Presence Of Knee Osteoarthritis Research Articles

10-Year Survival and Clinical Improvement of Meniscal Allograft Transplantation in Early to Moderate Knee Osteoarthritis

Background: Meniscal allograft transplantation (MAT) is a viable option for patients experiencing unicompartmental knee pain after total or subtotal meniscectomy. Nonetheless, caution is recommended when suggesting this procedure in the presence of knee osteoarthritis (OA) because of the higher risk of poor survival and outcomes. Purpose/Hypothesis: The purpose was to document the long-term survival of MAT performed as a salvage procedure in patients with knee OA. The hypothesis was that MAT would significantly reduce pain and increase the function of the affected joint at a long-term follow-up compared with the preoperative condition, with a low number of failures and knee replacement surgeries. Study Design: Case series; Level of evidence, 4. Methods: A total of 47 patients (37 men and 10 women) with symptomatic knee OA (Kellgren-Lawrence grades 2 or 3) treated with MAT were evaluated at baseline, 5 years, and a minimum 10-year final follow-up (11.1 ± 1 years) using the Lysholm score, the visual analog scale for pain, the Knee injury and Osteoarthritis Outcome Score subscales, and the Tegner score. A total of 44 patients had undergone previous surgeries. Patient satisfaction, revision surgeries, and failures were also recorded. Results: A statistically significant improvement was observed in all clinical scores from the baseline assessment to the final follow-up. The Lysholm score improved significantly from 46.4 ± 17.2 at the preoperative assessment to 77.7 ± 20.4 at the intermediate follow-up (P < .001), with a significant decrease at the final follow-up (71 ± 23.3; P = .018). A similar trend was reported for the visual analog scale scale for pain, Knee injury and Osteoarthritis Outcome Score, and Tegner score, with no complete recovery to the previous sports activity level. A total of 33 patients required concurrent procedures, such as anterior cruciate ligament reconstructions, osteotomies, and cartilage procedures. Five patients underwent reoperation and were considered surgical failures, while 15 patients presented a clinical condition of <65 of the Lysholm score and were considered clinical failures. Among these, 4 patients were considered both surgical and clinical failures. Conclusion: MAT surgery has proven to be a valid option for improving pain and function even in OA joints (Kellgren-Lawrence grades 2 or 3), yielding satisfactory results despite a worsening clinical outcome in the long-term follow-up. Therefore, based on the data from this study, orthopaedic surgeons may consider recommending MAT as a salvage procedure even in knees affected by early to moderate OA, while advising patients that the need for combined interventions could potentially reduce graft survival.

Modified Mason-Allen vs Two Simple Stitch Fixation for Medial Meniscus Posterior Root Tears: A Systematic Review and Meta-analysis

Background: Various suture configurations are available for medial meniscus posterior root tear (MMPRT) repair. The modified Mason-Allen (MMA) technique has been proposed as a refixation technique for MMPRT instead of the conventional 2 simple stitches (TSS). This is in view of its superior biomechanical characteristics. Purpose: To perform a systematic review and meta-analysis to compare MMA and TSS configuration techniques for MMPRT repair and identify any differences between the 2 techniques in terms of clinical outcomes, medial meniscal extrusion (MME), and postoperative healing. Study Design: Meta-analysis; Level of evidence, 4. Methods: The Cochrane Controlled Register of Trials, PubMed, Medline, and Embase databases were used to perform a systematic review and meta-analysis using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms: (“meniscus” OR “meniscal injuries”) AND (“Mason-Allen” OR “simple stitch” OR “suture techniques”). Data pertaining to all patient-reported outcome measures, postoperative complications, MME, postoperative healing, cartilage degeneration, and progression of knee osteoarthritis were extracted from each study. The pooled outcome data were analyzed using random- and fixed-effects models. Results: After abstract and full-text screening, 6 clinical studies were included. In total, there were 291 patients; 160 underwent MMA fixation, and 131 underwent the TSS technique. The majority of studies had similar surgical techniques regarding repair technique, suture material, tibial fixation, and number and position of tibial tunnels. There were no differences between the groups in terms of patient-reported outcome measures at 14.2 months. Both techniques were also similar in the degree of postoperative MME and meniscal healing. Conclusion: Both suture configurations were equivalent in terms of clinical outcomes, the extent of meniscal extrusion, and postoperative healing. The TSS technique may offer advantages in terms of faster learning curve and shorter operative time. However, randomized controlled trials with large sample sizes, longer follow-up and assessment of chondral degeneration, and presence of knee osteoarthritis are required to assess whether a true difference exists, as the majority of included studies were limited by their retrospective design.

