Knee Pain Research Articles

The Relevance of Implanted Percutaneous Electrical Nerve Stimulation in Orthopedics Surgery: A Systematic Review.

Background: Percutaneous peripheral nerve stimulation (PNS) is a form of neuromodulation that involves the transmission of electrical energy via metal contacts known as leads or electrodes. PNS has gained popularity in orthopedic surgery as several studies have supported its use as a pain control device for patients suffering from pain due to orthopedic pathologies involving the knee, shoulder, and foot. The purpose of this systematic review is to summarize the literature involving peripheral nerve stimulation in orthopedic surgery. The existing body of literature provides support for further research regarding the use of PNS in the management of knee pain, hip pain, shoulder pain, foot pain, and orthopedic trauma. Notably, the evidence for its efficacy in addressing knee and shoulder pain is present. Methods: This study was conducted following PRISMA guidelines. Seven hundred and forty-five unique entries were identified. Two blinded reviewers assessed each article by title and abstract to determine its relevance and categorized them as "include", "exclude", and "maybe". After a preliminary review was completed, reviewers were unblinded and a third reviewer retrieved articles labeled as "maybe" and those with conflicting labels to determine their relevance. Twenty-eight articles were included, and seven hundred and seventeen articles were excluded. Articles discussing the use of PNS in the field of orthopedic surgery in patients > 18 years of age after 2010 were included. Exclusion criteria included neuropathic pain, phantom limb pain, amputation, non-musculoskeletal related pathology, non-orthopedic surgery related pathology, spinal cord stimulator, no reported outcomes, review articles, abstracts only, non-human subjects. Results: A total of 16 studies analyzing 69 patients were included. All studies were either case series or case reports. Most articles involved the application of PNS in the knee (8) and shoulder (6) joint. Few articles discussed its application in the foot and orthopedic trauma. All studies demonstrated that PNS was effective in reducing pain. Discussion: Peripheral nerve stimulation can be effective in managing postoperative or chronic pain in patients suffering from orthopedic pathology. This systematic review is limited by the scarcity of robust studies with substantial sample sizes and extended follow up periods in the existing literature.

Effect of heat-reinforcing needling on hypoxia-inducible factor 1α and glycolysis activity in rabbits with cold syndrome of rheumatoid arthritis.

To observe the effect of heat-reinforcing needling (HRN) on synovial inflammation, hypoxia-inducible factor-1α (HIF-1α) and glycolytic activity in serum and synovial tissue in rabbits with cold syndrome of rheumatoid arthritis (RA), so as to explore its mechanisms underlying improvement of RA. A total of 32 rabbits were randomly divided into normal, model, inhibitor and HRN groups, with 8 rabbits in each group. The RA with cold syndrome model was induced by injecting ovalbumin dry powder and Freund's complete adjuvant combined with cold freezing. Rabbits in the inhibitor group were intraperitoneally injected with 2-methoxyestradiol (2.5 mg/kg), rabbits in the HRN group were received HRN at bilateral "Zusanli" (ST36) for 30 min. The treatments were conducted once daily for 14 consecutive days. After the interventions, the knee circumference and pain threshold were measured. The contents of nicotinamide adenine dinucleotide phosphoric (NADPH), Hexokinase II (HK2) and 6-phosphofructo-2-kinase/fructose-2, 6-biphosphatase 3 (PFKFB3) in serum of rabbits were detected by ELISA. The pathological morphology of synovial tissue of the knee joints were observed by HE staining. The positive expressions of tumor necrosis factor (TNF-α), interleukin (IL)-1β, IL-6 and IL-17 in synovial tissue of knee joint were detected by immunohistochemistry. The content of lactic acid in synovial tissue of rabbit knee joint was detected by spectrophotometry. The expression levels of HIF-1α, pyruvate kinase 2 (PKM2) and lactate dehydrogenase (LDHA) in synovial tissue of knee joint were detected by Western blot. After intervention, compared with the normal group, the knee circumference was significantly enlarged (P<0.05), the pain threshold was significantly decreased (P<0.05)；the synovial tissue of knee joints showed significant cell proliferation and inflammatory infiltration, the pathological score was significantly increased (P<0.05)；positive expressions of TNF-α, IL-1β, IL-6 and IL-17, the content of lactic acid in synovial tissue, the contents of NADPH, HK2 and PFKFB3 in serum, and the protein expression levels of HIF-1α, PKM2 and LDHA in synovial tissue were increased (all P<0.05) in the model group. Compared with model group, the circumference of knee joint was significantly decreased (P<0.05), the pain threshold was significantly increased (P<0.05)；in synovial tissue, the pathological score was decreased (P<0.05)；the positive expressions of TNF-α, IL-1β, IL-6 and IL-17 in synovial tissue were decreased (P<0.05), the lactic acid content in synovial tissue was decreased (P<0.05)；the contents of NADPH, HK2 and PFKFB3 in serum and the protein expression levels of HIF-1α, PKM2 and LDHA in synovial tissue were decreased (P<0.05) in inhibitor group and HRN group. Compared with the inhibitor group, the synovial pathological score was significantly increased (P<0.05), positive expressions of TNF-α, IL-1β, IL-6 and IL-17, the content of lactic acid in synovial tissue, the contents of NADPH, HK2 and PFKFB3 in serum, and the protein expression levels of HIF-1α, PKM2 and LDHA in synovial tissue were increased (all P<0.05) in HRN group. HRN can increase the pain threshold, reduce the knee circumference and inhibit the inflammatory response in rabbits with cold syndrome of RA. The possible mechanism is related to the down-regulation of HIF-1α and glycolysis activity.

