromas in pediatric and adolescent patients. A total of 264 cases were reviewed over a 14-year study period. All had radiographic diagnosis and histologic confirmation of the diagnosis by a pathologist. Sixty-five percent of tumors were pedunculated, and 35% were sessile. Fifty-nine percent were located at the distal femur, and 41% were at the proximal tibia or fibula. Sixty-nine percent were located on the medial knee, and 31 % were lateral. Ninety-six percent of patients returned to sports at an average of 2.5 months. Patient-reported outcome scores were excellent. Only 6 patients had a complication requiring re-operation, including 3 who had a recurrence of the tumor due to inadequate excision.The authors concluded that regardless of the orthopaedic surgeon’s fellowship training (oncologist, sports medicine, or pediatrics) or the location of the osteochondroma, surgical excision of the benign tumor resulted in excellent outcomes with minimal complications.Surgical excision of solitary osteochondromas about the knee in children and adolescents is safe and effective. As these benign tumors commonly present in adolescent athletes, pediatricians need to keep osteochondromas in the differential diagnosis of causes of knee pain.

Radiographic Findings in Flexion Instability after Total Knee Arthroplasty.

Flexion instability (FI) is one of the leading causes of knee pain and revision surgery. Generally, the biomechanical etiology is considered to be a larger flexion than extension gap. This may be due to mismatch of components sizes to the bone or malalignment. Other factors such as muscle weakness may also play a role, and the diagnosis of FI after total knee arthroplasty (TKA) relies on a combination of patient's complaints during stair descent or walking and physical examination findings. Our study examines the role of implant positioning and sizes in the diagnosis of FI. A retrospective review of 20 subjects without perceived FI and 13 patients diagnosed with FI after TKA was conducted. Knee injury and osteoarthritis outcome scores (KOOS) were documented, and postoperative radiographs were examined. Measurements including included tibial slope, condylar offset, femoral joint line elevation along with surrogate soft-tissue measures for girth and were compared between groups. The FI group was found to have a significantly lower KOOS score compared with the non-FI group (55.6 vs. 73.5; p = 0.009) as well as smaller soft-tissue measurements over the pretubercle region (6.0 mm vs. 10.6 mm; p = 0.007). Tibial slope, condylar offset ratios, and femoral joint line elevation were not significantly different between the FI and non-FI groups. We noted a significant difference in tibial slope in posterior-stabilized implants in subjects with and without FI (6.4° vs. 1.5°; p = 0.003). Radiographic measurements consistent with malalignment were not indicative of FI. X-ray measurements alone are not sufficient to conclude FI as patient symptoms, and clinical examinations remain the key indicators for diagnosis. Radiographic findings may aid in surgeon determination of an underlying cause for an already identified FI situation and help in planning revision surgery.

Symptomatic Calcification within the Lateral Collateral Ligament of Knee: A Case Report on Rare Abnormality

Introduction: Lateral collateral ligament calcification is a rare cause of knee pain. There are only a handful of case reports, and the findings are usually incidental and asymptomatic. The exact mechanism for calcific deposit remains unclear. We present a case of symptomatic calcification within the lateral collateral ligament treated by surgical enucleation. Case presentation: A 52-year-old active woman presented with complaints of pain over the lateral aspect of the left knee of 6 months’ duration. Her pain was severe, aggravated on descending stairs but relieved on rest. Clinical examination revealed tenderness over the lateral aspect of the knee joint. Standard standing anterior-posterior radiograph of the left knee revealed a homogenous dense opacity adjacent to the lateral femoral condyle. Conclusion: Calcification within the lateral collateral ligament is rare and treatment is determined by whether the patient is symptomatic or not. If symptoms of the patient cannot be alleviated with a conservative approach, we recommend a surgical enucleation of the calcification, which in our case had good results. Keywords: Calcification, Knee pain, Lateral collateral ligament

The effects of knee pain on knee contact force and external knee adduction moment in patients with knee osteoarthritis

