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Khader A, Zyout A, Al Fahoum A. Combining enhanced spectral resolution of EMG and a deep learning approach for knee pathology diagnosis. PLoS One 2024; 19:e0302707. [PMID: 38713653 DOI: 10.1371/journal.pone.0302707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 04/09/2024] [Indexed: 05/09/2024] Open
Abstract
Knee osteoarthritis (OA) is a prevalent, debilitating joint condition primarily affecting the elderly. This investigation aims to develop an electromyography (EMG)-based method for diagnosing knee pathologies. EMG signals of the muscles surrounding the knee joint were examined and recorded. The principal components of the proposed method were preprocessing, high-order spectral analysis (HOSA), and diagnosis/recognition through deep learning. EMG signals from individuals with normal and OA knees while walking were extracted from a publicly available database. This examination focused on the quadriceps femoris, the medial gastrocnemius, the rectus femoris, the semitendinosus, and the vastus medialis. Filtration and rectification were utilized beforehand to eradicate noise and smooth EMG signals. Signals' higher-order spectra were analyzed with HOSA to obtain information about nonlinear interactions and phase coupling. Initially, the bicoherence representation of EMG signals was devised. The resulting images were fed into a deep-learning system for identification and analysis. A deep learning algorithm using adapted ResNet101 CNN model examined the images to determine whether the EMG signals were conventional or indicative of knee osteoarthritis. The validated test results demonstrated high accuracy and robust metrics, indicating that the proposed method is effective. The medial gastrocnemius (MG) muscle was able to distinguish Knee osteoarthritis (KOA) patients from normal with 96.3±1.7% accuracy and 0.994±0.008 AUC. MG has the highest prediction accuracy of KOA and can be used as the muscle of interest in future analysis. Despite the proposed method's superiority, some limitations still require special consideration and will be addressed in future research.
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Affiliation(s)
- Ateka Khader
- Biomedical Systems and Informatics Engineering Department, Yarmouk University, Irbid, Jordan
| | - Ala'a Zyout
- Biomedical Systems and Informatics Engineering Department, Yarmouk University, Irbid, Jordan
| | - Amjed Al Fahoum
- Biomedical Systems and Informatics Engineering Department, Yarmouk University, Irbid, Jordan
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Daneshmand M, Panfilov E, Bayramoglu N, Korhonen RK, Saarakkala S. Deep learning based detection of osteophytes in radiographs and magnetic resonance imagings of the knee using 2D and 3D morphology. J Orthop Res 2024. [PMID: 38323840 DOI: 10.1002/jor.25800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/26/2023] [Accepted: 01/19/2024] [Indexed: 02/08/2024]
Abstract
In this study, we investigated the discriminative capacity of knee morphology in automatic detection of osteophytes defined by the Osteoarthritis Research Society International atlas, using X-ray and magnetic resonance imaging (MRI) data. For the X-ray analysis, we developed a deep learning (DL) based model to segment femur and tibia. In case of MRIs, we utilized previously validated segmentations of femur, tibia, corresponding cartilage tissues, and menisci. Osteophyte detection was performed using DL models in four compartments: medial femur (FM), lateral femur (FL), medial tibia (TM), and lateral tibia (TL). To analyze the confounding effects of soft tissues, we investigated their morphology in combination with bones, including bones+cartilage, bones+menisci, and all the tissues. From X-ray-based 2D morphology, the models yielded balanced accuracy of 0.73, 0.69, 0.74, and 0.74 for FM, FL, TM, TL, respectively. Using 3D bone morphology from MRI, balanced accuracy was 0.80, 0.77, 0.71, and 0.76, respectively. The performance was higher than in 2D for all the compartments except for TM, with significant improvements observed for femoral compartments. Adding menisci or cartilage morphology consistently improved balanced accuracy in TM, with the greatest improvement seen for small osteophyte. Otherwise, the models performed similarly to bones-only. Our experiments demonstrated that MRI-based models show higher detection capability than X-ray based models for identifying knee osteophytes. This study highlighted the feasibility of automated osteophyte detection from X-ray and MRI data and suggested further need for development of osteophyte assessment criteria in addition to OARSI, particularly, for early osteophytic changes.
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Affiliation(s)
| | - Egor Panfilov
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | | | | | - Simo Saarakkala
- University of Oulu and Oulu University Hospital, Oulu, Finland
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3
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Su K, Yuan X, Huang Y, Yuan Q, Yang M, Sun J, Li S, Long X, Liu L, Li T, Yuan Z. Improved Prediction of Knee Osteoarthritis by the Machine Learning Model XGBoost. Indian J Orthop 2023; 57:1667-1677. [PMID: 37766962 PMCID: PMC10519887 DOI: 10.1007/s43465-023-00936-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/19/2023] [Indexed: 09/29/2023]
Abstract
Objectives The accurate prediction of osteoarthritis (OA) severity in patients can be helpful to make the proper decision of intervention. This study aims to build up a powerful model to assess predictive risk factors and severity of knee osteoarthritis (KOA) in the clinical scenario. Methods A total of 4796 KOA cases and 1205 features were selected by feature selections from the public OA database, Osteoarthritis Initiative (OAI). Six machine learning-based models were constructed and compared for the accuracy of OA prediction. The gradient-boosting decision tree was used to identify important prediction features in the extreme gradient boosting (XGBoost) model. The performance of models was evaluated by F1-score. Results Twenty features were determined as predictors for KOA risk and severity, including the subject characteristics, knee symptoms/risk factors and physical exam. The XGBoost model demonstrated 100% prediction accuracy for 54.7% of examined samples, and the remaining 45.3% of samples showed Kellgren and Lawrence (KL) gradings very close to the actual levels. It showed the highest prediction accuracy with an F1-score of 0.553 among the tested six models. Conclusions We demonstrate that the XGBoost is the best model for the prediction of KOA severity in the six examined models. In addition, 20 risk features were determined as the essential predictors of KOA, including the physical exam, knee symptoms/risk factors and subject characteristics, which may be useful for the identification of high-risk KOA cases and for making appropriate treatment decisions as well.
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Affiliation(s)
- Kui Su
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Higher Education Mega Center, 100 Outside Ring West Road, Guangzhou, 510006 People’s Republic of China
| | - Xin Yuan
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Higher Education Mega Center, 100 Outside Ring West Road, Guangzhou, 510006 People’s Republic of China
| | - Yukai Huang
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, 510317 People’s Republic of China
| | - Qian Yuan
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Higher Education Mega Center, 100 Outside Ring West Road, Guangzhou, 510006 People’s Republic of China
| | - Minghui Yang
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Higher Education Mega Center, 100 Outside Ring West Road, Guangzhou, 510006 People’s Republic of China
| | - Jianwu Sun
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Higher Education Mega Center, 100 Outside Ring West Road, Guangzhou, 510006 People’s Republic of China
| | - Shuyi Li
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Higher Education Mega Center, 100 Outside Ring West Road, Guangzhou, 510006 People’s Republic of China
| | - Xinyi Long
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Higher Education Mega Center, 100 Outside Ring West Road, Guangzhou, 510006 People’s Republic of China
| | - Lang Liu
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Higher Education Mega Center, 100 Outside Ring West Road, Guangzhou, 510006 People’s Republic of China
| | - Tianwang Li
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, 510317 People’s Republic of China
| | - Zhengqiang Yuan
- School of Biomedical and Pharmaceutical Sciences, Guangdong University of Technology, Higher Education Mega Center, 100 Outside Ring West Road, Guangzhou, 510006 People’s Republic of China
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Telles RW, Machado LAC, Costa-Silva L, Barreto SM. Cohort Profile Update: The Brazilian Longitudinal Study of Adult Health Musculoskeletal (ELSA-Brasil MSK) cohort. Int J Epidemiol 2022; 51:e391-e400. [PMID: 35474011 DOI: 10.1093/ije/dyac084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/06/2022] [Indexed: 01/21/2023] Open
Affiliation(s)
- Rosa Weiss Telles
- Faculdade de Medicina, Universidade Federal da Minas Gerais, Belo Horizonte, Brazil.,Hospital das Clínicas-UFMG/EBSERH, Belo Horizonte, Brazil
| | | | | | - Sandhi Maria Barreto
- Faculdade de Medicina, Universidade Federal da Minas Gerais, Belo Horizonte, Brazil.,Hospital das Clínicas-UFMG/EBSERH, Belo Horizonte, Brazil
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Verma DK, Kumari P, Kanagaraj S. Engineering Aspects of Incidence, Prevalence, and Management of Osteoarthritis: A Review. Ann Biomed Eng 2022; 50:237-252. [DOI: 10.1007/s10439-022-02913-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/01/2022] [Indexed: 12/14/2022]
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Hart HF, Neogi T, LaValley M, White D, Zhang Y, Nevitt MC, Torner J, Lewis CE, Stefanik JJ. Relationship of Patellofemoral Osteoarthritis to Changes in Performance-based Physical Function Over 7 Years: The Multicenter Osteoarthritis Study. J Rheumatol 2022; 49:98-103. [PMID: 34470797 PMCID: PMC8724393 DOI: 10.3899/jrheum.210270] [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] [Accepted: 08/18/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the relationship of patellofemoral osteoarthritis (PFOA) to changes in performance-based function over 7 years. METHODS There were 2666 participants (62.2 ± 8.0 yrs, BMI 30.6 ± 5.9 kg/m2, 60% female) from the Multicenter Osteoarthritis Study with knee radiographs at baseline who completed repeated chair stands and a 20-meter walk test (20MWT) at baseline, 2.5, 5, and 7 years. Generalized linear models assessed the relation of radiographic PFOA and radiographic PFOA with frequent knee pain to longitudinal changes in performance-based function. Analyses were adjusted for age, sex, BMI, tibiofemoral OA, and injury/surgery. RESULTS Linear models demonstrated a significant group-by-time interaction for the repeated chair stands (P = 0.04) and the 20MWT (P < 0.0001). Those with radiographic PFOA took 1.01 seconds longer on the repeated chair stands (P = 0.02) and 1.69 seconds longer on the 20MWT (P < 0.0001) at 7 years compared with baseline. When examining the relation of radiographic PFOA with frequent knee pain to performance-based function, there was a significant group-by-time interaction for repeated chair stands (P = 0.05) and the 20MWT (P < 0.0001). Those with radiographic PFOA with frequent knee pain increased their time on the repeated chair stands by 1.12 seconds (P = 0.04) and on the 20MWT by 1.91 seconds (P < 0.0001) over 7 years. CONCLUSION Individuals with radiographic PFOA and those with radiographic PFOA with frequent knee pain have worsening of performance-based function over time. This knowledge may present opportunities to plan for early treatment strategies for PFOA to limit functional decline over time.
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Affiliation(s)
- Harvi F Hart
- H.F. Hart, PhD, Faculty of Health Sciences and Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Tuhina Neogi
- T. Neogi, MD, PhD, Division of Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Michael LaValley
- M. LaValley, PhD, Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Daniel White
- D. White, PT, PhD, Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
| | - Yuqing Zhang
- Y. Zhang, DSc, Department of Rheumatology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Michael C Nevitt
- M.C. Nevitt, PhD, MPH, Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - James Torner
- J. Torner, PhD, Department of Epidemiology, The University of Iowa, Iowa City, Iowa, USA
| | - Cora E Lewis
- C.E. Lewis, MD, MSPH, Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joshua J Stefanik
- J.J. Stefanik, PT, PhD, Division of Rheumatology, Boston University School of Medicine, and Department of Physical Therapy, Movement, and Rehabilitation Sciences, Northeastern University, Boston, Massachusetts, USA.
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Bayramoglu N, Nieminen MT, Saarakkala S. Machine learning based texture analysis of patella from X-rays for detecting patellofemoral osteoarthritis. Int J Med Inform 2021; 157:104627. [PMID: 34773800 DOI: 10.1016/j.ijmedinf.2021.104627] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/11/2021] [Accepted: 10/25/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To assess the ability of texture features for detecting radiographic patellofemoral osteoarthritis (PFOA) from knee lateral view radiographs. DESIGN We used lateral view knee radiographs from The Multicenter Osteoarthritis Study (MOST) public use datasets (n = 5507 knees). Patellar region-of-interest (ROI) was automatically detected using landmark detection tool (BoneFinder), and subsequently, these anatomical landmarks were used to extract three different texture ROIs. Hand-crafted features, based on Local Binary Patterns (LBP), were then extracted to describe the patellar texture. First, a machine learning model (Gradient Boosting Machine) was trained to detect radiographic PFOA from the LBP features. Furthermore, we used end-to-end trained deep convolutional neural networks (CNNs) directly on the texture patches for detecting the PFOA. The proposed classification models were eventually compared with more conventional reference models that use clinical assessments and participant characteristics such as age, sex, body mass index (BMI), the total Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, and tibiofemoral Kellgren-Lawrence (KL) grade. Atlas-guided visual assessment of PFOA status by expert readers provided in the MOST public use datasets was used as a classification outcome for the models. Performance of prediction models was assessed using the area under the receiver operating characteristic curve (ROC AUC), the area under the precision-recall (PR) curve -average precision (AP)-, and Brier score in the stratified 5-fold cross validation setting. RESULTS Of the 5507 knees, 953 (17.3%) had PFOA. AUC and AP for the strongest reference model including age, sex, BMI, WOMAC score, and tibiofemoral KL grade to predict PFOA were 0.817 and 0.487, respectively. Textural ROI classification using CNN significantly improved the prediction performance (ROC AUC = 0.889, AP = 0.714). CONCLUSION We present the first study that analyses patellar bone texture for diagnosing PFOA. Our results demonstrates the potential of using texture features of patella to predict PFOA.