Differences between Acupuncture at Local Points and Balance Method Acupuncture on Musculoskeletal Pain

Background: Acupuncture at Local Points (LA) was expected to overcome local pain by activating local analgesia and anti-inflammatory, improving microcirculation, and enhancing growth factors for tissue repair. Balance Method Acupuncture (BMA) is claimed to have effectiveness and immediate reaction in pain cases. This study aimed to compare the effectiveness of acupuncture at LA with BMA in overcoming musculoskeletal disability. Methods: This was a quantitative study with a randomized control trial (RCT) design on people with neuromusculoskeletal pain. A total of 34 samples were divided randomly into two groups where 17 subjects received LA and 17 subjects received BMA. The outcome was assessed with the Oswestry Disability Index (ODI). Results: The results showed a difference between LA and BMA effectiveness although it was not statistically significant (p=0.059). Both LA and BMA can be used as effective acupuncture methods to improve ODI in shoulder, lower back, and knee pain sufferers. Conclusion: Further research with larger research subjects is needed to provide better results.

A Video App for Screening Osgood-Schlatter Disease Using Soccer Instep Kicking Motion Analysis.

Osgood-Schlatter disease (OSD) is a type of osteochondrosis and traction apophysitis that results from repeated contractions of the quadriceps femoris muscle on the tibial tuberosity. Its prevention, early diagnosis, and treatment are crucial because it causes chronic knee pain and surgical approaches are required if left untreated. Three-dimensional motion analysis is a useful approach for elucidating the pathological factors of OSD; however, it requires advanced cameras, sophisticated facilities, and expensive software. Conversely, the advent of technology has provided affordable video recording devices, and smartphone/tablet-based applications have enabled two-dimensional (2D) motion analysis. This emerging tool and artificial intelligence technology were used to analyze the pivot leg from videos recorded on a tablet device during the instep kicks of adolescent soccer players. Therefore, in this study, we aimed to determine whether the pathological factors for OSD occurring in the pivot foot can be identified through a simple 2D motion analysis using a tablet device. In total, 94 knees of 47 soccer players (aged 14.1±0.8 years, all male) who belong to a single soccer club were evaluated. OSD was diagnosed using ultrasonography and physical examination (a positive bone fragment on ultrasonography or tenderness at the tibial tuberosity). Lower limb muscle tightness was evaluated using the finger-floor distance, straight leg raising test, heel-buttock distance, Thomas test, and ankle range of motion using a goniometer. We then performed motion analysis, and the instep kicking motion was recorded using a video camera on a tablet device. The joint angles of the hip, knee, and ankle were measured using a real-time human-pose detection system. Data were compared between the OSD and non-OSD groups. Overall, six of the 47 players (12.8%) were diagnosed with OSD. No correlation was found between lower limb tightness and the occurrence of OSD in all indices. However, the 2D motion analysis revealed that the knee flexion angle at the time of plantar placement during the instep kick movement was significantly larger in the OSD group than in the non-OSD group (OSD group: 42.0±7.2˚, non-OSD group: 33.5±6.6˚, *p=0.013). A video motion analysis revealed that the knee flexion angle during the instep kicking motion was significantly greater in athletes with OSD of the supporting foot.

