Kellgren-Lawrence Grading Scale Research Articles

Diagnosing the Severity of Knee Osteoarthritis Using Regression Scores From Artificial Intelligence Convolution Neural Networks.

This study focused on using deep learning neural networks to classify the severity of osteoarthritis in the knee. A continuous regression score of osteoarthritis severity has yet to be explored using artificial intelligence machine learning, which could offer a more nuanced assessment of osteoarthritis. This study used 8260 radiographic images from The Osteoarthritis Initiative to develop and assess four neural network models (VGG16, EfficientNetV2 small, ResNet34, and DenseNet196). Each model generated a regressor score of the osteoarthritis severity based on Kellgren-Lawrence grading scale criteria. Primary performance outcomes assessed were area under the curve (AUC), accuracy, and mean absolute error (MAE) for each model. Secondary outcomes evaluated were precision, recall, and F-1 score. The EfficientNet model architecture yielded the strongest AUC (0.83), accuracy (71%), and MAE (0.42) compared with VGG16 (AUC: 0.74; accuracy: 57%; MAE: 0.54), ResNet34 (AUC: 0.76; accuracy: 60%; MAE: 0.53), and DenseNet196 (AUC: 0.78; accuracy: 62%; MAE: 0.49). Convolutional neural networks offer an automated and accurate way to quickly assess and diagnose knee radiographs for osteoarthritis. The regression score models evaluated in this study demonstrated superior AUC, accuracy, and MAE compared with standard convolutional neural network models. The EfficientNet model exhibited the best overall performance, including the highest AUC (0.83) noted in the literature. The artificial intelligence-generated regressor exhibits a finer progression of knee osteoarthritis by quantifying severity of various hallmark features. Potential applications for this technology include its use as a screening tool in determining patient suitability for orthopedic referral. [Orthopedics. 202x;4x(x):xx-xx.].

Knee Measurement System with Osteoarthritis Levels Using Artificial Cartilage and Skeletons.

Knee osteoarthritis (OA), also known as degenerative arthritis, is a disease characterized by irreversible changes in the cartilage and bones comprising the joints, resulting in pain, impaired function, and deformity. Furthermore, independent of natural aging, the rate of change in joint cartilage has increased in recent years, which is mainly attributed to environmental factors. The rising incidence of knee-related disorders emphasizes the importance of analyzing the morphology and kinematics of knee structure. This study introduces a knee measurement system designed to replicate the motions of knee using 3D-printing technology, providing insights into knee mechanics with OA level. The research explores the stages of OA using the Kellgren-Lawrence (KL) grade scale, highlighting the variations in the force applied to the knee bone according to movement. The developed knee-simulation system, utilizing the four-bar-link theory, presents a novel approach to studying OA levels 0 to 4. As OA progresses, the cartilage deteriorates, affecting the movement of OA. The OA-based knee measurement system that incorporates soft tissues and skeletons can assist in developing a personalized diagnostic approach for knee disease. This will also help to enhance surgical effectiveness by facilitating the creation of personalized prosthetic joints for individual patients and offering a customized surgical simulation.

Medial meniscus extrusion during gait is associated with decrease in knee rotation in early-stage knee osteoarthritis

BackgroundIn patients with medial knee osteoarthritis (OA), medial meniscus extrusion during gait is aggravated by mechanical stress, such as knee adduction moment (KAM). Conversely, the decrease in the range of knee rotation during stance phase is also one of the important issues in early knee OA, whereas the correlation between medial meniscus extrusion and knee rotation during gait are unclear. Research questionTo investigate the correlation between increase in medial meniscus extrusion and range of knee rotation during gait in patients with early- and late-stage of knee OA. MethodsForty patients with medial knee OA were enrolled and divided into early- and late-OA group by Kellgren-Lawrence grading scale. During gait tasks, the extent of medial meniscus extrusion was measured using ultrasonography and kinetic/kinematic data were measured using three-dimensional motion analysis system. The correlation between medial meniscus extrusion and the range of knee rotation or KAM were evaluated in the overall, early-, and late- OA groups. ResultsA significant negative correlation was observed between an increase in medial meniscus extrusion and range of knee rotation angle in early-OA group only. However, an increase in medial meniscus extrusion significantly correlated with the second KAM peak in the overall and early-OA groups. SignificanceThe decrease in range of knee rotation during stance phase may be associated with the increase in medial meniscus extrusion during gait in patients with early knee OA.

