Kellgren Classification Research Articles

Comparison of the Effect of High-Intensity Laser Therapy and Quadriceps Muscle Strengthening Exercises Using Biofeedback on Pain, Stiffness and Function of Patients with Knee Osteoarthritis: A Randomized Clinical Trial

Objectives: This study aims to compare the effects of high-intensity laser therapy (HILT) and quadriceps muscle strengthening exercises using biofeedback on pain and function in patients with knee osteoarthritis (KOA). Methods: This randomized, two-group clinical trial included patients with KOA (grades II - III of the Lawrence Kellgren classification) who met the inclusion criteria. Written informed consent was obtained from participants before they were randomly allocated into one of two groups: HILT + therapeutic exercise (group A) or quadriceps muscle strengthening exercises using biofeedback + therapeutic exercise (group B). Both groups followed the same therapeutic exercise regimen during the study. Knee pain severity was evaluated using the Visual Analogue Scale (VAS), and functional disability was assessed with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire before the intervention. For group A, HILT was performed using a BTL-6000 HIL device (wavelength 1064 nm, maximum power 12 W) following the manufacturer-recommended protocol. A pain relief program (10 W, 120 J/cm²) was administered for 120 seconds per session over ten sessions. Treatment protocol, laser positioning, and session duration were standardized. Two follow-up assessments (immediately and one-month post-intervention) were conducted to evaluate outcomes based on the VAS and WOMAC scores. Results: The study included 40 participants with KOA, divided evenly between the two groups (20 in each). The average age of the participants was 59.34 ± 6.92 years. High-intensity laser therapy group (group A): Visual analogue scale pain scores decreased significantly immediately after and one month post-intervention compared to baseline (P < 0.01). However, the VAS score one month after the intervention showed no significant difference compared to the immediate post-intervention score (P = 0.59). Biofeedback group (group B): VAS pain scores also decreased significantly both immediately after and one month post-intervention compared to baseline (P < 0.05). The difference in VAS pain reduction between the two groups was significant, with the HILT group showing greater improvement immediately after the intervention and one month later (P = 0.007). Conclusions: The study findings suggest that both quadriceps muscle strengthening exercises using biofeedback and HILT effectively reduce pain in KOA patients. However, HILT demonstrated superior efficacy compared to biofeedback exercises. These results support the use of HILT as a noninvasive therapeutic modality for KOA, particularly for patients with a higher risk of surgery due to preexisting comorbidities.

Walking related performance fatigability in patients with knee osteoarthritis as compared to healthy controls

PURPOSE: Knee Osteoarthritis is a common degenerative joint disease associated with significant walking-related disability. Impaired gait mechanics can lead to an increase in energy expenditure and impaired energy recovery, causing an increase in perceived fatigue resulting in functional decline. However, despite the association of performance fatigability with negative health outcomes and walking-related disability, it is still not well understood in patients with knee osteoarthritis. METHODS: The study conducted a cross-sectional comparison between 20 participants with knee osteoarthritis (OA) classified as grade III or less on the Kellgren classification, and a control group of 20 healthy individuals matched in age, weight, height, body mass index (BMI) and gender. A six-minute walk test (6MWT) was used as an outcome measurement tool, and distance, gait velocity, and walking-related performance fatigability were calculated. SPSS version 21 was used to analyze the data, and the normality of the data was determined using the Shapiro-Wilk test. For normally distributed data, the independent t-test was employed, while the non-normally distributed data was analyzed using the Mann-Whitney U test. RESULTS: No significant differences (p > 0.05) were observed between healthy controls and participants with knee OA in terms of age, weight, height, and BMI. However, significant differences (p < 0.05) were observed in total distance covered in 6 minutes, distance covered in each minute, gait velocity and walking-related performance fatigability. Persons with knee OA demonstrated greater fatigability and lesser gait velocity and distance covered during the 6MWT. CONCLUSION: Individuals with knee OA exhibited greater fatigability and lower gait velocity and distance covered during the 6MWT.

