Knee-related Quality Research Articles

Association of Quality of Life With Moderate-to-Vigorous Physical Activity After Anterior Cruciate Ligament Reconstruction.

Better knee function is linked to psychological readiness to return to sport after anterior cruciate ligament reconstruction (ACLR). Individuals with ACLR participate in less physical activity than matched uninjured control individuals, yet the association between knee function and physical activity post-ACLR remains unclear. To determine the associations between (1) patient-reported knee function measured using the Knee Injury and Osteoarthritis Outcome Score Knee-Related Quality of Life (KOOS-QOL), daily steps, and minutes spent in moderate-to-vigorous physical activity (MVPA) of individuals with ACLR and (2) KOOS-QOL and daily steps and MVPA in individuals with ACLR who presented with (ie, symptomatic) or without (ie, asymptomatic) clinically meaningful knee-related symptoms. Cross-sectional study. Laboratory, free-living conditions. A total of 66 individuals with primary unilateral ACLR (36 women, 30 men; age = 22 ± 4 years, height = 1.71 ± 0.1 m, mass = 71.3 ± 12.6 kg, body mass index = 24.2 ± 2.9, time post-ACLR = 28 ± 33 months). We collected KOOS data and retrospectively stratified participants into those with (symptomatic group, n = 30) or without (asymptomatic group, n = 36) clinically meaningful knee-related symptoms based on previously defined KOOS cutoffs. We assessed daily steps and MVPA using accelerometers that participants wore on the right hip for 7 days. We conducted linear regressions to determine associations between KOOS-QOL and daily steps and MVPA. In the entire sample, no associations existed between KOOS-QOL and daily steps (ΔR2 = 0.01, P = .50) or MVPA (ΔR2 = 0.01, P = .36). In the symptomatic group, a greater KOOS-QOL was associated with more time in MVPA (ΔR2 = 0.12, P = .05). In the asymptomatic group, no associations were identified between the KOOS-QOL and daily steps and MVPA. Individuals with symptoms post-ACLR who spent more time in MVPA reported higher QOL.

Associations between early postoperative pain outcome measures and late functional outcomes in patients after knee arthroplasty.

Introduction/AimEarly rehabilitation, return to daily life activities and function are the ultimate goals of perioperative care. It is unclear which pain-related patient-reported outcome measures (PROM) mirror treatment effects or are related with early and late functional outcomes.MethodsWe examined associations between two approaches of pain management (scheduled vs ‘on demand’) and PROMs on post-operative days one and five (POD1, 5) with function on POD5 and 3 months after surgery in patients undergoing Total Knee Arthroplasty (TKA) in a single centre. The scheduled pain management consisted of pain assessment and routine administration of non-opioid drugs, and a weak opioid based on severity of pain reported by patients. The ‘on demand’ group received non-opioids and/or a weak opioid only when asking ‘on demand’ for analgesics.ResultsOn POD1, patients in the scheduled treatment group reported reduced severity of worst pain, less interference of pain with activities in-bed and sleep, and a higher proportion got out of bed. On POD5, these patients reported as well significantly less worst pain, spent significantly less time in severe pain, experienced less interference of pain with activities in bed, and felt less helpless. Furthermore, tests of function, extension and flexion ranges, Barthel index and 6 minutes walking test on POD5, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) 3 months later were significantly better in the scheduled treatment group compared to the ‘on demand’ treatment group. Pain related PROMs assessed at POD1 and especially at POD5 are associated with better knee range of motion, better performance in activities of daily living, and faster gait speed, as well as less pain, better performance in activities of daily living, as well as higher knee-related quality of life 3 months postoperatively.ConclusionsOur study demonstrates that severe postoperative pain after TKA might have long lasting consequences, and even small improvements in treatment, although being far from optimal, are accompanied by improved outcomes.