Effect of knee pain on muscles imbalance and physical limitation in individuals with bilateral knee osteoarthritis: A comparative cross-sectional study

Objectives: When osteoarthritis (OA) affects the knee, it causes muscle imbalance and physical limitations. This study aimed to determine the impact of knee pain on quadriceps strength, hamstring length, and physical limitations in individuals with bilateral knee OA. Methods: A cross-sectional study at Khyber Teaching Hospital and Northwest General Hospital, Peshawar, included individuals aged 50–65, who met the American College of Rheumatology criteria. Subjects diagnosed with bilateral knee OA (grade II or greater on the Kellgren–Lawrence grading scale) and experiencing pain in both knees (numeric pain rating scale [NPRS] score ≥ 1) were selected through purposive sampling (n = 70). Data collection involved the NPRS, modified belt stabilizer hand-held dynamometer, active knee extension test, and Western Ontario and McMaster Universities Arthritis Index (WOMAC) Urdu version questionnaire. Measurements from both knees assessed quadriceps muscle strength, hamstring length, and physical limitations. Results: The median interquartile range (IQR) of quadricep strength for the more painful knee was 0.53 (0.36) Nm/kg and 1.35 (0.34) Nm/kg for the less painful knee showing a significant difference in quadriceps strength (P < 0.01). In terms of hamstring length, the more painful knee had a median (IQR) of 29.0 (2.0) degrees whereas the less painful knee recorded 11.0 (6.0) degrees indicating a significant difference (P < 0.01). Likewise, there was a significant difference in WOMAC scores between the less painful and more painful knees (P < 0.01). Conclusion: This study found that individuals experiencing more knee pain demonstrated decreased quadriceps muscle strength and increased hamstring muscle tightness. In addition, those with more painful knees exhibited greater physical limitations in bilateral knee OA.

Correlation between Clinical Outcome and Radiologic Features After Open Reduction and Internal Fixation of Calcaneal Fractures.

We aimed to find probable correlation between postoperative radiologic variables and clinical outcomes of surgically treated calcaneal fractures. In a retrospective study, 70 unilateral displaced intraarticular calcaneal fractures in adults with follow-up more than 1 year were asked to have a visit. Weightbearing radiographs of both ankles were taken and radiologic parameters, including the differences in values in Böhler and Gissane angles in comparison with the uninjured side, and calcaneocuboid and subtalar joint arthritis based on the Kellgren-Lawrence grading scale, were evaluated. They were considered to find any correlation with clinical outcomes assessed by American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale, visual analogue scale, Foot Function Index, and Tegner Activity Scale. A total of 61 men (87.1%) and nine women (12.9%) with a mean age of 38.9 ± 12.7 years (range, 18-67 years) were included. Mean follow-up visit for the patients was 25.1 ± 12.7 months. Mean scores of American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale, visual analogue scale, Foot Function Index, and Tegner Activity Scale were 86.7 ± 12.9, 21.3 ± 22.2, 13.1 ± 15.4, and 5.2 ± 1.1, respectively. The mean Gissane angle and Böhler angle differences were -0.2 ± 8.6 and -3.7 ± 7.2, respectively. Regarding the calcaneocuboid arthritis, 50 (71.4%), 14 (20.0%), and six patients (8.6%) were categorized in grades 0, 1, and 2, respectively. Also, subtalar arthritis was seen in 15 (21.4%), 24 (34.3%), 20 (28.6%), and 11 patients (15.7%), categorized as grades 0, 1, 2, and 3, respectively. No statistical correlation was found between any of the radiologic variables and clinical scores. There was no significant correlation between Böhler and Gissane angles and the clinical outcomes in surgically treated calcaneal fractures. Also, functional outcomes do not change considerably among different grades of arthritis in calcaneocuboid and subtalar joints, at least during short- to mid-term follow-up periods. Radiologic findings after open reduction and internal fixation of calcaneal fractures are not predictors of function of the patients.

Evaluation of the serum tRNA-derived fragment tRF-5022B as a potential biomarker for the diagnosis of osteoarthritis

