Knee Injury Osteoarthritis Outcome Score Research Articles

Medial open wedge high tibial osteotomy is a viable option in young patients with advanced arthritis in a long-term follow-up.

This study aimed to evaluate the long-term outcomes of medial open wedge high tibial osteotomy (MOWHTO) as a treatment option for advanced medial compartment knee osteoarthritis (OA) Kellgren-Lawrence (K-L) III and IV. Patients with severe medial compartment arthritis, who underwent MOWHTO with locking plate between 2003 and 2015, were retrospectively reviewed. A locking plate for the osteotomy was utilized. Preoperative and postoperative patients' evaluation was performed using the International Knee Documentation Committee Score (IKDC), the Oxford Knee Score (OKS), the Knee Injury Osteoarthritis Outcome Score (KOOS) and the Short Form-12 Score (SF-12). Standardized standing whole-limb X-rays were taken to evaluate the mechanical tibiofemoral angle (mTFA) and proximal medial tibial angle (PMTA), and the severity of OA. A total of 32 patients, 35 knees (27 males, five females) of which 21 were classified as K-L Grade III and 14 as K-L Grade IV, and mean age 47.1 ± 9.17 years old, who were followed for 13.6 years (range 7-20 years), were included in the study. During the follow-up period, three knees required conversion to total knee replacement (91.5% survival rate). All clinical outcome scores (KOOS, OKS, IKDC and SF-12) showed a significant improvement compared to preoperative status (p < 0.05). Preoperative mTFA and PMTA were significantly corrected immediately after surgery and retained this improvement at the last follow-up. MOWHTO with a locking plate is an effective method to treat severe medial compartments. Clinical and radiological results are satisfactory and the survival rate is 91.5%, at a mean follow-up of 13.6 years after the procedure. Level IV.

Surgical management of combined osteoarthritis knee and proximal tibial stress fracture via long tibial stem total knee arthroplasty: assessment of medium-term results

Background The combined osteoarthritis knee and proximal tibial stress fracture is an uncommon condition that increases the complexity of the management for both. No common consensus among surgeons regarding management guidelines. We assessed the medium-term results (minimum 5 years) of using long tibial stem total knee arthroplasty (TKA) to restore limb alignment, achieve fracture union, and resurface the arthritic joint in a single procedure. Methods Total of 23 patients with combined osteoarthritis knee and proximal tibial stress fracture were enrolled in this study. Of those 23 patients, 18 were females and five were males. All patients were managed surgically by TKA (PCL sacrificing) with a long tibial stem (straight or with offset). Assessments of union and tibiofemoral alignment were carried out using radiographs. Clinically, patients were evaluated by assessment of knee range of motion, knee society score (KSS), and knee injury and OA outcome score. Results The average follow-up period was 6.5 ± 2.3 years (range from 5 to 9 years) all fractures united in 3–8 months (average 3.2 months), and mean range of motion improved from 89°±8° to 119°±6°, mean knee society score improved from 32 ± 8 to 87 ± 5, mean knee injury osteoarthritis outcome score improved from 27 ± 6 preoperatively to 79 ± 5 after a minimum of 5 years follow-up. no complications (instability, infection, or patella mal-tracking) were reported, although 1 case had a femoral intraoperative condyle fracture which was fixed by screws with no effect on the outcome. Conclusion The use of a long tibial stem TKA is an effective and reproducible single surgical procedure in the management of combined osteoarthritis knee and proximal tibial stress fracture. Satisfactory clinical scores and radiological outcomes were achieved and proper limb alignment was restored obviating the need for further fixation or grafting.

