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Shangguan L, Ding M, Wang Y, Xu H, Liao B. Denosumab ameliorates osteoarthritis by protecting cartilage against degradation and modulating subchondral bone remodeling. Regen Ther 2024; 27:181-190. [PMID: 38840731 PMCID: PMC11150975 DOI: 10.1016/j.reth.2024.03.019] [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: 11/16/2023] [Revised: 03/08/2024] [Accepted: 03/17/2024] [Indexed: 06/07/2024] Open
Abstract
Osteoarthritis (OA) is the most prevalent degenerative joint disease worldwide. Effective management for early-stage OA is crucial. Denosumab (DS) has been widely used to treat osteoporosis (OP) and rheumatoid arthritis, but its potential for managing OA remains clear. We assessed the effects of DS on osteoclast activity and chondrocyte apoptosis using tartrate-resistant acid phosphatase (TRAP) assay, quantitative real-time polymerase chain reaction (qRT-PCR), flow cytometry, and TUNEL staining. To assess the impact of DS on the NF-κB pathway, we performed Western blot and immunofluorescence staining. Additionally, we used an OA model to explore the influence of DS on subchondral bone remodeling and cartilage degeneration in vivo. We found that DS hindered receptor activator of nuclear factor kappa B ligand (RANKL)-induced osteoclastogenesis by inhibiting the activity of the NF-κB pathway. Besides, DS alleviated reactive oxygen species (ROS)-induced apoptosis in chondrocytes by regulating the expression of genes related to apoptosis. Moreover, we observed an attenuation of OA-related subchondral bone remodeling and cartilage degeneration in vivo. Our findings indicate that DS could effectively suppress osteoclast activity and chondrocyte apoptosis, thereby mitigating OA-related subchondral bone remodeling and cartilage degeneration. These results provide a mechanistic basis for using DS to treat OA.
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Affiliation(s)
- Lei Shangguan
- Department of Orthopedic Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Ming Ding
- Department of Orthopedic Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Yingchun Wang
- Department of Orthopedic Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Hu Xu
- Department of Orthopedic Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Binghui Liao
- Department of Orthopedic Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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van Netten JJ, Dahmen R, Holtkamp F, Aussems JP, Jansen G, Mik E, Bus SA. Development of a research agenda for medical grade footwear in the Netherlands: A multidisciplinary multiphase project to determine the key research questions to advance scientific knowledge in the field. J Foot Ankle Res 2024; 17:e12016. [PMID: 38956878 DOI: 10.1002/jfa2.12016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/30/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND The field of medical grade footwear is dynamic. Originally, a field where individual knowledge, expertise and skills determined the footwear and its outcomes, now becoming a more evidence-based and data-driven field with protocols and systems in place to create appropriate footwear. However, scientific evidence concerning medical grade footwear is still limited. Evidently, all stakeholders, from patients to pedorthists to rehabilitation physicians, will profit from a larger evidence-base in this field. A widely supported research agenda is an essential first step to advance and facilitate new knowledge. METHODS We formed a multidisciplinary team and followed the methodology from Dutch medical societies for the development of a research agenda on medical grade footwear. This consisted of seven steps: (1) inventory of relevant questions with users and professionals; (2) analyses of responses; (3) analyses of existing knowledge and evidence; (4) formulating research questions; (5) prioritising research questions by users and professionals; (6) finalising the research agenda and (7) implementing the research agenda. RESULTS In phase 1, 109 participants completed a survey, including 50% pedorthists, 6% rehabilitation physicians and 3% users. Participants provided 228 potential research questions. In phases 2-4, these were condensed to 65 research questions. In phase 5, 152 participants prioritised these 65 research questions, including 50% pedorthists, 13% rehabilitation physicians and 9% users. In phase 6, the final research agenda was created, with 26 research questions, categorised based on the International Classification of Functioning Disability and Health 'process description assistive devices'. In phase 7, an implementation meeting was held with over 50 stakeholders (including users and professionals), resulting in seven applications for research projects based on one or more research questions from the research agenda. CONCLUSIONS This research agenda structures and guides knowledge development within the field of medical grade footwear in the Netherlands and elsewhere. We expect that this will help to stimulate the field to tackle the research questions prioritised and with that to advance scientific knowledge in this field.
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Affiliation(s)
- Jaap J van Netten
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
| | - Rutger Dahmen
- Amsterdam Rehabilitation Research Center/Reade, Amsterdam, The Netherlands
| | - Fred Holtkamp
- Department of Allied Health Professions, Fontys University of Applied Science, Eindhoven, The Netherlands
| | | | | | - Esther Mik
- Livit Orthopedie, Amsterdam, The Netherlands
| | - Sicco A Bus
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands
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Debie V, Boymans T, Ottenheijm R, van Schayck O, Gidding-Slok A. Expanding the ABCC-tool for osteoarthritis: Development and content validation. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100488. [PMID: 38807711 PMCID: PMC11130725 DOI: 10.1016/j.ocarto.2024.100488] [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: 01/16/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024] Open
Abstract
Objective Osteoarthritis (OA) care should be more person-centered based on physical, emotional and social aspects, instead of the current stepped-care approach solely based on physical symptoms, according to OA patients. By developing a novel module for OA in the Assessment of Burden of Chronic Condition (ABCC)-tool, a tool based on these three aspects, experienced quality of OA care and shared-decision making are expected to improve. Design The development of the novel OA module involved a triangular iterative process, interviewing OA patients and healthcare professionals in the field of OA, an expert panel and a literature search to identify the needs to improve OA care. Patients provided feedback on the first version of the OA module, leading to a second version. This second version was used to evaluate content validity. OA patients and healthcare professionals in the field of OA were asked to evaluate relevance, comprehensiveness and comprehensibility, based on the COSMIN methodology. For healthcare professionals, the item-content validity index (I-CVI) was calculated. Results The module includes questions about pain, kinesiophobia and joint stiffness. For all three questions, 94% of the patients found these questions important for patients with OA. The I-CVI scores of the healthcare professionals ranged from 1.0 (pain, kinesiophobia) to 0.75 (joint stiffness). Conclusion A novel, condition-specific OA module is developed for the ABCC-tool, as a supplement to the generic questions. The module includes three questions, to measure OA specific complaints. This novel module is intended to make the ABCC-tool more elaborate and useable for a larger population.
