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Jahn J, Ehlen QT, Huang CY. Finding the Goldilocks Zone of Mechanical Loading: A Comprehensive Review of Mechanical Loading in the Prevention and Treatment of Knee Osteoarthritis. Bioengineering (Basel) 2024; 11:110. [PMID: 38391596 PMCID: PMC10886318 DOI: 10.3390/bioengineering11020110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
In this review, we discuss the interaction of mechanical factors influencing knee osteoarthritis (KOA) and post-traumatic osteoarthritis (PTOA) pathogenesis. Emphasizing the importance of mechanotransduction within inflammatory responses, we discuss its capacity for being utilized and harnessed within the context of prevention and rehabilitation of osteoarthritis (OA). Additionally, we introduce a discussion on the Goldilocks zone, which describes the necessity of maintaining a balance of adequate, but not excessive mechanical loading to maintain proper knee joint health. Expanding beyond these, we synthesize findings from current literature that explore the biomechanical loading of various rehabilitation exercises, in hopes of aiding future recommendations for physicians managing KOA and PTOA and athletic training staff strategically planning athlete loads to mitigate the risk of joint injury. The integration of these concepts provides a multifactorial analysis of the contributing factors of KOA and PTOA, in order to spur further research and illuminate the potential of utilizing the body's own physiological responses to mechanical stimuli in the management of OA.
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Affiliation(s)
- Jacob Jahn
- University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Quinn T Ehlen
- University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Chun-Yuh Huang
- Department of Biomedical Engineering, College of Engineering, University of Miami, Coral Gables, FL 33146, USA
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Lanois CJ, Collins N, Neogi T, Guermazi A, Roemer FW, LaValley M, Nevitt M, Torner J, Lewis CE, Stefanik JJ. Associations between anterior knee pain and 2-year patellofemoral cartilage worsening: The MOST study. Osteoarthritis Cartilage 2024; 32:93-97. [PMID: 37783341 PMCID: PMC10842622 DOI: 10.1016/j.joca.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/24/2023] [Accepted: 09/17/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVE Anterior knee pain (AKP) is associated with patellofemoral osteoarthritis (PFOA), but longitudinal studies are lacking. If AKP precedes PFOA, it may create an opportunity to identify and intervene earlier in the disease process. The purpose of this study was to examine the longitudinal relation of AKP to worsening patellofemoral (PF) cartilage over two years. DESIGN Participants were recruited from the Multicenter Osteoarthritis Study, a longitudinal study of individuals with or at risk for knee osteoarthritis (OA). Exclusion criteria included bilateral knee replacements, arthritis other than OA, and radiographic PFOA. At baseline, participants completed a knee pain map questionnaire and underwent knee magnetic resonance imaging (MRI). Imaging was repeated at 2-year follow-up. Exposure was presence of frequent AKP. Outcome was worsening cartilage damage in the PF joint defined as increase in MRI Osteoarthritis Knee Score from baseline to 2 years. Log-binomial models were used to calculate risk ratios (RR). RESULTS One knee from 1083 participants (age 56.7 ± 6.6 years; body mass index 28.0 ± 4.9 kg/m2) was included. Frequent AKP and frequent isolated AKP were present at baseline in 14.5% and 3.6%, respectively. Frequent AKP was associated with an increased risk (RR: 1.78, 95% confidence interval: 1.21, 2.62) of 2-year worsening cartilage damage in the lateral PF compartment. No association was found between frequent AKP and worsening in the medial PF joint. CONCLUSION Frequent AKP at baseline was associated with worsening cartilage damage in the lateral PF joint over 2 years.
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Affiliation(s)
- C J Lanois
- Northeastern University, Boston, MA, United States
| | - N Collins
- The University of Queensland, Brisbane, Australia
| | - T Neogi
- Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - A Guermazi
- Boston University, Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - F W Roemer
- Friedrich-Alexander University Erlangen-Nurnber, Erlangen, Germany
| | - M LaValley
- Boston University, School of Public Health, Boston, MA, United States
| | - M Nevitt
- University of California San Francisco, San Francisco, CA, United States
| | - J Torner
- University of Iowa, Iowa City, IA, United States
| | - C E Lewis
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - J J Stefanik
- Northeastern University, Boston, MA, United States.
