Kellgren-Lawrence Scale Research Articles

Integration of focal vibration and intra-articular oxygen–ozone therapy in rehabilitation of painful knee osteoarthritis

ObjectiveTo examine the pain-reducing effects of intra-articular oxygen–ozone (O2O3) injections and mechanical focal vibration (mFV) versus O2O3 injections alone in patients with knee osteoarthritis.MethodsPatients with chronic pain (>6 weeks) due to knee osteoarthritis (II–III on the Kellgren–Lawrence scale) were consecutively enrolled and divided into two groups: O2O3 (n = 25) and O2O3-mFV (n = 24). The visual analog scale (VAS), Knee Injury and Osteoarthritis Outcome Score (KOOS), and Medical Research Council (MRC) Manual Muscle Testing scale were administered at baseline (before treatment), after 3 weeks of treatment, and 1 month after the end of treatment. Patients received three once-weekly intra-articular injections of O2O3 into the knee (20 mL O3, 20 μg/mL). The O2O3-mFV group also underwent nine sessions of mFV (three sessions per week).ResultsThe VAS score, KOOS, and MRC score were significantly better in the O2O3-mFV than O2O3 group. The within-group analysis showed that all scores improved over time compared with baseline and were maintained even 1 month after treatment. No adverse events occurred.ConclusionAn integrated rehabilitation protocol involving O2O3 injections and mFV for 3 weeks reduces pain, increases autonomy in daily life activities, and strengthens the quadriceps femoris.

A probiotic intervention on pain hypersensitivity and microbiota composition in patients with osteoarthritis pain: Study protocol for a randomized controlled trial.

Objectives This study aims to examine the effects of probiotics on pain hypersensitivity at the end of a six-week intervention program in patients with osteoarthritis (OA)-related pain.Patients and methods This double-blind randomized controlled clinical trial with two parallel arms will be conducted between January 2021 and July 2022. At least 30 participants (age range, 50 to 90 years) of both sexes with a diagnosis of symptomatic hip or knee (Kellgren-Lawrence scale ≥3) will be recruited in each arm (total n=60) to achieve adequate statistical power in the analyses. The intervention will be administered for six weeks followed by a four-week follow-up period. The experimental group will receive a probiotic product plus the usual medical care. The control group will receive a probiotical sham plus the usual medical care. Assessment points will be measured at baseline, end of intervention, and one-month post-intervention. The outcomes of this intervention will be a change in visual analog scale pain and the gut microbiota composition. Group by time effects will be compared using mixed-model analysis of variance.ConclusionA reduction in pain hypersensitivity in patients with knee OA-related pain could suggest an involvement of microbiota, or part of it, in chronic pain state mechanisms.

The presence of erosive joints is a strong predictor of radiological progression in hand osteoarthritis: results of a 2-year prospective follow-up of the Li\xe8ge Hand Osteoarthritis Cohort (LIHOC)

BackgroundThis study measured the magnitude and determinants of clinical and radiological progression in patients with hand osteoarthritis (HOA) over a 2-year prospective follow-up to gain a greater understanding of the disease time course.MethodsTwo hundred three consecutive outpatients diagnosed with HOA were followed for 2 years (183 women, median age 69 years). Pain and function were evaluated using the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), and clinical examination recorded the number of painful/swollen joints and nodes. X-rays were scored using Kellgren-Lawrence (KL) and Verbruggen-Veys scales. Clinical progression was defined as deterioration in AUSCAN ≥ the minimal clinically important difference. Radiographic progression was defined as (a) one new erosive/remodeled joint, (b) progression of ≥ one anatomical stage in one joint, or (c) change in KL total score above the smallest detectable difference. Logistic regression was performed to determine whether patient characteristics influenced clinical and radiological progression.ResultsAfter 2 years, all radiographic scores deteriorated significantly in the study population (p < 0.05), and the number of proximal and distal interphalangeal nodes was significantly higher (p < 0.01). The AUSCAN, number of painful joints at rest or at pressure, number of swollen joints, and pain measure on a visual analog scale remained unchanged. At the individual level, the number of patients with clinically meaningful progression ranged from 25 to 42% (clinical progression) and from 22 to 76% (radiological progression). The only significant predictor of worsening of total AUSCAN was AUSCAN pain subscale < 74.5 (odds ratio [OR] 1.02 [1.01, 1.03]; p < 0.01). The presence of ≥ four swollen joints (OR 2.78 [1.21, 6.39]; p = 0.02) and erosive osteoarthritis (OR 13.23 [5.07, 34.56]; p < 0.01) at baseline predicted a new erosive joint. A meaningful change in KL was more frequent with painful joints at baseline (OR 3.43 [1.68, 7.01]; p < 0.01).ConclusionsEvidence of radiological progression over 2 years was observed in patients with HOA in the LIHOC population even without clinical worsening of disease. For individual patients, baseline pain level is predictive for clinical progression and the presence of erosive or swollen joints are significant predictors of radiological progression.