Diagnosis and Management of Upper Gastrointestinal Bleeding in Long-Term NSAID Users : Case Report

Upper gastrointestinal bleeding is one of the most frequently encountered emergency cases. For most general practitioners, diagnosing and providing initial management is a challenge in itself. Upper gastrointestinal bleeding is divided into variceal and non-variceal bleeding. Clinical symptoms that can be found include hematemesis or melena. Patients with melena tend to have lower hemoglobin (Hb) levels than hematemesis because clinical manifestations appear more slowly. Drug Induced NSAIDs are also one of the etiologies that can cause upper gastrointestinal bleeding. Endoscopy is the gold standard for diagnosis, but not all health facilities are able to perform it. This case reported a 66-years-old male patient came to the emergency room with complaints of blackish stools with a soft, sticky consistency for 6 days, accompanied by weakness, dizziness, nausea in the stomach and disruption of daily activities. The patient has a history of taking over-the-counter NSAIDs long term to relieve his knee pain. On physical examination, hepatomegaly and splenomegaly were not found and the patient’s hemodynamics is stable. On laboratory examination, Hb was found to be 3.4 g/dl. It was suspected that there was upper gastrointestinal bleeding, then received therapy in the form of PPI injections, antiemetic injections and planned PRC transfusion.

Comprehensive Treatment of Knee Osteoarthritis Pain through Cryoneurolysis: A Promising Approach for Deep and Superficial Genicular Nerve Modulation - Case Report

Background Knee osteoarthritis is a prevalent and debilitating condition characterized by joint pain, stiffness, and limited mobility. Conventional non-operative treatment approaches often do not provide adequate relief of the patient’s symptoms. Cryoneurolysis of the superficial genicular nerves is a growing and accepted technique used to treat knee pain, however, there is limited literature demonstrating the effectiveness of treating both the superficial and deep genicular nerves, as well as the use of subsequent repeat treatments. Case Report This case study reports on a 65 year-old male with Kellgren-Lawrence grade 2-3 tricompartmental bilateral knee osteoarthritis who underwent cryoneurolysis of the superficial and deep genicular nerves with the iovera° cryoneurolysis device followed by two subsequent repeat cryoneurolysis treatments. Conclusion The results demonstrated a complete resolution of the patient’s pain and enhanced quality of life following cryoneurolysis. Furthermore, subsequent repeat treatments sustained the pain reduction, offering the patient an extended period of improved mobility and reduced discomfort. This case study demonstrates that cryoneurolysis holds promise as a valuable addition to the armamentarium of interventions available for managing knee pain and improving the quality of life for patients suffering from osteoarthritis when they are unable or decide not to pursue surgical intervention.

THE IMPACT OF A SENSOR BASED PLATFORM ON THE OUTCOME OF MEDIAL OFF-LOADER BRACING IN INDIVIDUALS WITH KNEE OSTEOARTHRITIS: A PILOT RANDOMIZED CLINICAL TRIAL.

Determine the effectiveness of a medial off-loader brace with sensor monitoring capabilities and associated phone application in improving outcomes for individuals with knee osteoarthritis (OA). Randomized clinical trial of participants with knee OA, aged 40-75 with two groups: 1) brace-only 2) brace+sensor (sensor providing walking time, knee range of motion and 7-day activity streak). Both groups received a prefabricated custom-fitted medial off-loader brace and 12-week self-guided exercise therapy program. Baseline and post-intervention assessments included subjective and objective outcomes. 60 participants were recruited (n = 30/group). The brace+sensor group demonstrated higher study retention(88.89%) compared to the brace-only group(73.33%). Significant improvement in KOOS knee pain and other KOOS sub-scores compared to baseline was observed for both groups. However, only the brace+sensor group improved beyond the established minimal clinically important difference for KOOS pain(11.31+/-13.87). KOOS ADL was also significantly improved in the brace+sensor group compared to brace only group(p = 0.049). Both treatment groups had significant improvement in functional outcomes(10 m walk, 5x sit-to-stand, p < 0.05). Only the brace+sensor group had significant improvements in the 6-minute walk test(p = 0.02) and reduction in participant weight(p = 0.01) at 12 weeks. Incorporating wearable technology in standard bracing for individuals with knee OA has potential in improving clinical outcomes.

