Symptomatic Knees Research Articles

Investigating the Chronology of Meniscus Root Tears: Do Medial Meniscus Posterior Root Tears Cause Extrusion or the Other Way Around?

Objectives:Meniscus root tears are increasingly being recognized. Meniscus extrusion has previously been associated with medial root tears; however, the relationship between secondary meniscus restraints, such as the meniscotibial (MT) ligament, extrusion, and root tears has yet to be formally evaluated. The purpose of this study was to better understand the association between MT ligament competence, medial meniscus extrusion, and medial meniscus posterior root tears (MMPRT), as well as to determine the progression of meniscus extrusion over time.Methods:Serial MRI’s from our institution were reviewed for patients who showed evidence of medial meniscus extrusion and MMPRT on at least one of 2+ available MRI’s. All patients were symptomatic at the time of diagnosis. All MRI’s were analyzed independently by two board-certified musculoskeletal radiologists. MT ligament disruption, medial meniscus extrusion, and MMPRT presence was recorded for each MRI. The time between MRI’s, presence of insufficiency fractures, and Outerbridge classification for the medial femur and tibia were also evaluated.Results:27 knees in 26 patients were included in this study, with a total of 63 MRI’s analyzed (21 knees with 2 MRI’s, 3 with 3 MRI’s, and 3 with 4 MRI’s). All patients demonstrated clear medial meniscus extrusion and meniscotibial ligament disruption prior to the subsequent development of MMPRTs (p < 0.001). Mean extrusion at the time of initial MRI was 3.3 ± 1.1 mm, and increased significantly to 5.5 ± 1.8 mm at the time of first imaging with an identified MMPRT (p < 0.001). The average time between initial MRI and the first identification of MMPRT on a later MRI was 1.7 ± 1.6 years.Conclusions:In a sample of 27 symptomatic knees with serial MRI’s both before and after MMPRT diagnosis, all patients demonstrated MT ligament disruption and associated meniscus extrusion prior to the development of subsequent medial meniscus root tears. These findings suggest that MT ligament disruption and medial meniscus extrusion represent early and predisposing events contributing to MMPRT. Therefore, this provides a possible explanation of why meniscus extrusion is not corrected with medial meniscus root repair.

Validation of joint space narrowing on plain radiographs and its relevance to partial knee arthroplasty.

AimsTo explore the clinical relevance of joint space width (JSW) narrowing on standardized-flexion (SF) radiographs in the assessment of cartilage degeneration in specific subregions seen on MRI sequences in knee osteoarthritis (OA) with neutral, valgus, and varus alignments, and potential planning of partial knee arthroplasty.MethodsWe retrospectively reviewed 639 subjects, aged 45 to 79 years, in the Osteoarthritis Initiative (OAI) study, who had symptomatic knees with Kellgren and Lawrence grade 2 to 4. Knees were categorized as neutral, valgus, and varus knees by measuring hip-knee-angles on hip-knee-ankle radiographs. Femorotibial JSW was measured on posteroanterior SF radiographs using a special software. The femorotibial compartment was divided into 16 subregions, and MR-tomographic measurements of cartilage volume, thickness, and subchondral bone area were documented. Linear regression with adjustment for age, sex, body mass index, and Kellgren and Lawrence grade was used.ResultsWe studied 345 neutral, 87 valgus, and 207 varus knees. Radiological JSW narrowing was significantly (p < 0.01) associated with cartilage volume and thickness in medial femorotibial compartment in neutral (r = 0.78, odds ratio (OR) 2.33) and varus knees (r = 0.86, OR 1.92), and in lateral tibial subregions in valgus knees (r = 0.87, OR 3.71). A significant negative correlation was found between JSW narrowing and area of subchondral bone in external lateral tibial subregion in valgus knees (r = −0.65, p < 0.01) and in external medial tibial subregion in varus knees (r = −0.77, p < 0.01). No statistically significant correlation was found in anterior and posterior subregions.ConclusionSF radiographs can be potentially used for initial detection of cartilage degeneration as assessed by MRI in medial and lateral but not in anterior or posterior subregions.Cite this article: Bone Joint Res 2021;10(3):173–187.

