			Home About us Contact

Knee Pain (knee + pain)

Distribution by Scientific Domains

Medical Sciences	97%

Distribution within Medical Sciences

Rheumatology	51%
Radiology & Imaging	7%
Pain Medicine	5%
10 Other Subdomains	37%

Kinds of Knee Pain

anterior knee pain

Selected Abstracts

Ultrasonographic assessment of Baker's cysts after intra-articular corticosteroid injection in knee osteoarthritis

JOURNAL OF CLINICAL ULTRASOUND, Issue 3 2006
J. Carlos Acebes MD
Abstract Purpose: To assess sonographic changes in Baker's cysts (BCs) of patients with knee osteoarthritis after a single intra-articular corticosteroid injection. Methods: Thirty patients with knee osteoarthritis complicated with a symptomatic BC received a single intra-articular injection of 40 mg triamcinolone acetonide. Knee pain, swelling, and range of motion were evaluated. BC area and thickness of the cyst wall were measured with sonography before and 4 weeks after local treatment. Results: A significant improvement in knee pain, swelling, and range of motion after corticosteroid injection was accompanied by a decrease in size of the BCs as well as in thickness of the cyst wall as measured by sonography. Moreover, the reduction of BC area on sagittal scans after treatment was significantly correlated with the improvement in range of motion. Conclusions: In this series of osteoarthritis patients, injection of corticosteroids inside the knee joint accounted for a reduction in BC dimensions as well as cyst wall thickness. Sonography can be used not only for the diagnosis of BCs but also to monitor response to therapy. © 2006 Wiley Periodicals, Inc. J Clin Ultrasound 34:113,117, 2006 [source]

Knee pain in the ACL-deficient osteoarthritic knee and its relationship to quality of life

PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 2 2003
Michael Hartwick
Abstract Background and Purpose Pain during activities of daily living is a common presenting complaint of individuals with knee osteoarthritis and anterior cruciate ligament injury. Knee pain is also associated with a decrease in quality of life for people with osteoarthritis. The purpose of the present study was to examine the dose,response relationship between knee joint forces and painful symptoms, and whether the acute symptoms, were associated with individuals' quality of life. Method This was a cross-sectional cohort correlation study. Seventeen individuals with anterior cruciate ligament (ACL)-deficient knees diagnosed with ipsilateral knee osteoarthritis completed the ACL quality of life questionnaire (ACL-QOL). The subjects also rated pain associated with each of five incremental isometric knee extension tests, proportional to their body weight. Analysis of variance was used to assess the association between pain and normalized torque. Linear regression was used to assess the correlation between the ACL-QOL score and the total pain experienced during the graded test. Results A strong relationship was found between the level of perceived knee pain and the amount of isometric torque produced (Pearson's r = 0.98; p<0.001). There was a statistically significant relationship between pain during the graded isometric test and the ACL-QOL (Pearson's r = ,0.56; p = 0.016). Conclusions Since knee joint compression is a function of active isometric knee extension torque, increased painful symptoms were associated with increased compression forces at the knee joint for these subjects. The relationship between pain provocation and disease-specific quality of life provides evidence for the proposed joint provocation test for this subject population. Weakness caused by osteoarthritis (OA) may, in part, be a negative conditioning response that would need to be overcome in rehabilitation. Copyright © 2003 Whurr Publishers Ltd. [source]

A randomized crossover trial of a wedged insole for treatment of knee osteoarthritis,

ARTHRITIS & RHEUMATISM, Issue 4 2007
Kristin Baker
Objective In uncontrolled studies, a lateral-wedge insole has reduced knee pain in patients with medial knee osteoarthritis (OA). The aim of this study was to test the efficacy of this simple, low-cost intervention for pain in patients with medial knee OA. Methods We conducted a double-blind, randomized, crossover trial designed to detect a small effect of treatment. Participants were at least 50 years of age and had medial joint space narrowing on posteroanterior semiflexed radiographs and scores indicating moderate pain for 2 of the 5 items on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale. Participants were randomized to receive a 5° lateral-wedge insole or a neutral insole for 6 weeks. Following a 4-week washout period, participants crossed over to the other treatment for 6 weeks. Knee pain, the primary outcome, was assessed by the WOMAC pain scale (visual analog scale version). Secondary outcomes included the WOMAC disability subscale, overall knee pain, 50-feet walk time, chair-stand time, and use of medications for knee pain. Results Ninety patients were randomized. The mean difference in pain between the 2 treatments was 13.8 points on the WOMAC pain scale (95% confidence interval ,3.9, 31.4 [P = 0.13]). We observed similar small effects for the secondary outcomes. Conclusion The effect of treatment with a lateral-wedge insole for knee OA was neither statistically significant nor clinically important. [source]

Knee pain reduces joint space width in conventional standing anteroposterior radiographs of osteoarthritic knees