Efficacy and safety of curcumin in patients with metabolic phenotype of osteoarthritis: A pilot study

The aim of this study was to assess efficacy and safety of curcumin in metabolic syndrome- associated osteoarthritis (MetS-OA). All patients provided written informed consent. Knee OA was diagnosed according to American College of Rheumatology criteria; MetS was diagnosed according to Russian Scientific Society of Cardiology Guidelines. The study had before-and-after design. The main inclusion criteria were presence of knee OA and MetS, levels of global health assessment and pain assessment more than 50 mm using 0-100 visual analogue scale (VAS). The main outcome was VAS global. The other outcomes were VAS pain, Knee injury and Osteoarthritis Outcome Score (KOOS) consisting of five subscales: pain (KOOS pain), other symptoms (KOOS symptoms), activities in daily living (KOOS ADL), function in sport and recreation (KOOS Sport/Rec) and knee related Quality of life (KOOS QoL). The level of depression was measured using PHQ- 9. For pain, proportion of patients achieving minimal clinically important improvement (MCII) was assessed using the cut-offs of (a) 15 of 100 for absolute improvement and 20% for relative improvement.The treatment consisted of C. longa extract 1000 mg/day for 4 weeks. The assessments were performed on baseline and 4 weeks thereafter. Eighteen women with MetS-OA of the knee were included in the study.At the end of treatment, there were significant improvements in the VAS global scale by an average 33.9 mm (p = 0.001), VAS pain by 25 mm (p = 0.001). There was a trend towards improvement in PHQ-9 by 2.9 (p = 0.05). The mean improvement in KOOS pain was 11 (p = 0.001). KOOS symptoms improved by 9 (p = 0.025), KOOS ADL - by 12.4 (p = 0.001), KOOS Sport/Rec by 10.3 (p = 0.044), and KOOS QOL by 14.4 (p = 0.009). The proportion of patients achieving clinically significant improvement (MCII) were nine (56%) for both global health and pain. There were no adverse events during the study. The findings of this study suggest clinical efficacy and safety of C. Longa in MetS-associated knee OA. There is a need for large controlled studies to confirm these results.

Knee Osteoarthritis in Relation to the Risk Factors of the Metabolic Syndrome Components and Environment of Origin.

Knee osteoarthritis (KOA) is a chronic degenerative pathology that is associated with multiple risk factors such as age, sex, obesity, or metabolic syndrome (MetS). The present clinical trial aimed to investigate the influence of the environment of origin, body mass index (BMI), and MetS parameters on the KOA differentiated degrees. 85 patients were admitted for the clinical study. The KOA presence was investigated using X-rays analysis. The Kellgren-Lawrence classification (KL) of the KOA severity and the MetS characteristic parameters using freshly collected blood were performed for each patient. All data collected were used for ANOVA statistic interpretation. The total cholesterol and glycemia were found to be statistically significant (p &lt; 0.028, and p &lt; 0.03, respectively), with a high level in patients with severe KOA compared to healthy ones. Patients from rural regions are 5.18 times more prone to develop severe KOA when compared to ones from urban areas. The results of the statistical analysis confirmed the correlation between the incidence and severity of KOA and the influence of increased values of BMI, glycemia, triglycerides, and total cholesterol. The investigations revealed a statistically significant influence of the environment of origin on the KOA degree of the patients.

The prevalence of fabella and its relationship with the lateral posterior condylar offset and lateral posterior tibial slope values.

This study aims to analyze whether the lateral posterior condylar offset (LPCO) and lateral posterior tibial slope (LPTS) values are associated with the presence of fabella by evaluating the frequency of fabella, its location, and whether it is bilateral and the relationship of the fabella with age, sex, and the presence of osteoarthritis. Between January 2016 and December 2020, computed tomography (CT) scans including 1,952 knee regions of 1,220 patients (861 males, 359 females; mean age: 54.5±19.7 years; range, 10 to 98 years) were retrospectively analyzed. Age, sex, and the presence of fabella whether unilateral (left or right) or bilateral were recorded. Of the patients with a bilateral knee CT, those with fabella on one side and without on the other were studied further to investigate the effect of fabella on the posterolateral corner (PLC). In these patients, the LPCO and LPTS values, presence of knee osteoarthritis, fabella-femoral distance, and sagittal anterior-posterior diameter of the fabella were evaluated. While there was no evidence of fabella in 867 (71.1%) patients, it was present in 353 (28.9%) patients. The linear correlation analysis revealed that the correlations between the right LPCO and the right LPTS (r=-0.295; p<0.001) and between the left LPCO and the left LPTS (r=-0.574; p<0.001) were significant. It was observed that LPTS decreased with increasing LPCO. According to the results of the point biserial correlation analysis, there was a significant correlation between the presence of fabella on the right side and the right LPCO value (r=-0.643; p<0.001) and between the presence of fabella on the left side and the left LPCO (r=-0.284; p=0.024). When the two knees were compared, fabella was less present in the knee whose LPCO was higher than that of the other knee, whereas it was more common in the knee whose LPCO was lower than that of the other knee. We found a significant correlation between each side's fabella and LPCO values and between the presence of fabella on the left side and the left LPTS. The presence of fabella in the knee joint may be associated with LPCO and LPTS values of the knee. The comparison of the two knees of the same patient may reveal that if a fabella is present in a knee, the LPCO value of that knee is lower than that of the other knee. We believe that the reason for this is that the presence of fabella increases the distance to the center of rotation of the knee joint.