Retrospective immediate post-operative comparative study of sequential bilateral total knee replacement versus unilateral total knee replacement for knee primary osteoarthritis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; The study is to compare the immediate post operative outcomes of sequential bilateral versus unilateral total knee replacement (TKR) for the treatment of primary knee osteoarthritis. Study comprised of 96 cases of tricompartmental knee primary osteoarthritis who have undergone unilateral and sequential bilateral total knee arthroplasty at Manipal Hospital, Goa from January 2016 to December 2018. The observations for each group was analysed and duration of hospital stay, post operative mobilisation, fall in haemoglobin level immediate post operative, need for blood transfusion, post operative complications, post operative pain and duration of surgery was recorded. The results were statistically compared. The mean duration of hospital stay, post operative blood loss in terms of fall in HB, post operative pain control, need of transfusions and duration of surgery revealed statistically significant differences.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Total 96 patients diagnosed with primary tricompartmental osteoarthritis were divided into two groups retrospectively. Group 1 operated with sequential bilateral TKR under single anaesthetic procedure and group 2 with unilateral TKR both operated by same surgeon and anaesthetist.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;It was observed that longer duration of surgery and hospital stay, higher fall in HB levels, increased need of analgesics and higher requirement of blood transfusions were associated with group 1 as compared to 2. Complication rates and post op mobilisation was similar in both groups.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Sequential bilateral TKR is a viable option for patient with symptomatic bilateral knees but patient selection and pre op counselling takes the priority. &lt;/p&gt;&lt;p class="abstract"&gt; &lt;/p&gt;

Meniscal and Mechanical Symptoms Are Associated with Cartilage Damage, Not Meniscal Pathology.

Traditionally defined "meniscal" and "mechanical" symptoms are thought to arise from meniscal tears. Yet meniscal tears and cartilage damage commonly coexist in symptomatic knees. To better characterize the primary driver of these symptoms, we investigated whether the presence of preoperative patient-reported knee symptoms (PRKS), including knee catching/locking, grinding/clicking/popping, and pain with pivoting, are associated with various intra-articular pathological conditions diagnosed at knee arthroscopy. We collected prospective data from 565 consecutive patients who underwent knee arthroscopy from 2012 to 2019 and had PRKS collected via the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire. The diagnosis of meniscal pathology and concomitant cartilage damage was confirmed and classified intraoperatively. We used multivariable regression models, adjusting for possible confounders, to examine the association of specific pathological conditions of the knee with the presence of preoperative PRKS. Tricompartmental cartilage damage was strongly associated with significantly worse PRKS, with an increase of 0.33 point (95% confidence interval [CI] = 0.08 to 0.58; p = 0.01) on a 0 to 4-point scale. We did not observe an association between meniscal pathology and preoperative PRKS. Contrary to current dogma, this study demonstrates that traditionally defined "meniscal" and "mechanical" knee symptoms are strongly associated with the burden and severity of underlying cartilage damage rather than with specific meniscal pathology. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Ultrasonographic Evaluation of Osteoarthritis-affected Knee Joints: Comparison with Kellgren-Lawrence Grading and Pain Scores.

Background:The objective was to compare ultrasonographic findings with clinical and radiographic findings in osteoarthritis (OA)-affected knee joints.Methods:This prospective study was conducted in Subharti Medical College, Meerut, after getting clearance from the ethical committee. Eighty-five symptomatic knees fulfilling American College of Rheumatology criteria for OA were included in the study. Patients with trauma, inflammatory, and infective conditions of the knee and with a history of intra-articular interventions and surgery were excluded. Demographic data, body mass index (BMI), visual analog scale (VAS), and Western Ontario and McMaster Universities Arthritis (WOMAC) questionnaire score were obtained. Kellgren–Lawrence (K-L) score was obtained on radiography. Ultrasonographic findings which were recorded include effusion, meniscal extrusion, femorotrochlear cartilage grading, maximum length of osteophytes at medial and lateral compartments, and presence or absence of Baker cyst.Results:A total of 85 consecutive symptomatic knees were examined. The male: female ratio was 22:63, with a mean age of 54.52 ± 9.44 years, mean duration of disease of 24.24 ± 19.14 months, mean BMI of 28.91 ± 3.69 kg/m2, and mean score of VAS and WOMAC pain scale of 6.27 ± 1.45 and 62.45 ± 10.96, respectively. K-L grading of 1, 2, 3, and 4 was reported in 12.9%, 21.2%, 25.9%, and 40% of the knees, respectively. The mean VAS score and WOMAC score showed statistically significant correlation with KL grading (P < 0.05). Knees with the presence of osteophytes, medial meniscal extrusion, effusion, and medial femoral trochlear cartilage grading showed statistically significant correlation with VAS and WOMAC scores (P < 0.05). However, the correlation was not significant for lateral meniscus extrusion and lateral femoral trochlear cartilage grading.Conclusion:Our study found that K-L grading and few ultrasonographic criteria showed a significant positive correlation with pain scores, while few other ultrasonographic criteria did not. Both imaging modalities are complementary to each other, rather than one being superior to the other.