ARTHRITIS & RHEUMATISM, Issue 5 2002
Steven A. Mazzuca
Objective A suspected, but heretofore undemonstrated, limitation of the conventional weight-bearing anteroposterior (AP) knee radiograph, in which the joint is imaged in extension, for studies of progression of osteoarthritis (OA) is that changes in knee pain may affect extension, thereby altering the apparent thickness of the articular cartilage. The present study was undertaken to examine the effect of changes in knee pain of varying magnitudes on radiographic joint space width (JSW) in the weight-bearing extended and the semiflexed AP views, in which radioanatomic positioning of the knee was carefully standardized by fluoroscopy. Methods Fifteen patients with knee OA underwent a washout of their analgesic/nonsteroidal antiinflammatory drug (NSAID) agents (duration 5 half-lives), after which standing AP and semiflexed AP knee radiographs of both knees were obtained. Examinations were repeated 1,12 weeks later (median 4.5 weeks, mean 6.0 weeks), after resumption of analgesic/NSAID therapy. Knee pain was measured with the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) Index (Likert scale). JSW was measured with a pair of calipers and a magnifying lens. Mixed model analyses of variance were used to test the significance of changes in pain and JSW within and between 2 groups of knees with mild-to-moderate radiographic severity of OA: (a) "flaring knees," in which the patient rated standing knee pain as severe or extreme after the washout and in which pain decreased to any degree after resumption of analgesics and/or NSAIDs (n = 12) and (b) "nonflaring knees," in which standing knee pain was absent, mild, or moderate after the washout or did not decrease after resumption of treatment (n = 15). Results After reinstitution of treatment, WOMAC pain scores decreased significantly in both flaring and nonflaring knees (,44%; P < 0.0001 and ,18%; P < 0.01, respectively). After adjustment for the within-subject correlation between knees, mean JSW (±SEM) in the extended view of the flaring OA knee increased significantly from the first to second examination (0.20 ± 0.06 mm; P = 0.005). In contrast, the change in adjusted mean JSW in the extended view of the nonflaring OA knee was negligible (,0.04 ± 0.04 mm) and significantly smaller than that observed in flaring knees (P < 0.01). Mean JSW in the semiflexed AP view was unaffected by the severity or responsiveness of standing knee pain in flaring and nonflaring OA knees. Conclusion JSW in weight-bearing extended-view radiographs of highly symptomatic OA knees can be altered significantly by changes in joint pain. In clinical trials and in epidemiologic studies of OA progression that use this radiographic technique, longitudinal variations in pain may confound changes in the apparent thickness of the articular cartilage. [source]

No gain with knee pain and aromatic massage

FOCUS ON ALTERNATIVE AND COMPLEMENTARY THERAPIES AN EVIDENCE-BASED APPROACH, Issue 4 2008
Article first published online: 3 JUN 2010
[source]

Haemorrhage into a popliteal cyst: an unusual complication of haemophilia A

HAEMOPHILIA, Issue 5 2002
V. Rodriguez
Summary. ,A 7½-year-old boy with severe haemophilia A had increasing discomfort and pain in his left knee after sledding on ice and landing on his knees. Left knee pain persisted for days despite recombinant factor VIII replacement. Imaging studies showed that by day 10 a popliteal cyst had ruptured, with diffusion of blood into the calf muscles. This case illustrates another possible bleeding complication in patients with a bleeding disorder and a popliteal cyst. [source]

A comparison of the performance of the EQ-5D and SF-6D for individuals aged , 45 years

HEALTH ECONOMICS, Issue 7 2008
Garry R. Barton
Abstract We sought to compare the performance of the EQ-5D and SF-6D with regard to the criteria of practicality, convergent validity, and construct validity, the level of agreement between the two measures was also assessed. Responses from 1865 individuals aged , 45 years in one general practice were analysed. Of these, 93.1% completed the EQ-5D, compared with 86.4% for the SF-6D, where individuals who were older, female, of a lower occupational skill level, from an area of lower deprivation, or used prescribed medication were significantly less likely to complete the SF-6D. The performance of both measures was comparable with regard to both convergent and construct validities, as both the EQ-5D and SF-6D scores were closely related to scores on the EuroQol visual analogue scale (VAS) (p<0.001) and able to discriminate between people who did and did not take: (i) analgesics and (ii) other prescribed medication. Despite EQ-5D and SF-6D scores being highly correlated (p<0.001), individuals who were healthier (according to the VAS) had higher mean scores on the EQ-5D (p<0.001), whereas less healthy individuals had higher mean scores on the SF-6D (individuals with knee pain, osteoarthritis, back pain, rheumatoid arthritis, and hip pain had significantly lower mean scores on the EQ-5D, p<0.001). Copyright © 2007 John Wiley & Sons, Ltd. [source]