Treatment of knee osteoarthritis by intra-articular injection of concentrated autologous adipose tissue: a twenty fourmonth follow-up study.

To evaluate the safety and efficacy of autologous concentrated adipose tissue for the treatment of knee OA. Eighty-seven patients with knee arthritis from grade 1 to 3, according to Kellgren-Lawrence scale, have been treated with knee arthroscopy and successive intra-articular injection of concentrated adipose tissue. The efficacy of the treatment has been evaluated by the Knee Society Score, Lysholm Score, Forgotten Joint Score, Knee Injury and Osteoarthritis Outcome Score and Noise Reporting Scale. A total of 78/87 patients concluded the study. Overall, the patients were satisfied with the intervention and a significant reduction of the pain was observed in 67 patients, while the others did not report any change in pain severity or worsening. A statistically significant improvement was observed in the considered orthopaedic index, and no major adverse effects were described. The first week after the intervention, most patients reported knee swelling. Five patients failed because they underwent knee replacement surgery between five and ninemonths from treatment. In patients with knee OA, a single intra-articular injection of autologous adipose tissue reduced knee pain, stiffness, improved knee function and quality of life without severe complications.

Union Rates and Deformity Correction Using the Hintermann Osteotomy in Type IIb Flatfoot Deformity

Category:Ankle; HindfootIntroduction/Purpose:Multiple Lateral column lengthening procedures have been described for the correction of the abduction component of stage II flatfoot deformity. The Hintermann osteotomy, although technically difficult, offers powerful lengthening of the lateral column with low risk of violating the articular cartilage of the subtalar joint as compared to the more widely performed Evans osteotomy. This study reports on the radiographic and clinical outcomes of the Hintermann osteotomy performed by a single surgeon.Methods:Patients who underwent reconstruction for stage II flatfoot deformity with a Hintermann lateral column lengthening were restrospectively identified. The talus-1st metatarsal angle, percent talus uncoverage, calcaneal pitch, lateral column length, CC joint subluxation, and distance from CC joint to the osteotomy were measured on pre and postop radiographs. Radiographic union was also assessed. The Kellgren-Lawrence scale was used to assess degenerative changes at the ST, CC, and TN joints.Charts were reviewed for comorbidities, clinical evidence of union, time to protected weightbearing, time to unrestricted weightbearing, signs of peroneal irritation, clinical signs of osteoarthritis progression, and complications. A paired students t test was used to identify differences in radiographic parameters.Results:Twenty-six patients (30 feet) met inclusion criteria. All osteotomies achieved union with only 1 (1/30) instance of delayed union. Average duration before clinical and radiographic union was 12.6 weeks (9-37). The AP Talus-1st metatarsal angle decreased on average of 12.3 degrees (STD 9.1) (p<0.0001). Percent talus uncoverage decreased on average 17.7 percent (STD 11.5%) (p<0.0001). Subluxation at the CC joint was found to increase on average 1.63mm (STD 1.99) (p<0.01). Only 3 patients (10%) had radiographic progression of osteoarthritis at either the CC or ST joint. No patients showed clinical signs of osteoarthritis and none went on to fusion. One patient had lateral hardware pain necessitating plate removal.Conclusion:The Hintermann osteotomy is a powerful tool for lateral column lengthening. In this series there was significant correction of the preoperative abduction deformity with no nonunions. Degenerative changes in the surrounding hindfoot joints were rare. One benefit of the Hintermann osteotomy is its ability to preserve the articular cartilage of the anterior and middle facets.

