Joint Space Changes Research Articles

Progression of osteoarthritis as a state of inertia

ObjectivesTo test whether knees which recently developed disease were at higher risk for subsequent x-ray progression than knees which had been stable, suggesting that recent change produces further change and...

Radiolucent Tissue and the Straight Child

There are many fascinating aspects about treating disorders involving the immature skeleton. The physiology or pathophysiology of radiolucent tissues may make treatment relatively straightforward or quite complicated for both patient and surgeon. The activities of cells in the epiphysis or physis, in the periosteum, and within the joint space change as growth occurs. A diaphyseal fracture generally presents fewer problems if the patient is younger, whereas a physeal fracture that has injured proliferating cartilage early in growth may require multiple surgical interventions. Furthermore, these cell populations are markedly influenced by mechanical force. An otherwise normal epiphysis in a developmentally dysplastic hip will not function appropriately if the hip remains dislocated or subluxated, yet if the hip dysplasia is detected early and the femoral head is relocated for a period of growth, the hip can be restored to a normal developmental trajectory. The ability to image radiolucent cell populations is a tremendous asset to the …

Relationship between lateral joint space narrowing and change in knee cartilage thickness: data from the OA initiative

s / Osteoarthritis and Cartilage 20 (2012) S54–S296 S212 64y, mean BMI 30) were compared to 122 right non-exposed control knees (47 males, 75 females, age 55y, BMI 24) in this analysis. The non-exposed age-gender-height adjusted distribution of the femur curvatures had a small overlap with the TKR femur curvature (95% Sensitivity, 95% specificity AUC1⁄40.99). The false discovery adjusted SPM analysis indicated that 94% of the TKR knees had significant abnormal flattening of the femur bone (Figure 1). The largest prevalence of bone flattening was located at the central medial condyle, and on average affected 25% of the medial condyle area whereas only 9% of the medial tibia was affected by significant bone abnormalities (9%) (Table 1). Figure 1. Statistical Parametric Mapping (SMP) analysis of bone abnormalities. Left, prevalence map of TKR bone abnormalities. Right, the non-exposed vs. TKR ROC curve of the femur curvature. Table 1: ROI analysis. Population means (Standard deviations) are shown for the TKR and non-exposed groups with corresponding Adjusted ROC values. The relative amount of abnormal bone shape is shown in the last column. Conclusions:Bone curvature of end stage OA knees differs significantly in specific locations from non-OA knees with the most extensive differences located in the central medial femur. Therefore, the presence of large bone shape abnormalities in the central medial femurmay be a possible imaging biomarker to predict the need for knee replacement. Mean change (mm) in the lateral (LFTC) and medial (MFTC) femorotibial compartme Unicompartimental lateral JSN: No JSN (grade 0) Any later FLASH sample: LFTC -17 -91

Allgemeine radiologische Symptomatologie peripherer Gelenke

Eine Diagnoseerstellung rheumatischer Erkrankungen basiert auf klinischen Parametern und auf dem differenzialdiagnostischen Potenzial von Röntgensymptomen. Die systematische Bildanalyse sollte initial beantworten, ob es sich um eine Erkrankung an der Synovia, am Knorpel oder an den Enthesen handelt.