Osteoid osteoma of the tibial tubercle , an unusual cause of anterior knee pain

INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 10 2004
A. Lakdawala
Summary This case report describes an atypical cause of anterior knee pain in an adolescent male. The osteoid osteoma was located in the tibial apophysis. [source]

Clinical manifestations of chondromalacia patella in 260 Iranian patients

INTERNATIONAL JOURNAL OF RHEUMATIC DISEASES, Issue 2 2005
I. SALEHI
Abstract Background and aim:, Chondromalacia patella, which is characterized by softening of the patellar cartilage, is the most common cause of anterior knee pain in young women. The aim of this study was to identify the clinical features of patients with chondromalacia patella in Iran. Methods:, All patients under 40 years, complaining of mechanical knee pain who were referred to Amir A'lam Rheumatology Unit, with positive shrug sign and normal knee X-rays during the period September 2000 to September 2002, were included in this study. After physical examination and knee radiography, patients with knee arthritis, knee osteoarthritis and knee periarthritis were excluded. Patients with the clinical diagnosis of chondromalacia patella were studied. The demographic data, clinical disease characteristics and disease course were recorded. Results:, There were 260 patients. They were predominantly female (F : M, 2.6 : 1), in the third decade of life and a mean age of 22.8 years at the onset of disease. Bilateral involvement was found in 92% of patients. The first manifestation was knee pain. The history of trauma or swelling of the knee occurred in about 20% of cases. The history of dislocation was 3%. Sitting with flexed knees, stairs, and the use of Turkish WCs aggravated the knee pain. About one-third had knee malalignment, mostly mild genu varus. Patella alta was seen in 1.6%. Q-angle more than 15° was seen in 90.8%. Mean Q-angle was 21.9°, mean patellar angle was 122.6°, and mean intercondylar angle was 141.5°. All patients had the shrug sign. About 90% had Rabot test and crepitation, 3.5% had knee effusion, and 1% had knee laxity. Lower limb discrepancy was seen in 6.2% and spinal deformity in 10%. Ninety-three percent of the patients were treated by conservative (medical) therapy. Conclusion:, So the classic case of chondromalacia patella is a woman in her third decade of life with mechanical knee pain and positive shrug test. [source]

Ultrasonographic assessment of Baker's cysts after intra-articular corticosteroid injection in knee osteoarthritis

Ex vivo magnetic resonance microscopy of an osteochondral transfer,

JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 5 2003
Erik F. Petersen BS
Abstract A 49-year-old woman with right knee pain and a chondral defect on the medial femoral condyle underwent an osteochondral transfer. The patient initially had pain relief, but then sustained a twisting injury and had progressive chondromalacia and pain on the affected side. She subsequently underwent a total knee replacement, and the tissue from the osteochondral transfer (OATS) site was harvested for analysis. In vitro MR microimaging of the excised joint segment revealed undamaged, full-thickness cartilage on the OATS plug, intact cartilage on the posterior condyle, and severely thinned and damaged cartilage on the anterior condyle. Alcian blue-stained sections revealed that proteoglycans were present throughout the OATS core but were nearly absent in the native cartilage. Quantitative T1 data acquired after equilibration with Gd-DTPA indicated a distribution of matrix fixed charge in the OATS plug and anterior tissue that agreed well with histology and literature observations, while the posterior native cartilage appeared to have fixed charge similar to that of the OATS tissue. Histology revealed poor graft integration between OATS and native cartilage, with a distinct layer of fibrous tissue at the posterior interface. MRI images, by comparison, showed a hypointense feature at the posterior interface but uniform intensity across the anterior interface. Quantitative T2, magnetization transfer and T1 data acquired with and without gadolinium contrast showed dependences on depth, location, and pathology that were consistent with measurements reported in the literature for articular cartilage. J. Magn. Reson. Imaging 2003;17:603,608. Published 2003 Wiley-Liss, Inc. [source]

Patellar blood flow during knee arthroplasty surgical exposure: Intraoperative monitoring by laser doppler flowmetry

JOURNAL OF ORTHOPAEDIC RESEARCH, Issue 10 2007
Axel Hempfing
Abstract Patellofemoral complications following knee arthroplasty are a well-known problem. Patellar ischemia has been suspected to be causative for fracture, anterior knee pain, and patella component failure. The purpose of this study was to assess the influence of knee arthroplasty surgical dissection on patellar blood flow. Patellar blood flow was measured by means of intraosseous laser Doppler flowmetry (LDF) in 10 patients undergoing total knee arthroplasty by a standard medial parapatellar approach. The initial blood flow was 121.6,±,114.7 AU. The signal significantly decreased by 71% (p,=,0.0051) when the knee was flexed and lost the pulsatile signal pattern in 80%. After arthrotomy, the signal was 100.1,±,120.3 AU in extension. The lowest signal was found in flexion and eversion of the patella (mean, 18,±,10.7 AU) and all signals lost pulsatility. As compared to the initial values, completion of the soft tissue dissection did not lead to a significant change of the blood flow signal (121.3,±,104.8; p,=,0.6835). Flexion of the knee joint markedly reduced patellar perfusion. Standard medial parapatellar approach did not significantly change patellar blood flow. This study does not support the theory of postoperative patellar ischemia as a cause of anterior knee pain or patellofemoral problems. © 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:1389,1394, 2007 [source]