Does a relationship between type of hip fracture and osteoarthritis exist?

Background/Aim: Many factors have been associated with the etiology of falls and hip fractures in the elderly. However, only a few studies have examined the relationship between osteoarthritis and hip fractures, which are common in this age group. The aim of this study was to determine the relationship between the knee and hip osteoarthritis (OA) and the type of hip fracture. Methods: Patients who underwent surgery in the Orthopedics and Traumatology Department between January 2017 and December 2021 were eligible to participate in this retrospective cohort study. Patients who were 60 years and older with a hip fracture and adequate medical records and radiographs of bilateral hip and knee joints met the inclusion criteria. Data concerning patient co-morbidities, type of hip fracture, whether they had OA in their hip and knee joints, and the severity of their OA were assessed. The severity of the osteoarthritis presence was categorized with using the Kellgren–Lawrence (KL) classification. To categorize the patients, three groups were identified: (1) femoral neck, (2) trochanteric, and (3) subtrochanteric fracture groups. The presence and severity status of OA in the hip and knee joints and co-morbidity data were compared between the groups. Results: Three-hundred forty-one patients with a M/F ratio of 148/193 are included in this study. Femoral neck fractures occurred in 142 (41.6%), trochanteric fractures in 147 (43.1%), and subtrochanteric fractures in 52 (15.2%) patients. The mean age of the cohort was 76.72 (10.165); The mean age of the patients in the trochanteric group was higher than in the subtrochanteric group (P = 0.001). No effect of any existing co-morbidities on fracture type was observed. The overall prevalence of OA in the cohort that was observed in the hip joint was 34.3% with 33.7% in males and 35.3% in females. These rates were 66.6%, 53.4%, and 76.7% in the knee joint, respectively. No difference could be observed between hip OA presence and any type of hip fracture group (P = 0.833 for right hip, P = 0.865 for left hip). Similar rates of moderate and severe hip OA were found in the femoral neck and trochanteric fracture groups. However, the frequency of moderate hip OA was lower and the frequency of severe hip OA was higher in subtrochanteric fracture group compared to other groups (P = 0.164 for right hip, P = 0.241 for left hip. Knee OA was observed to be more common in the trochanteric fracture group (P = 0.003 for the right knee, P = 0.002 for left knee) and also, the rate of severe OA was higher in the trochanteric fracture group compared to other groups (P = 0.013 for right knee, P = 0.006 for the left knee). Conclusion: In contrast to OA presence in the hip, knee OA presence and severity can be significant risk factors for occurrence of trochanteric type fractures in the elderly.

Self-reported walking difficulty influences gait characteristics in patients with medial compartment knee osteoarthritis

BackgroundTo differentiate gait strategies per knee osteoarthritis and self-reported walking difficulty during self-selected regular and fast gait speeds. We hypothesize that knee osteoarthritis gait characteristics during self-selected regular and fast gait speeds will be most accentuated by the osteoarthritis and walking difficulty group, followed by osteoarthritis and no walking difficulty, and least in the control group. MethodsProspective study of community-dwelling older adults (n = 39) who walk at functional speeds (≥1.0 m per second) were age and sex matched across the three groups. Gait strategies including knee excursion and moments, muscle activation and co-contraction, and limb dynamics (linear acceleration and jerk) were compared between groups during self-selected regular and fast gait speed trials. Significant group differences were defined as P < 0.05 and an effect size greater than small. FindingsBased on walking difficulty, adduction moments (P-range = 0.00–0.03; effect size range,r = 0.42–0.52) and lateral quadriceps-gastrocnemius co-activations (P = 0.01;r = 0.36) were significant during regular gait speeds; and extension (P = 0.03;d = 0.59) and adduction (P-range = 0.00–0.02;d = 0.86;r = 0.40) moments were significant during fast trials. Per knee osteoarthritis presence, adduction moment(P = 0.01;r = 0.49), medial-quadriceps (P = 0.00;d = 1.04;r = 0.61), lateral-hamstrings (P = 0.04;d = 0.55), medial-gastrocnemius (P = 0.02;r = 0.40), medial quadriceps-hamstrings (P = 0.02;r = 0.38), medial quadriceps-gastrocnemius (P = 0.00;r = 0.56), and all limb dynamics (P = 0.00–0.01;d = 1.13–1.18;r = 0.35–0.47) were significant during regular gait speeds. Extension excursion (P = 0.02;d = 0.63), adduction moment (P = 0.01;d = 0.85) and medial-quadriceps (P = 0.01;r = 0.38) were significant during fast trials. InterpretationMany gait strategies during regular speeds that differ per walking difficulty and knee osteoarthritis attenuated at fast speeds. Perhaps gait training at fast speeds for those with knee osteoarthritis related walking difficulty is biomechanically and functionally beneficial.