The Lateral Para-Patellar Approach for Intramedullary Tibia Nailing in Distal Tibia Extra-articular Fractures: A Prospective Cohort Study.

The treatment of extra-articular distal tibiafractures is still a subject of debate and frequently necessitates surgical treatment, and intramedullary nailing (IMN) offers a minimally invasive approach with excellent results. Important factors in these procedures are positioning, operative duration, and radiation exposure. This study details the semi-extended lateral para-patellar approach for IMN of distal tibia extra-articular fractures and documents our findings regarding operative time, intra-operative radiation exposure, residual anterior knee pain, knee functional and radiological outcomes at six months follow-up. We reviewed the cases of 60 patients who underwent IMNfor distal tibia extra-articular fractures from May 2022 to March 2024, employing an extra-articular lateral para-patellar approach in the semi-extended position. Patients were evaluated clinically and radio-graphically for a minimum follow-up period of six months. Data collected included duration of surgery, intraoperative radiation exposure, and knee functional scorefor all patients. Assessment of fracture healing, residual deformities, residual anterior knee pain, and range of motion of the treated knee compared to the contralateral knee was done at a six-monthfollow-up. The average surgery duration was 54 ± 5 minutes, with intraoperative imaging averaging 48 exposures. The average time to union was 16 ± 3 weeks. Six months post-surgery, the mean Knee Society Score was 86.4 ± 3.5 (out of 100). At the six months follow-up, all patients exhibited clinical and radiographic healing, with only two cases showing mal-alignment (angular deformity <10 degrees).All patients regained a comparable range of motion in their knees. The semi-extended lateral para-patellar approachfor nailing of distal tibiaextra-articular fracturesenhances reduction, simplifies nail insertion,reduces both fluoroscopy and operative time, minimizes anterior knee pain and improves knee functional outcomes at six months follow-up.

Preoperative subjective assessment of disease-specific quality of life significantly influenced the likelihood of achieving the minimal clinically important difference after surgical stabilization for recurrent lateral patellar instability.

To evaluate which factors exert a predictive value for not reaching the minimal clinically important difference (MCID) in patients who underwent a tailored operative treatment for recurrent lateral patellar dislocation(RLPD). A total of 237 patients (male/female 71/166; 22.4 ± 6.8 years) were included. The Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0) and subjective rating of knee function and pain (numeric analogue scale [NAS]; 0-10) were used to evaluate patients' outcomes from pre- to postoperatively. Gender, age at the time of surgery, body mass index (BMI), nicotine abuse, psychiatric diseases, cartilage statusand pathoanatomic risk factors were evaluated as potential predictors for achieving the MCID using univariate logistic regression analysis. The MCID for the BPII 2.0was calculated at 9.5 points. Although the BPII 2.0 and NAS for knee function and pain improved significantly in the total cohort from pre- to postoperatively (all p < 0.001), 29 patients did not reach the MCID at the final follow-up. The analysis yielded that only the preoperative NAS for function and BPII 2.0 score values were significant predictors for reaching the MCID postoperatively. The optimal threshold was calculated at 7 (NAS function) and 65.2 points (BPII 2.0). Age at the time of surgery should be considered for patients with a preoperative BPII 2.0 score >62.5. The probability of reaching BPII 2.0 MCID postoperatively depends only on the preoperative BPII 2.0 value and subjective rating of knee function, as well as age at the time of surgery for patients undergoing surgical treatment of RLPD. Here, presented results can assist clinicians in advising and presenting patients with potential outcomes following treatment for this often complex and multifactorial pathology. Level III.

