Reduce Knee Pain Research Articles

Pengaruh Phonophoresis Untuk Menurunkan Nyeri Pasien Osteoarthritis Lutut

Background: In everyday life activities human beings need prime conditions to create functional motion. One factor that interferes with functional motion is pain. The goal of physiotherapy for people with pain is to relieve pain. Many of the physiotherapy modalities recommended for reducing pain include phonophoresis. But the phonophoresis modality has not been widely implemented in Indonesia. Objective: To determine the effect of phonophoresis on reducing knee pain in patients with knee osteoarthritis. Methods: This study was a pure experiment with a pre-test and post-test with control group design. The study subjects were patients with knee osteoarthritis who met the inclusion and exclusion criteria. From the number of patients who came to the physiotherapy polyclinic of Dr Moewardi Hospital Surakarta, they would be randomized to the experimental group and the control group. The experimental group will get standard therapy at Dr Moewardi Hospital Surakarta plus phonophoresis, while the control group only gets standard therapy from the hospital. The independent variable is the administration of phonophoresis and the dependent variable is a decrease in knee pain. Statistical analysis using t-test. Results: Of Phonophoresis and standard therapy can reduce knee pain. More pain occurs in phonophoresis. Conclusion: Phonophoresis can be selected as a therapy to reduce pain in people with osteoarthritis

Laser Acupuncture for Patients with Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials.

Objectives To provide updated evidence from randomized controlled trials (RCTs) on the effectiveness of laser acupuncture for patients with knee osteoarthritis (KOA). Methods A literature search in 9 databases was conducted from their inception through February 2019. Randomized controlled trials (RCTs) written in English that compared active laser acupuncture with placebo in KOA patients were included. Two authors independently extracted data from these trials. Meta-analysis software was used to analyze the data. Included studies were assessed in terms of the follow-up period, the methodological quality, and appropriateness of their technical features. Results Of 357 studies, seven RCTs (totaling 395 patients) met the inclusion criteria. The short-term outcomes showed that laser acupuncture offered significant pain relief over placebo when assessed by the 100 mm visual analog scale (VAS) pain score (p = 0.02), while there was no significant difference between laser acupuncture and placebo based on Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain score (p = 0.25). For subgroup analysis, laser acupuncture had superiority over placebo in terms of both VAS and WOMAC pain scores in the appropriate technical features subgroup and the excellent methodological quality subgroup. But the effect of laser acupuncture on pain relief was not maintained in terms of either VAS (p = 0.19) or WOMAC pain score (p = 0.60). The pooled effect showed no significant difference between laser acupuncture and placebo at either time point according to WOMAC function scale, WOMAC stiffness scale, and quality of life outcome. Conclusions Our findings indicate that laser acupuncture can effectively reduce knee pain for patients with KOA at short term when appropriate technical features are applied, but the effect likely fades away during the subsequent follow-up period.

Medical imaging and diagnosis of subpatellar vertebrae based on improved Laplacian image enhancement algorithm

ObjectiveNowadays, arthroscopy is widely applied to the treatment of joint diseases. The experimental trials were designed to determine whether the infrapatellar plica was symptomatic or not, and to appraise the medical effects of these patients who underwent arthroscopic treatment. An improved Laplacian image enhancement algorithm is added to the experiment. The medical image of the Subpatellar vertebral body under arthroscope is processed by the algorithm. The processed image is compared with the original image, and the advantages and disadvantages of the improved Laplacian image enhancement algorithm are analyzed. MethodsRetrospective Medical trial design was executed in our study. In addition, X-ray film and magnetic resonance imaging (MRI) were included in the study. Visual Analogue Scale (VAS) and Lysholm Score were carried out. Arthroscopy results, MRI findings, and Medical features were researched and analyzed carefully. Then we use the improved Laplacian image enhancement algorithm to process the image, which makes the image more convenient for analysis and improves the diagnostic accuracy. ResultsSome of the experimental protomedical images are not clear enough, and the details and textures are difficult to judge, which hinders the diagnosis. After the improved Laplacian algorithm processing, the image effect has been significantly improved. From the image we get the result, although the wound healed after surgery, some patients have existence of transient swelling in recovery process but no effusion. The pain of all patients knee was sharply relieved and the function was improved. All patients’ conditions were most satisfactory. ConclusionThe findings in this study demonstrate a significant reduction in knee pain and improvement in function by releasing and removal of the symptomatic infrapatellar plica under arthroscopic surgery. The image processed by the improved Laplacian image enhancement algorithm can effectively retain the image details, which is conducive to diagnosis and improve the diagnostic accuracy.

