Cause Of Knee Pain Research Articles

Increased incidence of acute patellar dislocations and patellar instability surgical procedures across the United States in paediatric and adolescent patients.

PurposePatellofemoral instability is a common cause of knee pain and dysfunction in paediatric and adolescent patients. The purpose of the study was to evaluate the frequency of patellar dislocations seen in emergency departments (EDs) and the rates of surgical procedures for patellar instability at paediatric hospitals in the United States between 2004 and 2014.MethodsThe Pediatric Health Information System database was queried for all paediatric patients who underwent surgery for patellar instability or were seen in the ED for acute patellar dislocation between 2004 and 2014. This was compared with the annual numbers of overall orthopaedic surgical procedures.ResultsBetween 2004 and 2014, there were 3481 patellar instability procedures and 447 285 overall orthopaedic surgical procedures performed at the included institutions, suggesting a rate of 7.8 per 1000 orthopaedic surgeries. An additional 5244 patellar dislocations treated in EDs were identified. Between 2004 and 2014, the number of patellar instability procedures increased 2.1-fold (95% confidence interval (CI) 1.4 to 3.0), while orthopaedic surgical procedures increased 1.7-fold (95% CI 1.3 to 2.0), suggesting a 1.2-fold relative increase in patellar instability procedures, compared with total paediatric orthopaedic surgeries.ConclusionThis study shows a significant rise in the rate of acute patellar instability treatment events in paediatric and adolescent patients across the country. Surgery for patellar instability also increased over the study period, though only slightly more than the rate of all paediatric orthopaedic surgical procedures. This may suggest that increasing youth sports participation may be leading to a spectrum of increasing injuries and associated surgeries in children.Level of EvidenceIV

Heterotopic ossification in the post cruciate ligament of the knee: a case report and literature review

BackgroundHeterotopic ossification (HO) is noted most frequently in periarticular muscles and has not yet been reported in the cruciate ligaments of the knee. We present a rare case of symptomatic ossification of the posterior cruciate ligament (PCL).Case presentationA 59-year-old woman had a 2-year history of knee pain that was getting worse during knee motion and had restricted knee motion for 1 year. X-rays could not show the lesion clearly. Multi-planar computed tomography demonstrated ossification within the PCL with mild osteoarthritic changes and excluded any other intra-articular pathology. The patient underwent arthroscopic debridement and then experienced immediate relief of pain and complete recovery of range of motion.ConclusionThis is the first report of HO in the PCL as a possible cause of knee pain and restricted knee motion. On the basis of literature review, this case elaborates the difference between HO and calcification in the ligaments, the related factors inducing HO and the undefined pathogenesis, and favorable prognosis after adequate treatment.

INFLUENCE OF GENDER ON PAIN, QUALITY OF LIFE, AND PHYSICAL ACTIVITY IN PATIENTS WITH KNEE OSTEOARTHRITIS

Osteoarthritis is the most common cause of knee pain which contributes to adults’ disability. Females have an increased risk of knee osteoarthritis. However, little is known about the gender influence in pain perception, quality of life (QOL), and physical activity. Hence, this study aimed to investigate the influence of gender on pain perception, QOL, and physical activity in patients with knee osteoarthritis. A cross-sectional study design with a total of 186 patients(mean age of 56.64 ± 6.49) with knee osteoarthritis were recruited. Pain intensity, level of physical activity, and QOL of patients were assessed using a visual analog scale (VAS), global physical activity questionnaire (GPAQ), and Short Form-36 (SF-36) questionnaire. Among the studied patients, 52% of patients with knee osteoarthritis had a relatively low level of physical activity with females representing the majority of them. Lower mean was observed in QOL and physical activity whereas pain intensity was higher in females compared to males (p < 0.05). Pearson correlation demonstrated a strong negative correlation between physical activity and pain (r = -0.77, n = 186, p <0.01), and a weak correlation exist between physical activity and all domains of QOL except for the functional capacity and body pain. Majority of female participants with knee osteoarthritis exhibit poor QOL, physical activity, and increased pain intensity as compared to males. Clinicians need to be aware of the influence of gender in treating patients with knee osteoarthritis.