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Affiliation(s)
- V.H.J. Debie
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - T.A.E.J. Boymans
- Department of Orthopedic Surgery, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center, Maastricht, the Netherlands
| | - R.P.G. Ottenheijm
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - O.C.P. van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - A.H.M. Gidding-Slok
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Lim PQX, Menz HB, Landorf KB, Kaminski MR, Buldt AK, Lithgow MJ, Paterson KL, Halstead J, Munteanu SE. Efficacy of arch contouring foot orthoses for midfoot osteoarthritis: Protocol for a randomised controlled trial. J Foot Ankle Res 2024; 17:e70000. [PMID: 39223075 PMCID: PMC11368563 DOI: 10.1002/jfa2.70000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 08/08/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Midfoot osteoarthritis (OA) is a painful and disabling condition. Arch contouring foot orthoses have been recommended for midfoot OA, yet there is no high-quality evidence from randomised controlled trials to support their use. This clinical trial aims to evaluate the efficacy of arch contouring foot orthoses for midfoot OA. METHODS This will be a parallel-group randomised controlled superiority trial. One-hundred and forty community-dwelling people with painful midfoot OA will be randomised to receive either arch contouring foot orthoses or flat sham inserts. Outcome measures will be obtained at baseline, 4, 8 and 12 weeks; the primary endpoint for assessing efficacy being 12 weeks. The primary outcome measure will be average midfoot pain whilst walking over the last 7 days on an 11-point numerical rating scale. Secondary outcome measures include function (walking/standing subscale of the Manchester-Oxford Foot Questionnaire), participants' perception of overall treatment effect (self-reported global rating of change on a 15-point Likert scale), physical activity (Incidental and Planned Exercise Questionnaire), general health-related quality of life (Short Form-12 Version® 2.0), use of co-interventions and adverse events. DISCUSSION This trial will evaluate the efficacy of arch contouring foot orthoses for relieving pain and improving function, physical activity and health-related quality of life in people with midfoot OA. The findings will provide high-quality evidence as to whether arch contouring foot orthoses are efficacious and will help to inform clinical guidelines about the use of foot orthoses for midfoot OA. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry (ACTRN12623000953639).
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Affiliation(s)
- Polly Q. X. Lim
- Discipline of PodiatrySchool of Allied Health, Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
| | - Hylton B. Menz
- Discipline of PodiatrySchool of Allied Health, Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
| | - Karl B. Landorf
- Discipline of PodiatrySchool of Allied Health, Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
| | - Michelle R. Kaminski
- Discipline of PodiatrySchool of Allied Health, Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
- Department of PodiatryMonash HealthMelbourneVictoriaAustralia
- School of Primary and Allied Health CareMonash UniversityMelbourneVictoriaAustralia
| | - Andrew K. Buldt
- Discipline of PodiatrySchool of Allied Health, Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
| | - Merridy J. Lithgow
- Discipline of PodiatrySchool of Allied Health, Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
| | - Kade L. Paterson
- Department of PhysiotherapyCentre for Health, Exercise and Sports MedicineSchool of Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Jill Halstead
- University of LeedsNIHR Leeds Biomedical Research Centre, and Leeds Community Healthcare NHS TrustLeedsUK
| | - Shannon E. Munteanu
- Discipline of PodiatrySchool of Allied Health, Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
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Alanazi SA, Vicenzino B, van Bergen CJA, Hunter DJ, Wikstrom EA, Menz HB, Golightly YM, Smith MD. Development of a core domain set for ankle osteoarthritis: An international consensus study of patients and health professionals. Osteoarthritis Cartilage 2024:S1063-4584(24)01310-4. [PMID: 39029732 DOI: 10.1016/j.joca.2024.07.004] [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: 12/21/2023] [Revised: 06/21/2024] [Accepted: 07/12/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVES To develop an internationally agreed-upon core domain set for ankle osteoarthritis (OA). METHODS In a three-part Delphi process, a group of multidisciplinary health professionals with expertise in ankle OA and people with ankle OA responded to online questionnaires. The questionnaires proposed a list of 29 candidate domains derived from a systematic review of ankle OA research, and interviews with people with ankle OA and health professionals. Consensus was defined a priori as ≥70% agreement in people with ankle OA and health professionals whether a domain should or should not be included in a core domain set. An online consensus meeting was held to discuss and resolve undecided candidate domains. RESULTS A total of 100 people (75 health professionals and 25 people with ankle OA) from 18 countries (4 continents) participated in this study. Five domains reached consensus for inclusion in a core domain set for ankle OA - pain severity, health-related quality of life, function, disability and ankle range of motion. Twenty-one candidate domains reached agreement not to be included in the core domain set, and three domains remained undecided (ankle instability, physical capacity, and mental health). CONCLUSION This international consensus study, which included people with ankle OA and health professionals, has established a core domain set for ankle OA with five domains that should be measured and reported in all ankle OA trials - pain severity, health-related quality of life, function, disability and ankle range of motion. This core domain set will guide the reporting of outcomes in clinical trials on ankle OA. Future research should determine which outcome measurement instruments should be used to measure each of the core domains.
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Affiliation(s)
- Sultan Ayyadah Alanazi
- School of Health and Rehabilitation Sciences, Physiotherapy, The University of Queensland, Brisbane, Australia; Department of Physical Therapy, College of Applied Medical Sciences, Majmaah University, Al-Majmaah 11952, Saudi Arabia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, Physiotherapy, The University of Queensland, Brisbane, Australia
| | - Christiaan J A van Bergen
- Department of Orthopedic Surgery, Amphia Hospital, Breda 4818 CK, the Netherlands; Department of Orthopedic Surgery and Sports Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - Erik A Wikstrom
- MOTION Science Institute, Department of Exercise & Sport Science, University of North Carolina at Chapel Hill, NC, USA
| | - Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Yvonne M Golightly
- College of Allied Health Professionals, University of Nebraska Medical Center, Omaha, NE, USA; Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Michelle D Smith
- School of Health and Rehabilitation Sciences, Physiotherapy, The University of Queensland, Brisbane, Australia.
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Kim KC, Schmidt E, de Carvalho KAM, Lalevee M, Mansur N, Dibbern K, Auch E, Behrens A, Netto CDC. Prevalence of midfoot arthritis and lesser toe deformities. Foot Ankle Surg 2024; 30:423-431. [PMID: 38490924 DOI: 10.1016/j.fas.2024.03.001] [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: 09/10/2023] [Revised: 12/23/2023] [Accepted: 03/04/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The aim of this study was to investigate the epidemiology of Midfoot Arthritis (MA) and Lesser toe deformity (LTD) using Weight-Bearing Computed Tomography (WBCT). METHODS 606 cases (247 male, 359 female) among 1316 consecutive cases with WBCT data from September 2014 to April 2022 were retrospectively reviewed at a single referral institution. The Cochran-Armitage test was performed to evaluate the trend of prevalence with respect to age group and obesity classification. RESULTS 139 male (56.3%) and 210 female cases (58.5%) showed MA. 157 male (63.6%) and 222 female cases (61.6%) showed LTD. 115 male (19.0%) and 157 female cases (25.9%) showed both MA and LTD. The prevalence of MA and LTD increased with age in both genders. The incidence of MA in males showed an increasing tendency until obesity class II and then was slightly decreased in obesity class III. This is contrary to females whose prevalence increased with increasing obesity groups. LTD had a similar pattern in both genders to obesity classification. CONCLUSIONS The prevalence of MA and LTD increased with age and increasing obesity groups for both genders. LEVEL OF EVIDENCE Level III, Retrospective Comparative Study.
