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Bayramoglu N, Englund M, Haugen IK, Ishijima M, Saarakkala S. Deep Learning for Predicting Progression of Patellofemoral Osteoarthritis Based on Lateral Knee Radiographs, Demographic Data, and Symptomatic Assessments. Methods Inf Med 2024. [PMID: 38604249 DOI: 10.1055/a-2305-2115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
OBJECTIVE In this study, we propose a novel framework that utilizes deep learning and attention mechanisms to predict the radiographic progression of patellofemoral osteoarthritis (PFOA) over a period of 7 years. MATERIAL AND METHODS This study included subjects (1,832 subjects, 3,276 knees) from the baseline of the Multicenter Osteoarthritis Study (MOST). Patellofemoral joint regions of interest were identified using an automated landmark detection tool (BoneFinder) on lateral knee X-rays. An end-to-end deep learning method was developed for predicting PFOA progression based on imaging data in a five-fold cross-validation setting. To evaluate the performance of the models, a set of baselines based on known risk factors were developed and analyzed using gradient boosting machine (GBM). Risk factors included age, sex, body mass index, and Western Ontario and McMaster Universities Arthritis Index score, and the radiographic osteoarthritis stage of the tibiofemoral joint (Kellgren and Lawrence [KL] score). Finally, to increase predictive power, we trained an ensemble model using both imaging and clinical data. RESULTS Among the individual models, the performance of our deep convolutional neural network attention model achieved the best performance with an area under the receiver operating characteristic curve (AUC) of 0.856 and average precision (AP) of 0.431, slightly outperforming the deep learning approach without attention (AUC = 0.832, AP = 0.4) and the best performing reference GBM model (AUC = 0.767, AP = 0.334). The inclusion of imaging data and clinical variables in an ensemble model allowed statistically more powerful prediction of PFOA progression (AUC = 0.865, AP = 0.447), although the clinical significance of this minor performance gain remains unknown. The spatial attention module improved the predictive performance of the backbone model, and the visual interpretation of attention maps focused on the joint space and the regions where osteophytes typically occur. CONCLUSION This study demonstrated the potential of machine learning models to predict the progression of PFOA using imaging and clinical variables. These models could be used to identify patients who are at high risk of progression and prioritize them for new treatments. However, even though the accuracy of the models were excellent in this study using the MOST dataset, they should be still validated using external patient cohorts in the future.
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Affiliation(s)
- Neslihan Bayramoglu
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | - Martin Englund
- Orthopaedics, Department of Clinical Sciences Lund Faculty of Medicine, Lund University, Lund, Sweden
| | - Ida K Haugen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Muneaki Ishijima
- Department of Orthopaedics, Faculty of Medicine, Juntendo University, Tokyo, Japan
| | - Simo Saarakkala
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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Adel J, Hamoda RE, Mohamed AM, Balbaa AE, Neamat Allah NH, Hamada HA. Is muscle activation diverse in females with isolated patellofemoral osteoarthritis contrasted with age-matched healthy controls during stair descent task? Front Physiol 2024; 15:1286406. [PMID: 38737832 PMCID: PMC11082385 DOI: 10.3389/fphys.2024.1286406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/02/2024] [Indexed: 05/14/2024] Open
Abstract
Background: Patellofemoral osteoarthritis (PF OA) is exceptionally predominant and limiting. However, little is known about the risk factors that contribute to its onset and progression. Purpose: The aim of this study was to decide if women with PF OA descend stairs using different muscular activation strategies compared to similarly aged healthy controls. Methods: Thirty-one women with isolated PF OA and 11 similarly aged healthy women took part in this study. The activation onset and duration of PF OA in vastus medialis oblique (VMO), vastus lateralis (VL), gluteus medius (GM), transversus abdominis (TrA), and multifidus muscles were evaluated during the stair descent task using surface electromyography (EMG). Results: There was a non-significant difference between women with PF OA and healthy controls regarding all tested variables, except for the GM activation onset that was significantly delayed in women with PF OA, with the p-value of 0.011. Conclusion: The causes of PF OA differ and might not always be due to a lack of quadriceps strength or VMO activation deficiency, and prospective longitudinal studies are required to confirm this assumption.
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Affiliation(s)
- Jilan Adel
- Department of Physical Therapy for Musculoskeletal Disorders, Faculty of Physical Therapy, Kafrelsheikh University, Kafrelsheikh, Egypt
| | - Reham E. Hamoda
- Department of Physical Therapy for Woman’s Health, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Department of Physical Therapy for Obstetrics and Gynecology, Faculty of Physical Therapy, October 6 University, Giza, Egypt
| | - Ayah Mahmoud Mohamed
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Alaa Eldin Balbaa
- Department of Physical Therapy for Musculoskeletal Disorders and its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
- Dean of Faculty of Physical Therapy, Nahda University, Beni Suef, Egypt
| | - Neama H. Neamat Allah
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Hamada Ahmed Hamada
- Department of Biomechanics, Faculty of Physical Therapy, Cairo University, Giza, Egypt
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Elliott J, Ahedi H, Parker D. Anatomical site of radiographic degeneration is an independent variable influencing outcome of total knee arthroplasty. J ISAKOS 2024:S2059-7754(24)00002-6. [PMID: 38185248 DOI: 10.1016/j.jisako.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 12/26/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
OBJECTIVES We aimed to determine whether the site of anatomical degenerative change could be identified as an independent risk factor influencing clinical outcome of total knee arthroplasty (TKA) 12 months postoperatively. METHODS We compared preoperative, postoperative and the change observed in Oxford Knee Score (OKS) amongst TKA patients categorised as primarily medial, lateral or patellofemoral osteoarthritis (PFJOA). Multivariable regression analysis was conducted on 434 consecutive knees in 333 patients, adjusting for sex, age and body mass index (BMI). RESULTS Adjusted estimates showed that preoperatively, patients with medial and lateral osteoarthritis (OA) had a lower mean OKS of 2.1 (p = 0.049) and 2.3 (p = 0.056) points respectively, while those with PFJOA had mean scores 2.7 points higher (p = 0.062). There was no statistically significant difference between compartments in absolute postoperative OKS. The greatest improvement of 30.1 points (95% confidence interval (CI) 16.9-36.0, p = 0.012) in OKS was observed for those with lateral OA, followed by 28.9 points (95% CI 16.7-35.3, p = 0.049) for those with medial OA. The improvement observed postoperatively in patients with PFJOA was less than that observed for the average of the cohort at 24.5 (95% CI 11.5-29.7, p = 0.088). CONCLUSIONS The site of compartmental involvement in knee OA is an independent factor influencing clinical outcome of TKA. With arthroplasty registry adoption of patient-reported outcome measures (PROMs), this study supports precise anatomical categorisation of knee OA in outcome studies. LEVEL OF EVIDENCE Level III, Retrospective consecutive clinical study.
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Affiliation(s)
- Johanna Elliott
- Sydney Orthopaedic Research Institute Landmark Orthopaedics, Level 2, 500 Pacific Highway, St Leonards, NSW 2065, Australia; St Vinzenz Hospital, 31-33 Dr. Otto-Seidel Strasse, Dinslaken, 46535, Germany.
| | - Harbeer Ahedi
- Sydney Orthopaedic Research Institute Landmark Orthopaedics, Level 2, 500 Pacific Highway, St Leonards, NSW 2065, Australia
| | - David Parker
- Sydney Orthopaedic Research Institute Landmark Orthopaedics, Level 2, 500 Pacific Highway, St Leonards, NSW 2065, Australia
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Vella-Baldacchino M, Webb J, Selvarajah B, Chatha S, Davies A, Cobb JP, Liddle AD. Should we recommend patellofemoral arthroplasties to patients? Bone Jt Open 2023; 4:948-956. [PMID: 38096897 PMCID: PMC10721344 DOI: 10.1302/2633-1462.412.bjo-2023-0100.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Aims With up to 40% of patients having patellofemoral joint osteoarthritis (PFJ OA), the two arthroplasty options are to replace solely the patellofemoral joint via patellofemoral arthroplasty (PFA), or the entire knee via total knee arthroplasty (TKA). The aim of this study was to assess postoperative success of second-generation PFAs compared to TKAs for patients treated for PFJ OA using patient-reported outcome measures (PROMs) and domains deemed important by patients following a patient and public involvement meeting. Methods MEDLINE, EMBASE via OVID, CINAHL, and EBSCO were searched from inception to January 2022. Any study addressing surgical treatment of primary patellofemoral joint OA using second generation PFA and TKA in patients aged above 18 years with follow-up data of 30 days were included. Studies relating to OA secondary to trauma were excluded. ROB-2 and ROBINS-I bias tools were used. Results A total of nine studies were included, made up of four randomized controlled trials (domain 1) and five cohort studies (domain 2). PROMs and knee function specific scores developed for reporting TKA were unable to detect any difference between PFA and TKA. There was no significant difference in complications between PFA and TKA. PFAs were found to have a better postoperative range of motion. Conclusion TKA and PFA are both viable options for patients with primary PFJ OA. Over time, we have seen an emphasis on patient satisfaction and better quality of life. Recommending sacrificing healthy medial and lateral compartments to treat patellofemoral joint arthritis should be given further thought.
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Affiliation(s)
| | | | | | | | - Andrew Davies
- Department of Bioengineering, Imperial College London, London, UK
| | - Justin P. Cobb
- MSk Lab, Imperial College London, Department of Surgery & Cancer, Sir Michael Uren Hub, London, UK
| | - Alexander D. Liddle
- MSk Lab, Imperial College London, Department of Surgery & Cancer, Sir Michael Uren Hub, London, UK
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Ölmez SB, Maraş G, Ulucaköy C, Başar S. Reliability and validity of the Turkish version of the patellofemoral pain and osteoarthritis subscale of the KOOS. Physiother Theory Pract 2023:1-8. [PMID: 38059491 DOI: 10.1080/09593985.2023.2288197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 11/18/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Patellofemoral pain and patellofemoral osteoarthritis are highly prevalent knee disorders associated with pain and functional limitations. The subscale of the Knee Injury and Osteoarthritis Outcome Score for patellofemoral pain and osteoarthritis (KOOS-PF) was developed to evaluate patients with patellofemoral pain and osteoarthritis. PURPOSE This study aims to translate the KOOS-PF into Turkish and assess its measurement properties. METHODS The Turkish version of the KOOS-PF was tested for reliability and validity in a convenience sample of 55 patients with patellofemoral pain and/or osteoarthritis. Reliability analyses were conducted through a retest 7-14 days later with a subgroup of 35 patients. The KOOS-PF was compared with Kujala's Anterior Pain Scale (AKPS) and the Short Form-36 health survey (SF-36) to assess construct validity. Additionally, responsiveness analyses were performed on 29 patients who were followed up with a home-based exercise program three months later. RESULTS The Turkish version of KOOS-PF has high test-retest reliability (ICC2,1 = 0.96) and internal consistency (Cronbach's α = 0.91). It has a very good correlation with the AKPS (r = 0.77) and the SF-36 physical component summary (r = 0.64) with no floor or ceiling effects. Responsiveness is confirmed by a good correlation with the global rating of change score (r = 0.51). The minimal clinically important change is 16.5 points, and the minimal important difference is 10.2. CONCLUSION The Turkish version of the KOOS-PF is valid, reliable, and responsive for evaluating patients with patellofemoral pain and/or osteoarthritis.
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Affiliation(s)
- Sevim Beyza Ölmez
- Department of Physiotherapy and Rehabilitation, Faculty of Health Science, Karamanoğlu Mehmetbey University, Karaman, Turkey
| | - Gökhan Maraş
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Amasya University, Amasya, Turkey
| | - Coşkun Ulucaköy
- Department of Orthopedics and Traumatology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Yenimahalle/Ankara, Turkey
| | - Selda Başar
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Çankaya/Ankara, Turkey
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Yang Y, Chen Y, Wang Y, Wang J, Lu B, Zhu W, Yang N, Zhu J, Zhu C, Zhang X. The landscape of patellofemoral arthroplasty research: a bibliometric analysis. ARTHROPLASTY 2023; 5:65. [PMID: 38042843 PMCID: PMC10693710 DOI: 10.1186/s42836-023-00215-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/25/2023] [Indexed: 12/04/2023] Open
Abstract
PURPOSE Patellofemoral arthroplasty (PFA) was shown to be a potentially effective surgical technique for isolated patellofemoral osteoarthritis but varying reports on PFA-related implant failure and complications have rendered the procedure controversial. This study aimed to identify impactful publications, research interests/efforts, and collaborative networks in the field of PFA research. METHODS The study used the Web of Science Core Collection (WOSCC) database, Medline, Springer, BIOSIS Citation Index, and PubMed to retrieve relevant publications on PFA research published between 1950-2022. Statistical tests in R software were used for analysis while VOSviewer, Bibliometrix, and CiteSpace were employed for data visualization. RESULTS Two hundred forty-one articles were analyzed with the number of published papers increasing over time. Knee was the most frequent journal and Clinical Orthopaedics and Related Research was the most cited journal. Clinical outcomes, such as prosthesis survival, revision, and complications, were researched most frequently as demonstrated by keyword analysis. The United States was the top contributor to cooperative networks, followed by the United Kingdom while Technical University Munich formed close ties among authors. CONCLUSION Publications on PFA research have witnessed a notable surge. They primarily came from a limited number of centers and were characterized by low-level evidence. The majority of studies primarily focused on the clinical outcomes of PFA, while revision of PFA and patient satisfaction have emerged as new research areas.