Osteoarthritis (OA) is a degenerative disease. It is common in middle-aged and elderly people and is one of the main causes of disability. Currently, the etiology of OA is unclear, and no specific biomarkers for the diagnosis of OA have been identified. Therefore, finding a highly sensitive biomarker is essential for a proper diagnosis.TRNA-derived fragments (tRFs) and tRNA-derived stress-induced RNAs (tiRNAs) are newly discovered classes of noncoding RNAs. tRF has been proven in several studies to have significant associations with tumor diagnosis, making it a promising biomarker in cancer research. However, the diagnostic utility of tRF in OA patients and the correlation between OA progression and trf differential expression have yet to be elaborated. The purpose of this research was to identify tRFs with differential expression in OA to assess their potential as OA biomarkers. To determine the tRF-5022B expression level in this research, real-time fluorescence quantitative PCR has been employed. Agarose gel electrophoresis, Sanger sequencing, and other investigations have been employed for evaluating tRF-5022B's molecular properties. Receiver operating characteristic curve analysis has been utilized for assessing the diagnostic effectiveness of the tRF-5022B. The findings demonstrated that tRF-5022B expression was considerably lower in OA serum. The Kellgren–Lawrence grading scale was shown to correspond with serum expression levels. The ROC curve confirmed that tRF-5022B serum expression levels might differentiate OA cases from healthy individuals and RA patients. According to the aforementioned findings, tRF-5022B may be employed as a novel biomarker for OA diagnosis due to its excellent diagnostic value.

Correlation Between Synovial Fluid Levels of Matrix Metalloproteinase's (MMP-1, MMP-3, and MMP-9) and TNF-α with the Severity of Osteoarthritis Knee in Rural Indian Population.

In India, 22% to 39% of the ageing population suffers from degenerative knee osteoarthritis (OA), making it the most prevalent joint disorder in the knee. MMP-1, MMP-3, and MMP-9 protein expression levels have all been associated with OA. The aim of the present study was to establish a relationship between synovial fluid levels of matrix metalloproteinases (MMP-1, MMP-3, and MMP-9), and tumour necrosis factor-alpha (TNF-α) with different Kellgren-Lawrence Grading scale as per the severity of knee osteoarthritis (OA). This hospital-based observational study included 87 individuals with knee osteoarthritis examined at the orthopaedics department outpatient clinic at the tertiary care teaching hospital in rural area of north India. In-person interviews were conducted to gather data, through a semi-structured, pretested interview schedule. To determine the degree and severity of OA, the levels of the enzymes matrix metalloproteinase MMP-1, MMP-3, and MMP-9 as well as tumour necrosis factor (TNF-α) were assessed in the synovial fluid of knee of each study participant. The levels of MMP-1, MMP-3, MMP-9, and TNF-α in synovial fluid were significantly correlated with the severity of osteoarthritis as determined by the Kellgren-Lawrence Grading Scale. Age, duration of symptoms and BMI showed a strong positive and significant correlation with biochemical markers (MMP-1, MMP-3, MMP-9, and TNF-α) in synovial fluid of Knee. Level of biochemical markers (MMP-1, -3, -9, and TNF-α) in synovial fluid act as diagnostic markers and have a positive correlation with the severity of osteoarthritis knee, age, weight/BMI and duration of disease. However, no significant correlation was found between the level of aforementioned biochemical markers with sex, height, inflammation of the knee, morning stiffness, and age of onset of disease.

Effect of low-magnitude, variable-frequency vibration therapy on pain threshold levels and mobility in adults with moderate knee osteoarthritis—randomized controlled trial

BackgroundOsteoarthritis (OA) is one of the most commonly recorded diseases in clinical practice. Vibration therapy has been suggested for the treatment of knee OA. The purpose of the study was to determine the impact of vibrations of variable frequency and low amplitude on pain perception and mobility in patients suffering from knee OA.MethodsThirty-two participants were allocated into two groups – Group 1 (oscillatory cycloidal vibrotherapy-OCV) and Group 2—control (sham therapy). The participants were diagnosed with moderate degenerative changes in the knee (grade II based on the Kellgren-Lawrence (KL) Grading Scale). Subjects received 15 sessions of vibration therapy and sham therapy respectively. Pain, range of motion, and functional disability were assessed through Visual Analog Scale (VAS), Laitinen questionnaire, goniometer (ROM – range of motion), timed up and go test (TUG) and Knee Injury and Osteoarthritis Outcome Score (KOOS). Measurements were taken at baseline, after the last session and four weeks after the last session (follow up). T-test and U-Mann Whitney test compare baseline characteristics. The Wilcoxon and ANOVA tests compared mean VAS, Laitinen, ROM, TUG and KOOS. The significant P-value was less than 0.05.ResultsAfter 3 weeks (15 sessions) of vibration therapy, reduced the sensation of pain and improved mobility was recorded. There was a more significant improvement in the vibration therapy group than the control group in pain alleviation on VAS scale (p < 0.001), on Laitinen scale (p < 0.001), knee ROMs flexions (p < 0.001) and TUG (p < 0.001) at the last session. KOOS score with pain indicator, symptoms, activities of daily living, function in sport and recreation and knee related quality of life improved more in the vibration therapy group than the control group. Effects maintained up to 4 weeks in vibration group. No adverse events were reported.ConclusionsOur data demonstrated that the use of vibrations of variable frequency and low amplitude in patients with the knee OA is a safe and effective therapy. It is recommended to increase the number of treatments performed, primarily in patients with degeneration II° according to the KL classification.Trial registrationProspectively registered on ANZCTR (ACTRN12619000832178). Registered on 11 June 2019.