Biphasic Scaffold Loaded With Autologous Cartilage Yields Better Clinical Outcome and Magnetic Resonance Imaging Filling Compared With Marrow Stimulation for Focal Osteochondral Lesions in the Knee

PurposeThe purpose of this study was to evaluate the effectiveness of Marrow stimulation (MS) versus biphasic scaffold loaded with autologous cartilage (Scaffold) in treating focal osteochondral lesions of the knee. Methods54 patients with symptomatic focal chondral or osteochondral lesion in the knee were randomized to either the Scaffold group or the MS group. International Knee Documentation Committee (IKDC) subjective score, the Knee Injury Osteoarthritis Outcome Score (KOOS), and Magnetic Resonance Imaging (MRI) were assessed preoperatively, and at one and two years postoperatively to compare treatment outcomes. Biopsy and second-look arthroscopy were performed one year postoperatively for consenting patients. ResultsThere were 27 patients (Mean age 31.33 ± 10.95) in the Scaffold group, and 27 patients (31.74 ± 11.44) in the MS group. The scaffold group and the MS group both included 23 patients with lesions ≤12.5 × 12.5 mm2 mm in size. Additionally, each group had 4 patients with lesions between than 12.5 × 12.5 mm2 and ≤ 12.5 × 25 mm2. Both interventions achieved significant improvement in clinical outcome scores at two years. The Scaffold group had higher IKDC score than the MS group at two years (93.85 ± 9.55 vs 92.11 ± 9.84) and in the Symptoms/stiffness and Sport/recreation subscales of KOOS at two years (96.57 ± 5.97 vs 93.57 ± 6.52, P < 0.05) and (90.2 ± 17.76 vs 82.8 ± 16.08, P < 0.05). ConclusionThe use of biphasic scaffold loaded with autologous cartilage in treating focal osteochondral lesions demonstrates superior clinical outcomes and better cartilage refill on MRI at the two-year follow-up compared to marrow stimulation.

Seven tesla knee MRI T2*-mapping detects intrasubstance meniscus degeneration in patients with posterior root tears.

Medial meniscus root tears often lead to knee osteoarthritis. The extent of meniscal tissue changes beyond the localized root tear is unknown. To evaluate if 7 Tesla 3D T2*-mapping can detect intrasubstance meniscal degeneration in patients with arthroscopically verified medial meniscus posterior root tears (MMPRTs), and assess if tissue changes extend beyond the immediate site of the posterior root tear detected on surface examination by arthroscopy. In this prospective study we acquired 7 T knee MRIs from patients with MMPRTs and asymptomatic controls. Using a linear mixed model, we compared T2* values between patients and controls, and across different meniscal regions. Patients underwent arthroscopic assessment before MMPRT repair. Changes in pain levels before and after repair were calculated using Knee Injury & Osteoarthritis Outcome Score (KOOS). Pain changes and meniscal extrusion were correlated with T2* using Pearson correlation (r). Twenty patients (mean age 53 ± 8; 16 females) demonstrated significantly higher T2* values across the medial meniscus (anterior horn, posterior body and posterior horn: all P < .001; anterior body: P = .007), and lateral meniscus anterior (P = .024) and posterior (P < .001) horns when compared to the corresponding regions in ten matched controls (mean age 53 ± 12; 8 females). Elevated T2* values were inversely correlated with the change in pain levels before and after repair. All patients had medial meniscal extrusion of ≥2 mm. Arthroscopy did not reveal surface abnormalities in 70% of patients (14 out of 20). Elevated T2* values across both medial and lateral menisci indicate that degenerative changes in patients with MMPRTs extend beyond the immediate vicinity of the posterior root tear. This suggests more widespread meniscal degeneration, often undetected by surface examinations in arthroscopy.

Responsiveness and the Minimal Important Change of Knee Injury and Osteoarthritis Outcome Score Following Physiotherapy Intervention in Iraqi People with Knee Osteoarthritis

Background: The Knee Injury Osteoarthritis Outcome Score (KOOS) is a widely used patient-reported questionnaire to evaluate individuals with knee osteoarthritis or a history of knee injuries. Objectives: The aim of this study was to evaluate the responsiveness and establish the minimal important change (MIC) for the Arabic version of KOOS in Iraqi individuals with knee osteoarthritis following physiotherapy intervention. Methods: Fifty volunteers (13 male and 37 female, mean age: 59.3±9.6 years old) with an orthopedic diagnosis of knee osteoarthritis participated in this study. The Arabic KOOS was completed by the participants once before the intervention and once after completing a 4-week physiotherapy treatment program. A seven-item global rating of change scale was used as an external anchor to assess the participants' opinion about the treatment and its possible changes. Responsiveness was evaluated by calculating the receiver operating characteristic (ROC) curve, and the MIC was established by identifying an optimal cut-off on the ROC curve. Results: All subscales of the Arabic KOOS showed an area under the curve &gt; 0.70. The MICs reflecting the values required by the participants to feel the improvement were 15.5, 14.5, 11, 11.5, and 12.5 for the pain, symptoms, activities of daily living, sports and recreation, and quality of life subscales, respectively. Conclusions: All subscales of the Arabic KOOS are responsive to physiotherapy treatment. Therapists and researchers can use the MIC values to evaluate whether their prescribed treatment was satisfactory and effective from their patients' point of view.