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Affiliation(s)
- Yao Yang
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, China
- Department of Orthopedics, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230061, China
| | - Yuan Chen
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, China
- Department of Orthopedics, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230061, China
| | - Yingjie Wang
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, China
- Department of Orthopedics, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230061, China
| | - Junjie Wang
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, China
- Department of Orthopedics, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230061, China
| | - Baoliang Lu
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, China
- Department of Orthopedics, Graduate School of Bengbu Medical College, Bengbu, 233030, China
| | - Wanbo Zhu
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, 200233, China
| | - Ning Yang
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, China
| | - Junchen Zhu
- Department of Orthopedics, The Second Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, 230061, China.
| | - Chen Zhu
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, China.
| | - Xianzuo Zhang
- Department of Orthopedics, Division of Life Sciences and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230001, China.
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Lachance AD, Steika R, Lutton J, Austin D. Conversion of Patellofemoral Arthroplasty to Robotic-Assisted Total Knee Arthroplasty. Arthroplast Today 2023; 23:101215. [PMID: 37745967 PMCID: PMC10514419 DOI: 10.1016/j.artd.2023.101215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 09/26/2023] Open
Abstract
Conversion of patellofemoral arthroplasty to total knee arthroplasty (TKA) has been described as similar to primary TKA, although it may come with more challenges and worse outcomes. With the increased rate of revision following conversion TKA vs primary TKA, robotically assisted TKA provides an alternative technique to manual conversion. We present 3 cases of robot-assisted conversion of prior patellofemoral arthroplasty to TKA with good mechanical and clinical outcomes and no intraoperative complications.
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Affiliation(s)
| | - Roman Steika
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA, USA
| | - Jeffrey Lutton
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA, USA
| | - David Austin
- Department of Orthopaedic Surgery, Guthrie Clinic, Sayre, PA, USA
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Silvestre A, Lintingre PF, Pesquer L, Meyer P, Moreau-Durieux MH, Dallaudiére B. Retrospective Analysis of Responders and Impaired Patients with Knee Osteoarthritis Treated with Two Consecutive Injections of Very Pure Platelet-Rich Plasma (PRP). Bioengineering (Basel) 2023; 10:922. [PMID: 37627807 PMCID: PMC10451974 DOI: 10.3390/bioengineering10080922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/26/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVES To assess the effectiveness of two consecutive intraarticular injections of PRP to treat knee osteoarthritis (KOA), discriminating between responders and impaired patients. METHODS This retrospective study included 73 consecutive patients who were referred for two intra-articular PRP injections (one week apart) for treating symptomatic moderate/severe KOA. Biological characterization of the PRP, including platelets, leukocytes and erythrocytes, was evaluated. Patient's subjective symptoms were recorded before the treatment and 1 year after the second injection using pain VAS and WOMAC scores. Responders were defined by an improvement of 10 points on WOMAC. RESULTS At a 1-year follow up, we found 36 (49.3%) patients who fulfilled the criteria of responders, and 21 (28.8%) patients were impaired. A statistically and clinically significant global improvement of -29.2 ± 14.3 (p < 0.001) points in WOMAC score was observed 1 year after treatment in the responder group, with a higher response rate in patients with KL 2 (57.7%) compared to KL IV (28.6%). The percentage of patients with KL IV was higher in the impaired group (48.0%) compared to the responders (16.6%). As expected, the evaluation of the functionality of the knee in the impaired group indicates that it significantly worsened after one year from treatment (p = 0.027). However, the average pain score remained stable with no significant differences after 1 year (p = 0.843). No clinical complications or severe adverse events after the PRP injections were reported. CONCLUSION The present study suggests that two intra-articular injections of 10 mL of very pure PRP provide pain and functional improvement in symptomatic KOA.
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Affiliation(s)
| | | | | | | | | | - Benjamin Dallaudiére
- Clinique du Sport de Bordeaux Mérignac, 33700 Mérignac, France; (A.S.); (P.-F.L.); (L.P.); (P.M.); (M.-H.M.-D.)
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Silva NC, Silva MDC, Tamburús NY, Guimarães MG, Nascimento MBDO, Felicio LR. Adding neuromuscular training to a strengthening program did not produce additional improvement in clinical or kinematic outcomes in women with patellofemoral pain: A blinded randomised controlled trial. Musculoskelet Sci Pract 2023; 63:102720. [PMID: 36732139 DOI: 10.1016/j.msksp.2023.102720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/26/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Patellofemoral pain (PFP) is a knee pain condition with multifactorial aetiology, twice common in women. The recommended conservative treatment is based on strengthening of the core, hip, and knee musculatures. Addition of neuromuscular training to a strengthening protocol might provide further benefits on pain, function, and kinematics in PFP individuals. However, evidence for the effectiveness of this protocol is lacking. OBJECTIVE To investigate whether adding neuromuscular training to strengthening program could provide any additional improvements of pain, function, and kinematics in PFP women. METHODS 71 PFP women were randomly into two groups and submitted to different interventions for 12 weeks. The strengthening group (SG) performed strengthening exercises for the trunk, hip, and knee muscles, while the neuromuscular training group (NMTG) performed the same exercises as SG, plus neuromuscular training from the 4th week onwards. The primary outcomes were pain intensity, function, and 2-D kinematics of the trunk and lower limb. The secondary outcomes were isometric muscle strength and patient satisfaction level. All outcomes were evaluated at 12 weeks, immediately post-treatment. RESULTS At 12 weeks, there was no evidence of between-group differences for any outcome, but both interventions provided clinically significant improvements for pain intensity (SG: mean difference -3.9, 95% confidence interval [CI] -5.0, -2.9; NMTG: mean difference -3.1, 95% CI -4.1, -2.0) and function (SG: mean difference 15.3, 95% CI 11.5, 19.2; NMTG: mean difference 16.9, 95% CI 13.2, 20.7). CONCLUSION Neuromuscular training did not produce any additional benefits for pain, function, or kinematics at 12 weeks of treatment.
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Affiliation(s)
- Natália Camin Silva
- Physiotherapy Postgraduate Program, Universidade Federal de Uberlândia, Minas Gerais, Brazil.
| | - Matheus de Castro Silva
- Physiotherapy Postgraduate Program, Universidade Federal de Uberlândia, Minas Gerais, Brazil
| | | | | | | | - Lilian Ramiro Felicio
- Physiotherapy Postgraduate Program, Universidade Federal de Uberlândia, Minas Gerais, Brazil.
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E T, Wang C, Cui Y, Nai R, Zhang Y, Zhang X, Wang X. Automatic diagnosis and grading of patellofemoral osteoarthritis from the axial radiographic view: a deep learning-based approach. Acta Radiol 2023; 64:658-665. [PMID: 35410487 DOI: 10.1177/02841851221092164] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patellofemoral osteoarthritis (PFOA) has a high prevalence and is assessed on axial radiography of the patellofemoral joint (PFJ). A deep learning (DL)-based approach could help radiologists automatically diagnose and grade PFOA via interpreting axial radiographs. PURPOSE To develop and assess the performance of a DL-based approach for diagnosing and grading PFOA on axial radiographs. MATERIAL AND METHODS A total of 1280 (dataset 1) axial radiographs were retrospectively collected and utilized to develop the high-resolution network (HRNet)-based classification models. The ground truth was the interpretation from two experienced radiologists in consensus according to the K-L grading system. A binary-class model was trained to diagnose the presence (K-L 2∼4) or absence (K-L 0∼1) of PFOA. A multi-class model was used to grade the stage of PFOA, i.e. from K-L 0 to K-L 4. Model performances were evaluated using the receiver operating characteristics (ROC), confusion matrix, and the corresponding evaluation metrics (positive predictive value [PPV], negative predictive value [NPV], F1 score, sensitivity, specificity, accuracy) of the internal test set (n = 129) from dataset 1 and an external validation set (dataset 2, n = 187). RESULTS For the binary-class model, the area under the curve (AUC) was 0.91 in the internal test set and 0.90 in the external validation set. For grading PFOA, moderate to severe stage of PFOA exhibited a good performance in these two datasets (AUC = 0.91-0.98, PPV = 0.69-0.90, NPV = 0.92-0.99, F1 score = 0.72-0.87, sensitivity = 0.75-0.87, specificity = 0.90-0.99, accuracy = 0.87-0.98). CONCLUSION The HRNet-based approach performed well in diagnosing and grading radiographic PFOA, especially for the moderate to severe cases.
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Affiliation(s)
- Tuya E
- Department of Radiology, 26447Peking University First Hospital, Beijing, PR China
| | - Cen Wang
- Department of Radiology, Beijing Nuclear Industry Hospital, Beijing, PR China
| | - Yingpu Cui
- Department of Radiology, 26447Peking University First Hospital, Beijing, PR China
| | - Rile Nai
- Department of Radiology, 26447Peking University First Hospital, Beijing, PR China
| | - Yaofeng Zhang
- Beijing Smart-imaging Technology Co.Ltd, Beijing, PR China
| | - Xiaodong Zhang
- Department of Radiology, 26447Peking University First Hospital, Beijing, PR China
| | - Xiaoying Wang
- Department of Radiology, 26447Peking University First Hospital, Beijing, PR China
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Serino J, Weintraub MT, Burnett RA, Angotti ML, Courtney PM, Della Valle CJ. Complications and costs of patellofemoral arthroplasty versus total knee arthroplasty. Knee 2023; 41:58-65. [PMID: 36638704 DOI: 10.1016/j.knee.2022.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/16/2022] [Accepted: 12/14/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Patellofemoral arthroplasty (PFA) is an alternative to total knee arthroplasty (TKA) for the treatment of patellofemoral arthritis. Although PFA may preserve native kinematics and accelerate recovery, it has been associated with higher revision rates. The purpose of this study is to compare complication rates and costs between PFA and TKA. METHODS Using the PearlDiver database, 6,179 patients with isolated patellofemoral arthritis treated with PFA or TKA from 2010-2015 were retrospectively reviewed with 5-year follow up. PFA and TKA patients were matched by age, sex, and Elixhauser Comorbidity Index via a 1:1 stepwise algorithm. Five-year costs and complications were compared between matched cohorts. The lifetime costs of PFA and TKA were evaluated with Markov decision modeling. RESULTS Compared to TKA, PFA was associated with fewer Emergency Department (ED) visits (6.1% vs 3.9%, p = 0.004) but a higher 5-year revision rate (9.9% vs 4.2%, p < 0.001). After multivariate regression, PFA was independently more likely to require revision (odds ratio 2.60, 95% confidence interval 1.32-4.71, p = 0.003). PFA was associated with lower total healthcare costs at every time point between 3 months ($18,014 vs $26,473, p < 0.001) and 5 years ($20,837 vs $27,942, p < 0.001). On average, the lifetime cost of PFA per patient was $5,235 less than for TKA ($26,343 vs $31,578). CONCLUSIONS PFA is a less expensive alternative to TKA with a similar risk of medical complications but is associated with a significantly higher 5-year revision rate. Future studies should examine the reasons for PFA failure and methods to mitigate this risk.
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Affiliation(s)
- Joseph Serino
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60608, United States
| | - Matthew T Weintraub
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60608, United States
| | - Robert A Burnett
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60608, United States
| | - Morgan L Angotti
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60608, United States
| | - P Maxwell Courtney
- Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA 19107, United States
| | - Craig J Della Valle
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL 60608, United States.
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12
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Zhang K, Liu P, Xu S, Zhang B, Zhan H. Clinical observation of acupuncture combined with sitting-position knee-adjustment manipulations for patellofemoral arthritis. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2022. [DOI: 10.1007/s11726-022-1348-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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13
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Jachak S, Phansopkar P, Chitale N. Occulus-Guided Rehabilitation Approach in a Patient With Osteoarthritis Knee: A Case Report. Cureus 2022; 14:e29021. [PMID: 36237738 PMCID: PMC9552510 DOI: 10.7759/cureus.29021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/11/2022] [Indexed: 11/05/2022] Open
Abstract
Osteoarthritis (OA) is the most frequent musculoskeletal condition affecting the elderly's quality of life. Wear and tear, as well as the progressive deterioration of articular cartilage, are the causes of OA, also known as degenerative joint disease. There are two types of OA: primary and secondary. The condition can be treated both conservatively and surgically. Medication and physical therapy might be used to treat it conservatively. Physical rehabilitation can include advanced management through the use of virtual reality (VR). The other option for treatment is surgical management. We are presenting a case of a 52-year-old female who presented to musculoskeletal physiotherapy out patient department with complaints of left-sided knee pain, stiffness, and difficulty in sitting with crossed legs on the floor. On examination, crepitations were present. Knee range of motion and strength were significantly reduced. Physiotherapy treatment was planned for the same. In physiotherapy rehabilitation, Occulus-guided physiotherapy exercises were given to improve the strength and range of motion of the joint.