Superior Improvements in Knee Pain and Function with a Novel Synthetic Medial Meniscus Replacement Implant Compared to Non-surgical Care in Subjects with Knee Pain Following Partial Meniscectomy: Two-year Results from Two Prospective US Clinical Trials

Objectives:Arthroscopic partial meniscectomy (APM) is the most common surgical treatment for symptomatic, irreparable meniscal tears that do not improve with non-surgical care. For many patients, APM is associated with improvements in knee pain and function, but a subset of patients reports persistent or recurrent knee pain 1-2 years after APM surgery. Current treatment options for post-APM knee pain are limited, especially for patients considered too young for knee replacement. The polymeric medial meniscus implant mimics the biomechanical function of the natural medial meniscus and is intended to provide relief from pain and improved function in subjects with knee pain following APM. Two FDA-regulated clinical trials were conducted in the United States and pooled for analysis, to assess superiority of a synthetic medial meniscus implant to non-surgical care in treating persistent or recurrent knee pain following previous partial meniscectomy. The hypothesis was that the meniscus implant is superior to non-surgical care for improvements in composite measures of knee-related pain, function, and quality of life at 2 years of follow-up.Methods:242 patients (176 investigational, 66 control) were treated in 2 prospective, concurrent clinical trials in the U.S.: a randomized controlled superiority trial (RCT) comparing the medial meniscus implant to non-surgical care (control) and a single-arm, implant-only trial. Eligible subjects had persistent knee pain and one or more previous partial meniscectomies at least 6 months before trial entry. Treated subjects returned for follow-up visits at 1.5 months, 6 months, 1 year, and 2 years. Patient-reported knee pain, function, and quality of life were assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS). The primary patient-reported outcomes were 2 KOOS subscales: KOOS Pain and KOOS Overall. KOOS success was defined as subjects who achieved either (1) KOOS Pain ≥86.1 at 2 years and KOOS Overall ≥86.2 at 2 years or (2) a ≥20-point improvement from baseline to 2 years in KOOS Pain and KOOS Overall, with KOOS Pain ≥40 at 2 years. Treatment cessation was defined as any subject who discontinued the per-protocol treatment by permanent implant removal (implant group) or any surgical procedure on the index knee (control group). Implant subjects who underwent subsequent surgical procedures on index knees (e.g. implant exchange) remained in the trial. The two treatment groups were well-matched, except for baseline KOOS Sports and Recreation. Statistical analyses adjusted for high vs low baseline KOOS Sports and Recreation using 2-factor analysis of variance (ANOVA) for continuous variables and 2x2 logistic regression for dichotomous variables.Results:Sixteen subjects (6.6%; 14 control, 2 implant) were lost to follow-up or withdrew from the study over 2 years. The magnitude of improvement from baseline to 2 years was significantly greater in the implant group compared to control for 5 of 6 KOOS subscales (Figure 1), including the primary outcomes of KOOS Overall and KOOS Pain (Figure 1A,B). The proportion of subjects who achieved KOOS success was significantly higher in the implant group (63.4%) than the control group (27.9%), which remained true with or without the adjustment for baseline KOOS Sports and Recreation (P<.0001 in each case). Treatment cessation through 2 years was less frequent in the implant group (10.5%) compared to the control group (17.3%), but the difference was not statistically significant (P=.19).Conclusions:Two-year results from 2 prospective, concurrent, US clinical trials demonstrate that the synthetic meniscus implant provides superior relief from post-APM knee pain when compared to treatment with non-surgical care alone. In addition, the magnitude of change from baseline to 2 years in the primary patient-reported outcomes and the rate of KOOS success significantly favored the implant group compared to the control group. Subjects in the implant group tended to discontinue treatment at a lower rate compared to subjects in the control group, but the difference was not statistically significant. Subjects treated with the implant who underwent a device exchange or repositioning procedure were able to continue treatment therapy with the medial meniscus implant. Overall, the implant group experienced superior improvements and outcomes at 2 years compared to subjects receiving non-surgical care alone.

All-inside reconstruction of anterior cruciate ligament with single-bundle autogenous peroneal longus tendon

Objectives:To evaluate the curative effect of all-inside reconstruction of anterior cruciate ligament with single-bundle autogenous peroneal longus tendon.Methods:A total of 21 people who met the including criteria were enrolled into this study. The autogenous peroneal longus tendon were got to all-inside anterior cruciate ligament reconstruction. The complications were documented, while the clinical consequences was evaluated by Lachman test, KOOS, SF - 36 and AOFAS.Results:There were no serious complications after operation. Lachman test showed that the stability of knee joint after operation was significantly improved (P < 0.05). The KOOS score significantly improved at 12 months postoperatively, including pain, symptoms, activity of daily living, sport and recreation function and knee related quality of life, compared with those before operation (P<0.05). In addition, the SF-36 score also significantly improved at 12 months postoperatively compared with those preoperatively, with statistically significant differences in physical functioning, physical role functioning, bodily pain, general health perceptions, emotional role functioning and social role functioning (P<0.05), whereas no statistically significant differences in vitality and mental health (P>0.05).Conclusion:The all-inside reconstruction of anterior cruciate ligament with single-bundle peroneal longus tendon can effectively restore the stability of knee joint, reduce postoperative pain, improve the function of knee joint, and provide high satisfaction.