Baker’s cyst imaging

A 44-year-old female with HIV, type II diabetes and diabetic neuropathy presented to the emergency department with 2 days of left lower extremity pain and swelling. She denied chest pain, shortness of breath, trauma to the lower extremities and any history of deep vein thrombosis (DVT). Physical exam revealed pain over the anteromedial thigh, popliteal fossa and posterior calf. The pain was exacerbated by flexion and extension of the knee and ankle. An ultrasound of the left lower extremity (Fig. 1) did not show a DVT, but anechoic fluid tracked along the anteromedial calf between the gastrocnemius and semimembranous muscles. A subsequent computed tomography image (Fig. 2) demonstrated a loculated cyst at the distal point of insertion of the semimembranous muscle and fluid tracking distally around the gastrocnemeus and lateral to the soleus muscle down to the ankle. A calcified body could be seen in the area of loculation, suggesting arthritic changes of the knee joint. Radiology determined this finding to be a probable ruptured Baker’s cyst. Fig. 1 Ultrasound calf: Anechoic fluid is seen distal to the gastrocnemius muscle and along the soleus muscle. The hypoechoic nature of the fluid makes this being blood unlikely Fig. 2 CT scan of leg: A loculated cyst, identified as a Baker’s cyst, can be seen medial to the knee and superior to the gastrocnemius and soleus muscles. Medial to the loculated cysts is a calcified body, which is a common finding of arthritic changes ... Baker’s cysts are caused by fluid distention of the gastrocnemio-semimembranosus bursa and result in a painful synovial-lined fluid sac outside the knee joint. The most common underlying conditions are osteoarthritis (Fig. 3) and Charcot joint. The differential diagnosis includes DVT, tumor, hematoma and cellulitis [1]. Baker’s cysts may be confirmed by ultrasound, CT and MRI. Incidental findings of an asymptomatic Baker’s cyst do not require treatment and will resolve on their own. Painful cysts can be treated with intraauricular injections and needle aspiration. Fig. 3 X-ray of the knee: Narrowing of the joint space and degenerative changes consistent with advanced osteoarthritis

Effects of chondroitin sulfate and glucosamine in adult patients with Kaschin–Beck disease

The purpose is to investigate the effects of chondroitin sulfate and glucosamine on adult patients with Kaschin-Beck disease (KBD). A total of 80 patients, aged over 40 years, were randomized into two groups receiving either 1,600 mg oral mixture of chondroitin sulfate and glucosamine or placebo twice daily for 8 months. Posteroanterior radiographs of bilateral knee in full extension were taken at enrollment and after 8 months. Mean joint-space width of the assigned six points on the tibiofemoral joint compartment was measured by a graduated magnifying lens. The mean joint space decreased significantly in the placebo group (4.3 +/- 1.09 versus 4.1 +/- 1.07 mm, P < 0.0001) after 8 months and was unchanged in the experimental group (P = 0.51). There was no statistical significance in the mean joint space between two groups at baseline and follow-up (P = 0.65 and P = 0.84, respectively). But the overall mean change in joint space was significant between the two groups (P < 0.0001). Knee joint space of the experimental group narrowed slowly compared to the control group. Therefore, chondroitin sulfate and glucosamine might play a protective role in preserving articular cartilage and provide evidence for therapeutic drugs in adult patients with KBD.

Uso de biomarcadores para el diagnóstico de enfermedad articular en el caballo

SUMMARY Lameness associated to joint disease (JD) in athlete equines is an important cause of economic losses. Intensive training produces biomechanical overload of the synovial joints with a consequent activation of metalloproteinases, which have been associated to the pathogenesis of equine JD. This disease is characterized by the degradation of the extracellular matrix (ECM) of the articular cartilage causing the release of structural components of the cartilage matrix to the joint space and producing changes in the synovial fluid concentration of these ECM components, termed biomarkers. The changes in the concentration of some of these proteins in the synovial fluid might be used to evaluate both the onset and progression of equine JD. The measurement of the levels of aggrecan and collagen type II in the synovial fluid using specific monoclonal antibodies is an example of this approach. This review presents an update on biomarkers used for equine JD.