Biomechanical and biological factors of sexual dimorphism in anterior knee pain: Current concepts

Female gender is one of the commonly mentioned risk factors for anterior knee pain (AKP), among a spectrum of other factors including anatomical, biomechanical, hormonal, behavioral and psychological elements contributing to its development. Despite the focus on individual risk factors, there's a notable gap in comprehending how gender influences and interacts with other risk factors. The objective of this review was to identify and emphasize the connections between these interactions, gender-related risk factors for AKP, and the potential mechanisms that explain their associations with other risk factors, aiming to aid in the creation of precise prevention and treatment approaches. Gender influences the majority of risk factors for AKP, including anatomical, biomechanical, hormonal, behavioral and psychological factors. Women have on average smaller patellae, higher patellofemoral cartilage stress and for AKP, disadvantageous trochlear morphology, ligament and muscle composition and unfavorable neuromuscular control pattern. In contrast, men show on average an increased ability to strengthen their hip external rotators, which are both protective against AKP. Particularly in kinetic and kinematic analysis, men have been shown to have a distinctly different risk factor profile than women. Sex hormones may also play a role in the risk of AKP, with estrogen potentially influencing ligamentous laxity, increasing midfoot loading and affecting neuromuscular control of the lower extremities and testosterone positively affecting muscle mass and strength. The higher incidence of AKP in women is likely due to a combination of slightly increased risk factors. Although all risk factors can be present in both men and women and the holistic evaluation of each individual's risk factor composition is imperative regardless of gender, knowing distinctive risk factors may help with focused evaluation, treatment and implementing preventive measures of AKP.

Observational Study on osteoarthritis of the knee

Knee Osteoarthritis (KOA) is a common cause of functional impairment reducing independence in the elderly and increases cost. Aims: To assess factors associated with KOA Settings and Design: demographic and clinical data collected in a questionnaire. Methods and Material: Prospective cross-sectional study was performed over a period of 12 months. Patients attending orthopaedic clinic at Benghazi Medical Centre [BMC] with knee pain were included. Statistical analysis: Data were analysed by SPSS-version 23. Descriptive statistics to present numbers and percentages and Inferential statistics (x2 ) used to find difference in distribution of variables between groups, P-value ≤ 0.05 was considered significant. Results: Six Hundred and Sixty-Four (664) patients with KOA were included, 76.7% females and 23.3% males. 78.6% of the females were housewives, 40% of the males were retired, 38.7% of these were heavy labourer. 26.2 % were diabetic, 32.4 % were hypertensive. Bilateral KOA were 40%, 60.1%, and 76.8% in patients aged ≤40, 41-60 years and &gt;60 years respectively. Right knee was involved in (22%) in age group 40-60 years, left knee (38.3%) in age group ≤ 40years (p = 0.0001). Stage 4 KOA and Body Mass Index [BMI] ≥ 35 km2 (61% in males) and (68% in females) with (p 0.005). Conclusions: Obesity and female gender are significant risk factors for Osteoarthritis of the knee. Age and BMI determine the severity and the bilaterally of KOA. Keywords: Osteoarthritis, knee, Body weight Age ,Occupation, Gender

Telehealth mindful exercise for people with knee osteoarthritis: A decentralized feasibility randomized controlled trial

ObjectiveNegative psychological beliefs like fear avoidance and catastrophizing can interfere with exercise engagement in people with knee osteoarthritis (OA). Mindfulness, when integrated with exercise, could potentially address both psychological and physical impairments. Our objectives were to optimize and assess the feasibility of a novel telehealth, group-based mindful exercise intervention for people with knee OA. MethodsWe conducted a decentralized randomized controlled trial where participants (n ​= ​40) with symptomatic knee OA were randomized into mindful exercise (n ​= ​21) or exercise-only (n ​= ​19) groups. Both groups received supervised group-based interventions weekly for 8-weeks via Zoom. Primary outcomes were safety, fidelity, and feasibility of the mindful exercise intervention. Participants completed patient-reported outcomes (PRO) for pain, function, and psychological measures at baseline, week-8, and week-14. ResultsParticipants were from 21 US states; >90% identified as having White race, 16% were from rural areas, and approximately 40% had an annual income < $50,000. At 8-weeks, mindful exercise and exercise groups had retention rates of 86% (18/21) and 100% (19/19), and attendance was 54% (11.4/21) and 68% (13/19) respectively. There were no adverse events in the mindful exercise group and four in the exercise group related to exacerbation of knee pain. Preliminary findings showed numerically larger improvements in several PROs for the mindful exercise group. ConclusionAn 8-week telehealth, group-based, mindful exercise intervention was safe for people with knee OA. Our decentralized approach was feasible in terms of recruitment and retention. Further refinement is needed to improve intervention attendance and participant diversity.