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Affiliation(s)
- Neslihan Bayramoglu
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland.
| | - Miika T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.
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8
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Segal NA, Murphy MT, Everist BM, Brown KD, He J, Lynch JA, Nevitt MC. Clinical value of weight-bearing CT and radiographs for detecting patellofemoral cartilage visualized by MRI in the MOST study. Osteoarthritis Cartilage 2021; 29:1540-1548. [PMID: 34332048 PMCID: PMC8542599 DOI: 10.1016/j.joca.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/28/2021] [Accepted: 07/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The patellofemoral joint is frequently affected by osteoarthritis (PFOA) and is incompletely imaged on radiographs (XR). Weight-Bearing CT (WBCT) could offer advantages for visualization. This study determined the sensitivity, specificity, and accuracy of axial WBCT and lateral XR for detection of PFOA features in comparison with cartilage damage on MRI. DESIGN A convenience sample of 60 right knees from the MOST cohort were analyzed. WBCT and XR were read for OARSI JSN score and MRI for MOAKS cartilage score by two experienced musculoskeletal radiologists blinded to participant. Using MOAKS scoring on MRI (referent standard), the sensitivity, specificity and accuracy of patellofemoral OARSI JSN scores based on WBCT and XR were compared. RESULTS The mean ± SD age and BMI for the participants included (66.7% women) were 67.6 ± 9.8 years and 30.0 ± 5.3 kg/m2 respectively. WBCT demonstrated significantly greater sensitivity (0.85-0.97 on WBCT vs 0.47-0.57 on XR) and accuracy (0.85-0.92 on WBCT vs 0.48-0.57 on XR) for all parameters except lateral full-thickness cartilage loss (McNemar's test p-values all <0.001). There was moderate-to-strong and low-to-moderate agreement between PFOA findings on WBCT and XR, respectively, and semi-quantitative scores of PF cartilage on MRI. Inter-rater reliability for XR JSN [weighted kappa = 0.83 (0.64, 1.0)], WBCT JSN [kappa = 0.60 (0.48, 0.72)] and MRI MOAKS-CM [kappa = 0.70 (0.61, 0.79)] readings were good. CONCLUSION WBCT demonstrates significantly greater sensitivity and accuracy than radiographs for identification of PFOA. Given the same Relative Radiation Level as XR and improved visualization, WBCT holds promise to improve understanding of the weight-bearing patellofemoral joint.
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Affiliation(s)
- Neil A. Segal
- Department of Rehabilitation Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mailstop 1046, Kansas City, KS, 66160
| | - Michael T. Murphy
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Brian M. Everist
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kevin D. Brown
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jianghua He
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - John A. Lynch
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
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Bayramoglu N, Nieminen MT, Saarakkala S. Automated detection of patellofemoral osteoarthritis from knee lateral view radiographs using deep learning: data from the Multicenter Osteoarthritis Study (MOST). Osteoarthritis Cartilage 2021; 29:1432-1447. [PMID: 34245873 DOI: 10.1016/j.joca.2021.06.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/11/2021] [Accepted: 06/28/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the ability of imaging-based deep learning to detect radiographic patellofemoral osteoarthritis (PFOA) from knee lateral view radiographs. DESIGN Knee lateral view radiographs were extracted from The Multicenter Osteoarthritis Study (MOST) public use datasets (n = 18,436 knees). Patellar region-of-interest (ROI) was first automatically detected, and subsequently, end-to-end deep convolutional neural networks (CNNs) were trained and validated to detect the status of patellofemoral OA. Patellar ROI was detected using deep-learning-based object detection method. Atlas-guided visual assessment of PFOA status by expert readers provided in the MOST public use datasets was used as a classification outcome for the models. Performance of classification models was assessed using the area under the receiver operating characteristic curve (ROC AUC) and the average precision (AP) obtained from the Precision-Recall (PR) curve in the stratified 5-fold cross validation setting. RESULTS Of the 18,436 knees, 3,425 (19%) had PFOA. AUC and AP for the reference model including age, sex, body mass index (BMI), the total Western Ontario and McMaster Universities Arthritis Index (WOMAC) score, and tibiofemoral Kellgren-Lawrence (KL) grade to detect PFOA were 0.806 and 0.478, respectively. The CNN model that used only image data significantly improved the classifier performance (ROC AUC = 0.958, AP = 0.862). CONCLUSION We present the first machine learning based automatic PFOA detection method. Furthermore, our deep learning based model trained on patella region from knee lateral view radiographs performs better at detecting PFOA than models based on patient characteristics and clinical assessments.
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Affiliation(s)
- N Bayramoglu
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland.
| | - M T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.
| | - S Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland; Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland.
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Levin ES, Mandell JC, Smith SE. Do non-weight-bearing knee radiographs for chronic knee pain result in increased follow-up imaging? Skeletal Radiol 2021; 50:515-519. [PMID: 32820346 DOI: 10.1007/s00256-020-03585-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE While weight-bearing radiographs are considered the optimal method for evaluation of joint spaces in osteoarthritis, non-weight-bearing radiographs are often performed. The purpose of this study is to evaluate the rate of follow-up radiographs in patients receiving non-weight-bearing radiographs for chronic knee pain in the outpatient setting, compared with patients receiving weight-bearing radiographs. MATERIALS AND METHODS Consecutive patients who received non-weight-bearing knee radiographs for chronic knee pain between January 1, 2018, and June 15, 2019, were included. Exclusion criteria included trauma, concern for infection or tumor, and post-surgical radiographs. An age- and sex-matched control group of 100 patients who received weight-bearing knee radiographs was compiled. The proportion of follow-up radiographs within 1 year was compared between the study and control groups with chi-squared tests. RESULTS Four hundred non-weight-bearing knee radiographic examinations were included. There were 74/400 (18.5%) follow-up radiographs within 12 months. All follow-up radiographs were weight-bearing. In the control group, 4/100 (4%) had follow-up weight-bearing radiographs within 1 year (p < 0.001). CONCLUSION Outpatients who underwent non-weight-bearing knee radiographs for chronic pain had a higher frequency of repeat imaging than those who initially underwent weight-bearing knee radiographs. These results suggest that non-weight-bearing knee radiographs are of lower clinical utility compared with weight-bearing radiographs.
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Affiliation(s)
- Elizabeth S Levin
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
| | - Jacob C Mandell
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA
| | - Stacy E Smith
- Department of Radiology, Division of Musculoskeletal Imaging and Intervention, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.,The Neil and Elise Wallace STRATUS Center for Medical Simulation, Brigham and Women's Hospital, Boston, MA, USA
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Macri EM, Runhaar J, Damen J, Oei EH, Bierma-Zeinstra SM. Kellgren & Lawrence grading in cohort studies: methodological update and implications illustrated using data from the CHECK cohort. Arthritis Care Res (Hoboken) 2021; 74:1179-1187. [PMID: 33450140 PMCID: PMC9541941 DOI: 10.1002/acr.24563] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 11/26/2020] [Accepted: 01/12/2021] [Indexed: 11/13/2022]
Abstract
Objective The Cohort Hip and Cohort Knee (CHECK) is a cohort of middle‐aged individuals with hip or knee pain. Radiographs were assigned Kellgren/Lawrence (K/L) scores under different conditions at each follow‐up visit for 10 years. We aimed to describe and consolidate each scoring approach, then illustrate implications of their use by comparing baseline K/L scores assigned using 2 of these approaches, and evaluating their respective associations with joint replacement and incident radiographic osteoarthritis (ROA). Methods We compared baseline K/L scores assigned to hips and knees using 2 scoring approaches: 1) assigned by senior researchers to baseline images alone and 2) assigned by trained readers, with images read paired and in known sequence with up to 10 years of follow‐up radiographs (Poisson regression). We evaluated the associations of baseline ROA (any: K/L grade ≥1; established: K/L ≥2) with joint replacement, and of K/L 1 joints with incident established ROA (survival analysis). Results Of 1,002 participants (79% women, mean ± SD age 55.9 ± 5.2 years, body mass index 26.2 ± 4.0 kg/m2), the second scoring approach had 2.4 times (95% confidence interval [95% CI] 1.8–3.1 for knees) and 2.9 times (95% CI 2.3–3.7 for hips) higher prevalence of established ROA than the first approach. Established hip ROA had a higher risk of joint replacement using the first approach (hazard ratio [HR] 24.2 [95% CI 15.0–39.8] versus second approach HR 7.7 [95% CI 4.9–12.1]), as did knees (HR 19.3 [95% CI 10.3–36.1] versus second approach HR 4.8 [95% CI 2.4–9.6]). The risk of incident ROA did not differ by approach. Conclusion This study demonstrates that evaluating ROA prevalence and predicting outcomes depends on the scoring approach.
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Affiliation(s)
- Erin M Macri
- Department of General Practice, Erasmus University Medical Center Rotterdam, Netherlands.,Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus University Medical Center Rotterdam, Netherlands
| | - Jurgen Damen
- Department of General Practice, Erasmus University Medical Center Rotterdam, Netherlands
| | - Edwin Hg Oei
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, Netherlands
| | - Sita Ma Bierma-Zeinstra
- Department of General Practice, Erasmus University Medical Center Rotterdam, Netherlands.,Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, Netherlands
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Macri EM, Neogi T, Tolstykh I, Widjajahakim R, Lewis CE, Torner JC, Nevitt MC, Roux M, Stefanik JJ. Relation of Patellofemoral Joint Alignment, Morphology, and Radiographic Osteoarthritis to Frequent Anterior Knee Pain: Data from the Multicenter Osteoarthritis Study. Arthritis Care Res (Hoboken) 2020; 72:1066-1073. [PMID: 31199605 PMCID: PMC6911012 DOI: 10.1002/acr.24004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 06/11/2019] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Patellofemoral (PF) alignment and trochlear morphology are associated with PF osteoarthritis (OA) and knee pain, but whether they are associated with localized anterior knee pain is unknown, which is believed to be a symptom specific to PF joint pathology. We therefore aimed to evaluate the relation of PF alignment and morphology, as well as PFOA and tibiofemoral OA, to anterior knee pain. METHODS The Multicenter Osteoarthritis Study is a cohort study of individuals with, or at risk for, knee OA. We evaluated cross-sectional associations of PF alignment, trochlear morphology, and PF and tibiofemoral radiographic OA, with localized anterior knee pain (defined with a pain map). We used 2 approaches: a within-person knee-matched evaluation of participants with unilateral anterior knee pain (conditional logistic regression), and a cohort approach comparing those with anterior knee pain to those without (binomial regression). RESULTS With the within-person knee-matched approach (n = 110; 64% women, mean age 70 years, body mass index [BMI] 30.9), PF alignment, morphology, and tibiofemoral OA were not associated with unilateral anterior knee pain. Radiographic PFOA was associated with pain, odds ratio 5.3 (95% confidence interval [95% CI] 1.6-18.3). Using the cohort approach (n = 1,818; 7% of knees with anterior knee pain, 59% women, mean age 68 years, BMI 30.4), results were similar: only PFOA was associated with pain, with a prevalence ratio of 2.2 (95% CI 1.4-3.4). CONCLUSION PF alignment and trochlear morphology were not associated with anterior knee pain in individuals with, or at risk for, knee OA. Radiographic PFOA, however, was associated with pain, suggesting that features of OA, more so than mechanical features, may contribute to localized symptoms.