The Valenti technique in the treatment of hallux rigidus

Metatarsophalangeal joint osteoarthritis of the great toe (hallux rigidus) is a frequent condition for which numerous surgical techniques have been proposed. The most used ones are cheilectomy and arthrodesis. The objectives of this retrospective study are to present the midterm results of the Valenti procedure and to compare these results with those from other recognized surgical techniques. We conducted a retrospective analysis of a continuous group of 32 patients (41 cases) presenting hallux rigidus and treated using the Valenti technique from November 1999 to July 2004. The mean age of these patients at the time of surgery was 57 years. Forty-one percent of these patients also presented a static disorder of the foot. One or several additional procedures were undertaken, at the time of surgery, in 24% of these cases. Patients were assessed using the AOFAS score completed by the walking distance test, the gait test, the tiptoe test and self-evaluation of patient satisfaction. The radiographic work-up before surgery and at follow-up showed the progression of the joint space changes and allowed us to evaluate plantar subluxation at the base of the first phalanx under the metatarsal head. Twenty-four patients (32 cases) were reviewed and evaluated with a mean follow-up of 5.5 years. Two cases of reflex sympathetic dystrophy were observed as complications. The mean final score was 81 out of 100 from a preoperative score of 47 out of 100. Pain was absent or only occasional in 94% of the cases. Discomfort wearing shoes was absent or moderate in 91% of the cases. Joint range of movement was greater than 30 degrees in 72% of the cases and the toes were stable. Walking distance was unlimited in 79% of the cases. A mean 30% plantar subluxation at the base of the first phalanx was noted at follow-up, with no clinical consequence. The results were comparable irrelevantly of the hallux rigidus grade being treated. The numerous techniques proposed achieve comparable results both in terms of pain relief and functional result but each one has its own limitations. Only arthroplasties with silastic implants and the Keller technique give less satisfactory results. Arthrodesis remains the first-choice treatment for advanced hallux rigidus but failure is possible in case of technical error or malunion. Cheilectomy, a conservative intervention, is ideal for lesions that are not too advanced or remain limited to the dorsal part of the joint; this conservative option presents generally no specific complications. Prosthetic replacement--with, to date, little long-term experience for total arthroplasty--remains controversial because the results deteriorate over time. The Valenti procedure exposes the patient to a possible risk of metatarsophalangeal joint destabilization if the resection is too great, but this does not impair the final functional outcome. The arthrectomy described by Valenti is a highly reproducible intervention. We find it to be a good compromise between mobility and stability, providing good results for all hallux rigidus grades and entailing a low complication rate. Level IV. Therapeutic Study.

Radiologic assessment of age‐related knee joint space changes in women: A 4‐year longitudinal study

To analyze a population-based cohort of women in order to establish normal values of joint space width (JSW) and to evaluate the existence of age-related joint space loss (JSL). Knee radiographs were performed 4 years apart in women from the OFELY (Os des Femmes de Lyon) Cohort. Posteroanterior radiographs of both knees were taken in semiflexion with a standardized fluoroscopically assisted protocol. Radiographs were qualitatively evaluated using a scoring system based on the Altman score that assessed joint space narrowing, osteophytes, and sclerosis for each tibiofemoral compartment and each side. For quantitative assessment, radiographs were digitized using a video camera, and specific software was used to measure JSW in every compartment. We evaluated the radiographs of 606 women (ages 39-90 years, mean 62 years) and found that in all subjects, JSW significantly decreased with age in every compartment (r = -0.12 to -0.16, P < 0.001), including in 358 subjects without any radiographic abnormality related to osteoarthritis (OA) at baseline. The longitudinal analysis confirmed a significant loss over 4 years of approximately 0.30 mm (6%) for the medial compartment. Multiple regression analysis did not identify significant predictors of JSL among clinical risk factors and biochemical markers of bone and cartilage turnover. In this first longitudinal study of a population-based cohort of women, we have established normal values of JSW and shown that JSW decreases with aging, especially at the medial compartment, even in subjects without any radiographic abnormalities related to OA.

Gender differences exist in the hip joint moments of healthy older walkers

Gender differences in the incidence of symptomatic hip osteoarthritis (OA), changes in hip cartilage volume and hip joint space and rates hip arthroplasty of older people are reported in the literature. As the rate of progression of OA is in part mechanically modulated it is possible that this gender bias may be related to inherent differences (if they exist) in walking mechanics between older males and females. The purpose of this study was to examine potential mechanisms for gender differences in hip joint mechanics during walking by testing the hypotheses that females would exhibit higher hip flexion, adduction and internal rotation moments but not significantly greater normalized ground reaction forces (GRFs). Forty-two healthy subjects (21 male, 21 female), ages 50–79 yr were recruited for gait analysis. In support of the hypotheses, greater external hip adduction and internal rotation along with hip extension moments were found for females compared to males after normalizing for body size for all self-selected walking speeds. Differences in walking style (kinematics) were the main determinants in the joint kinetic differences as no differences in the normalized GRFs were found. As external joint moments are surrogate measures of the joint contact forces, the results of this study suggest the hip joint stress for the female population is higher compared to male population. This is in favor of a hypothesis that the increased joint contact stress in a female population could contribute to a greater joint degeneration at the hip in females as compared with males.