Radiographic Progression of Thumb CMC Osteoarthritis: A Systematic Review

PurposeThumb carpometacarpal (CMC) osteoarthritis (OA) is a prevalent disease that causes pain and disability. Determining the progression of CMC OA is problematic given the lack of consensus for classifications and scoring systems. We performed a systematic review to (1) determine which imaging modalities or scoring systems are used to evaluate CMC OA progression, and (2) describe the progression of CMC OA through available metrics.MethodsThis review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An English language literature search was performed in July 2019 and included studies evaluating CMC OA progression with an imaging modality or radiographic scoring system, with a minimum 1-year follow-up. Studies were analyzed with respect to their methodology, scoring systems, and relevant findings.ResultsThe initial search yielded 4,097 articles, 10 of which met inclusion criteria. Study size varied from 32 to 289 subjects; many subjects were included in multiple cohorts. Eight studies used radiography whereas 2 used scintigraphy. Estimates of progression varied from 20% to 70% (with large variation in follow-up time); the magnitude of progression varied from 3% to 48% (joint space narrowing) and from 0.6 to 1 points (Kellgren–Lawrence scale). The percentage of subjects who progressed and the progression degree varied widely and depended on follow-up length and the scoring system used.ConclusionsA paucity of literature exists to measure CMC OA progression; there is a lack of uniformly accepted imaging modality, scoring system, or follow-up interval. This absence provides the opportunity to determine consensus techniques and metrics to assess the natural history of thumb CMC OA.Type of study/level of evidenceDiagnostic III.

Effects of intra-articular autologous mesenchymal stem cell injection under ultrasonogram guidance in patients with osteoarthritis knee

Mesenchymal stem cells therapy opened new perspective in the management of osteoarthritis. This study focuses on a randomized controlled trial pilot on 10 patients of osteoarthritis knees to evaluate the intra-articular injections of mesenchymal stem cells could improve the symptoms, functional limitation and regeneration of cartilage. Mesenchymal stem cells were obtained from peripheral blood after mobilization of blood cell with granulocyte colony stimulating factor by apheresis machine. Single dose of mesenchymal stem cells were injected into the affected joints, WOMAC questionnaires scale used to record pre and post-treatment improvement, cartilage thickness measured by high frequency ultrasonogram. Four patients were having Grade II and six were having Grade III osteoarthritis. Kellgren-Lawrence scale was used for radiological grading. Pain score were decreased at the end of 24th weeks from 14.8 ± 2.2 to 4.1 ± 1.3, Stiffness score decreased from 5.8 ± 0.6 to 0.7 ± 0.6, Physical function limitation score reduced from 46.7 ± 6.5 to 20.3 ± 2.5. There was minor improvement of range of motion and cartilage thickness changes. This study demonstrates that mesenchymal stem cells injections improves all parameters of knee osteoarthritis and minimal regeneration of damaged cartilage.

Relationship between radiological severity and physical and mental health in elderly individuals with knee osteoarthritis

BackgroundThis study aimed to investigate the relationship between radiological severity, as assessed by the individual grades and grouped grades (grades “0 and 1” and “2 to 4”) of the Kellgren-Lawrence scale (K&Ls), and depression symptoms, cognitive loss, risk of falls, and quality of life in relation to knee osteoarthritis, as assessed by other instruments.MethodsData recorded between 2013 and 2014 in Amparo (São Paulo, Brazil) were retrieved for analysis. A total of 181 elderly patients who had knee osteoarthritis and underwent a radiologic exam were evaluated for depressive symptoms, cognitive loss, quality of life, and risk of falls by the Geriatric Depression Scale (GDS), Mini-Mental State Examination (MMSE), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), timed up and go test (TUG), and Berg balance scale (BBS). For statistical analyses, Fisher’s exact test, Mann-Whitney test, Kruskal-Wallis test, and Spearman’s coefficient analysis were used.ResultsThere was no significant relationship between the scores of the instruments investigated and the individual K&Ls grades. However, when the K&Ls scores were assessed by groups, grades “2 to 4” were associated with the worst WOMAC score and the highest frequency and risk of falls according to the BBS but not according to TUG. For the GDS and MMSE, no significant relationships with the K&Ls grades were found. In addition, the K&Ls grade was correlated with the WOMAC score, regardless of the domain.ConclusionThe radiological scores of the Kellgren-Lawrence (K&L) scale were associated with poorer WOMAC and BBS scores only when the K&Ls scores were evaluated in groups, and the WOMAC score was associated with an increase in the radiological grade.