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Bruce Leicht AS, Thompson XD, Kaur M, Hopper HM, Stolzenfeld RL, Wahl AJ, Sroufe MD, Werner BC, Diduch DR, Gwathmey FW, Brockmeier SF, Miller MD, Hart JM. Hip Strength Recovery After Anterior Cruciate Ligament Reconstruction. Orthop J Sports Med 2023; 11:23259671231169196. [PMID: 37435425 PMCID: PMC10331192 DOI: 10.1177/23259671231169196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/22/2023] [Indexed: 07/13/2023] Open
Abstract
Background Return-to-play (RTP) assessment after anterior cruciate ligament reconstruction (ACLR) rarely includes hip strength. Hypothesis It was hypothesized that (1) patients after ACLR will have weaker hip abduction (AB) and adduction (AD) strength compared with the contralateral limb, with larger deficits in women, (2) there will be a correlation between hip and thigh strength ratios and patient-reported outcomes (PROs), and (3) hip AB and AD strength will improve over time. Study Design Descriptive laboratory study. Methods Included were 140 patients (74 male, 66 female; mean age, 24.16 ± 10.82 years) who underwent RTP assessment at 6.1 ± 1.6 months after ACLR; 86 patients underwent a second assessment at 8.2 ± 2.2 months. Hip AB/AD and knee extension/flexion isometric strength were measured and normalized to body mass, and PRO scores were collected. Strength ratios (hip vs thigh), limb differences (injured vs uninjured), sex-based differences, and relationships between strength ratios and PROs were determined. Results Hip AB strength was weaker on the ACLR limb (ACLR vs contralateral: 1.85 ± 0.49 vs 1.89 ± 0.48 N·m/kg; P < .001) and hip AD torque was stronger (ACLR vs contralateral: 1.80 ± 0.51 vs 1.76 ± 0.52 N·m/kg; P = .004), with no sex-by-limb interaction found. Lower hip-to-thigh strength ratios of the ACLR limb were correlated with higher PRO scores (r = -0.17 to -0.25). Over time, hip AB strength increased in the ACLR limb more than in the contralateral limb (P = .01); however, the ACLR limb remained weaker in hip AB at visit 2 (ACLR vs contralateral: 1.88 ± 0.46 vs 1.91 ± 0.45 N·m/kg; P = .04). In both limbs, hip AD strength was greater at visit 2 than visit 1 (ACLR: 1.82 ± 0.48 vs 1.70 ± 0.48 N·m/kg; contralateral: 1.76 ± 0.47 vs 1.67 ± 0.47 N·m/kg; P < .01 for both). Conclusion The ACLR limb had weaker hip AB and stronger AD compared with the contralateral limb at initial assessment. Hip muscle strength recovery was not influenced by sex. Hip strength and symmetry improved over the course of rehabilitation. Although strength differences across limbs were minor, the clinical importance of these differences is still unknown. Clinical Relevance The evidence provided highlights the need to integrate hip strength into RTP assessments to identify hip strength deficits that may increase reinjury or lead to poor long-term outcomes.