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Affiliation(s)
- Erin M Macri
- University of Delaware, Newark, and Erasmus MC, Rotterdam, The Netherlands
| | - Tuhina Neogi
- School of Medicine, Boston University, Boston, Massachusetts
| | | | | | | | | | | | - Michael Roux
- Hospital for Special Surgery, New York, New York
| | - Joshua J Stefanik
- University of Delaware, Newark, and School of Medicine, Boston University and Northeastern University, Boston, Massachusetts
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13
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Higher frequency of osteoarthritis in patients with ACL graft rupture than in those with intact ACL grafts 30 years after reconstruction. Knee Surg Sports Traumatol Arthrosc 2020; 28:2139-2146. [PMID: 31664487 PMCID: PMC7347674 DOI: 10.1007/s00167-019-05726-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 09/16/2019] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim was to assess the results of anterior cruciate ligament (ACL) reconstruction regarding graft failure, knee laxity, and osteoarthritis (OA) from a longterm perspective. It was hypothesized that intact ACL graft reduces the risk for increased OA development. METHODS The cohort comprised 60 patients with a median follow-up 31 (range 28-33) years after ACL reconstruction. They were evaluated with magnetic resonance imaging, radiography, KT-1000 arthrometer and the pivot shift test. RESULTS Out of the 60 patients, 30 (50%) showed an intact ACL graft and 30 (50%) a ruptured or absent ACL graft. Patients with ruptured ACL grafts had more medial tibiofemoral compartment OA than those with an intact ACL graft (p = 0.0003). OA was asymmetric in patients with ruptured ACL grafts with more OA in the medial than in the lateral tibiofemoral compartment (p = 0.013) and the patellofemoral compartment (p = 0.002). The distribution of OA between compartments was similar in patients with an intact ACL graft. KT-1000 values of anterior knee laxity were higher in patients with ruptured compared to those with intact ACL grafts (p = 0.012). Side-to-side comparisons of anterior knee laxity showed higher KT-1000 values in patients with ruptured ACL graft (p = 0.0003) and similar results in those with intact graft (p = 0.09). The pivot shift grade was higher in the group with a ruptured ACL graft (p < 0.0001). CONCLUSIONS Median 31 (range 28-33) years after ACL reconstruction, 50% of the patients showed an intact ACL graft and no side-to-side difference regarding anterior knee laxity. Patients with ruptured ACL grafts had more OA of the medial tibiofemoral compartment than those with intact ACL grafts. LEVEL OF EVIDENCE Retrospective cohort study, Level III.
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14
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Performance of distinct knee osteoarthritis classification criteria in the ELSA-Brasil musculoskeletal study. Clin Rheumatol 2018; 38:793-802. [PMID: 30382545 DOI: 10.1007/s10067-018-4347-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 10/05/2018] [Accepted: 10/18/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To compare the performance of different knee osteoarthritis (OA) classification criteria in a subsample of subjects of ELSA-Brasil Musculoskeletal cohort (ELSA-Brasil MSK) in comparison with the clinical-radiographic evaluation of an experienced rheumatologist. METHOD A cross-sectional study of the diagnostic accuracy of different knee OA classification criteria: radiographic OA, symptomatic OA, clinical and clinical-radiographic criteria of the American College of Rheumatology (ACR), and the definition proposed by the National Institute for Health and Care Excellence (NICE), UK. The study also evaluated some alternative definitions of OA including a combination of criteria. In total, 250 subjects participated. Only one knee per subject was included. When both or none of the knees were affected, one knee was randomly selected for analysis. OA prevalence, sensitivity, specificity, positive and negative predictive values, and accuracy were presented (CI 95%; α = 5%). RESULTS The mean age was 56.1 years (SD = 8.7), 48.8% female, and 39.2% presented knee OA according to the rheumatologist. The sensitivity and the specificity of radiographic OA were 51% and 96.7%, respectively, while the NICE definition showed 57.0% and 76.3%, respectively. The other OA criteria showed good levels of specificity, but the levels of sensitivity were below 30%. Considering NICE and/or X-ray result in combination, the sensitivity increased (73.4%), while the specificity reduced slightly (73.0%) in relation to the original NICE definition. CONCLUSIONS Radiographic OA showed the best performance, followed by NICE definition, especially in combination with X-ray results.
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15
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LaPrade RF, Cram TR, Mitchell JJ, Geeslin AG, Lockard CA, Fitzcharles EK, Dornan GJ. Axial-Oblique Versus Standard Axial 3-T Magnetic Resonance Imaging for the Detection of Trochlear Cartilage Lesions: A Prospective Study. Orthop J Sports Med 2018; 6:2325967118801009. [PMID: 30327787 PMCID: PMC6178377 DOI: 10.1177/2325967118801009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Imaging of the femoral trochlea has been inherently difficult because of its
convex anatomy. Purpose/Hypothesis: The purpose of this study was to compare the diagnostic utility of a standard
axial magnetic resonance imaging (MRI) sequence with an axial-oblique MRI
sequence of the knee for the detection of trochlear articular cartilage
lesions on a high-field 3-T MRI scanner. We hypothesized that axial-oblique
MRI scans of the knee obtained along the true axis of the trochlea would
significantly improve the detection of high-grade cartilage lesions. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Patients who underwent MRI and subsequent surgery for any indication were
prospectively enrolled into this study between June 2014 and February 2015.
The articular cartilage of the trochlea was evaluated independently by 3
raters on axial and axial-oblique MRI and compared with arthroscopic
findings (gold standard). The interrater and intrarater reliability of mild
(International Cartilage Repair Society [ICRS] grades 1 or 2) and severe
(ICRS grades 3 or 4) lesions on MRI were assessed as well as the
sensitivity, specificity, positive predictive value, and negative predictive
value. Results: A total of 99 knees in 96 patients were included in the study. Interrater and
intrarater agreement for the identification of severe lesions were moderate
to good on the proximal trochlea and fair to moderate on the distal
trochlea. No significant differences in sensitivity were found between axial
and axial-oblique scans for any grade of lesion (55% vs 51%, respectively;
P = .700) or for severe lesions (61% vs 52%,
respectively; P = .289). Similarly, specificity for
detecting severe lesions was not significantly different between axial and
axial-oblique scans (95% vs 87%, respectively; P = .219).
Last, no significant differences in sensitivity or specificity were found
between MRI sequences when separately evaluating proximal and distal
trochlear lesions (all P > .05). Conclusion: The axial-oblique sequence was unable to improve the sensitivity of MRI in
detecting articular cartilage lesions on the trochlea. Both conventional
axial and axial-oblique sequences, reviewed independently of the complete
MRI series, had low sensitivity in detecting trochlear articular cartilage
lesions. For this reason, clinicians should utilize all MRI planes to
evaluate the articular cartilage of the trochlea. Future studies should
focus on improving MRI techniques for detecting and characterizing cartilage
lesions of the trochlea.
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Affiliation(s)
- Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Tyler R Cram
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Justin J Mitchell
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Andrew G Geeslin
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | | | - Eric K Fitzcharles
- Steadman Philippon Research Institute, Vail, Colorado, USA.,The Steadman Clinic, Vail, Colorado, USA
| | - Grant J Dornan
- Steadman Philippon Research Institute, Vail, Colorado, USA
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16
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Pirayeh N, Shaterzadeh-Yazdi MJ, Negahban H, Mehravar M, Mostafaee N, Saki-Malehi A. Examining the diagnostic accuracy of static postural stability measures in differentiating among knee osteoarthritis patients with mild and moderate to severe radiographic signs. Gait Posture 2018; 64:1-6. [PMID: 29778898 DOI: 10.1016/j.gaitpost.2018.04.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 03/26/2018] [Accepted: 04/29/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Clinicians need a reliable and accurate tools that can best identify and classify balance impairments between mild and moderate to severe grades of knee osteoarthritis (OA). RESEARCH QUESTION This study was designed to investigate the accuracy of postural measurements to discriminate between these two groups of knee OA. METHODS A total of 130 patients with knee OA based on the Kellgren-Lawrence (KL) grading scale were categorized into 65 patients with mild (a KL grade≤ 2) and 65 patient with moderate to severe (a KL grade≥3) radiographic sign. Static postural control was assessed on the force plate in three conditions of double leg stance with open (DO) and closed eyes (DC) and single leg stance with open eyes (SO). The accuracy for static postural control parameters was determined by calculation of sensitivity, specificity, area under the Receiver Operating Characteristic (ROC) curve (AUC) and likelihood ratios (LRs). RESULTS Our results showed that standard deviation (SD) of velocity in anterior-posterior (AP) direction had the highest sensitivity and specificity in conditions of DO and DC, respectively. ROC curve analysis indicated that measures of mean and SD velocity in medio-lateral (ML) direction in conditions of DO and DC had acceptable levels of accuracy (AUC > 0.70) in discriminating between the two groups of knee OA patients. Also, based on LR results, SD of velocity in AP direction had the best ability for ruling in and ruling out moderate to severe grade of knee OA patients in conditions of DC and DO, respectively. SIGNIFICANCE Our findings provide evidence for selection of mean velocity and SD of velocity in identifying and discriminating static postural performance in patients with mild and moderate to severe grades of knee OA.
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Affiliation(s)
- Nahid Pirayeh
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | | | - Hossein Negahban
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mohammad Mehravar
- Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | - Neda Mostafaee
- Department of Physical Therapy, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran; Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Amal Saki-Malehi
- Department of Biostatistics and Epidemiology, Faculty of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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17
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Mobilization with movement and kinesio taping in knee arthritis—evaluation and outcomes. INTERNATIONAL ORTHOPAEDICS 2018; 42:2807-2815. [DOI: 10.1007/s00264-018-3938-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 04/05/2018] [Indexed: 02/04/2023]
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18
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Grazina R, Andrade R, Bastos R, Costa D, Pereira R, Marinhas J, Maestro A, Espregueira-Mendes J. Clinical Management in Early OA. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1059:111-135. [PMID: 29736571 DOI: 10.1007/978-3-319-76735-2_5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Knee osteoarthritis affects an important percentage of the population throughout their life. Several factors seem to be related to the development of knee osteoarthritis including genetic predisposition, gender, age, meniscal deficiency, lower limb malalignments, joint instability, cartilage defects, and increasing sports participation. The latter has contributed to a higher prevalence of early onset of knee osteoarthritis at younger ages with this active population demanding more consistent and durable outcomes. The diagnosis is complex and the common signs and symptoms are often cloaked at these early stages. Classification systems have been developed and are based on the presence of knee pain and radiographic findings coupled with magnetic resonance or arthroscopic evidence of early joint degeneration. Nonsurgical treatment is often the first-line option and is mainly based on daily life adaptations, weight loss, and exercise, with pharmacological agents having only a symptomatic role. Surgical treatment shows positive results in relieving the joint symptomatology, increasing the knee function and delaying the development to further degenerative stages. Biologic therapies are an emerging field showing early promising results; however, further high-level research is required.
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Affiliation(s)
- Rita Grazina
- Orthopaedic Surgery at Centro Hospitalar de Vila Nova de Gaia/Espinho E.P.E, Vila Nova de Gaia, Portugal
| | - Renato Andrade
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,Faculty of Sports, University of Porto, Porto, Portugal
| | - Ricardo Bastos
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal.,Fluminense Federal University, Niteroi/Rio de Janeiro, Brazil
| | - Daniela Costa
- SMIC Dragão - Serviço Médico de Imagem Computorizada, Porto, Portugal
| | - Rogério Pereira
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Faculty of Sports, University of Porto, Porto, Portugal.,Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
| | - José Marinhas
- Orthopaedic Surgery at Centro Hospitalar de Vila Nova de Gaia/Espinho E.P.E, Vila Nova de Gaia, Portugal.,Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal.,Dom Henrique Research Centre, Porto, Portugal
| | - António Maestro
- Real Sporting de Gijón SAD, Gijón, Spain.,FREMAP Mutua de Accidentes, Gijón, Spain
| | - João Espregueira-Mendes
- Clínica do Dragão, Espregueira-Mendes Sports Centre - FIFA Medical Centre of Excellence, Porto, Portugal. .,Dom Henrique Research Centre, Porto, Portugal. .,Orthopaedics Department of Minho University, Minho, Portugal. .,3B's Research Group-Biomaterials, Biodegradables and Biomimetics, University of Minho, Headquarters of the European Institute of Excellence on Tissue Engineering and Regenerative Medicine, Guimarães, Portugal. .,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal.
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Sakellariou G, Conaghan PG, Zhang W, Bijlsma JWJ, Boyesen P, D'Agostino MA, Doherty M, Fodor D, Kloppenburg M, Miese F, Naredo E, Porcheret M, Iagnocco A. EULAR recommendations for the use of imaging in the clinical management of peripheral joint osteoarthritis. Ann Rheum Dis 2017; 76:1484-1494. [DOI: 10.1136/annrheumdis-2016-210815] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 02/25/2017] [Accepted: 03/05/2017] [Indexed: 11/04/2022]
Abstract
The increased information provided by modern imaging has led to its more extensive use. Our aim was to develop evidence-based recommendations for the use of imaging in the clinical management of the most common arthropathy, osteoarthritis (OA). A task force (including rheumatologists, radiologists, methodologists, primary care doctors and patients) from nine countries defined 10 questions on the role of imaging in OA to support a systematic literature review (SLR). Joints of interest were the knee, hip, hand and foot; imaging modalities included conventional radiography (CR), MRI, ultrasonography, CT and nuclear medicine. PubMed and EMBASE were searched. The evidence was presented to the task force who subsequently developed the recommendations. The strength of agreement for each recommendation was assessed. 17 011 references were identified from which 390 studies were included in the SLR. Seven recommendations were produced, covering the lack of need for diagnostic imaging in patients with typical symptoms; the role of imaging in differential diagnosis; the lack of benefit in monitoring when no therapeutic modification is related, though consideration is required when unexpected clinical deterioration occurs; CR as the first-choice imaging modality; consideration of how to correctly acquire images and the role of imaging in guiding local injections. Recommendations for future research were also developed based on gaps in evidence, such as the use of imaging in identifying therapeutic targets, and demonstrating the added value of imaging. These evidence-based recommendations and related research agenda provide the basis for sensible use of imaging in routine clinical assessment of people with OA.