Long term efficacy of mobilisation with movement on pain and functional status in patients with knee osteoarthritis: a randomised clinical trial

Objectives: To evaluate the long term effect of mobilisation with movement on disability, pain and function in subjects with symptomatic knee osteoarthritis Design: A randomised controlled trial. Setting: A general hospital Subjects: Forty adults with knee osteoarthritis (grade 1–3 Kellgren–Lawrence scale). Interventions: The experimental group received mobilisation with movement and usual care (exercise and moist heat) while the control group received usual care alone in six sessions over two weeks. Main Measures: The primary outcome was the Western Ontario McMaster University Osteoarthritis index, higher scores indicating greater disability. Pain intensity over 24 hours and during sit to stand were measured on a 10 centimetre visual analogue scale. Functional outcomes were the timed up and go test, the 12 step stair test, and knee range of motion. Patient satisfaction was measured on an 11 point numerical rating scale. Variables were evaluated blind pre- and post intervention, and at three and six months follow-up. Results: Thirty five participants completed the study. At each follow-up including six-months, significant differences were found between groups favouring those receiving mobilisation with movement for all variables except knee mobility. The primary outcome disability showed a mean difference of 7.4 points (95% confidence interval, 4.5 to 10.3) at six-months and a mean difference of 13.6 points (95% confidence interval, 9.3 to 17.9) at three-months follow-up. Conclusion: In patients with symptomatic knee osteoarthritis, the addition of mobilisation with movement provided clinically significant improvements in disability, pain, functional activities and patient satisfaction six months later.

Serum and synovial fluid concentrations of interleukin-18 and interleukin-20 in patients with osteoarthritis of the knee and their correlation with other markers of inflammation and turnover of joint cartilage.

IntroductionOsteoarthritis (OA) is the most common degenerative joint disease, and its aetiology is not entirely known. The aim of the study was to evaluate the involvement of interleukin-18 (IL-18) and interleukin-20 (IL-20) in the pathogenesis of knee OA and their correlations with other markers of inflammation and destruction of joint cartilage, as well as clinical and radiological changes.Material and methodsThe study included 25 patients with knee OA and a control group. The concentration of IL-18, IL-20, IL-6, MMP-1, MMP-3, COMP, PG-AG, and YKL-40 in serum and synovial fluid (SF) were determined. We also evaluated radiological lesions of the knee joint according to the Kellgren-Lawrence (K-L) scale, and clinical severity of the disease according to Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne Index.ResultsThe concentrations of IL-18 and IL-20 were statistically significantly higher in serum of patients with OA than in the control group (106.00 ±189.76 pg/ml vs. 16.73 ±16.99 pg/ml, p < 0.001, 17.69 ±13.45 pg/ml vs. 9.76 ±9.00 pg/ml, p < 0.014). Serum concentration of IL-18 positively correlated with MMP-3 (R = 0.58; p = 0.006) and YKL-40 (R = 0.48; p = 0.002). The degree of radiological advancement of OA (K-L scale) correlated positively with clinical evaluation (WOMAC, R = 0.74, p ≤ 0.001; Lequesne Index, R = 0.57, p = 0.003).ConclusionsThe analysis of ROC curves showed that IL-20 as well as COMP, MMP-3, and YKL-40 may be diagnostic markers of knee OA. The observations indicate that IL-18 potentially mediates mainly in intra-articular processes and IL-20 could be primarily responsible for the systemic inflammatory reaction.

Vitamin D deficiency in Egyptian and Yemeni primary knee osteoarthritis patients: Relation to physical function and radiographic severity