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Affiliation(s)
| | - Xavier D. Thompson
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Mandeep Kaur
- Department of Physical Therapy, Northern Arizona University, Phoenix, Arizona, USA
| | - Haleigh M. Hopper
- Department of Kinesiology, University of Virginia, Charlottesville, Virginia, USA
| | | | - Alexander J. Wahl
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Madison D. Sroufe
- School of Medicine, University of Virginia, Charlottesville, Virginia, USA
| | - Brian C. Werner
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - David R. Diduch
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - F. Winston Gwathmey
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Stephen F. Brockmeier
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Mark D. Miller
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Joe M. Hart
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
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Chang AH, Almagor O, Muhammad LN, Guermazi A, Prasad PV, Chmiel JS, Moisio KC, Lee J(J, Sharma L. Ambulatory support moment contribution patterns and MRI-detected tibiofemoral and patellofemoral disease worsening in adults with knee osteoarthritis: A preliminary study. J Orthop Res 2023; 41:1206-1216. [PMID: 36268875 PMCID: PMC10119326 DOI: 10.1002/jor.25475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 09/15/2022] [Accepted: 10/18/2022] [Indexed: 02/04/2023]
Abstract
We investigated whether baseline sagittal-plane ankle, knee, and hip contribution to the total support moment (TSM) are each associated with baseline-to-2-year tibiofemoral and patellofemoral tissue damage worsening in adults with knee osteoarthritis. Ambulatory lower-limb kinetics were captured and computed. TSM is the sum of ankle, knee, and hip extensor moments at each instant during gait. Ankle, knee, and hip contributions to TSM were computed as joint moments divided by TSM, expressed as percentages. Participants underwent MRI of both knees at baseline and 2 years later. Logistic regression models assessed associations of baseline ankle contribution to TSM with baseline-to-2-year cartilage damage and bone marrow lesion worsening, adjusted for age, sex, BMI, gait speed, disease severity, and pain. We used similar analytic approaches for knee and hip contributions to TSM. Sample included 391 knees from 204 persons (age[SD]: 64[10] years; 76.5% women). Greater ankle contribution may be associated with increased odds of tibiofemoral cartilage damage worsening (OR = 2.38; 95% CI: 1.02-5.57) and decreased odds of patellofemoral bone marrow lesion worsening (OR = 0.14; 95% CI: 0.03-0.73). The ORs for greater knee contribution were in the protective range for tibiofemoral compartment and in the deleterious range for patellofemoral. Greater hip contribution may be associated with increased odds of tibiofemoral worsening (OR = 2.71; 95% CI: 1.17-6.30). Greater ankle contribution to TSM may be associated with baseline-to-2-year tibiofemoral worsening, but patellofemoral tissue preservation. Conversely, greater knee contribution may be associated with patellofemoral worsening, but tibiofemoral preservation. Preliminary findings illustrate potential challenges in developing biomechanical interventions beneficial to both tibiofemoral and patellofemoral compartments.
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Affiliation(s)
- Alison H. Chang
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Orit Almagor
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lutfiyya N. Muhammad
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | | | - Joan S. Chmiel
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kirsten C. Moisio
- Department of Physical Therapy and Human Movement Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jungwha (Julia) Lee
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Leena Sharma
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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De Pieri E, Nüesch C, Pagenstert G, Viehweger E, Egloff C, Mündermann A. High tibial osteotomy effectively redistributes compressive knee loads during walking. J Orthop Res 2023; 41:591-600. [PMID: 35730475 DOI: 10.1002/jor.25403] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 06/09/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023]
Abstract
The objectives of this study were to estimate pre- and postoperative lower limb kinematics and kinetics and knee intra-articular forces during gait using musculoskeletal modeling in a cohort of patients with knee osteoarthritis (OA) undergoing high tibial osteotomy (HTO), compare these to controls, and determine correlations between changes in these parameters and Knee Injury and Osteoarthritis Outcome Score (KOOS) subscores after HTO. Sixteen patients with isolated, symptomatic medial compartment knee OA completed pre- and postoperative gait analysis (mean follow-up time: 8.6 months). Sixteen age- and sex-matched asymptomatic volunteers participated as controls. Musculoskeletal modeling was used to evaluate lower limb joint moments and knee contact forces during gait. While HTO had limited influence on sagittal plane kinematics and moments, significant changes in the load distribution at the knee after HTO were observed with a lower postoperative compressive load on the medial compartment during midstance and a higher compressive load on the lateral compartment during early and late stance. Moreover, the lateral shear force in midstance was significantly lower after HTO. Changes in the external knee adduction moment (KAM) did not always coincide with reductions in the knee compressive force in the medial compartment. Biomechanical changes did not correlate with improvements in KOOS subscores. Hence, HTO effectively unloaded the medial compartment by redistributing part of the overall compressive force to the lateral compartment during gait with limited influence on gait function. The KAM may not adequately describe compartmental load magnitude or changes induced by interventions at the compartment level. Clinical trial registration: ClinicalTrials. gov Identifier-NCT02622204. Clinical significance: This study provides important evidence for changes in joint level loads after corrective osteotomy as joint preserving surgery and emphasizes the need for additional biomechanical outcomes of such interventions.