Effects of glucosamine and chondroitin sulfate supplementation in addition to resistance exercise training and manual therapy in patients with knee osteoarthritis: A randomized controlled trial.

To determine the added benefits of short-term glucosamine and chondroitin sulfate supplementation in combination with manual therapy and resistance exercise training in the management of knee osteoarthritis. A parallel-design, double-blind randomised controlled trial was conducted from January to September 2020 at the Foundation University Institute of Rehabilitation Sciences and Fauji Foundation Hospital, Rawalpindi, Pakistan, and comprised of knee osteoarthritis patients of either gender having radiological evidence of grade III or less on Kellgren classification. The subjects were randomly allocated to active comparator group A and experimental group B. Both the groups received manual therapy and resistance exercise training, while group B additionally received glucosamine and chondroitin sulfate supplementation for 4 weeks. Study outcomes included pain, function, quality of life, range of motion, strength, fall risk, skeletal muscle mass, visceral fat area, body fat, intracellular water ratio, and segmental lean and fat mass. Data was analysed using SPSS 21. Of the 24 subjects, there were 12(50%) in each of the two groups. Each groups had 9(75%) males and 3(25%) females. In terms knee osteoarthritis grade, there was no significant difference between the groups (p=1.00). No significant differences were observed in any of the outcome measures neither at 2 weeks, nor at 4 weeks post-intervention between the groups (p>0.05) except for percentage change in segmental lean mass of the right leg at 2nd week and of the left leg at 4th week (p<0.05). Manual therapy and resistance exercise training are effective in the management of knee osteoarthritis, however, glucosamine and chondroitin sulfate supplementation for 4 weeks showed no additional benefits. NCT04654871. https://www.clinicaltrials.gov/ct2/show/NCT04654871.

Osteoarthritis classifications : Modification proposal for the criteria of Kellgren and Vallotton

In imaging diagnostics, classification schemes are very common. As far as osteoarthritis is concerned, the Kellgren classification is the most popular. However, the Kellgren classification, which has been used for more than 50years, is based on nonspecific criteria; thus, high interobserver variability has been reported. In addition, the Kellgren classifications have not been coordinated with magnetic resonance imaging (MRI)-based classification schemes, e.g., Vallotton. In this paper, we present some modifications concerning the criteria for both the Kellgren classification and its comparison with the MRI-based Vallotton classification. The current surgical and imaging classifications and the precision of the nomenclature are analyzed. X‑ray and MRI findings are compared. Suggestions for both amodification of the Kellgren classification as far as the criteria are concerned and ahierarchy (ranking) of X‑ray and MRI findings to make clinical decisions more valuable are proposed. These proposed modifications (Kellgren and ranking) would be helpful for routine reporting and allow for better interobserver reliability, in particular for special reports (e.g. consultations, expert opinions, advanced diagnostics).

Effectiveness of intraosseous infiltration of autologous platelet-rich plasma in the area of the bone marrow edema in osteoarthritis of the knee joint

Osteoarthritis (OA) affects both elderly people, for whom it is one of the main causes of disability, and people of active working age and is an urgent clinical and social problem of resistance of pain syndrome to therapy. The disease is characterized by both destruction of intra-articular and paraarticular structures, such as subchondral bone. While OA is an important sign of pathological changes believe the bone marrow edema (BME). This work examines the effect of BME on development osteoarthritis, and therapeutic approaches to the management of patients with OA. The aim of the study was to develop a method of treatment of BME in OA of the knee joint by locally intraosseous injection of autologous thrombotic-rich plasma (PRP) into the edema zone. In this study 17 patients with the diagnosis: Osteoarthritis II-IV Grade. according to the classification of Kellgren–Lawrence, in which areas of local inflammation in the form of BME were detected on MRI in the subchondral zone in accordance with the international classification of WORMS (Whole Organ Magnetic Resonance Imaging Score). The mean age of patients was 41,7 ± 14,3 years, 10 of them were women and 7 men. Patients were treated with autological platelet-rich plasma under x-ray control injected from extra-articular intraosseous access in the area of BME. Evaluation of effectiveness of treatment performed by VAS, WOMAC and KOOS scales, before the introduction of autoplasma, after 1 and 3 months after the start of treatment. Three months after the manipulation, there was a statistically significant decrease in the intensity of inflammatory syndrome: for WOMAC by 17.5%, for KOOS by 19.4% and for VAS by 33,1% (p &lt; 0,01). Thus, the efficiency of intraosseous Infiltration of autologous platelet-rich plasma in the treatment of patients with OA, accompanied by edema of the bone marrow in the subchondral zone, was proved.