Surgical Fixation of Chondral-Only Fragments of the Knee: A Case Series With a Mean 4-Year Follow-up.

Background:Chondral-only fragments of the knee have traditionally been treated with excision, with or without cartilage restoration procedures. This is because of the historical assumption that cartilage has limited ability to heal to cancellous or subchondral bone. There is now a growing body of evidence supporting surgical fixation of these fragments.Hypothesis:We hypothesized that surgical fixation of chondral fragments would result in acceptable rates of healing with improvement in clinical outcome scores.Study Design:Case series; Level of evidence, 4.Methods:Data were collected on 15 surgically fixed chondral-only fragments in 14 patients. We retrospectively collected participant demographic information, lesion characteristics, primary mechanism (osteochondritis dissecans vs traumatic shear injury), fixation methods, reoperation information, second-look arthroscopic information, and clinical outcome scores. The mean clinical follow-up was 3.96 years, with a minimum of 1-year follow-up. All patients underwent follow-up magnetic resonance imaging at a mean of 2 years after the index procedure.Results:The mean age of our cohort was 17.7 years. We found an 80% survival rate for fixation of the fragments at a mean 4-year follow-up. There were statistically significant improvements in postoperative Knee injury and Osteoarthritis Outcome Score and Tegner scores compared with preoperative scores. Follow-up magnetic resonance imaging scans showed complete healing in 10 knees, partial healing in 2 knees, and loss of fixation in 3 knees. Second-look arthroscopic surgery of 3 knees for reasons other than fragment symptoms showed healing of the fragment, while arthroscopic surgery of 3 symptomatic knees showed loss of fixation.Conclusion:Surgical fixation of chondral-only lesions showed an 80% success rate with improvements in the KOOS and Tegner scores.

Discordance between radiographic findings, pain, and superficial temperature in knee osteoarthritis.

IntroductionKnee pain is an imprecise marker of radiographic evidence of osteoarthritis (OA). These patients are more likely to develop central sensitisation to pain, a risk factor for chronic pain.ObjectivesThe aim of this study was to examine the associations among radiographic evidence of OA, self-reported pain, pressure pain thresholds (PPT), and superficial knee temperature in individuals with knee OA.Material and methodsThis cross-sectional study enrolled 25 patients with knee OA with clinic and radiographic diagnosis of bilateral OA (Kellgren-Lawrence grading scale 1–4 in X-ray images), but symptoms of pain and discomfort in only one of the knees, with pain perception in the symptomatic knee equal to or above 4 in a visual analogue scale. Volunteers underwent an evaluation including demographic data, superficial knee temperature (infrared thermography, mean superficial temperature of the region of the knee) and PPT (digital algometry at longus adductor, vastus lateralis, vastus medialis and tibialis anterior muscles, patellar tendon, and centre of the patella).ResultsComparisons between symptomatic and asymptomatic knees revealed no differences regarding Kellgren-Lawrence classification, knee superficial temperature, or PPT. Significant weak and moderate associations were found between radiographic classification of OA and PPT of both knees in almost all sites evaluated. Nonetheless, superficial temperature of the knee was not associated with PPT or Kellgren-Lawrence grading scale.ConclusionsPatients with bilateral knee OA presented no differences in symptomatic and asymptomatic knees regarding radiographic evidence, knee temperature, and PPT, indicating that central sensitisation may be present in them. Radiographic classification of OA was significantly associated with PPT in both knees.

Towards developing diagnostic criteria for early knee osteoarthritis: data from the CHECK study.

ObjectivesThere is a general consensus that a shift in focus towards early diagnosis and treatment of knee OA is warranted. However, there are no validated and widely accepted diagnostic criteria for early knee OA available. The current study aimed to take the first steps towards developing diagnostic criteria for early knee OA.MethodsData of 761 individuals with 1185 symptomatic knees at baseline were selected from the CHECK study. For CHECK, individuals with pain/stiffness of the knee, aged 45–65 years, who had no prior consultation or a first consultation with the general practitioner for these symptoms in the past 6 months were recruited and followed for 10 years. A group of 36 experts (17 general practitioners and 19 secondary care physicians) evaluated the medical records in pairs to diagnose the presence of clinically relevant knee OA 5–10 years after enrolment. A backward selection methods was used to create predictive models based on pre-defined baseline factors from history taking, physical examination, radiography and blood testing, using the experts’ diagnoses as gold standard outcome.ResultsPrevalence of clinically relevant knee OA during follow-up was 37%. Created models contained 7–11 baseline factors and obtained an area under the curve between 0.746 (0.002) and 0.764 (0.002).ConclusionThe obtained diagnostic models for early knee OA had ‘fair’ predictive ability in individuals presenting with knee pain in primary care. Further modelling and validation of the identified predictive factors is required to obtain clinically feasible and relevant diagnostic criteria for early knee OA.