IMMEDIATE AND SHORT TERM EFFECTS OF MULLIGAN MOBILIZATION WITH MOVEMENT, ON PAIN, DISABILITY AND RATIO OF VASTUS MEDIALIS AND VASTUS LATERALIS ACTIVITY IN INDIVIDUALS WITH KNEE OSTEOARTHRITIS IN THE AGE GROUP 50-70 YEARS.

Knee osteoarthritis is a common cause of knee pain and functional impairment. In this study immediate and short term effect of Mulligan mobilization with movement (MWM) technique on Pain,disability,and ratio of vastus medialis and vastus lateralis activity were assessed on 40 individuals with knee osteoarthritis in the age group of 50-70 years. Method- Duration of study for each participant was 2 weeks which included 4 sessions- on day 1,3,5 and 12.Immediate effect was assessed immediately after each treatment session and short term effect was assessed one week after the nal treatment session i.e on day 12.Outcome measures were Numerical Pain Rating Scale,Knee outcome Survey and EMG activity of vastus medialis and vastus lateralis. Result-Signicant immediate effect of MWM on pain was obtained in every session.(p<0.0001).There was signicant short term effect of Mulligan on pain. (p<0.0001).Signicant effect of MWM on disability reduction was also seen (p<0.0001). There was no immediate or short term effect of MWM on ratio of EMG activity of vastus medialis and vastus lateralis muscles.(p=0.5) Conclusion- Mulligan MWM has immediate and short term effect on pain and disability but not on ratio of vastus medialis and vastus lateralis activity in individuals with knee osteoarthritis in the age group of 50-70 years.

Non traumatic knee effusion: Pointer or Decoy? The commonly missed relationship of knee swelling with Lumbar disc disease: “The Dervan knee effusion sign”

Introduction: Knee pain and swelling are known amongst orthopedic surgeons as symptoms of a local pathology arising from the knee joint area. It is also often used by patients as an ‘umbrella term’. Although in most cases the causative pathology may be the knee joint itself, however, this umbrella term can cause prejudice among clinicians to look at only locally and not think of a lumbar pathology as a cause of knee pain and swelling. The objective of this pilot study was to make clinicians aware that causes knee pain and swelling may be beyond the anatomical confinements of the knee. Material and Methods: This is a prospective study in which we evaluated consecutive patients with non-traumatic knee joint pain and effusion coming in our hospital from 1st January to 1st February 2020. Detailed history and clinical examination were taken. After ruling out obvious causes of non-traumatic knee pain and effusion in these patients, we included 38 patients based on our inclusion and exclusion criteria. Written informed consent was taken. They were evaluated for knee joint with radiographs and lumbar spine with radiographs and MRI. Arthrocentesis and synovial fluid evaluation were done.Results: After synovial fluid examination, 2 patients were found to have subclinical inflammatory arthritis and were excluded out of the study. 36 of the 38 patients had a normal study on arthrocentesis. 2 out of these 36 patients had no abnormalities on spine MRI. Out of the remaining 34, 30 had disc degenerative disease at L45 or L5S1 (25 patient L4-5, 3 patient L5-S1, 4 patients with both L4-5 and L5-S1), 1 patient had a L34 disc degenerative disease, 3 patients had Grade 2 L45 spondylolisthesis with mild or no back pain. Conclusion: Although a disc degeneration can be seen incidentally in many asymptomatic patients, based on our observations we think that causes like “autonomic” overload can be one of the unheard reasons of knee pain and effusion. The clinician must be aware of possible causes of knee pain and swelling beyond the anatomical confinements of knee and that lumbar spine pathology need also to be ruled out. The clinician must not let prejudice rule his clinical judgement. We don’t claim direct association of lumbar disc degeneration and knee pain and swelling in this study. Further studies are needed.