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20
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van Tunen JAC, van der Esch M, Roorda LD, van der Leeden M, Lems WF, Dekker J. Reply. Arthritis Care Res (Hoboken) 2016; 69:763-764. [PMID: 27813362 DOI: 10.1002/acr.23144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 11/01/2016] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Leo D Roorda
- Amsterdam Rehabilitation Research Center
- Reade, Amsterdam, The Netherlands
| | - Marike van der Leeden
- Amsterdam Rehabilitation Research Center
- Reade and VU University Medical Center, Amsterdam, The Netherlands
| | - Willem F Lems
- Jan van Breemen Research Institute
- Reade and VU University Medical Center, Amsterdam, The Netherlands
| | - Joost Dekker
- VU University Medical Center, Amsterdam, the Netherlands
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21
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The Combination of the Tunnel View and Weight-Bearing Anteroposterior Radiographs Improves the Detection of Knee Arthritis. ARTHRITIS 2016; 2016:9786924. [PMID: 26925264 PMCID: PMC4746274 DOI: 10.1155/2016/9786924] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 12/28/2015] [Accepted: 12/30/2015] [Indexed: 11/18/2022]
Abstract
Imaging used for the evaluation of knee pain has historically included weight-bearing anteroposterior (AP), lateral, and sunrise radiographs. We wished to evaluate the utility of adding the weight-bearing (WB) posteroanterior (PA) view of the knee in flexion. We hypothesize that (1) the WB tunnel view can detect radiographic osteoarthritis (OA) not visualized on the WB AP, (2) the combination of the AP and tunnel view increases the radiographic detection of OA, and (3) this may provide additional information to the clinician evaluating knee pain. We retrospectively reviewed the WB AP and tunnel view radiographs of 100 knees (74 patients) presenting with knee pain and analyzed for evidence of arthritis. The combination of the WB tunnel view and WB AP significantly increased the detection of joint space narrowing in the lateral (p < 0.001) and medial (p = 0.006) compartments over the AP view alone. The combined views significantly improved the identification of medial subchondral cysts (p = 0.022), sclerosis of the lateral tibial plateau (p = 0.041), and moderate-to-large osteophytes in the medial compartment (p = 0.012), intercondylar notch (p < 0.001), and tibial spine (p < 0.001). The WB tunnel view is an effective tool to provide additional information on affected compartments in the painful knee, not provided by the AP image alone.
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22
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Duncan ST, Khazzam MS, Burnham JM, Spindler KP, Dunn WR, Wright RW. Sensitivity of standing radiographs to detect knee arthritis: a systematic review of Level I studies. Arthroscopy 2015; 31:321-8. [PMID: 25312767 DOI: 10.1016/j.arthro.2014.08.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/10/2014] [Accepted: 08/26/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to perform a systematic review of the available literature to define the level of quality evidence for determining the sensitivity and specificity of different radiographic views in detecting knee osteoarthritis and to determine the impact of different grading systems on the ability to detect knee osteoarthritis. METHODS A systematic review of the literature was conducted to identify studies that evaluated the standing anteroposterior (AP) and 45° posteroanterior (PA) views for tibiofemoral and patellofemoral arthritis and those comparing the use of the Kellgren-Lawrence versus the joint space narrowing (JSN) radiographic grading systems using arthroscopy as the gold standard. A comprehensive search of PubMed, Scopus, CINAHL, the Cochrane Database, Clinicaltrial.gov, and EMBASE was performed using the keywords "osteoarthritis," "knee," "x-ray," "sensitivity," and "arthroscopy." RESULTS Six studies were included in the evaluation. The 45° flexion PA view showed a higher sensitivity than the standing AP view for detecting severe arthritis involving either the medial or lateral tibiofemoral compartment. There was no difference in the specificities for the 2 views. The direct comparison of the Kellgren-Lawrence and the JSN radiographic grading systems found no clinical difference between the 2 systems regarding the sensitivities, although the specificity was greater for the JSN system. CONCLUSIONS The ability to detect knee osteoarthritis continues to be difficult without using advanced imaging. However, as an inexpensive screening tool, the 45° flexion PA view is more sensitive than the standing AP view to detect severe tibiofemoral osteoarthritis. When evaluating the radiograph for severe osteoarthritis using either the Kellgren-Lawrence or JSN grading system, there is no clinical difference in the sensitivity between the 2 methods; however, the JSN may be more specific for ruling in severe osteoarthritis in the medial compartment. LEVEL OF EVIDENCE Level I, systematic review of Level I studies.
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Affiliation(s)
- Stephen T Duncan
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A..
| | - Michael S Khazzam
- Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, Texas, U.S.A
| | - Jeremy M Burnham
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky, U.S.A
| | - Kurt P Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic Sports Health Center, Cleveland, Ohio, U.S.A
| | - Warren R Dunn
- Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A
| | - Rick W Wright
- Department of Orthopaedic Surgery, Washington University School of Medicine at Barnes-Jewish Hospital, St. Louis, Missouri, U.S.A
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Wang C, Iversen MD, McAlindon T, Harvey WF, Wong JB, Fielding RA, Driban JB, Price LL, Rones R, Gamache T, Schmid CH. Assessing the comparative effectiveness of Tai Chi versus physical therapy for knee osteoarthritis: design and rationale for a randomized trial. Altern Ther Health Med 2014; 14:333. [PMID: 25199526 PMCID: PMC4171546 DOI: 10.1186/1472-6882-14-333] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 08/27/2014] [Indexed: 01/05/2023]
Abstract
Background Knee osteoarthritis (OA) causes pain and long-term disability with annual healthcare costs exceeding $185 billion in the United States. Few medical remedies effectively influence the course of the disease. Finding effective treatments to maintain function and quality of life in patients with knee OA is one of the national priorities identified by the Institute of Medicine. We are currently conducting the first comparative effectiveness and cost-effectiveness randomized trial of Tai Chi versus a physical-therapy regimen in a sample of patients with symptomatic and radiographically confirmed knee OA. This article describes the design and conduct of this trial. Methods/Design A single-center, 52-week, comparative effectiveness randomized controlled trial of Tai Chi versus a standardized physical-therapy regimen is being conducted at an urban tertiary medical center in Boston, Massachusetts. The study population consists of adults ≥ 40 years of age with symptomatic and radiographic knee OA (American College of Rheumatology criteria). Participants are randomly allocated to either 12 weeks of Tai Chi (2x/week) or Physical Therapy (2x/week for 6 weeks, followed by 6 weeks of rigorously monitored home exercise). The primary outcome measure is pain (Western Ontario and McMaster Universities WOMAC) subscale at 12 weeks. Secondary outcomes include WOMAC stkiffness and function domain scores, lower extremity strength and power, functional balance, physical performance tests, psychological and psychosocial functioning, durability effects, health related quality of life, and healthcare utilization at 12, 24 and 52 weeks. Discussion This study will be the first randomized comparative-effectiveness and cost-effectiveness trial of Tai Chi versus Physical Therapy in a large symptomatic knee OA population with long-term follow up. We present here a robust and well-designed randomized comparative-effectiveness trial that also explores multiple outcomes to elucidate the potential mechanisms of mind-body effect for a major disabling disease with substantial health burdens and economic costs. Results of this study are expected to have important public health implications for the large and growing population with knee OA. Trial registration ClinicalTrials.gov identifier:
NCT01258985 Electronic supplementary material The online version of this article (doi:10.1186/1472-6882-14-333) contains supplementary material, which is available to authorized users.
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van der Esch M, Holla JF, van der Leeden M, Knol DL, Lems WF, Roorda LD, Dekker J. Decrease of muscle strength is associated with increase of activity limitations in early knee osteoarthritis: 3-year results from the cohort hip and cohort knee study. Arch Phys Med Rehabil 2014; 95:1962-8. [PMID: 24977932 DOI: 10.1016/j.apmr.2014.06.007] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/29/2014] [Accepted: 06/09/2014] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To determine whether a decrease in muscle strength over 3 years is associated with an increase in activity limitations in persons with early symptomatic knee osteoarthritis (OA), and to examine whether the longitudinal association between muscle strength and activity limitations is moderated by knee joint proprioception and laxity. DESIGN A longitudinal cohort study with 3-year follow-up. Measurements were performed at the second (t0) and fifth (t1) year of the Cohort Hip and Cohort Knee (CHECK) study. Statistical analyses included paired t tests, chi-square tests, and regression analyses. In regression analyses, the association between muscle strength and activity limitations was adjusted for confounders. SETTING A rehabilitation and rheumatology center. PARTICIPANTS Subjects (N=146) with early symptomatic knee OA from the CHECK study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Muscle strength, proprioception, and laxity were assessed using specifically designed measurement devices. Self-reported and performance-based activity limitations were measured with the Western Ontario and McMaster Universities Osteoarthritis Index, the Get Up and Go test, the walk test, and the stair-climb test. RESULTS A total of 116 women (79.5%) and 30 men (20.5%), with a mean age ± SD of 58.4±4.9 years and a mean body mass index ± SD of 25.5±3.6, were included in the study. Overall, small 3-year changes in muscle strength and activity limitations were observed. At the group level, the average muscle strength increased by 10% (1.0±0.3 to 1.1±0.3Nm/kg) over the 3 years. The 3-year decrease in muscle strength was independently associated with an increase in performance-based activity limitations on all 3 measures (B=-1.12, B=-5.83, and B=-1.25, respectively). Proprioception and laxity did not moderate this association. CONCLUSIONS In patients with early knee OA, decreased muscle strength is associated with an increase in activity limitations. Our results are a step toward understanding the role of muscle weakness in the development of activity limitations in knee OA. Further well-designed experimental studies are indicated to establish the causal role of muscle weakness in activity limitations.
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Affiliation(s)
- Martin van der Esch
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands.
| | - Jasmijn F Holla
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
| | - Marike van der Leeden
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands; Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Dirk L Knol
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Willem F Lems
- Department of Rheumatology, VU University Medical Center, Amsterdam, The Netherlands; Jan van Breemen Research Institute, Reade, Amsterdam, The Netherlands
| | - Leo D Roorda
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands
| | - Joost Dekker
- Amsterdam Rehabilitation Research Center, Reade, Amsterdam, The Netherlands; Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands; EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
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Stefanik JJ, Neogi T, Niu J, Roemer FW, Segal NA, Lewis CE, Nevitt M, Guermazi A, Felson DT. The diagnostic performance of anterior knee pain and activity-related pain in identifying knees with structural damage in the patellofemoral joint: the Multicenter Osteoarthritis Study. J Rheumatol 2014; 41:1695-702. [PMID: 24931959 DOI: 10.3899/jrheum.131555] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To determine the diagnostic test performance of location of pain and activity-related pain in identifying knees with patellofemoral joint (PFJ) structural damage. METHODS The Multicenter Osteoarthritis Study is a US National Institutes of Health-funded cohort study of older adults with or at risk of knee osteoarthritis. Subjects identified painful areas around the knee on a knee pain map and the Western Ontario and McMaster Universities Osteoarthritis Index was used to assess pain with stairs and walking on level ground. Cartilage damage and bone marrow lesions were assessed from knee magnetic resonance imaging. We determined the sensitivity, specificity, positive and negative predictive values for presence of anterior knee pain (AKP), pain with stairs, absence of pain while walking on level ground, and combinations of tests in discriminating knees with isolated PFJ structural damage from those with isolated tibiofemoral joint (TFJ) or no structural damage. Knees with mixed PFJ/TFJ damage were removed from our analyses because of the inability to determine which compartment was causing pain. RESULTS There were 407 knees that met our inclusion criteria. "Any" AKP had a sensitivity of 60% and specificity of 53%; and if AKP was the only area of pain, the sensitivity dropped to 27% but specificity rose to 81%. Absence of moderate pain with walking on level ground had the greatest sensitivity (93%) but poor specificity (13%). The combination of "isolated" AKP and moderate pain with stairs had poor sensitivity (9%) but the greatest specificity (97%) of strategies tested. CONCLUSION Commonly used questions purported to identify knees with PFJ structural damage do not identify this condition with great accuracy.