Investigating the Chronology of Meniscus Root Tears: Do Medial Meniscus Posterior Root Tears Cause Extrusion or the Other Way Around?

Background:Meniscus root tears are increasingly being recognized. Meniscal extrusion has previously been associated with medial root tears; however, the relationship between secondary meniscal restraints, such as the meniscotibial (MT) ligament, extrusion, and root tears has yet to be formally evaluated.Purpose:To better understand the association between MT ligament competence, medial meniscal extrusion, and medial meniscus posterior root tears (MMPRTs) as well as to determine the progression of meniscal extrusion over time.Study Design:Case series; Level of evidence, 4.Methods:Serial magnetic resonance imaging (MRI) scans were reviewed for patients who showed evidence of medial meniscal extrusion and MMPRTs on at least 1 of ≥2 available MRI scans. All patients were symptomatic at the time of diagnosis. All MRI scans were analyzed independently by 2 board-certified musculoskeletal radiologists. MT ligament disruption, medial meniscal extrusion, and MMPRTs were recorded for each MRI scan. The time between MRI scans, presence of insufficiency fractures, and Outerbridge classification for the medial femur and tibia were also evaluated.Results:Overall, 27 knees in 26 patients were included in this study, with a total of 63 MRI scans analyzed (21 knees with 2 MRI scans, 3 with 3 MRI scans, and 3 with 4 MRI scans). All patients demonstrated clear medial meniscal extrusion and MT ligament disruption before the subsequent development of MMPRTs (P < .001). Mean extrusion at the time of initial MRI was 3.3 ± 1.1 mm and increased significantly to 5.5 ± 1.8 mm at the time of first imaging with an identified MMPRT (P < .001). The mean time between initial MRI and the first identification of an MMPRT on later MRI was 1.7 ± 1.6 years.Conclusion:In a sample of 27 symptomatic knees with serial MRI scans both before and after an MMPRT diagnosis, all patients demonstrated MT ligament disruption and associated meniscal extrusion before the development of subsequent medial meniscus root tears. These findings suggest that MT ligament disruption and medial meniscal extrusion represent early and predisposing events contributing to MMPRTs. Therefore, this provides a possible explanation of why meniscal extrusion is not corrected with medial meniscus root repair.

Ultrasound Characterization of Patellar Tendon in Non-Elite Sport Players with Painful Patellar Tendinopathy: Absolute Values or Relative Ratios? A Pilot Study.

Imaging findings in patellar tendinopathy are questioned. The aim of this pilot study was to characterize ultrasound measures, by calculating ultrasound ratio and neovascularization of the patellar tendon in non-elite sport players with unilateral painful patellar tendinopathy. Cross-sectional area (CSA), width, and thickness of the patellar tendon were assessed bilaterally in 20 non-elite sport-players with unilateral painful patellar tendinopathy and 20 asymptomatic controls by a blinded assessor. Ultrasound ratios were calculated to discriminate between symptomatic and asymptomatic knees. The Ohberg score was used for characterizing neovascularization. We found that non-elite sport players with patellar tendinopathy exhibited bilateral increases in CSA, width, and thickness of the patellar tendon compared to asymptomatic controls (Cohen d > 2). The ability of ultrasound ratios to discriminate between painful and non-painful patellar tendons was excellent (receiver operating characteristic, ROC > 0.9). The best diagnostic value (sensitivity: 100% and specificity: 95%) was observed when a width ratio ≥ 1.29 between the symptomatic and asymptomatic patellar tendon was used as a cut-off. Further, neovascularization was also observed in 70% of non-elite sport players with unilateral patellar tendinopathy. A greater CSA ratio was associated with more related-disability and higher tendon neovascularization. This study reported that non-elite sport players with painful unilateral patellar tendinopathy showed structural ultrasound changes in the patellar tendon when compared with asymptomatic controls. Ultrasound ratios were able to discriminate between symptomatic and asymptomatic knees. Current results suggest that ultrasound ratios could be a useful imaging outcome for identifying changes in the patellar tendon in sport players with unilateral patellar tendinopathy.