Lack of evidence that beta blocker use reduces knee pain, areas of joint pain, or analgesic use among individuals with symptomatic knee osteoarthritis

The potential for beta blocker use to reduce joint pain and analgesic use in osteoarthritis (OA) patients has not been well established. The objective of this study was to estimate the association between beta blocker use and knee pain, areas of joint pain, and analgesic use among participants with symptomatic knee OA. We selected participants with symptomatic knee OA from the Osteoarthritis Initiative. Outcome measures included knee pain (e.g., WOMAC pain subscale), areas of joint pain (e.g., widespread joint pain), and analgesic use (e.g., use of strong pain prescriptions including opioids). We decomposed time-varying beta blocker use into within-person and between-person variation, and included these components in linear mixed effects models for repeated outcome measures of knee pain, joint pain, and analgesic use over 8 years. Among 1,168 participants, 15% reported beta blocker use at baseline. Beta blocker users (5.2, 95% CI [4.7, 5.8]) had similar estimated mean WOMAC pain scores as other anti-hypertensive users (4.9, 95% CI [4.6, 5.2]), with an estimated within-person difference of 0.1 (95% CI [-0.3, 0.4]). Proportion of participants reporting widespread joint pain was similar between beta blocker users and other anti-hypertensive users (40.1% vs 40.3%; within-person effect, odds ratio [OR]=0.87, 95% CI [0.63, 1.22]). Reported use of strong prescription pain medication was also similar between beta blocker users and other anti-hypertensive users (7.7% vs 8.2%; within-person effect, OR=1.39, 95% CI [0.75, 2.55]). We found no evidence that beta blockers confer a clinically meaningful reduction in knee pain severity, areas of joint pain, or analgesic use among participants with symptomatic knee OA.

Implementation of Electrical Auricular Acupuncture and Low Frequency Modulated Electric Current Therapy in Pain Management of Patients with Knee Osteoarthritis: A Randomized Pilot Trial.

Background: Knee osteoarthritis is a major cause of knee pain. Conservative therapy resources are limited due to adverse effects. Therefore, alternative non-invasive therapy approaches to reduce pain medications are gaining importance. The current study analyses if electrical auricular acupuncture (EAA) or low frequency modulated electric current therapy (LFMECT) could support analgesic treatment. Methods: In a randomized pilot trial patients with painful knee OA were treated with EAA (group 1) or LFMECT (group 2) additional to standard pharmacological analgesic treatment. In total 19 female and 10 male patients with a mean age of 59.1 years (standard deviation ± 13.6) and a mean BMI of 28.9 kg/m2 (± 5.2) were included. Patients were randomly assigned to one of the groups stratified for age, gender and BMI. Before starting of the active study period and collecting of the initial data on day 1, all patients received a pharmacological analgesic baseline therapy for one week. At the next study stage patients started their randomly assigned treatment protocol for 42 days and final follow-up was set on day 70. Patients recorded their pain intensity (numerical rating scale; NRS) using a standardized patient diary. The pain free walking time in min was recorded and range of motion was assessed. Results: Rescue medication intake was comparable between both groups on day 42 (p = 0.55) and day 70 (p = 0.35). After the active study period (day 42) pain scores decreased significantly in both groups (group 1 p = 0.02; group 2 p = 0.0006). At follow up median pain scores further decreased in group 1 (p = 0.0002) and remained at a low level in group 2 (p = 0.001). Level of pain decreased in about 50% in both groups and was comparable during the study period. Total mean range of motion (ROM) increased in both groups (group 1 p = 0.0003; group 2 p = 0.02). Group 1 had more improvement of mean total ROM compared to group 2 (p = 0.034). Pain-free walking time increased in both groups and was comparable between both groups (p = 0.31). Any adverse effects due to EAA or LFMECT were not observed. Conclusions: Data of the current study indicates that implementation of EAA or LFMECT seems to be beneficial to reduce knee pain and improve knee function in patients with knee osteoarthritis.

