Symptomatic Knee Research Articles

Bone Healing and Clinical Outcome Following Medial Opening-wedge High Tibial Osteotomy Using Wedge-Shaped Cancellous Allograft.

Medial opening-wedge high tibial osteotomy (MOWHTO) is considered to be an effective treatment for symptomatic knee osteoarthritis (KOA) of isolated the medial compartment with varus alignment of the lower extremity. However, the choice of material to fill the void remains controversial. This study aims to evaluate the bone union of the osteotomy gap using a novel wedge-shaped cancellous allograft after MOWHTO and its effect on clinical outcomes. All patients who underwent MOWHTO using a novel wedge-shaped cancellous allograft combined with TomoFix locking compression plate (LCP) fixation between January 2016 and July 2020 were enrolled. The radiographic parameters including hip-knee-ankle angle (HKAA), medial proximal tibial angle (MPTA), femorotibial angle (FTA) and posterior tibial slope angle (PTSA) were measured between pre-operative and post-operative radiographs. Knee Society score (KSS) and range of motion (ROM) were assessed preoperatively and at last follow-up. Patients included in this study were divided into two groups according to the correction angle: small correction group (< 10°; SC group) and large correction group (≥ 10°; LC group). The modified Radiographic Union score for tibial fractures (mRUST) was used to assess the difference in bone healing between the two groups at 1, 3, 6, and 12 months postoperatively and at the final follow-up. A paired student's t test was conducted for comparison of differences of the relevant data pre-operatively and post-operatively. A total of 82 patients (88 knees) were included in this study. The HKAA, MPTA, FTA and PTSA increased from -6.4° ± 3.0°, 85.1° ± 2.6°, 180.1° ± 3.2° and 7.7° ± 4.4° preoperatively to 1.2° ± 4.3° (p < 0.001), 94.4° ± 3.3° (p < 0.001), 171.0° ± 2.8° and 11.8° ± 5.8° (p < 0.001) immediately postoperatively, respectively. However, no significant statistic difference was found in above-mentioned parameters at last follow-up compared to immediate postoperative data (p > 0.05). All patients in this study achieved good bone healing at the final follow-up and no significant differences in mRUST scores were seen between the SC group and LC group. The KSS-Knee score and KSS-Function score improved significantly from 55.4 ± 3.7 and 63.3 ± 4.6 preoperatively to 86.4 ± 2.8 (p < 0.001) and 89.6 ± 2.9 (p < 0.001) at last follow-up, respectively. Nevertheless, there was no significant difference in ROM between pre-operation and last follow-up (p > 0.05). For MOWHTO, the wedge-shaped cancellous allograft was a reliable choice for providing good bone healing and clinical outcomes.

Cross-Sectional and Longitudinal Associations of Comorbidities with Knee Symptoms and Radiographic Abnormalities of Osteoarthritis.

This study aimed to investigate the associations of comorbidities with knee symptoms and radiographic abnormalities of osteoarthritis (OA). Participants were from the Osteoarthritis Initiative. Comorbidities were identified at baseline using the modified Charlson Comorbidity Index. For both knees, symptoms were assessed annually from baseline to 48 months using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and function scores (rescaled range 0-100), and radiographic abnormalities using the Kellgren-Lawrence (KL, 0-4) grades. The presence of significant pain and functional disability was defined as a WOMAC score of ≥ 25 and ≥ 22, respectively, and radiographic OA (ROA) as KL ≥ 2. An increase of ≥ 9 in WOMAC scores and ≥ 1 in KL grades were defined as symptomatic and radiographic progression, respectively. Of 3337 participants, 28% and 9% had one and ≥ 2 comorbidities, respectively. The number of comorbidities was associated with the presence of significant functional disability (odds ratios [ORs] 1.15; 1.46) and predicted the progression of both knee pain and functional disability (ORs 1.11; 1.51). For the type of comorbidities, non-OA musculoskeletal diseases were associated with the presence of ROA and significant functional disability (ORs 1.63; 1.82) and showed a trend to predict incident ROA (OR 1.84, 95% confidence interval 1.00-3.38 p = 0.051). Diabetes and kidney diseases were associated with symptomatic progression of OA (ORs 1.38; 2.72). Having more comorbidities, especially diabetes and kidney diseases, is associated with symptomatic progression of knee OA. Moreover, non-OA musculoskeletal diseases may be associated with the presence and onset of ROA.

Association of Foot Symptoms With Decreased Time to All-Cause Mortality: The Johnston County Osteoarthritis Project.