Direct cost of medical care in patients with gonarthrosis

ObjectiveTo determine the cost of medical care in patients with gonarthrosis. Material and methodsCost study in patients over 40 years of age with gonarthrosis, diagnosed according to the radiological classification of Kellgren and Lawrence. The average annual cost (euros) was estimated taking the unit cost plus average use of services such as family medicine, imaging, laboratory, electrodiagnosis, orthopaedics, hospitalisation, physical therapy, surgery, nutrition, preoperative assessment and medication. Projections based on assumptions were made for three scenarios. ResultsGrade 2 gonarthrosis predominated at 39.7% (95% confidence interval, 33.8–45.6). The annual cost of care for a patient with gonarthrosis was €108.87 in the intermediate scenario, €86.73 in the lower cost scenario and €132.60 in the higher cost scenario. For a population of 119,530,753 inhabitants, with 10,937,064 gonarthrosis patients, the annual cost in the intermediate scenario was €1,190,685,273 and represented 4.48% of the health expenditure. ConclusionThe average annual cost of gonarthrosis is relatively low, but when related to prevalence and prevalence trends, it can become a serious problem for health services.

Efficacy of local injection therapy with hyaluronic acid of different molecular weight in patients with knee osteoarthritis

Intra-articular administration of hyaluronic acid (HA) is one of the methods of conservative treatment of knee osteoarthritis (OA). However, the data of its efficacy in the modern literature are contradictory.Objective: to assess the efficacy of intra-articular administration of HA preparations with different molecular weight in the treatment of patients with knee OA and to study the factors that can influence the effectiveness of such therapy.Subjects and methods. HA preparations were administered to 60 patients with idiopathic and posttraumatic knee OA. The ratio of women to men was 3:1. The average age was 59.5±13.7 years and body mass index – 30.3±5.8 kg/m2. The presence of enthesitis was evaluated prior to treatment by the characteristic clinical picture. The x-ray stage of OA was determined in accordance with the classification of Kellgren–Lawrence. Distribution of of knee joint lesions, relationship of femur and tibia anatomical axes, presence of varus and valgus deformities were also evaluated. The patients were divided into three groups: 18 patients received low-molecular (LM), 19 – medium-molecular (MM) and 23 – high-molecular (HM) HA. To assess the efficacy of the treatment the severity of pain on a visual analog scale (VAS) and the total score of the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire before, 1, 3 and 6 months after treatment were evaluated.Results and discussion. Enthesitis was detected in 17 (28,3%) patients. Stage I of knee OA was diagnosed in 10 (16.6%), II – in 36 (60%) and III – in 14 (23.3%) patients. Varus deformity was detected in 43 (71.7%) patients, neutral axis of the lower limb - in 14 (23.3%), valgus deformity – in 3 (5%). The most significant decrease in the severity of pain was noted in patients with stage I of knee OA: from 54±17.1 to 10.0±10.0 mm. At stage II, the pain decreased from 59.4±12.6 to 45.5±20.3 mm, and at stage III – from 66.4±13.5 to 60.7±23.3 mm. By the 6th month, the severity of pain in patients with enthesitis was higher, and the values of KOOS total score were worse than in patients without it. At stages II and III of knee OA, the ratio of positive to unsatisfactory results for MM, LM and HM HA was as follows: 2:1, 3:1 and 3.6:1. In the group of patients with excellent results, the value of varus deformation averaged 8.5±1.5°, in patients with a good result – 9.8±2.8°, with a satisfactory result – 11.3±4.5°, and with an unsatisfactory – 11.5±3.2°.Conclusion. Intra-articular injection of HA is very effective at stage I of knee OA. The expression and duration of this effect are reducedwith decrease of cartilage thickness and increase of knee joint varus deformation (i.e., at the II and III stages of knee OA). The presence of varus deformation does not affect HA efficacy. Three factors are important: the appearance of varus deformation of the lower limb with initially neutral axis; the increase of varus deformation; the value of varus deformation &gt;10°.