Immediate responses of multi-focal low level laser therapy on quadriceps in knee osteoarthritis patients.

Low-level laser therapy (LLLT) applying on knee osteoarthritis (OA) patients has shown positive outcomes in analgesic effect and functional recovery. However, few studies applied such therapy on large area of quadriceps muscle in these patients. The aim of this study was to evaluate immediate effect of multi-focal LLLT on quadriceps of knee OA patients in pain and functional performance. Fifty-one participants with knee OA were enrolled and evaluated before (T1) and immediately after intervention (T2) by knee joint pain in numeric rating scale (NRS), walking speed, timed five-chair stands, and quadriceps strength by isokinetic dynamometer. Intervention with two multi-focal Gallium-Aluminum-Arsenide laser devices, each device with 36 laser diodes (wavelength 808 ± 10 nm, continuous, mean power 50 mW, 30 minutes), applied simultaneously over bilateral quadriceps with a total dose of 180 J for each thigh. The multi-focal LLLT significantly improved knee joint pain as measured by the NRS (54% reduction), timed five-chair stands, and walking speed (P < .05). Knee extensor strength also increased in terms of peak torque and force of concentric and eccentric contraction as measured by isokinetic dynamometer (P < .05). In conclusion, single-session multi-focal LLLT on quadriceps in knee OA patients has immediate beneficial effect on knee pain reduction, quadriceps strengthening and functional performance recovery. Long-term effect requires further investigation. Multi-focal LLLT on quadriceps might serve as an alternative non-invasive treatment option in these patients.

Anterior Knee Pain reduction by patellar thickness reduction in Total Knee Replacement

Eleven early maize (Zea mays) genotypes were evaluated for their yield and yield attributing traits at the research block of Regional Agriculture Research Station (RARS) Lumle, Kaski, Nepal during kharif season of 2016.

Multimodal Impact of Acupuncture, Exercise Therapy, And Concurrent Functional Electrical Stimulation On Osteoarthritis of the Knee: a Case Report

Knee osteoarthritis (OA) causes functional limitation in weight-bearing actlVltles including walking. To investigate the multimodal impact of acupuncture, exercise therapy, and concurrent functional electrical stimulation (FES) on knee osteoarthritis. We designed a multidisciplinary treatment package including acupuncture; home based exercise therapy, and concurrent functional electrical stimulation during treadmill walking. Outcomes measurements included the numerical rating scale (NRS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the Tampa Scale of Kinesiophobia (TSK). Measurements were completed at baseline and following the treatment phase which consisted of six individual sessions. A 48-year-old male, office worker presented with a history of chronic right knee. During the previous year, he was diagnosed with knee osteoarthritis after clinical physical examination by a sports medicine physician. Following our novel training intervention, the patient reported a reduction in pain intensity from 8 to 2 on the NRS, improved in all KOOS subscale scores, and improved in the TSK scale (reduction from 15 to 11). In addition, the patient reported that he was able to return to work and undertake normal activities of daily living with reduced knee pain. This case report showed that our novel multimodal intervention including six sessions of acupuncture, exercise therapy, and treadmill walking with functional electrical stimulation (FES) had a positive impact on knee pain and function in a middle-aged male with knee osteoarthritis.

Short-Term Therapeutic Effects of Ozone in the Management of Pain in Knee Osteoarthritis: A Meta-Analysis.