Effect of hip joint mobilisations and strength training on pain, physical function and dynamic balance in patients with Knee Osteoarthritis: A randomized controlled trial.

To determine the effects of hip joint mobilisations and strengthening exercises on pain, physical function and dynamic balance in patients with knee osteoarthritis. The single-blind three-arm parallel randomised controlled trial was conducted at Sindh Institute of Physical Medicine and Rehabilitation, the outpatient department of Dow University of Health Sciences' Ojha Campus, Rabia Moon Memorial Welfare Trust and the Civil Hospital, Karachi, from January to July 2021. The sample comprised patients aged at least 50 years having knee osteoarthritis grade 1-3. The patients were randomised into 3 equal groups, with group A receiving hip mobilisations along with strengthening exercises of hip and conventional knee exercises, group B receiving strengthening exercises of hip along with conventional knee interventional exercises, and group C receiving conventional knee exercises only. Pain, physical function and dynamic balance were assessed using visual analogue scale, knee injury osteoarthritis outcome score and four-step square test, respectively, at baseline and after 18th session. Data was analysed using SPSS 21. Of the 74 subjects assessed, 66(89.2%) were included; 22(33.3%) in each of the three groups. The sample had 19(28.8%) male subjects and 47(71.2%) female. The mean age in groups A, B and C were 55.64±3.56 years, 53.64±4.65 years and 54.91±4.30 years, respectively. There was significant difference among groups post-treatment (p<0.001). Significant improvement was also found in inter-group analyses of all outcomes (p<0.001). Addition of hip joint mobilisations provided better results compared to the other two groups. https://clinicaltrials.gov/ct2/show/NCT04769531.

The impact of postoperative inclination of the joint line on clinical outcomes in total knee arthroplasty using a prosthesis with anatomical geometry

The goal of this study was to investigate the impact of postoperative inclination of the joint line on clinical results after total knee arthroplasty (TKA) using a prosthesis with anatomical geometry. This study included 145 primary cruciate-retaining type of knee prosthesis with anatomical geometry. Three years postoperatively, clinical outcomes including the patient-reported outcomes (PROs) were recorded. Limb alignment was evaluated by the hip-knee-ankle (HKA) axis and inclination of the joint line was assessed by the joint line orientation angle (JLOA). Knees were divided into two groups according to the HKA: in-range (− 3 to 3°) and outlier group (< − 3° or > 3°) or the JLOA: in-range (2–4°) and outlier group (< 2° or > 4°), and clinical outcomes were compared between the groups. Postoperative Knee Society Function Score (KS-FS) was significantly higher in the HKA in-range group than the outlier group (p = 0.01). The Knee Society Knee Score and all subscales of the Knee injury Osteoarthritis Outcome Score were comparable between the groups. A multivariate analysis revealed a significant association between age at operation and postoperative KS-FS > of 80 points. Neither HKA in-range nor JLOA in-range were associated with the higher knee function. In conclusion, TKA-postoperative inclination of the joint line was not relevant to the short-term PROs. Treatment strategies that attempt to make joint line inclination in order to improve postoperative PROs should be avoided, and alignment goals such as kinematic alignment should be considered carefully.

Robotic-arm assisted lateral unicompartmental knee arthroplasty: 5-Year outcomes & survivorship.