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Affiliation(s)
- Joshua J Stefanik
- From Boston University, Boston, Massachusetts; the University of California, San Francisco, California; the University of Alabama, Birmingham, Alabama; the University of Iowa, Iowa City, Iowa, USA; Klinikum Augsburg, Augsburg, Germany.J.J. Stefanik, MSPT, PhD, Research Assistant Professor of Physical Therapy and Athletic Training; T. Neogi, MD, PhD, Associate Professor of Medicine; J. Niu, DSc, Clinical Epidemiology and Research Training Unit; A. Guermazi, MD, PhD, Professor of Radiology; D.T. Felson, MD, MPH, Professor of Medicine, Boston University; F.W. Roemer, MD, Associate Professor, Klinikum Augsburg; M.C. Nevitt, PhD, Professor of Epidemiology and Biostatistics, University of California, San Francisco; C.E. Lewis, MD, Professor of Medicine, University of Alabama; N.A. Segal, MD, Associate Professor of Orthopedics and Rehabilitation, University of Iowa.
| | - Tuhina Neogi
- From Boston University, Boston, Massachusetts; the University of California, San Francisco, California; the University of Alabama, Birmingham, Alabama; the University of Iowa, Iowa City, Iowa, USA; Klinikum Augsburg, Augsburg, Germany.J.J. Stefanik, MSPT, PhD, Research Assistant Professor of Physical Therapy and Athletic Training; T. Neogi, MD, PhD, Associate Professor of Medicine; J. Niu, DSc, Clinical Epidemiology and Research Training Unit; A. Guermazi, MD, PhD, Professor of Radiology; D.T. Felson, MD, MPH, Professor of Medicine, Boston University; F.W. Roemer, MD, Associate Professor, Klinikum Augsburg; M.C. Nevitt, PhD, Professor of Epidemiology and Biostatistics, University of California, San Francisco; C.E. Lewis, MD, Professor of Medicine, University of Alabama; N.A. Segal, MD, Associate Professor of Orthopedics and Rehabilitation, University of Iowa
| | - Jingbo Niu
- From Boston University, Boston, Massachusetts; the University of California, San Francisco, California; the University of Alabama, Birmingham, Alabama; the University of Iowa, Iowa City, Iowa, USA; Klinikum Augsburg, Augsburg, Germany.J.J. Stefanik, MSPT, PhD, Research Assistant Professor of Physical Therapy and Athletic Training; T. Neogi, MD, PhD, Associate Professor of Medicine; J. Niu, DSc, Clinical Epidemiology and Research Training Unit; A. Guermazi, MD, PhD, Professor of Radiology; D.T. Felson, MD, MPH, Professor of Medicine, Boston University; F.W. Roemer, MD, Associate Professor, Klinikum Augsburg; M.C. Nevitt, PhD, Professor of Epidemiology and Biostatistics, University of California, San Francisco; C.E. Lewis, MD, Professor of Medicine, University of Alabama; N.A. Segal, MD, Associate Professor of Orthopedics and Rehabilitation, University of Iowa
| | - Frank W Roemer
- From Boston University, Boston, Massachusetts; the University of California, San Francisco, California; the University of Alabama, Birmingham, Alabama; the University of Iowa, Iowa City, Iowa, USA; Klinikum Augsburg, Augsburg, Germany.J.J. Stefanik, MSPT, PhD, Research Assistant Professor of Physical Therapy and Athletic Training; T. Neogi, MD, PhD, Associate Professor of Medicine; J. Niu, DSc, Clinical Epidemiology and Research Training Unit; A. Guermazi, MD, PhD, Professor of Radiology; D.T. Felson, MD, MPH, Professor of Medicine, Boston University; F.W. Roemer, MD, Associate Professor, Klinikum Augsburg; M.C. Nevitt, PhD, Professor of Epidemiology and Biostatistics, University of California, San Francisco; C.E. Lewis, MD, Professor of Medicine, University of Alabama; N.A. Segal, MD, Associate Professor of Orthopedics and Rehabilitation, University of Iowa
| | - Neil A Segal
- From Boston University, Boston, Massachusetts; the University of California, San Francisco, California; the University of Alabama, Birmingham, Alabama; the University of Iowa, Iowa City, Iowa, USA; Klinikum Augsburg, Augsburg, Germany.J.J. Stefanik, MSPT, PhD, Research Assistant Professor of Physical Therapy and Athletic Training; T. Neogi, MD, PhD, Associate Professor of Medicine; J. Niu, DSc, Clinical Epidemiology and Research Training Unit; A. Guermazi, MD, PhD, Professor of Radiology; D.T. Felson, MD, MPH, Professor of Medicine, Boston University; F.W. Roemer, MD, Associate Professor, Klinikum Augsburg; M.C. Nevitt, PhD, Professor of Epidemiology and Biostatistics, University of California, San Francisco; C.E. Lewis, MD, Professor of Medicine, University of Alabama; N.A. Segal, MD, Associate Professor of Orthopedics and Rehabilitation, University of Iowa
| | - Cora E Lewis
- From Boston University, Boston, Massachusetts; the University of California, San Francisco, California; the University of Alabama, Birmingham, Alabama; the University of Iowa, Iowa City, Iowa, USA; Klinikum Augsburg, Augsburg, Germany.J.J. Stefanik, MSPT, PhD, Research Assistant Professor of Physical Therapy and Athletic Training; T. Neogi, MD, PhD, Associate Professor of Medicine; J. Niu, DSc, Clinical Epidemiology and Research Training Unit; A. Guermazi, MD, PhD, Professor of Radiology; D.T. Felson, MD, MPH, Professor of Medicine, Boston University; F.W. Roemer, MD, Associate Professor, Klinikum Augsburg; M.C. Nevitt, PhD, Professor of Epidemiology and Biostatistics, University of California, San Francisco; C.E. Lewis, MD, Professor of Medicine, University of Alabama; N.A. Segal, MD, Associate Professor of Orthopedics and Rehabilitation, University of Iowa
| | - Michael Nevitt
- From Boston University, Boston, Massachusetts; the University of California, San Francisco, California; the University of Alabama, Birmingham, Alabama; the University of Iowa, Iowa City, Iowa, USA; Klinikum Augsburg, Augsburg, Germany.J.J. Stefanik, MSPT, PhD, Research Assistant Professor of Physical Therapy and Athletic Training; T. Neogi, MD, PhD, Associate Professor of Medicine; J. Niu, DSc, Clinical Epidemiology and Research Training Unit; A. Guermazi, MD, PhD, Professor of Radiology; D.T. Felson, MD, MPH, Professor of Medicine, Boston University; F.W. Roemer, MD, Associate Professor, Klinikum Augsburg; M.C. Nevitt, PhD, Professor of Epidemiology and Biostatistics, University of California, San Francisco; C.E. Lewis, MD, Professor of Medicine, University of Alabama; N.A. Segal, MD, Associate Professor of Orthopedics and Rehabilitation, University of Iowa
| | - Ali Guermazi
- From Boston University, Boston, Massachusetts; the University of California, San Francisco, California; the University of Alabama, Birmingham, Alabama; the University of Iowa, Iowa City, Iowa, USA; Klinikum Augsburg, Augsburg, Germany.J.J. Stefanik, MSPT, PhD, Research Assistant Professor of Physical Therapy and Athletic Training; T. Neogi, MD, PhD, Associate Professor of Medicine; J. Niu, DSc, Clinical Epidemiology and Research Training Unit; A. Guermazi, MD, PhD, Professor of Radiology; D.T. Felson, MD, MPH, Professor of Medicine, Boston University; F.W. Roemer, MD, Associate Professor, Klinikum Augsburg; M.C. Nevitt, PhD, Professor of Epidemiology and Biostatistics, University of California, San Francisco; C.E. Lewis, MD, Professor of Medicine, University of Alabama; N.A. Segal, MD, Associate Professor of Orthopedics and Rehabilitation, University of Iowa
| | - David T Felson
- From Boston University, Boston, Massachusetts; the University of California, San Francisco, California; the University of Alabama, Birmingham, Alabama; the University of Iowa, Iowa City, Iowa, USA; Klinikum Augsburg, Augsburg, Germany.J.J. Stefanik, MSPT, PhD, Research Assistant Professor of Physical Therapy and Athletic Training; T. Neogi, MD, PhD, Associate Professor of Medicine; J. Niu, DSc, Clinical Epidemiology and Research Training Unit; A. Guermazi, MD, PhD, Professor of Radiology; D.T. Felson, MD, MPH, Professor of Medicine, Boston University; F.W. Roemer, MD, Associate Professor, Klinikum Augsburg; M.C. Nevitt, PhD, Professor of Epidemiology and Biostatistics, University of California, San Francisco; C.E. Lewis, MD, Professor of Medicine, University of Alabama; N.A. Segal, MD, Associate Professor of Orthopedics and Rehabilitation, University of Iowa
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van der Esch M, Knol DL, Schaffers IC, Reiding DJ, van Schaardenburg D, Knoop J, Roorda LD, Lems WF, Dekker J. Osteoarthritis of the knee: multicompartmental or compartmental disease? Rheumatology (Oxford) 2013; 53:540-6. [PMID: 24292347 DOI: 10.1093/rheumatology/ket393] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Knee OA has been conceptualized as a multicompartmental disease, as a compartmental disease or as a combination of these two disease processes. The aim of this study was to determine the associations between four radiographic features (joint space narrowing, osteophyte formation, sclerosis and cysts) across and within the three knee compartments (medial tibiofemoral, lateral tibiofemoral and patellofemoral compartment) in knee OA. METHODS Data from the Amsterdam OA Cohort were used. In 298 patients diagnosed with knee OA, radiographic features were examined in three knee joint compartments. Radiographic features were scored according to standardized scoring methods. Factor analysis was used to examine associations between the four radiographic features across and within compartments. RESULTS A bifactor model showed a general multicompartmental factor: 10 of 12 radiographic features across the entire joint were associated with the general factor. The bifactor model also showed three compartmental factors-one for each compartment: joint space narrowing, sclerosis and to a lesser extent osteophyte formation were associated with these compartmental factors. CONCLUSION These findings suggest a multicompartmental disease process in the knee, characterized by associations among features across the entire joint, as well as compartmental disease processes in each knee compartment, characterized by associations among features within specific compartments. Longitudinal studies are needed to explore the possibility of the development from a compartmental disease to a multicompartmental disease and the impact of contributing factors on the development.
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Affiliation(s)
- Martin van der Esch
- Amsterdam Rehabilitation Research Centre Reade, Dr Jan van Breemenstraat 2, PO 58271, 1040 HG Amsterdam, The Netherlands.
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Stefanik JJ, Niu J, Gross D, Roemer FW, Guermazi A, Felson DT. Using magnetic resonance imaging to determine the compartmental prevalence of knee joint structural damage. Osteoarthritis Cartilage 2013; 21:695-9. [PMID: 23428598 PMCID: PMC3638815 DOI: 10.1016/j.joca.2013.02.003] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 12/18/2012] [Accepted: 02/08/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the prevalence of magnetic resonance imaging (MRI) detected structural damage in the patellofemoral joint (PFJ) and tibiofemoral joint (TFJ) in a population-based cohort. A secondary aim was to evaluate the patterns of compartmental involvement in knees with pain, between men and women, and in different age and body mass index (BMI) categories. METHODS We studied 970 knees, one knee per subject, from the Framingham Osteoarthritis Study, a population-based cohort study of persons 51-92 years old. Cartilage damage and bone marrow lesions (BMLs) were assessed using the Whole Organ Magnetic Resonance Imaging Score (WORMS). The prevalence of isolated PFJ, isolated TFJ, and mixed structural damage was determined using the following definitions: any cartilage damage, full thickness cartilage loss, any BML, and the combination of full thickness cartilage loss with any BML. RESULTS The mean age and BMI was 63.4 years and 28.6 m/kg(2), respectively; 57% were female. Isolated PFJ damage occurred in 15-20% of knees and isolated TFJ damage occurred in 8-17% of knees depending on the definition used. The prevalence of isolated PFJ damage was greater than isolated TFJ damage using all definitions except the any BML definition. This pattern was similar between genders and among age and BMI categories. In those with knee pain, isolated PFJ was at least as common as TFJ damage depending on the definition used. CONCLUSION Using MRI to assess knee joint structural damage, isolated PFJ damage was at least as common as, if not more common than, isolated TFJ damage.