Functional results of total-knee arthroplasty versus medial unicompartmental arthroplasty: two-year results of a randomised, assessor-blinded multicentre trial

ObjectiveThe primary objective of the trial was to assess the clinical effectiveness of medial unicompartmental knee arthroplasty versus total knee arthroplasty in patients with isolated medial osteoarthritis of the knee.DesignProspective,...

Ten-Year Results of the Triathlon Knee Replacement: A Cohort Study.

IntroductionStudies evaluating the outcomes of different brands of knee prostheses are important to monitor patient outcomes and generate evidence to aid decisions around the choice of implant. The Triathlon® prosthesis (Stryker, Limerick, Ireland), one of the most commonly used total condylar knee prosthesis, is designed to provide greater knee motion and the potential for longer implant survivorship. The aim of this cohort study was to evaluate outcomes and survivorship of the Triathlon total knee replacement (TKR) up to 10 years post-operative.MethodsTwo-hundred sixty-six (266) patients listed for a Triathlon TKR in one orthopaedic hospital were recruited. Assessments were conducted preoperatively and then at three months and one, two, three, five, seven, and 10 years after surgery. Outcomes assessed included pain, function, knee-related quality of life (QoL), satisfaction, kneeling ability, activity levels, American Knee Society Score, complications, and survivorship.ResultsLarge improvements in patient-reported outcomes were observed in the first three months after surgery, followed by small improvement up to one year post-operative, and then outcomes plateaued up to 10 years post-operative. Satisfaction with overall outcome ranged from 79%-94% over the duration of follow-up. Activity levels and kneeling ability were similar before and after surgery. There was a large improvement in the median American Knee Society score in the first three months post-operative, followed by a small but gradual improvement to 10 years post-operative. Survivorship was 95.4% (95% confidence interval 91.8-97.5%) at 10 years post-operative.ConclusionsThis study found that the Triathlon TKR results in excellent outcomes and survivorship to 10 years post-operative.

Efficacy of UC‐II® undenatured type II collagen on knee joint function in healthy subjects: an exploratory post hoc analyses of a randomized double blind, placebo ‐ controlled trial

Background UC-II® brand collagen is a unique joint health ingredient derived from chicken sternum. In a previous study, UC-II® collagen was shown to improve knee joint function in healthy subjects (≥30 to ≤65 y) as demonstrated by greater knee extension range of motion. The same study showed that subjects consuming UC-II® collagen were able to exercise longer than pre-supplementation values. Objective The purpose of the current exploratory analyses was to assess the select items from the Knee Injury and Osteoarthritis Outcome Score (KOOS) in healthy subjects who previously participated in a 120-day randomized controlled trial and were aged greater or equal than 50 years. Methods A total of 18 subjects met the analyses criteria (age ≥50 years). These healthy subjects reported knee pain after participating in a standardized stepmill test and were randomized to receive placebo (n = 8) or the UC-II® (40 mg daily, n = 10) product for 120 days. KOOS survey results were collected at different time points during the study. The KOOS survey is a validated instrument consisting of multiple questions that are classified into sub-scales such as pain, other symptoms, function in daily living, function in sport and recreation, and knee related quality of life. It measures the subjects’ opinion about their knees and their ability to perform daily activities during the past week. The KOOS survey is useful for assessing changes in knee pathology over time, with or without treatment. Statistical software SAS release 8.2 (SAS Institute Inc., Cary, NC) was used for the analyses. The intent-to-treat analysis was conducted between the treatment and within groups. P-values ≤0.05 were considered statistically significant. Results After 120 days of supplementation, subjects in the UC-II® group exhibited a statistically significant improvement versus the placebo in KOOS items which include reduced pain during standing upright and going up or down stairs, decreased discomfort in climbing ascending stairs or bending to floor to pick an object or squatting during period of high physical activity (p<0.05). Conclusion Results of this post hoc analysis suggest that UC-II® collagen supplementation has the potential to improve knee joint function, mobility, flexibility, free movements and performance of daily activities in ≥ 50 year old healthy subjects.