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Affiliation(s)
- Ki Chun Kim
- Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, South Korea.
| | - Eli Schmidt
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | | | - Matthieu Lalevee
- Department of Orthopedic Surgery, Rouen University Hospital, 37 Boulevard Gambetta, 76000 Rouen, France
| | - Nacime Mansur
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Kevin Dibbern
- Orthopaedic and Rehabilitation Engineering Center, Marquette and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Elijah Auch
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Andrew Behrens
- Department of Orthopedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Rhim HC, Schon JM, Xu R, Nolan D, Ahn J, Short K, Schon LC. Prehabilitation for Patients Undergoing Elective Foot and Ankle Surgery: A Contemporary Review. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241255136. [PMID: 38812567 PMCID: PMC11135079 DOI: 10.1177/24730114241255136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Affiliation(s)
- Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA, USA
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Jason M. Schon
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Raylin Xu
- Harvard Medical School, Boston, MA, USA
| | - David Nolan
- Department of Physical Therapy, Movement, and Rehabilitation Science, Northeastern University, Boston, MA, USA
- Sports Physical Therapy Service, Massachusetts General Hospital, Boston, MA, USA
| | - Jiyong Ahn
- Foot & Ankle Research and Innovation Lab (FARIL), Department of Orthopaedic Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kelly Short
- Center for Restorative Therapies, Mercy Medical Center, Baltimore, MD, USA
| | - Lew C. Schon
- Director of Orthopaedic Innovation, Institute for Foot and Ankle Reconstruction, Mercy Medical Center, Baltimore, MD, USA
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, New York University Langone Health, NY, USA
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Gao F, Hu Q, Chen W, Li J, Qi C, Yan Y, Qian C, Wan M, Ficke J, Zheng J, Cao X. Brain regulates weight bearing bone through PGE2 skeletal interoception: implication of ankle osteoarthritis and pain. Bone Res 2024; 12:16. [PMID: 38443372 PMCID: PMC10914853 DOI: 10.1038/s41413-024-00316-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 01/12/2024] [Accepted: 01/15/2024] [Indexed: 03/07/2024] Open
Abstract
Bone is a mechanosensitive tissue and undergoes constant remodeling to adapt to the mechanical loading environment. However, it is unclear whether the signals of bone cells in response to mechanical stress are processed and interpreted in the brain. In this study, we found that the hypothalamus of the brain regulates bone remodeling and structure by perceiving bone prostaglandin E2 (PGE2) concentration in response to mechanical loading. Bone PGE2 levels are in proportion to their weight bearing. When weight bearing changes in the tail-suspension mice, the PGE2 concentrations in bones change in line with their weight bearing changes. Deletion of cyclooxygenase-2 (COX2) in the osteoblast lineage cells or knockout of receptor 4 (EP4) in sensory nerve blunts bone formation in response to mechanical loading. Moreover, knockout of TrkA in sensory nerve also significantly reduces mechanical load-induced bone formation. Moreover, mechanical loading induces cAMP-response element binding protein (CREB) phosphorylation in the hypothalamic arcuate nucleus (ARC) to inhibit sympathetic tyrosine hydroxylase (TH) expression in the paraventricular nucleus (PVN) for osteogenesis. Finally, we show that elevated PGE2 is associated with ankle osteoarthritis (AOA) and pain. Together, our data demonstrate that in response to mechanical loading, skeletal interoception occurs in the form of hypothalamic processing of PGE2-driven peripheral signaling to maintain physiologic bone homeostasis, while chronically elevated PGE2 can be sensed as pain during AOA and implication of potential treatment.
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Affiliation(s)
- Feng Gao
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Qimiao Hu
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Wenwei Chen
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Jilong Li
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Cheng Qi
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Yiwen Yan
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Cheng Qian
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Mei Wan
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - James Ficke
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Junying Zheng
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA
| | - Xu Cao
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA.
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, 21205, USA.
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Molyneux P, Bowen C, Ellis R, Rome K, Fitzgerald K, Clark P, Carroll M. Reliability of an ultrasound imaging acquisition procedure for examining osteoarthritis in the first metatarsophalangeal joint. J Foot Ankle Res 2024; 17:e12002. [PMID: 38551304 PMCID: PMC11296711 DOI: 10.1002/jfa2.12002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/01/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE Given the ability of ultrasound imaging (USI) to depict tissue-specific morphological changes before the onset of pain and before the point of irreversible structural damage, USI could play a fundamental role in earlier detection and assessment of foot osteoarthritis (OA). The current guidelines require further refinement of anatomical landmarks to establish a standardized imaging procedure to improve the interpretability and reproducibility between studies evaluating the first metatarsophalangeal joint (MTPJ). The aims were to develop an USI acquisition procedure and grading system to examine OA features in the first MTPJ and to determine intra-examiner and inter-examiner reliability of a newly developed USI acquisition procedure. DESIGN Thirty participants with first MTPJ OA confirmed radiographically with the use of the La Trobe Foot Atlas were included. An experienced sonographer applied a newly developed USI procedure to examine the following features: joint effusion, synovial hypertrophy, synovitis, joint space narrowing, osteophytes, and cartilage thickness. A semiquantitative grading system was applied to all features. A continuous measure was also examined for osteophyte size, joint space narrowing, and cartilage thickness. To determine the intra-examiner and inter-examiner reliability, an experienced radiologist and sonographer applied the developed grading system to the images acquired from two imaging sessions. Intra-examiner and inter-examiner reliability were calculated using intraclass correlation coefficients (ICCs). RESULTS ICCs for intra-examiner between session reliability ranged from 0.58 to 0.92 for semiquantitative grading and 0.39 to 0.94 for continuous measures. Joint effusion and osteophytes achieved the highest intra-examiner reliability (ICC = 0.78-0.94). ICCs for session one inter-examiner reliability ranged from 0.61 to 1.0 for semiquantitative grading; all continuous measures had an ICC of 1. ICCs for session two inter-examiner reliability ranged from 0.55 to 1.0 for semiquantitative grading and 0.9 to 0.97 for continuous measures. Inter-examiner reliability was good for grading joint effusion (ICC = 0.55-0.62) and was excellent for all other USI features (ICC = 0.77-1.0). CONCLUSION The USI acquisition procedure and grading system are reliable in evaluating first MTPJ OA features in participants with radiologically confirmed OA. The study will inform the methodological development of an ultrasound atlas for grading the degree of osteoarthritic change in the first MTPJ.