Robotic-arm assisted unicompartmental knee arthroplasty (RA-UKA) has demonstrated accurate component positioning and excellent outcomes for medial components. However, there is a paucity of literature on lateral compartment RA-UKA. The purpose of our study was to assess the midterm clinical outcomes and survivorship of lateral RA-UKA. This study was a retrospective review of a single-center prospectively maintained cohort of 33 patients (36 knees) indicated for lateral UKA. Perioperative, and postoperative two- and five-year Knee injury Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Score (WOMAC), and Forgotten Joint Score (FJS) patient reported outcome measures were collected. Five-year follow-up was recorded in 29 patients (32 knees). Mean follow up was 5.1 ± 0.1years. Mean age and BMI was 70.9 ± 7.2years and 29.0 ± 4.2kg/m2, respectively. At discharge, mean distance walked was 273.4 ± 70.4 feet, and mean pain score was 2.0 ± 2.5. At 2-year follow up, mean KOOS, WOMAC, and FJS were 75.1 ± 13.5, 15.0 ± 7.2, and 81.0 ± 23.3, respectively. At 5-year follow up, mean KOOS, WOMAC, and FJS were 75.3 ± 14.6, 14.9 ± 5.0, and 75.8 ± 27.4, respectively. Mean change in KOOS and WOMAC were 35.6 ± 27.1 and 11.7 ± 13.4 (p< .001 and p< .001). 94% of patients were very satisfied/satisfied, 3% neutral, and 3% dissatisfied. 91% met activity expectations, and 59% were more active than before. Survivorship was 100% at 5years. In this study, lateral RA-UKA demonstrated significantly improved clinical outcomes, high patient satisfaction, met expectations, and excellent functional recovery at midterm follow up. Comparative studies are needed to determine differences between robotic-assisted and conventional lateral UKA, as well as TKA.

Responsiveness and the Minimal Important Change of Knee Injury and Osteoarthritis Outcome Score Following Physiotherapy Intervention in Iraqi People with Knee Osteoarthritis

Background: The Knee Injury Osteoarthritis Outcome Score (KOOS) is a widely used patient-reported questionnaire to evaluate individuals with knee osteoarthritis or a history of knee injuries. Objectives: The aim of this study was to evaluate the responsiveness and establish the minimal important change (MIC) for the Arabic version of KOOS in Iraqi individuals with knee osteoarthritis following physiotherapy intervention. Methods: Fifty volunteers (13 male and 37 female, mean age: 59.3 ± 9.6 years old) with an orthopedic diagnosis of knee osteoarthritis participated in this study. The Arabic KOOS was completed by the participants once before the intervention and once after completing a 4-week physiotherapy treatment program. A seven-item global rating of change scale was used as an external anchor to assess the participants' opinion about the treatment and its possible changes. Responsiveness was evaluated by calculating the receiver operating characteristic (ROC) curve, and the MIC was established by identifying an optimal cut-off on the ROC curve. Results: All subscales of the Arabic KOOS showed an area under the curve &gt; 0.70. The MICs reflecting the values required by the participants to feel the improvement were 15.5, 14.5, 11, 11.5, and 12.5 for the pain, symptoms, activities of daily living, sports and recreation, and quality of life subscales, respectively. Conclusions: All subscales of the Arabic KOOS are responsive to physiotherapy treatment. Therapists and researchers can use the MIC values to evaluate whether their prescribed treatment was satisfactory and effective from their patients' point of view.

What's New in Adult Reconstructive Knee Surgery.

What's New in Adult Reconstructive Knee Surgery.

Low percentage of patients passed the ‘Back in Action’ test battery 9 months after bone-patellar tendon-bone anterior cruciate ligament reconstruction

BackgroundAnterior cruciate ligament (ACL) reconstruction is recommended in patients who intend to return to high-level sports. However, there is only a 55–80% return to pre-injury level of sports after ACL reconstruction, with a re-injury rate up to 20%. The aim of this study was to determine the percentage of patients passing the Back in Action (BIA) test 9 months after primary bone-patellar-tendon-bone (BPTB) ACL reconstruction, and evaluate the association between passing the BIA test and patient reported outcome measurements (PROMs). MethodsPatients underwent the BIA test 9 months after BPTB ACL reconstruction. In total 103 patients were included. Passing the BIA test (PASSED-group) was defined as a normal or higher score at all sub-tests with limb symmetry index (LSI) ≥90% for the dominant leg and LSI >80% for the non-dominant leg. Patients who did not meet these criteria were defined as the FAILED-group. PROMs included the International Knee Documentation Committee, Knee injury Osteoarthritis Outcome Score and Anterior Cruciate Ligament-Return to Sport after Injury. ResultsEighteen patients (17.5%) passed the BIA test 9 months after BPTB ACL reconstruction. PROMs were not statistically significant different between the PASSED- and FAILED-group. ConclusionLow percentage of patients passed the BIA test 9 months after BPTB ACL reconstruction. Although current PROMs cut-off values were met, the BIA test results show persistent functional deficits. Therefore, the BIA test could be of additional value in the decision-making process regarding return to sport (RTS). This study highlights the need for additional rehabilitation as RTS in a condition of incomplete recovery may increase the risk of re-injury. Level of evidenceII.