The Association Between Gonarthrosis Pain Severity and Radiographic Findings on X-Ray: A Cross-Sectional Study.

Knee osteoarthritis (KOA) is a degenerative joint disease that progresses over time due to articular cartilage loss. Orthopedic surgeons use plain radiography (X-ray) with an anteroposterior (AP) standing (weight-bearing) view, which is currently considered the gold standard modality, to diagnose KOA. They base this diagnosis on the clinical history and physical examination of the knee joint. However, many previous studies have reported a weak correlation between knee-joint structural abnormalities on X-rays and described pain. Therefore, our study aimed to assess the incompatibility between patients' pain-severity complaints and radiographic findings on standing AP view. No similar study has been recently published in the Middle East. 158 participants were selected for the study from King Abdulaziz University Hospital, Jeddah, between March 2022 and August 2022. We graded the patients' AP knee radiographs using the Kellgren-Lawrence (KL) grading scale and the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, by which we made phone calls to assess pain severity on a 0-10 pain subscale. We found a significant association between the 0-10 pain subscale and WOMAC questions describing difficulty in sitting (p < 0.05). Comparing KL scores on X-ray on a 0-10 pain subscale, we found a significant association between mild pain and severe radiological findings on X-ray and vice versa. In addition, the comparison between KL scores on X-ray and WOMAC questions describing difficulty in sitting showed a significant association between moderate difficulty in sitting and severe radiological findings and vice versa. Our results indicated that there was a significant relationship between mild pain and severe radiological findings on X-rays and vice versa. Additionally, there was a significant relationship, based on the KL score and the WOMAC item that assessed sitting difficulty, between moderate sitting difficulty and severe radiological findings and vice versa. This may suggest that central and peripheral sensitization could be one factor in the causes of pain.

The Significance of Neutrophil Lymphocyte Ratio, Platelet Lymphocyte Ratio, and Red Cell Distribution Width in Osteoarthritis

Background: The neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and red cell distribution width (RDW) are routinely available inflammatory biomarkers. Their significance in osteoarthritis (OA) is poorly understood. This is a systematic review, and meta-analysis aimed to determine the association of these biomarkers with the presence and severity of OA. Methods: We searched MEDLINE, EMBASE, and Cochrane library for studies reporting on associations between NLR, PLR, and RDW with OA from October 1, 2022, to November 18, 2022. We generated pooled effect measures using random-effects inverse-variance modeling to compare biomarker levels in patients with OA against healthy controls. We generated pooled effect measures to compare patients with severe OA against mild/moderate OA as defined by the Kellgren-Lawrence grading scale, a classification of OA severity based on radiographic findings. We performed metaregression to explore between-study heterogeneity. Results: We included 20 studies involving 5,109 patients in this review. Both NLR and PLR were significantly elevated in OA. RDW was not significantly elevated with OA presence or severity. Only NLR demonstrated a significant elevation with OA severity. Conclusions: In this systematic review and meta-analysis, both NLR and PLR were associated with the presence of OA, whereas only NLR was associated with the severity of disease.

Serum and synovial fluid 14-3-3η protein in patients with primary knee osteoarthritis compared with rheumatoid arthritis: relation to functional status and radiographic damage

Aim of the workThe aim of the present work was to examine the association between 14-3-3η protein levels in both serum and synovial fluid (SF) with radiographic damage and physical function in patients with primary knee osteoarthritis (OA) compared with rheumatoid arthritis (RA) patients.Patients and methodsThis is a cross-sectional study that involved two groups: group 1 included 50 primary knee OA patients, and group 2 included 50 RA patients. All study patients were assessed for serum and SF levels of 14-3-3η protein that was measured through ELISA technique. Functional assessment of OA patients was done using Western Ontario and McMaster Osteoarthritis index (WOMAC). Radiological assessment was evaluated using Kellgren–Lawrence (KL) grading scale.ResultsThe mean age of OA patients was 51.7 ± 10.4 years, disease duration was 24.8 ± 5.2 months, and mean WOMAC and KL grading scores were 18.5 ± 6.5 and 2.0 ± 0.99, respectively. Serum and SF 14-3-3η protein was significantly higher among RA compared with OA (1.5 ± 0.51 and 3.6 ± 1.1 ng/ml vs. 0.24 ± 0.03 and 0.24 ± 0.03, P = 0.004 and 0.018, respectively). There were no significant differences in serum and SF 14-3-3η protein between male and female OA patients (P = 0.99 and 0.87, respectively). A significant correlation was found between serum levels of 14-3-3η and erythrocyte sedimentation rate (r = 0.49, P = 0.014). The correlations between 14-3-3η protein in OA patients with WOMAC and KL grading scale were weak and not significant (P > 0.05).Conclusions14-3-3η protein levels were significantly lower in OA patients compared with RA patients. Although 14-3-3η levels were significantly correlated with inflammation, there was no correlation with functional status or radiological damage in knee OA patients.