Ozone therapy has been used widely to decrease pain related to osteoarthritis, but the effectiveness of this treatment has not been evaluated. To evaluate the effectiveness of ozone therapy in the reduction of pain in patients with knee osteoarthritis, according to the type of intervention and duration of the effect. TYPE: Meta-analysis. We performed an online search using PUBMED, DIALNET, SCIELO, MEDIGRAPHIC, and ISCO3 databases. We searched for articles published up to January 2018. We selected eight studies including a total of 355 patients and 363 controls. Only randomized-controlled trials that assessed the efficacy of intraarticular or periarticular infiltrations with ozone to treat knee osteoarthritis in humans were included in the analysis. The results are expressed as standardized mean difference and 95% confidence intervals. The meta-analysis was performed in accordance with the statement of Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We observed that ozone treatment had a therapeutic effect when compared with placebo (d = -0.81, 95% CI -1.06 to -0.55, I2 = 34.79, P(Q) = .47) or other noninvasive treatments. No significant effects were found in favor of the ozone treatment when compared with the use of hyaluronic acid or platelet-rich plasma. However, the use of ozone had a significant short-term benefit reducing knee pain (d = -2.26, 95% CI -2.26 to -3.72, I2 = 97, P(Q) < .001). Pain relief benefits lasted between 3 and 6 months. Our results indicate that intraarticular infiltrations of ozone can be used as an optional effective treatment for the management of pain related to knee osteoarthritis. There are short-term effect benefits that peak at around 1 month of treatment, with a gradual decline in efficacy after 3 to 6 months of treatment. More studies are needed to improve our understanding of the efficacy of this interventional treatment. I.

An infrapatellar nerve block reduces knee pain in patients with chronic anterior knee pain after tibial nailing: a randomized, placebo-controlled trial in 34 patients

Background and purpose — Anterior knee pain is common after tibial nailing. Its origin is poorly understood. Injury of the infrapatellar nerve is a possible cause. In this randomized controlled trial we compared changes in knee pain after an infrapatellar nerve block with lidocaine or placebo in patients with persistent knee pain after tibial nailing.Patients and methods — Patients with chronic knee pain after tibial nailing were randomized to an infrapatellar nerve block with 5 ml 2% lidocaine or placebo (sodium chloride 0.9%), after which they performed 8 daily activities. Before and after these activities, pain was recorded using a numeric rating scale (NRS; 0–10). Primary endpoint was the change in pain during kneeling after the infrapatellar nerve block. Secondary outcomes were changes in pain after the nerve block during the other activities.Results — 34 patients (age 18–62 years) were equally randomized. A significant reduction of the NRS for kneeling pain with an infrapatellar nerve block with lidocaine was found compared with placebo (–4.5 [range –10 to –1] versus –1 [–9 to 2]; p = 0.002). There were no differences between the treatments for the NRS values for pain during other activities.Interpretation — Compared with placebo, an infrapatellar nerve block with lidocaine was more effective in reducing pain during kneeling in patients with chronic knee pain after tibial nailing. Our findings support the contention that kneeling pain after tibial nailing is a peripheral nerve-related problem.

The Efficacy of a Lateral Wedge Insole for Painful Medial Knee Osteoarthritis After Prescreening: A Randomized Clinical Trial.

Lateral wedge shoe insoles decrease medial knee loading, but trials have shown no effect on pain in medial knee osteoarthritis (OA). However, loading effects of insoles are inconsistent, and they can increase patellofemoral loading. We undertook this study to investigate the hypothesis that insoles would reduce pain in preselected patients. Among patients with painful medial knee OA, we excluded those with patellofemoral OA and those with a pain rating of <4 of a possible 10. We further excluded participants who, in a gait analysis using lateral wedges, did not show at least a 2% reduction in knee adduction moment (KAM), compared to wearing their shoes and a neutral insole. We then randomized subjects to lateral wedge versus neutral insole for 8-week periods, separated by an 8-week washout. The primary outcome measure was knee pain (0-10 scale) during the past week, and secondary outcome measures included activity pain and pain rated in the Knee Injury and Osteoarthritis Outcome Score questionnaire. We carried out mixed model analyses adjusted for baseline pain. Of 83 participants, 21 (25.3%) were excluded from analysis because of insufficient reduction in KAM. In the 62 patients included in analysis, the mean ± SD age was 64.2 ± 9.1 years, and 37.1% were women. Lateral wedge insoles produced a greater reduction in knee pain than neutral insoles (mean difference of 0.7 on 0-10 scale [95% confidence interval 0.1, 1.2]) (P = 0.02). Findings for secondary outcome measures were mixed. In participants prescreened to eliminate those with patellofemoral OA and biomechanical nonresponders, lateral wedge insoles reduced knee pain, but the effect of treatment was small and is likely of clinical significance in only a minority of patients. Targeting patients may identify those who respond to this treatment.