Aim of the workTo investigate the relationship between serum 25(OH)D (25-hydroxyvitamin D) level and primary knee osteoarthritis (KOA) in Egyptian and Yemeni patients, and to demonstrate its impact on physical function and radiographic severity. Patients and methodsThis study included 82 KOA patients; (41 Egyptian, 41 Yemeni), together with 80 controls; (40 Egyptian, 40 Yemeni). Serum 25(OH)D level was measured using enzyme-linked immunosorbent assay. Physical function was evaluated using 6-minute walk test (6MWT), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score and chair stand test (CST). Knee radiographic grading was based on Kellgren-Lawrence (KL) scale. ResultsThe mean age of Egyptian and Yemeni patients was 53.4 ± 7.1 and 56.2 ± 7.5 years respectively. Serum 25(OH)D level was significantly decreased in Egyptian (13.3 ng/ml;5.3–39.6) and Yemeni (9.5 ng/ml; 3.8–49) KOA patients compared to their corresponding controls (27.7 ng/ml; 12.8–51.4 and 20.9 ng/ml; 8–45.5; p < 0.001 each) and was the only significant predictor of KOA in Egyptian (p < 0.0001) and Yemeni (p = 0.001) patients. Yemeni patients exhibited significantly lower 25(OH)D compared to Egyptian patients (p = 0.008) with a significant increase in smoking (p = 0.002) and niqab wearing (p < 0.001). Serum 25(OH)D level significantly negatively correlated with radiographic grading in Egyptian (p = 0.03) and Yemeni (p = 0.02) patients. Regression analysis showed no relationship between 25(OH)D levels with WOMAC, 6MWT or CST; the relation was significant with KL grading in Egyptian (p = 0.01) and Yemeni (p = 0.005) patients. ConclusionThere is an association between vitamin D deficiency and primary KOA especially to the radiographic severity but not to physical function in Egyptian or Yemeni primary KOA patients.

AB0857 A NEW BIOPSYCHOSOCIAL QUESTIONNAIRE FOR PATIENTS WITH KNEE OSTEOARTHRITIS

Background:OA is a problem that cartilage damage occurs, which leads to stiffness in the joint, pain and functional limitations (1). This problem can also cause psychosocial impact like other chronic diseases (2). As with other rheumatic diseases, this complex picture of inflammation required biopsychosocial approaches and measurement methods for knee OA.Objectives:This study was planned to investigate the validity and reliability of a new biopsychosocial questionnaire which is named Cognitive Exercise Therapy Approach Biopsychosocial Questionnaire (BETY-BQ) in individuals with knee osteoarthritis (OA).Methods:The study included 150 individuals who diagnosed knee osteoarthritis at stage 1 or 2 according to the Kellgren-Lawrence scale. For determining daily living activities; Health Assessment Questionnaire (HAQ), for quality of life Short Form-36 (SF-36) Quality of Life Scale, for anxiety and depression levels; Hospital Anxiety and Depression Scale (HADS), for severity of disease Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and for biopsychosocial evaluation BETY-BQ were used.Results:The correlation between BETY-BQ and other scales was examined by Spearman correlation analysis (r=-0.252, 0.633, p&lt;0,05). Cronbach’s alpha coefficient and item-total correlation were used as reliability methods. Cronbach’s alpha coefficient was examined for the internal consistency of the scale and was found to be 0.887 for the first evaluation, 0.917 for measurements after 1 week and 0.843 for measurements after 3 months. Item total correlation, which was another indicator of reliability, ranged from 0.632 to 0.854 (p&lt;0.05).Table 1.Correlation coefficients between all questionnaires and Cognitive Exercise Therapy Approach Biopsychosocial Questionnaire (BETY-BQ).Spearman Correlation AnalysisCognitive Exercise Therapy Approach Biopsychosocial Questionnaire (BETY-BQ)rpWOMAC-Pain0,473&lt;0,001WOMAC-Stiffness0,458&lt;0,001WOMAC-Physical Function0,514&lt;0,001WOMAC-Total Score0,553&lt;0,001hospital anxiety and depression scale- anxiety0,615&lt;0,001hospital anxiety and depression scale-depression0,2520,002*Health Assessment Questionnaire0,633&lt;0,001Short Form-36 Role limitations due to physical health-0,440&lt;0,001Short Form-36 Role limitations due to emotional problems-0,357&lt;0,001Short Form-36 Physical functioning-0,469&lt;0,001Short Form-36 Social functioning-0,355&lt;0,001Short Form-36 Pain-0,487&lt;0,001Short Form-36 General Health-0,513&lt;0,001Short Form-36 Emotional well-being-0,508&lt;0,001Short Form-36 Energy/fatigue-0,453&lt;0,001Conclusion:As a result of our study, it was concluded that BETY-BQ is a valid and reliable biopsychosocial questionnaire in individuals with knee OA diagnosis. This result showed that BETY-BQ can be used in clinics to evaluate biopsychosocial involvement in patients with knee OA.