Adults with foot symptoms (ie, pain, aching, or stiffness) may be at increased risk of reduced time to all-cause mortality. The purpose of this study was to evaluate whether foot symptoms are independently associated with all-cause mortality in older adults. We analyzed longitudinal data from 2613 participants from the Johnston County Osteoarthritis Project, a longitudinal population-based cohort of adults 45 years of age and older. Participants completed questionnaires at baseline to determine presence of foot symptoms and covariable status. Baseline walking speed was measured via an 8-foot walk test. To examine the association of foot symptoms with time to mortality, hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression models, adjusted for potential confounders. We observed 813 deaths over 4 to 14.5 years of follow-up. At baseline, 37% of participants had foot symptoms, mean age was 63 years, mean body mass index was approximately 31 kg/m2 , 65% were women, and 33% were Black. Moderate to severe foot symptoms were associated with reduced time to mortality after adjustment for demographics, comorbidities, physical activity, and knee and hip symptoms (HR=1.30, 95% CI 1.09-1.54). Importantly, this association was not modified by walking speed or diabetes. Individuals with foot symptoms had an increased hazard of all-cause mortality compared with those with no foot symptoms. These effects were independent of key confounders and were not moderated by walking speed. Effective interventions to identify and manage at least moderate foot symptoms may reduce the risk of decreased time to mortality.

OSTEOARTHRITIS OF KNEE JOINTS: THE EFFECT OF CONCOMITANT THERAPY IN COMORBID PATHOLOGY

Introduction. Osteoarthritis is the most common disease of the musculoskeletal system, characterized by chronic inflammation and involvement of all components of the joint in the pathological process. Osteoarthritis leads to a decrease in the quality of life, disability of the population, and an increase in mortality. According to experts, osteoarthritis affects about 240 million people worldwide, including approximately 10% of men and 18% of women over the age of 60. In another epidemiological study by American scientists, it was found that that symptomatic knee osteoarthritis occurs in approximately 7% of adults over the age of 25. The prevalence of osteoarthritis is higher in women than in men and increases with age (the trend is present until the age of 70). Approximately 9% of men and 30% of women have at least one joint affected, 11 % and 23% have at least two. Osteoarthritis ranks the 1st position in the structure of musculoskeletal pathology, the 2nd in the number of visits to a family doctor, giving the pass only to cardiovascular diseases, and the 3rd commonest cause of disability. The aim of this study is to analyze and emphasize modern findings regarding the pathogenetic links between osteoarthritis and concurrent comorbid conditions to provide a rationale for novel approaches to enhance the treatment of patients with this pathology. Furthermore, the study aims to evaluate the impact of treatment in patients with gonarthrosis who also present comorbid conditions, with a specific focus on the use of chondroprotective agents such as chondroitin sulphate and glucosamine sulphate, as well as prescription crystalline glucosamine sulphate. Additionally, the study assesses the effects of medications like sartans (e.g., vazar/losartan), statins (e.g., rosart), and nonsteroidal anti-inflammatory drugs (e.g., celecoxib, ibuprofen, diclofenac potassium) in this context. Materials and methods. For this study, we conducted a comprehensive scientific search across both printed and electronic publications and scientific databases. Our research focused on analyzing, comparing, and synthesizing information related to the interplay between osteoarthritis and comorbid pathologies. The study was conducted at the Rheumatology Center at M.V. Sklifosovskiy Poltava Regional Clinical Hospital, which is affiliated with the Department of Family Medicine and Therapy at the Poltava State Medical University. We enrolled a total of 100 participants, comprising both outpatients and inpatients. Among the participants, 81% were women, while 19% were men. Their ages ranged from 48 to 73 years, and all of them presented with primary gonarthrosis at the I-II X-ray stage according to the Kellgren and Lawrence classification in combination with comorbid pathologies. Results. During a 3-month follow-up period, patients under the age of 50 years had mild and moderate manifestations of metabolic syndrome and polymorbid conditions including chronic obstructive pulmonary diseases, lesions of the genitourinary system. Most often, one, rarely two comorbid diseases and one or two diseases that had no proven connection with osteoarthritis were detected. At the age of 50-60, such comorbid processes as arterial hypertension, coronary heart disease, heart failure, obesity, type 2 diabetes, diseases of the digestive system, and polymorbid processes as chronic obstructive pulmonary disease, lesions of the genitourinary system, skin, diseases of the upper respiratory tract, depressive states demonstrated an increasing prevalence. Conclusions. This study has demonstrated a significant clinical effect from applying 3-month therapy that we developed. The therapy, including crystalline glucosamine sulphate and celecoxib, yielded 92% positive response in patients of the main group with osteoarthritis and comorbid pathology. It resulted in a significant reduction in pain, improved joint mobility, enhanced ability to perform daily activities, and positive shifts in laboratory indicators. This led to an improvement in the quality of life, manifested by normalized blood pressure, reduced cardiac and joint pain, and diminished reliance on nonsteroidal anti-inflammatory and antihypertensive medications.