Focal Periphyseal Oedema: A Physiologic Finding in Paediatric Knee Pain

Knee pain is a common reason for adolescent calls or visits to a primary care clinician. The authors present a case of an 14-year-old male adolescent with progressive bilateral nociceptive somatic knee pain. The pain was worse with weight bearing, and relieved at rest. It was located over the medial joint line. The patient was treated conservatively with nonsteroidal anti-inflammatory drugs and a rehabilitation program. Magnetic Resonance Imaging (MRI) showed bone marrow oedema, and Focal Periphyseal Oedema (FOPE) diagnosis was made. After a total of 6 months of treatment, the patient was asymptomatic. The literature is limited to a few case reports and radiologic studies describing this symptomatic physeal pathology, not reporting physical examination or treatment. The goals of this case report were to elucidate physicians of this condition, a newly reported cause of knee pain in adolescent, and to elicit the importance of a patient-tailored rehabilitation program in the treatment of this finding. FOPE is a clinical entity that should not be ignored and must be treated for the patient’s comfort. It is a self-limited condition and has an excellent prognosis.

Relationship of neuropathic pain component and osteoarthritis stage in patients with knee osteoarthritis

Aim: The aim of this study was to determine the frequency of neuropathic pain (NP) in patients with knee osteoarthritis (OA) and the relationship between knee OA stage and NP degree.Materials and Methods: This study included 63 patients (11 male, 52 female; mean age 62.4 ± 11.9 years; range 40-89 years) who were diagnosed with knee OA according to the American College of Rheumatology between January and May 2019. For all the participants, the knee pain was evaluated with the Visual Analog Scale (VAS), the functional evaluation was performed through Western Ontario and McMaster University (WOMAC) Osteoarthritis Index, and the neuropathic pain (NP) component was evaluated through Pain-DETECT Questionnaire (PDQ). The Kellgren-Lawrence grading system was used to determine radiological severity.Results: Of the total, 18 patients (28.5%) were classified as possible NP and 15 patients (23.5 %) were classified as likely NP. The symptom durations of the patients with final NP diagnosis were longer (p<0.05). The PDQ score was determined to be moderate and positively correlated with the WOMAC subscale scores and total score (pain score: r=0.450, p<0.001; stiffness score: r=0.4011, p=0.001; physical function score: r=0.397, p=0.001; total score: r=0.424, p=0.001). A positive and weak correlation was detected between the knee OA stage and neuropathic pain scores (p<0.05; r: 0.265).Conclusion: This study showed that the underlying cause of knee pain in the significant part of knee-OA patients has the NP component. Knee-OA patients with neuropathic pain component had higher rates of OA-related disability. There was a poor correlation between NP scores and radiographically advanced osteoarthritis symptoms. However, we suggest that further studies should be conducted with larger sample groups, the NP component should be kept in mind and should be included in the treatment plan for the knee-OA patients.

Pulsed radiofrequency ablation of genicular nerve versus intra-articular radiofrequency ablation combined with platelets rich plasma for chronic kneeosteoarthritis

ABSTRACT Background knee osteoarthritis is considered as one of the most important causes of knee pain. Conventional noninvasive lines of treatment are several, including platelet-rich plasma (PRP) that has been revealed to be helpful in the management of knee osteoarthritis. The goal of this study is to appraise the PRP ultrasound-guided injection in the management of knee osteoarthritis. Settings and Design This study was a prospective randomised double blind study. Methods Sixty adult knee osteoarthritis patients were involved in the current study. They were randomly selected from the pain clinic Faculty of Medicine, Alexandria University. There were two groups ultrasound-guided (USG) pulsed waves radiofrequency (PRF) ablation on genicular nerve (group 1) or intra-articular PRP (group 2) injection under ultrasonography (US)-guidance and articular surface RF ablation. Assessment was done applying visual analogue scale (VAS) for pain intensity. Functionally, WOMAC and IKDC scores were used at baseline and 6th month after injection. Results Intra-articular PRP (group 2) showed a significant improvement in pain severity and physical limitations in patients with knee pain. It also showed significant improvement compared to genicular nerve RF considering VAS score with p value (0.012*) up to 12 months follow up, WOMAC, IKDC scores with p value (<0.001*) up to 12 months and US joint assessment with p value (0.028*) up to 6 months follow up. Conclusion The use of US IA-PRP injection combined to pulsed radiofrequency ablation of articular surface show significant improvement in pain compared to the genicular nerve PRF.