ACL deficiency and varus osteoarthritis: high tibial osteotomy alone or combined with ACL reconstruction?

This study investigates the mid- to long-term clinical and radiological outcome in patients with symptomatic varus osteoarthritis (OA) and deficiency of the anterior cruciate ligament (ACL) and analyzes whether there are differences between isolated high tibial osteotomy (HTO) or combined single-stage HTO and ACL reconstruction (ACLR). 26 patients who underwent HTO alone (group 1) and 26 patients who underwent single-stage HTO and ACLR (group 2) because of varus OA and ACL deficiency were examined at a mean of 5.8years (SD 3.6years) post-operatively. Assessment at follow-up (FU) was performed using a questionnaire including clinical scores (Lysholm, IKDC) and the KT-2000 arthrometer to examine anterior knee stability. Radiographic knee alignment and signs of OA according to the classification of Kellgren and Lawrence (KL) were assessed pre-operatively and at FU. Eighty-one percent of all patients reported an improvement of pain and 79% an improvement of instability without significant group difference. Significant worse results were observed in group 1 for the Lysholm score (group 1: 69.4, SD 15.7; group 2: 78.3, SD 16.4; p=0.020) and the IKDC score (group 1: 64.8, SD 13.0; group 2: 74.0, SD 15.6; p=0.006). No group difference was found for the KT-2000 examination. A significant post-operative increase of radiographic OA could be seen in both groups without significant group difference (KL pre-operative: 2.3, SD 0.63; KL FU: 2.8, SD 0.74; p<0.001). The radiographic leg alignment at FU showed a significant lower valgus alignment in group 1 (group 1: 0.4 degree, SD 3.3 degree; group 2: 2.1 degree, SD 2.1 degree; p=0.039). The rate of post-operative complications was low with 4%, and no significant group differences were found. This study shows that HTO alone can improve pain and even subjective knee stability. Additional ACLR was in the mid term not associated with a higher increase of OA or a higher rate of post-operative complications in our study collective.

Reproducibility assessment of different descriptions of the Kellgren and Lawrence classification for osteoarthritis of the knee

ObjectiveTo assess the inter- and intraobserver reproducibility of the original version and different descriptions of the Kellgren and Lawrence classification used in epidemiological studies for osteoarthritis of the knee. MethodsThe study included 72 patients with osteoarthritis of the knee. Three medical members of the Brazilian Society of Knee Surgery were invited to evaluate the images. An intra- and interobserver analysis was conducted, with an interval of one month. The intraobserver agreement was analyzed using the weighted Cohen's Kappa coefficient. The interobserver agreement was analyzed using the Krippendorff alpha coefficient (α). ResultsThe intraobserver assessment indicated conflicting results. In the interobserver analysis, the level of agreement was superficial. ConclusionsThe classification of Kellgren and Lawrence and its variants generated a low reproducibility between observers. The intraobserver analysis showed a lack of uniformity in the use of this classification and its variants, even among experienced observers.

Assessment of the Relationship between the Shape of the Lateral Meniscus and the Risk of Extrusion Based on MRI Examination of the Knee Joint.