Clinical Risk Profile for a Second Anterior Cruciate Ligament Injury in Female Soccer Players After Anterior Cruciate Ligament Reconstruction

Background: The risk of a second anterior cruciate ligament (ACL) injury when participating in pivoting sports after ACL reconstruction is high. Risk factors associated with a second ACL injury are complex. Purpose: To investigate the combinations of various clinical risk factors associated with second ACL injury in female soccer players with a primary unilateral ACL reconstruction, using Classification and Regression Tree (CART) analysis. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 117 active female soccer players (mean ± SD age, 20 ± 2 years) were included. Athletes were enrolled 19 ± 9 months after ACL reconstruction and were prospectively followed for 2 years. At baseline, all players underwent assessment of knee and ankle joint range of motion (ROM), participated in functional tests (postural control, hop performance, and movement asymmetries in the lower limbs and trunk), and answered questionnaires (patient-reported knee function, knee-related quality of life, psychological and personality factors). A clinical prediction model using CART was developed. Results: A total of 28 players (24%) sustained a second ACL injury (21 ipsilateral and 7 contralateral ruptures) while playing soccer. CART analysis selected 9 of 19 independent variables associated with second ACL injury: the 5-jump test, knee collapse on the non–ACL reconstructed leg in a drop vertical jump, tuck jump, limb symmetry index on side hop and the single hop for distance, side difference in ankle dorsiflexion ROM, and scores for the questionnaires ACL-Return to Sport After Injury and the Swedish Universities Scales of Personality subscales of Stress Susceptibility and Adventure Seeking. The accuracy of the model was 89%, with 100% sensitivity and 76% specificity. CART analysis indicated that the interaction of longer jumps in the 5-jump test (>916 cm) with more side difference in ankle dorsiflexion ROM (>–2.5°) and more knee valgus collapse in the nonreconstructed knee (>−1.4 cm) (relative risk, 4.03; 95% CI, 2.21-7.36) best predicted an increased likelihood of a second ACL injury. Conclusion: The risk profiles selected by CART could accurately identify female soccer players at high risk for a second ACL injury. There was an interaction between functional performance, clinical assessment, and psychological factors, and it is reasonable to include these factors in return-to-sport decisions and in athlete screening after ACL injury.

Association between received treatment elements and satisfaction with care for patients with knee osteoarthritis seen in general practice in Denmark

Objective While education, exercise, and weight reduction when indicated, are recommended first-line treatments for knee osteoarthritis patients, they remain poorly implemented in favour of pain killer treatment, imaging and referral to surgery. A reason could be that patients are more satisfied with receiving these adjunctive treatment elements. This study aimed to investigate the associations between the received elements of care and the patient’s satisfaction with the care for knee osteoarthritis in general practice. Design Cross-sectional study. Setting A Danish general practice. Subjects All consecutive patients ≥30 years of age who consulted the general practitioner (GP) with chronic knee complaints during 18 months and who replied to a mailed questionnaire (n = 136). Main outcome measures The questionnaire addressed patient’s knee-related quality of life, and overall satisfaction with care, as well as reception of seven types of information, which are known quality indicators. Information on reception of adjunctive treatment elements was obtained from electronic medical records. Results Patient satisfaction (versus neutrality/dissatisfaction) was positively associated with reception of information on: physical activity and exercise (relative risks [RR] 1.38, 95% bootstrap percentile interval [BPI] 1.02–4.33), and the relationship between weight and osteoarthritis (1.38, 1.01–4.41). No significant associations were found for the five remaining types of information and all the adjunctive treatment elements. Conclusion Providing information as education to patients with knee osteoarthritis as part of the treatment is positively associated with satisfaction with care. KEY POINTS General practitioners worry about the doctor–patient relationship when addressing recommended lifestyle changes. However, this study revealed: •Patients in general practice with knee osteoarthritis are satisfied with care after having received information on lifestyle changes, such as exercise and the relationship between weight and osteoarthritis. •Patient satisfaction was not associated with the reception of adjunctive treatment elements for osteoarthritis.

Changes in physical activity during a one-year weight loss trial with liraglutide in participants with knee osteoarthritis: secondary analyses of a randomised trial

Changes in physical activity during a one-year weight loss trial with liraglutide in participants with knee osteoarthritis: secondary analyses of a randomised trial

Responses to gait retraining using pressure-based auditory feedback for medial knee osteoarthritis

Responses to gait retraining using pressure-based auditory feedback for medial knee osteoarthritis

Patient Characteristics Independently Associated With Knee Osteoarthritis Symptom Severity at Initial Orthopedic Consultation.