Medial Meniscal Posterior Horn Tears Are Associated With Increased Posterior Tibial Slope: A Case-Control Study

Background: While the medial meniscal posterior horn (MMPH) is reported to bear a considerable portion of overall load on the knee joint, including compressive and shear forces, no study has yet investigated the relationship between the MMPH and posterior tibial slope (PTS), which is a geometric factor associated with the shear force component in the presence of a compressive load in the knee joint. Hypothesis/Purpose: The purpose was to investigate the relationship between the PTS and MMPH tears in patients without ligamentous injury. It was hypothesized that the PTS is greater in patients with MMPH tears as compared with those without. Study Design: Cohort study; Level of evidence, 3. Methods: From March 2015 to December 2018, 159 patients with isolated MMPH tears and 60 patients without any pathologic findings on magnetic resonance imaging (control group) were included in this study. The PTS in the affected and contralateral knees was compared between the groups, which were statistically matched according to baseline characteristics (ie, age, sex, body mass index, radiographic osteoarthritis grade according to the Kellgren-Lawrence scale, and hip-knee-ankle angle) via the inverse probability of treatment weighting method. Furthermore, the MMPH tear group was subdivided according to meniscal tear patterns; these subgroups were then compared with the control group. Results: The mean PTS was significantly greater in the MMPH tear group than in the control group (affected knee: MMPH tear group, 7.0°± 3.4° [mean ± SD]; control group, 5.2°± 2.1°, P < .001; contralateral knee: MMPH tear group, 6.7°± 3.3°; control group, 4.7°± 2.2°, P < .001). The mean PTS in each subgroup also tended to be greater than that in the control group. In the receiver operating characteristic curve analysis, the cutoff point of the PTS discriminating between the MMPH tear and control groups was 6.6° for the affected knee (sensitivity, 55.3%; specificity, 75.0%) and 5.5° for the contralateral knee (sensitivity, 61.0%; specificity, 76.7%). Conclusion: An increased PTS is strongly associated with an increased incidence of MMPH tears and less affected by the meniscal tear patterns.

The complexity of molecular processes in osteoarthritis of the knee joint.

Osteoarthritis (OA) is a common medical problem leading to chronic pain and physical disability among the world’s population. Analyzing the molecular background of the degenerative arthritis creates the potential for developing novel targeted methods of treatment. Fifty samples of meniscus, anterior cruciate ligaments (ACLs) and articular surfaces were collected from patients who underwent total knee arthroplasty in 2016. Enzyme-linked immunosorbent assay was used to assess the levels of interleukin (IL)-1β, IL-6, tumor necrosis factor (TNF), transforming growth factor-β1 and LUMINEX for MMP-1, MMP-2, MMP-3, MMP-9 and MMP-13. The collected data were correlated with the severity of radiological OA, demographic data and clinical scales. Strong positive correlations in the concentration of metalloproteinases and proinflammatory cytokines, TNF-α (MMP-2 and MMP-13) and IL-6 (MMP-13), were identified. MMP-13 had a positive correlation with the concentration of MMP-1, MMP-2 and MMP-9. Negative correlation coefficient exists between clinical conditions measured with the Western Ontario and McMaster Universities Osteoarthritis Index scale and the level of TNF-α and MMP-1. The TNF-α concentration was lower in the cartilage of the articular surface among patients who took non-steroidal anti-inflammatory drugs periodically. The decrease in MMP-2 in the cartilage of the articular surface corresponded with the severity of radiological OA on the Kellgren–Lawrence scale. Current treatment methods for OA do not stop disease progression. Identifying signaling pathways and molecular particles engaged in OA and their correlations with the patient’s clinical condition brings new therapeutic possibilities.