Synovial chondromatosis: a rare cause of knee pain and swelling

&lt;p&gt;Synovial chondromatosis (SC) is a rare, benign, metaplastic, monoarticular disorder of synovial membrane and bursae of large joints. It commonly affects the large joints such as the knee, hips, wrist, ankle and shoulder. Here we report a case of SC of right knee in a 60-year-old female presenting with chief complaints of pain, swelling, restriction of movement in right knee for 1 year after a fall at home. X-ray of right knee revealed multiple calcified loose bodies. The final diagnosis was established by correlating radiologic findings with the histopathology of the excised specimen. Patient was successfully treated by open partial synovectomy of knee using anterior approaches in a single step procedure.&lt;/p&gt;

Engineering Anisotropic Meniscus: Zonal Functionality and Spatiotemporal Drug Delivery.

Human meniscus is a fibrocartilaginous structure that is crucial for an adequate performance of the human knee joint. Degeneration of the meniscus is often followed by partial or total meniscectomy, which enhances the risk of developing knee osteoarthritis. The lack of a satisfactory treatment for this condition has triggered a major interest in drug delivery (DD) and tissue engineering (TE) strategies intended to restore a bioactive and fully functional meniscal tissue. The aim of this review is to critically discuss the most relevant studies on spatiotemporal DD and TE, aiming for a multizonal meniscal reconstruction. Indeed, the development of meniscal tissue implants should involve a provision for adequate active molecules and scaffold features that take into account the anisotropic ultrastructure of human meniscus. This zonal differentiation is reflected in the meniscus biochemical composition, collagen fiber arrangement, and cell distribution. In this sense, it is expected that a proper combination of advanced DD and zonal TE strategies will play a key role in the future trends in meniscus regeneration. Impact statement Meniscus degeneration is one of the main causes of knee pain, inflammation, and reduced mobility. Currently used suturing procedures and meniscectomy are far from being ideal solutions to the loss of meniscal function. Therefore, drug delivery (DD) and tissue engineering (TE) strategies are currently under investigation. DD systems aim at an in situ controlled release of growth factors, whereas TE strategies aim at mimicking the anisotropy of native meniscus. The goal of this review is to discuss these two main approaches, as well as synergies between them that are expected to lead to a real breakthrough in the field.

Associations Between Flexion Deformity And Sagittal Gait Impairments In Knee Osteoarthritis Patients

PURPOSE: Knee flexion deformity and gait impairments (GIs) are common clinical findings in knee osteoarthritis (KOA) patients. This study aimed at assessing the associations between the presence of flexion deformity and sagittal GIs in KOA patients. METHODS: Patients were included if 1) KOA was the main cause of knee pain, 2) their worst pain in the past 7 days was ≥ 4 on a 0-10 pain intensity scale, 3) they had Kellgren-Lawrence grade ≥ 2. Therapists involved in the study (N=10) assessed flexion deformity by goniometry. They assessed the presence of four known sagittal GIs in KOA patients (flexum at heel strike, fixed flexion during loading and during stance, limited dynamic range of motion (DROM) during a cycle) with a knee kinesiography. Fischer’s tests were used to assess between-group (presence or absence of flexion deformity) differences on the proportion of patients with each GI. RESULTS: 214 patients from 54 clinics participated. 61.2% were women, the mean age was 63 years (95%CI: 62;64), and the mean BMI was 29.4 kg/m2 (28.7;30.1). Almost one out of two patients (40.2%) had a flexion deformity. More than two thirds of the participants showed a limited DROM (69.2%). The proportion of patients with a limited DROM was significantly higher in the group who had a flexion deformity (+22.4%; p<0.001). However, more than half of the patients with a limited DROM did not have a flexion deformity (77/148: 52.0%). Similar results were observed on the three other sagittal GIs (Table; all p≤0.01). CONCLUSION: Results support that patients with knee flexion deformity are more likely to have sagittal GIs. However, the majority of patients who had sagittal GIs did not have a flexion deformity. It supports that it remains essential to assess deformity and also the value of completing clinical evaluation with a dynamic kinematic measurement to ensure that assessors do not miss the presence of gait alterations, even in the absence of flexion deformity.This was funded by the FPQIS (Quebec Government).