The objective of this study was to identify patient and disease characteristics associated with the symptomatic severity of knee osteoarthritis (OA) at the time of initial knee OA diagnosis by an orthopedist. This medical records review included patients initially diagnosed with knee OA during 2016 to 2017 by a single orthopedic surgeon in a university-based tertiary care setting. All variables were assessed at first OA diagnosis. Main outcomes were subscales of the Knee Injury and Osteoarthritis Outcome Score-Pain, other Symptoms, knee-related quality of life, and function in daily living. Multivariable regression analyses examined the following predictors of main outcomes: sex, race, age, insurance type, body mass index, Charlson comorbidity index, and radiographic OA severity (Kellgren-Lawrence grade). Of the 559 patients included in the study, most were African American (52.1%), female (71.7%), and had severe radiographic OA (Kellgren-Lawrence grade, 4; 68.7%). Female sex, African American racial/ethnic group, Medicaid insurance, younger age, and severe radiographic OA were independently statistically significantly associated with worse symptoms, pain, and function (p < 0.05 for all). Body mass index and Charlson comorbidity index were not statistically significant predictors of any outcome. This study identified disparities in the perception of knee OA problems at initial orthopedist diagnosis based on sex, age, race, insurance, and radiographic OA severity. Because most of these variables are also associated with more rapid progression of OA, identifying their biopsychosocial underpinnings may help determine which interventions are most likely to redress these disparities and delay progression to end-stage knee OA.

Clinical and cost-effectiveness of bracing in symptomatic knee osteoarthritis management: protocol for a multicentre, primary care, randomised, parallel-group, superiority trial

BackgroundBrace effectiveness for knee osteoarthritis (OA) remains unclear and international guidelines offer conflicting recommendations. Our trial will determine the clinical and cost-effectiveness of adding knee bracing (matched to patients’ clinical...

Clinical outcome after knee ligament reconstruction with tendon allografts

PurposeThe purpose of this study is to investigate the clinical outcome for patients after knee ligament reconstructions with allografts at a university hospital.MethodsA total of 33 patients received allografts for reconstructive knee surgery between 2007 and 2017. The follow up evaluation consisted of a clinical knee examination including evaluation of range of motion (ROM), lateral and medial laxity, the Lachman test, the Pivot shift test, the sag test, the posterior drawer test and checking for patellofemoral pain. The following patient-reported outcome measures (PROMs) were used; the Lysholm Function Score, the Tegner activity score, and the Knee injury and Osteoarthritis Outcome Score (KOOS).ResultsTwenty-one (64%) patients were available for the follow-up evaluation and the mean follow-up time was 4.8 years. A total of 16 out of 21 patients had multiligament injuries of which the ACL was the ligament most frequently ruptured. At the time of follow-up, 14 out of 16 patients (87%) with ACL injury had Lachman test grade 0 or grade 1 + , and 12 out of 13 (92%) had a pivot shift grade 0 or 1 + . The mean Lysholm Score was 74. All mean KOOS subscale values were ≥ 59 at the follow-up. The preoperative Tegner activity score was 3 (range, 1–6) and 4 (range, 2–6) at follow up. There were no deep postoperative infections. A total of 19 out of 21 patients (90%) reported that they would have undergone surgery again had they known the clinical outcome in advance.ConclusionsThe patients improved from the preoperative score to the follow-up score in the knee-related Quality of Life (QoL) KOOS subscale. None of the patients were diagnosed with deep postoperative infections.

Exercise therapy and patient education versus intra-articular saline injections in the treatment of knee osteoarthritis: an evidence-based protocol for an open-label randomised controlled trial (the DISCO trial)