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Affiliation(s)
- Prue Molyneux
- School of Clinical SciencesAuckland University of TechnologyAucklandNew Zealand
- Active Living and Rehabilitation: Aotearoa New ZealandHealth and Rehabilitation Research InstituteSchool of Clinical SciencesAuckland University of TechnologyAucklandNew Zealand
| | - Catherine Bowen
- School of Health SciencesFaculty of Environmental and Life SciencesUniversity of SouthamptonSouthamptonUK
- Centre for Sport, Exercise and Osteoarthritis Versus ArthritisUniversity of SouthamptonSouthamptonUK
| | - Richard Ellis
- School of Clinical SciencesAuckland University of TechnologyAucklandNew Zealand
- Active Living and Rehabilitation: Aotearoa New ZealandHealth and Rehabilitation Research InstituteSchool of Clinical SciencesAuckland University of TechnologyAucklandNew Zealand
| | - Keith Rome
- School of Clinical SciencesAuckland University of TechnologyAucklandNew Zealand
| | | | | | - Matthew Carroll
- School of Clinical SciencesAuckland University of TechnologyAucklandNew Zealand
- Active Living and Rehabilitation: Aotearoa New ZealandHealth and Rehabilitation Research InstituteSchool of Clinical SciencesAuckland University of TechnologyAucklandNew Zealand
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Minnig MCC, Golightly YM, Nelson AE. Epidemiology of osteoarthritis: literature update 2022-2023. Curr Opin Rheumatol 2024; 36:108-112. [PMID: 38240280 PMCID: PMC10965245 DOI: 10.1097/bor.0000000000000985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
PURPOSE OF REVIEW This review highlights recently published studies on osteoarthritis (OA) epidemiology, including topics related to understudied populations and joints, imaging, and advancements in artificial intelligence (AI) methods. RECENT FINDINGS Contemporary research has improved our understanding of the burden of OA in typically understudied regions, including ethnic and racial minorities in high-income countries, the Middle East and North Africa (MENA) and Latin America. Efforts have also been made to explore the burden and risk factors in OA in previously understudied joints, such as the hand, foot, and ankle. Advancements in OA imaging techniques have occurred alongside the developments of AI methods aiming to predict disease phenotypes, progression, and outcomes. SUMMARY Continuing efforts to expand our knowledge around OA in understudied populations will allow for the creation of targeted and specific interventions and inform policy changes aimed at reducing disease burden in these groups. The burden and disability associated with OA is notable in understudied joints, warranting further research efforts that may lead to effective therapeutic options. AI methods show promising results of predicting OA phenotypes and progression, which also may encourage the creation of targeted disease modifying OA drugs (DMOADs).
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Affiliation(s)
- Mary Catherine C. Minnig
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Yvonne M. Golightly
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Amanda E. Nelson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
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Callaghan MJ, Gala JP, Roddy E. Ankle osteoarthritis: an online survey of current treatment practices of UK-based podiatrists and physiotherapists. J Foot Ankle Res 2023; 16:89. [PMID: 38082323 PMCID: PMC10714609 DOI: 10.1186/s13047-023-00683-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Patients with painful ankle osteoarthritis (OA) have a mixed experience of non-surgical management which they may attribute to a lack of guidance for clinicians on usual care treatment. Therefore, the purpose of this study was to survey the current clinical practices of UK-based physiotherapists and podiatrists for the treatment of painful ankle osteoarthritis (OA). METHODS UK-based physiotherapists and podiatrists who treat patients with ankle OA completed a self-administered online questionnaire about their professional and clinical service characteristics, diagnostic criteria, treatment aims, preferred treatment options, and treatment outcome measures. Data were collected anonymously and stored on JISC online survey. 'Usual care' was defined as a combination of 'Always', and 'Frequently', and 'Not usual care' was defined as 'Sometimes' 'Rarely,' 'Never', and 'not applicable' combined. Statistically significant differences in responses between the physiotherapists and podiatrists were analysed using X2 tests for each treatment modality. Statistical significance was set at p < 0.05. RESULTS Between 1st June 2021 and 31st August 2021, 100 responses were received; 2 were invalid. Of the 98 valid responses, 63 were from physiotherapists and 35 from podiatrists. The most common treatment aims in both professions were to reduce pain (n = 87, 89%) and improve quality of life (n = 82, 84%). 50 respondents (51%) offered 3 or 4 treatment sessions and 53 respondents (54%) saw patients for 30-40 min at the first treatment session. The five most common modalities used by physiotherapists were patient education (n = 63, 100%), teaching self-management (n = 58, 92%), lifestyle modification (n = 54, 86%), ankle strengthening (n = 55, 87%), and proprioception exercises (n = 54, 86%). For podiatrists, these were patient education (n = 35, 100%), ankle strengthening (n = 31, 89%), activity pacing (n = 28, 80%), lifestyle modification (n = 27, 77%), and gait training (n = 27, 77%). CONCLUSIONS This first-ever survey revealed physiotherapists' and podiatrists' current practices to treat painful ankle OA. This study provides a better understanding of how ankle OA is treated in UK current clinical practice and can inform future clinical trials to compare current practice with new treatment modalities.
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Affiliation(s)
- Michael J Callaghan
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK.
- Centre for Musculoskeletal Research, University of Manchester, Manchester, UK.