BackgroundMeniscus extrusion is a serious and relatively frequent clinical problem. For this reason the role of different risk factors for this pathology is still the subject of debate. The goal of this study was to verify the results of previous theoretical work, based on the mathematical models, regarding a relationship between the cross-section shape of the meniscus and the risk of its extrusion.Materials and MethodsKnee MRI examination was performed in 77 subjects (43 men and 34 women), mean age 34.99 years (range: 18–49 years), complaining of knee pain. Patients with osteoarthritic changes (grade 3 and 4 to Kellgren classification), varus or valgus deformity and past injuries of the knee were excluded from the study. A 3-Tesla MR device was used to study the relationship between the shape of the lateral meniscus (using slope angle, meniscus-cartilage height and meniscus-bone angle) and the risk of extrusion.ResultsAnalysis revealed that with values of slope angle and meniscus-bone angle increasing by one degree, the risk of meniscus extrusion raises by 1.157 and 1.078 respectively. Also, an increase in meniscus-cartilage height by 1 mm significantly elevates the risk of extrusion. At the same time it was demonstrated that for meniscus-bone angle values over 42 degrees and slope angle over 37 degrees the risk of extrusion increases significantly.ConclusionsThis was the first study to demonstrate a tight correlation between slope angle, meniscus-bone angle and meniscus-cartilage height values in the assessment of the risk of lateral meniscus extrusion. Insertion of the above parameters to the radiological assessment of the knee joint allows identification of patients characterized by an elevated risk of development of this pathology.

Avaliação da reprodutibilidade das diferentes descrições da classificação de Kellgren e Lawrence para osteoartrite do joelho

ObjetiveTo assess the inter‐ and intraobserver reproducibility of the original version and different descriptions of the Kellgren and Lawrence classification used in epidemiological studies for osteoarthritis of the knee. MethodsThe study included 72 patients with osteoarthritis of the knee. Three medical members of the Brazilian Society of Knee Surgery were invited to evaluate the images. An intra‐ and interobserver analysis was conducted, with an interval of one month. The intraobserver agreement was analyzed using the weighted Cohen's Kappa coefficient. The interobserver agreement was analyzed using the Krippendorff Alpha coefficient (α). ResultsThe intraobserver assessment indicated conflicting results. In the interobserver analysis, the level of agreement was superficial. ConclusionsThe classification of Kellgren and Lawrence and its variants generated a low reproducibility between observers. The intraobserver analysis showed a lack of uniformity in the use of this classification and its variants, even among experienced observers.

Peculiarities of rehabilitation of the patents presenting with coxosteoathritis and gonosteoathritis

Under the term of osteoarthritis (OA) is currently meant the clinical condition with the predominant syndrome that manifests itself as the combination of joint pain and compromised functional activity leading to the deterioration of the quality of life for the affected patients. The principal objective of rehabilitation of the patients presenting with OA which practically all of them strongly need after each next aggravation of the pathological process consists in the reduction of the pain syndrome, elimination of synovitis, restoration of the functional ability of the joints lost during the exacerbation, and, eventually, the improvement of the quality of life in the patients experiencing the constantly progressing degenerative process in the musculoskeletal apparatus. The effectiveness of the rehabilitative treatment was evaluated based on the following criteria: the degree of pain alleviation, the increase in the levels of joint functional activity, and the improvement of the general condition of the patients. These criteria were chosen according to the recommendations of the OMERACT (Outcome measures in Rheumatology) international working group. Also, the quality of life related to the health status and side effects of the rehabilitative measures were estimated. One of the most important aspects of the treatment of the patients with osteoarthritis bearing in mind frequent cases of co-morbidity is the scientifically-sound substantiation of the application of the non-medicinal technologies of physical therapy, remedial gymnastics, and massage for the management of the secondary aseptic inflammatory process and the subsequent rehabilitation for the restoration of the compromised locomotory stereotype and, as the result, the improvement of the quality of life in these patients. One of the effective methods for physical therapy used in the treatment and rehabilitation of patients with OA is hyperbaric gas cryotherapy (HBGCT). This method is based on the rapid withdrawal of heat from the organism that responds by the compensatory and/or reflective activation of the heat production processes in the tissues as a consequence of stimulation of metabolic processes, vascular, neuroendocrine and immune systems of regulation of homeostasis producing the desirable therapeutic effect in the form of elimination of secondary aseptic inflammation and progression of the OA-associated degenerative process. In this context, the objective of the present research consisted of the scientific substantiation of hyperbaric gas cryotherapy as a component of the combined treatment of the patients presenting with gonosteoathritis and coxosteoathrosis. The article was designed to report the results of the combined treatment of 110 patients (22 men and 88 women) at the age from 40 to 75 years suffering gonosteoathritis and coxosteoathrosis of the II-III stages (based on the classification of Kellgren). They were randomly divided into two groups (each comprised of 55 patients). The patients of the main group, unlike those in the control one (group of comparison) were given, in addition to the traditional treatments such as instrumental physical therapy, balneotherapy, remedial gymnastics, and massage, hyperbaric gas cryotherapy with the assessment of the results based on the Lequesne, WOMAC, Likert international indexes. Such an approach allowed to identify the predictors for the use of hyperbaric gas cryotherapy and to raise by 33%, in comparison with controls, the effectiveness of the combined treatment of the patients with osteoarthrosis of the large joints. The dispersion analysis has demonstrated the high clinical efficiency of the proposed therapeutic modality in 90% of the cases of gonosteoathritis and in 64% of the patients presenting with coxosteoathritis. These data were not statistically different from those characterizing the effectiveness of HBGCT in the patients with coxosteoathritis included in the group of comparison.