Association between knee osteoarthritis and mortality: a serial propensity score-matched cohort study

Background/Aims: The association between symptomatic knee osteoarthritis (OA) and higher cardiovascular disease (CVD) mortality is established; however, findings from studies that utilized regression analysis were limited, attributed to the strong association between OA and metabolic risk factors. This study aimed to evaluate the association between knee OA and mortality through propensity score matching.Methods: This was a cohort study including Korean National Health and Nutrition Examination Survey (2010–2013) participants aged ≥ 50 years. By linking the survey data to cause of death data (through 2019) from Statistics Korea, mortality and cause-specific mortality data were obtained. Radiographic knee OA (ROA) was defined as bilateral Kellgren–Lawrence grade ≥ 2. Propensity score matching (1:1) was conducted between asymptomatic ROA, knee pain, and symptomatic ROA groups and normal groups, balancing the confounding factors. Time to death was analyzed using Cox proportional hazard modeling.Results: A higher CVD mortality was observed in the symptomatic ROA group, but not in others; the risk estimates were asymptomatic ROA (hazard ratio [HR] 1.12; 95% confidence interval [CI] 0.77–1.65), knee pain (HR 0.61; 95% CI 0.27–1.38), and symptomatic ROA (HR 1.39; 95% CI 0.89–2.17). No association was found between the all-cause/cancer mortality and other groups.Conclusions: When propensity score matching controls metabolic risk factor imbalances, the association between symptomatic knee OA and higher CVD mortality was weaker compared to results of prior studies that used regression adjustment. The results may be more precise estimates of the total risk of knee OA for mortality in Koreans.

Psychological Readiness, Injury-Related Fear, and Persistent Knee Symptoms After Anterior Cruciate Ligament Reconstruction.

Poor psychological responses after anterior cruciate ligament reconstruction (ACLR) have been associated with a failure to return to sport and increased secondary injury risk. However, we do not know whether poor psychological responses after ACLR influence patient-reported knee function and knee symptoms. To examine the association between psychological factors (ie, psychological readiness and injury-related fear) and the presence of persistent knee symptoms in individuals 6 to 12 months after ACLR. Cross-sectional study. Research laboratory. In total, 101 participants, aged 13 to 25 years old, between 6 and 12 months after primary unilateral ACLR were enrolled in the study. Persistent knee symptoms were identified using an established criterion based on the subscales of the Knee injury and Osteoarthritis Outcome Score. Participants also completed the Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) and the Tampa Scale of Kinesiophobia-11 (TSK-11) to assess psychological readiness and injury-related fear, respectively. Higher ACL-RSI scores indicate higher psychological readiness, and higher TSK-11 scores indicate higher injury-related fear. Twenty-nine participants (29%) met the criteria for persistent knee symptoms. For every 1 SD lower in the ACL-RSI score, participants had 2.1 times greater odds of persistent knee symptoms after ACLR (95% CI = 1.3, 3.6). For every 1 SD higher in the TSK-11 score, participants had 1.9 times greater odds of persistent knee symptoms after ACLR (95% CI = 1.1, 3.3). Both the ACL-RSI and TSK-11 were considered good at classifying persistent knee symptoms, as the areas under the curve were 0.78 and 0.73, respectively. Individuals with a lower level of psychological readiness and more injury-related fear after ACLR had greater odds of persistent knee symptoms. Overall, these results highlight the potential clinical benefit of a comprehensive, biopsychosocial approach to managing health and wellness for individuals after ACLR.

Development and validation of a French-language cross-cultural adaptation of the Pedi-IKDC Questionnaire

BackgroundThe Pedi-IKDC is an English-language, knee-specific, paediatric questionnaire used by orthopaedic surgeons around the world as a valuable patient-reported outcome measure (PROM). The objective of this study was thus to extend the applicability of the Pedi-IKDC to French-speaking Canadian patients, for both clinical practice and research, by developing a French-language cross-cultural adaptation of the original version. HypothesisThe French adaptation of the Pedi-IKDC is valid and reliable for evaluating French-speaking children with knee conditions. Patients and methodsThe Pedi-IKDC was translated to French by a panel of orthopaedic surgeons then back-translated by a professional translator. The original English version and the back-translation were compared to assess their similarity and confirm the faithfulness of the French translation. The validity of the French version was then tested at a major paediatric hospital in French-speaking Canada, in 203 children, including 163 with knee pain and 40 without knee symptoms. Internal consistency, construct validity, and discriminant capacity of the French version were assessed. ResultsInternal consistency of the Pedi-IKDC adaptation was excellent (Cronbach's alpha, 0.934 in the knee-pain group). Construct validity was robust, with all nine hypotheses adapted from the original Pedi-IKDC article demonstrating strong (n=7) or moderate (n=2) correlations (p<0.001). The evaluation of discriminant capacity identified no statistically significant score differences according to most of the respondent characteristics (body mass index, age group, type of diagnosis, and type of treatment). However, scores differed significantly between females and males. DiscussionThe French-language cross-cultural adaptation of the Pedi-IKDC obtained using a universally recognized method for translating PROMs demonstrated good performance, with psychometric properties similar to those of the original Pedi-IKDC and of its Danish, Italian, and Russian adaptations. Level of evidenceII.

Meniscal Repair Compared to Meniscectomy for Meniscal Injury: 3-year Outcomes from a Retrospective Cohort Study.