The Effect of Intra-articular Injection of Hypertonic Saline Versus Dextrose Prolotherapy for Knee Osteoarthritis

Background: Knee osteoarthritis (OA) is the most common chronic arthritis worldwide, often causing knee stiffness, pain, and functional impairment. This study aims to compare the effects of Dextrose prolotherapy and Hypertonic saline prolotherapy on knee pain, stiffness, and function in patients with knee OA. Methods: The study was conducted as a randomized clinical trial. Patients meeting radiological and clinical criteria for knee OA were sequentially contacted and provided written informed consent. Participants were randomly assigned to receive injections of Hypertonic saline (n = 30) or dextrose prolotherapy (n = 33). The primary outcome measure was clinical manifestations assessed using the compound score of the Western Ontario and McMaster University Arthritis Index (WOMAC). Results: Within-group analysis revealed significant differences in outcome scores for both treatments after 6 months. Both Hypertonic saline and dextrose prolotherapy showed significant improvements in the Visual Analog Scale (VAS), WOMAC composite score, pain, stiffness, and function. In the first month, VAS scores were higher with hypertonic saline compared to dextrose. Additionally, stiffness decreased more with dextrose than with hypertonic saline. After 6 months of treatment, although not statistically significant, hypertonic saline showed better outcomes in the mean WOMAC composite score and pain sub-score compared to dextrose. Conclusions: Among patients with knee OA, Hypertonic saline prolotherapy administered by a trained specialist yields safe and significant improvements in knee pain, stiffness, and function. Our results suggest no significant difference in VAS and WOMAC scores between hypertonic saline and dextrose prolotherapy.

Are Sleep Quality, Daytime Sleepiness and Depression Associated with Knee Pain? A Cross-Sectional Study in Older Adults

Abstract Introduction Osteoarthritis (OA) is common among older adults, and studies have suggested that it is commonly associated with sleep problems and depression. However, the results are inconsistent concerning overall sleep quality, daytime sleepiness, and depression in studies that consider OA knee pain specifically. Objectives To examine the relationship between sleep quality, daytime sleepiness and depression, and OA knee pain in older adults. Methods This was a cross-sectional study. Adults aged 60 and above with OA knee pain according to the National Institute for Health and Care Excellence (NICE) guidelines, and who had preserved cognitive function were recruited. Sleep quality, daytime sleepiness, and depression symptoms were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Epworth Sleepiness Scale (ESS), and the Center for Epidemiologic Studies Depression Scale (CESD), respectively. The generalized linear model (GzLM) approach was used in the statistical analysis. A logistic regression model was performed to evaluate whether ESS, PSQI, and CESD symptoms were associated with knee pain. Results The sample comprised 451 older adults. Sleep quality (OR = 1.22, 95% confidence interval [CI]: 1.07 to 1.40) and depressive symptoms (OR = 1.09, 95%CI: 1.01 to 1.17) were associated with knee pain, but there was no association with excessive daytime sleepiness (OR= 1.09, 95%CI: 0.90 to 1.20). Conclusions Sleep quality and depression symptoms are associated with knee pain.

Heuristic evaluation and end-user testing of a machine learning-based lower-limb exercise training system for management of knee pain in individuals aged 55 years or over

ObjectiveUsing machine learning techniques, we have developed an interactive exercise training system to assist individuals aged 55 years or over with knee pain to perform lower-limb exercises to improve their knee health. The system has three features: video-based exercise demonstrations, real-time feedback on exercise movements, and tracking of exercise performance and progress. The current study aimed to evaluate the design of the computer prototype of the system, and determine its usability and end users’ intention to use it (i.e., acceptance of it). MethodsHeuristic evaluation and end-user testing of the computer-based prototype system were conducted. Three human factors practitioners identified the design deficiencies, with reference to 64 design principles. In addition, 10 individuals with knee pain were recruited to use the prototype system to complete five tasks in the study laboratory. We recorded and examined the task success rate, number of requests for assistance, difficulties encountered during tasks, and perceptions of usability and acceptance. ResultsFour design deficiencies were identified, regarding recognition and recovery of errors, navigation, auditory perception, and help documentation. Most participants had difficulty in calibrating the camera and performing exercises. However, in general, the prototype system was perceived as usable and acceptable. ConclusionsThe use of heuristic evaluation and end-user testing revealed the capacity to systematically detect design deficiencies in interactive self-help systems, allowing for effective system adjustments. Moreover, our system shows potential for individuals managing knee pain, but conducting iterative usability testing is necessary to identify additional improvements. Furthermore, several design propositions have been submitted.