Proximal Fibular Osteotomy for Medial Compartment Knee Osteoarthritis: Is It Worth?

Osteoarthritis of knee is one of the important causes of knee pain in elderly patients and is a debilitating disease. It often leads to varus deformity of knee. Many treatment options are available for this progressive knee joint disorder. Proximal fibular osteotomy (PFO) is a novel yet simple procedure used to alleviate the symptoms of medial compartment knee osteoarthritis. The present study was undertaken to evaluate whether this procedure improves the symptoms, functions and limb alignment in patients with medial compartment knee osteoarthritis. Following approval by the Institutional Review Board, this prospective study included 42 cases (56 knees) with Kellgren-Lawrence grade II and III medial compartment knee osteoarthritis and underwent proximal fibular osteotomy. Clinical assessment was done by visual analogue scale (VAS) score and The Western Ontario and McMaster universities osteoarthritis Index (WOMAC) score pre-operatively and at 3, 6 and 12months follow-up for pain and functional improvement. Radiological assessment was done by measuring femoro-tibial angles (FTA) pre-operatively and at 1year follow-up. The mean age was 58.30years. There were 30 females and 12 males. The preoperative mean WOMAC score was 87.3, at 3months follow-up it was 29.4 this was significantly better (p < 0.05) but the improvement was not significant at subsequent follow-up visits. Similarly the VAS scores also showed significant improvement at 3months, but not at 6 and 12months follow-up. There was no significant improvement in the femoro-tibial angle (FTA) at 1year follow-up. The study highlights that both the VAS scores and WOMAC scores were significantly better at 3months after surgery. However these did not show any significant improvement at 6 and 12months. It does not change the alignment of knee at one year follow-up. The authors conclude that proximal fibular osteotomy provides only short-term relief in patients of medial compartment knee osteo-arthritis.

Hope, Hype, Hurdles &amp; Future Perspective for PRP, PRP versus Hyaluronic Acid Injection in Osteoarthritis of Knee: A Review Article.

BackgroundComparative studies of platelet-rich plasma (PRP) and hyaluronic acid show variable results.&#x0D; PurposeA review was conducted to understand the current role of PRP and its efficacy versus hyaluronic acid in osteoarthritis (OA) of the knee joint.&#x0D; MethodsOut of 170 identified studies, 14 studies involving 1575 patients with 637 males and 938 females were selected based on PRISMA flow chart guidelines and were analyzed for the study.&#x0D; ResultsA standard PRP regimen consisting of 2–3 intra-articular injections (IA) of 4–6 mL of leucocyte poor PRP at 1–2 weekly intervals provides a better result than HA during the first 3–6 months, and which may continue up to one year. PRP and HA may have synergistic effect; pain and swelling are the two most com-mon complications with PRP, the incidence is more with leucocyte rich PRP (LP-PRP) and intra-osseous PRP treatment.ConclusionPRP provides hope and is more effective than hyaluronic acid in pain relief and improving the quality of life in mild to moderate osteoarthritis of the knee joint. However, hype, that is effective in all, irrespective of grades of OA, mal-aligned or stiff knee, ligamentous laxity, and can avoid joint replacement is a big hindrance in establishing it as a preferred treatment in OA knee. The author follows the above-mentioned PRP regimen; and recommends to combine leucocyte poor PRP with HA for IA injections &amp; with LP-PRP injections along with the two most common painful points (medial collateral ligament, pesanisernius) in a highly painful OA knee. PRP may not address extra-articular causes of knee pain (mal-alignment, muscle wasting, tendinosis), should be corrected for optimum outcome. Contact sports, running, exercises putting pressure on knee and NSAID should be avoided during PRP treatment. Also, more randomized controlled trials are required to further standardize the PRP preparation, administration, injection interval &amp; proper documentation of efficacy and complications in the regenerative registry.