The effect of chiropractic adjusting, exercises and modalities on a 32-year-old professional male golfer with hallux rigidus

Stiffness and pain in the big toe, known as hallux rigidus (HR), is a complication of acute or chronic sprain/strain of the first metatarsophalangeal joint (MTPJ). As a cause of pain and dysfunction in the big toe, HR is the most common athletic disorder and secondary only to hallux abductovalgus in incidence. HR is divided into three grades based on the amount of degenerative joint disease found at the first MTPJ. Grade 1 HR cases, those with little or no degenerative changes, and possibly some Grade 2 HR cases, with mild-to-moderate loss of joint space and degenerative changes, appear to improve with joint mobilization/manipulation, modalities and exercise. A 31-year-old male professional golfer presented with a complaint of big toe pain of 7 months’ duration. After history, physical and regional evaluation, and radiography of the right foot and big toe, a diagnosis of Grade 1 hallux rigidus was made. Management of the patient included chiropractic adjusting of the first MTPJ using graded axial elongation, mobilization of the sesamoids, adjustment of additional foot and ankle joint dysfunction, big toe and foot flexor strengthening and stretching exercises, and ultrasound. Outcome measures included the Lower Extremity Functional Index (LEFI), Numerical Rating Scale (NRS) and goniometric range of motion (ROM). The patient received 17 visits over 10 months. The initial NRS was 6, and on the final visit was 0–1. Initial goniometer ROM of the big toe in passive dorsiflexion was 45° and on the final visit was 84°. The LEFI had a score of 22% on the initial visit and 2% on the final visit. Substantial improvement was noted after the first treatment and in fact the patient did not return for further treatment for 5 months. Slowly, mild big toe pain and stiffness returned and the patient came back, and remained compliant with treatment. Steady and substantial improvement occurred after his return. Although an occasional mild increase in symptoms occurs after prolonged practice or play, he has resumed normal professional activities with no restrictions and is pleased with treatment outcome. Natural history, a desire to please the doctor and lack of control does not allow extrapolation of these findings to the general population. Nevertheless, in this patient, chiropractic adjusting, foot flexor strengthening and ultrasound was effective in treatment of hallux rigidus. Randomized controlled trials are needed.

Change in joint space width: Hyaline articular cartilage loss or alteration in meniscus?

To explore the relative contribution of hyaline cartilage morphologic features and the meniscus to the radiographic joint space. The Boston Osteoarthritis of the Knee Study is a natural history study of symptomatic knee osteoarthritis (OA). Baseline and 30-month followup assessments included knee magnetic resonance imaging (MRI) and fluoroscopically positioned weight-bearing knee radiographs. Cartilage and meniscal degeneration were scored on MRI in the medial and lateral tibiofemoral joints using a semiquantitative grading system. Meniscal position was measured to the nearest millimeter. The dependent variable was joint space narrowing (JSN) on the plain radiograph (possible range 0-3). The predictor variables were MRI cartilage score, meniscal degeneration, and meniscal position measures. We first conducted a cross-sectional analysis using multivariate regression to determine the relative contribution of meniscal factors and cartilage morphologic features to JSN, adjusting for body mass index (BMI), age, and sex. The same approach was used for change in JSN and change in predictor variables. We evaluated 264 study participants with knee OA (mean age 66.7 years, 59% men, mean BMI 31.4 kg/m(2)). The results from the models demonstrated that meniscal position and meniscal degeneration each contributed to prediction of JSN, in addition to the contribution by cartilage morphologic features. For change in medial joint space, both change in meniscal position and change in articular cartilage score contributed substantially to narrowing of the joint space. The meniscus (both its position and degeneration) accounts for a substantial proportion of the variance explained in JSN, and the change in meniscal position accounts for a substantial proportion of change in JSN.