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Macri EM, Neogi T, Jarraya M, Guermazi A, Roemer F, Lewis CE, Torner JC, Lynch JA, Tolstykh I, Jafarzadeh SR, Stefanik JJ. Magnetic Resonance Imaging-Defined Osteoarthritis Features and Anterior Knee Pain in Individuals With, or at Risk for, Knee Osteoarthritis: A Multicenter Study on Osteoarthritis. Arthritis Care Res (Hoboken) 2022; 74:1533-1540. [PMID: 33768706 PMCID: PMC8463633 DOI: 10.1002/acr.24604] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 01/21/2021] [Accepted: 03/23/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The lack of strong association between knee osteoarthritis (OA) structural features and pain continues to perplex researchers and clinicians. Evaluating the patellofemoral joint in addition to the tibiofemoral joint alone has contributed to explaining this structure-pain discordance, hence justifying a more comprehensive evaluation of whole-knee OA and pain. The present study, therefore, was undertaken to evaluate the association between patellofemoral and tibiofemoral OA features with localized anterior knee pain (AKP) using 2 study designs. METHODS Using cross-sectional data from the Multicenter Osteoarthritis Study, our first approach was a within-person, knee-matched design in which we identified participants with unilateral AKP. We then assessed magnetic resonance imaging (MRI)-derived OA features (cartilage damage, bone marrow lesions [BMLs], osteophytes, and inflammation) in both knees and evaluated the association of patellofemoral and tibiofemoral OA features to unilateral AKP. In our second approach, MRIs from 1 knee per person were scored, and we evaluated the association of OA features to AKP in participants with AKP and participants with no frequent knee pain. RESULTS Using the first approach (n = 71, 66% women, mean ± SD age 69 ± 8 years), lateral patellofemoral osteophytes (odds ratio [OR] 5.0 [95% confidence interval (95% CI) 1.7-14.6]), whole-knee joint effusion-synovitis (OR 4.7 [95% CI 1.3-16.2]), and infrapatellar synovitis (OR 2.8 [95% CI 1.0-7.8]) were associated with AKP. Using the second approach (n = 882, 59% women, mean ± SD age 69 ± 7 years), lateral and medial patellofemoral cartilage damage (prevalence ratio [PR] 2.3 [95% CI 1.3-4.0] and PR 1.9 [95% CI 1.1-3.3], respectively) and lateral patellofemoral BMLs (PR 2.6 [95% CI 1.5-4.7]) were associated with AKP. CONCLUSION Patellofemoral but not tibiofemoral joint OA features and inflammation were associated with AKP.
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Affiliation(s)
- Erin M. Macri
- Erasmus MC, Rotterdam, The Netherlands, and University of DelawareNewark
| | - Tuhina Neogi
- Boston University and Boston Imaging Core LabBostonMassachusetts
| | | | - Ali Guermazi
- Boston University and Boston Imaging Core LabBostonMassachusetts
| | - Frank Roemer
- Boston University, Boston, Massachusetts, and Friedrich‐Alexander University Erlangen‐NurembergErlangenGermany
| | | | | | | | | | | | - Joshua J. Stefanik
- University of Delaware, Newark, and Northeastern UniversityBostonMassachusetts
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Carvalho C, de Oliveira MPB, Pisani GK, Marolde IB, Serrão PRMDS. Biomechanical characteristics and muscle function in individuals with patellofemoral osteoarthritis: A systematic review of cross-sectional studies. Clin Biomech (Bristol, Avon) 2022; 98:105721. [PMID: 35868250 DOI: 10.1016/j.clinbiomech.2022.105721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 06/02/2022] [Accepted: 07/12/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Our objective was to investigate kinematic and kinetic characteristics and changes in muscle function in individuals with patellofemoral osteoarthritis compared to healthy individuals. METHODS Searches were performed of the Medline, Embase, Web of Science, The Cochrane Library, LILACS, and SciELO databases until May of 2022 for observational studies comparing individuals with patellofemoral osteoarthritis to a control group. The PRISMA guidelines and recommendations of the Cochrane Collaboration were followed. The GRADE approach was used to analyze and synthesize the level of evidence. FINDINGS Fourteen studies were included, involving a total of 594 participants (360 with patellofemoral osteoarthritis and 234 controls). The level of evidence for pelvis, hip adduction and knee abduction angles at 45° of knee flexion during the single-leg squat, and knee flexion angle during the task of walking was very low. Regarding muscle strength, the level of evidence for isometric strength of the hip abductors, extensors and external rotators, and concentric strength of the knee extensors and flexors was very low. It was not possible to synthesize any type of evidence for kinetic, electromyography, or muscle volume variables. INTERPRETATION The level of evidence was very low for all synthesized evidence for kinematic and muscle strength variables. However, individuals with patellofemoral osteoarthritis have lower isometric strength of the hip abductor muscles. Further studies with adequate adjustment for confounding factors, such as the non-inclusion of individuals with osteoarthritis in the tibiofemoral compartment concomitant to patellofemoral osteoarthritis, are needed to gain a better understanding of the clinical characteristics of patellofemoral osteoarthritis.
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Affiliation(s)
- Cristiano Carvalho
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil.
| | - Marcos Paulo Braz de Oliveira
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Giulia Keppe Pisani
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Isabela Bianchini Marolde
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
| | - Paula Regina Mendes da Silva Serrão
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, SP, Brazil; Physical Therapy Post-Graduate Program, Federal University of São Carlos, São Carlos, SP, Brazil
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16
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Siqueira MS, Souto LR, Martinez AF, Serrão FV, de Noronha M. Muscle activation, strength, and volume in people with patellofemoral osteoarthritis: a systematic review and meta-analysis. Osteoarthritis Cartilage 2022; 30:935-944. [PMID: 35257862 DOI: 10.1016/j.joca.2022.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 01/20/2022] [Accepted: 01/31/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This systematic review investigated whether people with patellofemoral osteoarthritis (PFOA) have muscle strength, volume, and activation around the hip and knee that is different from asymptomatic controls. METHODS Searches were carried out in five electronic databases, with terms related to PFOA, including muscle strength, volume and activation. Only studies with at least one group with symptomatic PFOA and one asymptomatic group were included. The methodological quality of the studies was assessed using the Downs and Black checklist. Certainty of evidence was assessed using the GRADE methodology. Using the random effects model, a meta-analysis was performed when there were at least two studies reporting the same domain. RESULTS Eight studies (250 participants) met the inclusion criteria. Subjects with PFOA had weaker hip abduction (SMD -0.96; 95%CI = -1.34 to -0.57), hip external rotation (-0.55;-1.07 to -0.03), hip extension (-0.72;-1.16 to -0.28), and knee extension (-0.97;-1.41 to -0.53) when compared to asymptomatic controls. People with PFOA also presented with smaller volumes of the gluteus medius, gluteus minimus, tensor fascia lata, vastus medialis (VM), vastus lateralis (VL) and rectus femoris when compared to asymptomatic controls. Also, people with PFOA presented with changes in muscle activation for the VL, VM and gluteus maximus (GMax) when compared to asymptomatic controls. CONCLUSION People with PFOA present with lower strength and volume of the hip and quadriceps muscles and altered muscle activation of the VM, VL and GMax during ascending and descending stairs when compared to asymptomatic controls. However, the certainty of these findings are very low. TRIAL REGISTRATION NUMBER PROSPERO systematic review protocol (ID = CRD42020197776).
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Affiliation(s)
- M S Siqueira
- Department of Physical Therapy, Center of Biological and Health Sciences, Federal University of São Carlos, Washington Luiz Road, km 235, SP310, São Carlos, São Paulo 13565-905, Brazil.
| | - L R Souto
- Department of Physical Therapy, Center of Biological and Health Sciences, Federal University of São Carlos, Washington Luiz Road, km 235, SP310, São Carlos, São Paulo 13565-905, Brazil.
| | - A F Martinez
- Department of Physical Therapy, Center of Biological and Health Sciences, Federal University of São Carlos, Washington Luiz Road, km 235, SP310, São Carlos, São Paulo 13565-905, Brazil.
| | - F V Serrão
- Department of Physical Therapy, Center of Biological and Health Sciences, Federal University of São Carlos, Washington Luiz Road, km 235, SP310, São Carlos, São Paulo 13565-905, Brazil.
| | - M de Noronha
- Rural Department of Allied Health, Rural Health School, La Trobe University, Bendigo, VIC 3660, Australia.
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Zhang H, Bei M, Zheng Z, Liu N, Cao X, Xiao Y, Lian Q, Wang Y, Hou X, Tian F. Parathyroid Hormone (1-34) Attenuates Cartilage Degradation and Preserves Subchondral Bone Micro-architecture in Rats with Patella Baja-Induced-Patellofemoral Joint Osteoarthritis. Calcif Tissue Int 2022; 111:87-95. [PMID: 35179619 DOI: 10.1007/s00223-022-00958-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/04/2022] [Indexed: 11/28/2022]
Abstract
Several studies have revealed that PTH1-34 may possess the potential for treating osteoarthritis (OA) and osteoporosis. However, no study has yet determined whether PTH1-34 can be used for the treatment of patella baja-induced patellofemoral joint OA (PFJOA). Thus, this study sought to assess the efficacy of PTH1-34 for the treatment of PFJOA in a rat model. Patella baja was induced in 3-month-old female Sprague-Dawley (SD) rats by patellar ligament shortening (PLS), after which the rats were randomly divided into three groups (n = 12): Sham, PLS, and PTH group (PTH + PLS, PTH1-34, 30 µg/kg/d, 5 days per week for 10 weeks). Thereafter, radiographic imaging, macroscopic and microscopic analyses, immunohistochemistry, and microcomputed tomography (CT) analysis were performed. The appearance of PLS-induced PFJOA promoted obvious changes in the patellar position and structure in the PLS group, which were characterized by cartilage degeneration, subchondral bone microstructure deterioration, patella baja, and increasing patella length. However, these negative characteristics were markedly ameliorated by PTH1-34, which not only inhibited cartilage catabolism by decreasing MMP-13 and ADAMTS-4 but also enhanced anabolism by increasing Col-II and Aggrecan. Furthermore, the micro-CT results showed a marked improvement in subchondral bone microarchitecture. The findings presented herein demonstrated that early treatment with PTH1-34 could improve cartilage metabolism and subchondral bone health in this PFJOA model.
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Affiliation(s)
- Hongfei Zhang
- School of Public Health, North China University of Science and Technology, Bohai Road 21, Caofeidian Dis., Tangshan, 063210, Hebei, People's Republic of China
| | - Mingjian Bei
- Department of Orthopedic Surgery, Beijing Ji Shui Tan Hospital, Xinjiekoudongjie 31, Xicheng Dis., Beijing, 100035, People's Republic of China
| | - Zhiyuan Zheng
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, People's Republic of China
| | - Ning Liu
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, People's Republic of China
| | - Xuehui Cao
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, People's Republic of China
| | - Yaping Xiao
- Department of Orthopedic Surgery, The Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, People's Republic of China
| | - Qiangqiang Lian
- School of Public Health, North China University of Science and Technology, Bohai Road 21, Caofeidian Dis., Tangshan, 063210, Hebei, People's Republic of China
| | - Yudan Wang
- School of Public Health, North China University of Science and Technology, Bohai Road 21, Caofeidian Dis., Tangshan, 063210, Hebei, People's Republic of China
| | - Xiaoli Hou
- School of Public Health, North China University of Science and Technology, Bohai Road 21, Caofeidian Dis., Tangshan, 063210, Hebei, People's Republic of China
| | - Faming Tian
- School of Public Health, North China University of Science and Technology, Bohai Road 21, Caofeidian Dis., Tangshan, 063210, Hebei, People's Republic of China.
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Macri EM, van Middelkoop M, Damen J, Bos PK, Bierma-Zeinstra SM. Higher risk of knee arthroplasty during ten-year follow-up if baseline radiographic osteoarthritis involves the patellofemoral joint: a CHECK Cohort Study. BMC Musculoskelet Disord 2022; 23:600. [PMID: 35733205 PMCID: PMC9215039 DOI: 10.1186/s12891-022-05549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 06/13/2022] [Indexed: 11/23/2022] Open
Abstract
Background Patellofemoral OA is a strong risk factor for progression to generalized whole knee OA, but it is unknown whether involvement of the patellofemoral joint in early radiographic OA (ROA) is associated with risk of undergoing future knee arthroplasty. This is clinically relevant because patellofemoral OA likely requires a different treatment approach than tibiofemoral OA, and identifying prognostic factors for future arthroplasty might assist clinicians with prioritizing and guiding early interventions that could improve long-term outcomes. Therefore, we evaluated association of baseline patellofemoral or tibiofemoral ROA with undergoing knee arthroplasty over 10 years. Methods Using the multicenter Cohort Hip and Cohort Knee (CHECK) study, we acquired three views of radiographs in both knees of individuals aged 45–65 years with complaints of knee symptoms in at least one knee. From baseline radiographs, we categorized each knee as having one of four patterns of ROA: no ROA, isolated patellofemoral ROA, isolated tibiofemoral ROA, or combined ROA. We evaluated the 10-year relative hazard for undergoing going arthroplasty, based on baseline ROA pattern, using Cox proportional hazard models, adjusting for age, sex body mass index, and pain severity. Result Our sample (n = 842) included 671 (80%) women and had mean (SD) age 56 (5) years, and BMI 26.3 (4.0) kg/m2. Arthroplasties were undertaken in 44/1678 knees. In comparison to having no ROA at baseline, adjusted hazard ratios (aHR) for arthroplasty were highest for combined ROA (aHR 14.2 [95% CI 5.8, 34.6]) and isolated patellofemoral ROA (aHR 12.7 [5.6, 29.0]). Isolated tibiofemoral ROA was not significantly associated with arthroplasty (aHR 2.9 [0.6, 13.6]). Conclusions In a sample of middle-aged individuals with complaints in one or both knees, the 10-year relative hazard for undergoing arthroplasty, compared to no ROA, was increased when OA involved the patellofemoral joint, regardless of whether it was isolated to the patellofemoral joint or occurred in combination with tibiofemoral OA. Further research is needed to confirm this association and to clarify the causal mechanism of this relationship. However, our results provide preliminary evidence that identifying patellofemoral ROA may be a clinically useful prognostic indicator in early knee OA. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05549-6.
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Affiliation(s)
- Erin M Macri
- Department of General Practice, Erasmus University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands. .,Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.
| | - Marienke van Middelkoop
- Department of General Practice, Erasmus University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Jurgen Damen
- Department of General Practice, Erasmus University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - P Koen Bos
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Sita Ma Bierma-Zeinstra
- Department of General Practice, Erasmus University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.,Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
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19
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Abstract
Knee osteoarthritis is rising in prevalence, and more imaging studies are being requested to evaluate these patients. Although conventional radiographs of the knee are the most widely requested and available studies, other imaging modalities such as MRI, CT, and ultrasound may also be used. This article reviews commonly used imaging modalities, advantages and limitations of each, and their clinical applicability in diagnosing and monitoring knee osteoarthritis. New and advanced imaging techniques are also discussed as possible methods of early diagnosis and improved understanding of osteoarthritis pathophysiology.