BackgroundKnee osteoarthritis (OA) is a highly prevalent musculoskeletal condition causing pain, physical disability, and reduced quality of life. Exercise and patient education are non-pharmacological interventions for knee OA unanimously recommended as first-line treatments based on extensive research evidence. However, none of the numerous randomised controlled trials of exercise and education for knee OA has used adequate sham/placebo comparison groups because the ‘active’ ingredients are unknown. Designing and executing an adequate and ‘blindable placebo’ version of an exercise and education intervention is impossible. Therefore, using an open-label study design, this trial compares the efficacy of a widely used ‘state-of-art’ exercise and education intervention (Good Life with osteoarthritis in Denmark; GLAD) with presumably inert intra-articular saline injections on improvement in knee pain in patients with knee OA.MethodsIn this open-label randomised trial, we will include 200 patients with radiographically verified OA of the knee and randomly allocate them to one of two interventions: (i) 8 weeks of exercise and education (GLAD) or (ii) Intra-articular injections of 5 ml isotonic saline every second week for a total of 4 injections. Outcomes are taken at baseline, after 8 weeks of treatment (week 9; primary endpoint) and after an additional 4 weeks of follow-up (week 12). The primary outcome is change from baseline in the Knee Injury and Osteoarthritis Outcome Score questionnaire (KOOS) pain subscale score. Secondary outcomes include the Physical function in Activities of Daily Living, Symptoms, and Knee-related Quality of Life subscales of the KOOS, the patients’ global assessment of disease impact, physical performance tests, and presence of knee joint swelling.DiscussionThis current trial compares a presumably active treatment (GLAD) with a presumably inert treatment (IA saline injections). Both study interventions have well-established and anticipated similar effects on knee OA symptoms, but the underlying mechanisms are unknown. The interpretation of the results of this trial will likely be difficult and controversial but will contribute to a better understanding of the bias introduced in the effect estimation of classically unblindable exercise and education interventions for knee OA.Trial registrationwww.ClinicalTrials.govNCT03843931. Prospectively registered on 18 February 2019.

Low knee-related quality of life and persistent physical asymmetries in participants up to 10 years post-ACL reconstruction – A cross-sectional study

ObjectiveTo compare self-report and functional outcomes between participants with anterior cruciate ligament reconstruction (ACLR) with age and activity matched controls. DesignCross-sectional study. SettingUniversity laboratory-based study. ParticipantsTwenty-five participants (30.8 ± 9.7 years; 13 women), two to ten years post anterior cruciate ligament reconstruction; 24 controls (31.0 ± 10 years, 13 women). Main outcome measuresKnee Osteoarthritis and Injury Outcome Score (KOOS), Tegner, Marx Activity and Fear of Re-injury scales, and SF-12; isokinetic quadriceps and hamstring peak torque and single-leg hop distance. ResultsThere were no between-groups differences for the Tegner and the Marx Activity Scales. The ACLR group had lower KOOS dimensions (p < 0.001), SF-12 Physical Component Scores (p = 0.008), and higher Fear of Reinjury Scores (<0.001) than the controls. No significant differences were found for physical performance measures between the ACLR and the control groups. Significant between-side differences for the ACLR group were evident for concentric quadriceps (p < 0.001) and concentric hamstring peak torque (p = 0.002), and hop distance (p < 0.001). ConclusionKnee-specific symptoms and function, activity and quality of life were lower, and fear of re-injury was higher for participants with ACLR than controls. Side-to-side thigh muscle strength and hop distance deficits were evident for the ACLR group.

High kinesiophobia and pain catastrophizing in people with articular cartilage defects in the knee and associations with knee function

PurposeThe purpose of this study was to evaluate the extent to which individuals with knee articular cartilage defects (ACDs) have kinesiophobia and pain catastrophizing, and how these psychological factors relate to self-reported knee outcomes. MethodsThirty-five individuals seeking surgical consultation for an ACD in the knee confirmed with 3.0T MRI and 18 controls without history of knee injury participated in the study. Kinesiophobia was measured with the Tampa Scale of Kinesiophobia (TSK), and scored using the modified 11-item (TSK-11) methods. Pain catastrophizing was measured with the Pain Catastrophizing Scale (PCS). Data were analyzed using descriptive statistics, independent t-tests, chi-squared tests and Spearman’s correlation coefficients, as appropriate (α = 0.05). ResultsParticipants with ACDs reported higher TSK-11 scores (median 27 [IQR 25–29]) and higher PCS scores (median 10 [IQR 4–18]) than controls (median TSK-11 16 [IQR 14–17], p < 0.001; median PCS 0 [IQR 0–9], p < 0.001). Within those with knee ACDs, higher TSK-11 scores were associated with worse knee pain, function on activities of daily living, sports/recreation, and knee-related quality of life scores (rho = −0.38 to −0.61). Higher pain catastrophizing was associated with worse function with activities of daily living and knee-related quality of life (rho = −0.37 to −0.40). ConclusionsKinesiophobia and pain catastrophizing in people with knee ACDs were higher than controls. Higher kinesiophobia and pain catastrophizing were associated with worse function and quality of life. Further study of the impact of these psychological factors on outcomes and prognosis in people with knee ACDs is warranted.