Subchondral bone cysts regress after correction of malalignment in knee osteoarthritis: comply with Wolff's law.

The purpose of this study is to discuss the mechanical function of subchondral bone cysts and its relationship with Wolff's law. One hundred forty symptomatic knees (120 patients) with osteoarthritis were subjected to MRI before high tibial osteotomy (HTO). Subchondral bone cysts (SBCs) were detected on 72 knees of these 140 knees. SBCs, bone marrow lesion (BML), and hip-knee-ankle (HKA) axis were measured by using validated methods. After HTO, the evolution of cysts was evaluated on MRI performed with a fiveyear follow-up on the 72 knees with pre-operative cysts. At baseline, 70 (97%) of these 72 knees had a BML surrounding the SBCs; the maximum cyst volume was 874mm3 and the average cyst volume 9. 6 ± 4.1mm3. In the subregions where cysts were present, adjacent cartilage was still present without full thickness defects. The mean pre-operative hip-knee-ankle angle was 7.3 ± 3 degrees (0° to 14°) of varus and differed significantly (p = 0.01) between the 68 knees without cysts (average 3 ± 2 degrees) and the 72 knees with cysts (average 9.2 ± 4 degrees). Five years after HTO, the number of cysts had decreased, the maximum cyst volume was 532mm3, and the average cyst volume was 6.3 ± 2.8mm3. Regression of subchondral bone cysts may be related to restoration of an appropriate load at the subchondral bone. With applying poroelasticity to bone mechaincs, thisfinding may suggest that SBCs andBMLs may be a physiological adaptation to mechanic overload. More basic research is needed to prove this matter.

Accuracy of clinical diagnosis in meniscal tears

Introduction: Meniscal injuries of the knee are common indications for arthroscopic knee surgery. Most of the meniscal tears can be diagnosed by clinical evaluation alone. This study aims to test the accuracy of the commonly performed tests for meniscal tears in our set up.&#x0D; Method: This was a prospective observational study of 32 symptomatic knees that underwent clinical evaluation followed by arthroscopy. The sensitivity, specificity and diagnostic accuracy of three clinical tests (McMurray’s test, Apley’s compression test and Joint line tenderness) were calculated against arthroscopic findings.&#x0D; Result: Among clinical tests, maximum sensitivity (94.44%) was with Joint Line Tenderness for Medial Meniscus Tear (MMT) and minimum (54.54%) with Apley’s Compression Test for Lateral meniscus Tear (LMT). Specificity was maximum (90.48%) with Joint Line Tenderness for LMT and minimum (64.28%) with Apley’s Compression Test for MMT. Diagnostic accuracy was maximum (90.6%) with McMurray’s test for LMT and minimum (75%) with Apley’s Compression Test for MMT and LMT.&#x0D; Conclusion: All three clinical tests (McMurray’s, Apley’s compression and Joint line tenderness) were found reliable for diagnosing meniscus tears. Joint Line Tenderness had the best diagnostic accuracy followed by McMurray’s test.

Assessment of knee osteoarthritis by ultrasonography and its association with knee pain.

Pain is a significant cause of disability in knee osteoarthritis. Conventional radiography is widely used in the assessment of knee osteoarthritis, however radiographic findings do not correlate well with pain. Ultrasonography can be used to evaluate the soft tissue structures of the knee that can be related to pain. To evaluate pain-related soft tissue structures of the knee with ultrasonography. This cross-sectional study included a total of 198 knees from 99 patients with knee osteoarthritis. Knee pain and functional status were evaluated by performing visual analogue scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). On the ultrasound, cartilaginous thickness, knee effusion and presence of Baker's cyst were assessed and the correlation to pain was investigated. Baker's cyst was significantly more frequent in symptomatic knees (13.9%) compared to asymptomatic knees (2.5%). Patients with Baker's cyst had a significantly more limited degree of knee flexion, significantly higher resting VAS pain scores and worse WOMAC scores compared to patients without Baker's cyst. In log-linear analysis, presence of Baker's cyst increased the risk of pain by 2.94 times. Ultrasound as a modality that is easily accessible, inexpensive and without radiation exposure is helpful to demonstrate factors related to pain in knee osteoarthritis by allowing assessment of soft tissue structures.