Prolonged vastus lateralis denervation after botulinum toxin type A injection

MOVEMENT DISORDERS, Issue 3 2010
FRACP, John W Dunne MBBS (Hons)
Abstract Intramuscular injection of botulinum toxin (BoNT) produces reversible blockade of neuromuscular transmission. In animal experimental models, recovery begins within four weeks and is usually complete by twelve weeks. We present evidence of prolonged denervation following BoNT injection of the vastus lateralis (VL) muscle to correct quadriceps muscle imbalance in patients with chronic anterior knee pain. Needle electromyography data were obtained from 10 subjects who had received a single BoNT treatment 5 to 19 months earlier as part of a clinical trial. Insertional and spontaneous activity, recruitment, and motor unit action potentials were examined. Clear differences between the injected and non-injected VL muscles, which correlated with the time since injection, were identified in all subjects. All 10 subjects studied with needle EMG showed evidence of persisting denervation in the BoNT-A injected VL muscle beyond the period of neuromotor recovery expected from animal experimental studies. © 2010 Movement Disorder Society [source]

Impact of Chronic Musculoskeletal Pathology on Older Adults: A Study of Differences between Knee OA and Low Back Pain

PAIN MEDICINE, Issue 4 2009
Natalia E. Morone MD
ABSTRACT Objectives., The study aimed to compare the psychological and physical characteristics of older adults with knee osteoarthritis (OA) vs those of adults with chronic low back pain (CLBP) and to identify psychological and physical predictors of function as measured by gait speed. Design., Secondary data analysis. Method and Patients., Eighty-eight older adults with advanced knee OA and 200 with CLBP who had participated in separate randomized controlled trials were selected for this study. Measures., Inclusion criteria for both trials included age ,65 and pain of at least moderate intensity that occurred daily or almost every day for at least the previous 3 months. Psychological constructs (catastrophizing, fear avoidance, self-efficacy, depression, affective distress) and physical measures (comorbid medical conditions, pain duration, pain severity, pain related interference, self-rated health) were obtained. Results., Subjects with CLBP had slower gait (0.88 m/s vs 0.96 m/s, P = 0.002) and more comorbid conditions than subjects with knee pain (mean 3.36 vs 1.97, P < 0.001). All the psychological measures were significantly worse in the CLBP group except the Multidimensional Pain Inventory,Affective Distress score. Self-efficacy, pain severity, and medical comorbidity burden were associated with slower gait regardless of the location of the pain. Conclusions., Older adults with chronic pain may have distinct psychological and physical profiles that differentially impact gait speed. These findings suggest that not all pain conditions are the same in their psychological and physical characteristics and may need to be taken into consideration when developing treatment plans. [source]

Acupuncture for Chronic Pain: Is Acupuncture More than an Effective Placebo?

PAIN PRACTICE, Issue 2 2010
A Systematic Review of Pooled Data from Meta-analyses
Abstract Objectives: There is controversy as to whether or not acupuncture is more effective than placebo. To help clarify this debate, we synthesized the evidence gathered from systematic reviews on the pooled data of high-quality randomized controlled trials comparing acupuncture to sham acupuncture for chronic pain. Method: Systematic reviews of acupuncture for the most commonly occurring forms of chronic pain (back, knee, and head) published between 2003 and 2008 were sourced from Ovid databases: Medline, Allied and Complementary Medicine database, Cochrane Library and Web of Science during December 2008. Eight systematic reviews with meta-analyses of pooled data were eligible for inclusion. Data were extracted for short- and longer-term outcomes for the most commonly occurring forms of pain. Two independent reviewers assessed methodological quality. Results: For short-term outcomes, acupuncture showed significant superiority over sham for back pain, knee pain, and headache. For longer-term outcomes (6 to12 months), acupuncture was significantly more effective for knee pain and tension-type headache but inconsistent for back pain (one positive and one inconclusive). In general, effect sizes (standardized mean differences) were found to be relatively small. Discussion: The accumulating evidence from recent reviews suggests that acupuncture is more than a placebo for commonly occurring chronic pain conditions. If this conclusion is correct, then we ask the question: is it now time to shift research priorities away from asking placebo-related questions and shift toward asking more practical questions about whether the overall benefit is clinically meaningful and cost-effective? [source]

Knee pain in the ACL-deficient osteoarthritic knee and its relationship to quality of life

Association between psychosocial factors and musculoskeletal symptoms among Iranian nurses

AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 10 2010
Ramin Mehrdad MD
Abstract Background While psychosocial factors have been associated with musculoskeletal symptoms among nurses in some countries, previous studies of Iranian nurses show little association using a demand and control questionnaire. The aim of this study is to assess and evaluate the prevalence of musculoskeletal symptoms and to assess their relationships with psychosocial factors among nurses in Iran. Methods In a cross-sectional study, 347 hospital nurses completed a self-reported questionnaire containing the Standardized Nordic questionnaire for musculoskeletal symptoms and the General Nordic questionnaire for Psychological and Social factors at work (QPS Nordic 34+ Questionnaire). Results Prevalence of low back pain, knee pain, shoulder pain, and neck pain were 73.2%, 68.7%, 48.6%, and 46.3%, respectively. Middle and high stress groups had higher crude and adjusted odds than the low stress group for all body sites. The association for neck, wrist/hand, and upper back and ankle/foot reports (adjusted odds ratio for high stress ranging from 2.4 to 3.0) were statistically significant. Conclusions We observed a high prevalence of self-reported musculoskeletal symptoms at a number of body sites, which were associated with psychosocial factors and specifically stress as defined by the QPS Nordic 34+ Questionnaire. Am. J. Ind. Med. 53:1032,1039, 2010. © 2010 Wiley-Liss, Inc. [source]

Allotransplantation of Cryopreserved Parathyroid Tissue for Severe Hypocalcemia in a Renal Transplant Recipient

AMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2010
S. M. Flechner
We report the successful allotransplantation of cryopreserved parathyroid tissue to reverse hypocalcemia in a kidney transplant recipient. A 36-year-old male received a second deceased donor kidney transplant, and 6 weeks later developed severe bilateral leg numbness and weakness, inability to walk, acute pain in the left knee and wrist tetany. His total calcium was 2.6 mg/dL and parathormone level 5 pg/mL (normal 10,60 pg/mL). He underwent allotransplantation of parathyroid tissue cryopreserved for 8 months into his left brachioradialis muscle. Immunosuppression included tacrolimus (target C0 10,12 ng/mL), mycophenolate mofetil and steroids. Within 2 weeks, the left knee pain, leg weakness and numbness resolved, and by 1 month he could walk normally. After a peak at month 2, his parathyroid hormone (PTH) level fell to <10 pg/mL; therefore at month 3 he received a second parathyroid transplant from the same donor. Eight months later (11 months after initial graft) he has a total calcium of 9.3 mg/dL, PTH level 15 pg/mL and is clinically asymptomatic. The amount of parathyroid tissue needed to render a patient normocalcemic is not known. In our case, the need for second transplant suggests that the amount of tissue transferred for an allograft may need to be substantially greater than for an autograft. [source]

Total knee replacement in the morbidly obese: a literature review

ANZ JOURNAL OF SURGERY, Issue 9 2010
Anthony J. Samson
Abstract Background:, The ,obesity epidemic' is expected to result in an increased incidence of knee osteoarthritis and hence total knee replacements (TKRs). Reviews have demonstrated the conflicting results of TKR for all obese (body mass index (BMI) >30). The aim of this literature review was to specifically evaluate outcomes of TKR in patients with morbid obesity (MO; BMI >40). Methods:, A systematic review of medical databases (PubMed, Medline, Cochrane Library, ScienceDirect) by use of keywords from January 1990 to September 2009 was undertaken. Results:, Clinical and functional Knee Society Scores (KSS) improve after TKR for patients with MO. The post-operative functional KSS was, in general, less than in controls. Radiographic analysis was inconclusive because of small study populations and short duration of follow-up. All studies reporting complications noted a greater prevalence in MO patients (10,30%). Of concern was the significantly higher prevalence of deep prosthetic infection (3,9-times that of controls). The morbidly obese also had a significantly higher incidence of wound complications. TKR did not result in weight loss for MO patients, and therefore has no benefit on weight-related medical conditions. Bariatric surgery in MO under 65 years of age has been shown to be a cost-effective and clinically effective method of weight reduction. This surgery also results in significant improvement in weight-related medical conditions, the KSS and knee pain. Conclusions:, Given the increase in complications for MO patients after TKR, these patients should be advised to lose weight before surgery and, if suitable, would probably benefit from bariatric surgery. [source]

The need for patellar resurfacing in total knee arthroplasty: a literature review

ANZ JOURNAL OF SURGERY, Issue 4 2010
John D. Swan
Abstract The controversy over whether or not to routinely resurface the patella during a total knee arthroplasty has persisted despite three decades of successful joint replacement procedures. Advocates for routine patellar resurfacing admit the occasional need for secondary patellar resurfacing and declare increased incidence of anterior knee pain in patients with non-resurfaced patellae as a cause for worry. Surgeons that leave the patella unresurfaced cite avoidance of complications that include patellar fracture, avascular necrosis, patellar tendon injury and instability. This review discusses the available literature on patellar resurfacing through an evidence-based analysis of randomized and pseudo-randomized controlled trials and published meta-analyses to date. The published literature seems to favour resurfacing the patellar routinely. Selective patellar resurfacing would be the ideal solution if sound pre-operative criteria could be established. So far, a method for accurately predicting which patients can avoid patellar resurfacing has not been found. Future research looking at patellar resurfacing should concentrate on developing criteria for selecting those patients that would benefit from patellar resurfacing and those that would do as well without resurfacing, and thus, limiting potential surgical complications. [source]