Risk Factors for Early Reherniation after Lumbar Discectomy with or without Annular Closure: Results of a Multicenter Randomized Controlled Study

Aim: Reherniation (RH) after lumbar discectomy (LD) is known as a failure and reported in the literature ranging from 3 to 18%. Different risk factors for RH have been discussed such as age, sex, BMI, smoking, type and size of annular defect, amount of removed disc volume, grade of disc degeneration, disc height, etc. The aim of this study was to identify preoperative demographic, radiological, and intraoperative surgical factors associated with early RH in patients undergoing one level LD with or without annular closure within 3 months after surgery. Methods: This study is based on the analysis of data of a postmarketing, prospective, multicenter RCT in Europa including patients undergoing standard LD with or without implantation of an annular closure device (ACD) (Barricaid®, Intrinsic Therapeutics, Inc., Massachusetts, United States). Enrollment of 554 patients in 21 Centers in Europa (DE, CH, AT, BE, NL, FR) started in 2010 and was completed by October 2014. A total of 276 patients were randomized to the ACD group and 278 patients to the control group. Results: Within 3 months after surgery, 20 (3.7%) patients had a symptomatic RH. 4 (1.5%) occurred in the ACD group and 16 (5.8%) in the Control group. Reoperation was performed in 3 patients in the ACD group and 9 patients in the Control group. Regarding the risk factors for RH, there was a trend with gender in the overall population (p = 0.077) – A 5.5% rate of RH was observed in females (12/219) in comparison to 2.5% (8/326) in male patients. A larger annular defect was a significant risk factor for RH overall (p = 0.017) and in the Control Group (p = .0.01). 21 (4%) patients had a defect size > 54 mm2 and 14.3% of these patients developed a RH. In the ACD group all 4 RH were found in patients with defects ≤ 54 mm2. Disc degeneration according to the classification of Kellgren and Lawrence showed a trend as a predictor for RH overall (p = 0.077) and was a significant risk factor in the Control group (p = 0.017). In addition the Pfirrmann classification correlated significantly with RH, both overall (p = 0.004) and in the Control group (p = 0.010). Out of 400 patients who showed a Pfirrmann Grade 2, 2.5% suffered RH, while 9.5% of the 95 patients with a Pfirrmann Grade 3 reherniated. Conclusion: Risk factors for early RH after LD in our study were large annular defect and disc degeneration. The ACD significantly reduces the risk for early RH. These results suggest that implantation of an ACD can prevent early RH after LD.