A computer simulation study for preserving the tibial posterior slope in open-wedge high tibial osteotomy

To measure the medial opening gap and examine a technique for preserving the tibial posterior slope (TPS) in open-wedge high tibial osteotomy (OWHTO) using computer-simulated three-dimensional (3D) surgery. This study included 24 symptomatic knees from 20 patients (7 men and 13 women; mean age, 67.9years; range 54-89years). Digital imaging and communications from computed tomography examination were applied to a 3D picture software program, and several anatomical landmarks were registered. Then, computer simulation of OWHTO as a virtual surgery was performed: the correction angle was decided to make the femorotibial angle 170°, and the TPS did not differ between pre- and postplanification. The distance between the proximal and distal cortices of the medial tibia was measured at three points, which were the anterior (AD), posterior (PD), and longest (LD) distance sites in the sagittal plane, using the 3D view, and the ratios of AD/PD and AD/LD were measured. The anteromedial opening gap was compared to the posteromedial gap and the longest distance gap at the osteotomy site. Spearman's rank correlation coefficient test was used in statistical analysis. Mean AD/PD was 0.740 ± 0.051 (range 0.651-0.850), and mean AD/LD was 0.652 ± 0.040 (range 0.571-0.768). The correction angle was not associated with the values of both AD/PD and AD/LD. Difference in AD/PD and AD/LD between each patient was regarded as a significant variation. Therefore, preoperative planification with 3D computer simulation to measure AD/PD and AD/LD may be helpful to avoid a significant increase in TPS.

The effect of Kinesio-tape® on pain and vertical jump performance in active individuals with patellar tendinopathy

BackgroundPatellar tendinopathy is a common inflammatory condition in athletes who undergo large volumes of running and jumping. Kinesio-tape® (KT) is proposed to provide pain relief; however, its effect has not been examined on patellar tendinopathy. ObjectiveTo examine the effects of KT on pain modulation for active individuals with patellar tendinopathy during functional activities. MethodsThirteen symptomatic knees from seven college-aged females (6 bilateral; 1 unilateral) were included. Participants underwent three data collection sessions with KT, sham, and no tape (NT) in a randomized order. During the session, participants performed a maximum vertical jump, single-leg squats and isometric knee extension. The KT intervention was applied according to the KT manual and the sham utilized the same pattern without tension. Pain level was evaluated using the numeric pain scale before, during and after each activity. Function was assessed as maximum vertical jump height and maximum isometric strength. A separate repeated measures ANOVA was used to compare each dependent variable (pain level, vertical jump height, and isometric strength) among the conditions. ResultsReported pain scores were significantly lower (p = 0.05) during the maximal vertical jump test for KT (3.38 ± 1.26) compared to NT (4.54 ± 2.22). Significantly lower jump heights were found under KT (17.73 ± 3.06in) during the maximum vertical jump test compared to sham (18.65 ± 2.17in, p = 0.000) and NT (18.18 ± 2.93in, p = 0.008). ConclusionsThe use of the KT tape with a tendon corrective strip and muscle facilitative strip was effective for decreasing pain associated with patellar tendinopathy during jump landing but led to decreased maximum jump height. Clinical trial identifierNCT04153877.

Single-leg hop mechanics are correlated with self-reported knee function early after anterior cruciate ligament reconstruction

BackgroundBiomechanical changes that persist after anterior cruciate ligament (ACL) injury may impact short- and long-term outcomes. Understanding the relationship of biomechanics during a dynamic task and patient reported function can better identify patients who are most vulnerable to sub-optimal long-term outcomes, such as osteoarthritis (OA). The purpose of this study was to determine whether hip and knee biomechanics during single-leg hop landing were significantly correlated with the Knee injury and Osteoarthritis Outcome Score (KOOS), and whether symptomatic knees displayed altered biomechanics relative to asymptomatic knees. MethodsHip and knee biomechanics during the landing phase of a single-leg hop of thirty subjects with ACLR were analyzed. Subjects were also classified as symptomatic or asymptomatic based on their KOOS results. Correlation analyses and group comparisons between symptomatic and asymptomatic subjects were conducted. FindingsKOOS Symptoms, Pain, and Sport subscales were significantly correlated with frontal and sagittal plane hip and knee biomechanics. Furthermore, those with symptomatic knees demonstrated greater hip and knee flexion angles, and greater hip flexion moments. InterpretationThese results indicate that biomechanics associated with ACLR during a single-leg hop are correlated with worse KOOS outcomes. However, these correlations may be due to symptoms of the recovery from ACLR rather than those of OA. The results of this study may help to identify rehabilitation opportunities for patients at risk for worse long-term outcomes after ACLR.