Meniscal injury is a common problem that can lead to knee pain and dysfunction. Meniscal repair and meniscectomy are two treatment approaches for meniscal injury, but the latter may increase the risk of osteoarthritis. We aimed to compare the 3-year outcomes of a new method of meniscal suturing with meniscectomy among patients with meniscal injury. This retrospective cohort study compared meniscal repair (treatment group) and meniscectomy (control group) in patients with meniscal injury. We evaluated the outcomes of 134 patients. under treatment with these approaches based on the Lysholm scale, which measures knee function and symptoms. The study used the chi-square test and the Mann-Whitney U test to compare the proportion of patients with different outcomes and the Lysholm scale scores between the treatment and control groups. The study also conducted subgroup analyses based on gender and age using the Mann-Whitney U test. The level of significance was set at P < 0.05 for all statistical tests. The treatment group had a higher proportion of patients with excellent results, although the difference was not statistically significant (17.2% in the treatment group vs. 10.0% in the control group, P = 0.223). However, a comparative analysis of the proportion of patients with good results revealed statistically significant differences, with 67.2% of patients in the treatment group achieving good outcomes compared to 45.7% in the control group (χ2 = 6,256, df = 1 P = 0.012, HR 1,470 95%CI 1,081-1,999). The average score on the Lysholm scale was significantly higher in the treatment group (87.48, 95% CI 85.1-89.7, SD = 9.2) compared to the control group (81.73, 95% CI 78.4-84.9, SD = 13.7) (U = 1609, Z = -2.813, P = 0.005). Subgroup analyses based on gender and age also showed significant differences in the Lysholm scale scores. The study demonstrates that meniscal repair is more effective than meniscectomy in improving patient outcomes, with a higher proportion of patients achieving excellent and good results and higher scores on the Lysholm scale. These findings support the use of meniscal repair as a preferred treatment approach for patients with meniscal injuries.

Quadriceps strength, patellar tendon quality, relative load exposure, and knee symptoms in male athletes before the anterior cruciate ligament reconstruction.

Anterior cruciate ligament (ACL) injuries cause knee instability, knee pain, weight-bearing adjustments, and functional deficits but their association to patellar tendon quality is unknown. Our purpose was to investigate quadriceps strength, patellar tendon quality, relative load exposure, perceived knee stability, knee pain, extension angle, and time from ACL injury; in addition to examining their relative associations. Injured and uninjured legs of 81 male athletes of different sports with a unilateral ACL injury (18-45 years) were examined. Participants reported location and intensity of knee pain and their perceived stability using a numerical rating scale (NRS 0-10). Strength was tested with an isokinetic device. Tendon quality was measured using ultrasound tissue characterization. Means ± standard deviation (SD) of perceived knee stability, knee extension angle, knee pain, isokinetic quadriceps strength in relation to body mass, proportion of echo-types (I-IV), tendon volume, and number of days from ACL injury to assessment are reported. Values of effect sizes (ES) and correlations (rs) were calculated. ACL injured leg demonstrated reduced reported knee stability (6.3 ± 2.5), decreased knee extension angle (-0.7 ± 3.1° vs. -2.7 ± 2.2°; ES = 0.7; P < 0.001), greater knee pain (NRS 3.1 ± 2.2 vs. 0.0 ± 0.1; ES = 2.0; P < 0.001), and 22% lower quadriceps strength (228.0 ± 65.0 vs. 291.2 ± 52.9 Nm/kg: ES = 1.2; P < 0.001) as compared to the uninjured leg. However, patellar tendons in both legs displayed similar quality. Quadriceps strength was associated with stability (rs = -0.54; P < 0.001), pain (rs = -0.47; P < 0.001), extension angle (rs = -0.39; P < 0.001), and relative load exposure (rs = -0.34; P < 0.004). Echo-types distribution was beneficially associated with time from ACL injury (rs range: -0.20/ -0.32; P < 0.05). ACL injured athletes displayed knee pain, extension deficit, and weaker quadriceps in the injured leg. While there were no differences in patellar tendon quality between legs, longer time from ACL injury showed better tendon quality.

Longer-term quality of care, effectiveness, and cost-effectiveness of implementing a model of care for osteoarthritis: A cluster-randomized controlled trial

To assess the quality of care, effectiveness, and cost-effectiveness over 12 months after implementing a structured model of care for hip and knee osteoarthritis (OA) in primary healthcare as compared to usual care. In this pragmatic cluster-randomized, controlled trial with a stepped-wedge cohort design, we recruited 40 general practitioners (GPs), 37 physiotherapists (PTs), and 393 patients with symptomatic hip or knee OA from six municipalities (clusters) in Norway. The model included the delivery of a 3-hour patient education and 8-12 weeks individually tailored exercise programs, and interactive workshops for GPs and PTs. At 12 months, the patient-reported quality of care was assessed by the OsteoArthritis Quality Indicator questionnaire (16 items, pass rate 0-100%, 100%=best). Costs were obtained from patient-reported and national register data. Cost-effectiveness at the healthcare perspective was evaluated using incremental net monetary benefit (INMB). Of 393 patients, 109 were recruited during the control periods (control group) and 284 were recruited during interventions periods (intervention group). At 12 months the intervention group reported statistically significant higher quality of care compared to the control group (59% vs. 40%; mean difference: 17.6 (95% confidence interval [CI] 11.1, 24.0)). Cost-effectiveness analyses showed that the model of care resulted in quality-adjusted life-years gained and cost-savings compared to usual care with mean INMB €2020 (95% CI 611, 3492) over 12 months. This study showed that implementing the model of care for OA in primary healthcare, improved quality of care and showed cost-effectiveness over 12 months compared to usual care. ClinicalTrials.gov NCT02333656.