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Affiliation(s)
- Preeti A Sukerkar
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA; Department of Radiology, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA.
| | - Zoe Doyle
- Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143, USA; Department of Radiology, San Francisco Veterans Affairs Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA
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20
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Efficacy of Knee Taping in addition to a Supervised Exercise Protocol to Manage Pain and Functional Status in Individuals with Patellofemoral Osteoarthritis: A Randomized, Controlled Clinical Trial. Pain Res Manag 2022; 2022:2856457. [PMID: 35371366 PMCID: PMC8975673 DOI: 10.1155/2022/2856457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/22/2022] [Accepted: 03/04/2022] [Indexed: 11/23/2022]
Abstract
Purpose This study aimed to investigate the effect of knee taping in addition to a supervised exercise protocol on the pain intensity and functional status of individuals with patellofemoral osteoarthritis (PF OA). Methods The study was based on a randomized, controlled pretest-posttest experimental group design. Following an initial screening, forty people with PF OA (mean age 55, range 40–60) were randomly assigned to one of two groups, Group A or Group B (n = 20 each). Group A underwent knee taping and participated in a supervised exercise program, whereas Group B only participated in a supervised exercise program. For four weeks, both groups received their prescribed treatment five consecutive days each week. At baseline (day 1 preintervention) and 4 weeks postintervention, the visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were obtained. To compare the effect of stipulated interventions within and between groups, paired and unpaired t tests were performed, with the level of significance set at p < 0.05. Results When comparing the outcome scores at 4 weeks postintervention with baseline scores, the within-group analysis revealed significant mean differences for the outcomes within groups A (VAS: MD = −3.08–0.76; T = 9.70; p < 0.05 and WOMAC: MD = −7.05–0.81; T = 11.11; p < 0.05) and B (WOMAC: MD = −1.6–0.17; T = 2.35; p < 0.05), but a nonsignificant mean difference for the outcomes of VAS within group B (∆MD = 0.08 ± 0.03; T = −0.56; p > 0.05). Similarly, when the score of VAS (MD = −2.73–1.29; T = −9.17; p < 0.05) and WOMAC (MD = −5.95–1.63; T = −5.86; p < 0.05) were compared at 4 weeks postintervention, there was a significant mean difference between groups A and B. Conclusions In people with patellofemoral osteoarthritis, combining knee taping with a supervised exercise protocol was more effective than the supervised exercise protocol alone in relieving pain and enhancing functional status.
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D'Souza N, Charlton J, Grayson J, Kobayashi S, Hutchison L, Hunt M, Simic M. Are biomechanics during gait associated with the structural disease onset and progression of lower limb osteoarthritis? A systematic review and meta-analysis. Osteoarthritis Cartilage 2022; 30:381-394. [PMID: 34757028 DOI: 10.1016/j.joca.2021.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 10/12/2021] [Accepted: 10/23/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate if gait biomechanics are associated with increased risk of structurally diagnosed disease onset or progression of lower limb osteoarthritis (OA). METHOD A systematic review of Medline and Embase was conducted from inception to July 2021. Two reviewers independently screened records, extracted data and assessed risk of bias. Included studies reported gait biomechanics at baseline, and either structural imaging or joint replacement occurrence in the lower limb at follow-up. The primary outcome was the Odds Ratio (OR) (95% confidence interval (CI)) of the association between biomechanics and structural OA outcomes with data pooled for meta-analysis. RESULTS Twenty-three studies reporting 25 different biomechanical metrics and 11 OA imaging outcomes were included (quality scores ranged 12-20/21). Twenty studies investigated knee OA progression; three studies investigated knee OA onset. Two studies investigated hip OA progression. 91% of studies reported a significant association between at least one biomechanical variable and OA onset or progression. There was an association between frontal plane biomechanics with medial tibiofemoral and hip OA progression and sagittal plane biomechanics with patellofemoral OA progression. Meta-analyses demonstrated increased odds of medial tibiofemoral OA progression with greater baseline peak knee adduction moment (KAM) (OR: 1.88 [95%CI: 1.08, 3.29]) and varus thrust presence (OR: 1.97 [95%CI: 1.32, 2.96]). CONCLUSION Evidence suggests that certain gait biomechanics are associated with an increased odds of OA onset and progression in the knee, and progression in the hip. REGISTRATION NUMBER PROSPERO CRD42019133920.
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Affiliation(s)
- N D'Souza
- The Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Australia.
| | - J Charlton
- Graduate Programs in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Canada; Motion Analysis and Biofeedback Laboratory, University of British Columbia, Canada.
| | - J Grayson
- The Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Australia.
| | - S Kobayashi
- The Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Australia.
| | - L Hutchison
- The Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Australia.
| | - M Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Canada; Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Canada.
| | - M Simic
- The Discipline of Physiotherapy, Faculty of Medicine and Health, University of Sydney, Australia.
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Lopez-Franco M. Editorial Commentary: Isolated Patellofemoral Osteoarthritis May Be Treated Arthroscopically: Arthroscopic Partial Lateral Facetectomy Is a Good Alternative to More Aggressive Techniques. Arthroscopy 2022; 38:900-901. [PMID: 35248236 DOI: 10.1016/j.arthro.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 12/01/2021] [Indexed: 02/02/2023]
Abstract
Isolated patellofemoral osteoarthritis is not uncommon, and treatment remains controversial. Several surgical procedures have been performed to treat this condition. The success of surgery highly depends on the technique and the patient selection. The surgeon can choose between a relatively extreme total knee replacement, with predictable results, or operations demanding less surgical dissection and resection, but offering less certainty. Partial lateral facetectomy is a minimally invasive procedure that is simple and effective enough in selected patients with up to 10 years follow-up. An even less aggressive technique, the arthroscopic partial lateral facetectomy in combination with lateral retinacular release, has been shown to be safe, practical, reproducible, and with a low rate of complications and revision surgery at mid-term follow-up. Benefits of arthroscopic techniques include decreased bleeding, less postoperative pain, ability to treat concomitant pathology, and better cosmesis.
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23
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Vasso M, Corona K, Capasso L, Toro G, Schiavone Panni A. Intraarticular injection of microfragmented adipose tissue plus arthroscopy in isolated primary patellofemoral osteoarthritis is clinically effective and not affected by age, BMI, or stage of osteoarthritis. J Orthop Traumatol 2022; 23:7. [PMID: 35122541 PMCID: PMC8818068 DOI: 10.1186/s10195-022-00628-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 01/25/2022] [Indexed: 01/08/2023] Open
Abstract
Purpose This study aimed to report the clinical and functional results of a series of patients with isolated primary patellofemoral osteoarthritis (PFOA) treated with intraarticular injection of microfragmented autologous adipose tissue plus knee arthroscopy. The results were also analyzed in relation to the age and body mas index (BMI) of patients, and to the stage of PFOA. Methods Twenty-three patients with early-to-moderate (stage 1–3 according to the Iwano classification system) PFOA who received this treatment were retrospectively analyzed, with a mean follow-up of 22.1 ± 4.2 months. Patients were assessed using the International Knee Society (IKS) knee and function and visual analog scale (VAS) scores, and relative to their capacity for climbing stairs. Differences in improvements of IKS and VAS scores in relation to age (< 60 versus ≥ 60 years), BMI (< 30 versus ≥ 30 kg/m2), and stage of PFOA (stages 1–2 versus stage 3) were finally analyzed. Results The mean IKS knee score significantly improved from 35.6 ± 14.9 points preoperatively to 61.9 ± 17.8 points at the latest follow-up, while the mean IKS function score significantly improved from 52.0 ± 14.7 points preoperatively to 82.3 ± 19.1 points at the latest follow-up. The mean VAS score significantly decreased from 8.7 ± 2.2 preoperatively to 5.2 ± 2.5 at the latest follow-up. A significant improvement in the capacity to climb stairs was found. No significant differences in improvements of IKS knee and function and VAS scores were found in relation to age, BMI, or stage of PFOA. Conclusion Intraarticular injection of microfragmented autologous adipose tissue following arthroscopic debridement significantly improved overall clinical and functional scores in patients with early or moderate isolated primary PFOA at a mean follow-up of almost 2 years. Improvements were not significantly affected by age, BMI, or stage of PFOA. Level of evidence Level IV, retrospective case series.
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Affiliation(s)
- Michele Vasso
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Katia Corona
- Department of Medicine and Health Sciences "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
| | - Luigi Capasso
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Giuseppe Toro
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Alfredo Schiavone Panni
- Multidisciplinary Department of Medico-Surgical and Dentistry Specialties, "Luigi Vanvitelli" University of Campania, Naples, Italy
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de Andrade DC, Saaibi D, Sarría N, Vainstein N, Ruiz LC, Espinosa R. Assessing the burden of osteoarthritis in Latin America: a rapid evidence assessment. Clin Rheumatol 2022; 41:1285-1292. [PMID: 35094195 PMCID: PMC9056472 DOI: 10.1007/s10067-022-06063-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/14/2021] [Accepted: 01/10/2022] [Indexed: 11/03/2022]
Abstract
Abstract
This rapid evidence assessment (REA) was conducted to explore the burden of weight-bearing joint osteoarthritis in the developing countries of Latin America. REA methodology used a standardized search strategy to identify observational studies published from 2010 to 23 April 2020 that reported outcomes pertaining to the epidemiology and humanistic or economic burden of weight-bearing osteoarthritis. Relevant data from each included study were used to populate bespoke data extraction tables and qualitatively analyzed. Thirteen publications were identified that reported on knee and hip osteoarthritis in the Latin American region. Overall prevalence of physician-diagnosed symptomatic knee osteoarthritis in adults ranged from 1.55% in Peru to 7.4% in Ecuador. Total prevalence of grade ≥ 2 radiographic knee osteoarthritis was 22% among those ≥ 39 years of age in Brazil and 25.5% among those ≥ 40 years of age in Mexico. The prevalence of symptomatic/radiographic knee osteoarthritis was 7.1% in people ≥ 18 years of age in Mexico and 17.6% among those ≥ 40 years of age. Prevalence of hip osteoarthritis was similar to or slightly lower than knee osteoarthritis. The limited data available indicates weight-bearing osteoarthritis negatively affects quality of life and that the economic burden may vary between countries with different healthcare systems. The limited evidence found in the published literature suggests the burden of osteoarthritis in Latin America is substantial. Our analysis identified several evidence gaps, particularly for health-related quality of life and socioeconomic outcomes. Further research is of particular importance in areas where government-subsidized healthcare and resources are scarce.
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Zhao J. Arthroscopic Debridement, Facetectomy, and Synovectomy for Isolated Patellofemoral Osteoarthritis. Arthrosc Tech 2021; 10:e2741-e2745. [PMID: 35004156 PMCID: PMC8719265 DOI: 10.1016/j.eats.2021.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 08/13/2021] [Indexed: 02/03/2023] Open
Abstract
Isolated patellofemoral osteoarthritis (PFOA) is a condition that affects climbing, squatting, and standing up movements in daily life and sports. Various surgical methods have been developed to address the various causes, different degrees of cartilage degeneration, and combined lesions. We describe an arthroscopic patellofemoral arthroplasty technique, with the main purpose to decrease the pain originating from the patellofemoral joint and related structures. The critical points of this technique are patellofemoral denervation and partial patellar facetectomy. Our clinical experience indicates that this technique is effective to address all kinds of PFOA. We consider that the introduction of this technique will provide a feasible choice when surgical treatment of PFOA is indicated.
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Affiliation(s)
- Jinzhong Zhao
- Address correspondence to Jinzhong Zhao, M.D., Department of Sports Medicine, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233, China.