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Affiliation(s)
| | - Jingbo Niu
- Boston University School of Medicine, Boston, MA
| | - Douglas Gross
- Boston University School of Medicine, Boston, MA
- Massachusetts General Hospital Institute of Health Professions, Boston, MA
| | - Frank W. Roemer
- Boston University School of Medicine, Boston, MA
- Klinikum Augsburg, Augsburg, Germany
| | - Ali Guermazi
- Boston University School of Medicine, Boston, MA
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Prasad A, Nardo L, Schooler J, Joseph G, Link T. T₁ρ and T₂ relaxation times predict progression of knee osteoarthritis. Osteoarthritis Cartilage 2013; 21:69-76. [PMID: 23059757 PMCID: PMC3596874 DOI: 10.1016/j.joca.2012.09.011] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 08/29/2012] [Accepted: 09/18/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate whether T(2) and T(1ρ) relaxation times of knee cartilage determined with 3T magnetic resonance imaging (MRI) at baseline predict longitudinal progression of cartilage degenerative changes. METHODS Quantitative analysis of cartilage was performed using 3T MRI with both T(2) and T(1ρ) mapping techniques in 55 subjects without evidence of severe osteoarthritis (OA) [Kellgren-Lawrence (KL) score of 0-3] at baseline. Morphological abnormalities of cartilage, menisci, ligaments and bone marrow were analyzed on sagittal fat-saturated intermediate-weighted fast spin echo (FSE) sequences. Progression of degenerative changes was analyzed over a period of 2 years. Progression was detected in 27 subjects while in 28 subjects no changes were found. Differences between T(2) and T(1ρ) relaxation times in these two cohorts were compared using one-way analysis of variance (ANOVA) and t tests. RESULTS Baseline T(2) and T(1ρ) values were significantly higher in the progression cohort in all compartments (P < 0.05) except the lateral tibia (LT) for T(2) and the medial tibia (MT) for T(1ρ). Progression of cartilage degenerative disease was most pronounced at the medial femoral condyles and at the femoro-patellar joint; differences between the two cohorts for T(2) and T(1ρ) were also most significant in these compartments. CONCLUSIONS T(2) and T(1ρ) measurements were significantly higher at baseline in individuals that showed progression of cartilage abnormalities over a period of 2 years and may therefore serve as potential predictors for progression of degenerative cartilage abnormalities in knee OA.
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Affiliation(s)
| | | | | | | | - T.M. Link
- Address correspondence and reprint requests to: T.M. Link, Department of Radiology and Biomedical Imaging, University of California San Francisco, 400 Parnassus Ave., A 367, Box 0628, San Francisco, CA 94143-0628, USA. Tel: 1-415-353-8940; Fax: 1-415-476-8550. (A.P. Prasad), (L. Nardo), (J. Schooler), (G.B. Joseph), , (T.M. Link)
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Knoop J, Dekker J, Klein JP, van der Leeden M, van der Esch M, Reiding D, Voorneman RE, Gerritsen M, Roorda LD, Steultjens MPM, Lems WF. Biomechanical factors and physical examination findings in osteoarthritis of the knee: associations with tissue abnormalities assessed by conventional radiography and high-resolution 3.0 Tesla magnetic resonance imaging. Arthritis Res Ther 2012; 14:R212. [PMID: 23039323 PMCID: PMC3580524 DOI: 10.1186/ar4050] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 10/05/2012] [Indexed: 01/11/2023] Open
Abstract
Introduction We aimed to explore the associations between knee osteoarthritis (OA)-related tissue abnormalities assessed by conventional radiography (CR) and by high-resolution 3.0 Tesla magnetic resonance imaging (MRI), as well as biomechanical factors and findings from physical examination in patients with knee OA. Methods This was an explorative cross-sectional study of 105 patients with knee OA. Index knees were imaged using CR and MRI. Multiple features from CR and MRI (cartilage, osteophytes, bone marrow lesions, effusion and synovitis) were related to biomechanical factors (quadriceps and hamstrings muscle strength, proprioceptive accuracy and varus-valgus laxity) and physical examination findings (bony tenderness, crepitus, bony enlargement and palpable warmth), using multivariable regression analyses. Results Quadriceps weakness was associated with cartilage integrity, effusion, synovitis (all detected by MRI) and CR-detected joint space narrowing. Knee joint laxity was associated with MRI-detected cartilage integrity, CR-detected joint space narrowing and osteophyte formation. Multiple tissue abnormalities including cartilage integrity, osteophytes and effusion, but only those detected by MRI, were found to be associated with physical examination findings such as crepitus. Conclusion We observed clinically relevant findings, including a significant association between quadriceps weakness and both effusion and synovitis, detected by MRI. Inflammation was detected in over one-third of the participants, emphasizing the inflammatory component of OA and a possible important role for anti-inflammatory therapies in knee OA. In general, OA-related tissue abnormalities of the knee, even those detected by MRI, were found to be discordant with biomechanical and physical examination features.
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Stefanik J, Roemer F, Zumwalt A, Zhu Y, Gross K, Lynch J, Frey-Law L, Lewis C, Guermazi A, Powers C, Felson D. Association between measures of trochlear morphology and structural features of patellofemoral joint osteoarthritis on MRI: the MOST study. J Orthop Res 2012; 30:1-8. [PMID: 21710542 PMCID: PMC3217080 DOI: 10.1002/jor.21486] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 05/27/2011] [Indexed: 02/04/2023]
Abstract
The sulcus angle has been widely used in the literature as a measure of trochlear morphology. Recently, lateral trochlear inclination and trochlear angle have been reported as alternatives. The purpose of this study was to determine the association between measures of trochlear morphology and patellofemoral joint (PFJ) cartilage damage and bone marrow lesions (BMLs). Nine hundred seven knees were selected from the Multicenter Osteoarthritis Study, a cohort study of persons aged 50-79 years with or at risk for knee OA. Trochlear morphology was measured using lateral trochlear inclination, trochlear angle, and sulcus angle on axial MRI images; cartilage damage and BMLs were graded on MRI. We determined the association between quartiles of each trochlear morphology variable with the presence or absence of cartilage damage and BMLs in the PFJ using logistic regression. The strongest associations were seen with lateral trochlear inclination and lateral PFJ cartilage damage and BMLs, with knees in the lowest quartile (flattened lateral trochlea) having more than two times the odds of lateral cartilage damage and BMLs compared to those in the highest quartile (p < 0.0001). Lateral trochlear inclination may be the best method for assessment of trochlear morphology as it was strongly association with structural damage in the PFJ.
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Affiliation(s)
- J.J. Stefanik
- Boston University School of Medicine, Boston, Massachusetts
| | - F.W. Roemer
- Boston University School of Medicine, Boston, Massachusetts,Department of Radiology, Klinikum Augsburg, Augsburg, Germany
| | - A.C. Zumwalt
- Boston University School of Medicine, Boston, Massachusetts
| | - Y. Zhu
- Boston University School of Medicine, Boston, Massachusetts
| | - K.D. Gross
- Boston University School of Medicine, Boston, Massachusetts,Massachusetts General Hospital Institute for Health Professions, Boston, Massachusetts
| | - J.A. Lynch
- University of California, San Francisco, CA
| | | | | | - A. Guermazi
- Boston University School of Medicine, Boston, Massachusetts
| | - C.M. Powers
- University of Southern California, Los Angeles, CA
| | - D.T. Felson
- Boston University School of Medicine, Boston, Massachusetts
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Holla JFM, van der Leeden M, Roorda LD, Bierma-Zeinstra SMA, Damen J, Dekker J, Steultjens MPM. Diagnostic accuracy of range of motion measurements in early symptomatic hip and/or knee osteoarthritis. Arthritis Care Res (Hoboken) 2011; 64:59-65. [DOI: 10.1002/acr.20645] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Determinants of range of joint motion in patients with early symptomatic osteoarthritis of the hip and/or knee: an exploratory study in the CHECK cohort. Osteoarthritis Cartilage 2011; 19:411-9. [PMID: 21272657 DOI: 10.1016/j.joca.2011.01.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 01/12/2011] [Accepted: 01/18/2011] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Reduced range of motion (ROM) is supposed to be a characteristic feature of osteoarthritis (OA). Because little is known about determinants of ROM, the objective of the present study was to explore the association between demographic, articular, and clinical factors and ROM in patients with early symptomatic knee and/or hip OA. DESIGN Baseline data of 598 participants of the Cohort Hip and Cohort Knee (CHECK) study were used in this cross-sectional study. METHODS Separate analyses were performed for participants with knee and participants with hip symptoms. Active knee flexion, and hip internal rotation, external rotation, flexion, adduction, and abduction were assessed using a goniometer. Participants underwent a standardised physical and radiographic examination, and completed a questionnaire. Exploratory regression analyses were performed to explore the association between ROM and demographic [i.e., age, gender, body mass index (BMI)], articular [i.e., osteophytosis, joint space narrowing (JSN)], and clinical (i.e., pain, stiffness) factors. RESULTS In patients with early symptomatic knee OA, osteophytosis, bony enlargement, crepitus, pain, and higher BMI were associated with lower knee flexion. JSN was associated with lower ROM in all planes of motion. In addition, osteophytosis, flattening of the femoral head, femoral buttressing, pain, morning stiffness, male gender, and higher BMI were found to be associated with lower hip ROM in two planes of motion. CONCLUSION Features of articular degeneration are associated with lower knee ROM and lower hip ROM in patients with early OA. Pain, stiffness, higher BMI, and male gender are associated with lower ROM as well.
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Laidlaw MS, Rolston LR, Bozic KJ, Ries MD. Assessment of tibiofemoral position in total knee arthroplasty using the active flexion lateral radiograph. Knee 2010; 17:38-42. [PMID: 19733084 DOI: 10.1016/j.knee.2009.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 07/19/2009] [Accepted: 07/20/2009] [Indexed: 02/02/2023]
Abstract
This study is a retrospective comparative cohort radiographic analysis of 114 consecutive patients who underwent posterior cruciate retaining (PCR) total knee arthroplasty (TKA), medial and patellofemoral compartment bicruciate retaining arthroplasty (BCR), or bicruciate substituting (BCS) TKA. In an effort to obtain a quantitative measurement of both anteroposterior (AP) tibiofemoral position and active knee flexion we have routinely taken post-operative lateral radiographs in a position of maximal active flexion. Passive range of motion (PRoM) after TKA was significantly greater than pre-operative passive range of motion for each cohort (p<0.001). When comparing post-operative active range of motion (ARoM) to PRoM, there was a statistically significant difference within the PCR and BCR cohorts (p<0.001 and p<0.005, respectively), while none was detected in the BCS group (p=0.09). The mean rollback of PCR was -1.2 mm, BCR was -3.3 mm and BCS was -12.0 mm. The mean rollback of all three groups was similar to measurements reported from previous fluoroscopic historical control data. Our findings indicate that tibiofemoral AP translation during knee flexion can be assessed on an active flexion lateral knee radiograph and provide additional information that is not available from a routine lateral radiograph.
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Affiliation(s)
- Michael S Laidlaw
- Department of Orthopaedic Surgery, University of California in San Francisco, San Francisco, CA 94103, United States.
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Menz HB, Munteanu SE, Landorf KB, Zammit GV, Cicuttini FM. Radiographic evaluation of foot osteoarthritis: sensitivity of radiographic variables and relationship to symptoms. Osteoarthritis Cartilage 2009; 17:298-303. [PMID: 18789728 DOI: 10.1016/j.joca.2008.07.011] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2008] [Accepted: 07/21/2008] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate a radiographic atlas for grading foot osteoarthritis (OA) in relation to the relative sensitivity of different radiographic and views and features, and to examine the relationship between radiographic OA and foot symptoms. METHODS Weightbearing dorso-plantar (DP) and lateral foot radiographs were obtained from 197 people (126 women and 71 men) aged 62-94 years (mean age 75.9, standard deviation [SD] 6.6). The prevalence of OA in five joints (the first metatarsophalangeal joint [1st MPJ], the first cuneo-metatarsal joint [1st CMJ], the second cuneo-metatarsal joint [2nd CMJ], the navicular-first cuneiform joint [N1st CJ] and the talo-navicular joint [TNJ]) was then determined using both views in combination (as recommended in the atlas), or by using either view in isolation. Associations between radiographic OA in individual foot joints and symptoms were then explored. RESULTS Joint-specific prevalence of OA using both DP and lateral views was 1st MPJ (42.4%), 1st CMJ (22.6%), 2nd CMJ (60.2%), N1st CJ (39.1%) and TNJ (32.7%). Using only the DP view detected almost all cases of 1st MPJ OA (94.6%), however, the sensitivity was lower for the other joints (31.0-60.7%). Using only the lateral view detected almost all cases of OA (83.8 to 86.9%), with the exception of the 1st MPJ and 1st CMJ (50.9% and 60.7%, respectively). Using either osteophytes (OP) alone or joint space narrowing (JSN) alone showed low sensitivity for all joints (14.3-63.0%), with the exception of OP alone in the DP view for the 1st MPJ and JSN in the lateral view for the 2nd CMJ (83.8% and 84.0%, respectively). Radiographic OA in individual foot joints and the total number of joints affected were both moderately associated with foot symptoms. CONCLUSION Epidemiological and clinical studies should incorporate observation of both OP and JSN from both DP and lateral views to determine the presence of OA in the foot, as the number of cases detected is reduced if only one radiographic feature or view is used. Radiographic foot OA is common in older people and is moderately associated with foot symptoms.