Validation of a questionnaire for Central nervous system Aspects of joint Pain: the CAP questionnaire.

Neuropathic-like pain, fatigue, cognitive difficulty, catastrophising, anxiety, sleep disturbance, depression, and widespread pain associate with a single factor in people with knee pain. We report the Central Aspects of Pain questionnaire (CAP) to characterise this across painful musculoskeletal conditions. CAP was derived from the 8 item CAP-Knee questionnaire, and completed by participants with joint pain in the Investigating Musculoskeletal Health and Wellbeing survey. Subgroups had osteoarthritis, back pain or fibromyalgia. Acceptability was evaluated by feedback and data missingness. Correlation coefficients informed widespread pain scoring threshold in relation to the other items, and evaluated associations with pain. Factor analysis assessed CAP structure. Intraclass Correlation Coefficient (ICC) between paper and electronic administration assessed reliability. Friedman test assessed score stability over 4 years in people reporting knee osteoarthritis. Data were from 3579 participants (58% female, median age; 71 years), including subgroups with osteoarthritis (n = 1158), back pain (n = 1292) or fibromyalgia (n = 177). Across the 3 subgroups, ≥10/26 painful sites on the manikin scored widespread pain. Reliability was high (ICC= 0.89 (95% CI: 0.84-0.92)) and CAP scores fit to 1 and 2 factor model, with a total CAP score that was associated with pain severity and quality (r = 0.50-0.72). In people with knee pain, CAP scores were stable over 4 years at the group level, but displayed significant temporal heterogeneity within individual participants. Central Aspects of Pain is reliably measured by the CAP questionnaire across a range of painful musculoskeletal conditions, and is a changeable state.

LGG-19. SLIPPED CAPITAL FEMORAL EPIPHYSIS (SCFE): A RARE ADVERSE EVENT ASSOCIATED WITH FGFR TYROSINE KINASE INHIBITOR THERAPY IN A CHILD

Abstract BACKGROUND FGFR tyrosine kinase inhibitors (FGFR-TKIs) are being increasingly used off-label in children with hard-to-treat tumors harboring specific FGFR alterations. We report a case of Slipped Capital Femoral Epiphysis (SCFE), an on target skeletal toxicity of a pan-FGFR TKI inhibitor, erdafitinib. METHODS Data was extracted from chart review of the patient and literature search for the use of FGFR-TKIs in children and their side effects. RESULTS A 13-year-old boy was diagnosed to have a optic pathway/ hypothalamic glioma with signs of increased intracranial pressure and obstructive hydrocephalus requiring placement of ventriculo-peritoneal (VP) shunt. Sequencing of the tumor showed FGFR1-Tyrosine kinase domain internal tandem duplication (FGFR1-KD-ITD) and was negative for BRAF mutation/ fusion. Two weeks later, he was treated for a VP shunt infection (surgical revision and 6 weeks antibiotics). He developed hypothalamic obesity with rapid weight gain and BMI &amp;gt;30. After a four-month delay from the initial diagnosis, he was started on erdafitinib a pan-FGFR1-4 inhibitor, through a special access program. At 12 weeks of treatment, he developed persistent knee pain. X-ray of the hips showed slipped capital femoral epiphysis (SCFE) of the right hip. Erdafitinib was discontinued and he underwent surgery with in-situ pinning of the right hip and prophylactic pinning of the left hip. MRI at the time of stopping the medication showed a 30% decrease in the size of the tumor, which has remained stable at 6 months follow up. CONCLUSIONS Based on our experience and literature review of pediatric patients who are treated with pan-FGFR TKIs, we recommend: a) monitoring both rate of weight gain/ BMI for obesity and growth velocity while on therapy and b) update the drug toxicity profile of FGFR TKIs to include skeletal toxicities and inform parents/ patients of these toxicities at the time of consent for therapy.

