Association Between Declining Walking Speed and Increasing Bone Marrow Lesion and Effusion Volume in Individuals with Accelerated Knee Osteoarthritis

Sarcopenia and Sarcopenic Obesity and Osteoarthritis: A Discussion among Muscles, Fat, Bones, and Aging

Aging is a physical procedure for people and nature. Our aging world is expanding because of the life span extension. Aging has a crucial relationship with our body composition (muscles, bones, and adipose tissue), which is characterized by an increase in fat mass and a gradual decrease in muscle mass and strength and bone density. These alterations affect physical performance and impact quality of life enhancing the risk for non-communicable diseases, immobilization, and disability. As far we know, osteoarthritis of lower limbs, sarcopenic obesity, and muscle mass and/or strength loss are treated separately. However, bones, muscles, adipose tissue, and aging appear to have an interconnection through a dialogue as they talk to each other. Health disorders are coming into the surface when this relationship is disrupted. The aim of our study is to search deeper into this interconnection, so that when adipose tissue increases, we have to take a look into the condition of muscle mass, bone, and connective tissue and vice versa, through the assessment of physical performance. Consequently, the triad muscle-bone-adipose tissue disorders by aging should be treated as a single entity.

Knee symptoms do not affect walking biomechanics among women 6 months after anterior cruciate ligament reconstruction

Women with anterior cruciate ligament reconstruction report worse pain and knee-related symptoms, and also exhibit biomechanical changes that may be related to knee osteoarthritis (OA) development. This is particularly concerning as symptom state has been previously associated with knee OA development. The purpose of this study was to compare lower extremity walking biomechanics between women (age: 21.40 ± 8.54 years) experiencing clinically significant knee-related symptoms and women with acceptable symptoms 6 months following surgery. Twenty-eight women with history of primary, unilateral anterior cruciate ligament reconstruction who completed a lower extremity walking biomechanics assessment 6 months following surgery were included in this analysis. Women were dichotomized as experiencing acceptable or clinically significant knee symptoms according to Knee injury and OA Outcomes Score cut-offs described by Englund et al. Walking biomechanics were compared between women with clinically significant and acceptable symptoms using one-way analysis of covariances for involved limb biomechanics. Biomechanical variables of interest were: peak vertical ground reaction forces (vGRFs), vGRF loading rates, knee flexion angles, knee extension moments, knee adduction angles, and knee adduction moments, and gait speed. Nearly 60% of women reported clinically significant knee symptoms 6 months postoperative. There were no statistically significant differences between symptom groups for walking biomechanics and gait speed outcomes. These findings suggest patient reported knee symptoms may not be a primary influence on walking biomechanics 6 months following anterior cruciate ligament reconstruction. Though, longitudinal assessment of changes in symptom state and walking biomechanics may be warranted as poorer walking biomechanics and symptoms are indicators of knee OA.

Novel Framework for Measuring Whole Knee Osteoarthritis Progression Using Magnetic Resonance Imaging

OBJECTIVE

We developed and validated a set of composite scores that combine quantitative magnetic resonance imaging (MRI)-based measurements of hyaline cartilage damage, bone marrow lesions (BMLs), and effusion-synovitis into composite scores.

METHODS

We selected 300 participants (n = 100 for development cohort; n = 200 for validation cohort) from the Osteoarthritis Initiative with complete clinical, radiographic, and MRI data at baseline and 24 months. We used semiautomated programs to quantify tibiofemoral and patellar cartilage damage, BML volume, and whole-knee effusion-synovitis volume. The candidate composite scores were formed by summing changes from baseline to 24 months based on prespecified methods. We evaluated the candidate composite scores for 1) the ability to differentiate groups with and without knee osteoarthritis progression (17 radiographic and patient-reported definitions), 2) sensitivity to change (standardized response means), and 3) relative performance relating to legacy outcome measures of knee osteoarthritis progression.

RESULTS

Three of 13 developed composite scores qualified for testing in the validation cohort (ranked by sensitivity to change): whole-knee cumulative cartilage damage, unweighted total knee score, and BML plus effusion-synovitis volume. Change in cumulative cartilage damage associated with radiographic progression (Kellgren/Lawrence grade: odds ratio [OR] 1.84; joint space width progression: OR 2.11). Changes in the unweighted total knee score (OR 1.97) and BML plus effusion-synovitis score (OR 1.92) associated with Western Ontario and McMaster Universities Osteoarthritis Index knee pain progression.

CONCLUSION

Two composite scores emerged, reflecting discrete domains of knee osteoarthritis progression. First, cumulative damage, which is measured by a whole-knee cartilage damage score, reflects the damage accrued over time. Second, dynamic disease activity, which is measured by a BML plus effusion-synovitis score, relates to changes in a patient's state of disease and symptoms.