Computerised dynamic posturography in women with knee osteoarthritis

The aim of this study was to compare the postural control of women with knee OA and healthy women peers and to determine the effect of knee OA on postural control. Thirty-two individuals, sixteen women with knee osteoarthritis(52.12±10.69)and sixteen healthy women(51.00±10.00)who were same age (±3yr), were evaluated on postural control as measured by a NeuroCom EquiTest. Outcomes included equilibrium scores, sensory analysis ratios, sway energy score, and latenciesfrom sensory organisationtest, motor control test, and adaptation testandwere examined using the independent t-test.Equilibrium scores (in condition 1: p=0.030, condition 3: p=0.019, condition 4: p=0.045, condition 5: p=0.010, condition 6: p=0.041, and Composite value: p=0.011), strategy score (Strategy 5: p= 0.015), sensory analysis ratios (vestibularratio: p=0.013 and managementratio: p=0.023), and latencies (largeforward: p=0.020 and comprehensivelatency: p=0.016) were significantly better in the healthy women group. The presence of knee OA had an impact on the sensory system's effectiveness and its utilization in postural control. Lower values of equilibrium scores, strategy scores, sensory analysis ratios for women knee OA group were evidence of larger displacements of the center of gravity in the forward–backward direction suggesting that women knee OA group was unable to maintain balance compared to healthy knee controls. Also, women with knee OA displayed a longer neuromuscular response latency to balance perturbations, indicating a reduced ability to begin in recover balance quickly following an unexpected disturbance. This observation should be taken into account in the fall prevention, especially, individuals should place in dynamic situations with conflicted sensory environment, as these are found in daily life.

Association Between the Morphology of Proximal Tibiofibular Joint and the Presence of Knee OA.

Objective: The aim of this study was to evaluate the association between the morphology of the proximal tibiofibular joint (PTFJ) and the presence of knee osteoarthritis (OA).Methods: Twenty-eight OA subjects and 30 healthy subjects were enrolled in this study. A 3D model of the lower limb of each subject was constructed from CT scans and used to measure the characteristics of the PTFJ, including the shape of the articular facets, articular surface area, joint inclination, relative articular height, and joint declination. The association between the characteristics of the PTFJ and presence of knee OA was assessed using binomial logistic regression analysis.Results: There was a significant difference between the OA and healthy groups in terms of the inclination (p = 0.028) and declination (p = 0.020) of the PTFJ and relative articular height (p = 0.011). A greater inclination angle (OR: 1.463, 95% CI: 1.124–1.582, p = 0.021), greater declination angle (OR: 1.832, 95% CI: 1.691–2.187, p = 0.009), and lower relative articular height (OR: 0.951, 95% CI: 0.826–0.992, p = 0.008) were found to be associated with an increased likelihood of knee OA being present.Conclusion: The results of this study suggest that abnormal PTFJ morphology is associated with the presence of knee OA.

Patient-Centered Outcomes of Microfragmented Adipose Tissue Treatments of Knee Osteoarthritis: An Observational, Intention-to-Treat Study at Twelve Months.