Correlación de la Escala de Kellgren-Lawrence con la Clasificación de Outerbridge en Pacientes con Gonalgia Crónica

BackgroundThe correlation between radiographic and arthroscopic scales for the degree of joint injury in patients with osteoarthritis (OA) is inconsistent. The study seeks to determine the correlation between the degree of joint injury according to the Kellgren-Lawrence (KL) radiographic scale and the Outerbridge (CO) arthroscopic classification. MethodsAdult patients (> 18 years) with chronic gonalgia were analyzed by evaluating the knee radiographs according to the KL scale. Subsequently, the same patients underwent arthroscopy where the degree of chondral injury was assessed according to CO. A Spearman correlation was made between the rating scales. Sensitivity, specificity, positive predictive value, negative predictive value of radiography to diagnose OA (grade>1 in CO) were calculated. Results80 patients were analyzed, 52.5% were women. The KL radiographic classification showed an average sensitivity of 90.2%, specificity of 24.6%, PPV of 86.3% and NPV of 32.0% to diagnose any degree of OA in relation to CO. On average, a moderate to low correlation (Rho 0.40, p <0.001) was found between the KL scale and the CO. The percentage of correspondence between the grades of KL and CO was 17.5% on average. DiscussionThe KL classification is sensitive for diagnosing OA in the knees, however, our study suggests that it is not very specific and has a moderate correlation with the degrees of injury diagnosed by arthroscopy using CO. Evidence LevelIV.

Association between Knee Osteoarthritis and Metabolic Syndrome in Non-Institutionalized Elderly Patients.

Objective This study aimed to analyze the association between knee osteoarthritis (OA) and metabolic syndrome (MS) in non-institutionalized elderly patients. Methods A cross-sectional, randomized study, drawn from a probabilistic cluster study conducted with 416 elderly people from a Family Health Unit (USF, in the Portuguese acronym) of our municipality. Metabolic syndrome was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III), and OA according to the Kellgren-Lawrence (KL) scale (≥ 2). Results For the statistical analysis, we performed an exploratory data analysis, Mann-Whitney or Chi-Squared tests and univariate and multivariate logistic regressions, with significance level of p < 0.05; the concordance between the evaluators was verified through the Kappa coefficient. There was an association between OA and body mass index (BMI) ( p = 0.0021) and between OA and waist circumference (WC) ( p < 0.001; odds ratio [OR] = 3.524). There was no significant association between OA and the number of metabolic components nor with SM itself. Conclusion We conclude that knee OA is associated with WC, regardless of weight, and that the increase in its measure reflects a greater chance of MS in non-institutionalized elderly patients.

Synovial Adiponectin Was More Associated with Clinical Severity than Synovial Leptin in Women with Knee Osteoarthritis.

Different adipokines have been reported to play a role in the development, progression, and severity of knee osteoarthritis, but this association may be mediated by obesity. The aim of this study was to evaluate separately the associations of leptin and adiponectin with clinical severity and inflammatory markers in nonobese and obese women with knee osteoarthritis. Cross-sectional study with systematic inclusion of 115 women with symptomatic primary knee osteoarthritis. Age, physical exercise, symptoms duration, and body mass index were collected. Radiographic severity was evaluated according to Kellgren-Lawrence scale. Pain and disability were assessed by WOMAC-total, -pain, -function subscales. Two adipokines (leptin and adiponectin) and 3 inflammatory markers (TNF-α, hsCRP, and IL-6) were measured by ELISA in synovial fluid and serum. Synovial fluid adiponectin was associated with WOMAC pain, function, and total and with synovial fluid IL-6 in nonobese female knee osteoarthritis after controlling by confounders (partial correlation coefficient [PCC] = 0.395, 0.387, 0.427, and 0.649, respectively). Synovial fluid and serum leptin were significantly associated with IL-6 (PCC = 0.354) after controlling by confounders but associations with clinical severity and the rest of inflammatory markers were mitigated after control. Adiponectin in synovial fluid was associated with clinical severity and local inflammatory markers in knee osteoarthritis women, while leptin relation was attenuated when controlled by confounders.

Can a fibular malunion be corrected by a Z-shaped fibular osteotomy?