How the Increase of the Cervical Disc Space Height Affects the Facet Joint

In vitro study on the effect of increasing the height of the cervical disc space on the facet joint. To demonstrate how facet joint articulation is affected by increasing the cervical disc space height. A surgeon attempts to increase the disc space and inserts a larger artificial disc than normal in order to keep the intervertebral foramen open and the prosthesis stable. However, it is hypothesized by the current authors that this procedure could have an adverse effect on the facet joints. Computerized tomography images passing through the disc space and the center of the C4-C7 facet joints (sagittal plane) were obtained from 15 cadaveric cervical spine specimens. A 1-mm incremental increase to a total 5 mm in disc space height was performed to simulate the changes seen in disc replacement. The change in the facet joint articulation overlap and space in the sagittal plane at normal and each displacement was measured. Each 1-mm incremental increase in disc space at C4-C5 translated to a decrease in the facet joint articulation overlap in the sagittal plane by approximately 8%. The mean facet joint space increased approximately 0.8 mm. At the C5-C6 and the C6-C7 levels, the articulation overlap decreased by approximately 7% and the facet joint space increased approximately 0.8 mm. There is a significant decrease of the facet joint articulation overlap in the sagittal plane and an increase in the facet joint space following an increase in the cervical disc space. The inappropriate increase of the disc space height may result in facet joint subluxation and could lead to the accelerated failure of the artificial disc.

Cartilage Healing After Microfracture in Osteoarthritic Knees

To evaluate the clinical and radiologic results, second-look arthroscopic findings, histologic evaluation, and results of immunohistochemical staining and the Western blotting test for type II collagen after microfracture for full-thickness chondral defects in patients with osteoarthritic knee. Between October 1997 and December 1998, 49 knees in 46 patients who had moderate osteoarthritic changes underwent microfracture; 44 patients (47 cases) had second-look arthroscopy and biopsy performed 1 year after surgery. The clinical outcomes were assessed by use of Baumgaertner's 9-point scale and joint space changes were measured radiographically; 18 knees underwent immunohistochemical study and 21 knees underwent Western blotting tests to identify formation of type II collagen. Significant improvements were noted for the parameters of daily living activity and pain (P < .05). The joint spaces were widened by 1.06 mm on standing anteroposterior and by 1.37 mm on standing lateral radiographs, which showed statistical significance (P < .05). Individual defects were filled with white tissue resembling cartilage on second-look arthroscopy, and the cartilage healing was found by histologic evaluation. Type II collagen formation was identified qualitatively by immunohistochemical staining. Quantitative collagen formation by Western blotting showed 44% growth compared with the normal control. This healed tissue is a combination, or hybrid, of fibrocartilage and hyaline-like cartilage, and it is shown to contain type II collagen on immunohistochemical staining and the Western blotting test. Patients with full-thickness chondral defects in the osteoarthritic knee can have improved function and see an increase in joint space after microfracture. Cartilaginous tissue containing type II collagen is formed after the microfracture procedure in the osteoarthritic knee. Level IV, retrospective case series.

In vivo serial joint space measurements during dynamic loading in a canine model of osteoarthritis

To devise a reliable, sensitive method to measure joint space in vivo during dynamic loading. Additionally, to determine if dynamic joint space changes were related to the severity of long-term cartilage damage. Subjects were 23 adult foxhounds (18 experimental, 5 control). Experimental subjects had surgically transected cranial cruciate ligaments (CCL). Dynamic joint space was serially measured in vivo over 2 years using a unique high speed stereo radiographic system in combination with subject-specific computed tomography reconstructions. Dynamic joint space was measured in vivo with a within-day precision of 0.09 mm. Half of the experimental subjects developed minor articular cartilage damage and the other half developed severe articular cartilage damage in the medial knee compartment. Joint space during treadmill running increased significantly in the minor damage group in both the medial (+0.61 mm, P = 0.036) and lateral (+0.84 mm, P = 0.002) compartments of the knee. Dynamic joint space in the severe damage group did not increase significantly on either the medial (+0.27 mm, P = 0.408) or lateral (+0.44 mm, P = 0.199) side. The majority of the change in joint space occurred the first year after CCL transection. Medial meniscus damage was related to severity of medial articular cartilage damage (tau = 0.447, P = 0.003). The minor damage group developed 73% of all osteophytes noted at dissection. This technique is a precise tool for measuring joint space serially in vivo under dynamic loading conditions. The data suggest decreased severity in long-term articular cartilage damage is related to: osteophyte formation, less severe medial meniscus damage and increased joint space the first 12 months after injury.