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26
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Mestriner AB, Ackermann J, Merkely G, Galvão PHSAF, Ambra LFM, Gomoll AH. Etiology of Cartilage Lesions Does Not Affect Clinical Outcomes of Patellofemoral Autologous Chondrocyte Implantation. Cartilage 2021; 13:1298S-1305S. [PMID: 34286619 PMCID: PMC8808922 DOI: 10.1177/19476035211030991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine the relationship between cartilage lesion etiology and clinical outcomes after second-generation autologous chondrocyte implantation (ACI) in the patellofemoral joint (PFJ) with a minimum of 2 years' follow-up. METHODS A retrospective review of all patients that underwent ACI in the PFJ by a single surgeon was performed. Seventy-two patients with a mean follow-up of 4.2 ± 2.0 years were enrolled in this study and were stratified into 3 groups based on the etiology of PFJ cartilage lesions: patellar dislocation (group 1; n = 23); nontraumatic lesions, including chondromalacia, osteochondritis dissecans, and degenerative defects (group 2; n = 28); and other posttraumatic lesions besides patellar dislocations (group 3; n = 21). Patient's mean age was 29.6 ± 8.7 years. Patients in group 1 were significantly younger (25.4 ± 7.9 years) than group 2 (31.7 ± 9.6 years; P = 0.025) and group 3 (31.5 ± 6.6 years; P = 0.05). Body mass index averaged 26.2 ± 4.3 kg/m2, with a significant difference between group 1 (24.4 ± 3.2 kg/m2) and group 3 (28.7 ± 4.5 kg/m2; P = 0.005). A clinical comparison was established between groups based on patient-reported outcome measures (PROMs) and failure rates. RESULTS Neither pre- nor postoperative PROMs differed between groups (P > 0.05). No difference was seen in survivorship between groups (95.7% vs. 82.2% vs. 90.5%, P > 0.05). CONCLUSION Cartilage lesion etiology did not influence clinical outcome in this retrospective study after second generation ACI in the PFJ. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Alexandre Barbieri Mestriner
- Universidade Federal de São
Paulo–Escola Paulista de Medicina, São Paulo, Brazil,Cartilage Repair Center, Brigham and
Women’s Hospital, Harvard Medical Center, Boston, MA, USA,Alexandre Barbieri Mestriner, 334 Jorge
Chammas Street, Apartment 18, Sao Paulo, SP, 04016-070, Brazil.
| | - Jakob Ackermann
- Sports Medicine Center, Massachusetts
General Hospital, Boston, MA, USA,Balgrist University Hospital, Zurich,
Switzerland
| | - Gergo Merkely
- Cartilage Repair Center, Brigham and
Women’s Hospital, Harvard Medical Center, Boston, MA, USA,Department of Traumatology, Semmelweis
University, Budapest, Hungary
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Kamat Y, Prabhakar A, Shetty V, Naik A. Patellofemoral joint degeneration: A review of current management. J Clin Orthop Trauma 2021; 24:101690. [PMID: 34900577 PMCID: PMC8636808 DOI: 10.1016/j.jcot.2021.101690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 11/30/2022] Open
Abstract
The patellofemoral component of the knee joint is affected by a wide range of degenerative causes without involving the other parts of the knee. It is often the presenting pathology in early knee osteoarthritis and missed due to a variable presentation. Accurate examination and focused investigation can help with early diagnosis and guide treatment. Various aspects to treatment need to be addressed after thorough evaluation. Guidelines to approach the multifactorial pathology of the patello-femoral joint are provided with focus on the degenerative component of disease.
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Affiliation(s)
- Yogeesh Kamat
- KMC Hospital, Ambedkar Circle, Manipal Academy of Higher Education, India,Corresponding author. KMC Hospital, Dr B R Ambedkar Circle, Mangalore, Karnataka, 575001, India.
| | - Ashish Prabhakar
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | | | - Arjun Naik
- Trauma and Orthopaedics, Kings College Hospital, UK
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28
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Said MKM, Said HG, Elkady H, Said MKM, Ramadan IKA, El-Radi MA. Does arthroscopic patellar denervation with high tibial osteotomy improve anterior knee pain? J Exp Orthop 2021; 8:104. [PMID: 34750692 PMCID: PMC8575725 DOI: 10.1186/s40634-021-00411-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/01/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Patellofemoral (PF) joint osteoarthritis (OA) is a major cause of anterior knee pain. Combined PF and medial tibiofemoral (TF) OA is common in older adults. We evaluated the effect of arthroscopic patellar denervation (PD) in patients with combined TF and PFOA after malalignment correction. METHODS Forty-five patients [females/males, 27/18; age, 30-59 years (45.5 ± 8.50); mean body mass index, 25.15 ± 3.04 kg/m2] were treated in our department from March 2017 to March 2019. The patients were randomised into 2 groups: group A included 22 patients who underwent open-wedge high tibial osteotomy (OWHTO) and arthroscopic PD and group B included 23 patients who underwent OWHTO without denervation. The effect of denervation was statistically and clinically evaluated using the Knee injury and Osteoarthritis Outcome Score (KOOS) and Kujala (anterior knee pain score) score. RESULTS After 24 months, 40 patients were available for the final follow-up. The final values of KOOS and the Kujala score were significantly different between the groups (p < 0.001). For group A, the average KOOS improved from 42.73 to 72.38 (p < 0.001) and the Kujala score improved from 42 to 74.1 (p < 0.001), whereas in group B, the average KOOS improved from 39.22 to 56.84 (p < 0.001) and the Kujala score improved from 39.7 to 56.4 (p < 0.001). CONCLUSION Adding arthroscopic PD to OWHTO relieves anterior knee pain in patients with combined TF and PFOA and improves knee joint function and quality of life. LEVEL OF EVIDENCE Level I prospective randomised control clinical trial.
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Affiliation(s)
| | - Hatem G Said
- Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
| | - Hesham Elkady
- Faculty of Medicine, Assiut University, Assiut, 71515, Egypt
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29
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Go DJ, Kim DH, Kim JY, Guermazi A, Crema MD, Hunter DJ, Kim HA. Serum uric acid and knee osteoarthritis in community residents without gout: a longitudinal study. Rheumatology (Oxford) 2021; 60:4581-4590. [PMID: 33493331 DOI: 10.1093/rheumatology/keab048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/26/2020] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES Emerging evidence suggests a potential link between OA and gout; however, the association between serum uric acid (UA) itself and knee OA remains uncertain due to a lack of longitudinal studies. Here, we investigated the association between serum UA and knee OA according to cartilage status in elderly community residents without gout. METHODS In this longitudinal study, participants without a history of gout were recruited from among the Korean cohort of the Hallym Aging Study (n = 296 for radiography study and n = 223 for MRI study). Weight-bearing knee radiographs and 1.5-T MRI scans, along with blood collection for analysis of serum UA, were performed at baseline and after 3 years. The severity and structural progression of knee OA were evaluated using the Kellgren-Lawrence grading system and the Whole-Organ MRI Score (WORMS) cartilage scoring method. Multivariable logistic regression analysis was conducted using generalized estimating equation (GEE) models. RESULTS Serum UA levels were not associated with radiographic progression after adjusting for age, sex and BMI. There was no significant association between serum UA and tibiofemoral cartilage loss on MRI. However, baseline serum UA levels were negatively associated with patellofemoral cartilage loss over 3 years (adjusted odd ratio 0.70 per 1 mg/dl increase, 95% CI: 0.49, 0.98). CONCLUSION In this population-based cohort, serum UA was not a risk factor for knee OA progression. Further large-scale longitudinal studies in other populations are needed to validate the effects of UA on cartilage damage.
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Affiliation(s)
- Dong Jin Go
- Division of Rheumatology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine.,Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Institute, Seoul National University, Seoul
| | - Dong Hyun Kim
- Department of Social and Preventive Medicine, Hallym Research Institute of Clinical Epidemiology, Hallym University, Chuncheon
| | - Jie Young Kim
- Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang.,Institute for Skeletal Aging, Hallym University, Chuncheon, Republic of Korea
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Michel Daoud Crema
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - David J Hunter
- Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, University of Sydney, Sydney, NSW, Australia
| | - Hyun Ah Kim
- Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang.,Institute for Skeletal Aging, Hallym University, Chuncheon, Republic of Korea
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Bayramoglu N, Nieminen MT, Saarakkala S. Automated detection of patellofemoral osteoarthritis from knee lateral view radiographs using deep learning: data from the Multicenter Osteoarthritis Study (MOST). Osteoarthritis Cartilage 2021; 29:1432-1447. [PMID: 34245873 DOI: 10.1016/j.joca.2021.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/11/2021] [Accepted: 06/28/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the ability of imaging-based deep learning to detect radiographic patellofemoral osteoarthritis (PFOA) from knee lateral view radiographs. DESIGN Knee lateral view radiographs were extracted from The Multicenter Osteoarthritis Study (MOST) public use datasets (n = 18,436 knees). Patellar region-of-interest (ROI) was first automatically detected, and subsequently, end-to-end deep convolutional neural networks (CNNs) were trained and validated to detect the status of patellofemoral OA. Patellar ROI was detected using deep-learning-based object detection method. Atlas-guided visual assessment of PFOA status by expert readers provided in the MOST public use datasets was used as a classification outcome for the models. Performance of classification models was assessed using the area under the receiver operating characteristic curve (ROC AUC) and the average precision (AP) obtained from the Precision-Recall (PR) curve in the stratified 5-fold cross validation setting. RESULTS Of the 18,436 knees, 3,425 (19%) had PFOA. AUC and AP for the reference model including age, sex, body mass index (BMI), the total Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, and tibiofemoral Kellgren-Lawrence (KL) grade to detect PFOA were 0.806 and 0.478, respectively. The CNN model that used only image data significantly improved the classifier performance (ROC AUC = 0.958, AP = 0.862). CONCLUSION We present the first machine learning based automatic PFOA detection method. Furthermore, our deep learning based model trained on patella region from knee lateral view radiographs performs better at detecting PFOA than models based on patient characteristics and clinical assessments.
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Affiliation(s)
- N Bayramoglu
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland.
| | - M T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | - S Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.
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Preliminary Evaluation of a New Orthotic for Patellofemoral and Multicompartment Knee Osteoarthritis. Rehabil Res Pract 2021; 2021:5923721. [PMID: 34540291 PMCID: PMC8441257 DOI: 10.1155/2021/5923721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/20/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose Traditional knee osteoarthritis (OA) braces are usually indicated for a minority of patients with knee OA, as they are only suitable for those with unicompartmental disease affecting the tibiofemoral joint. A new assistive brace design is intended for use in a wider range of knee OA patients with heterogeneous symptoms characteristic of patellofemoral, tibiofemoral, or multicompartmental knee OA. The purpose of this case series was to explore whether the use of this novel “tricompartment offloader” (TCO) brace was associated with clinically relevant improvements in pain and function. Materials and Methods A retrospective analysis of individuals with knee OA (n = 40) was conducted to assess pain, function, physical activity, and use of medication and other treatments before and after brace use. Validated outcome measures including the Visual Analog Scale (VAS) and Lower Extremity Functional Scale (LEFS) were used to assess pain and physical function (primary outcome measures). Exploratory measures were used to quantify physical activity levels and use of medication and other treatments (secondary outcome measures). Results Average total pain (VAS) scores decreased by 36.6 mm and physical function (LEFS) scores increased by 16.0 points following the use of the TCO brace. Overall, 70% of the participants indicated increased weekly physical activity and 60% reported a decrease in their use of at least one other treatment. Conclusions Results from this case series suggest that the TCO brace shows strong potential to fill a conservative treatment gap for patients with heterogeneous symptoms of knee OA that are characteristic of patellofemoral or multicompartment disease. Further investigation is warranted.
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32
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Dai Y, Yin H, Xu C, Zhang H, Guo A, Diao N. Association of patellofemoral morphology and alignment with the radiographic severity of patellofemoral osteoarthritis. J Orthop Surg Res 2021; 16:548. [PMID: 34481492 PMCID: PMC8418017 DOI: 10.1186/s13018-021-02681-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Risk factors for the severity of patellofemoral osteoarthritis (PFOA) are poorly understood. This research aims to evaluate the association between patellofemoral joint (PFJ) morphology and alignment with the radiographic severity of PFOA. Methods A retrospective analysis of CT scan and lateral radiograph data were acquired in patients with PFOA. The radiographic grade of PFOA and tibiofemoral osteoarthritis (TFOA), lateral and medial trochlear inclination angle, sulcus angle, and the Wiberg classification of patella morphology, the congruence angle, patellar tilt angle, and lateral patellar angles, and tibial tubercle trochlear groove distance (TT-TG) and patella height (i.e., Caton-Deschamps index) were assessed using CT scans and sagittal radiographs of the knee. All the PFJ morphology and alignment data were divided into quarters, and the relationships between each of these measures and the severity of PFOA were investigated. Results By studying 150 patients with PFOA, we found a U-shaped relationship between the Caton-Deschamps index and the severity of PFOA (P < 0.001). A lower value of sulcus angle and lateral patellar angle, a higher value of congruence angle, and type III patella were associated with more severity of lateral PFOA. Compared with the highest quarter of each measure, the adjusted odds ratios (OR) of the severity of PFOA in the lowest quarter of sulcus angle, lateral patellar angle, and congruence angle; and type I patella was 8.80 (p = 0.043), 16.51 (P < 0.001), 0.04 (P < 0.001), and 0.18 (p = 0.048) respectively. Conclusions Extreme value of patella height, a higher value of lateral patellar displacement and lateral patellar tilt, lower value of sulcus angle, and type III patella were associated with more severity of PFOA.
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Affiliation(s)
- Yike Dai
- Department of Orthopedic, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng, Beijing, 100050, People's Republic of China
| | - Heyong Yin
- Department of Orthopedic, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng, Beijing, 100050, People's Republic of China
| | - Chongyang Xu
- Department of Orthopedic, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng, Beijing, 100050, People's Republic of China
| | - Hongrui Zhang
- Department of Orthopedic, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng, Beijing, 100050, People's Republic of China
| | - Ai Guo
- Department of Orthopedic, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng, Beijing, 100050, People's Republic of China
| | - Naicheng Diao
- Department of Orthopedic, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng, Beijing, 100050, People's Republic of China.
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Association between Patellofemoral and medial Tibiofemoral compartment osteoarthritis progression: exploring the effect of body weight using longitudinal data from osteoarthritis initiative (OAI). Skeletal Radiol 2021; 50:1845-1854. [PMID: 33686488 DOI: 10.1007/s00256-021-03749-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/25/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate the associations of medial and lateral patellofemoral osteoarthritis (PF-OA) at baseline with symptomatic and radiographic OA outcomes in the medial tibiofemoral compartment (MTFC) over 4 years, according to baseline overweight status. METHODS Data and MRI images of 600 subjects in the FNIH-OA biomarkers consortium were used. Symptomatic worsening and radiographic progression of MTFC-OA were defined using Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scores and MTFC joint space narrowing (JSN) from baseline to 4-year follow-up. Baseline MRIs were read to establish PF-OA diagnosis. The association between baseline regional PF-OA pattern and odds for MTFC-OA progression was evaluated using regression models (adjusted for relevant confounding covariates including body mass index (BMI), age, sex, PF alignment measurements, KL grade, and knee alignment). To evaluate the effect modifying role for overweight status, stratification analysis was performed (BMI ≥ 25 vs. < 25 kg/m2). RESULTS At baseline, 340 (56.7%), 255 (42.5%), and 199 (33.2%) subjects had OA in the medial, lateral, and both PF compartments. Baseline medial PF-OA was associated with WOMAC pain score and MTFC JSN progression at 4 years (Adjusted OR:1.56[95%CI:1.09-2.23] and 1.59[1.11-2.28], respectively) but not lateral PF-OA. In stratification analysis, overweight status was found to be an effect modifier for medial PF-OA and WOMAC pain (OR in overweight vs. non-overweight subjects:1.65[1.13-2.42] vs. 0.50[0.12-1.82]) as well as MTFC-JSN progression (1.63[1.12-2.4] vs. 0.75[0.19-2.81]). CONCLUSIONS In addition to the known confounding effect of BMI for PF-OA and MTFC-OA, the overweight status may also play an effect modifier role in the association between baseline medial PF-OA and MTFC-OA progression, which is amenable to secondary prevention.