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Affiliation(s)
- H B Menz
- Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria 3086, Australia.
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Wesseling J, Dekker J, van den Berg WB, Bierma-Zeinstra SMA, Boers M, Cats HA, Deckers P, Gorter KJ, Heuts PHTG, Hilberdink WKHA, Kloppenburg M, Nelissen RGHH, Oosterveld FGJ, Oostveen JCM, Roorda LD, Viergever MA, ten Wolde S, Lafeber FPJG, Bijlsma JWJ. CHECK (Cohort Hip and Cohort Knee): similarities and differences with the Osteoarthritis Initiative. Ann Rheum Dis 2008; 68:1413-9. [PMID: 18772189 DOI: 10.1136/ard.2008.096164] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To describe the osteoarthritis study population of CHECK (Cohort Hip and Cohort Knee) in comparison with relevant selections of the study population of the Osteoarthritis Initiative (OAI) based on clinical status and radiographic parameters. METHODS In The Netherlands a prospective 10-year follow-up study was initiated by the Dutch Arthritis Association on participants with early osteoarthritis-related complaints of hip and/or knee: CHECK. In parallel in the USA an observational 4-year follow-up study, the OAI, was started by the National Institutes of Health, on patients with or at risk of symptomatic knee osteoarthritis. For comparison with CHECK, the entire cohort and a subgroup of individuals excluding those with exclusively hip pain were compared with relevant subpopulations of the OAI. RESULTS At baseline, CHECK included 1002 participants with in general similar characteristics as described for the OAI. However, significantly fewer individuals in CHECK had radiographic knee osteoarthritis at baseline when compared with the OAI (p<0.001). In contrast, at baseline, the CHECK cohort reported higher scores on pain, stiffness and functional disability (Western Ontario and McMaster osteoarthritis index) when compared with the OAI (all p<0.001). These differences were supported by physical health status in contrast to mental health (Short Form 36/12) was at baseline significantly worse for the CHECK participants (p<0.001). CONCLUSION Although both cohorts focus on the early phase of osteoarthritis, they differ significantly with respect to structural (radiographic) and clinical (health status) characteristics, CHECK expectedly representing participants in an even earlier phase of disease.
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Affiliation(s)
- J Wesseling
- University Medical Center Utrecht, Department of Rheumatology and Clinical Immunology (F02.127), PO Box 85500, 3508 GA Utrecht, The Netherlands.
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Biochemical markers of bone turnover and their association with bone marrow lesions. Arthritis Res Ther 2008; 10:R102. [PMID: 18759975 PMCID: PMC2575616 DOI: 10.1186/ar2494] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Revised: 08/15/2008] [Accepted: 08/29/2008] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Our objective was to determine whether markers of bone resorption and formation could serve as markers for the presence of bone marrow lesions (BMLs). METHODS We conducted an analysis of data from the Boston Osteoarthritis of the Knee Study (BOKS). Knee magnetic resonance images were scored for BMLs using a semiquantitative grading scheme. In addition, a subset of persons with BMLs underwent quantitative volume measurement of their BML, using a proprietary software method. Within the BOKS population, 80 people with BMLs and 80 without BMLs were selected for the purposes of this case-control study. Bone biomarkers assayed included type I collagen N-telopeptide (NTx) corrected for urinary creatinine, bone-specific alkaline phosphatase, and osteocalcin. The same methods were used and applied to a nested case-control sample from the Framingham study, in which BMD assessments allowed evaluation of this as a covariate. Logistic regression models were fit using BML as the outcome and biomarkers, age, sex, and body mass index as predictors. An receiver operating characteristic curve was generated for each model and the area under the curve assessed. RESULTS A total of 151 subjects from BOKS with knee OA were assessed. The mean (standard deviation) age was 67 (9) years and 60% were male. Sixty-nine per cent had maximum BML score above 0, and 48% had maximum BML score above 1. The only model that reached statistical significance used maximum score of BML above 0 as the outcome. Ln-NTx (Ln is the natural log) exhibited a significant association with BMLs, with the odds of a BML being present increasing by 1.4-fold (95% confidence interval = 1.0-fold to 2.0-fold) per 1 standard deviation increase in the LnNTx, and with a small partial R2 of 3.05. We also evaluated 144 participants in the Framingham Osteoarthritis Study, whose mean age was 68 years and body mass index was 29 kg/m2, and of whom 40% were male. Of these participants 55% had a maximum BML score above 0. The relationship between NTx and maximum score of BML above 0 revealed a significant association, with an odds ratio fo 1.7 (95% confidence interval = 1.1 to 2.7) after adjusting for age, sex, and body mass index. CONCLUSIONS Serum NTx was weakly associated with the presence of BMLs in both study samples. This relationship was not strong and we would not advocate the use of NTx as a marker of the presence of BMLs.
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Wang C, Schmid CH, Hibberd PL, Kalish R, Roubenoff R, Rones R, Okparavero A, McAlindon T. Tai Chi for treating knee osteoarthritis: designing a long-term follow up randomized controlled trial. BMC Musculoskelet Disord 2008; 9:108. [PMID: 18664276 PMCID: PMC2529300 DOI: 10.1186/1471-2474-9-108] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Accepted: 07/29/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knee Osteoarthritis (KOA) is a major cause of pain and functional impairment among elders. Currently, there are neither feasible preventive intervention strategies nor effective medical remedies for the management of KOA. Tai Chi, an ancient Chinese mind-body exercise that is reported to enhance muscle function, balance and flexibility, and to reduce pain, depression and anxiety, may safely and effectively be used to treat KOA. However, current evidence is inconclusive. Our study examines the effects of a 12-week Tai Chi program compared with an attention control (wellness education and stretching) on pain, functional capacity, psychosocial variables, joint proprioception and health status in elderly people with KOA. The study will be completed by July 2009. METHODS/DESIGN Forty eligible patients, age > 55 yr, BMI < or = 40 kg/m2 with tibiofemoral osteoarthritis (American College of Rheumatology criteria) are identified and randomly allocated to either Tai Chi (10 modified forms from classical Yang style Tai Chi) or attention control (wellness education and stretching). The 60-minute intervention sessions take place twice weekly for 12 weeks. The study is conducted at an urban tertiary medical center in Boston, Massachusetts. The primary outcome measure is the Western Ontario and McMaster Universities (WOMAC) pain subscale at 12 weeks. Secondary outcomes include weekly WOMAC pain, function and stiffness scores, patient and physician global assessments, lower-extremity function, knee proprioception, depression, self-efficacy, social support, health-related quality of life, adherence and occurrence of adverse events after 12, 24 and 48 weeks. DISCUSSION In this article, we present the challenges of designing a randomized controlled trial with long-term follow up. The challenges encountered in this design are: strategies for recruitment, avoidance of selection bias, the actual practice of Tai Chi, and the maximization of adherence/follow-up while conducting the clinical trial for the evaluation of the effectiveness of Tai Chi on KOA. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00362453.
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Affiliation(s)
- Chenchen Wang
- Division of Rheumatology, Tufts Medical Center, Tufts University School of Medicine, Boston, MA, USA.
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Hunter DJ, Li J, LaValley M, Bauer DC, Nevitt M, DeGroot J, Poole R, Eyre D, Guermazi A, Gale D, Felson DT. Cartilage markers and their association with cartilage loss on magnetic resonance imaging in knee osteoarthritis: the Boston Osteoarthritis Knee Study. Arthritis Res Ther 2008; 9:R108. [PMID: 17958892 PMCID: PMC2212578 DOI: 10.1186/ar2314] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2007] [Revised: 09/12/2007] [Accepted: 10/24/2007] [Indexed: 11/24/2022] Open
Abstract
We used data from a longitudinal observation study to determine whether markers of cartilage turnover could serve as predictors of cartilage loss on magnetic resonance imaging (MRI). We conducted a study of data from the Boston Osteoarthritis of the Knee Study (BOKS), a completed natural history study of knee osteoarthritis (OA). All subjects in the study met American College of Rheumatology criteria for knee OA. Baseline and follow-up knee magnetic resonance images were scored for cartilage loss by means of the WORMS (Whole Organ Magnetic Resonance Imaging Score) semiquantitative grading scheme. Within the BOKS population, 80 subjects who experienced cartilage loss and 80 subjects who did not were selected for the purposes of this nested case control study. We assessed the baseline levels of cartilage degradation and synthesis products by means of assays for type I and II cleavage by collagenases (Col2:3/4Cshort or C1,2C), type II cleavage only with Col2:3/4Clongmono (C2C), type II synthesis (C-propeptide), the C-telopeptide of type II (Col2CTx), aggrecan 846 epitope, and cartilage oligomeric matrix protein (COMP). We performed a logistic regression to examine the relation of levels of each biomarker to the risk of cartilage loss in any knee. All analyses were adjusted for gender, age, and body mass index (BMI); results stratified by gender gave similar results. One hundred thirty-seven patients with symptomatic knee OA were assessed. At baseline, the mean (standard deviation) age was 67 (9) years and 54% were male. Seventy-six percent of the subjects had radiographic tibiofemoral OA (Kellgren & Lawrence grade of greater than or equal to 2) and the remainder had patellofemoral OA. With the exception of COMP, none of the other biomarkers was a statistically significant predictor of cartilage loss. For a 1-unit increase in COMP, the odds of cartilage loss increased 6.09 times (95% confidence interval [CI] 1.34 to 27.67). After the analysis of COMP was adjusted for age, gender, and BMI, the risk for cartilage loss was 6.35 (95% CI 1.36 to 29.65). Among subjects with symptomatic knee OA, a single measurement of increased COMP predicted subsequent cartilage loss on MRI. The other biochemical markers of cartilage synthesis and degradation do not facilitate prediction of cartilage loss. With the exception of COMP, if changes in cartilage turnover in patients with symptomatic knee OA are associated with cartilage loss, they do not appear to affect systemic biomarker levels.
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Affiliation(s)
- David J Hunter
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA, USA.
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Hunter DJ, Lavalley M, Li J, Zhang Y, Bauer D, Nevitt M, Guermazi A, Degroot J, Sakkee N, Gale D, Felson DT. Urinary pentosidine does not predict cartilage loss among subjects with symptomatic knee OA: the BOKS Study. Osteoarthritis Cartilage 2007; 15:93-7. [PMID: 16857393 DOI: 10.1016/j.joca.2006.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2006] [Accepted: 06/17/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Age-related changes in articular cartilage are likely to play a role in the etiology of osteoarthritis (OA). One of the major changes in the extracellular matrix of cartilage is the age-related accumulation of advanced glycation end products (AGEs). Pentosidine, an AGE crosslink, is one of the few characterized AGEs and is considered an adequate marker for the many AGEs that are formed in vivo. We used data from a longitudinal observation study to determine if urinary pentosidine could serve as a marker to predict cartilage loss. METHODS We conducted a prospective analysis of data from the Boston Osteoarthritis of the Knee Study (BOKS); a completed natural history study of knee OA. All subjects in the study met American College of Rheumatology (ACR) criteria for knee OA. Knee magnetic resonance (MR) images were scored for cartilage in 14 plates of the knee using the Whole Organ Magnetic Resonance Imaging Score (WORMS) semiquantitative grading scheme. Within the BOKS population, a nested sample of 127 subjects (39% of the whole sample) who had both baseline pentosidine and longitudinal magnetic resonance imaging (MRI) measurements (MRIs performed at baseline and 30 months later) was assessed. Urinary pentosidine was assayed and normalized to creatinine to account for differences in urine concentrations. We analyzed the data using three different methods to assess if baseline measures of pentosidine predicted subsequent cartilage loss on MRI. These were (1) analysis 1: logistic regression with the outcome cartilage loss in any plate; (2) analysis 2: proportional odds model where the outcome was defined as 0=no cartilage loss, 1=cartilage loss in one plate, 2=cartilage loss in two plates, and 3=cartilage loss in at least three plates; and (3) analysis 3: Poisson regression with the outcome the number of plates with cartilage loss. All analyses were adjusted for age, sex and Body Mass Index (BMI). RESULTS At baseline the mean (standard deviation) age was 67 (9) years and 54% were male. The results for the three analytic steps are as follows: Analysis 1: the odds ratio for cartilage loss is 1.01 (95% confidence interval (CI) 0.93-1.09) with 1 unit increase in pentosidine. Analysis 2: the odds ratio for more cartilage loss is 0.99 (95% CI 0.92-1.06) with 1 unit increase in pentosidine. Analysis 3: the relative number of plates with cartilage loss decreased was 1.00 (95% CI 0.95-1.03) with a 1 unit increase in pentosidine. CONCLUSION Urinary pentosidine does not predict knee cartilage loss. Previous studies have suggested that local content within cartilage of AGEs is elevated in persons at high risk for progression. Our data suggest that these changes are not measurable systemically. Alternatively, urinary pentosidine levels reflect cartilage degradation in all joints (thus whole body cartilage breakdown) and may therefore not relate to OA severity in a single knee joint.