A rare case of calcific tendinitis of biceps femoris presenting with lateral knee pain

Distal biceps femoris tendon is an unusual site of calcific tendinitis and a rare cause of knee pain. We present a case of 72-year-old lady who presented with a six-month history of pain over the lateral aspect of knee. Subsequent imaging demonstrated calcific deposits within the biceps femoris tendon substance. She was then successfully treated with ultrasound-guided barbotage of the calcium deposits and peri-tendinous corticosteroid injection. Clinical awareness of the unusual sites of calcific tendinitis with imaging evidence is important for early diagnosis and appropriate management.

PRESENTING FEATURES, CLINICAL COURSE, SURGICAL TECHNIQUES, AND OUTCOMES ASSOCIATED WITH OPERATIVE TREATMENT OF BIPARTITE PATELLA IN PEDIATRIC AND ADOLESCENT ATHLETES: A RETROSPECTIVE COMPARISON TO A NON-OPERATIVELY TREATED COHORT

Background:The bipartite patella is a developmental variant in which incomplete ossification leads to a fibrocartilaginous synchondrosis between ossification centers; repetitive traction on the synchondrosis in young athletes may lead to pain. Few series of surgical cases exist to guide treatment approaches to refractory pain.Hypothesis/Purpose:To investigate the presenting features, clinical course, surgical techniques, and outcomes associated with operative treatment of symptomatic bipartite patella in pediatric and adolescent athletes, with comparison to a control group of symptomatic, non-operative patients.Methods:A retrospective medical record review of patients ≤20 years-old diagnosed with symptomatic, radiographically-confirmed bipartite patellae between 2003 and 2018 at a single tertiary-care pediatric hospital was conducted. Patients for whom knee pain could not be attributed to bipartite patella were excluded. Additional clinical and operative variables were collected for the subset that underwent surgical treatment. Outcomes analyzed included time to return to sport (RTS) and re-operation.Results:278 patients (37.8% females; mean age: 12.7 years, range 7-20 years) were included, 27 (mean age: 15.3 years, range 10-20 years) of whom were treated operatively (9.7%). Compared to the 251 patients who underwent non-operative treatment (consisting of physical therapy, activity modification, non-steroidal anti-inflammatory medicines, and cryotherapy), the operatively treated patients were more likely to be older (mean age 12.4 years vs. 15.3 years, p<0.001), female (35.5% vs. 59.3%, p=0.02) and competitive athletes (83.6% vs. 100%, p=0.10). Of the operative patients, 16 (59%) had Saupe III (superolateral) ossicles, 8 (30%) had Saupe II (lateral) ossicles, and 3 (11%) had Saupe I (inferior) ossicles. Most operative patients (79%) reported insidious onset of pain, with minor trauma precipitating symptom onset in the remainder (21%). Symptom duration prior to surgery was 2.2 years (range 1.7 mo-10.1yrs). Procedures were categorized as isolated fragment excision (n=10), fragment excision with lateral release (n=9), isolated lateral release (n=4), ORIF (n=3), and arthroscopic drilling (n=1). Operative outcomes are found in Table 1.Conclusions:Bipartite patella may be an underappreciated cause of knee pain in adolescent athletes. Patients who underwent surgery displayed symptoms lasting >2 years, representing ˜10% of cases, and were most likely to have superolateral bipartite fragments with a mean size of ˜1cm2. Surgery was more common amongst females, competitive athletes, and older adolescents. There was an overall 11% risk of persistent or recurrent symptoms warranting re-operation. Prospective multi-center investigations may be warranted to identify optimal candidates for earlier interventions, as well as optimal non-operative and operative treatment techniques.Table 1.Summary of operative outcomes for patients who underwent isolated fragment excision (FE), FE and lateral release (FE + LR), isolated LR, open reduction internal fixation (ORIF), or arthroscopic drilling for symptomatic bipartite patella.Surgical Techniquen (%)Fragment area (mm2)Fragment %*Ave time to radiographic healingAvg time to Return to SportRe-operationRe-operation TechniqueIsolatedFE10 (37%)128.810.5%---2.0 mo1/10 (10%)ALR(4 yrs postop)FE + LR9 (33%)71.47.4%---2.7 mo1/9 (11%)2nd ALR(4 yrs postop)IsolatedLR4 (15%)75.89.5%---1.8 mo0---ORIF3 (11%)93.139.2%4.8 mo3.0 mo1/3 (33%)ROH(2 yrs postop)Arthroscopic Drilling1 (4%)64.036.7%3.2 mo3 mo0---All operations2796.68.8%---2.2 mo3/27 (11%)---*Fragment % was calculated as the area of the bipartite fragment divided by the overall area of the patella.