Effectiveness of Different Concentrations of Dextrose Prolotherapy in Osteoarthritis Knee: A Double-Blind Randomised Comparative Study

Background: Intra-articular dextrose prolotherapy (DPT) is reported to improve the outcomes in the treatment of the osteoarthritis (OA) knee. Outcomes may be variable as per the concentration of the agent, scales for evaluation, patients’ perception and severity of the disease. Methods: This was a double-arm double-blind randomised prospective study. As per computer-generated randomisation, participants were divided into two Groups A and B and subjected to four intra-articular injections either of 12.5% or 25% dextrose, respectively, at 0, 3rd, 6th and 9th week. Outcomes are measured by two scales, i.e., Visual Analogue Scale (VAS) at all subsequent visits, 12th and 20th week, and knee injury osteoarthritis outcome score (KOOS) (five subscales) at baseline and 20th week (at 95% confidence interval, and P &lt; 0.05 significant). A common exercise regimen was given to both groups. Results: A total of 78 patients were enrolled, out of which only 50 participants (25 in each group) completed the study. Both the treatment arms were age- and sex-matched with a female preponderance of 64% and males 36%. Following treatment, the VAS score of both the groups showed parallel improvement in the first three visits, but Group B was found to be statistically significant for 9th week (P = 0.024) onwards (P = 0.0071 at 12th and P = 0.013 at 20th week). The KOOS score also improved in both groups but the Group B had a superior effect compared with Group A in all the subscales (P &lt; 0.05). Conclusion: Intra-articular DPT improves the symptomatic picture of patients with OA knee in a concentration-dependent manner. It also showed a dose–response relationship following serial injections on VAS. DPT is found to be cost-effective, safe and beneficial therapy for OA knee.

Multi-group invariance testing of the knee injury osteoarthritis outcome score for joint replacement scale

ObjectiveThe Knee Osteoarthritis Outcome Score for Joint Replacement (KOOS-JR) scale is commonly used to assess patient progress. Scale structural validity has not been completely assessed. The purpose of this study was to assess the internal consistency, structural validity, and multi-group invariance properties of the KOOS-JR in a large sample of patients receiving knee arthroplasty or non-operative care. MethodsA cross-sectional study using the Surgical Outcome System (SOS) database. Patients receiving care for degenerative knee conditions were included in the study. Internal consistency was assessed using Cronbach's alpha and McDonald's Omega. A confirmatory factor analysis was conducted to confirm scale structure of the KOOS-JR using a priori cut-off values (Comparative Fit Index [CFI], Tucker-Lewis Index [TLI], Incremental Fit Index [IFI] ​≥ ​0.95, Root Mean Square Error of Approximation [RMSEA] ​≤ ​0.06 preferred and ≤0.08 acceptable). Multigroup invariance testing was conducted across sex, age, and intervention groups. ResultsInternal consistency was acceptable (alpha ​= ​0.83; omega ​= ​0.83). The unidimensional structure of the KOOS-JR exceeded most contemporary model fit recommendations (CFI ​= ​0.976, TLI ​= ​0.964, IFI ​= ​0.976, RMSEA ​= ​0.067). The KOOS-JR was invariant across groups, allowing for comparison of variances and means between sex, age, and intervention groups. ConclusionThe KOOS-JR met or exceeded most of the recommendations for model fit. The scale can be used to assess differences between males and females, middle and older aged adults, and between baseline measures of patients who received total knee arthroplasty or non-operative care.