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Villa JC, Paoli AR, Nelson-Williams HW, Badr RN, Harper KD. Onlay Patellofemoral Arthroplasty in Patients With Isolated Patellofemoral Arthritis: A Systematic Review. J Arthroplasty 2021; 36:2642-2649. [PMID: 33795175 DOI: 10.1016/j.arth.2021.02.054] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Patellofemoral arthroplasty (PFA) for isolated patellofemoral osteoarthritis (OA) remains controversial due to variable postoperative outcomes and high failure rates. Second-generation (2G) onlay prostheses have been associated with improved postoperative outcomes. This systematic review was performed to assess the current overall survivorship and functional outcomes of 2G PFA. METHODS A search was performed using PubMed, Cochrane Library, EMBASE, and Google Scholar. Thirty-three studies published in the last 15 years (2005-2020) were included; of these 22 studies reported patient-reported outcome measures. Operative and nonoperative complications were analyzed. Pooled statistical analysis was performed for survivorship and functional scores using Excel 2016 and Stata 13. RESULTS The mean age of the patients was 59.7. When analyzing all studies, weighted survival at mean follow-up of 5.52 was 87.72%. Subanalysis of studies with minimum 5 years of follow up showed a survival of 94.24%. Fifteen studies reported Oxford Knee Score with a weighted mean postoperative Oxford Knee Score of 33.59. Mean American Knee Society Score pain was 79.7 while mean American Knee Society Score function was 79.3. The most common operative complication was OA progression for all implants. The percentage of revisions and conversions reported after analyzing all studies was 1.37% and 7.82% respectively. CONCLUSION Safe and acceptable results of functional outcomes and PFA survivorship can result from 2G PFAs at both short and mid-term follow-up for patients with isolated patellofemoral OA. However, long-term follow-up outcomes are still pending for the newer implants. More extensive studies using standardized functional outcomes and long-term cost benefits should be evaluated.
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Affiliation(s)
- Jordan C Villa
- Orthopaedic Surgery Department, Howard University Hospital, Washington, DC
| | - Albit R Paoli
- Orthopaedic Surgery Department, Howard University Hospital, Washington, DC
| | | | - Rhamee N Badr
- Orthopaedic Surgery Department, Howard University Hospital, Washington, DC
| | - Katharine D Harper
- Orthopaedic Surgery Department, Washington DC Veterans Affairs Medical Center, Washington, DC
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Li C, Li Z, Shi L, Gao F, Sun W. The short-term effectiveness and safety of second-generation patellofemoral arthroplasty and total knee arthroplasty on isolated patellofemoral osteoarthritis: a systematic review and meta-analysis. J Orthop Surg Res 2021; 16:358. [PMID: 34078392 PMCID: PMC8171053 DOI: 10.1186/s13018-021-02509-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/25/2021] [Indexed: 12/01/2022] Open
Abstract
Background We aimed to compare second-generation patellofemoral arthroplasty (2G PFA) with total knee arthroplasty (TKA) in treating isolated patellofemoral osteoarthritis (PFOA) by assessing the percentages of revisions, complications, and patient-reported outcome measures (PROMs). Methods Studies that compared the outcomes of 2G PFA and TKA in the treatment of isolated PFOA were searched in electronic databases, including MEDLINE, Embase, and Web of Science. Two researchers independently identified eligible studies, extracted the data, and evaluated the quality of the literature. Pooled risk ratios (RRs) or weighted mean differences with 95% confidence intervals were calculated using either fixed or random effects models. Descriptive analysis was used when data could not be pooled. Results A total of six studies were included in the review. For the revision percentage and complications, there were no significant differences between 2G PFA and TKA (RR = 2.29, 95% CI 0.69–7.58, P = 0.17; RR = 0.56, 95% CI 0.23–1.40, P = 0.22, respectively). Second, the results demonstrated that the differences in the Oxford Knee Score (OKS) and the University of California, Los Angeles (UCLA) activity score between 2G PFA and TKA were not significant (WMD −4.68, 95% CI −16.32 to 6.97, p = 0.43; WMD 0.16, 95% CI −1.21 to 1.53, P = 0.82). The Knee Injury and Osteoarthritis Outcome Score (KOOS), the American Knee Society Score (AKSS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were presented in a narrative form due to methodological heterogeneity. Conclusion For isolated PFOA, 2G PFA demonstrated similar results to TKA with respect to the percentages of revisions, complications, and PROMs.
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Affiliation(s)
- Chengxin Li
- Department of Orthopedics, Peking University China-Japan Friendship School of Clinical Medicine, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Zhizhuo Li
- Department of Orthopedics, Peking University China-Japan Friendship School of Clinical Medicine, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Lijun Shi
- Department of Orthopedics, Graduate School of Peking Union Medical College, China-Japan Friendship Institute of Clinical Medicine, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Fuqiang Gao
- Beijing Key Laboratory of Immune Inflammatory Disease, China-Japan Friendship Hospital, Peking Union Medical College, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China
| | - Wei Sun
- Beijing Key Laboratory of Immune Inflammatory Disease, China-Japan Friendship Hospital, Peking Union Medical College, 2 Yinghuadong Road, Chaoyang District, Beijing, 100029, China.
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Nejima S, Kumagai K, Kobayashi H, Fujimaki H, Yamada S, Sotozawa M, Hisatomi K, Inaba Y. Medialization of the mechanical axis of the tibia is related to lateralization of the tibial tuberosity in knee osteoarthritis. Knee 2021; 30:134-140. [PMID: 33895612 DOI: 10.1016/j.knee.2021.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/24/2021] [Accepted: 03/30/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine whether medialization of the proximal tibia due to a varus deformity is related to lateralization of the tibial tuberosity in varus knee osteoarthritis (OA). METHODS A total of 120 knees that underwent osteotomies around the knee for varus knee OA were enrolled. Mechanical medial proximal tibial angle (mMPTA) was measured on radiographs. The angle between the mechanical and anatomical axes of the tibia (angle MA) and the distance between the centre of the tibial plateau and the anatomical axis (distance MA) were measured in the coronal plane on computed tomography images. The tibial tuberosity-posterior cruciate ligament (TT-PCL) distance, the distance between the midpoint of the tibial tuberosity and the centre of the tibial plateau (TT-centre distance), and the angle between the line through the midpoint of the tibial tuberosity and the centre of the tibial plateau and the anteroposterior axis (TT-centre angle) were measured in the axial plane. The correlations of these parameters were evaluated. RESULTS mMPTA correlated negatively with angle MA (r = -0.37, P < 0.01) and distance MA (r = -0.55, P < 0.01). Angle MA and distance MA correlated with TT-PCL distance (r = 0.39, P < 0.01, r = 0.42, P < 0.01), TT-centre distance (r = 0.35, P < 0.01, r = 0.38, P < 0.01) and TT-centre angle (r = 0.36, P < 0.01, r = 0.36, P < 0.01). CONCLUSIONS Medialization of the proximal tibia due to a varus deformity may induce lateralization of the tibial tuberosity.
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Affiliation(s)
- Shuntaro Nejima
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
| | - Hideo Kobayashi
- Department of Orthopaedic Surgery, International University of Health and Welfare Atami Hospital, Atami, Japan
| | - Hiroshi Fujimaki
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Shunsuke Yamada
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Masaichi Sotozawa
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kensuke Hisatomi
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, Yokohama, Japan
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Analan PD, Ozdemir H. The Effect of Patellar Height by Using Insall Salvati Index on Pain, Function, Muscle Strength and Postural Stability in Patients with Primary Knee Osteoarthritis. Curr Med Imaging 2021; 17:532-538. [PMID: 32811402 DOI: 10.2174/1573405616999200817172649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 05/19/2020] [Accepted: 06/10/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE The Insall-Salvati Index (ISI) is the ratio of the patellar tendon length to the length of the patella. This ratio is the most commonly used method for evaluating patellar placement and patellofemoral imbalance. The position of the patella is important for the knee joint function and also for biomechanics. The abnormal position of the patella may lead to patellofemoral malalignment and instability. Herein, we aimed to analyze the relationship between the ISI and pain, physical function, muscle strength, fall risk, and postural stability in patients with primary knee osteoarthritis (OA). METHODS Sixty-two symptomatic knees of 45 patients (aged between 40 -75 years) who were suffering from the primary knee OA according to the American College of Rheumatology criteria were included retrospectively in the study. Patients with stages II and III osteoarthritis according to the Kellgren-Lawrence (K/L) radiological grading system were included. The ISI was measured on the lateral knee radiograph in a 30° flexed posture. Visual Analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) and Lequesne indexes were recorded for evaluating pain and function. Tetrax Interactive Balance System was used to assess fall risk and postural stability. Isokinetic muscle strength measurements of quadriceps and hamstrings were recorded at the constant angular velocities of 60 and 180°/sec. RESULTS The mean age of the study population was 58.52 ±8.01 years. The frequency of the patellar situation types was as follows; patella alta; 15 (24.2%), patella baja; n=2(3.2%), and normal patellar height; n=45(72.6%). The mean ISI was 1.19 ±0.17 on the right side and 1.18±0.16 on the left side. There was no significant correlation between the ISI and VAS, WOMAC and Lequesne indexes, postural stability scores, and isokinetic measurements (r<0.3, p>0.05). CONCLUSION In primary knee OA, the ISI may not have an effect on pain, physical function, fall risk, postural stability, and isokinetic muscle strength. CLINICAL TRIAL REGISTRATION NUMBER KA18/170.
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Affiliation(s)
- Pinar Doruk Analan
- Department of Physical Medicine and Rehabilitation, Baskent University Faculty of Medicine, Adana, Turkey
| | - Hulya Ozdemir
- Department of Radiology, Baskent University Faculty of Medicine, Adana, Turkey
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Peng G, Liu M, Guan Z, Hou Y, Liu Q, Sun X, Zhu X, Feng W, Zeng J, Zhong Z, Zeng Y. Patellofemoral arthroplasty versus total knee arthroplasty for isolated patellofemoral osteoarthritis: a systematic review and meta-analysis. J Orthop Surg Res 2021; 16:264. [PMID: 33858458 PMCID: PMC8048312 DOI: 10.1186/s13018-021-02414-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/07/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Isolated patellofemoral osteoarthritis (PF-OA) is a common subtype of knee osteoarthritis, leading to a huge economic burden on health care systems. Although previous studies have shown that patellofemoral arthroplasty (PFA) and total knee arthroplasty (TKA) have good clinical effects, it remains largely unclear which treatment is more effective for patients with isolated PF-OA. We aimed to compare postoperative function, complications, revision rates, level of physical activity, and satisfaction rate between the two surgical techniques. METHODS Our study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Search of literature was conducted in MEDLINE, EMBASE, Cochrane Library, and Web of Science until November 2020. The included studies were those that provided direct comparison of postoperative outcomes between PFA and TKA. Data were extracted from eligible studies and combined to calculate the pooled odds ratio (OR) and 95% confidence interval (CI). Sensitivity analysis and subgroup analysis were conducted to evaluate heterogeneity between the two groups. RESULTS A total of 7 eligible studies (3 recent randomized controlled trials and 4 nonrandomized controlled trials) were included in this meta-analysis. The pooled results showed that both the PFA group and the TKA group had improved postoperative indicators, suggesting that the two operation modes could improve the knee function and quality of life of patients. Throughout the first 2 years postoperatively, higher activity level, and better functional recovery were observed for PFA compared with TKA in this study; moreover, the differences between the two operation modes were statistically significant (p < 0.05). We found no significant difference in complications, revision rates, and satisfaction rate between the two procedures. CONCLUSION Although there was no observed difference in the complications, revision rates, and satisfaction rate between PFA and TKA, PFA was superior to TKA in terms of knee function and physical activity in the first 2 years postoperatively. Therefore, PFA is a safe, effective, and less invasive treatment for patients with isolated PF-OA. Our findings are consistent with the systematic review of current evidence that PFA may be more suitable for younger patients with high activity needs. Patient selection is, therefore, thought to be of paramount importance. Individualized surgical plan should be designed according to the patient's age, BMI, KOA site, and activity level and combined with the doctor's personal experience.