Effects of Class IV Laser in Knee Osteoarthritis: A Randomized ControlTrial

Background: Knee osteoarthritis (KOA) is characterized by a gradual wearing away of the cartilage in the joint through strain originating from weight bearing, repeated injury, and/or damage and is one of the most associated causes of knee pain. Current options for pain management include medication or surgery. Consequently patients are alternatively seeking a non-invasive approach that can help manage their pain. Recently, Class IV laser has gained popularity due to its clinical efficacy in pain management and non-invasive application. Objective: The aim of this randomized control trial was to evaluate the effects of a 30W powered Class IV laser with 1064 nm wavelength on knee pain in the treatment of patients with KOA. Methods: Patients were randomly assigned into two groups. Each patient underwent 7 treatment sessions every other day. Group-I (Laser group): 30 patients were treated with a semi conductive Class IV Laser with Scanning System applicator (BTL Industries Ltd.) With a maximal power of 30 W and 1064 nm wavelength. Group-II (Control group): 30 patients were treated with the same device without emission from the laser diode, and only a visible navigation beam to act as a placebo. All patients perception of pain was evaluated prior to beginning treatment (baseline), following the first session, after the 7 therapies, and 1 month following the last treatment using the Visual Analogue Scale (VAS). Results: The Man-Whitney test revealed there was a significant (P=0.01) reduction in pain according to the VAS results for the laser group (44.24% improvement), whereas the control group displayed no significant difference (3.93% improvement) in pain perception following the treatment(s). Conclusion: Class IV laser treatment was found to be an effective modality in reducing knee pain in KOA patients.

Ultrasound-Guided Cutting Wire Release of the Posterior Iliotibial Band: A Feasibility Study.

Distal iliotibial band friction syndrome (ITBFS) is a common cause of knee pain in endurance athletes. Nonsurgical treatment is usually successful, but surgery is occasionally required for recalcitrant cases. No published studies to date have evaluated the feasibility of an ultrasound-guided (USG) partial iliotibial band (ITB) release. To determine the feasibility of an USG partial ITB release using a cutting wire. A secondary aim was to assess whether adjacent structures were damaged. We hypothesized that the posterior distal ITB could be partially transected with a cutting wire under USG with no injury to adjacent structures. Cadaveric study. Quaternary-care academic institute. Ten cadaveric knees ranging from 76-89 years old with a mean body mass index of 21.9 kg/m2 . One physician sonographer performed USG releases of the posterior ITBs at the level of the lateral femoral epicondyle with a cutting wire. Dissection was carried out by an independent second physician to assess for primary and secondary outcomes. (1) Release of the posterior border of the ITB; (2) width of the release; (3) evaluation for any injury to adjacent structures; (4) technical difficulty of the procedure (0 = no difficulty, 10 = most difficult procedure possible); (5) duration of time it took to complete the procedure. All 10 knees had the posterior border of the ITB transected. Mean release length was 16 mm (range 15-17), which was within 1 mm of the target release length of 15 mm. No adjacent structures were damaged. A USG release of the posterior ITB utilizing a cutting wire is feasible and safe in a cadaveric model. Translational research is warranted to determine how these results apply to the clinical setting.

HAPPi Kneecaps! Protocol for a participant- and assessor-blinded, randomised, parallel group feasibility trial of foot orthoses for adolescents with patellofemoral pain