Synovial Fluid Biomarker Concentrations in Knees with Symptomatic Meniscus Injury Compared to Asymptomatic Contralateral Knees

Objectives: Changes in the joint microenvironment following an intra-articular injury have been implicated in the pathogenesis of knee osteoarthritis. Few studies have evaluated alterations in the joint microenvironment in the setting of meniscus injury. The purpose of the current study was to determine the changes in synovial fluid biomarker concentrations caused by meniscus pathology by comparing samples from injured, symptomatic knees to samples from asymptomatic contralateral knees. Methods: Patients undergoing surgery for unilateral meniscus injury were prospectively enrolled in this institutional review board approved study from October 2011 to December 2016. A cohort was formed consisting of patients that had synovial fluid samples collected from both the injured and contralateral uninjured knee at the time of arthroscopic surgery. Patients with ligamentous injury of the knee were excluded from the current analysis. Synovial fluid samples were collected just prior to incision and the concentrations of 10 biomarkers of interest were determined using a multiplex magnetic bread immunoassay. Results: The current analysis included synovial fluid samples from 82 knees (41 operative and 41 contralateral knees) from 41 patients undergoing arthroscopic surgery to treat a symptomatic meniscus injury. The mean age of patients was 49.86 +/- 11.75 years. Based on linear mixed effects models, there were significantly greater concentrations of 4 of the 5 pro-inflammatory biomarkers in symptomatic knees compared to asymptomatic knees when controlling for the duration of symptoms, BMI, age, and the random effects of by-patient variability. Knees with symptomatic meniscus injuries had 126.8 times greater concentration of IL-6, 2.7 times greater concentration of MCP-1, 2.0 times greater concentration of MIP-1beta, and 5.4 times greater concentration of MMP-3 compared to the contralateral, asymptomatic knee (Table 1). When controlling for the chronicity of the injury, presence of synovitis, and age of the patient, knees with concomitant high-grade cartilage lesions (ICRS 3 or 4) were associated with 2.1 times greater concentration of MCP-1, 1.9 times greater concentration of MIP-1beta, and 3.4 times greater concentration of VEGF compared to knees with concomitant low-grade cartilage lesions (ICRS 1 or 2). When controlling for the other variables, the presence of synovitis was associated with an 89.5% lower concentration of TIMP-1 compared to operative knees without synovitis. The age of the patient was found to affect the concentrations of IL-6, MCP-1, and VEGF. For all knees included in the study, each 1 year increase in age was associated with a 6% increase in IL-6, 3% increase in MCP-1, and 4% increase in VEGF (Figure 1). Conclusion: This study is the first that examines the synovial fluid biomarker concentrations in the setting of a symptomatic isolated meniscus injury. We demonstrated that 4 of the 5 proinflammatory biomarkers that were tested are found in greater concentration in the symptomatic knee. Furthermore, we described the effects of associated cartilage damage, synovitis, and patient age on biomarker concentrations. Understanding the implication of these alterations in the intra-articular microenvironment in the setting of meniscal pathology may hold the key to identifying treatment targets in an effort to prevent the onset of post-meniscectomy osteoarthritis. [Table: see text]

Knee-related quality of life, functional results and osteoarthritis at a minimum of 20 years' follow-up after anterior cruciate ligament reconstruction

BackgroundFew studies in the literature show results with more than 20 years of follow-up after anterior cruciate ligament reconstruction (ACLR). The main purpose of this retrospective study was to describe knee-specific quality of life, functional results and prevalence of osteoarthritis (OA) of the knee in patients with ACLR using bone–patellar tendon–bone (BPTB) autograft with ultra-long-term follow-up. MethodsProspective analyzed data included demographics, meniscus status, radiographic OA, KT-1000 arthrometer measurements and physical examinations. KOOS, Lysholm and IKDC subjective surveys were conducted. Multivariate and univariate logistic models were used to determine the effect of potential predictors of OA and symptomatic knees. ResultsSeventy-two knees were included at a median follow-up of 22 (IQR 21–25) years postoperatively. Radiographic scores were normal in 15%, nearly normal in 57%, abnormal in 18% and severely abnormal in 10%. Multivariate analysis showed that the predictive factor for the presence of OA in the long-term was an associated meniscal lesion; patients with meniscal lesions were 3.9 times as likely to develop OA in comparison with those without meniscal injury. The subjective scores were progressively and significantly lower as the level of OA was greater. ConclusionAt a median of 22 years of follow-up, this study shows that patellar tendon autograft ACL reconstruction provides good clinical outcomes, with clinically objective knee stability and a 28% prevalence of OA. Additionally, we identified that meniscal injury at time of surgery was an independent predictor of OA. Level of evidenceLevel IV; case series.