Introduction Microfragmented adipose tissue (MFAT) has been shown to benefit osteoarthritic patients by reducing pain and supporting tissue regeneration through a mesenchymal stem cell (MSC)-related paracrine mechanism. This observational study of 110 knees assessed patient-centered outcomes of pain, functionality, and quality of life, analyzing their variation at twelve months following one ultrasound-guided intra-articular injection of autologous MFAT for the treatment of knee osteoarthritis (KOA). Method Inclusion criteria were as follows: VAS >50, and the presence of KOA as diagnosed on X-ray and MRI. Exclusion criteria included the following: recent injury (<3 months) of the symptomatic knee, intra-articular steroid injections performed within the last three months, and hyaluronic acid injections prior to this treatment. Changes in VAS, OKS, and EQ-5D were scored at baseline and twelve months following a single intra-articular injection of autologous MFAT. Score variation was analyzed utilizing a nonparametric paired samples Wilcoxon test. The statistical analysis is reproducible with Open Access statistical software R (version 4.0.0 or higher). The study was carried out with full patient consent, in a private practice setting. Results Median VAS (pain) improved from 70 (IQR 20) to 30 (IQR 58) (p < 0.001); median OKS (function) improved from 25 (IQR 11) to 33.5 (IQR 16) (p < 0.001); and median EQ-5D (quality of life) improved from 0.62 (IQR 0.41) to 0.69 (IQR 0.28) (p < 0.001). No adverse events were reported during the intraoperative, recovery, or postoperative periods. Conclusions For patients with all grades of knee osteoarthritis who were treated with intra-articular injections of MFAT, statistically significant improvements in pain, function, and quality of life were reported. Although further research is warranted, the results are encouraging and suggest a positive role for intra-articular injection of MFAT as a treatment for knee osteoarthritis.

O05 How does radiographic knee OA impact musculoskeletal aging in midlife? Findings from the Hertfordshire Cohort study

Abstract Background With an aging population, the burden of musculoskeletal aging in joints, bones and muscles carries with it significant morbidity. Osteoarthritis (OA) is the most common joint condition, and can be defined clinically or radiologically. Musculoskeletal aging in bone and muscle can be assessed through change in body composition, grip strength and physical performance. The aim of this study was to investigate whether a diagnosis of radiological knee OA impacted involution in muscle or bone in the midlife in a group of community-dwelling older adults in the UK. Methods Our study comprised 220 members of the Hertfordshire Cohort Study (118 males and 102 females), a group of community dwelling older adults in the United Kingdom. Knee radiographs were performed at baseline (1999-2003), with osteoarthritis defined as a Kellgren and Lawrence score ≥2. At baseline and follow-up (2017) questionnaires assessed physical activity and lifestyle factors; JAMAR dynamometry was performed to assess grip strength; 8 foot walk test was performed to assess gait speed and DXA was performed to assess bone mineral density at the hips and body composition. Linear regression was performed to analyse associations in males and females, before and after adjustment for follow-up time, lifestyle factors (including smoking, alcohol consumption, social class, calcium intake and physical activity), anthropometric measures (BMI) and HRT use and age at menopause in women. The development of hand osteoarthritis was adjusted for grip strength outcomes. Results The mean age of participants at baseline was 65.0 years. Median follow-up was 16.7 years (range 15.0-18.4 years). Knee osteoarthritis was present in 75 (34%) participants. Radiographic knee osteoarthritis status at baseline was significantly associated with grip strength (β=-3.2kg, -5.3 to -1.1, p &amp;lt; 0.01) at follow-up in females but not in males (β=-2.9, -5.8 to 0.1, p = 0.06). No significant associations between radiographic osteoarthritis status at baseline and other measures of sarcopenia (gait speed or lean mass) or bone mineral density were found in either sex. Conclusion Our findings demonstrate that the presence of knee osteoarthritis in midlife can have a substantial bearing on grip strength in women over 15 years later independent of the presence of hand osteoarthritis. Grip strength has been shown to correlate closely with lower limb strength and so the demonstrated association between grip strength and knee osteoarthritis is representative of a global weakness resulting from the disease. Reduction in grip strength has been associated with an increased risk of morbidity including falls and fractures. Thus, in order to countermand this association, it may be that concerted interventions (including physical therapy, strengthening and surgical intervention) should be recommended for those with knee osteoarthritis at this stage in the lifecourse. Of course, these findings require replication and validation in other cohorts. Disclosures N.R. Fuggle None. M. Clynes None. F. Laskou None. K. Jameson None. C. Cooper None. E. Dennison None.

Evaluation of vastus lateralis architecture and strength of knee extensors in middle-aged and older individuals with knee osteoarthritis.

To investigate any differences in muscle architecture (fascicle angle, fascicle length, and muscle thickness) and muscle strength in people of different ages with and without knee osteoarthritis (OA). This is a cross-sectional study conducted with 40 individuals with and 40 without knee OA. Four groups were analyzed, middle-aged OA group (KL II/III) aged 40-50years (n = 20), middle-aged healthy (H) group aged 40-50years (n = 20), older OA group (KL II/III) aged 70years and over (n = 20), and older H group, aged 70years and over (n = 20). Outcomes analyzed were isometric and isokinetic peak torque of knee extensors, level of physical activity, self-reported pain level, and vastus lateralis fascicle length, fascicle angle, and muscle thickness assessed by ultrasound. One-way ANOVA was used to identify differences between groups, followed by the Tukey post hoc test. There were no differences between the middle-aged OA group and older H group for any variables. The older OA group presented the smallest muscle architecture parameters and worst isometric and concentric peak torques compared to the other three groups (p < 0.001). In contrast, the middle-aged H group presented the largest muscle architecture parameters and was the strongest group compared to the others (p < 0.001). The presence of knee OA is associated with early muscular changes and seems to intensify these thigh changes that are similar to the effects of the aging process.