- Department of Physiotherapy, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.
| | - Jinal Pravin Gala
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Edward Roddy
- School of Medicine, Keele University, Staffordshire, UK
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12
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Smith MD, Vuvan V, Collins NJ, Hunter DJ, Costa N, Smith MMF, Vicenzino B. Protocol for a randomised feasibility trial comparing a combined program of education and exercise versus general advice for ankle osteoarthritis. J Foot Ankle Res 2023; 16:72. [PMID: 37858226 PMCID: PMC10588035 DOI: 10.1186/s13047-023-00669-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 10/02/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Ankle osteoarthritis (OA) is a serious problem with high associated pain and disability. While education and exercise are recommended for the initial management of OA, this has not been investigated in ankle OA. The primary aim of this study is to establish the feasibility of running a full-scale randomised controlled trial (RCT) investigating a combined education and exercise program compared to a general advice program for people with ankle OA. The secondary aims are to collect preliminary data which will inform sample size calculations, and understand the perspectives of people with ankle OA on their participation in the trial. METHODS Thirty individuals aged 35 years or older with symptomatic radiographic ankle OA will be recruited from the community and randomised to receive either a combined education and exercise program or a general advice program, both of which will be delivered by a physiotherapist in a group setting. Primary outcomes of feasibility include responses to study advertisements, number of eligible participants, recruitment rate, adherence with the intervention, fidelity of the intervention, adverse events, drop-out rate, and credibility and expectancy of the intervention. Secondary participant-reported outcomes will include global rating of change, patient acceptable symptom state, severity of ankle pain and stiffness, self-reported function, quality of life, satisfaction with treatment, and use of co-interventions. Follow up will be at 8 weeks and 3 months. Physical measures of 40 m walking speed, timed stairs descent, heel raise endurance and ankle dorsiflexion range of motion will be collected at baseline and 8 weeks. Primary feasibility outcomes will be reported descriptively, and estimates of the variability of secondary participant-reported and physical outcomes will be calculated. Semi-structured interviews will be conducted with participants to understand perspectives about the intervention and participation in the trial, with data analyzed thematically. DISCUSSION Study findings will establish the feasibility of running a full-scale RCT to investigate a combined education and exercise program compared to a general advice program for people with ankle OA. This study is a necessary first step to advance the international research agenda of evaluating the efficacy of exercise in the management of ankle OA. TRIAL REGISTRATION ACTRN12623000017628. Registered 10 January 2023, https://www.anzctr.org.au/ACTRN12623000017628.aspx .
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Affiliation(s)
- Michelle D Smith
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia.
| | - Viana Vuvan
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia
| | - Natalie J Collins
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, Rheumatology Department, The University of Sydney, Royal North Shore Hospital, Sydney, Australia
| | - Nathalia Costa
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia
- Sydney School of Health Sciences, The University of Sydney, Physiotherapy, Sydney, NSW, Australia
| | - Melinda M Franettovich Smith
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia
- School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Bill Vicenzino
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia
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13
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Gao F, Hu Q, Qi C, Wan M, Ficke J, Zheng J, Cao X. Mechanical loading-induced change of bone homeostasis is mediated by PGE2-driven hypothalamic interoception. RESEARCH SQUARE 2023:rs.3.rs-3325498. [PMID: 37790467 PMCID: PMC10543368 DOI: 10.21203/rs.3.rs-3325498/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Bone is a mechanosensitive tissue and undergoes constant remodeling to adapt to the mechanical loading environment. However, it is unclear whether the signals of bone cells in response to mechanical stress are processed and interpreted in the brain. In this study, we found that the hypothalamus of the brain regulates bone remodeling and structure by perceiving bone PGE2 concentration in response to mechanical loading. Bone PGE2 levels are in proportion to their weight bearing. When weight bearing changes in the tail-suspension mice, the PGE2 concentrations in bones change in line with their weight bearing changes. Deletion of Cox2 or Pge2 in the osteoblast lineage cells or knockout Ep4 in sensory nerve blunts bone formation in response to mechanical loading. And sensory denervation also significantly reduces mechanical load-induced bone formation. Moreover, mechanical loading induces CREB phosphorylation in the hypothalamic ARC region to inhibit sympathetic TH expression in the PVN for osteogenesis. Finally, we show that elevated PGE2 is associated with ankle osteoarthritis (AOA) and pain. Together, our data demonstrate that in response to mechanical loading, skeletal interoception occurs in the form of hypothalamic processing of PGE2-driven peripheral signaling to maintain physiologic bone homeostasis, while chronically elevated PGE2 can be sensed as pain during AOA and implication of potential treatment.
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Affiliation(s)
- Feng Gao
- Department of Orthopedic Surgery and Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Qimiao Hu
- Department of Orthopedic Surgery and Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Cheng Qi
- Department of Orthopedic Surgery and Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Mei Wan
- Department of Orthopedic Surgery and Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - James Ficke
- Department of Orthopedic Surgery and Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Junying Zheng
- Department of Orthopedic Surgery and Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
| | - Xu Cao
- Department of Orthopedic Surgery and Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA
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14
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Chapman LS, Jones J, Redmond AC, Flurey CA, Richards P, Hofstetter C, Smith TO, Arnold JB, Hannan MT, Maxwell LJ, Menz HB, Shea B, Golightly YM, Tugwell P, Beaton D, Conaghan PG, Helliwell PS, Siddle HJ. Developing a core outcome set for foot and ankle disorders in rheumatic and musculoskeletal diseases: A scoping review and report from the OMERACT 2022 foot and ankle special interest group session. Semin Arthritis Rheum 2023; 61:152210. [PMID: 37156170 DOI: 10.1016/j.semarthrit.2023.152210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/28/2023] [Accepted: 05/02/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVES Foot and ankle involvement is common in rheumatic and musculoskeletal diseases, yet high-quality evidence assessing the effectiveness of treatments for these disorders is lacking. The Outcome Measures in Rheumatology (OMERACT) Foot and Ankle Working Group is developing a core outcome set for use in clinical trials and longitudinal observational studies in this area. METHODS A scoping review was performed to identify outcome domains in the existing literature. Clinical trials and observational studies comparing pharmacological, conservative or surgical interventions involving adult participants with any foot or ankle disorder in the following rheumatic and musculoskeletal diseases (RMDs) were eligible for inclusion: rheumatoid arthritis (RA), osteoarthritis (OA), spondyloarthropathies, crystal arthropathies and connective tissue diseases. Outcome domains were categorised according to the OMERACT Filter 2.1. RESULTS Outcome domains were extracted from 150 eligible studies. Most studies included participants with foot/ankle OA (63% of studies) or foot/ankle involvement in RA (29% of studies). Foot/ankle pain was the outcome domain most commonly measured (78% of studies), being the most frequently specified outcome domain across all RMDs. There was considerable heterogeneity in the other outcome domains measured, across core areas of manifestations (signs, symptoms, biomarkers), life impact, and societal/resource use. The group's progress to date, including findings from the scoping review, was presented and discussed during a virtual OMERACT Special Interest Group (SIG) in October 2022. During this meeting, feedback was sought amongst delegates regarding the scope of the core outcome set, and feedback was received on the next steps of the project, including focus group and Delphi methods. CONCLUSION Findings from the scoping review and feedback from the SIG will contribute to the development of a core outcome set for foot and ankle disorders in RMDs. The next steps are to determine which outcome domains are important to patients, followed by a Delphi exercise with key stakeholders to prioritise outcome domains.