Symptomatic bone marrow lesions induced by reduced bone mineral density in middle-aged women: a cross-sectional Japanese population study

BackgroundThe etiology of bone marrow lesions (BMLs) without knee osteoarthritis (KOA) and their association with bone fragility are unclear. We aimed to investigate the association between BMLs, bone mineral density (BMD), and bone markers in women without radiographic evidence of KOA.MethodsThis single-center cross-sectional study in a Japanese population included 266 women without radiographic evidence of KOA, which was defined as a Kellgren-Lawrence grade < 2. All participants underwent coronal and sagittal T2-weighted fat-suppressed magnetic resonance imaging of their right knee. BML severity was scored according to the Whole-Organ MRI Scoring method. BMD was measured by dual-energy X-ray absorptiometry of the forearm. Levels of bone markers (bone-alkaline phosphatase [BAP], type I procollagen N-terminal propeptide [PINP], cross-linked N-telopeptide of type I collagen [NTx], and tartrate-resistant acid phosphatase-5b [TRACP-5b]), pentosidine, and homocysteine were assessed in the serum. Knee symptoms were evaluated on the basis of the Knee injury and Osteoarthritis and Outcome Score (KOOS). Participants were divided into symptomatic knee and asymptomatic knee groups on the basis of their KOOS according to the classification criteria for early KOA. Multiple linear regression analysis was performed to evaluate the relationship between BMLs, BMD, and bone markers.ResultsThe prevalence of BML was 35.3%. Age and some bone marker levels (BAP, PINP, NTx, and TRACP-5b) were higher, and all KOOS subscale scores and BMD were lower in participants with BMLs than in those without BMLs. On multiple linear regression analysis, BMD was negatively associated with BMLs (p = 0.014) in participants with symptomatic knees. There was no such association in participants with asymptomatic knees (p = 0.918). Among the bone markers, BAP (p = 0.006) and PINP (p = 0.043) were positively associated with BMLs in participants with symptomatic knees, while BAP (p = 0.038) and TRACP-5b (p = 0.011) were positively associated with BMLs in participants with asymptomatic knees.ConclusionsIn symptomatic Japanese women without radiographic evidence of KOA, BMD is negatively associated and some bone markers are positively associated with BMLs after adjustment for age and BMI. Thus, maintaining systemic bone metabolism could contribute to BML prevention in patients with pre-radiographic KOA.

Tramadol in Knee Osteoarthritis: Does Preoperative Use Affect Patient-Reported Outcomes After Total Knee Arthroplasty?

BackgroundThe 2013 American Academy of Orthopedic Surgeons evidence-based guidelines recommend against the use of preoperative narcotics in the management of symptomatic osteoarthritic knees; however, the guidelines strongly recommend tramadol in this patient population. To our knowledge, no study to date has evaluated outcomes in patients who use tramadol exclusively as compared with narcotics naive patients. MethodsThis is a retrospective study of prospectively collected data for patients who underwent unilateral primary total knee arthroplasty between January 2017 and March 2018. PRO scores were obtained using a novel electronic patient rehabilitation application, which pushed PRO surveys via email and mobile devices within 1 month prior to surgery and 3 months postoperatively. ResultsOne hundred and thirty-six patients were opiate naïve, while 63 had obtained narcotics before the index operation. Of those, 21 patients received tramadol. The average preoperative Knee Disability and Osteoarthritis Outcome Scores were 50.4, 49.95, and 48.01 for the naïve, tramadol, and narcotic populations, respectively, (P = .60). The tramadol cohort had the least gain in 3 months postoperative Knee Disability and Osteoarthritis Outcome Scores, improving on average 12.5 points in comparison to the 19.1 and 20.1 improvements seen in the narcotic and naïve cohorts, respectively (P = .09). This difference was statistically significant when comparing the naïve and tramadol populations alone in post hoc analysis (P = .016). ConclusionsWhen comparing patients who took tramadol preoperatively to patients who were opiate naïve, patients that used tramadol trended toward significantly less improvement in functional outcomes in the short-term postoperative period.