Robotic-armassisted total knee arthroplasty is associated with comparable functional outcomes but improved forgotten joint scores compared with conventional manual total knee arthroplasty at five-year follow-up.

This study reports the five-year functional outcomes from a prospective cohort study comparing robotic-armassisted total knee arthroplasty (RO TKA) versus conventional manual total knee arthroplasty (CO TKA). This prospective single-surgeon study included 120 patients with symptomatic end-stage knee arthritis undergoing primary TKA. This included 60 consecutive patients undergoing CO TKA followed by 60 consecutive patients undergoing RO TKA using a semi-automated robotic device. Study patients were reviewed at one, two, and five years after surgery and the following outcomes recorded: The University of California at Los Angeles activity-level(UCLA), Knee Society Score (KSS), Oxford Knee Score (OKS) Forgotten Joint Score (FJS), and any complications. There were no statistical differences between RO TKA and CO TKA in the median UCLA score (p = N.S), median KSS (p = N.S), and median OKS (p = N.S) at five-year follow-up. RO-TKA was associated with statistically significant improvements in the FJS at one (p = 0.001), two (p = 0.003), and five (p = 0.025) years of follow-up compared with CO TKA. There was no statistical difference in the incidence of knee stiffness requiring manipulation under anesthesia between the two treatment groups (p = N.S). Patients in both treatment groups had excellent functional outcomes with comparable patient reported outcomes at five-year follow-up. RO TKA was associated with statistically significant improvements in the FJS compared with CO TKA, but these differences did not reach the minimal clinically important difference at any follow-up interval. There was no overall difference in complications between the two treatment groups at five-year follow-up. II (Prospective cohort study).

Tenosynovial giant cell tumor: a case report

BackgroundThis case reports the synchronous diagnosis of two rare unrelated diseases; leiomyosarcoma and tenosynovial giant cell tumor of the knee. It focuses on the challenges of diagnosing tenosynovial giant cell tumor, including cognitive biases in clinical medicine that delay diagnosis. It also demonstrates the pathogenic etiology of tenosynovial giant cell tumor, evidenced by the transient deterioration of the patients’ knee symptoms following the administration of prophylactic granulocyte colony-stimulating factor given as part of the chemotherapeutic regime for leiomyosarcoma.Case presentationA 37-year-old Caucasian man presented with a left groin lump and left knee pain with swelling and locking. Investigations including positron emission tomography-computed tomography and biopsy revealed leiomyosarcoma in a lymph node likely related to the spermatic cord, with high-grade uptake in the left knee that was presumed to be the primary site. His knee symptoms temporarily worsened each time granulocyte colony-stimulating factor was administered with each cycle of chemotherapy for leiomyosarcoma to help combat myelosuppressive toxicity. Subsequent magnetic resonance imaging and biopsy of the knee confirmed a tenosynovial giant cell tumor. His knee symptoms relating to the tenosynovial giant cell tumor improved following the completion of his leiomyosarcoma treatment.ConclusionsTenosynovial giant cell tumor remains a diagnostic challenge. We discuss the key clinical features and investigations that aid prompt diagnosis. The National Comprehensive Cancer Network clinical practice guidelines for soft tissue sarcoma have recently been updated to include the pharmacological management of tenosynovial giant cell tumor. Our case discussion provides an up-to-date review of the evidence for optimal management of patients with tenosynovial giant cell tumor, with a particular focus on novel pharmacological options that exploit underlying pathogenesis.

THU471 Resolution Of Elevated Alkaline Phosphatase After Joint Replacement In Severe Osteoarthritis