Clinical images: Unilateral knee pain and swelling

ARTHRITIS & RHEUMATISM, Issue 8 2010
Pippa Watson MD
No abstract is available for this article. [source]

Denuded subchondral bone and knee pain in persons with knee osteoarthritis

ARTHRITIS & RHEUMATISM, Issue 12 2009
Kirsten Moisio
Objective It is unclear how articular cartilage loss contributes to pain in patients with knee osteoarthritis (OA). Full-thickness cartilage defects expose the subchondral bone plate. The relationship between denuded bone and pain has not been examined. The aim of this study was to investigate whether the percent of denuded bone is associated with moderate-to-severe knee pain or frequent knee pain and longitudinally with frequent knee pain 2 years after the baseline evaluation. Methods We studied 182 persons with knee OA (305 knees). Applying specialized magnetic resonance imaging techniques, manual segmentation was used to compute cartilage-covered and denuded bone areas for each surface. Moderate-to-severe knee pain was defined as a score of ,40 mm on a knee-specific 100-mm visual analog scale, and frequent knee pain was defined as pain on most days during the past month. Logistic regression and generalized estimating equations were used in analyses, adjusting for age, sex, body mass index, and bone marrow lesions. Results Cross-sectional analyses revealed that moderate-to-severe knee pain was associated with percent denuded bone in the medial compartment (adjusted odds ratio [OR] 3.90, 95% confidence interval [95% CI] 1.33,11.47), in the medial and patellar surfaces together, and in the lateral and patellar surfaces. Frequent knee pain was associated with percent denuded bone in the patellar surface (adjusted OR 3.11, 95% CI 1.24,7.81), in the medial and patellar surfaces, and in the lateral and patellar surfaces. Longitudinal analyses (in 168 knees without frequent knee pain at baseline) revealed that percent denuded bone in the medial and patellar surfaces was associated with frequent incident knee pain (adjusted OR 4.19, 95% CI 1.56,11.22). Conclusion These results support a relationship between subchondral bone plate exposure and prevalent and incident knee pain in patients with knee OA. [source]

Trabecular morphometry by fractal signature analysis is a novel marker of osteoarthritis progression,

ARTHRITIS & RHEUMATISM, Issue 12 2009
Virginia Byers Kraus
Objective To evaluate the effectiveness of using subchondral bone texture observed on a radiograph taken at baseline to predict progression of knee osteoarthritis (OA) over a 3-year period. Methods A total of 138 participants in the Prediction of Osteoarthritis Progression study were evaluated at baseline and after 3 years. Fractal signature analysis (FSA) of the medial subchondral tibial plateau was performed on fixed flexion radiographs of 248 nonreplaced knees, using a commercially available software tool. OA progression was defined as a change in joint space narrowing (JSN) or osteophyte formation of 1 grade according to a standardized knee atlas. Statistical analysis of fractal signatures was performed using a new model based on correlating the overall shape of a fractal dimension curve with radius. Results Fractal signature of the medial tibial plateau at baseline was predictive of medial knee JSN progression (area under the curve [AUC] 0.75, of a receiver operating characteristic curve) but was not predictive of osteophyte formation or progression of JSN in the lateral compartment. Traditional covariates (age, sex, body mass index, knee pain), general bone mineral content, and joint space width at baseline were no more effective than random variables for predicting OA progression (AUC 0.52,0.58). The predictive model with maximum effectiveness combined fractal signature at baseline, knee alignment, traditional covariates, and bone mineral content (AUC 0.79). Conclusion We identified a prognostic marker of OA that is readily extracted from a plain radiograph using FSA. Although the method needs to be validated in a second cohort, our results indicate that the global shape approach to analyzing these data is a potentially efficient means of identifying individuals at risk of knee OA progression. [source]

Association of biomarkers with pre,radiographically defined and radiographically defined knee osteoarthritis in a population-based study