Impact of prior knee surgery on reduction in knee pain following education and supervised exercise therapy: analysis of 13,120 patients with knee osteoarthritis

Impact of prior knee surgery on reduction in knee pain following education and supervised exercise therapy: analysis of 13,120 patients with knee osteoarthritis

Pullout repair using modified Mason-Allen suture induces better meniscal healing and superior clinical outcomes: A comparison between two surgical methods

BackgroundPullout repairs of medial meniscus posterior root tears (MMPRTs) have many surgical options. However, there has been no reliable clinical study conducted to compare the superiority of each pullout repair technique. The current study hypothesized that pullout repairs using a modified Mason-Allen suture with FasT-Fix (F-MMA) would have several advantages in postoperative clinical outcomes and meniscal healing compared with single FasT-Fix. The aim of this study was to investigate the clinical usefulness of these two techniques in treating MMPRTs. MethodsThirty-eight patients who had complete MMPRTs were included. All patients underwent transtibial pullout repairs. To compare the clinical usefulness between pullout repairs using single FasT-Fix and F-MMA techniques, patients were divided into two groups. Second-look arthroscopic evaluations of meniscal healing were performed at one year postoperatively. Clinical outcomes were assessed using: Lysholm and visual analogue scale (VAS) pain scores, and Knee Injury and Osteoarthritis Outcome Score (KOOS). ResultsSingle FasT-Fix and F-MMA pullout repairs improved clinical outcomes in patients with MMPRTs. At second-look arthroscopy, VAS pain, KOOS pain, and arthroscopic meniscal healing scores following F-MMA pullout repairs were superior to those after single FasT-Fix pullout repairs. ConclusionsThis study demonstrated that F-MMA suture configuration obtained better meniscal healing and superior clinical outcomes compared with single FasT-Fix repairs in patients with MMPRTs. These results suggest that the F-MMA pullout repair may possibly reduce knee pain in arthroscopic treatments of MMPRTs.