Naviculo-Medial Cuneiform Coalition: Radiological Features

Purpose: To define the radiological features of the naviculo-medial cuneiform coalition. Materials and Methods: This study examined 35 feet from 25 patients (mean age 26 years) with a naviculo-medial cuneiform coalition. The images were analyzed retrospectively with regard to irregular articular surface, subchondral sclerosis, subchondral cyst, beak-like spur, the change in joint space, bony fusion seen on plain radiographs (n=35) and CT (n=14), and the histological type of coalition on MRI (n=3). The extent of joint involvement was also evaluated. Results: Of the 35 feet, plain radiographs and/or CT showed an irregular articular surface in 34 (97.1%), subchondral sclerosis in 30 (85.7%), a subchondral cyst in 29 (82.9%), a beak-like spur in 23 (65.7%), a narrowing of the joint space in 24 (68.6%) and no bony fusions (0%). The T1-weighted images revealed low signal intensity, and the T2-weighted fast spin-echo and gradient images revealed high signal intensity in the three feet with a cartilaginous coalition. The coalition involved the plantar part of the joint in all 35 feet. Conclusion: The characteristic radiological features of a naviculo-medial cuneiform coalition include an irregular articular surface with possible secondary degenerative changes in the plantar margin of the joint, non-osseous type.

Semianalytical solutions for fluid flow in rock joints with pressure‐dependent openings

If fluid is injected into joints in rock masses, the pressure required might result in changes in the joint space between rock blocks that accommodate the fluid transport. At one extreme, very low injection rate and pressure, the joint space is unaffected, and the fluid pressure follows the usual law of linear diffusion. At the opposite extreme, very high injection rates, as used, for example, during hydraulic fracturing, the pressure is so high as to overcome the original Earth stress holding the rock blocks in contact. They “lift off,” resulting in huge changes in joint space, and the flow equation then becomes so nonlinear that pressure pulses are no longer transmitted in a smooth, diffusive manner but more like a propagating shock wave. In between these extremes, at more modest pressure, the result is not liftoff, but nevertheless, the effective stress tending to close the joint space is reduced; this space dilates, and the effective permeability and storativity of the joint will increase. While the pressure wave will not propagate quite as sharply as it does for liftoff, nonlinearities greatly influence the results, exhibiting behavior far from that predicted by linear diffusion.

Effect of Laser in Arthroscopic Knee Surgery

1068 Laser technology has come into common use in orthopaedics over the last 10–15 years. The most commonly used laser in orthopaedics is the Holumim:YAG (Ho: YAG) (laser). PURPOSE: To review the clinical outcomes of laser vs. non-laser meniscectomy and chondroplasty using subjective rating scales and radiographic analysis. METHODS: This was a retrospective study of patients who had undergone arthroscopic meniscectomy, with or without chondroplasty, by a single surgeon with a minimum 2 years follow-up. Patients were subjectively evaluated with the Lysholm Knee Score and SF-36. In addition, AP and lateral radiographs were obtained at follow-up and compared to preoperative radiographs which were evaluated in a blinded manner and evaluated for joint space narrowing in the medial and lateral compartments of the knee. Statistical analysis between the laser and non-laser groups was performed using student t-test with the level of significance set at p<0.05. RESULTS: Functional results were available on 81 patients, 48 laser and 33 non-laser (mean age at surgery 52.1 ± 12.8 yrs and 47.5 ± 19.6 yrs, respectively). At an average follow-up of 35.9 ± 10.6 months for the laser group and 38.9 ± 12.8 months for the non-laser, the average Lysholm knee scores were 77.45 and 81.80, respectively (p = 0.38). In each of the eight categories of the SF-36 outcome evaluation, there were no statistically significant differences between the laser and non-laser groups. Radiographic analysis was available on 40 patients at the time of follow-up (23 laser patients and 17 non-laser patients). For the medial compartment of the knee, the average decrease in joint space was 0.87mm in the laser group versus 0.26mm in the non laser group (p = 0.09). For the lateral compartment, the average change in joint space was −0.04 mm in the laser group versus −0.35 mm in the non laser group (p = 0.20). No evidence of osteonecrosis of the femoral condyles was seen in either group. CONCLUSIONS: Overall, the results indicate that laser use in the knee for meniscectomy is as safe and as effective as traditional meniscectomy. Although slightly more expensive, the laser becomes an especially valued and effective tool in the tight knee with difficult to reach spaces.