ARTHRITIS & RHEUMATISM, Issue 5 2009
Jolanda Cibere
Objective To evaluate 10 biomarkers in magnetic resonance imaging (MRI),determined, pre,radiographically defined osteoarthritis (pre-ROA) and radiographically defined OA (ROA) in a population-based cohort of subjects with symptomatic knee pain. Methods Two hundred one white subjects with knee pain, ages 40,79 years, were classified into OA subgroups according to MRI-based cartilage (MRC) scores (range 0,4) and Kellgren/Lawrence (K/L) grades of radiographic severity (range 0,4): no OA (MRC score 0, K/L grade <2), pre-ROA (MRC score ,1, K/L grade <2), or ROA (MRC score ,1, K/L grade ,2). Urine and serum samples were assessed for levels of the following biomarkers: urinary biomarkers C-telopeptide of type II collagen (uCTX-II), type II and types I and II collagen cleavage neoepitopes (uC2C and uC1,2C, respectively), and N-telopeptide of type I collagen, and serum biomarkers sC1,2C, sC2C, C-propeptide of type II procollagen (sCPII), chondroitin sulfate 846 epitope, cartilage oligomeric matrix protein, and hyaluronic acid. Multicategory logistic regression was performed to evaluate the association of OA subgroup with individual biomarker levels and biomarker ratios, adjusted for age, sex, and body mass index. Results The risk of ROA versus no OA increased with increasing levels of uCTX-II (odds ratio [OR] 3.12, 95% confidence interval [95% CI] 1.35,7.21), uC2C (OR 2.13, 95% CI 1.04,4.37), and uC1,2C (OR 2.07, 95% CI 1.06,4.04), and was reduced in association with high levels of sCPII (OR 0.53, 95% CI 0.30,0.94). The risk of pre-ROA versus no OA increased with increasing levels of uC2C (OR 2.06, 95% CI 1.05,4.01) and uC1,2C (OR 2.06, 95% CI 1.12,3.77). The ratios of type II collagen degradation markers to collagen synthesis markers were better than individual biomarkers at differentiating the OA subgroups, e.g., the ratio of [uCTX-II][uC1,2C] to sCPII was associated with a risk of ROA versus no OA of 3.47 (95% CI 1.34,9.03) and a risk of pre-ROA versus no OA of 2.56 (95% CI 1.03,6.40). Conclusion Different cartilage degradation markers are associated with pre-ROA than are associated with ROA, indicating that their use as diagnostic markers depends on the stage of OA. Biomarker ratios contrasting cartilage degradation with cartilage synthesis are better able to differentiate OA stages compared with levels of the individual markers. [source]

Serum levels of vitamin D, sunlight exposure, and knee cartilage loss in older adults: The Tasmanian older adult cohort study

ARTHRITIS & RHEUMATISM, Issue 5 2009
Changhai Ding
Objective To determine the associations between serum levels of vitamin D, sunlight exposure, and knee cartilage loss cross-sectionally and longitudinally in older adults. Methods A total of 880 randomly selected subjects (mean age 61 years [range 51,79 years], 50% women) were studied at baseline, and 353 of these subjects were studied 2.9 years later. Serum levels of 25-hydroxyvitamin D (25[OH]D) were assessed by radioimmunoassay, and sunlight exposure was assessed by questionnaire. T1-weighted fat-suppressed magnetic resonance imaging (MRI) of the right knee was performed to determine knee cartilage volume and defects. Knee radiographic osteoarthritis (OA) and knee pain were also assessed. Results The mean 25(OH)D serum level was 52.8 nmoles/liter at baseline (range 13,119 nmoles/liter). Winter sunlight exposure and serum 25(OH)D level were both positively associated with medial and lateral tibial cartilage volume, and a serum 25(OH)D level <50 nmoles/liter was associated with increased medial tibiofemoral joint space narrowing (all P < 0.05). Longitudinally, baseline serum 25(OH)D level predicted change in both medial and lateral tibial cartilage volume (, = +0.04% per annum per nmole/liter for both; P < 0.05), and change in serum 25(OH)D level was positively associated with change in medial tibial cartilage volume. These associations were consistent in subjects with radiographic OA and knee pain and/or in women, but not in men or in subjects without radiographic OA or knee pain. Conclusion Sunlight exposure and serum 25(OH)D levels are both associated with decreased knee cartilage loss (assessed by radiograph or MRI). This is best observed using the whole range of 25(OH)D levels rather than predefined cut points and implies that achieving vitamin D sufficiency may prevent and/or retard cartilage loss in knee OA. [source]

Quadriceps strength and the risk of cartilage loss and symptom progression in knee osteoarthritis