NEURAL CORRELATES OF KNEE MOTOR CONTROL FOR YOUNG FEMALES WITH PATELLOFEMORAL PAIN

Background: Patellofemoral pain (PFP) is a common knee pain condition that affects up to 30% of adolescents and is disproportionately distributed between sexes, affecting females 2-10 times more frequently than male counterparts (Fulkerson, 2002). PFP, characterized by retro- or peripatellar pain, can be debilitating, leading to cessation of physical activity in 74% of adolescents (Fairbank, Pynsent, van Poortvliet, &amp; Phillips, 1984). Aberrant lower-extremity biomechanics for those with PFP has been identified (Souza &amp; Powers, 2009; Willson &amp; Davis, 2008), but the underlying brain activation patterns contributing to pain-disrupted knee motor control is unknown. Patients with knee ligament deficiency demonstrate decreased sensorimotor activity and increased prelimbic activity in response to knee pain, compared with matched controls (Kadowaki, Tadenuma, Kumahashi, &amp; Uchio, 2017), and those with knee ligament reconstruction demonstrate a disrupted sensory-motor brain activation strategy to control the knee (Grooms et al., 2017; Grooms, Page, &amp; Onate, 2015). As PFP has been identified as a contributing factor to knee osteoarthritis later in life (Utting, Davies, &amp; Newman, 2005), identifying the neural mechanisms driving pain-disrupted motor control could guide innovative neural-targeted interventions to treat and reduce knee pain. We hypothesized that patients with PFP, like those with knee ligament deficiencies and reconstruction, would demonstrate decreased sensorimotor brain activation and increased medial pain network brain activation to control the knee. We used our previously established knee motor control neuroimaging paradigm that simulates knee flexion and extension movements (Grooms et al., 2015) to identify altered neural activation patterns for those with PFP and compared those with matched controls. Methods: Four adolescent girls with patellofemoral pain (PFP: n = 4, 15.4 ± 2.2yrs, 158.5 ± 5.4 cm, 61.5 ± 15.6 kg) were matched with four adolescent girls with no history of knee pain (controls) based on age, height, and weight (Con: n =4, 16.4 ± 1.8yrs, 161.8 ± 5.1 cm, 54.9 ± 6.9 kg). Participants were positioned supine in a magnetic resonance imaging (MRI) scanner and completed a series of unilateral 45° knee extension/flexion movements at a velocity of 1.2 Hz (Figure 1; Left Panel). Various torso straps and head packing procedures were utilized to restrict excessive head motion. A second level mixed-effects (FLAME 1+2) independent samples t-test contrasted brain activation between the PFP and controls using a significance level set a priori at p &lt; .05; Gaussian random field cluster corrected and z threshold set at z &gt; 1.5. Results: Results revealed significantly depressed brain activation in the right parietal operculum cortex (z = 5.99, p &lt; .001) and left Heschl’s gyrus (z = 3.83, p &lt; .001) for the PFP compared to the controls (Figure 1; Right Panel). Discussion: The present study revealed significant differences in the neural activation patterns to control the knee between adolescent girls with PFP and those with no knee pain. Patients with PFP demonstrated less activation in sensorimotor cortices, seen in the parietal operculum, and sensory integration, seen in Heschl’s gyrus, when compared to healthy controls (Grooms et al., 2017; Kadowaki et al., 2017). These results indicate that pain may be suppressing sensory integration to control the knee for those with PFP. Congruent with previous neuroimaging investigations assessing those with knee injury (Grooms et al., 2017; Kadowaki et al., 2017), PFP appears to also induce neuroplastic effects identifiable using fMRI. These results provide a potential neural target for interventions that aim to restore sensorimotor integration in those with PFP, reduce pain, and restore an active lifestyle in young females. [Figure: see text]

The effectiveness of Kinesio Taping® for pain management in knee osteoarthritis: a randomized, double-blind, controlled clinical trial.

Background:Kinesio Taping® method is a nonpharmacological alternative for pain management in musculoskeletal disorders. However, the existing evidence is insufficient to assess its full effectiveness for pain management in knee osteoarthritis (KO). Our aim was to evaluate the effectiveness of the Kinesio Taping method in reducing knee pain for KO patients.Methods:In this randomized, double blind, controlled trial, we recruited 187 patients with grade I-III KO who were allocated to either the Kinesio Taping or control group. The study was carried out in outpatient facility. Either Kinesio Taping or nonspecific taping was applied on the affected knee area for 4 weeks. Pain evaluation was performed at baseline, after 1 month of taping and after 1 further month without taping. The data on usage of painkillers were collected; Numeric Pain Rating Scale; an algometer, and Knee injury and Osteoarthritis Outcome Scores (KOOS) pain subscale were used to assess pain. Tolerance and subjective opinions toward the effectiveness of taping were evaluated. The chosen level of significance was p < 0.05, ß ⩽ 0.2.Results:The majority (>70%) of both groups’ patients indicated that tapes reduced the knee pain. The reported use of painkillers decreased, in addition to self-reported increase in the KOOS subscale, thereby indicating pain alleviation. All self-reported improvement remained at the 1-month follow up (p < 0.05). Significantly higher and clinically meaningful reduction of pain intensity was found in the Kinesio Taping group after the treatment month, in comparison with the control group (p < 0.05). More pain reduction was reported in the daytime for participants in the Kinesio Taping group at the follow up (p = 0.022). No changes in algometry results were observed.Conclusions:Elastic taping can safely relieve knee pain and reduce the need for pharmacological management in KO. A specific Kinesio Taping technique is clinically more beneficial for knee-pain alleviation in comparison with nonspecific taping.[ClinicalTrials.gov identifier: NCT03076177.]

Maslinic acid derived from olive fruit in combination with resistance training improves muscle mass and mobility functions in the elderly.