Abstract Disclosure: J. Rakholiya: None. S. Nagaraj: None. P. Sharma: None. Introduction: Alkaline phosphatase (ALP) elevation is commonly seen in hepatobiliary disorders. Conditions of high turnover such as healing fractures, hyperparathyroidism, Pagets’ disease of the bone, also lead to ALP elevation (1). Osteoarthritis (OA), characterised by degeneration of articular cartilage, joint space narrowing, and osteophyte formation, rarely causes ALP elevation. We present a case of ALP elevation that resolved after the arthritic joint was replaced. Case Presentation: A 60-year-old female with history of bilateral knee OA presented to the endocrinology clinic due to elevated ALP for over a year. She reported chronic fatigue, sleep disturbance, dry skin, hair loss, inability to lose weight and anxiety. ALP level at presentation was 165 U/L. An extensive work-up showed unremarkable serum and ionized calcium, serum phosphorus, parathyroid hormone, vitamin D 25-OH, calcitriol, 24-hour urine calcium, serum protein electrophoresis, and 24-hour urine protein electrophoresis. Dual x-ray absorptiometry (DXA) scan was normal with Fracture risk assessment tool (FRAX) score 5.9% for major osteoporotic fracture and 0.2% for hip fracture. Patient underwent total left knee arthroplasty following which ALP improved from 165 U/L to 135 U/L within 9 weeks of the procedure. Five months later, ALP was elevated (164 U/L) again. She then underwent right knee arthroplasty and ALP dropped to normal level (114 U/L) within 1 week post-surgery. Discussion: We report the rare phenomenon of ALP elevation in severe OA, that resolved after joint replacement. OA is characterised by inflammation mediated cartilage destruction, subchondral bone change, osteophyte formation, and alterations of ligaments and meniscuses. Bone change in severe OA is associated with increased synovial fluid ALP level. However, there is a paucity of literature studying the association of ALP with OA. A cross-sectional study of 3060 patients demonstrated higher serum ALP with symptomatic knee OA. Another study showed higher ALP levels with increased joint stiffness. The ALP elevation was attributed to low grade inflammation causing an inflammatory response in chondrocytes, and osteoarthritic pain. There is a need for more studies to evaluate the utility of serum ALP as a biomarker for severe OA. Presentation: Thursday, June 15, 2023

Morphological analysis of three-dimensional MR images of patellofemoral joints in asymptomatic subjects

The existing methods for analyzing patellofemoral (PF) osteoarthritis (OA) are limited. Our purpose was to clarify the frequency, localization, and morphological progression of PFOA by observing three-dimensional (3D) magnetic resonance (MR) images from a cohort population. The subjects were 561 patients aged 30–79 years from the Kanagawa Knee Study who had not visited a hospital for more than three consecutive months for knee symptoms. MR images of the PF joints, separated into the medial and lateral types, were presented in order of the highest to lowest patella cartilage area ratios. Cartilage defects in the patella were detected in 37 subjects (6.6%). Medial lesions (4.6%) were significantly more frequent than lateral lesions (2.0%) (p < 0.01). For both medial and lateral lesions, the patellar cartilage defects were divided into confined and unconfined types. The 3D MR images of the PF joint showed that the patellar cartilage defect occurred along each ridge of the femoral trochlea. The 3D MR images revealed a 6.6% prevalence of patellar cartilage defects, higher in the medial than lateral regions. The 3D MR images can easily determine PF morphology and cartilage defect location, making them useful in understanding the pathophysiology and etiology of PFOA.

Changes in clinical outcomes and alignment of the ipsilateral knee and ankle after supramalleolar osteotomy in patients with varus osteoarthritis of the ankle: a short-term follow-up study.

The purpose of this study was to investigate the changes in clinical outcomes and alignment of the ipsilateral knee and ankle in patients with varus ankle osteoarthritis after supramalleolar osteotomy (SMO). We retrospectively reviewed 23 patients (24 ankles) with Takakura II, IIIa and IIIb ankle osteoarthritis treated with SMO between May 2017 and March 2022. The radiologic parameters of ankles contained medial distal tibial angle (TAS), tibiotalar angle (TT), tibial lateral surface (TLS), tibial plafond inclination (TPI) and talar inclination (TI). The radiologic parameters of knees contained medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), the knee joint line orientation relative to ground (G-KJLO) and WBL. Hip-knee-ankle angle (HKA) was also collected. The Takakura system was used for evaluating the ankle osteoarthritis and the Kellgren-Lawrence (KL) system was used for evaluating the knee osteoarthritis. Clinical evaluation of the ankle joints contained American Orthopedic Foot and Ankle Society (AOFAS), range of motion (ROM) and visual analogue scale (VAS). Clinical evaluation of the knee joints contained Japanese Orthopaedic Association Scores (JOA), ROM, VAS. The mean follow-up times were 20.3 ± 7.3months (range 12-38). According to the radiologic evaluation, the TAS increased from preoperative 84.7° ± 2.0° to 91.2° ± 1.8° at the last follow-up (P < 0.001). The TPI and TI decreased from 4.4° ± 4.2° and 11.0° ± 5.2° to 0.1° ± 4.7° and 4.1° ± 4.8° (P < 0.001 for both). The TT angel improved from 9.5° ± 4.1° to 4.9° ± 3.3° (P < 0.001). No significant differences were found regarding MPTA, JLCA, G-KJLO, knee WBL and HKA (P > 0.05 for all). The Takakura stage improved after SMO (P < 0.001) whilst the KL stage maintains the similar lever (P > 0.05). According to the clinical evaluation, the AOFAS significantly increased from 67.5 ± 10.6 to 88.5 ± 9.3 and the VAS of the ankle decreased from 4.7 ± 1.6 to 1.2 ± 1.1, whilst there were no changes on VAS and even the JOA and knee ROM after SMO (P > 0.05 for all). SMO can alleviate the symptoms of varus ankle osteoarthritis and delay the time for ankle replacement or arthrodesis by redistributing the abnormal stress of the ankle and restoring the congruence of the tibiotalar joint. In addition, it did not induce the clinical symptoms of knee without compromising lower limb alignment or knee joint line orientation in the short term. Level IV case series.