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Affiliation(s)
- Guanrong Peng
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China.,Yudu People's Hospital, Huancheng North Road 2#, District Yudu, Ganzhou, Jiangxi, China
| | - Min Liu
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Zhenhua Guan
- Yudu People's Hospital, Huancheng North Road 2#, District Yudu, Ganzhou, Jiangxi, China
| | - Yunfei Hou
- Peking University People's Hospital, Arthritis Clinic and Research Center Beijing, Beijing, China
| | - Qiang Liu
- Peking University People's Hospital, Arthritis Clinic and Research Center Beijing, Beijing, China
| | - Xiaobo Sun
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Xingyang Zhu
- The First Clinical Medical School, Guangzhou University of Chinese Medicine, Jichang Road 12#, District Baiyun, Guangzhou, Guangdong, China
| | - Wenjun Feng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, Guangdong, China
| | - Jianchun Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, Guangdong, China
| | - Zhangrong Zhong
- Yudu People's Hospital, Huancheng North Road 2#, District Yudu, Ganzhou, Jiangxi, China.
| | - Yirong Zeng
- Department of Orthopaedics, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Jichang Road 16#, District Baiyun, Guangzhou, Guangdong, China.
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Stoddart JC, Dandridge O, Garner A, Cobb J, van Arkel RJ. The compartmental distribution of knee osteoarthritis - a systematic review and meta-analysis. Osteoarthritis Cartilage 2021; 29:445-455. [PMID: 33253887 DOI: 10.1016/j.joca.2020.10.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/10/2020] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES For a population with knee osteoarthritis (OA), determine: 1) the prevalence of single compartmental, bicompartmental and tricompartmental OA, 2) the prevalence of isolated medial tibiofemoral, lateral tibiofemoral, or patellofemoral OA, and combinations thereof. METHODS PubMed and Web of Science databases, and reference lists of identified studies, were searched to find studies which reported on the compartmental distribution and prevalence of knee OA. Two independent reviewers assessed studies against pre-defined inclusion criteria and prevalence data were extracted along with subject characteristics. The methodological quality of each included study was assessed. A random-effects model meta-analysis was performed for each OA category to estimate the relative prevalence of OA in the knee compartments amongst people with knee OA. RESULTS 16 studies (3,786 knees) met the inclusion criteria. High heterogeneity was measured. Normalised for knees with OA, estimated prevalence rates (95% CI) were: single compartmental 50% (31.5-58.3%), bicompartmental 33% (23.1-37.2%) and tricompartmental only 17% (8.8-24.8%). Isolated medial tibiofemoral OA, isolated patellofemoral OA, and combined medial tibiofemoral and patellofemoral OA were more common than tricompartmental disease, occurring in 27% (15.2-31.1%), 18% (9.9-22.7%) and 23% (14.1-27.3%) of people respectively. Single/bicompartmental patterns of disease involving the lateral tibiofemoral compartment were less common, summing to 15% (8.5-18.7%). CONCLUSION Three-quarters of people with knee OA do not have tricompartmental disease. This is not reflected in the frequency with which partial and combined partial knee arthroplasties are currently used. TRIAL REGISTRATION NUMBER PROSPERO systematic review protocol (CRD42019140345).
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Affiliation(s)
- J C Stoddart
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK.
| | - O Dandridge
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK.
| | - A Garner
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK; Health Education Kent, Surrey and Sussex Higher Surgical Training Programme, London, UK; Dunhill Medical Trust and Royal College of Surgeons of England Joint Research Fellowship, London, UK.
| | - J Cobb
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK.
| | - R J van Arkel
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK.
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Prevalence and incidence of osteoarthritis among people living in the Gulf Cooperation Council countries: a systematic review and meta-analysis. Clin Rheumatol 2021; 40:3523-3531. [PMID: 33715078 DOI: 10.1007/s10067-021-05662-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/14/2021] [Accepted: 02/18/2021] [Indexed: 10/21/2022]
Abstract
Osteoarthritis (OA) is a common degenerative disease affecting joints with an increasing prevalence around the world and in the Middle East region. Research about the prevalence/incidence of OA in the Gulf Cooperation Council (GCC) countries was limited with inconsistent findings. Therefore, the aim of this study was to conduct a systematic review and meta-analysis for studies reporting the prevalence/incidence of OA among people living in the GCC countries. A comprehensive search was performed using MEDLINE, PubMed, CINAHL, Web of Science, and Google Scholar from inception to December 2020 to identify eligible studies examining the prevalence/incidence of OA in the GCC countries. Meta-analysis was conducted, and the Newcastle Ottawa Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies was utilized to evaluate methodological quality. Thirteen studies were included (12 studies reported prevalence and one study reported incidence), with a total of 24,625 participants with an estimated overall prevalence of 16.13% and incidence of 3.5% of OA in the GCC countries. The quality of the included studies was unsatisfactory (six studies), satisfactory (six studies), and good quality (one study). Common risk factors were being older adult, female, obese, and having lower scores for quality of life. This study shows a high prevalence of OA among individuals living in the GCC countries at approximately 16.13%. Only one study reported incidence of 3.5% of OA in this population. This prevalence rate needs to be confirmed in future research with a similar population and at the site of joint OA levels. Common risk factors should be interpreted with caution since only a few studies reported risk factors. Key Points • The pooled prevalence of Osteoarthritis in the Gulf Cooperation Council countries was 16.13% based on 12 included studies.
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Autologous protein solution as selective treatment for advanced patellofemoral osteoarthritis in the middle-aged female patient: 54% response rate at 1 year follow-up. Knee Surg Sports Traumatol Arthrosc 2021; 29:988-997. [PMID: 32451622 DOI: 10.1007/s00167-020-06064-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/13/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE The study wanted to investigate the benefit, durability and safety of autologous protein solution (APS) injection(s) in a middle-aged female-only cohort suffering predominantly from patellofemoral osteoarthritis. METHODS Fifty females (aged 50.4 ± 6.5) with mainly moderate-severe (86%) patellofemoral cartilage wear (PFCW) were treated with a unilateral intra-articular APS injection. The KOOS, NRS, Kujala, UCLA and EQ-5D were assessed at baseline and 1, 3, 6, and 12 months post-injection. Therapeutic response rate (TRR) was based on KOOS pain improvement > 10 points. Absolute improvement for, respectively, therapy responders and non-responders was determined. Second APS injection was administered if improvement was deemed insufficient by the patient after 3 months. RESULTS The TRR remained stable averaging to 53.7% at final follow-up with subjects improving overall from 40.3 ± 18.7 to 57.3 ± 24.8 points on KOOS pain (p = 0.0002) and from 48.4 ± 13.0 to 56.3 ± 18.1 points on Kujala (p = 0.0203) at 12 months. Significant improvement was observed for the other KOOS subscales and NRS at each follow-up. In absolute values, APS responders improved with 30.5 ± 11.4 points on KOOS pain at 12 months. In contrast, non-responders deteriorated with 5.9 ± 8.9 points relative to baseline. A second APS injection was administered in 28 subjects. Patients with definite synovitis improved more on KOOS symptoms (p = 0.017) and KOOS ADL (p = 0.037) at 12 months compared to non-synovitis subjects. Mild-moderate arthralgia (46%) and effusion (29%) were commonly observed during the first month post-injection. CONCLUSION This study evidenced a 54% response rate at 12 months to a single or second APS injection in a middle-aged female population with advanced patellofemoral cartilage wear. Moderate temporary flares can be expected without affecting clinical outcomes. Second APS injection has low efficacy in initially poor responding patients after 3 months. Major synovitis on baseline MRI appeared to be a beneficial prognosticator for pain relief and functional improvement after APS. LEVEL OF EVIDENCE IV.
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Nejima S, Kumagai K, Kobayashi H, Yamada S, Akamatsu T, Ogino T, Sotozawa M, Inaba Y. Varus inclination of the tibia is related to patellofemoral osteoarthritis in Japanese female patients with moderate knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2021; 29:652-658. [PMID: 32318752 DOI: 10.1007/s00167-020-06000-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 04/15/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to investigate whether the tibial tuberosity-trochlear groove (TT-TG) distance and lateral patellar tilt, which induce patellofemoral osteoarthritis (OA), are related to the coronal deformity of the lower limb in varus knee OA. It was hypothesized that varus inclination of the tibia was negatively correlated with the TT-TG distance and lateral patellar tilt in Japanese female patients with moderate knee OA. METHODS A total of 104 female patients (139 knees) scheduled to undergo knee osteotomy for varus knee OA were enrolled. The coronal lower limb alignment was measured on anteroposterior whole-leg radiographs. The TT-TG distance, patellar tilt angle, and the patellofemoral joint space were measured both medially and laterally on computed tomography images. The correlations between coronal lower limb alignment and the TT-TG distance or patellar tilt angle, and the correlations between the TT-TG distance or patellar tilt angle and patellofemoral joint space were evaluated. RESULTS The medial proximal tibial angle was negatively correlated with the TT-TG distance (r = - 0.383, P < 0.01) and patellar tilt angle (r = - 0.34, P < 0.01). Lateral patellofemoral joint space was negatively correlated with the TT-TG distance (r = - 0.256, P = 0.002) and patellar tilt angle (r = - 0.205, P = 0.016). CONCLUSIONS Varus inclination of the proximal tibia may induce lateralization of the tibial tuberosity and lateral patellar tilt. The tibial tuberosity lateralization and lateral patellar tilt may induce lateral patellofemoral OA in patients with varus knee OA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Shuntaro Nejima
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Ken Kumagai
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
| | - Hideo Kobayashi
- Department of Orthopaedic Surgery, Yokohama Medical Center, Yokohama, Japan
| | - Shunsuke Yamada
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Tomotaka Akamatsu
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Takahiro Ogino
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Masaichi Sotozawa
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Yutaka Inaba
- Department of Orthopaedic Surgery, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Charlton JM, Esculier JF, Kobsar D, Thatcher D, Hunt MA. Symptomatic knee osteoarthritis is associated with worse but stable quality of life and physical function regardless of the compartmental involvement: Data from the OAI. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 2:100117. [DOI: 10.1016/j.ocarto.2020.100117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 10/26/2020] [Indexed: 11/25/2022] Open
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Zikria B, Rinaldi J, Guermazi A, Haj-Mirzaian A, Pishgar F, Roemer FW, Hakky M, Sereni C, Demehri S. Lateral patellar tilt and its longitudinal association with patellofemoral osteoarthritis-related structural damage: Analysis of the osteoarthritis initiative data. Knee 2020; 27:1971-1979. [PMID: 33248351 DOI: 10.1016/j.knee.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/03/2020] [Accepted: 11/01/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Increase in lateral patellar tilt-(LPT) can cause increased pressure on the lateral facet of the knee and can lead to patellar or femoral cartilage damage and further osseous changes. This study aims to test the hypothesis whether there is an association between increased LPT and MRI-based patellofemoral osteoarthritis-(OA) features at baseline and their worsening over a 2-year follow-up in participants of the Osteoarthritis Initiative-(OAI). METHODS Recorded clinical and imaging data of 600 participants in the FNIH-OA biomarkers consortium was extracted from its database. The LPT-(as the angle betweenthe longest patella diameter and posterior aspect of condyles) was measured using theaxial knee MRI. Associations of LPT (every 5° increase) with MRI OA Knee Scoring-(MOAKS) for OA-related features, including cartilage and bone marrow lesions (BMLs) in addition to knee cartilage volume at baseline and their worsening after 2-year follow-up were assessed using regression models adjusted for several possible confounders. RESULTS The mean LPT angle in this sample was 8.84° ± 5.19. In baseline, higher LPT was associated with lower cartilage volumes and higher cartilage lesions and BMLs MOAKS scores in the lateral trochlear and patellar subregions. Over the follow-ups, subjects with higher LPT measures in the baseline showed higher odds of experiencing BML score worsening in the lateral trochlear subregion-(OR:1.25[1.01-1.56]) over the 2-year follow-ups. CONCLUSIONS Increase in LPT measures may be associated with OA-related features in the trochlear subregion. Therefore, aside from its use as an indicator of patellofemoral instability syndrome, LPT may be associated with longitudinal progression of patellofemoral OA.
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Affiliation(s)
- Bashir Zikria
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD, USA.
| | - Joseph Rinaldi
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Arya Haj-Mirzaian
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Farhad Pishgar
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Frank W Roemer
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg & Universitätsklinikum Erlangen, Erlangen, Germany
| | - Michael Hakky
- Department of Radiology, Florida Hospital, Maitland, FL, USA
| | - Christopher Sereni
- Department of Radiology, University of Massachusetts Medical School, Boston, MA, USA
| | - Shadpour Demehri
- Russell H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
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Kneeling as a risk factor of patellofemoral joint cartilage damage worsening: an exploratory analysis on the Osteoarthritis Initiative. Eur Radiol 2020; 31:2601-2609. [PMID: 33009589 DOI: 10.1007/s00330-020-07337-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/21/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To determine whether kneeling activity is associated with the MRI measures of patellofemoral (PF) joint cartilage damage worsening in subjects with/without patella alta (PA). METHODS Baseline and 24-month 3-T MR images and semi-quantitative MRI Osteoarthritis Knee Score (MOAKS) of PF joint of 600 subjects from the FNIH study, a nested study within the Osteoarthritis Initiative (OAI), were extracted. At baseline visit, subjects were asked how many days per week they participated in kneeling activities lasted ≥ 30 min. Insall-Salvati ratio (ISR) (patellar tendon/patellar height) was measured on baseline MRIs by a musculoskeletal radiologist; ISR ≥ 1.3 was considered PA. Regression analysis adjusted for confounding variables was used to assess the impact of kneeling on worsening of MOAKS cartilage over 24 months. The potential moderating effect of PA was evaluated using adjusted regression analysis. RESULTS Six hundred subjects (58.8% female, years, BMI = 30.7 ± 4.8 kg/m2) were included; 13.7%, 6.2%, and 5.5% of participants reported 1 day, 2-5 days, and ≥ 6 days of kneeling activities per week. A higher frequency of kneeling activity was associated with the increased risk of MOAKS cartilage score worsening (adjusted OR (95% CI): 2.33 (1.08-5.06)). Stratification analysis showed that only ≥ 6 days/week of kneeling activities was associated with the worsening of MOAKS cartilage scores (2.74 (1.03-7.27)). When we included the presence of PA in regression models, the OR (95% CI) for the association between kneeling and PF cartilage damage will decrease to 1.26 (0.78-2.04), suggesting the potential role of PA as the moderator variable. CONCLUSION Extensive kneeling activity (≥ 6 days/week) may be associated with the MRI-based worsening of PF cartilage damage, specifically in subjects with an underlying patella alta. KEY POINTS • Frequent daily kneeling activity is associated with a higher risk of patellofemoral cartilage damage resulting in patellofemoral osteoarthritis. • The cartilage damage associated with extensive kneeling activity may be worse in subjects with an underlying patella alta (i.e., high-riding patella).