Clinical findings in patellofemoral osteoarthritis compared to individually-matched controls: a pilot study

ObjectiveTo explore clinical characteristics in individuals with patellofemoral osteoarthritis (PFOA) compared to individually-matched asymptomatic controls. We also explored associations between functional performance and patient-reported symptoms with patellofemoral alignment.MethodsWe assessed 15...

Symptomatic knee osteoarthritis is associated with worse but stable quality of life and physical function regardless of the compartmental involvement: Data from the OAI

ObjectiveTo test whether combined patellofemoral and tibiofemoral osteoarthritis (OA), in addition to symptoms, is associated with greater changes in quality of life and objective physical function measures when compared with asymptomatic isolated tibiofemoral osteoarthritis. DesignOf the 4796 participants in the Osteoarthritis Initiative, 577 were categorized into four groups based on the presence of symptoms (asymptomatic and symptomatic) and the structural involvement within the knee, where tibiofemoral OA was graded with the Kellgren and Lawrence scale, while patellofemoral OA was based on the Magnetic Resonance Imaging Osteoarthritis Knee Scoring cartilage loss feature. Knee-related quality of life was examined using the Knee Injury and Osteoarthritis Outcome Scale quality of life subscale, and objective physical function was examined by the 20 m Walk Test, 30-s Chair Stand Test, and isometric knee strength. These outcomes were measured at Baseline, Year 2, and Year 4. Mixed effects models were fit to test whether the change in outcome, and the Baseline scores, differed based on group. ResultsQuality of life worsened for the asymptomatic combined group but improved for the symptomatic combined group. However, these quality of life changes and changes in other outcomes were all within measurement error. Large between-group differences were found at Baseline, whereby individuals with symptoms had worse quality of life and physical function test scores. ConclusionsQuality of life and physical function are largely stable over four years. However, having symptoms is strongly associated with worse quality of life and physical function, regardless of structural disease distribution within the knee.

Psychometric properties of the 12-item Knee injury and Osteoarthritis Outcome Score (KOOS-12) Spanish version for people with knee osteoarthritis.

To evaluate the validity, reliability, and responsiveness to change of the 12-item Knee injury and Osteoarthritis Outcome Score (KOOS) Spanish version questionnaire. This study was based on a questionnaire validation design. A cross-sectional survey of 199 patients with knee osteoarthritis (KOA) and ten healthy controls was studied to evaluate the validity and reliability of KOOS-12. One hundred and sixteen patients were assessed for test-retest reliability, and 38 patients were included for a responsiveness assessment. Structural validity was assessed by the confirmatory factor analysis (CFA). Item response theory-based methods were used to determine the performance of the items. Internal consistency reliability was appropriate for all scales (Cronbach's alpha = 0.85-0.94). The intra-class correlation coefficient of KOOS-12 scales ranged from 0.60 to 0.71. The CFA and generalized partial credit model showed that KOOS-12 scales presented a good overall model fit. No differential item functioning was found. Convergent validity was demonstrated by strong correlations (Spearman's rho ≥ 0.70) with KOOS, International Knee Documentation Committee subjective knee evaluation form (IKDC), and Knee Intermittent and Constant Osteoarthritis Pain (ICOAP). Known-groups validity showed that KOOS-12 well discriminated subgroups of patients (radiographic severity and nutritional status). Standardized response means for KOOS-12 scales were ≥ 0.75. Changes in KOOS-12 scales had a moderate to strong correlation (Pearson's r ≥ 0.40) with the changes in the KOOS, ICOAP, and IKDC scales. The KOOS-12 Spanish version is a valid, reliable, and responsiveness to change questionnaire to measure patients' opinions about their knee and associated problems in Mexican subjects with KOA. Key Points • KOOS-12 is a short self-reported measure that assesses patient's opinions about the difficulties they experience due to problems with their knee and also covers aspects of pain, functional limitations, and knee-related quality of life. • The Spanish version of KOOS-12 questionnaire is a valid instrument for measuring the patients' opinions about their knee and associated problems, and is both reliable and responsiveness to change.