Maslinic acid, derived from olive fruit, reduces pro-inflammation cytokines, which are involved in muscle fiber atrophy. Therefore, the maslinic acid ingestion may enhance the muscular response to resistance training through anti-inflammatory action. We therefore conducted a parallel, double-blind, randomized, placebo-controlled trial that examined whether a combination of maslinic acid supplementation and resistance training improve mobility functions in community-dwelling elderly persons. Over a 12-week period, 36 participants underwent moderate resistance training and are assigned to the maslinic acid supplementation (n = 17, 60 mg/day) or the placebo (n = 19) group. At baseline and at 12-weeks, we assessed body composition, grip strength, walking speed, leg strength, mobility functions, and knee pain scores. Following the 12-weeks, skeletal muscle mass, segmental muscle mass (right arm, left arm, and trunk) and knee pain score of the right leg were significantly improved in the maslinic acid group, while there was no change or parameters had worsened in the placebo group. Grip strength of the better side significantly increased only in the maslinic acid group. These results suggest that maslinic acid supplementation combined with moderate resistance training may increase upper muscle mass and grip strength, and reduce knee pain, could be effective for preventing mobility-related disability in elderly persons. Clinical trial registration number: UMIN000017207.

The impact of painful knee osteoarthritis on mortality: a community-based cohort study with over 24 years of follow-up

To investigate the impact of knee osteoarthritis (OA) and/or knee pain on excess mortality. We analyzed data from 4,182 participants in a community-based prospective cohort study of African American and Caucasian men and women aged ≥45 years. Participants completed knee radiographs and questionnaires at baseline and at up to three follow-ups to determine knee OA (rOA), knee pain and covariate status. Mortality was determined through 2015. We used Cox proportional hazards regression with time-varying covariates (TVC) to estimate hazard ratios (HR) and 95% confidence intervals (CI). Additional analyses stratified by sex, race and age were carried out. Median follow-up time was 14.6 years during which 1822 deaths occurred. Baseline knee radiographic osteoarthritis (rOA) was 27.7%, 38.8% at first follow-up, 52.6% at second follow-up and 61.9% at the third follow-up. Knee rOA with pain and knee pain alone were both associated with a >15% increase in premature all-cause mortality. In analyses stratified by sex, race and age, associations between knee pain, with or without knee rOA, and all-cause death were found among women, Caucasians, those ≤65 years of age, and those with a body mass index (BMI)≥30, with observed increased risks of death between 21% and 65%. We observed similar, somewhat attenuated, results for cardiovascular disease (CVD) deaths. In models taking into account variables that change over time, individuals who had knee pain, alone or with knee rOA, had increased mortality. These effects were particularly strong among those obese. Effective interventions to reduce knee pain, particularly those including weight management and prevention of comorbidities, could reduce mortality.

Treatment satisfaction with pharmaceutical interventions in Japanese adults with osteoarthritis and chronic knee pain: an analysis of a web-based survey.

PurposePatient satisfaction is an important outcome in successful osteoarthritis (OA) treatment. The aim of this study was to evaluate treatment satisfaction for medication (TSM) in people with knee OA (KOA), identify the factors predictive of treatment satisfaction, and describe the burden of illness.Patients and methodsThis cross-sectional, patient-reported study used an Internet-based survey and analyzed responses of respondents with KOA (N=400) on characteristics including pain sites and levels (including pain ratings using the Numerical Rating Scale and Short-Form McGill Pain Questionnaire), treatment satisfaction (Global, Effectiveness, and Convenience scores) based on the Treatment Satisfaction Questionnaire for Medication (TSQM-9), and quality of life (QoL; based on the Arthritis Impact Measurement Scale 2-Short Form). Respondents with only KOA (n=237) were compared with those having KOA and additional painful sites (KOA+; n=163). Factors predicting TSM were identified using multivariable linear regression analyses.ResultsRespondents with KOA were more likely to report intermittent pain for 3 months or more compared with those with KOA+ (58.6% vs 48.5%, respectively; P=0.044), while those with KOA+ were more likely to report consistent pain for 3 months or more (P=0.022). Respondents with KOA+ also had more difficulty due to their knee pain while sleeping (P=0.022) and resting (P=0.015). Reported TSM did not differ significantly across KOA vs KOA+ groups, with both groups reporting low satisfaction; all domains of QoL were worse for those with KOA+. Knee pain reduction by medication predicted higher satisfaction across domains, while lower pre-medication pain and post-medication pain matching expectations predicted higher TSQM-9 Global and Effectiveness scores.ConclusionMedication treatment satisfaction rates were low among Japanese respondents with KOA. Given that lower pain, greater pain reduction post-medication, and meeting pain management expectations were predictive of higher satisfaction, treatment strategies that can better address pain may prove beneficial for overall patient satisfaction.