Physiopathology of patello-femoral osteoarthritis: current concepts

Patellofemoral osteoarthritis (PFOA) is the result of degeneration and loss of articular cartilage of the patella and trochlea, and is a common cause of anterior knee pain. PFOA is triggered by insufficient adaptation to overload of the articular cartilage of the PF joint created by abnormal biomechanics. It is important to understand the pathophysiology and natural history to make the diagnosis and to plan treatment. Innate factors including malalignment, patellar instability, kinematic disorders, and acquired factors like trauma, obesity, and endocrine diseases have been found to be causes of PFOA. Genetic predisposition is also described as a contributing cause but without much scientific evidence. The diagnosis will be based on clinical manifestations, such as anterior knee pain aggravated by overloading activities, identification of risk factors, and exclusion of referred pain from other pathologies, followed by a systematic and structured physical examination. Imaging will be useful for assessing the presence of early osteoarthritis in the other compartments, for classification of the PFOA, and to identify features to establish an adequate treatment. This paper discusses varying management options for different causes of patellofemoral disease and explains the complexity of the PF joint and its often poorly understood biomechanics.

The Incidence of Osgood-Schlatter Injuries in Young Athletes and Non-Athletes - A Systematic Review

This systematic review explores the incidence of Osgood-Schlatter Disease (OSD) in young athletes and non-athletes, focusing on its epidemiology and characteristics. OSD marked by patellar tendon irritation, local pain, and swelling, primarily arises from repetitive quadriceps strain during adolescence and sports activities. The study conducted a systematic review of twelve eligible studies, encompassing a total of 4814 participants. Football and basketball were identified as the sports most linked to OSD, with the condition more prevalent in young athletes than non-athletes. The heightened occurrence of OSD in athletes can be attributed to the repetitive stress on the tibial tubercle during activities like running and jumping. This research underscores the significance of understanding OSD's epidemiological aspects for effective prevention and management, particularly among adolescents experiencing growth spurts. It also emphasizes the need to educate young athletes on injury prevention and the early recognition of OSD symptoms, including knee pain and swelling.

Comparison of effectiveness of tibial intramedullary nailing fixation via suprapatellar approach and medial parapatellar approach in treatment of multiple tibial fractures

To compare the effectiveness of intramedullary nailing fixation via suprapatellar approach and medial parapatellar approach in semi-extended position in the treatment of multiple tibial fractures. The clinical data of 43 patients with multiple tibial fractures treated with intramedullary nailing fixation between July 2018 and December 2022 were retrospectively analyzed, including 23 patients treated with suprapatellar approach in semi-extended position (group A) and 20 patients with medial parapatellar approach in semi-extended position (group B). There was no significant difference in gender, age, cause of injury, time from injury to operation, AO/Orthopaedic Trauma Association (AO/OTA) classification, preoperative visual analogue scale (VAS) score, and range of motion (ROM) of the knee joint between the two groups ( P>0.05). The operation time, intraoperative blood loss, incision length, intraoperative fluoroscopy frequency, and fracture healing time were recorded and compared. The VAS score and ROM of the knee joint were analyzed at 4, 8, and 12 weeks after operation, and the incidence of postoperative complications was observed; knee function was evaluated by Lysholm score at last follow-up. The operations were successfully completed in both groups, and there was no complication such as nerve and blood vessel injury during operation, and all incisions healed by first intention. There was no significant difference in operation time, intraoperative blood loss, and intraoperative fluoroscopy frequency between the two groups ( P>0.05), but the incision length in group B was significantly longer than that in group A ( P<0.05). Patients in both groups were followed up 12-30 months, with an average of 21.1 months. The VAS score decreased and ROM increased gradually in both groups with time after operation, showing significant differences between different time points ( P<0.05). The VAS score of group B was significantly lower than that of group A at 4 and 8 weeks after operation ( P<0.05); there was no significant difference in VAS score and ROM between the two groups at other time points ( P>0.05). There was no significant difference in fracture healing time between the two groups ( P>0.05). During the follow-up, there was no complication such as internal fixator loosening, breakage, and loss of fracture reduction. At last follow-up, the Lysholm score in group B was significantly better than that in group A ( P<0.05). Both the suprapatellar approach and the medial parapatellar approach in semi-extended position can achieve satisfactory results in the treatment of multiple tibial fractures. The medial parapatellar approach has lower symptoms of early knee pain and better long-term function.