The German version of the KOOS-Child questionnaire (Knee injury and Osteoarthritis Outcome Score for children) shows a good to excellent internal consistency and a high test–retest reliability in children with knee problems

PurposeThe Knee Injury Osteoarthritis Outcome Score for children (KOOS-Child) is a self-administered, valid and reliable questionnaire for children and adolescents with knee disorders such as Osgood Schlatter disease, anterior knee pain, and patella dislocation. This study aimed to cross-culturally adapt the German version of the KOOS-Child questionnaire and test the reliability in two groups of children, one treated conservatively and the other surgically.MethodsA forward–backward translation of the original questionnaire into the German language was conducted. Children and adolescents between 10 and 18 years of age with knee disorders were included. Two groups were compared: sample one consisted of 24 participants with knee pain [20.8% boys; mean age = 13.4 (1.8) years treated conservatively. These participants completed the KOOS-Child questionnaire twice within two weeks to assess test–retest reliability. The second sample included 23 subjects (21.7% boys; mean age = 15.3 (1.9) years] treated surgically due to a knee disorder. They completed the questionnaire before surgery and six months postoperatively. Test–retest reliability and internal consistency were assessed using Spearman’s rank correlation and Cronbach’s alpha.ResultsAll subscales showed a good to excellent internal consistency at both measurement points in both groups (conservatively treated group: a = 0.88–0.95; surgery group a = 0.80–0.91), with the exception of the subscale knee problems (conservatively treated: a = 0.60 and 0.52; surgery: α = 0.77 and 0.66). Test–retest reliability was between r = 0.85 and 0.94.ConclusionThe predominantly good to excellent internal consistency and the high test–retest reliability justifies the use of the German adaptation of the KOOS-Child questionnaire as a reliable multidimensional instrument for measuring health status and therapeutic effects in adolescents’ knee disorders.

High Tibial Osteotomy Using the ‘Tomofix™’ Plating System: Short Term Outcomes in Young Adults

Proximal tibial valgus osteotomy is one of the treatment options for painful medial compartment osteoarthritis and varus deformity of the knee. The aim of our study was to determine and quantify how much osteotomy altered symptoms from medial compartment gonoarthrosis. In addition we aimed to establish whether the Tomofix plating system would permit early weight bearing and achieve union without the use of bone grafts. We prospectively analysed our experience with medial opening wedge high tibial osteotomy using the Tomofix plate.&#x0D; Thirty-five knees were included in the study. The mean age was 47 years (36-59 years). Mean duration of follow-up was 23 months (7-48 Months). All patients underwent medial opening wedge high tibial osteotomy using the Tomofix plating system. Data was recorded using the Oxford Knee score, the Knee Injury Osteoarthritis Outcome score and through review of pre and postoperative x-rays. Good outcomes were seen with statistically significant improvement of both scores.&#x0D; There were two delayed unions, the remainder united without requirement for graft. There was improvement, in Oxford and Knee injury osteoarthritis scores. Correction of mal-alignment was seen in all cases. Early weight bearing was found to be permissible without risk of adverse event.&#x0D; The Tomofix plate provided immediate stability and satisfactory healing of the osteotomy site without the need for bone graft. Good functional results were seen.

5-Year Survivorship and Outcomes of Robotic-Arm-Assisted Medial Unicompartmental Knee Arthroplasty.