Validation of a Survey to Characterize Barriers to Physical Activity After Anterior Cruciate Ligament Reconstruction.

Although 84% of patients expected to return to activity within 1 year of anterior cruciate ligament (ACL) reconstruction (ACLR), as few as 24% will return to their preinjury level of activity. By considering a patient's perceptions of reengagement in activity after ACLR, clinicians and researchers may be better equipped to implement interventions that are patient centered. To describe the validation of the ACL Reasons survey, a tool to aid clinicians and researchers in understanding patient perceptions of barriers to physical activity (PA) engagement after ACLR. Cross-sectional study. The ACL Reasons survey was administered via Qualtrics to 78 patients 6 to 24 months after primary, unilateral ACLR. Patients were categorized as active, more challenging, or less active based on their responses to the ACL Reasons. Development of the ACL Reasons survey occurred via an iterative process of drafting and revising based on feedback from a team of external expert reviewers. Tegner activity level, Marx activity score, the Knee injury and Osteoarthritis Outcomes Score (KOOS), ACL Return to Sport after Injury score, and Tampa Scale of Kinesiophobia score were compared among groups using analysis-of-variance and Kruskal Wallis tests. Groups differed based on Tegner activity level (P < .001), Marx activity score (P = .01), KOOS pain score (P = .02), KOOS symptom score (P = .04), KOOS sports and recreation score (P < .001), KOOS quality of life score (P < .001), ACL Return to Sport after Injury score (P < .001), and Tampa Scale of Kinesiophobia score (P < .001), with the less active group performing worse on each. Knee symptoms, fear of knee symptoms or movement, and fear of injury were the most common reasons for the change in PA engagement. These results support the validity of the ACL Reasons survey as a tool for identifying barriers to PA engagement after ACLR. This tool may help facilitate communication between patients with ACLR and their health care providers to enhance patient-centered care.

Changes in Coronal and Sagittal Alignment of the Ankle Joint After High Tibial Osteotomy: Evaluation Using Low Extremity Scanogram and EOS Imaging System

Category: Ankle; Hindfoot Introduction/Purpose: High tibial osteotomy (HTO) is a useful treatment option for symptomatic knee patients with varus knee alignment and medial compartment arthritis. Changes in coronal and sagittal alignment of the knee joint have been reported in several previous studies. However, no study have investigated the changes of both coronal and sagittal alignment of the ankle joint after HTO. The purpose of this study was to investigate changes in coronal and sagittal alignment of the ankle joint after HTO. Our hypothesis was that alignment of ankle joint, as well as knee joint, change significantly after HTO. Methods: Total 46 patients (49 cases) were retrospectively analyzed after HTO for varus knee osteoarthritis. Preoperative and follow-up of low extremity scanogram and EOS imaging system were taken. The hip–knee–ankle (HKA) angle, medial proximal tibial angle (MPTA), knee tibia plafond angle (KTPA), were measured by scanogram to evaluate coronal alignment of the knee. Tibial anterior surface angle (TAS), Tibial plafond inclination (TPI), talar tilt (TT), and ankle joint axis point on the weight-bearing- line (AAWBL) were measured by scanogram to investigate coronal alignment of the ankle. Tibial lateral surface angle (TLS) and lateral knee tibial plafond angle (LKTPA) were measured by EOS to evaluate sagittal alignment of the ankle. Radiologic outcomes of the knee and ankle were evaluated pre- and postoperatively. Results: Varus alignment of the knee was corrected by significant coronal change of the HKA angle, MPTA, KTPA after HTO (P &lt; 0.05). There was significant coronal change in TPI and AAWBL in ankle alignment (P &lt; 0.05). The ankle joint axis point on the weightbearing axis moved laterally which was demonstrated by AAWBL. However, there was no significant difference between preoperative and follow up TAS and TT (P &gt; 0.05). In sagittal alignment of ankle by EOS, LKTPA significantly increased after HTO (P &gt; 0.05), but TLS showed no significant difference postoperatively (P &gt; 0.05). Conclusion: Coronal and sagittal alignment of ankle joint was significantly changed after HTO by lateral shift of ankle joint axis and LKTPA increase after HTO. Further study is necessary to investigate the effects of the present radiologic results on clinical symptoms of the patients.