Comparison of spatial and temporal variables of gait between individuals above and below 65 years with bilateral knee osteoarthritis

Background:Osteoarthritis (OA) of the knees is a chronic degenerative disease that causes changes in the articular cartilage, the most common musculoskeletal disease worldwide (Blanco et al., 1998). The World Health Organization estimates that 25% of those over 65 years suffer from pain and disability associatedwith this disease. Symptoms of kneeOA are related to pain joint, loss of muscle strength of the lower extremities, gait disturbance and decreased aerobic capacity (Fransen et al., 2001). Considering that this disease increases with advancing age, it is important to evaluate the influence of aging on parameters of gait in individuals with knee OA. Purpose:To compare the parameters of gait in individuals above and below 65 years with bilateral knee osteoarthritis. Methods: Twenty individuals of both sexes with bilateral knee OA grades I-III according to the classification of Kellgren and Lawrence were evaluated and divided into group 1 (n= 10): individuals with OA below 65 years (45–55 years) and group 2 (n= 10): individuals with OA over 65 years (65–75 years) who live in the city of Ribeirao Preto, Brazil, which signed a consent form agreeing to participate in this study, approved by the Committee of Ethics of the Clinical Hospital, Medicine School of Ribeirao Preto. Participants underwent a radiograph of bilateral knees and all were diagnosed with some degree of OA (I–III in both knees) by an experienced radiologist. For analysis of gait variables (speed and step length) the equipmentGAITRitePlatinum26′ Portable Walkway System was used. The participants were instructed to walk (simulating habitual gait) on the carpet of the equipment, the gait starting 1 meter before and finishing 1 meter after the carpet to exclude acceleration and deceleration (repeating the task 3 times). For statistical analyses the T test of Student with level of significance p≤ 0.05 was used. Results: Subjects in group 1 presented amean (±standard deviation) value of speed gait of 1.08± 0.11m/s and left step length of 56.92± 3.34 cm and right step length of 57.42± 3.14 cm, with no significant difference compared to group 2 who presented mean value of speed gait of 1.02± 0.14m/s and left step length of 57.96± 5.39 cm and right step length of 56.80± 5.54 cm. Conclusion(s):Neither the aging process or OA presence promoted changes in gait parameters in individuals with OA. It can be concluded that aging was not a factor that promoted changes in variables of gait of subjects with knee OA. Further studies should be conducted to evaluate and to compare gait parameters between subjects with and without OA with different age ranges. Implications: The better understanding of the impact of aging process on gait aspects in individuals with knee OA is important to help in the elaboration of physical therapy intervention.

Метод консервативного лечения тяжелого посттравматического гонартроза

Introduction. Joint replacement is currently a routine surgery and a radical method of osteoarthrosis treatment. However, the high cost of implants, the development of serious complications, and the presence of contraindications to surgical treatment make to continue searching efficient conservative techniques of osteoarthrosis treatment. Materials and Methods. The clinical experience of treating 35 patients, males and females, at the age of 31-75 years with posttraumatic gonarthrosis of Stage 3-4 according to Kellgren classification with the existing contraindications to joint replacement or those resisting surgical treatment for any reason. The treatment consisted in consecutive courses of intraarticular injections of Cel-T and Adgelon chondroprotectors. Results. By three (3) months after the end of treatment the pain syndrome released significantly, the number of overcome staircases without the need of rest increased, as well as the range of motion in the joint, both the crepitation in the involved joint and the need for analgetics decreased. Conclusion. In our opinion, the achievement of a positive result is associated with the pharmacological effect of potentiating the action of two different chondroprotectors, and gives the possibility to continue working in the desired direction.

GCT: What happened after 10 years of curettage and cement? Retrospective study of 46 cases.

OBJECTIVE: To compare the functional outcome of patients with and without arthrosis, and to determine whether the development of arthrosis is related to the distance of the tumor from the subchondral bone. METHODS: Forty six patients treated for Giant-cell tumor (GCT) between 1975 and 1999 met inclusion criteria. GCT was diagnosed by percutaneous biopsy and confirmed after resection, in all cases. Campanacci's and Kellgren's classification, the distance of the cement to the articular surface and MSTS score were obtained throughout the sample. RESULTS: The distance of the cement to the subchondral bone was associated with greater risk of developing arthrosis, but there was no difference in MSTS scores between patients with or without arthrosis. CONCLUSION: We found that the distance from the cement to the subchondral bone has a prognostic value regarding future arthrosis, but it does not impact on the functional outcome. Level of Evidence IV, Therapeutic Study