Validation of a new topographic classification of bone marrow lesions in the knee: the six-letter system

PURPOSE

The aim of this study was to propose and validate a new six-item topographical classification of knee bone marrow lesions in coronal MRI images, to provide an easy-to-use aid to describe their location in a more reproducible and accurate way.

METHODS

This study was conducted in four phases. The first was to do a literature search for methods of describing bone marrow lesions in MRI of the knee. The second was creation of a six-area topographic classification of bone marrow lesions in coronal MRI of the knee. The third phase was selection of cases with bone marrow lesions on knee MRI performed in a single hospital between January of 2017 and December of 2018. The fourth phase was categorization of the bone marrow lesions' location according to the new proposed classification by three independent examiners, two orthopedic surgeons and one radiologist. Patient's demographic data and associated lesions were collected. The inter-observer and intra-observer reliability of the proposed classification was then calculated.

RESULTS

MRI examination of 4000 patients were studied and in 520 patients a total of 666 bone marrow lesions were identified and their location classified using the new system. The inter-observer and intra-observer reliability analysis found a Fleiss' Kappa value of 0.96 (0.95-0.97) and 0.97 (0.96-0.97), respectively, confirming the high reproducibility of the proposed classification.

CONCLUSIONS

The proposed six-location classification of bone marrow lesions is highly reproducible and can help researchers develop studies and share information in a more accurate and reliable way. The correct classification of bone marrow lesions can lead to a more accurate description of this pathology and help clinicians to propose appropriate therapies for this group of patients.

LEVEL OF EVIDENCE

V.

A Decline in Walking Speed Is Associated With Incident Knee Replacement in Adults With and at Risk for Knee Osteoarthritis

OBJECTIVE

To determine if a 1-year change in walking speed is associated with receiving an incident knee replacement during the following year in adults with and at risk for knee osteoarthritis (OA).

METHODS

Using data from the Osteoarthritis Initiative, we determined a 1-year change in the 20-meter walk speed from 3 observation periods (i.e., 0-12, 12-24, and 24-36 months). We operationally defined 1-year change in walking speed as either (1) decline: ≤ -0.1 m/s change, (2) no change: between -0.1 and 0.1 m/s change, and (3) increase: ≥ 0.1 m/s change. Incident knee replacement was defined using each subsequent 1-year period (i.e., 12-24, 24-36, and 36-48 months). Combining data from the 3 observation periods, we performed a Poisson regression with robust error variance to determine the relative risk between a change in walking speed (exposure) and incident knee replacement over the following year (outcome).

RESULTS

Of the 4264 participants included within this analysis (11,311 total person visits), 115 (3%) adults received a knee replacement. Decline in walking speed was associated with a 104% increase in risk [adjusted relative risk (RR) 2.04, 95% CI 1.40-2.98], while an increase in walking speed associated with a 55% decrease in risk (RR 0.45; 95% CI 0.22-0.93) of incident knee replacement in the following year compared to a person with no change in walking speed.

CONCLUSION

A 1-year decline in walking speed is associated with an increased risk, while a 1-year increase in walking speed is associated with a decreased risk of future incident knee replacement.

Biomechanical effects of manipulating peak vertical ground reaction force throughout gait in individuals 6-12 months after anterior cruciate ligament reconstruction

BACKGROUND

We aimed to determine the effect of cueing an increase or decrease in the vertical ground reaction force impact peak (peak in the first 50% of stance) on vertical ground reaction force, knee flexion angle, internal knee extension moment, and internal knee abduction moment waveforms throughout stance in individuals 6-12 months after an anterior cruciate ligament reconstruction.

METHODS

Twelve individuals completed 3 conditions (High, Low, and Control) where High and Low Conditions cue a 5% body weight increase or decrease, respectively, in the vertical ground reaction force impact peak compared to usual walking. Biomechanics during High and Low Conditions were compared to the Control Condition throughout stance.

FINDINGS

The High Condition resulted in: (a) increased vertical ground reaction forces at each peak and decreased during mid-stance, (b) greater knee excursion (i.e., greater knee flexion angle in early stance and a more extended knee in late stance), (c) greater internal extension moment for the majority of stance, and (d) lesser second internal knee abduction moment peak. The Low Condition resulted in: (a) vertical ground reaction forces decreased during early stance and increased during mid-stance, (b) decreased knee excursion, (c) increased internal extension moment throughout stance, and (d) decreased internal knee abduction moment peaks.

INTERPRETATION

Cueing a 5% body weight increase in vertical ground reaction force impact peak resulted in a more dynamic vertical ground reaction force loading pattern, increased knee excursion, and a greater internal extension moment during stance which may be useful in restoring gait patterns following anterior cruciate ligament reconstruction.