Association of knee and hip osteoarthritis with the risk of falls and fractures: a systematic review and meta-analysis

ObjectiveStudies evaluating the association of knee and hip osteoarthritis (OA) with falls and fractures have inconsistent findings. We aimed to investigate associations of symptomatic and radiographic knee and hip OA with risk of falls, recurrent falls, and fractures.MethodsWe conducted an electronic search of databases from inception to February 2023. Two authors independently screened studies, extracted data, and assessed the risk of bias using the Newcastle-Ottawa Scale tool in eligible studies. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models.ResultsOf 17 studies included (n = 862849), 2 had a high risk of bias. Among studies that evaluated falls or fractures as outcomes, 7/8 (87.5%) and 5/11 (45.5%) were self-reported, respectively. Both symptomatic knee and hip OA were associated with increased risk of recurrent falls (knee: OR = 1.55, 95% CI 1.10 to 2.18; hip: OR = 1.50, 95% CI 1.28 to 1.75) but not falls or fractures. Radiographic knee OA increased risk of falls (OR = 1.28, 95% CI 1.03 to 1.59) and did not significantly increase risk of recurrent falls (OR = 1.39, 95% CI 0.97 to 1.97) or fractures (OR = 1.22, 95% CI 0.99 to 1.52). Radiographic hip OA decreased the risk of recurrent falls (OR = 0.70, 95% CI 0.51 to 0.96) but had no statistically significant association with fractures (OR = 1.16, 95% CI 0.79 to 1.71).ConclusionSymptomatic knee and hip OA were both associated with an increased risk of recurrent falls, and radiographic knee OA was associated with an increased risk of falls. No statistically significant associations of radiographic and symptomatic knee or hip OA with fractures were found.

Towards digital counselling in primary care management of symptomatic knee osteoarthritis: a qualitative descriptive study in Finnish primary care

Digital counselling may improve patients’ health outcomes, when eHealth solutions are accessible and tailored to the patients’ needs, which is especially important for people with chronic and long-term conditions such as knee osteoarthritis. This study aims to identify patients’ eHealth needs to improve the quality of digital counselling in a primary care management of symptomatic knee osteoarthritis. A qualitative study was used to collect patients’ eHealth needs through semi-structured interviews in a single outpatient clinic in Finland between August 2020 and November 2020. The data was analyzed using both deductive and inductive content analysis approaches. The study was reported in accordance with the Consolidated Criteria for Reporting Qualitative research checklist to improve the transparency of the study. Analysis of the data revealed five main categories to be considered when implementing digital counselling in patients with symptomatic knee osteoarthritis: background factors (functional impairments, health literacy, digital literacy, cost-related access barriers), resources (digital methods and materials), sufficiency (knee osteoarthritis-related knowledge and skills), implementation (simplicity, trust, patient-centeredness), and benefits (self-care capabilities, confidence). According to our findings, both health and digital literacy seems to be important contributors to the adoption of digital counselling in a primary care management of symptomatic knee osteoarthritis. New eHealth solutions should not replace the first visit in the outpatient clinic. Instead, the use of eHealth solutions should be based on the first visit, during which a trusting relationship between patients and healthcare providers is established. In future, the level of health and digital literacy in patients with symptomatic knee osteoarthritis should be taken account.

Comparison of Knee Pain and Difficulty With Kneeling Between Patellar Tendon and Hamstring Tendon Autografts After Anterior Cruciate Ligament Reconstruction: A Study From the New Zealand ACL Registry

Background: The bone–patellar tendon–bone (BTB) autograft is associated with difficulty with kneeling after anterior cruciate ligament (ACL) reconstruction; however, it is unclear whether it results in a more painful or symptomatic knee compared with the hamstring tendon autograft. Purpose: To identify the rate and risk factors for knee pain and difficulty with kneeling after ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: Primary ACL reconstruction procedures prospectively recorded in the New Zealand ACL Registry from April 2014 to May 2021 were analyzed. The Knee injury and Osteoarthritis Outcome Score (KOOS) was used to identify patients reporting consequential knee pain (CKP), defined as a KOOS Pain subscore of ≤72 points, and severe kneeling difficulty (SKD), defined as a self-report of “severe” or “extreme” difficulty with kneeling. Absolute values of the KOOS Pain and Symptoms subscales were also compared. Results: A total of 10,999 patients were analyzed. At 2-year follow-up, 9.3% (420/4492) reported CKP, and 12.0% (537/4471) reported SKD. The most important predictor of CKP at 2-year follow-up was having significant pain before surgery (adjusted odds ratio, 4.10; P < .001). The most important predictor of SKD at 2-year follow-up was the use of a BTB autograft rather than a hamstring tendon autograft (21.3% vs 9.4%, respectively; adjusted odds ratio, 3.12; P < .001). There was no difference between the BTB and hamstring tendon grafts in terms of CKP (9.9% vs 9.2%, respectively; P = .494) or in absolute values of the KOOS Pain (mean, 88.7 vs 89.0, respectively; P = .37) and KOOS Symptoms (mean, 82.5 vs 82.1, respectively; P = .49) subscales. Conclusion: At 2-year follow-up after primary ACL reconstruction, 9.3% of patients reported CKP, and 12.0% reported SKD. The BTB autograft was associated with difficulty with kneeling, but it did not result in a more painful or symptomatic knee compared with the hamstring tendon autograft.