An Open-Labeled Randomized Prospective Multi-center Study to Evaluate the Efficacy and Safety of Intra-articular Injection of OSSINEXT™, an Autologous Growth Factor Concentrate (AGFC) Compared to Hyaluronic Acid (HA) in Knee Osteoarthritis.

Osteoarthritis (OA) is known as degenerative arthritis and is the second most common rheumatologic problem with a prevalence of 22%-39% in India. Knee OA (KOA) is a major cause of mobility impairment, particularly among females. Non-surgical treatment options for KOA include intra-articular injections of platelet-rich plasma (PRP) and hyaluronic acid (HA). Most commercially available PRP preparation kits do not remove RBCs and WBCs which are detrimental to the healing effects. Wockhardt Regenerative Pvt. Ltd., Mumbai, India has developed a kit known as Ossinext™ which has an advantage over traditional PRP in that it eliminates RBCs and WBCs. This study was conducted to evaluate the effectiveness and safety of intra-articular injection of Wockhardt's Ossinext™ an autologous growth factor concentrate (AGFC) versus HA in KOA. Male and female patients in the age group between 30 and 75 years with confirmed KOA on radiological assessment with Grades I-III on the Kellgren-Lawrence Grading Scale and with visual analog scale (VAS) pain score of 4 or more (on the numeric rating scale) in spite of taking non-steroidal anti-inflammatory drugs (NSAIDs) since past 2 weeks were considered for study participation. This was an open-labeled study and eligible patients were randomly allocated to AGFC or HA in a 1:1 fashion. Three intra-articular injections were given in the affected knee joint, i.e. at baseline, month 1, and month 2 visits. Patients were evaluated at regular intervals, i.e. at months 5, 8, and 11 for primary and secondary endpoints. The primary efficacy endpoint for this study was change from baseline in WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) scores at month 11 whereas the secondary efficacy endpoints were change from baseline of VAS pain scale at months 1, 2, 5, 8, and 11 as well as change from baseline of WOMAC, KOOS (Knee and Osteoarthritis Outcome System), and IKDC (International Knee Documentation Committee) scale at month 5, 8, and 11. For analysis a mixed model for repeated measures was used. Out of the 100 patients who were enrolled, 50 patients each were randomized to AGFC and HA arm. The results were analyzed from 99 patients (49 for AGFC and 50 for HA) who met the criteria for the modified intent to treat (mITT) population. At month 11 on the WOMAC scale, there was greater improvement seen with Ossinext™ compared to HA group which was also statistically significant with p-value of 0.0332. Within the group, there was statistically significant improvement before and after treatment in all scales, i.e.WOMAC, KOOS, IKDC, and VAS at all time points, i.e. months 5, 8, and 11 with a p-value as low as <0.0001. Within the group, the VAS score showed statistically significant improvement even at months 1 and 2 as well. A total of 24 patients reported 37 adverse events (AEs) during the study, most common being pain, pyrexia and swelling but none of the AEs reported during the study were considered as severe in intensity. There were no safety concerns reported. In conclusion, greater and statistically significant improvement was seen with Ossinext™ in WOMAC scores at month 11 compared to HA. Ossinext™ also showed marked statistically significant improvement from before treatment to after treatment in the WOMAC, KOOS, IKDC, and VAS scales used for the assessment of KOA with a p-value as low as <0.0001. Ossinext™ was also safe and well-tolerated.

Midterm Follow-up of a Novel Algorithm for Nonoperative Weber B Ankle Fractures.