Cause and Effect Relationship of Body Weight and Knee Osteoarthritis: Experience from a Tertiary Institution in South-Eastern Nigeria

It is well established that obesity is related to osteoarthritis of the knees. The aim of this study was to investigate the risk of knee osteoarthritis in relation to body mass index (BMI) and specifically, to assess the risk of knee osteoarthritis (OA) attributable to obesity. We also aimed to determine if there is a higher risk with an increase in BMI. This is an observational case-referent study of patients with knee pain. Patients were recruited from the orthopaedics clinic. The cases were patients that presented with radiologically diagnosed knee osteoarthritis, while the referents were other patients that also attended the orthopedic clinic at the same time. The referents were randomly selected. Body Mass Index was calculated and classified based on the WHO international classification. Data were analyzed using SPSS version 21. A total of 152 patients were included in the study and 67.1% were females while 32.9% were males giving a ratio of 2:1. The mean age was 57.72+/-12.5 years, the mean weight was 79.47+/- 13.41kg (95% CI 77.32 – 81.62) and the mean BMI was 27.80+/-6.2kg/m2. 56.6% had knee osteoarthritis. 8.6% (n = 13) were bilateral, 18.4% (n = 28) in the left knee and 29.6% (n = 45) in the right knee. The relationship between obesity and the presence of knee osteoarthritis was statistically significant (p 0.047). A Chi-squared test for trend also did not show an increased risk for knee osteoarthritis with increasing BMI (p 0.105). In conclusion, knee osteoarthritis is a degenerative joint disease that mostly affects the elderly. Our findings give strong support to the already existing knowledge of the positive relationship between obesity and knee osteoarthritis; however, increasing BMI did not increase the risk of knee OA.

One Hour a Week: Moving to Prevent Disability in Adults With Lower Extremity Joint Symptoms

Physical activity guidelines recommend minimum thresholds. This study sought to identify evidence-based thresholds to maintain disability-free status over 4years among adults with lower extremity joint symptoms. Prospective multisite Osteoarthritis Initiative accelerometer monitoring cohort data from September 2008 through December 2014 were analyzed. Adults (n=1,564) aged ≥49years at elevated disability risk because of lower extremity joint symptoms were analyzed for biennial assessments of disability-free status from gait speed ≥1meter/second (mobility disability-free) and self-report of no limitations in activities of daily living (activities of daily living disability-free). Classification tree analyses conducted in 2017-2018 identified optimal thresholds across candidate activity intensities (sedentary, light, moderate-vigorous, total light and moderate-vigorous activity, and moderate-vigorous accrued in bouts lasting ≥10 minutes). Minimal thresholds of 56 and 55 moderate-vigorous minutes/week best predicted disability-free status over 4years from mobility and activities of daily living disabilities, respectively, across the candidate measures. Thresholds were consistent across sex, BMI, age, and knee osteoarthritis presence. Mobility disability onset was one eighth as frequent (3% vs 24%, RR=0.14, 95% CI=0.09, 0.20) and activities of daily living disability onset was almost half (12% vs 23%, RR=0.55, 95% CI=0.44, 0.70) among people above versus below the minimum threshold. Attaining an evidence-based threshold of approximately 1-hour moderate-vigorous activity/week significantly increased the likelihood of maintaining disability-free status over 4years. This minimum threshold tied to maintaining independent living abilities has value as an intermediate goal to motivate adults to take action towards the many health benefits of a physically active lifestyle.

What are the perceptions about running and knee joint health among the public and healthcare practitioners in Canada?

ObjectivesTo evaluate the perceptions of the general public and healthcare practitioners (HCP) in Canada about the relationship between running and knee joint health, and to explore HCP`s usual recommendations to runners with knee osteoarthritis (KOA).MethodsNon-runners and runners (with and without KOA) and HCP completed an online survey regarding the safety of running for knee joint health. HCP also provided information related to usual clinical recommendations. Proportions of agreement were compared between non-runners and runners.ResultsA total of 114 non-runners, 388 runners and 329 HCP completed the survey. Overall, running was perceived as detrimental for the knee joint by 13.1% of the general public, while 25.9% were uncertain. More uncertainty was reported regarding frequent (33.9%) and long-distance (43.6%) running. Statistical analyses revealed greater proportions of non-runners perceiving running negatively compared with runners. Overall, 48.4% believed that running in the presence of KOA would lead to disease progression, while 53.1% believed running would lead to premature arthroplasty. In HCP, 8.2%, 9.1% and 22.2% perceived that running in general, running frequently, or running long-distances are risk factors for KOA, respectively. 37.1% and 2.7% of HCP typically recommended patients with KOA to modify their running training or to quit running, respectively.ConclusionHigh rates of uncertainty among the general public and HCP in Canada outline the need for further studies about running and knee joint health. Filling knowledge gaps will help inform knowledge translation strategies to better orientate the general public and HCP about the safety of running for knee joint health.