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Affiliation(s)
- Enrico De Pieri
- Laboratory for Movement Analysis, University of Basel Children's Hospital, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Geert Pagenstert
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Clarahof Orthopaedics, Basel, Switzerland
| | - Elke Viehweger
- Laboratory for Movement Analysis, University of Basel Children's Hospital, Basel, Switzerland
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Neuro-Orthopaedics, University of Basel Children's Hospital, Basel, Switzerland
| | - Christian Egloff
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
- Department of Spine Surgery, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
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Cagnin A, Choinière M, Bureau NJ, Durand M, Mezghani N, Gaudreault N, Hagemeister N. Targeted exercises can improve biomechanical markers in individuals with knee osteoarthritis: A secondary analysis from a cluster randomized controlled trial. Knee 2023; 40:122-134. [PMID: 36423400 DOI: 10.1016/j.knee.2022.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 10/07/2022] [Accepted: 10/26/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND It is not clear whether exercise therapy significantly improves knee biomechanics during gait in osteoarthritis (OA) patients. This study aimed to determine whether targeted exercises based on a knee kinesiography exam improve biomechanical markers (BMs) compared with conventional primary care (CPC) management. METHODS This was a secondary analysis of a cluster randomized controlled trial in which patients were assigned to one of three groups: (1) Control (CPC), (2) Exercise, and (3) Exercise&Education. Fourteen known BMs in knee OA patients were assessed. The primary outcome was the global evolution ratio (GER), which was calculated as the sum of improved BMs over the sum of deteriorated BMs 6 months after baseline assessment. GER scores were categorized with three different sets of cut-off values into clinical levels: (a) Deteriorated, (b) Stabilized, and (c) Improved. Ordinal logistic regressions were performed on the per-protocol population to determine whether there was a relationship between group assignment and GER levels. RESULTS Of the 221 eligible participants, 163 were included. Two different regression models showed that patients from Group 3 (Exercise&Education) were 2.5-times more likely to be in an upper GER level (i.e., Stabilized or Improved) than patients from the control group (both odds ratio (OR) > 2.46, Wald Χ2(1) ≥ 7.268, P ≤ 0.01). They also reported significantly more improvement in pain and function (Knee Injury and Osteoarthritis Outcome Score, both P ≤ 0.01). CONCLUSIONS Results suggest that targeted exercises can improve biomechanical markers in knee OA patients compared with CPC treatment. Further studies are needed to confirm these findings and refine the biomechanical markers to address to maximize patients' clinical outcomes.
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Affiliation(s)
- Alix Cagnin
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Laboratoire de Recherche en Imagerie et Orthopédie de l'École de Technologie Supérieure (ÉTS), Montreal, Quebec, Canada
| | - Manon Choinière
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Université de Montréal, Montreal, Quebec, Canada
| | - Nathalie J Bureau
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Université de Montréal, Montreal, Quebec, Canada
| | - Madeleine Durand
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Université de Montréal, Montreal, Quebec, Canada
| | - Neila Mezghani
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Université TÉLUQ, #1105, Montreal, Quebec, Canada
| | - Nathaly Gaudreault
- Faculté de Médecine et des Sciences de la Santé, School of Rehabilitation, Sherbrooke Research and Development Centre, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Nicola Hagemeister
- Research Centre of the Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada; Laboratoire de Recherche en Imagerie et Orthopédie de l'École de Technologie Supérieure (ÉTS), Montreal, Quebec, Canada.