Stable Weber B ankle fractures are routinely treated nonoperatively. Our group previously presented a novel algorithm that provides radiographic parameters guiding when Weber B ankle fractures can be treated nonoperatively.2 The purpose of this study is to evaluate the durability of those results with a minimum 5-year follow-up. All 51 patients who were included in the initial study were contacted by telephone and asked to return to clinic for repeat evaluation where American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot, Olerud-Molander Ankle (OMA), and visual analog scale (VAS) scores were collected. Bilateral standing ankle radiographs were obtained and evaluated using the Kellgren-Lawrence grading scale for ankle arthritis. Twenty-nine of 51 patients (56%) participated in this follow-up study with a mean follow-up of 6.8 (range 5.6-8) years. Average functional score results were as follows: AOFAS, 98.43; OMA score, 94.11; and VAS, 0.46. AOFAS scores improved by an average of 5 points between 1 year and 5 years (P = .002); OMA and VAS scores were stable. All patients achieved union of their fracture on follow-up radiographs. Our findings demonstrate the durability of the previous study results conducted by Holmes et al,2 and support that appropriately selected patients can be treated nonoperatively using the study's novel algorithm. This reinforces our theory that medial clear space widening on weightbearing radiographs up to 7 mm should be considered for nonoperative management. Level IV, case series.

Mediating effect of self-efficacy on the relationship between social support and self-management behaviors among patients with knee osteoarthritis: a cross-sectional study

BackgroundGood self-management behaviors in patients with knee osteoarthritis can improve disease awareness, treatment effectiveness, quality of life, and reduce medical costs. However, there is a paucity of studies focusing on patients with knee osteoarthritis. Therefore, the purpose of this study was to explore the mediating effect of self-efficacy on aspects of social support and self-management behaviors in this population.MethodsThis study employed a cross-sectional design and convenience sampling to survey patients with knee osteoarthritis in an outpatient department of a regional hospital in northern Taiwan from February 22, 2021, to April 15, 2021. The inclusion criteria for patients were (1) those diagnosed by a physician with knee osteoarthritis and (2) who could communicate in Chinese or Taiwanese. Participants were asked to complete a demographic questionnaire, the Arthritis Self-Efficacy Scale (ASE), the Inventory of Socially Supportive Behavior (including enacted support and perceived social support), and the Arthritis Self-Management Assessment Tool (ASMAT). In addition, the Kellgren-Lawrence Grading Scale was obtained from a chart review. Data were analyzed with descriptive statistics, t-test, one-way analysis of variance, Pearson product-moment correlation, and mediation analysis.ResultsA total of 140 patients met the inclusion criteria. The mean age of participants was 70.21 ± 10.84years; most (73.6%) were female. The mean total score of the ASMAT was 64.27 ± 14.84. Scores for the ASE, enacted support, and perceived social support were significantly positively correlated with ASMAT (all p < .001). The standardized coefficient for total effect and direct effect of perceived social support on ASMAT was 0.899 (p < .001) and 0.754 (p < .05), respectively. After introducing the ASE into the model, the indirect effect was 0.145 (p < .05), which indicated that ASE had a partial mediating effect on the relationship between perceived social support and ASMAT.ConclusionOur findings might suggest that perceived social support indirectly affected ASMAT through ASE. Therefore, interventions designed to increase self-efficacy and social support could enhance self-management behaviors for patients with knee osteoarthritis.

Minimum 2-Year Clinical Outcomes of Medial Meniscus Root Tears in Relation to Coronal Alignment

Background: The effect of coronal plane alignment on the outcomes of repairs of the medial meniscus root remains unclear. Hypothesis: Increased preoperative varus alignment is associated with higher failure rates and lower patient-reported outcomes (PROs) after isolated repair of the medial meniscus root. Study Design: Case series; Level of evidence, 4. Methods: Patients aged 18 years or older who underwent arthroscopy-assisted repair of the medial posterior meniscus root over a 7-year period were included. The mechanical axis of the knee was measured preoperatively. Osteoarthritis was assessed radiographically preoperatively and at the final follow-up according to the Kellgren-Lawrence grading scale. Failure was defined as any patient having to undergo revision root repair, partial meniscectomy of the previously repaired meniscus, debridement, lysis of adhesions, or conversion to arthroplasty. Results: A total of 53 patients (29 women, 24 men) with a mean age of 51.3 years were included in the follow-up analysis. The mean time of follow-up after surgery was 3.3 years (range, 22-77 months). Significant improvements were observed in all PROs analyzed. Decreased varus as measured by alignment percentage was correlated with baseline Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain (P = .023) and WOMAC Stiffness (P = .022). Alignment percentage was also significantly negatively correlated with postoperative WOMAC Stiffness (P = .005) and positively correlated with Lysholm (P = .003) and International Knee Documentation Committee (P = .009) scores. Higher baseline Kellgren-Lawrence grade was correlated with worse postoperative PROs (P < .05), except 12-Item Short Form Health Survey Mental Component Summary and satisfaction. Eight patients who underwent a concomitant high tibial osteotomy (HTO) achieved lower PROs in all scales analyzed, regardless of their alignment. When excluding patients who underwent HTO, postoperative Lysholm score (P = .004) and postoperative WOMAC Stiffness (p = 0.014) were inferior among the patients with >5° of varus. Conclusion: Lower extremity alignment closest to neutral correlated with improved PROs. Patients who underwent a concurrent HTO had worse PROs than those who did not undergo HTO.