Knee osteoarthritis (OA) is a major cause of knee pain, leading to physical dysfunction. External knee adduction moment (KAM), a surrogate measure of knee contact force (KCF) in the medial compartment, is related to knee pain, but the association between KCF and pain severity remains unclear. This study aimed to reveal the differences in KCF due to pain severity. Twenty-eight patients with knee OA were evaluated knee symptoms including pain severity via the Knee Society Score. Based on the median symptom score, 17 points in this study, subjects were classified as having Mild symptomatic OA (n = 15) and Severe symptomatic OA (n = 13). Subjects walked three times at a comfortable speed along a six-meter walkway, and we calculated KAM during the stance phase. KCF magnitude and distribution were also computed using the subject-specific musculoskeletal model, considering physical characteristics such as the femorotibial angle measured by X-ray. No differences in physical characteristics such as femorotibial angle and gait speed were found by symptom severity, whereas KAM and medial KCF at minimum and second peak in Severe symptomatic OA patients were significantly greater than those in Mild symptomatic OA. A significant medial shift of KCF in Severe symptomatic OA was also seen at first peak and minimum. Severe symptomatic OA had a greater medial KCF and medial shift of KCF. Detailed evaluations of KCF magnitude and distribution in addition to KAM would provide crucial information on knee contact force in relation to symptom severity.

Nationwide Cross-Sectional Study of the Association between Knee Pain and Weight Change: Analysis of the Korea National Health and Nutrition Examination Survey (KNHANES 2013-2015).

The knee is a hinge joint that provides stability and control, which are essential in daily life. Obesity is a major cause of knee pain and its incidence continues to increase worldwide. In this study, we analyzed Korea National Health and Nutrition Examination Survey data on the general population, and showed an association between weight change and knee pain. A total of 22,948 participants were enrolled; those under the age of 50 and those who did not answer the questions about knee pain or weight change were excluded. In all, 8480 patients were analyzed, 7001 (82.56%) of whom indicated that they did not have knee pain, versus 1479 (17.44%) who did experience knee pain. Multivariate regression analysis was performed to analyze the association between knee pain and weight change. With full adjustment for covariates, weight gain per se (OR 1.37; p = 0.002), and gains of 3–6 kg (OR 1.28; p = 0.029) and ≥6 kg (OR 1.62; p = 0.012), showed significant associations with knee pain. This cross-sectional study confirmed a significant association between knee pain and weight change. Therefore, when evaluating patients with knee pain, it is necessary to evaluate weight gain.

Magnetic Resonance Imaging Evaluation of Patellofemoral Joint.

Patellofemoral pain is the leading cause of knee pain in young adults. Magnetic resonance imaging plays an important role in early diagnosis of patellofemoral joint pathology. This study was carried out to evaluate the patellofemoral joint using magnetic imaging resonance and describe various predisposing factors for patellofemoral instability. The study was carried in Department of Radiology, BPKIHS over a period of six months from February 2020 to August 2020. All patients with clinical diagnosis of patellar instability were included and Magnetic resonance imaging was done using standard knee protocol and findings were noted on structured proforma. Analysis was done using statistical package for the social sciences version 20 applying simple descriptive statistical methods. A total of 60 patients who underwent MRI knee were analyzed, out of which 28(46.7%) patients were male while 32(53.3%) patients were female. 44 patients (58.3%) had various predisposing factors for patellar instability. The commonest predisposing factor was patellar subluxation (73.3%) followed by abnormal trochlear groove angle (58.3%) and patellar translation (increased tibia tubercle trochlear groove distance) (53.3%). Various MRI findings in our study were bone contusion (28 cases,46.7%), joint effusion (36 cases,60%), medial patellofemoral ligament injury (11cases ,18.3%), erosion of patellar cartilage (5 cases,8.3%), femoral cartilage erosion (3 cases,5%),loose bodies (2 cases,3.3%), subchondral edema (3 cases,5%) and meniscus injury (18 cases,30%). Magnetic resonance imaging is not only useful in assessing lesions of the bone, cartilage and ligaments of patellofemoral joint but also enables detection of various predisposing factors for patellofemoral instability.