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Selçuk H, Roos EM, Grønne DT, Thorlund JB, Sarı Z, Skou ST. Influence of Self-Reported Knee Instability on Outcomes Following Education and Exercise: A Cohort Study of 2,466 Patients With Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2022. [PMID: 36373427 DOI: 10.1002/acr.25060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/02/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To study the influence of self-reported knee instability on changes in knee pain and gait speed following patient education and supervised exercise therapy in patients with knee osteoarthritis (OA). METHODS We included patients enrolled in the Good Life With Osteoarthritis in Denmark (GLA:D) program, an 8-week education and supervised neuromuscular exercise program. Patients were classified into 4 groups according to their level of self-reported knee instability (never; rarely; sometimes; most of the time or all the time). Knee pain intensity was evaluated on a 0-100 mm scale and gait speed from the 4 × 10 meters fast-paced walk test at baseline and after the program. Using linear regression, we examined the association between knee instability and the change in pain and gait speed, respectively. Sex, age, body mass index, physical activity level, and previous knee surgery were covariates in adjusted models. RESULTS Among 2,466 patients with knee OA, mean baseline pain and gait speed varied between 38-59 mm and 1.39-1.56 meters/second in patients experiencing no instability and patients experiencing instability most or all the time, respectively. All instability groups improved in pain and gait speed. Compared to the no instability group, patients reporting instability most or all the time experienced larger improvements in pain (4.3 mm [95% confidence interval 1.2, 7.5]), while no difference between instability groups was found for gait speed. CONCLUSION Knee OA patients with self-reported instability seem to benefit even more from a patient education and supervised exercise therapy program than OA patients without instability.
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Affiliation(s)
| | - Ewa M Roos
- University of Southern Denmark, Odense, Denmark
| | | | | | | | - Søren T Skou
- University of Southern Denmark, Odense, Denmark, and Naestved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
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Nalbant A, Unver B, Karatosun V. Test-retest reliability of the L-Test in patients with advanced knee osteoarthritis. Physiother Theory Pract 2022; 38:2983-2987. [PMID: 34410898 DOI: 10.1080/09593985.2021.1967539] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND The reliability of tests to be used in research or clinical practice should be established for each population specific to their intended use. Reliability is important because it allows correct evaluations to be made about treatment effects or about the amount of changes. OBJECTIVES To evaluate the test-retest reliability and minimal detectable change of the L-test in patients with advanced knee osteoarthritis (OA). METHODS The intraclass correlation coefficient (ICC2,1) was used to assess the test-retest reliability of the L-test. The minimal detectable change with 95% confidence interval (MDC95) was calculated to determine the true change. The inclusion criteria were diagnosis of knee OA, had Kellgren Lawrence Grade IV and age of ≥40 years. RESULTS Twenty-five participants who met the inclusion criteria were included. Five were male and the mean age was 62.32±9.77 years. All of the participants had radiographic findings indicative of Kellgren-Lawrence Grade IV. The L-test showed excellent test-retest reliability. The ICC was 0.99, the SEM and the MDC95 was 1,90 and 5.28 seconds, respectively. CONCLUSIONS The L-test is a reliable outcome measurement for the assessment of walking ability in patients with advanced knee OA, and it showed very high test-retest reliability in these patients. This test may assist clinicians and researchers in assessing the functional mobility of patients and planning rehabilitation in patients with advanced knee OA.
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Affiliation(s)
- Abdurrahman Nalbant
- Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Iğdır University, Merkez-Iğdır, Turkey
| | - Bayram Unver
- Dokuz Eylul University, School of Physical Therapy and Rehabilitation, Balçova- Izmir, Turkey
| | - Vasfi Karatosun
- Dokuz Eylul University, School of Medicine, Department of Orthopaedics and Traumatology, Balçova- Izmir, Turkey
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Silva MDC, Perriman DM, Fearon AM, Tait D, Spencer TJ, Walton-Sonda D, Simic M, Hinman RS, Bennell KL, Scarvell JM. Effects of neuromuscular gait modification strategies on indicators of knee joint load in people with medial knee osteoarthritis: A systematic review and meta-analysis. PLoS One 2022; 17:e0274874. [PMID: 36129904 PMCID: PMC9491578 DOI: 10.1371/journal.pone.0274874] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 09/06/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES This systematic review aimed to determine the effects of neuromuscular gait modification strategies on indicators of medial knee joint load in people with medial knee osteoarthritis. METHODS Databases (Embase, MEDLINE, Cochrane Central, CINAHL and PubMed) were searched for studies of gait interventions aimed at reducing medial knee joint load indicators for adults with medial knee osteoarthritis. Studies evaluating gait aids or orthoses were excluded. Hedges' g effect sizes (ES) before and after gait retraining were estimated for inclusion in quality-adjusted meta-analysis models. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS Seventeen studies (k = 17; n = 362) included two randomised placebo-controlled trials (RCT), four randomised cross-over trials, two case studies and nine cohort studies. The studies consisted of gait strategies of ipsilateral trunk lean (k = 4, n = 73), toe-out (k = 6, n = 104), toe-in (k = 5, n = 89), medial knee thrust (k = 3, n = 61), medial weight transfer at the foot (k = 1, n = 10), wider steps (k = 1, n = 15) and external knee adduction moment (KAM) biofeedback (k = 3, n = 84). Meta-analyses found that ipsilateral trunk lean reduced early stance peak KAM (KAM1, ES and 95%CI: -0.67, -1.01 to -0.33) with a dose-response effect and reduced KAM impulse (-0.37, -0.70 to -0.04) immediately after single-session training. Toe-out had no effect on KAM1 but reduced late stance peak KAM (KAM2; -0.42, -0.73 to -0.11) immediately post-training for single-session, 10 or 16-week interventions. Toe-in reduced KAM1 (-0.51, -0.81 to -0.20) and increased KAM2 (0.44, 0.04 to 0.85) immediately post-training for single-session to 6-week interventions. Visual, verbal and haptic feedback was used to train gait strategies. Certainty of evidence was very-low to low according to the GRADE approach. CONCLUSION Very-low to low certainty of evidence suggests that there is a potential that ipsilateral trunk lean, toe-out, and toe-in to be clinically helpful to reduce indicators of medial knee joint load. There is yet little evidence for interventions over several weeks.
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Affiliation(s)
- M. Denika C. Silva
- Faculty of Health, University of Canberra, Bruce, Australia
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australia
- Department of Physiotherapy, General Sir John Kotelawala Defence University, Werahera, Sri Lanka
| | - Diana M. Perriman
- Faculty of Health, University of Canberra, Bruce, Australia
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australia
- College of Medicine and Health Sciences, Australian National University, Canberra, Australia
| | - Angela M. Fearon
- Faculty of Health, University of Canberra, Bruce, Australia
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australia
- Research Institute for Sport and Exercise, University of Canberra, Bruce, Australia
| | - Daniel Tait
- Faculty of Health, University of Canberra, Bruce, Australia
- Research Institute for Sport and Exercise, University of Canberra, Bruce, Australia
| | - Trevor J. Spencer
- Faculty of Health, University of Canberra, Bruce, Australia
- Research Institute for Sport and Exercise, University of Canberra, Bruce, Australia
| | | | - Milena Simic
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rana S. Hinman
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Kim L. Bennell
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Jennie M. Scarvell
- Faculty of Health, University of Canberra, Bruce, Australia
- Trauma and Orthopaedic Research Unit, Canberra Hospital, Canberra, Australia
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Thomas DT, R S, Prabhakar AJ, Dineshbhai PV, Eapen C. Hip abductor strengthening in patients diagnosed with knee osteoarthritis - a systematic review and meta-analysis. BMC Musculoskelet Disord 2022; 23:622. [PMID: 35768802 PMCID: PMC9241212 DOI: 10.1186/s12891-022-05557-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 06/03/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Globally osteoarthritis of the knee is a leading cause of disability. Hip abductor strength and activation are essential for maintaining postural balance during transfers and are related to joint loading and progression during weight-bearing activities. Strength deficits in the hip abductors might cause a reduction in the lower extremity force generation, thereby causing stress on the medial tibiofemoral joint. The aim of this systematic review is to assess the effectiveness of hip abductor strengthening on knee joint loading, knee pain and functional outcome measures in patients with knee osteoarthritis. METHODS Database such as Scopus, PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL) database and PEDro were reviewed to recognize the trials published in English from inception to December 2020. Randomized controlled trials that studied the effectiveness of hip abductor strengthening in subjects with knee osteoarthritis and its impact on knee joint loading, knee pain and functional outcome measures were included. RevMan 5.4 was used for meta-analysis and forest plot construction. Quality assessment of the included studies was carried out using the PEDro scale. RESULTS AND DISCUSSION The search yielded 260 results of which 29 full-text articles were screened. The review includes 7 randomized controlled trials and 3 studies with good methodological quality were included for meta-analysis. The meta-analysis of the articles favored hip abductor strengthening intervention over the control group. Hip abductor strengthening had significantly reduced the VAS [ SMD = -0.60[-0.88, -0.33] p < 0.0001]at 95% CI and improved the WOMAC scores [SMD - 0.75[-1.05,-0.45] p < 0.0001] at 95% CI. All of the included studies concluded that strengthening the hip abductor muscle had a positive impact on knee pain and functional outcomes. CONCLUSION The current study found high-quality evidence to support the use of hip abductor muscle strengthening exercises as a rehabilitative treatment for subjects with knee osteoarthritis. TRIAL REGISTRATION CRD42021256251 .