BackgroundPatellofemoral pain (PFP) is a common cause of knee pain in adolescents, but there are limited evidence-based treatment options for this population. Foot orthoses can improve pain and function in adults with PFP, and may be effective for adolescents. The primary aim of this study is to determine the feasibility of conducting a full-scale randomised controlled trial (RCT) evaluating the effects of contoured foot orthoses on knee pain severity and patient-perceived global change, compared to flat shoe insoles, in adolescents with PFP. The secondary aim is to provide an estimate of treatment effects for foot orthoses, compared to flat insoles, in adolescents with PFP.MethodsThis randomised, controlled, participant- and assessor-blinded, feasibility trial has two parallel groups. Forty adolescents (aged 12–18 years) with clinical symptoms of PFP will be recruited from Queensland, Australia. Participants will be randomised to receive either prefabricated contoured foot orthoses or flat shoe insoles. Both interventions will be fit by a physiotherapist, and worn for 3 months. Feasibility will be evaluated through assessing willingness of volunteers to enrol, number of eligible participants, recruitment rate, adherence with the study protocol, adverse effects, success of blinding, and drop-out rate. Secondary outcomes will evaluate knee-related pain, symptoms, function, quality of life, global rating of change, patient acceptable symptom state, and use of co-interventions, at 6 weeks and 3 months. Primary outcomes will be reported descriptively, while estimates of standard deviation and between-group differences (with 95% confidence intervals) will be reported for secondary outcomes.DiscussionFindings of this study will inform the feasibility of a full-scale RCT investigating the efficacy of contoured foot orthoses in adolescents with PFP. This full-scale study is necessary to improve the evidence base for management of adolescent PFP, and enhance outcomes for this population.Trial registrationACTRN12619000957190.

Impact of ultrasonography-detected pes anserine bursitis on pain and function in patients with primary knee osteoarthritis

Background: Pes anserine bursitis (PAB) is one of the most common causes of knee pain. Hence, this study aimed to compare the pain and function among all primary knee osteoarthritis (KOA) patients with or without ultrasonic-detected PAB and the associated clinical and radiological findings.Methods: A single-center cross-sectional study was conducted on 245 patients with primary KOA. The more symptomatic knee examined with musculoskeletal ultrasound (MSUS), were then categorized into two groups according to the presence of PAB; PAB was graded from 0 to 2 on a semi-quantitative scale. Radiological grades of Kellgren–Lawrence were recorded. Pain and functional status was assessed by visual analog scale (VAS), Health Assessment Questionnaire-II (HAQ-II), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).Results: A total of 110 (44.9%) patients were diagnosed with PAB where 91 (82.7%) of them had Grade 1 and only 19 (17.3%) had Grade 2. The presence of PAB was statistically significant related (P < 0.05*) with age, VAS, HAQ-II, WOMAC subscales, synovitis, and radiographic Grades 3 and 4. However, there was no statistically significant difference (P ≥ 0.05) between KOA patients without PAB and KOA patients with PAB, regarding sex, body mass index, Baker cyst, and effusion.Conclusion: The presence of PAB on MUS is associated with increased pain and disability in KOA. MSUS should be more widely used to establish the association between PAB and symptom severity and disability among KOA patients.

Association of Knee Pain and Crouch Gait in Individuals With Cerebral Palsy.

Crouch gait (ie, excessive knee flexion) is commonly seen in patients with cerebral palsy (CP) and has been inconsistently linked with knee pain. The definitive cause of knee pain is unknown, but may result from increased joint forces due to crouch gait kinematics. Our purpose was to determine whether knee pain is positively associated with knee flexion in gait among a large sample of ambulatory individuals with CP. We hypothesized that knee pain prevalence would increase as knee flexion increased. In this retrospective study, pain questionnaire and 3-dimensional gait analysis data from 2015 to 2018 were extracted from the medical records of individuals with CP who had a clinical gait analysis. The pain questionnaire asked caregivers/patients to indicate the location of pain and when it occurs. A multivariate logistic regression was performed with minimum knee flexion in stance, patella alta, age, and sex as predictors of knee pain. Among the 729 participants included in the analysis, 147 reported knee pain (20.1%). The odds of knee pain were not associated with minimum knee flexion in stance or sex. However, the odds of knee pain increased 73.2% when patella alta was present (P=0.008) and tended to increase 2.2% as age increased (P=0.059). The data suggest that there is not a meaningful association between crouch gait and knee pain. Having patella alta was associated with pain. Further studies that use validated pain questionnaires are needed to understand the multifactorial etiology of knee pain within ambulatory individuals with CP. Level III-case-control study.