Effect of Laser in Arthroscopic Knee Surgery

1068 Laser technology has come into common use in orthopaedics over the last 10–15 years. The most commonly used laser in orthopaedics is the Holumim:YAG (Ho: YAG) (laser). PURPOSE: To review the clinical outcomes of laser vs. non-laser meniscectomy and chondroplasty using subjective rating scales and radiographic analysis. METHODS: This was a retrospective study of patients who had undergone arthroscopic meniscectomy, with or without chondroplasty, by a single surgeon with a minimum 2 years follow-up. Patients were subjectively evaluated with the Lysholm Knee Score and SF-36. In addition, AP and lateral radiographs were obtained at follow-up and compared to preoperative radiographs which were evaluated in a blinded manner and evaluated for joint space narrowing in the medial and lateral compartments of the knee. Statistical analysis between the laser and non-laser groups was performed using student t-test with the level of significance set at p<0.05. RESULTS: Functional results were available on 81 patients, 48 laser and 33 non-laser (mean age at surgery 52.1 ± 12.8 yrs and 47.5 ± 19.6 yrs, respectively). At an average follow-up of 35.9 ± 10.6 months for the laser group and 38.9 ± 12.8 months for the non-laser, the average Lysholm knee scores were 77.45 and 81.80, respectively (p = 0.38). In each of the eight categories of the SF-36 outcome evaluation, there were no statistically significant differences between the laser and non-laser groups. Radiographic analysis was available on 40 patients at the time of follow-up (23 laser patients and 17 non-laser patients). For the medial compartment of the knee, the average decrease in joint space was 0.87mm in the laser group versus 0.26mm in the non laser group (p = 0.09). For the lateral compartment, the average change in joint space was −0.04 mm in the laser group versus −0.35 mm in the non laser group (p = 0.20). No evidence of osteonecrosis of the femoral condyles was seen in either group. CONCLUSIONS: Overall, the results indicate that laser use in the knee for meniscectomy is as safe and as effective as traditional meniscectomy. Although slightly more expensive, the laser becomes an especially valued and effective tool in the tight knee with difficult to reach spaces.

Glucosamine sulfate reduces osteoarthritis progression in postmenopausal women with knee osteoarthritis: evidence from two 3-year studies

To investigate the effect of glucosamine sulfate on long-term symptoms and structure progression in postmenopausal women with knee osteoarthritis (OA). This study consisted of a preplanned combination of two three-year, randomized, placebo-controlled, prospective, independent studies evaluating the effect of glucosamine sulfate on symptoms and structure modification in OA and post-hoc analysis of the results obtained in postmenopausal women with knee OA. Minimal joint space width was assessed at baseline and after 3 years from standing anteroposterior knee radiographs. Symptoms were scored by the algo-functional WOMAC index at baseline and after 3 years. All primary statistical analyses were performed in intention-to-treat, comparing joint space width and WOMAC changes between groups by ANOVA. Of 414 participants randomized in the two studies, 319 were postmenopausal women. At baseline, glucosamine sulfate and placebo groups were comparable for demographic and disease characteristics, both in the general population and in the postmenopausal women subset. After 3 years, postmenopausal participants in the glucosamine sulfate group showed no joint space narrowing [joint space change of +0.003 mm (95% CI, -0.09 to 0.11)], whereas participants in the placebo group experienced a narrowing of -0.33 mm (95% CI, -0.44 to -0.22; P < 0.0001 between the two groups). Percent changes after 3 years in the WOMAC index showed an improvement in the glucosamine sulfate group [-14.1% (95%, -22.2 to -5.9)] and a trend for worsening in the placebo group (5.4% (95% CI, -4.9 to 15.7) (P = 0.003 between the two groups). This analysis, focusing on a large cohort of postmenopausal women, demonstrated for the first time that a pharmacological intervention for OA has a disease-modifying effect in this particular population, the most frequently affected by knee OA.