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Affiliation(s)
- D J Hunter
- Boston University Clinical Epidemiology Research and Training Unit, Boston, MA 02118, USA.
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Szebenyi B, Hollander AP, Dieppe P, Quilty B, Duddy J, Clarke S, Kirwan JR. Associations between pain, function, and radiographic features in osteoarthritis of the knee. ACTA ACUST UNITED AC 2006; 54:230-5. [PMID: 16385522 DOI: 10.1002/art.21534] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To assess the associations between pain, loss of function, and radiographic changes in knee osteoarthritis (OA), taking into account both the patellofemoral and tibiofemoral compartments. METHODS Both knees of 167 community-based patients with OA in at least 1 of their knees were assessed. Pain was measured by visual analog scale, and function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index. Anteroposterior standing radiographs with the knee in extension and lateral 30 degrees flexion were obtained and assessed for the Kellgren/Lawrence score and for individual features (osteophytes, joint space narrowing, and subchondral bone sclerosis) in each compartment. RESULTS Knees with structural changes in both compartments were more likely to be painful and to be associated with loss of function than were knees in which only 1 compartment was affected. The individual feature most strongly associated with pain was subchondral bone sclerosis. CONCLUSION Studies exploring the associations between structural and symptomatic knee OA need to include an assessment of the patellofemoral compartment, and individual radiographic features rather than a global severity score should be considered in these studies.
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Affiliation(s)
- Béla Szebenyi
- Academc Rheumatology, Department of Clinical Science at North Bristol, University of Bristol, Avon Orthopaedic Centre, Southmead Hospital, Bristol BS10 5NB, UK.
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Duncan RC, Hay EM, Saklatvala J, Croft PR. Prevalence of radiographic osteoarthritis--it all depends on your point of view. Rheumatology (Oxford) 2006; 45:757-60. [PMID: 16418199 DOI: 10.1093/rheumatology/kei270] [Citation(s) in RCA: 191] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Knee pain and disability in older people may occur in the apparent absence of radiographic osteoarthritis. However, the view chosen to define radiographic osteoarthritis may be critical. We have investigated the prevalence and compartmental distribution of radiographic osteoarthritis in people with knee pain using different combinations of three separate radiographic views. METHODS We performed a population-based study of 819 adults aged 50 yr and over with knee pain (part of the Clinical Assessment Study - Knee [CAS(K)]). Three radiographic views were obtained: weight-bearing posteroanterior (PA) semiflexed/metatarsophalangeal view; supine skyline; and supine lateral. RESULTS Complete data for all three views were available on 777 subjects. The distribution of compartmental radiographic osteoarthritis was 314 (40%) combined tibiofemoral/patellofemoral, 186 (24%) isolated patellofemoral, 31 (4%) isolated tibiofemoral and 246 (32%) normal. Hence, the overall prevalence of radiographic osteoarthritis was 531/777 (68.3%) in this symptomatic population. Using a PA view alone (reflecting tibiofemoral osteoarthritis only) would identify 56.7% of the 531, whilst the addition of a skyline or lateral view increased this to 87.0%. When using both skyline and lateral views in addition to the PA view, 98.7% cases of radiographic osteoarthritis were identified. In addition to prevalence, compartmental distribution altered markedly when different combinations of views were used. CONCLUSIONS Multiple views detect more radiographic osteoarthritis than single views alone. When different combinations of views are used, the prevalence and compartmental distribution of osteoarthritis changes and this may alter the accepted relationship, or lack of it, between symptoms and radiographic change.
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Affiliation(s)
- R C Duncan
- Primary Care Sciences Research Centre, Keele University, Keele, Staffordshire, UK.
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LaValley MP, McLaughlin S, Goggins J, Gale D, Nevitt MC, Felson DT. The lateral view radiograph for assessment of the tibiofemoral joint space in knee osteoarthritis: Its reliability, sensitivity to change, and longitudinal validity. ACTA ACUST UNITED AC 2005; 52:3542-7. [PMID: 16255043 DOI: 10.1002/art.21374] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the reliability, validity, and sensitivity to change of tibiofemoral (TF) narrowing on lateral radiographic views. METHODS In a natural history study of symptomatic knee osteoarthritis (OA), both lateral view and fluoroscopically positioned posteroanterior (PA) semiflexed view radiographs of the knee in 30 degrees of flexion and with weight bearing were obtained at baseline and at 30 months. Test-retest reliability was evaluated using repeat radiographs, with joint space width measured using electronic calipers. All radiographs were scored on a 0-3 scale, and progression of joint space loss was defined as narrowing of the joint space by 1 grade. We evaluated sensitivity to change compared with the PA view. We evaluated validity by examining whether knees with progression showed expected malalignment on full-limb films. RESULTS Test-retest reliability of the TF joint space using the lateral view had a root mean square error of 0.303 mm, with 92.5% of repeats within 1 mm. More knees showed progression on the lateral view alone (n = 41) than on the PA view alone (n = 27). Compared with knees without joint space loss, knees with medial compartment loss on the lateral view only were more varus malaligned (P < 0.001), while those with lateral compartment loss were more valgus malaligned (P = 0.008). CONCLUSION In the assessment of TF joint space loss, lateral view radiographs are reliable, valid, and more sensitive to change than fluoroscopically positioned PA radiographs.
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Affiliation(s)
- Michael P LaValley
- Boston University School of Medicine, A203, 715 Albany Street, Boston, MA 02118, USA
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Yang K, Saris D, Dhert W, Verbout A. Osteoarthritis of the knee: current treatment options and future directions. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.cuor.2004.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Baker KR, Xu L, Zhang Y, Nevitt M, Niu J, Aliabadi P, Yu W, Felson D. Quadriceps weakness and its relationship to tibiofemoral and patellofemoral knee osteoarthritis in Chinese: The Beijing osteoarthritis study. ACTA ACUST UNITED AC 2004; 50:1815-21. [PMID: 15188358 DOI: 10.1002/art.20261] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Weakness has been documented as a feature of tibiofemoral knee osteoarthritis (OA) and may cause disease in this compartment by shock absorption during impulse loading at heel strike, when the patellofemoral joint is not engaged. Our objective was to determine the association of muscle weakness with compartment-specific knee OA, to evaluate sex-specific differences in this relationship, and to determine, by evaluating asymptomatic individuals with OA, whether symptoms may produce the weakness seen in OA. METHODS This cross-sectional study involved 2,472 subjects (1,475 women and 997 men) ages 60 years or older from 4 central districts of Beijing, China. For all subjects, a skyline view of each knee and an anteroposterior (AP) or posteroanterior (PA) radiograph of both knees were obtained during weight bearing. Radiographs were read by one reader for Kellgren/Lawrence (K/L) grade, joint space narrowing (JSN), and osteophytes. We defined a subject as having tibiofemoral OA when the K/L grade was > or =2 on AP/PA view, patellofemoral OA on skyline view when the osteophyte score was > or =2 (or when the JSN score was > or =2 and the osteophyte score was > or =1), and mixed OA when the knee had both patellofemoral and tibiofemoral radiographic OA. Strength was measured isometrically for each leg separately, and knee pain was evaluated by questionnaire. RESULTS In women, quadriceps weakness was associated with tibiofemoral OA (odds ratio [OR] 0.7, 95% confidence interval [95% CI] 0.4-1.0), patellofemoral OA (OR 0.6, 95% CI 0.4-0.9), and mixed OA (OR 0.4, 95% CI 0.3-0.6). In men, weakness was associated with mixed OA (OR 0.5, 95% CI 0.3-0.8), and the ORs suggesting an association of patellofemoral OA with weakness were the same as those in women, although in men this trend did not reach statistical significance (P = 0.12). In men, isolated tibiofemoral disease was not associated with weakness; however, the sample size in this analysis was limited. When subjects with knee symptoms were excluded, the relationship of quadriceps weakness to OA was attenuated, with only the relationship between muscle weakness and mixed OA remaining significant. CONCLUSION There is a relationship between quadriceps weakness and knee OA in all compartments, with the strongest association in mixed disease. Pain may contribute to some of this weakness.
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Affiliation(s)
- Kristin R Baker
- Clinical Epidemiology and Research Training Center, Boston University School of Medicine, Massachusetts 02118, USA.
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Abstract
OBJECTIVE Whilst the characteristic pathologic feature of OA is the loss of hyaline cartilage, prior studies have demonstrated a poor relationship between severity of reported knee pain and degree of radiographic change. The aim of this study was to examine the association between knee symptoms and MRI cartilage volume. DESIGN A cross-sectional study was performed to assess the association between knee symptoms and MRI cartilage volume in an unselected, community based population. The subjects were 133 postmenopausal females. The subjects had a T2-weighted fat saturated sagittal gradient-echo MRI performed of their right knee. Femoral, tibial and patella cartilage volumes were measured using three-dimensional (3D) Slicer, a software that facilitates semi-automatic segmentation, generation of 3D surface models and quantitative analysis. Qualitative data relating to symptoms, stiffness, pain, physical dysfunction and the quality of life using the WOMAC were recorded. The statistical analyses conducted to determine measures of association between knee pain/symptoms and cartilage volume were correlation, multiple regression and inter-quartile regression. RESULTS Assessment of the association between patella cartilage volume and the WOMAC domains showed an inverse relationship between patella cartilage volume and pain, function and global score in a model including body mass index, physical activity and leg extensor power (all P=0.01). Inter-quartile regression comparing the lowest 25% with highest 25% patella cartilage volume demonstrated a stronger inverse relationship (P=0.005). CONCLUSION This study suggests that alterations in patella volume are associated with pain, function and global scores of the WOMAC. In participants with more knee pain, there was an association with severity of patella cartilage reduction. Other MRI cartilage volume features were not strongly associated with WOMAC sub-scores.
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Affiliation(s)
- D J Hunter
- Institute of Bone and Joint Research, Royal North Shore Hospital, Sydney, Australia.
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Kerrigan DC, Lelas JL, Goggins J, Merriman GJ, Kaplan RJ, Felson DT. Effectiveness of a lateral-wedge insole on knee varus torque in patients with knee osteoarthritis. Arch Phys Med Rehabil 2002; 83:889-93. [PMID: 12098144 DOI: 10.1053/apmr.2002.33225] [Citation(s) in RCA: 222] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To test whether a lateral-wedged insole, inclined at 5 degrees or 10 degrees, significantly reduces knee varus torque during walking in patients with knee osteoarthritis compared with both using no insole and with wearing nonwedged control insoles of the same material and average thickness. DESIGN Patients with medial knee osteoarthritis were studied while they walked wearing their comfortable shoes (1) without an insole; (2) with a 5 degrees lateral wedge compared with a nonwedged, 3.175-mm (1/8-in) even-thickness control insole; and (3) with a 10 degrees lateral wedge compared with a nonwedged 6.35-mm ((1/4)-in) even-thickness control insole. SETTING A gait laboratory with 3-dimensional motion analysis and force platform equipment. PARTICIPANTS Fifteen patients with clinical and radiographic osteoarthritis of the medial compartment of 1 knee. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Peak external knee varus torques during the stance period of gait. Data regarding lower-extremity joint torques and motions were collected, and knee joint torques using the different insoles and wedges were compared by analysis of variance. RESULTS Although responses varied among individuals, as a group, both the 5 degrees and 10 degrees lateral-wedge insoles significantly reduced the knee varus torque during walking compared with walking with no insole and walking with nonwedged 3.175-mm and 6.35-mm control insoles. Compared with no insole, the 5 degrees wedge reduced the peak knee varus torque values by about 6% and the 10 degrees wedge reduced the peaks by about 8%. Although there were no significant differences in speed of walking between the conditions, the 10 degrees wedge and 6.35-mm control insoles were associated with varying degrees of discomfort. CONCLUSION Both wedge insoles are effective in reducing the varus torque during walking beyond what theoretically could be explained by a reduced walking speed or cushioning effect from the insole. These data imply that wedged insoles are biomechanically effective and should reduce loading of the medial compartment in persons with medial knee osteoarthritis. Although the effect of the 5 degrees wedge was smaller, it may be more comfortable than the 10 degrees wedge to wear inside one's own shoes.
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Affiliation(s)
- D Casey Kerrigan
- University of Virginia, Department of Physical Medicine and Rehabilitation, Charlottesville 22903-2981, USA.
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