Purpose While unicompartmental knee arthroplasty (UKA) has demonstrated benefits over total knee arthroplasty (TKA) in selected populations, component placement continues to be challenging with conventional surgical instruments, resulting in higher early failure rates. Robotic-arm-assisted UKA (RA-UKA) has shown to be successful in component positioning through preop planning and intraop adjustability. The purpose of this study is to assess the 5-year clinical outcomes of medial RA-UKA. Methods This study was a retrospective review of a single-center prospectively maintained cohort of 133 patients (146 knees) indicated for medial UKA from 2009 to 2013. Perioperative data and 2- and 5-year Knee injury Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster Universities Osteoarthritis Score (WOMAC), and Forgotten Joint Score (FJS) outcome measures were collected. Five-year follow-up was recorded in 119 patients (131 knees). Results Mean follow-up was 5.1 ± 0.2 years. Mean age and BMI were 68.0 ± 8.1 years and 29.3 ± 4.7 kg/m2, respectively. At 2-year follow-up, mean KOOS, WOMAC, and FJS were 71.5 ± 15.3, 14.3 ± 7.9, and 79.1 ± 25.8, respectively. At 5-year follow-up, mean KOOS, WOMAC, and FJS were 71.6 ± 15.2, 14.2 ± 7.9, and 80.9 ± 25.1, respectively. Mean change in KOOS and WOMAC was 34.6 ± 21.4 and 11.0 ± 13.6, respectively (p < 0.001 and p < 0.001). For patient satisfaction at last follow-up, 89% of patients were very satisfied/satisfied and 5% were dissatisfied. For patient activity expectations at last follow-up, 85% met activity expectations, 52% were more active than before, 25% have the same level of activity, 23% were less active than before, and 89% were walking without support. All patients returned to driving after surgery at a mean 15.2 ± 9.4 days. Survivorship was 95% (95% CI 0.91-0.98) at 5 years. One knee (1%) had a patellofemoral revision, two knees (1.3%) were revised to different partial knee replacements, and five knees (3.4%) were converted to TKA. Conclusion Overall, medial RA-UKA demonstrated improved patient-recorded outcomes, high patient satisfaction, met expectations, and excellent functional recovery. Midterm survivorship was excellent. Longitudinal follow-up is needed to evaluate long-term outcomes of robotic-arm-assisted UKA procedures.

Effect of Bilateral Lower Extremity Cold-Compression on Knee Pain

Cold-compression (CC) therapies are common modalities used to reduce pain, provide symptomatic management in disease, and mitigate delayed onset muscle soreness. CC is routinely applied after acute injury or following surgery; however, little is known regarding its use in chronic knee pain. We hypothesized the use of the Aquilo bilateral lower extremity CC system would significantly reduce participants' knee pain immediately following and up to 2 days after a single therapy session. Fifteen participants (11 females, 4 males; avg age 50.6±16.9) with chronic knee pain. The protocol was a pre-posttest study of cardio-vascular, pain pressure thresholds (PPT) and perceived knee pain immediately after and 1- and 2-days post-treatment using Aquilo Sports bilateral cold compression system. CC lowered mean knee skin temperature 12.0 °C (± 1.1) while applying an average compression of 5.8 (± 1.8) mmHg. This occurred without significant changes vitals. Mean PPT values rose 3.2-4.0 (± 0.7-0.9) lbf following CC. Pain Catastrophizing Scale scores fell from 7.8(± 1.9) to 2.8(± 1.6) 48 hours post CC. All 5 domains of the Knee Injury Osteoarthritis Outcome Score (KOOS) had increases in mean scores 1- and 2-days post CC. The CC session was effective at improving self-reported pain levels over 2 days post. CC effectively lowered skin temperature and increased PPT without adverse events. There is a real clinical need for effective and affordable treatments for management of chronic knee pain in adults. The Aquilo CC system may offer a non-pharmaceutical intervention to improve analgesia, which may serve as a tool to enhance participation in physical activity, improve mobility, and quality of life for those with knee pain.

Platelet-Rich Plasma and Adipose-Derived Mesenchymal Stem Cells in Association with Arthroscopic Microfracture of Knee Articular Cartilage Defects: A Pilot Randomized Controlled Trial.