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Affiliation(s)
- Lara S Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK
| | - Jennifer Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK
| | - Anthony C Redmond
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK
| | - Caroline A Flurey
- Department of Health and Social Sciences, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | | | | | | | - John B Arnold
- Alliance for Research in Exercise, Nutrition & Activity (ARENA), Allied Health & Human Performance Unit, University of South Australia, Adelaide, Australia
| | - Marian T Hannan
- Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Lara J Maxwell
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Hylton B Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Beverley Shea
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, NC, USA; College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Peter Tugwell
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dorcas Beaton
- Department of Occupational Science and Occupational Therapy, Institute for Work and Health, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, UK; National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK
| | - Philip S Helliwell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK
| | - Heidi J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, 2nd Floor, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK.
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15
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Alanazi SA, Vicenzino B, Maclachlan LR, Smith MD. "It's like a nail being driven in the ankle": A qualitative study of individuals' lived experiences to inform a core domain set for ankle osteoarthritis. Musculoskelet Sci Pract 2023; 66:102813. [PMID: 37421757 DOI: 10.1016/j.msksp.2023.102813] [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: 04/13/2023] [Revised: 05/29/2023] [Accepted: 06/19/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES Explore individuals' lived experience with ankle osteoarthritis and to identify health-related domains for ankle osteoarthritis based on the perspectives of people living with the condition, as an initial step to address the International Foot and Ankle Osteoarthritis Consortium's recommendation to develop a core domain set for ankle osteoarthritis. METHODS A qualitative study using semi-structured interviews was conducted. Interviews were undertaken with individuals with symptomatic ankle osteoarthritis who were aged ≥35 years. Interviews were recorded, transcribed verbatim and thematically analysed. RESULTS Twenty-three individuals (16 females; mean (range) age 62 (42-80) years) were interviewed. Five themes were identified: pain, often severe, is a central feature of living with ankle osteoarthritis; stiffness and swelling are key symptoms; ankle osteoarthritis induced mobility impairments compromise enjoyment in life; ankle osteoarthritis instability and balance impairments lead to concerns about falling; there are financial implications of living with ankle osteoarthritis. We propose 17 domains based on individuals' experiences. CONCLUSION Study findings indicate that individuals with ankle osteoarthritis live with chronic ankle pain, stiffness and swelling which affect their ability to participate in physical, and social activities, maintain an active lifestyle, and work in physical occupations. From the data, we propose 17 domains that are important to people with ankle osteoarthritis. These domains require further evaluation to ascertain their inclusion in a core domain set for ankle osteoarthritis.
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Affiliation(s)
- Sultan Ayyadah Alanazi
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia; Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Majmaah, 11952, Kingdom of Saudi Arabia. https://twitter.com/PTsultan_
| | - Bill Vicenzino
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia. https://twitter.com/Bill_Vicenzino
| | - Liam R Maclachlan
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia. https://twitter.com/LiamRobMac
| | - Michelle D Smith
- The University of Queensland, School of Health and Rehabilitation Sciences, Physiotherapy, Brisbane, QLD, 4072, Australia.
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16
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Harmon S, Alvarez C, Hannan MT, Callahan LF, Gates LS, Bowen CJ, Menz HB, Nelson AE, Golightly YM. Association of Foot Symptoms With Decreased Time to All-Cause Mortality: The Johnston County Osteoarthritis Project. Arthritis Care Res (Hoboken) 2023:10.1002/acr.25186. [PMID: 37386686 PMCID: PMC10755075 DOI: 10.1002/acr.25186] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/26/2023] [Accepted: 06/27/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Adults with foot symptoms (ie, pain, aching, or stiffness) may be at increased risk of reduced time to all-cause mortality. The purpose of this study was to evaluate whether foot symptoms are independently associated with all-cause mortality in older adults. METHODS We analyzed longitudinal data from 2613 participants from the Johnston County Osteoarthritis Project, a longitudinal population-based cohort of adults 45 years of age and older. Participants completed questionnaires at baseline to determine presence of foot symptoms and covariable status. Baseline walking speed was measured via an 8-foot walk test. To examine the association of foot symptoms with time to mortality, hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression models, adjusted for potential confounders. RESULTS We observed 813 deaths over 4 to 14.5 years of follow-up. At baseline, 37% of participants had foot symptoms, mean age was 63 years, mean body mass index was approximately 31 kg/m2 , 65% were women, and 33% were Black. Moderate to severe foot symptoms were associated with reduced time to mortality after adjustment for demographics, comorbidities, physical activity, and knee and hip symptoms (HR = 1.30, 95% CI 1.09-1.54). Importantly, this association was not modified by walking speed or diabetes. CONCLUSION Individuals with foot symptoms had an increased hazard of all-cause mortality compared with those with no foot symptoms. These effects were independent of key confounders and were not moderated by walking speed. Effective interventions to identify and manage at least moderate foot symptoms may reduce the risk of decreased time to mortality.
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Affiliation(s)
- Skylar Harmon
- Thurston Arthritis Research Center, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Nova Southeastern University- Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL USA
| | - Carolina Alvarez
- Thurston Arthritis Research Center, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Marian T. Hannan
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston MA, USA
- Hinda and Arthur Marcus Institute of Aging Research, Hebrew SeniorLife, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Leigh F. Callahan
- Thurston Arthritis Research Center, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Lucy S. Gates
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - Catherine J. Bowen
- School of Health Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Southampton, Southampton, SO17 1BJ, UK
| | - Hylton B. Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, AUS
| | - Amanda E. Nelson
- Thurston Arthritis Research Center, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Yvonne M. Golightly
- Thurston Arthritis Research Center, Division of Rheumatology, Allergy, and Immunology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE USA
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17
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Posmyk L, Carter-Wale RL, Clark K, Donson L, Halstead J, Lennox N, Milnes H. Research priority setting in UK podiatric surgery. J Foot Ankle Res 2023; 16:32. [PMID: 37268962 DOI: 10.1186/s13047-023-00629-9] [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: 02/12/2023] [Accepted: 05/07/2023] [Indexed: 06/04/2023] Open
Abstract
Evidence-based practice provides the foundation for high quality patient care, and in the NHS, research is seen as vital to enable service transformation and improve outcomes. Research is one of the four pillars of enhanced and advanced clinical practice and is therefore a fundamental part of podiatric surgery services. In order to meet the UK health research strategies, the most recent being 'Saving and Improving Lives: The Future of UK Clinical Research Delivery' (2021), the Faculty of Podiatric Surgery in the UK agreed to support the development of research priorities in order to inform a future research strategy.The Podiatric Surgery Research Strategy Group was set up and embarked on a project with the aim of engaging its members in formulating and agreeing national research priorities. The initial stage included a national research scoping survey to identify key themes, topic, and research questions. The final stage consisted of developing and enabling a live consensus vote conducted at the 2022 national Faculty of Podiatric Surgery Conference. At the end of the vote, the top five research topics that met the agreement criteria were: 1. Surgical treatment - forefoot, 2. Patient reported outcome measures, 3. Post-operative management, 4. Surgical treatment - midfoot and 5. Service delivery. The top five research questions that met the criteria were1. How does quality of life improve following elective foot surgery? 2. How does podiatric surgery benefit the health of the population? 3. How does podiatric surgery benefit the health of the population in the at-risk foot? 4. What is the most effective Lapidus fixation option? and 5. What is the benefit of utilising PASCOM-10 to improve large scale outcome data? These will inform the initial UK podiatric surgery research priorities in the next three to five years.