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Macri EM, Neogi T, Tolstykh I, Widjajahakim R, Lewis CE, Torner JC, Nevitt MC, Roux M, Stefanik JJ. Relation of Patellofemoral Joint Alignment, Morphology, and Radiographic Osteoarthritis to Frequent Anterior Knee Pain: Data from the Multicenter Osteoarthritis Study. Arthritis Care Res (Hoboken) 2020; 72:1066-1073. [PMID: 31199605 PMCID: PMC6911012 DOI: 10.1002/acr.24004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 06/11/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Patellofemoral (PF) alignment and trochlear morphology are associated with PF osteoarthritis (OA) and knee pain, but whether they are associated with localized anterior knee pain is unknown, which is believed to be a symptom specific to PF joint pathology. We therefore aimed to evaluate the relation of PF alignment and morphology, as well as PFOA and tibiofemoral OA, to anterior knee pain. METHODS The Multicenter Osteoarthritis Study is a cohort study of individuals with, or at risk for, knee OA. We evaluated cross-sectional associations of PF alignment, trochlear morphology, and PF and tibiofemoral radiographic OA, with localized anterior knee pain (defined with a pain map). We used 2 approaches: a within-person knee-matched evaluation of participants with unilateral anterior knee pain (conditional logistic regression), and a cohort approach comparing those with anterior knee pain to those without (binomial regression). RESULTS With the within-person knee-matched approach (n = 110; 64% women, mean age 70 years, body mass index [BMI] 30.9), PF alignment, morphology, and tibiofemoral OA were not associated with unilateral anterior knee pain. Radiographic PFOA was associated with pain, odds ratio 5.3 (95% confidence interval [95% CI] 1.6-18.3). Using the cohort approach (n = 1,818; 7% of knees with anterior knee pain, 59% women, mean age 68 years, BMI 30.4), results were similar: only PFOA was associated with pain, with a prevalence ratio of 2.2 (95% CI 1.4-3.4). CONCLUSION PF alignment and trochlear morphology were not associated with anterior knee pain in individuals with, or at risk for, knee OA. Radiographic PFOA, however, was associated with pain, suggesting that features of OA, more so than mechanical features, may contribute to localized symptoms.
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Affiliation(s)
- Erin M Macri
- University of Delaware, Newark, and Erasmus MC, Rotterdam, The Netherlands
| | - Tuhina Neogi
- School of Medicine, Boston University, Boston, Massachusetts
| | | | | | | | | | | | - Michael Roux
- Hospital for Special Surgery, New York, New York
| | - Joshua J Stefanik
- University of Delaware, Newark, and School of Medicine, Boston University and Northeastern University, Boston, Massachusetts
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Peat G, Rathod-Mistry T, Paskins Z, Marshall M, Thomas MJ, Menz HB, Nicholls E, Myers H, Duncan R, van der Windt DA, Roddy E, Dziedzic KS. Relative prevalence and distribution of knee, hand and foot symptomatic osteoarthritis subtypes in an English population. Musculoskeletal Care 2020; 18:219-224. [PMID: 31995282 DOI: 10.1002/msc.1457] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 12/20/2019] [Accepted: 12/22/2019] [Indexed: 06/10/2023]
Abstract
In this brief report, we used data from a series of three related cohorts on pain and osteoarthritis (OA) of the knee, hand and foot, which were conducted in North Staffordshire, England. We used a common approach for sampling, data collection and coding, to estimate the relative prevalence of 10 different symptomatic radiographic OA subtypes in the knee, hand and foot and to compare their association with age, sex, socioeconomic position and body mass index. Overall, symptomatic hand OA was more common than knee or foot OA (22.4% vs 17.4% vs 16.5%), due mainly to the high prevalence of nodal interphalangeal joint OA among women. The first carpometacarpal joint OA was the most frequent subtype, with patellofemoral, tibiofemoral, (nodal) interphalangeal and midfoot OA also common. Of the risk factors examined, the greatest differences between subtypes appeared to be their associations with sex and obesity: sex differences were noticeably greater for all forms of hand OA except non-nodal interphalangeal joint OA, while obesity appeared most strongly associated with forms of knee OA. The prevalence of all subtypes was higher among older ages, and among those with lower educational attainment.
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Affiliation(s)
- George Peat
- Primary Care Centre Versus Arthritis, School of Primary, Community, and Social Care, Keele University, UK
| | - Trishna Rathod-Mistry
- Primary Care Centre Versus Arthritis, School of Primary, Community, and Social Care, Keele University, UK
- Keele Clinical Trials Unit, Keele University, Staffordshire, UK
| | - Zoe Paskins
- Primary Care Centre Versus Arthritis, School of Primary, Community, and Social Care, Keele University, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire, UK
| | - Michelle Marshall
- Primary Care Centre Versus Arthritis, School of Primary, Community, and Social Care, Keele University, UK
| | - Martin J Thomas
- Primary Care Centre Versus Arthritis, School of Primary, Community, and Social Care, Keele University, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire, UK
| | - Hylton B Menz
- Discipline of Podiatry and La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Elaine Nicholls
- Primary Care Centre Versus Arthritis, School of Primary, Community, and Social Care, Keele University, UK
- Keele Clinical Trials Unit, Keele University, Staffordshire, UK
| | - Helen Myers
- Primary Care Centre Versus Arthritis, School of Primary, Community, and Social Care, Keele University, UK
- Keele Clinical Trials Unit, Keele University, Staffordshire, UK
| | - Rachel Duncan
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Danielle A van der Windt
- Primary Care Centre Versus Arthritis, School of Primary, Community, and Social Care, Keele University, UK
| | - Ed Roddy
- Primary Care Centre Versus Arthritis, School of Primary, Community, and Social Care, Keele University, UK
- Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire, UK
| | - Krysia S Dziedzic
- Primary Care Centre Versus Arthritis, School of Primary, Community, and Social Care, Keele University, UK
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Associations of trochlea morphology and patellofemoral alignment with prevalent radiographic patellofemoral osteoarthritis. Osteoarthritis Cartilage 2020; 28:824-830. [PMID: 32179198 DOI: 10.1016/j.joca.2020.01.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 12/23/2019] [Accepted: 01/16/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the relation of trochlea morphology and patellofemoral alignment to prevalent radiographic patellofemoral osteoarthritis (PFOA). DESIGN A within-person knee-matched case-control study was performed. Participants with unilateral radiographic PFOA were selected from the Multicenter Population-based Osteoarthritis Study (MPOA) in three towns in northern China that was approved by Peking University Health Science Center Ethics Committee (2018PHB166-01). Radiographic PFOA, radiographic tibiofemoral OA, sulcus angle, patellofemoral index and patella displacement were assessed using posterio-anterior and skyline views of the knee. We classified sulcus angle, patellofemoral index and patella displacement into quarters and investigated the relation of each of these measures to prevalent radiographic PFOA. RESULTS Among 451 participants (mean age: 65.2 years, women: 66.8%) with unilateral radiographic PFOA, a reverse J-shaped relationship was observed between sulcus angle and prevalent radiographic PFOA (P = 0.039 for quadratic term). Both higher patellofemoral index and patella displacement were associated with higher prevalent radiographic PFOA. Adjusted odds ratios (ORs) of prevalent radiographic PFOA in the highest quarter of patellofemoral index and patella displacement were 4.69 and 3.60 (P for trend <0.001), respectively, compared with the lowest quarter of each measurement. A similar relationship was observed between sulcus angle with either prevalent radiographic lateral or medial PFOA. Higher values of patellofemoral index and patella displacement were statistically significantly associated with higher prevalent radiographic lateral (ORs = 5.07 and 4.59, respectively), but not medial PFOA (ORs = 0.58 and 0.76, respectively). CONCLUSION Extreme sulcus angles as well as higher values of patellofemoral index and patella displacement were associated with higher prevalent radiographic PFOA.
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Short-term Revision Risk of Patellofemoral Arthroplasty Is High: An Analysis from Eight Large Arthroplasty Registries. Clin Orthop Relat Res 2020; 478:1222-1231. [PMID: 32348089 PMCID: PMC7319370 DOI: 10.1097/corr.0000000000001268] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellofemoral arthroplasty (PFA) is one option for the treatment of isolated patellofemoral osteoarthritis, but there are limited data regarding the procedure and results. Because isolated patellofemoral arthritis is relatively uncommon, available case series generally are small, and even within national registries, sample sizes are limited. Combining data from multiple registries may aid in assessing worldwide PFA usage and survivorship. QUESTIONS/PURPOSES We combined and compared data from multiple large arthroplasty registries worldwide to ask: (1) What proportion of patients undergoing primary knee arthroplasty have PFA? (2) What are the patient and prosthesis characteristics associated with PFA in common practice, as reflected in registries? (3) What is the survivorship free from revision of PFA and what are the reasons for and types of revisions? METHODS Data were provided by eight registries that are members of the International Society of Arthroplasty Registries (ISAR) who agreed to share aggregate data: Australia, New Zealand, Canada, Sweden, Finland, Norway, the Netherlands, and the United States. De-identified data were obtained for PFA performed from either the beginning of year 2000, or the earliest recorded implantation date after that in each individual registry when PFA data collection commenced, up to December 31, 2016. This included patient demographics, implant use, all-cause revision rate (determined by cumulative percent revision [CPR]), and reasons for and type of revision. RESULTS During the data collection period, 6784 PFAs were performed in the eight countries. PFAs comprised less than 1% of primary knee replacements in all registries. Patient demographics were comparable in all countries. Patients were generally more likely to be women than men, and the mean age ranged from 50 years to 60 years. All registries showed a high rate of revision for PFA. The 5-year CPR for any reason ranged from 8.0% (95% CI 4.5 to 11.5) in Norway to 18.1% (95% CI 15.5 to 20.7) in the Netherlands. The most common reason for revision across all countries was disease progression (42%, 434 of 1034). Most PFAs (83%, 810 of 980) were revised to a TKA. CONCLUSIONS The revision risk of PFA in all registries surveyed was more than three times higher than the reported revision risk of TKA at the same times. The survivorship of PFA is similar to that of the no-longer-used procedure of metal-on-metal conventional hip replacement. Although there may be potential functional benefits from PFA, these findings of consistent and alarmingly high rates of revision should create concern, particularly as this procedure is often used in younger patients. LEVEL OF EVIDENCE Level III, therapeutic study.
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Li Z, Liu Q, Zhao C, Gao X, Han W, Stefanik JJ, Jin Q, Lin J, Zhang Y. High prevalence of patellofemoral osteoarthritis in China: a multi-center population-based osteoarthritis study. Clin Rheumatol 2020; 39:3615-3623. [PMID: 32472462 DOI: 10.1007/s10067-020-05110-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 03/25/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND To describe the prevalence and risk factors of patellofemoral osteoarthritis (PFOA) among Chinese residents. METHODS A multi-center population-based osteoarthritis study was conducted in 2014. Residents aged ≥ 50 years old were recruited using a cluster sampling method. Subjects completed a home interview and physical examination and had skyline view of radiographs at patellofemoral (PF) joints. Radiographs were read by two trained musculoskeletal researchers, and discordance of a subject's PFOA status between two readers was adjudicated with a third musculoskeletal researcher present. Radiographic OA at PF joint was defined if osteophytes (OST) score was ≥ 2 or if joint space narrowing (JSN) score was ≥ 2 with concurrent grade 1 OST in the PF joint. RESULTS Of 3446 subjects (63.0% women) included in this analysis, the prevalence of radiographic PFOA was 23.9% (20.5% men vs. 25.8% women). Prevalence of lateral radiographic OA was higher than medial radiographic OA at PF joint. Grades of both osteophytes and joint space narrowing in the lateral patellofemoral compartment were higher than those in the medial patellofemoral compartment (all P values < 0.001). Women, older age, higher BMI, and fewer years of education were significantly associated with higher prevalence of radiographic PFOA, osteophytes, and joint space narrowing. CONCLUSION Prevalence of radiographic PFOA was high among Chinese population. Key Points • The multi-center population-based osteoarthritis study shows the prevalence of radiographic PFOA was high among Chinese population. • Older age, female gender, obesity, and few years of education were associated with a high risk of PFOA. • Prevalence of lateral radiographic OA was higher than medial radiographic OA at PF joint.
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Affiliation(s)
- Zhanglai Li
- Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, China.,Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Qiang Liu
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Changsheng Zhao
- Peking University International Hospital, Peking University, Beijing, China
| | - Xiwu Gao
- The General hospital of Ningxia Medical University, Yinchuan, China
| | - Wenchao Han
- Chinese Medicine Hospital of Puyang Henan, Puyang, China
| | - Joshhua J Stefanik
- Department of Physical Therapy, Movement & Rehabilitation Sciences, Northeastern University, Boston, MA, USA
| | - Qunhua Jin
- The General hospital of Ningxia Medical University, Yinchuan, China.
| | - Jianhao Lin
- Arthritis Clinic and Research Center, Peking University People's Hospital, Peking University, Beijing, 100044, China.
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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