ARTHRITIS & RHEUMATISM, Issue 1 2009
Shreyasee Amin
Objective To determine the effect of quadriceps strength in individuals with knee osteoarthritis (OA) on loss of cartilage at the tibiofemoral and patellofemoral joints (assessed by magnetic resonance imaging [MRI]) and on knee pain and function. Methods We studied 265 subjects (154 men and 111 women, mean ± SD age 67 ± 9 years) who met the American College of Rheumatology criteria for symptomatic knee OA and who were participating in a prospective, 30-month natural history study of knee OA. Quadriceps strength was measured at baseline, isokinetically, during concentric knee extension. MRI of the knee at baseline and at 15 and 30 months was used to assess cartilage loss at the tibiofemoral and patellofemoral joints, with medial and lateral compartments assessed separately. At baseline and at followup visits, knee pain was assessed using a visual analog scale, and physical function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index. Results There was no association between quadriceps strength and cartilage loss at the tibiofemoral joint. Results were similar in malaligned knees. However, greater quadriceps strength was protective against cartilage loss at the lateral compartment of the patellofemoral joint (for highest versus lowest tertile of strength, odds ratio 0.4 [95% confidence interval 0.2, 0.9]). Those with greater quadriceps strength had less knee pain and better physical function over followup (P < 0.001). Conclusion Greater quadriceps strength had no influence on cartilage loss at the tibiofemoral joint, including in malaligned knees. We report for the first time that greater quadriceps strength protected against cartilage loss at the lateral compartment of the patellofemoral joint, a finding that requires confirmation. Subjects with greater quadriceps strength also had less knee pain and better physical function over followup. [source]

Correlation of the development of knee pain with enlarging bone marrow lesions on magnetic resonance imaging

ARTHRITIS & RHEUMATISM, Issue 9 2007
David T. Felson
Objective Results of cross-sectional studies have suggested that bone marrow lesions (BMLs) visualized on magnetic resonance imaging (MRI) are related to knee pain, but no longitudinal studies have been done. This study was undertaken to determine whether enlarging BMLs are associated with new knee pain. Methods Subjects ages 50,79 years with knee osteoarthritis (OA) or at high risk of knee OA were asked twice at baseline about the presence of knee pain, aching, or stiffness (classified as frequent knee pain) on most days; absence of knee pain was the baseline eligibility criterion. At 15 months' followup, subjects were again queried twice about frequent knee pain. A case knee was defined as absence of knee pain at baseline but presence of knee pain both times at followup. Controls were selected randomly from among knees with absence of pain at baseline. All MR images were scored for volume of BMLs in the medial, lateral, and patellofemoral compartments. We focused on the maximal change in BML score among the knee compartments from baseline to 15 months. Multiple logistic regression, with adjustments for demographic and clinical variables, was used to assess whether an increased BML score is predictive of the development of knee pain. Results Among case knees, 54 of 110 (49.1%) showed an increase in BML score within a compartment, whereas only 59 of 220 control knees (26.8%) showed an increase (P < 0.001 by chi-square test). A BML score increase of at least 2 units was much more common in case knees than in control knees (27.5% versus 8.6%; adjusted odds ratio 3.2, 95% confidence interval 1.5,6.8). Among case knees with increased BMLs, most already had BMLs at baseline, with enlarging BMLs at followup, but among the subset of knees with no BMLs at baseline, new BMLs were more common in case knees (11 [32.4%] of 34) than in control knees (9 [10.8%] of 83). Conclusion Development of knee pain is associated with an increase in BMLs as revealed on MRI. [source]

A randomized crossover trial of a wedged insole for treatment of knee osteoarthritis,

Periarticular lesions detected on magnetic resonance imaging: Prevalence in knees with and without symptoms

ARTHRITIS & RHEUMATISM, Issue 10 2003
Catherine L. Hill
Objective To evaluate, using magnetic resonance imaging (MRI), the prevalence of periarticular lesions in older persons with or without knee pain, and to assess the association of these lesions with knee pain. Methods Subjects ages 45 years and older, with or without knee pain, were recruited from Veterans Affairs medical centers and from the community. Weight-bearing posteroanterior, skyline, and lateral radiographs were obtained in all subjects. Subjects were divided into 3 groups: those with radiographic OA (ROA) and knee pain (n = 376), those with ROA and no knee pain (n = 51), and those with neither ROA nor knee pain (n = 24). A single knee (the more symptomatic one in subjects with knee pain) was imaged with a 1.5T scanner using T1- and T2-weighted and proton-density spin-echo imaging sequences. MRIs were read for the presence of periarticular lesions, which were categorized (according to their general location) as being either peripatellar (prepatellar, superficial infrapatellar, deep infrapatellar) or "other periarticular lesions" (semimembranosus,tibial collateral ligament bursitis, anserine bursitis, iliotibial band syndrome, tibiofibular cyst). Results Patients with knee pain had more severe radiographic disease than did subjects who were asymptomatic. Peripatellar lesions (prepatellar or superficial infrapatellar) were present in 12.1% of the patients with knee pain and ROA, in 20.5% of the patients with ROA and no knee pain, and in 0% of subjects with neither ROA nor knee pain (P = 0.116). However, other periarticular lesions were present in 14.9% of patients with both ROA and knee pain, in only 3.9% of patients with ROA but no knee pain, and in 0% of the group with no knee pain and no ROA (P = 0.004). Conclusion Although peripatellar lesions are equally common among subjects with knee pain and those without knee pain, other periarticular lesions (including bursitis and iliotibial band syndrome) are significantly more common among subjects with knee pain and may contribute to pain in these individuals. [source]