Relationship between knee extensor torque and physical function in men with early knee osteoarthritis

Relationship between knee extensor torque and physical function in men with early knee osteoarthritis

Wirkungsweise von Hyaluronsäure bei Gonarthrose beider Kniegelenke im Rechts/Links-Vergleich

In a controlled prospective randomized study we evaluated the effectiveness of intraarticular injected hyaluronic acid regarding the changes in the parameters dynamometry, synovial oxygen partial pressure, intraarticular temperature and the knee joint function (Lequesne score). We examined 18 patients with osteoarthritis in both knee joints (Kellgren classification II or III according to x-ray) in right/left comparison. The evaluated parameters were measured before and after a 5-week treatment phase with 5 intraarticular injections (one injection per week). With regard to the efficacy results changes in dynamometric measurement for flexion and extension (for all angular velocities) and Lequesne-score indicate a marked improvement after treatment with hyaluronic acid. The differences between treated and untreated knee were significant. In extension the p-value was 0.0008 and in flexion p = 0.0015. The p-value of the Lequesne-index between the verum and control group was p = 0.0002. After treatment values for oxygen pressure were higher than at baseline and for the intraarticular temperature a small decrease at the end of the treatment phase was documented. The intraarticular injection of hyaluronic acid is effective and safe in the treatment of patients with gonarthrosis. The treatment resulted in a functional improvement of the knee joint and had a good pain-lowering effect in patients suffering from gonarthrosis.

Imaging findings predicting the outcome of cervical facet joint blocks

To determine which cross-sectional imaging findings predict the short-term outcome of cervical facet joint blocks (FJB) and to evaluate the effect of combined intra-/periarticular versus periarticular injection on pain. Fifty facet joints in 37 patients were included in the study. Single, unilateral FJBs in 24 patients, and bilateral single level FJBs in 13 patients were performed, respectively. In all patients, pain relief was assessed using a visual analogue scale. All computed tomography (CT) examinations were blindly reviewed by two radiologists. Osteoarthritis was rated using the Kellgren classification. The presence of combined intra-/periarticular vs. sole periarticular injection of contrast was evaluated. Kellgren Grades 0 (n=23), 1 (n=5), 2 (n=3), 3 (n=9), and 4 (n=10) were found. Mean pain relief after injection was 35% (range: 0-100%). 40% of all injections were combined intra-/periarticular. There was neither a statistically significant difference between pain relief and combined intra-/periarticular versus sole periarticular injection (p=0.64) nor the grade of osteoarthritis (p=0.49). Pain relief after cervical FJBs does not correlate with morphologic alterations seen on CT. Periarticular FJBs are not less successful than combined intra-/periarticular FJBs.

Melox (meloxicam) clinical efficacy in chronic joint diseases

Objective. To study efficacy and safety of Iwo doses of melox (meloxicam) in pts with rheumatoid arthritis (RA) and osteoarthritis (OA). Material and methods. An open uncontrolled study of melox was performed on 20 pts with chronic rheumatic diseases: 10 with RA and 10 with OA, 18 female and 2 male, mean age respectively 57,5±11,1 and 65,0±7,6 years, mean duration of the disease - 11,1 ±9,9 and 5,6±6,2 years. 90% of RA pis had 2nd activity degree and 1I-IV stage of the disease. 6 pts of OA group had gonarthritis and 4 - coxarthri- tis, 7 pts had 11 and 3 - 111 radiological stage according to Kellgren classification. The drug was administered orally during 4 weeks. Initial dose was 7,5 mg/day. In case of insufficient efficacy it was increased till 15 mg/day in 5 days. Results. All 20 pts completed 4-weeks study. There were no adverse events leading to withdrawal of melox. In 10 pts dose was increased from 7,5 to 15 mg/day - 2 with OA and 8 with RA. According to opinion of pts and investigators efficacy and tolerability were good or fair in 100%. Conclusion. The results of the study confirm that selective COX-2 inhibitors such as melox are effective, have good safety and usually do not cause serious adverse effects.