The aim of this study was to assess the short-term clinical and radiographic outcomes in patients who underwent realigning Z‑shaped fibular osteotomy. Between January 2007 and December 2014, 28patients with apainful fibular malunion underwent aZ-shaped realignment fibular osteotomy. The mean age was 42.2 ± 14.1 years (range 19.1-67.8 years) and the mean follow-up was 7.0 ± 1.7 years (range 4.0-9.7 years), with no loss to follow-up. Weight-bearing radiographs were used to determine the distal fibula alignment based on Weber's criteria. Degenerative changes of the tibiotalar joint were assessed using the Kellgren-Lawrence scale. Clinical assessment included pain evaluation, measurement of ankle range of motion (ROM), sports activities, and quality of life outcomes. There were no intraoperative or perioperative complications. No delayed unions or nonunions were observed. One patient had radiographic progression of degenerative changes in the tibiotalar joint. Postoperative complications included removal of hardware (n = 15) and arthroscopic tibiotalar joint debridement (n = 2). At the last follow-up the mean visual analog scale (VAS) decreased from 6.5 ± 1.1 to 2.1 ± 1.1 (p < 0.001),the ROM improved from 39º ± 6º to 45º ± 4.5º (p < 0.001), the short form health survey questionnaire (SF-36) physical and mental outcome scores improved from 49 ± 8 to 84 ± 7 (p < 0.001) and from 61 ± 4 to 83 ± 5 (p < 0.001), respectively. The Z‑shaped realignment osteotomy of the distal fibula can provide pain relief and functional improvement in the treatment of fibular malunion. Further studies are needed to address long-term outcomes in this patient cohort.

Risk factors for hand osteoarthritis

Introduction. Hand osteoarthritis is a joint degenerative disease characterized by hand deformities affecting the hand strength and function, leading to greater disability and increased healthcare utilization. The objective of this study was to estimate the impact of different risk factors on the incidence of hand osteoarthritis. Material and Methods. The study was a prospective cross-sectional study conducted at the Special Hospital for Rheumatic Diseases Novi Sad, Serbia, during a one year period (2017 - 2018). It included 100 postmenopausal women aged 60 to 70 years presenting with pain in the hands ? 3 according to the visual analogue scale. All respondents were divided into two groups, according to radiographic findings graded using the Kellgren-Lawrence scale. Risk factors responsible for the development of hand osteoarthritis were examined and the research procedure included medical history data, physical examination of the hand joints, anthropometric measurements, and laboratory tests. Statistical processing and analysis was performed using Statistical Package for the Social Sciences ver. 25. Results. Statistically significant differences were found between the two groups in relation to positive family history of degenerative changes in the hand joints (p = 0.000), as well as in relation to metabolic syndrome (p = 0.001). Conclusion. A positive family history of degenerative changes of the hands and presence of metabolic syndrome are significant risk factors for the development of hand osteoarthritis.

Efficacy of Piroxicam Mesotherapy in Treatment of Knee Osteoarthritis: A Randomized Clinical Trial.

Introduction Knee osteoarthritis (KOA) is one of the most common degenerative diseases that lead to pain and disability. Oral NSAIDs are effective drugs used to alleviate symptoms in patients with KOA, but they have several important complications, especially in the elderly. In this study, we evaluated the effectiveness of mesotherapy on pain reduction and improvement of functioning in patients with KOA. Methods Sixty-two patients with KOA, grade 2-3 of the Kellgren–Lawrence scale, were randomized into two groups: the mesotherapy group, in which two injections were applied with piroxicam at a 10-day interval, and the oral group, in which piroxicam was prescribed for 10 days. The patients were evaluated before the treatment and 2, 4, and 8 weeks after it using the Visual Analogue Scale (VAS), Oxford Knee Scare (OKS), and Western Ontario McMaster University Osteoarthritis Index (WOMAC, Persian version). Results There was no significant difference in demographic characteristics and baseline pain and function scores between the two groups. After 2, 4, and 8 weeks of follow-up, VAS, WOMAC, and OKS scores significantly improved in both groups (in the mesotherapy group: p value <0.001 in all three scores and in the oral group: p value <0.001 in the VAS scale and p value <0.05 in WOMAC and OKS scores). There was no significant difference between the two groups at any time in the VAS score, but improvement in WOMAC and OKS scales in the mesotherapy group was significantly better (p value <0.05 in both scales [p value <0.03 in OKS and p value <0.02 in WOMAC scales]). Side effects in both groups were not serious: limited heart burn in 32.2% of the total subjects in the oral group and pain at the injection site in 3.2% and bruises in 38.7% of the total subjects in the mesotherapy group. Conclusion Mesotherapy is an effective and safe treatment modality in patients with mild-to-moderate KOA in the short term. This trial is registered with IRCT2017052434113N1.