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Affiliation(s)
- Dias Tina Thomas
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Shruthi R
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Ashish John Prabhakar
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Patel Vivekbhai Dineshbhai
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Charu Eapen
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
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Tay SH, Yeo JG, Leong JY, Albani S, Arkachaisri T. Juvenile Spondyloarthritis: What More Do We Know About HLA-B27, Enthesitis, and New Bone Formation? Front Med (Lausanne) 2021; 8:666772. [PMID: 34095174 PMCID: PMC8174582 DOI: 10.3389/fmed.2021.666772] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/20/2021] [Indexed: 12/13/2022] Open
Abstract
Juvenile spondyloarthritis (JSpA) refers to a diverse spectrum of immune-mediated inflammatory arthritides whose onset occurs in late childhood and adolescence. Like its adult counterpart, JSpA is typified by a strong association with human leukocyte antigen-B27 (HLA-B27) and potential axial involvement, while lacking rheumatoid factor (RF) and distinguishing autoantibodies. A characteristic manifestation of JSpA is enthesitis (inflammation of insertion sites of tendons, ligaments, joint capsules or fascia to bone), which is commonly accompanied by bone resorption and new bone formation at affected sites. In this Review, advances in the role of HLA-B27, enthesitis and its associated osteoproliferation in JSpA pathophysiology and treatment options will be discussed. A deeper appreciation of how these elements contribute to the JSpA disease mechanism will better inform diagnosis, prognosis and therapy, which in turn translates to an improved quality of life for patients.
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Affiliation(s)
- Shi Huan Tay
- SingHealth Duke-National University of Singapore Academic Medical Centre, Translational Immunology Institute, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Joo Guan Yeo
- SingHealth Duke-National University of Singapore Academic Medical Centre, Translational Immunology Institute, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Rheumatology and Immunology Service, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jing Yao Leong
- SingHealth Duke-National University of Singapore Academic Medical Centre, Translational Immunology Institute, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Salvatore Albani
- SingHealth Duke-National University of Singapore Academic Medical Centre, Translational Immunology Institute, Singapore, Singapore.,Duke-National University of Singapore Medical School, Singapore, Singapore.,Rheumatology and Immunology Service, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - Thaschawee Arkachaisri
- Duke-National University of Singapore Medical School, Singapore, Singapore.,Rheumatology and Immunology Service, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
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Bornstein B, Konstantin N, Alessandro C, Tresch MC, Zelzer E. More than movement: the proprioceptive system as a new regulator of musculoskeletal biology. CURRENT OPINION IN PHYSIOLOGY 2021. [DOI: 10.1016/j.cophys.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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13
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National Clinical Research Center For Geriatric Disorders Xiangya Hospital CSU, Joint Surgery Branch Of The Chinese Orthopedic Association. [Expert consensus on surgical treatment of patellofemoral osteoarthritis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:1-7. [PMID: 33448191 DOI: 10.7507/1002-1892.202012037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Patellofemoral osteoarthritis (PFOA) is one of the most common causes of anterior knee pain in middle-aged and elderly population. In general, elementary therapy and drug therapy are the preferred choices for PFOA management. However, for those who cannot achieve satisfactory effectiveness with standard non-surgical treatment, surgical therapy stands as an alternative treatment. The surgical therapy includes repair surgery and reconstruction surgery. The choice of surgical plans for PFOA management mainly depends on the etiology, pathogenesis, location, and severity of the lesions. To aid clinical decision-making, the National Clinical Research Center for Geriatric Disorders (Xiangya Hospital) and the Joint Surgery Branch of the Chinese Orthopedic Association arranged nationwide orthopedic specialists to set up a work panel. After reviewing the research progress of surgical therapy and the latest guidelines and consensus for PFOA management, the work panel discussed repeatedly to reach this consensus. The present consensus aims to provide valid evidences for clinical practices of the surgical therapy of PFOA, so as to avoid inappropriate and irregular treatment behaviors, reduce surgical trauma, improve surgical efficacy and the quality of life, and to ease the burden of PFOA.