Association between metabolic syndrome and radiographic spine osteoarthritis: Cross-sectional analysis using data from the Korea National Health and Nutrition Examination Survey.

A relationship between spine osteoarthritis (OA) and metabolic syndrome has not been established. This study evaluated whether metabolic syndrome is associated with radiographic spine OA in the Korean population. A total of 2252 subjects older than 50years who underwent plain radiography of the lumbar spine during the Korea National Health and Nutrition Examination Survey (KNHANES) 2012 were enrolled. Radiographic grading of the lumbar spine was performed using the Kellgren-Lawrence (K-L) grading scale, ranging from grade 0 to grade 2. K-L grade 2 was defined as lumbar spine OA, while those of K-L grade 0 or 1 were defined as controls. The prevalence of spine OA was 28.1% (n=689). The prevalence of metabolic syndrome in spine OA was not different from that among controls. The cumulative number of metabolic syndrome components was significantly different between spine OA and controls (P=.027). Subjects with K-L grade 1 or grade 2 showed higher proportion of metabolic syndrome and its cumulative components than those of K-L grade 0. Two or 3 or more metabolic syndrome components were significantly associated with spine OA (P=.012 and P=.010, respectively). Abnormal waist circumference was weakly associated with spine OA (odds ratio 1.233, 95% CI 1.000-1.520, P=.050). Multivariate logistic regression analysis showed that older age and female gender were linked with spine OA, but not metabolic syndrome. This study found lack of association between metabolic syndrome and radiographic spine OA.

Evaluation of serum calprotectin level as a biomarker of disease activity in rheumatoid arthritis and osteoarthritis patients

Aim of the workTo measure the levels of serum calprotectin (CLP) in rheumatoid arthritis (RA) and osteoarthritis (OA) patients and to assess its association with disease activity, severity and functional status. Patients and methodsA total of 30 RA and30 OA patients and 30 controlswere included. Rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP), Disease activity score (DAS28), health assessment questionnaire (HAQ) and RA medical records-based index of severity (RARBIS) were assessed in RA patients. Western Ontario and McMaster Osteoarthritis index (WOMAC) and Kellgren-Lawrence (KL) grading scale were assessed in OA patients and serum CLP levels were measured. ResultsThe mean age of RA and OA patients was 48.6 ± 8.6 and 50.8 ± 9.3 years respectively andthe majority of studied groups were females. CLP was significantly higher in RA patients in comparison to OA patients and healthy control (2.70 ± 2.08 vs. 1.18 ± 0.35 vs 1.11 ± 0.24 μg/ml); p < 0.0001). Serum CLP correlated with swollen joint count (SJC) (r = 0.7, p < 0.0001), tender joint count (TJC) (r = 0.73, p < 0.0001), patient global assessment (PGA) (r = 0.51, p = 0.004), Physician global assessment (PhGA) (r = 0.58, p = 0.001), HAQ (r = 0.6,p < 0.0001), erythrocyte sedimentation rate (ESR) (r = 0.5, p = 0.005), DAS28 (r = 0.69, p < 0.0001), RARBIS (r = 0.66, p < 0.0001). At a cut-off value of 2.5 µg/ml CLP can significantly differentiate active RA patients from those in remission (AUC 0.896; p < 0.0001) at a sensitivity of 83.3%, specificity of 88.9%, and accuracy of 86.7%.CLP was significant predictor for RA activity. ConclusionThe serum CLP levels were significantly high in RA patients compared to OA patients and controls and these high levels were associated with disease activity, severity, and functional status.