Consumption of dairy products in relation to the presence of clinical knee osteoarthritis: The Maastricht Study

PurposeObservational studies showed inverse associations between milk consumption and knee osteoarthritis (knee OA). There is lack of information on the role of specific dairy product categories. We explored the association between dairy consumption and the presence of knee osteoarthritis in 3010 individuals aged 40–75 years participating in The Maastricht Study.MethodsThe presence of knee OA was defined according to a slightly modified version of the American College of Rheumatology (ACR) clinical classification criteria. Data on dairy consumption were appraised by a 253-item FFQ covering 47 dairy products with categorization on fat content, fermentation or dairy type. Multivariable logistic regression analyses were performed to estimate odd ratios (ORs) and 95% confidence intervals (95%CI), while correcting for relevant factors.Results427 (14%) participants were classified as having knee OA. Significant inverse associations were observed between the presence of knee OA and intake of full-fat dairy and Dutch, primarily semi-hard, cheese, with OR for the highest compared to the lowest tertile of intake of 0.68 (95%CI 0.50–0.92) for full-fat dairy, and 0.75 (95%CI 0.56–0.99) for Dutch cheese. No significant associations were found for other dairy product categories.ConclusionIn this Dutch population, higher intake of full-fat dairy and Dutch cheese, but not milk, was cross-sectionally associated with the lower presence of knee OA. Prospective studies need to assess the relationship between dairy consumption, and in particular semi-hard cheeses, with incident knee OA.

Does Anterior Cruciate Ligament Reconstruction Improve Functional and Radiographic Outcomes Over Nonoperative Management 5 Years After Injury?

Background: Current practice patterns for the management of anterior cruciate ligament (ACL) injury favor surgical reconstruction. However, long-term outcomes may not differ between patients completing operative and nonoperative treatment of ACL injury. Differences in outcomes between operative and nonoperative treatment of patients in the United States is largely unknown, as are outcomes in long-term strength and performance measures. Purpose: To determine if differences exist in 5-year functional and radiographic outcomes between patients completing operative and nonoperative treatment of ACL injury when both groups complete a progressive criterion-based rehabilitation protocol. Study Design: Cohort study; Level of evidence, 2. Methods: From an original group of 144 athletes, 105 participants (mean ± SD age, 34.3 ± 11.4 years) with an acute ACL rupture completed functional testing (quadriceps strength, single-legged hop, and knee joint effusion testing; patient-reported outcomes) and knee radiographs 5 years after ACL reconstruction or completion of nonoperative rehabilitation. Results: At 5 years, patients treated with ACL reconstruction versus rehabilitation alone did not differ in quadriceps strength (P = .817); performance on single-legged hop tests (P = .234-.955); activity level (P = .349-.400); subjective reports of pain, symptoms, activities of daily living, and knee-related quality of life (P = .090-.941); or presence of knee osteoarthritis (P = .102-.978). When compared with patients treated nonoperatively, patients treated operatively did report greater global ratings of knee function (P = .001), and lower fear (P = .035) at 5 years but were more likely to possess knee joint effusion (P = .016). Conclusion: The current findings indicate that favorable outcomes can occur after both operative and nonoperative management approaches with the use of progressive criterion-based rehabilitation. Further study is needed to determine clinical algorithms for identifying the best candidates for surgical versus nonoperative care after ACL injury. These findings provide an opportunity to improve the educational process between patients and clinicians regarding the expected clinical course and long-term outcomes of operative and nonoperative treatment of ACL injuries.

Arthroscopic Partial Meniscectomy for Painful Degenerative Meniscal Tears in the Presence of Knee Osteoarthritis in Patients Older than 50 Years of Age: Predictors of an Early (1 to 5 Years) Total Knee Replacement.