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Affiliation(s)
- Lesley Posmyk
- Department of Podiatric Surgery, North Tees & Hartlepool NHS Foundation Trust, Hartlepool, UK.
| | - Robyn L Carter-Wale
- Department of Podiatric Surgery, Central London Community Healthcare NHS Trust, London, UK
| | - Kerry Clark
- Department of Podiatric Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Lorna Donson
- Department of Podiatric Surgery, Wye Valley NHS Trust, Hereford, UK
| | - Jill Halstead
- Department of Podiatry, Leeds Community Healthcare NHS Trust, Leeds, UK
| | - Natalie Lennox
- Department of Podiatric Surgery, Wye Valley NHS Trust, Hereford, UK
| | - Helen Milnes
- Department of Podiatric Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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18
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Lim PQX, Lithgow MJ, Kaminski MR, Landorf KB, Menz HB, Munteanu SE. Efficacy of non-surgical interventions for midfoot osteoarthritis: a systematic review. Rheumatol Int 2023:10.1007/s00296-023-05324-3. [PMID: 37093273 DOI: 10.1007/s00296-023-05324-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 03/31/2023] [Indexed: 04/25/2023]
Abstract
This systematic review aims to investigate the efficacy of non-surgical interventions for midfoot osteoarthritis (OA). Key databases and trial registries were searched from inception to 23 February 2023. All trials investigating non-surgical interventions for midfoot OA were included. Quality assessment was performed using the National Institutes of Health Quality Assessment Tool. Outcomes were pain, function, health-related quality of life, and adverse events. Effects (mean differences, standardised mean differences, risk ratios) were calculated where possible for the short (0 to 12 weeks), medium (> 12 to 52 weeks), and long (> 52 weeks) term. Six trials (231 participants) were included (one feasibility trial and five case series) - all were judged to be of poor methodological quality. Two trials reported arch contouring foot orthoses to exert no-to-large effects on pain in the short and medium term, and small-to-very-large effects on function in the short and medium term. Two trials reported shoe stiffening inserts to exert medium-to-huge effects on pain in the short term, and small effects on function in the short term. Two trials of image-guided intra-articular corticosteroid injections reported favourable effects on pain in the short term, small effects on pain and function in the medium term, and minimal long term effects. Two trials reported minor adverse events, and none reported health-related quality of life outcomes. The current evidence suggests that arch contouring foot orthoses, shoe stiffening inserts and corticosteroid injections may be effective for midfoot OA. Rigorous randomised trials are required to evaluate the efficacy of non-surgical interventions for midfoot OA.
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Affiliation(s)
- Polly Q X Lim
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia.
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia.
| | - Merridy J Lithgow
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - Michelle R Kaminski
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
- Department of Podiatry, Monash Health, Melbourne, Victoria, 3168, Australia
- School of Primary and Allied Health Care, Monash University, Melbourne, Victoria, 3199, Australia
| | - Karl B Landorf
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - Shannon E Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
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19
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Feng J, Weiss J, Thompson A, Meeker JE. Passive Dynamic Ankle Foot Orthoses Use in Civilian Patients with Arthritic Conditions of the Foot and Ankle. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231157734. [PMID: 36937807 PMCID: PMC10014983 DOI: 10.1177/24730114231157734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Background Nonsurgical interventions such as bracing with ankle foot orthoses (AFOs) aim to assist, restore, and redirect weightbearing forces to address difficulty with mobilization. We identified a custom carbon fiber passive dynamic ankle foot orthosis (PDAFO) that was designed to meet the needs of military combat veterans. We sought to evaluate the off-loading properties of one model of PDAFO (ExoSym) in a civilian population. Methods Civilian patients 18 years or older were prescribed a PDAFO by a single surgeon. Pedobarographic data were obtained using the Tekscan F-Scan system. With the insole, participants were instructed to walk at a self-selected pace along a 20 m walkway under 3 conditions: (1) insole placed in between the brace and foot (over); (2) insole placed between the brace and insole of the shoe (under); (3) without the brace, the insole was placed in between the foot and insole of the shoe in both limbs (without).For assessment, forefoot and heel areas were evaluated with respect to maximal force, force*time integral (FTI), maximal contact area, maximal contact pressure, pressure*time integral (PTI), center of force (COF) excursion. Results Six patients with arthritic foot and ankle conditions completed pedobarographic assessment for analysis. The brace reduced forefoot maximal force and contact pressures by 66% and 49%, respectively (538 ± 236 to 185 ± 130 N [P < .001], and 99 ± 38 to 50 ± 24 P < .002). Additionally, participants were observed to load the forefoot portion of the brace with double the maximum contact pressures compared to the unbraced foot (204 ± 57 to 99 ± 38 kPa, P < .001). Conclusion The results of this study showed that the PDAFO unloaded substantial force and pressure experienced by the forefoot. Participants loaded the brace to a greater extent than when going unbraced. ADAFO can provide measurable pressure relief for patients with arthritic conditions. Level of Evidence Level IV, case series.