The most common classification in the mechanical diagnosis and therapy for patients with a primary complaint of non-acute knee pain was Spinal Derangement: a retrospective chart review

ABSTRACTObjectives: To preliminarily investigate in patients with a primary complaint of non-acute knee pain for ≥ 1 month: 1) the proportion of patients with non-acute knee pain classified by Mechanical Diagnosis and Therapy (MDT) as Spinal Derangements, 2) the number of sessions taken to identify the concluding classification, and 3) the ability of MDT classifications, demographics, and symptomatic baselines to predict pain reduction at 1-month follow-up.Methods: This study reviewed data from outpatients managed with MDT. For modeling knee pain reduction at the 1-month follow-up, 3 MDT provisional or concluding classifications (Spinal Derangement, Knee Derangement, and Non-Derangement) and the following variables were included: 1) gender, 2) symptom duration, 3) presence of low back pain (LBP), 4) the Japanese Knee Osteoarthritis Measure, 5) average pain intensity at the initial session using a 0–10 numerical rating scale, and 6) the Kellgren–Lawrence grade.Results: Data from 101 patients were extracted. The percentage of patients with the concluding classification of Spinal Derangement was 44.6%. This was greater in those patient’s reporting concomitant LBP (p = .002) and without radiographic findings of knee osteoarthritis (p < .001). A concluding classification was determined by the fourth session in 80% of patients. Multiple regression modeling demonstrated that only the concluding classification significantly predicted the knee pain reduction at the 1-month follow-up.Discussion: These findings suggest the importance of careful screening assessments of the lumbar spine and the importance of detecting Derangements throughout the follow-up sessions for patients with a primary complaint of knee pain.

Single intra-articular injection of lightly cross-linked hyaluronic acid reduces knee pain in symptomatic knee osteoarthritis: a multicenter, double-blind, randomized, placebo-controlled trial.

The primary objective was to demonstrate the safety and effectiveness of Monovisc™ in the relief of joint pain in patients with idiopathic knee OA compared to saline injection. It was hypothesized that patient success, defined as ≥ 50% improvement from baseline and ≥ 20mm absolute improvement from baseline in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) visual analog scale (VAS) pain score, would be greater in the Monovisc™ group compared to the Saline control group. In this multicenter, double-blind, randomized, placebo-controlled trial, patients with idiopathic, symptomatic, knee OA were randomized to either 4ml single injection of Monovisc™ or 4ml injection of 0.9% saline. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess patient outcomes at 2, 4, 8, 12, 20, and 26 weeks post-injection. The primary effectiveness endpoint was a 50% improvement and ≥ 20mm improvement from baseline in the WOMAC pain through 26 weeks. Secondary outcome measures included a ≥ 20mm improvement from baseline on the WOMAC physical function, patient global assessment, evaluator global assessment, and knee range of motion. 369 patients (154 male, 215 female) were randomized to either Monovisc™ or saline. The Monovisc™ group had a significantly greater rate of patient success (e.g. ≥ 50% improvement and ≥ 20mm absolute improvement from baseline in the WOMAC pain through Week 26) compared to saline (p = 0.043). Monovisc™, a single-injection intra-articular HA device, is a safe and effective treatment for providing a clinically meaningful reduction in knee pain within 2 weeks. The results of this study support the use of a single injection of hyaluronic acid (Monovisc™) for patients with symptomatic knee OA in patients older than 45 years, as a safe and effective alternative for patients who may want an alternative treatment modality or may not be candidates for partial or total knee replacement. I, multicenter, double-blind, randomized, placebo-controlled trial.