The role of arthroscopic partial meniscectomy (APM) for painful degenerative meniscal tears (PDMT) is currently controversial.To define the rate of early (1 to 5 years) conversion to total knee replacement (TKR) and their predictors after APM for PDMT in patients with knee osteoarthritis and more than 50 years of age. Retrospective cohort study of patients more than 50 years of age with the diagnosis of PDMT, treated by means of APM. Patients were classified in two groups: Patients that required an early (between 1 and 5 years after APM) TKR (TKR group) after its failure and patients that did not require a TKR (non-TKR group). Patient demographics, general characteristics, Kellgren & Lawrence (KL) classification, Outerbridge classification, and other characteristics were analyzed. Postoperative variables were also analyzed: pain, use of walking aids and use of intra-articular injections (hyaluronic acid or corticosteroids) at 3, 6, and 12 months of follow-up. A total of 356 patients (356 APMs) were included. Forty-nine patients (13.7%) required an early (1.8 years on average) TKR and 307 did not. The main predictor of early TKR was the grade of the KL classification. After APM, the presence of pain and the need of walking aids also were predictors of an early TKR. In patients older than 50 years with PDMT, APM should be cautiously indicated in case of KL grade of 1 or more. Postoperative pain and prolonged need of walking aids were also predictors of an early (mean 1.8 years) TKR.

Chinese Ethnicity Is Associated With Concomitant Cartilage Injuries in Anterior Cruciate Ligament Tears.

Background:Chinese ethnicity is associated with the presence of knee osteoarthritis. This raises the possibility that it may similarly be associated with concomitant meniscus and cartilage injuries in patients with anterior cruciate ligament (ACL) tears. There are currently no published data on the effect of Chinese ethnicity in this regard.Purpose:The primary aim was to determine whether Chinese ethnicity is associated with concomitant intra-articular injuries in patients with ACL tears and to verify the correlation of age, sex, body mass index, mechanism of injury, cause of injury, and presence of bone contusions on magnetic resonance imaging with such injuries. A secondary purpose was to determine the optimal time frame for surgical reconstruction in patients with identified risk factors for concomitant injuries.Study Design:Cohort study; Level of evidence, 3.Methods:The medical records of 696 patients from a multiethnic population who underwent ACL reconstruction from January 2013 to August 2016 were retrospectively analyzed. Univariate and multivariate logistic regression analyses were performed to identify patient factors that were associated with medial meniscus tears, lateral meniscus tears, and cartilage injuries. Further univariate analysis was conducted to determine the earliest time point for surgery, after which the rate of concomitant injuries was significantly higher.Results:Over half (69.1%, n = 481) of our study population sustained at least 1 other concomitant knee injury. Meniscus tears were most frequently associated with ACL tears (24.1% medial, 25.6% lateral, and 15.5% medial and lateral meniscus tears). Cartilage injuries were present in 18.4% of our cohort. Chinese ethnicity was associated with concomitant cartilage injuries. Increased age (≥30 years) was significantly associated with cartilage injuries and male sex with medial and lateral meniscus tears. Among patients with these factors, significantly fewer medial meniscus tears and cartilage injuries were noted when surgery was carried out within 12 months of the index trauma.Conclusion:This is one of the first studies to have identified an association between Chinese ethnicity and concomitant cartilage injuries in ACL tears. This study also found an association between increased age and an increased prevalence of cartilage injuries. Male sex was associated with both medial and lateral meniscus tears. Definitive surgery should be performed within 12 months of the index injury to minimize further intra-articular injuries.

Knee Osteoarthritis and Risk of Hypertension: A Longitudinal Cohort Study.

Although previous research has indicated an association between osteoarthritis (OA) and cardiovascular disease, it remains unclear whether people with OA are at greater risk of developing hypertension. The aim of this study was to answer this uncertainity. We used the data of the Osteoarthritis Initiative, an ongoing public and private longitudinal study including people at higher risk of OA or having knee OA. Knee OA was defined through radiological and clinical assessment. Incident hypertension was defined as a systolic blood pressure ≥140 mmHg and/or a diastolic value ≥90 mmHg. Multivariate Cox's regression analyses were constructed considering the presence of knee OA as the exposure and incident hypertension as the outcome during a 96-month follow-up interval. A total of 3558 people with normative blood pressure values at baseline were analyzed (1930 OA/1628 controls). Incidence of hypertension within the follow-up interval was significantly higher in people with knee OA than in those without (60/[1000 person-years] vs. 55/[1000 person-years]; p < 0.0001). After adjusting for 13 confounders, people with knee OA had a 13% higher chance of developing hypertension (hazard ratio = 1.13; 95% confidence interval: 1.01-1.26; p = 0.03). Propensity score analysis did not alter these conclusions. In conclusion, this is the first longitudinal data analysis to demonstrate that people with knee OA have a higher chance of developing hypertension than those without OA. Our data suggest that monitoring blood pressure and prescribing health promotion interventions may be warranted among people with OA to mitigate the potential onset and adverse consequences of hypertension.