Background This study aims to compare the effects of platelet-rich plasma (PRP) alone or in combination with adipose-derived mesenchymal stem cells (AD-MSCs) in patients affected by cartilage defects, undergoing knee arthroscopic microfracture. Methods Thirty-eight patients diagnosed with a knee monocompartmental cartilage defect (Outerbridge grade IV) on the MRI, underwent an arthroscopic procedure. After the confirmation of the lesion, they all received the same bone marrow stimulation technique (microfracture) and were randomized into two groups: the first one had additional PRP injection (group A), while the second received PRP and AD-MSC injection (group B). Knee assessment and pain score were documented with Knee Injury Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, Short-Form (SF) 12, and Visual Analogue Scale (VAS) before the treatment and at 1, 3, 6, and 12 months of follow-up postoperatively. An additional arthroscopic procedure, performed in four patients for a subsequent meniscal lesion, let us evaluate cartilage evolution by performing a macro/microscopical assessment on cartilage biopsy specimens. Results At the 12-month follow-up, both groups showed a comparable functional improvement. The scores on the IKDC form, KOOS, pain VAS, and SF-12 significantly improved from baseline (p < 0.05) to 12 months postoperatively in both treatment groups. The four second-look arthroscopies showed a complete repair of the articular defects by smooth solid cartilage layer, with a good chondrocytic population, in both groups. A thick smooth hyaline-like cartilage with a predominantly viable cell population and normal mineralization (a form closely resembling native tissue) was observed in group B. Conclusions Modern regenerative medicine techniques, such as PRP and AD-MSC, associated with traditional arthroscopic bone marrow stimulating techniques, seem to enhance cartilage restoration ability. The preliminary results of this pilot study encourage the synergic use of these regenerative modulating systems to improve the quality of the regenerated cartilage.

Long Non-Coding RNA PVT1 and Its Target miRNA-146a as Potential Prognostic Biomarkers in Rheumatoid Arthritis Patients.

Objective: Long non-coding RNAs (lncRNAs) and their target microRNAs were documented in multiple studies to have a significant role in different joint disorders such as rheumatoid arthritis (RA) and osteoarthritis (OA). The current work aimed to determine the potential role of lnc-PVT1 and miR-146a as promising biomarkers to distinguish between RA, OA patients, and healthy individuals. Methods: The expression levels of lnc-PVT1 and its target miR-146a in the serum were measured for three different groups, including patients with RA (40), OA patients (40), and healthy controls (HCs) (40). Participating individuals were subjected to a full history investigation and clinical examination. Blood samples were tested for ESR, RF, CBC, as well as liver and renal functions. Serum was used to detect the relative expression levels of lnc-PVT1 and miR-146a and we correlated the levels with RA and OA activity and severity signs. Results: Lnc-PVT1 expression level was greater among patients with RA compared to that of OA patients, with a fold change median of 2.62 and 0.22, respectively (p = 0.001). The miR-146a fold change was significantly demonstrated between the RA, OA, and HCs groups. There was no correlation between both biomarkers with the disease activity scales (DAS28) of RA, the Knee injury Osteoarthritis Outcome Score (KOOS), or any sign of detection of the disease severity of OA. Conclusions: lnc-PVT1 and miR-146a could be considered as promising biomarkers for the diagnosis of RA and OA and may have an important role as therapeutic targets in the future.

Interpreting the Knee Osteoarthritis Outcome Score Joint Replacement: Minimum clinically important difference values vary over time within the same patient population

Introduction Total knee arthroplasty (TKA) is the preferred treatment for end-stage osteoarthritis. Minimal clinical important difference (MCID) quantifies if a patient achieves a successful outcome following TKA. This study aims to determine the MCID for Knee Injury Osteoarthritis Outcome Score Joint Replacement (KOOS JR) at two designated time intervals and to compare methodologies for calculating MCID. Methods Patient-Reported Outcome Measures (PROM) were prospectively evaluated for 956 patients undergoing TKA between 2017 and 2018 at a single health care system. Patients who completed baseline, 3-month and 1-year post-operative PROM surveys at clinical follow-up were included in the study. MCID was calculated from baseline to 3-months and baseline to 1-year using anchoring and distribution-based methods. Results Average KOOS JR scores at baseline, 3-month, and 1-year follow-up were 51.7 ± 11.7, 69.2 ± 12.0, and 76.3 ± 14.5. The KOOS JR MCID determined by the PROMIS10 physical health anchoring method was 21.5 ± 14.9 and 27.9 ± 16.0 for the 3-month and 1-year intervals. The KOOS JR MCID determined by the PROMIS10 quality-of-life anchoring method was 21.2 ± 14.9 and 28.9 ± 15.8 for the 3-month and 1-year intervals. The MCID calculated by the distribution method was 7.4 and 8.2 for the 3-month and 1-year intervals. Conclusion KOOS JR MCID varies as a function of time and is variable within the same population depending on MCID calculation methodology. Improved strategy for calculating or standardizing MCID is required to better guide use of KOOS JR and other PROMs in clinical decision-making.