Relationship Between Inflammation Parameters Which Are Obtained From Blood Count And Knee Osteophytes

Objective:Osteoarthritis is no longer considered a degenerative disease. The presence of underlying low-grade inflammation has been well demonstrated. Although osteophytes are used to determining the radiological stage, the development mechanism is not fully understood. The aim of this study is to separately evaluate the relationship between various inflammation parameters associated with complete blood count with osteophytes and radiological stage. Methods:Patients who met the American College of Rheumatology clinical knee osteoarthritis criteria, retrospectively selected. Kellgren-Lawrence grading scale was used for disease severity and Osteoarthritis research society international grading was used for osteophyte size evolution. Red blood cell distribution width, platelet to lymphocyte ratio, neutrophil to lymphocyte ratio, neutrophil to monocyte ratio, lymphocyte to monocyte ratio, and mean platelet volume obtained from complete blood count, and C-reactive protein levels were recorded. The relationship between inflammation markers and osteophytes and disease stage was evaluated by logistic regression analysis. Results:A significant correlation was shown between CRP and PLR in the early stage of the disease. No correlation was found in the advanced stage. No correlation was found between osteophyte progression and inflammatory markers in the analysis based on osteophyte size Conclusion:In this study, we have shown that there is a relationship between systemic low-grade markers of inflammation and early stages of knee osteoarthritis, but this relationship was not detected in advanced stages. There was not a relation between osteophyte progression and these markers. Even though it seems to be running together, we can assume that the progression of the disease and osteophyte formation have different mechanisms.

The relationship between alcohol consumption and knee osteoarthritis in Korean population over 50 years-old: Results from Korea National Health and Nutrition Examination Survey.

There is still debate regarding the pathogenic relationship between alcohol intake and osteoarthritis (OA). This study investigated the association between alcohol consumption and knee OA in a Korean population.Among 8058 subjects who participated in the Korea National Health and Nutrition Examination Survey (KNHANES) 2012, a total of 2917 subjects over the age of 50 and taken plain radiography was included in this analysis. Knee OA was classified based on the Kellgren-Lawrence (K-L) grading scale. Multivariate logistic regression analyses were used to evaluate the odds ratios (ORs) and 95% confidence intervals (CIs) of variables for knee OA (K-L grade ≥ 2).There were 1022 subjects with knee OA (29.2%). Subjects with knee OA tended to have lower daily alcohol intake (g/day) than did those without knee OA (10.4 [6.2-14.6] vs. 15.8 [12.8-18.8], P = .04). Similarly, those with knee OA demonstrated less makgeolli intake than did those without knee OA (P = .002). Subjects who consumed >0.6 g/day of beer also demonstrated less knee OA than did those who consumed <0.6 g/day of beer (OR 0.68, 95% CI 0.46-0.99). However, knee OA was not associated with the categories of alcohol consumption amount (g/day), including total daily alcohol intake (g/day), soju daily intake (g/day), and makgeolli daily intake (g/day) (P > .05 of all).Alcohol consumption was negatively associated with prevalence of knee OA in a Korean population. This preliminary observation will need to be confirmed in future studies.

Predictors of efficacy of viscosupplementation for the treatment of hip osteoarthritis: a retrospective cohort study

Background: Hip injections of hyaluronic acid (HA) have been used off-label to treat osteoarthritis (OA). The purpose of this retrospective cohort study of adults with OA was to review predictive factors and duration of action for patients who responded to HA hip injections. Methods: After institutional review board (IRB) approval, patients who had HA hip injections from 2014 to 2018 were retrospectively reviewed. Visual analog scale (VAS) scores obtained 1 mo after three injections were collected. Patients were classified into two groups: positive outcome (50% or greater reduction of VAS) and negative outcome (less than 50% reduction of VAS). Comparison of demographics, functional status, OA severity on Kellgren-Lawrence Grading Scale (KL), previous treatments, type of HA, and procedure techniques were performed. Continuous variables were summarized in mean and standard deviation (SD), and compared using two-sample t-test. Categorical variables were summarized in frequency and proportion, then compared using chi-square test or Fisher exact test. Results: The 157 patients who were reviewed had the following levels of OA severity: 24.3% mild (KL grade II), 25% moderate (KL grade III), 50.7% severe (KL grade IV). Positive outcomes were reported in 29.3% of patients, and 70.7% had “negative” outcomes. The positive outcome group had a mean duration (for 50% or greater decrease of VAS) of 4.24 mo (SD 3.62). The positive outcome group had milder OA (KL grades II to III) (P&lt;0.001) and younger age (P=0.03). No difference was noted among the two groups for other variables. Conclusions: Injections of HA for hip OA using the full recommended dosage regimen of commercially available HA products can be beneficial in select patients. The main predictors of significant response were younger age and mild to moderate (KL grade II to III) OA. Level of Evidence: Level III.