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Affiliation(s)
- Jing Feng
- Motion Analysis Center, Shriners
Hospitals for Children, Portland, OR, USA
| | - Jason Weiss
- Department of Orthopaedics and
Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Austin Thompson
- Department of Orthopaedics and
Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - James E. Meeker
- Department of Orthopaedics and
Rehabilitation, Oregon Health & Science University, Portland, OR, USA
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20
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Kim JS, Amendola A, Barg A, Baumhauer J, Brodsky JW, Cushman DM, Gonzalez TA, Janisse D, Jurynec MJ, Lawrence Marsh J, Sofka CM, Clanton TO, Anderson DD. Summary Report of the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society's Symposium on Targets for Osteoarthritis Research: Part 1: Epidemiology, Pathophysiology, and Current Imaging Approaches. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221127011. [PMID: 36262469 PMCID: PMC9575439 DOI: 10.1177/24730114221127011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This first of a 2-part series of articles recounts the key points presented in a collaborative symposium sponsored jointly by the Arthritis Foundation and the American Orthopaedic Foot & Ankle Society with the intent to survey the state of scientific knowledge related to incidence, diagnosis, pathologic mechanisms, and injection treatment options for osteoarthritis (OA) of the foot and ankle. A meeting was held virtually on December 3, 2021. A group of experts were invited to present brief synopses of the current state of knowledge and research in this area. Part 1 overviews areas of epidemiology and pathophysiology, current approaches in imaging, diagnostic and therapeutic injections, and genetics. Opportunities for future research are discussed. The OA scientific community, including funding agencies, academia, industry, and regulatory agencies, must recognize the needs of patients that suffer from arthritis of foot and ankle. The foot and ankle contain a myriad of interrelated joints and tissues that together provide a critical functionality. When this functionality is compromised by OA, significant disability results, yet the foot and ankle are generally understudied by the research community. Level of Evidence: Level V - Review Article/Expert Opinion.
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Affiliation(s)
- Jason S. Kim
- The Arthritis Foundation, Atlanta, GA,
USA,Jason S. Kim, PhD, The Arthritis
Foundation, 1355 Peachtree St NE, Suite 600, Atlanta, GA 30309, USA.
| | | | - Alexej Barg
- Department of Orthopaedics, University
of Utah, Salt Lake City, UT, USA
| | - Judith Baumhauer
- Department of Orthopaedic Surgery,
University of Rochester Medical Center, Rochester, NY, USA
| | | | - Daniel M. Cushman
- Division of Physical Medicine &
Rehabilitation, University of Utah, Salt Lake City, UT, USA
| | - Tyler A. Gonzalez
- Department of Orthopaedic Surgery,
University of South Carolina, Lexington, SC, USA
| | | | - Michael J. Jurynec
- Department of Orthopaedics and Human
Genetics, University of Utah, Salt Lake City, UT, USA
| | - J. Lawrence Marsh
- Department of Orthopedics and
Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Carolyn M. Sofka
- Department of Radiology and Imaging,
Hospital for Special Surgery, New York, NY, USA
| | | | - Donald D. Anderson
- Department of Orthopedics and
Rehabilitation, University of Iowa, Iowa City, IA, USA
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21
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Fu S, Yang K, Li X, Chen C, Mei G, Su Y, Xue J, Zou J, Zhang J, Shi Z. Radiographic and Clinical Outcomes After Arthroscopic Microfracture for Osteochondral Lesions of the Talus: 5-Year Results in 355 Consecutive Ankles. Orthop J Sports Med 2022; 10:23259671221128772. [PMID: 36263313 PMCID: PMC9575450 DOI: 10.1177/23259671221128772] [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: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Arthroscopic microfracture for osteochondral lesion of the talus (OLT) has
shown good functional outcomes in the short and long term. Purpose: To investigate 5-year radiographic and clinical outcomes after arthroscopic
microfracture in treatment of OLT and the effectiveness of adjunct therapies
including platelet-rich plasma (PRP) and hyaluronic acid (HA). Study Design: Cohort study; Level of evidence, 2. Methods: We prospectively enrolled 432 patients who underwent arthroscopic
microfracture for OLT from May 1, 2011, to May 31, 2015. Magnetic resonance
imaging (MRI) and weightbearing radiographs were performed annually after
the initial surgery. The MOCART (magnetic resonance observation of cartilage
repair tissue) score was used to evaluate the structure of the repaired
cartilage on MRI, and patient-reported outcomes (American Orthopaedic Foot
and Ankle Society ankle-hindfoot scale [AOFAS] and the Foot and Ankle
Outcome Score) were collected annually. The primary outcome measure was
5-year AOFAS score. We recorded baseline characteristics including age, body
mass index (BMI), and lesion size, and other potentially related factors
including number of PRP/HA injection and change in BMI from baseline. Results: Included were 355 patients, all with minimum 5-year follow-up data. The
overall reoperation rate was 9.0% (32 of 355). According to multivariable
analysis, 5-year AOFAS scores were associated with number of PRP injections
(correlation coefficient, 3.12 [95% CI, 2.36 to 3.89]; P
< .001), BMI at baseline (correlation coefficient, -0.222 [95% CI, -0.363
to -0.082]; P = .002), and mean BMI change from baseline
(correlation coefficient, -1.15 [95% CI, -1.32 to -0.98]; P
< .001). When comparing number of PRP injections (0, 1-2, or ≥3), we
found that patients who had serial PRP injection (≥3 with at least a 3-month
interval between injections) had diminished functional and radiographic
deterioration over time. Conclusion: Arthroscopic microfracture improved patient-reported and structural outcomes
for patients with OLT at 5 years after surgery. Serial PRP injections and
reduction in BMI from baseline were able to slow radiographic and functional
deterioration. Future trials regarding the combination of microfracture and
PRP in treatment of OLT should focus on the efficacy of longer term,
intra-articular, serial injections of PRP instead of single injections.
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Affiliation(s)
- Shaoling Fu
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital,
Shanghai, China
| | - Kai Yang
- Department of Radiology, Shanghai Sixth People’s Hospital, Shanghai,
China
| | - Xueqian Li
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital,
Shanghai, China
| | - Cheng Chen
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital,
Shanghai, China
| | - Guohua Mei
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital,
Shanghai, China
| | - Yan Su
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital,
Shanghai, China
| | - Jianfeng Xue
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital,
Shanghai, China
| | - Jian Zou
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital,
Shanghai, China
| | - Jieyuan Zhang
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital,
Shanghai, China.,Zhongmin Shi, MD, or Jieyuan Zhang, MD, Department of Orthopedic
Surgery, Shanghai Sixth People’s Hospital, 600 Yishan Road, Shanghai 200233,
China ( or
)
| | - Zhongmin Shi
- Department of Orthopedic Surgery, Shanghai Sixth People’s Hospital,
Shanghai, China.,Zhongmin Shi, MD, or Jieyuan Zhang, MD, Department of Orthopedic
Surgery, Shanghai Sixth People’s Hospital, 600 Yishan Road, Shanghai 200233,
China ( or
)
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