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Raghava Neelapala YV, Bhagat M, Shah P. Hip Muscle Strengthening for Knee Osteoarthritis: A Systematic Review of Literature. J Geriatr Phys Ther 2021; 43:89-98. [PMID: 30407271 DOI: 10.1519/jpt.0000000000000214] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Osteoarthritis (OA) of the knee joint results in chronic pain and functional decline among older adults. Hip muscle weakness has been observed in persons with knee OA and is claimed to increase the medial compartment loading on the knee joint. Although individual studies are available, no review has yet integrated the literature on the benefits of hip muscle strengthening for persons with knee OA. This review aims to systematically summarize the current evidence on the effectiveness of hip muscle strengthening on knee pain, lower extremity function, and biomechanical measures of the knee in persons with knee OA. METHODS An extensive electronic literature search was conducted in the databases PubMed, Scopus, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and Physiotherapy Evidence Database (PEDro) to identify the published trials in the English language from January 1990 to August 2017. Randomized controlled trials that studied the effectiveness of hip muscle strengthening in persons with knee OA on knee pain, physical function, and biomechanical measures of the knee were considered for inclusion. The key word combinations were knee osteoarthritis, degenerative arthritis, arthralgia, muscle strengthening, and resistance training using the Boolean operators AND, OR. Two reviewers independently performed the study selection, and a third reviewer intervened when the consensus was not attained. Quality assessment of the included studies was carried out using the PEDro scale. RESULTS AND DISCUSSION The search produced 774 results, from which 81 full-text articles were studied. Five randomized controlled trials of good methodological quality, including 331 participants, were included in the review. The effectiveness of hip muscle strengthening was assessed in isolation, combination, and comparison with other lower extremity exercise. Overall, the studies reported clear benefits of hip muscle strengthening on knee pain, physical function, and hip muscle strength. However, hip muscle strengthening was ineffective in improving the biomechanical measures such as dynamic alignment and knee adduction (also known as valgus) moment. CONCLUSION The current review identified strong, high-quality evidence to recommend hip muscle strengthening in the conservative management of persons with knee OA. Further research is needed to establish the underlying mechanisms for the clinical benefits.
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Affiliation(s)
- Y V Raghava Neelapala
- Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Karnataka, India
| | - Madhura Bhagat
- Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Karnataka, India
| | - Purvi Shah
- Department of Physiotherapy, School of Allied Health Sciences, Manipal Academy of Higher Education, Karnataka, India
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15
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Ferreira V, Simões R, Gonçalves RS, Machado L, Roriz P. The optimal degree of lateral wedge insoles for reducing knee joint load: a systematic review and meta-analysis. Arch Physiother 2019; 9:18. [PMID: 31890292 PMCID: PMC6921534 DOI: 10.1186/s40945-019-0068-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 11/08/2019] [Indexed: 12/17/2022] Open
Abstract
Background Lateral wedge insoles are traditionally used to reduce the adduction moment that crosses the knee during walking in people with medial knee osteoarthritis. However, the best degree to reduce knee joint load is not yet well established. Methods Electronic databases were searched from their inception until May 2017. Included studies reported on the immediate biomechanical effects of different degrees of lateral wedge insoles during walking in people with knee osteoarthritis. The main measures of interest relating to the biomechanics were the first and second peak of external knee adduction moment and knee adduction angular impulse. For the comparison of the biomechanical effects of different degrees of insoles, the studies were divided in three subgroups: insoles with a degree higher than 0° and equal to or lower than 5°; insoles higher than 5° and equal to or lower than 9°; and insoles higher than 9°. Eligible studies were pooled using random-effects meta-analysis. Results Fifteen studies with a total of 415 participants met all eligibility criteria and were included in the final review and meta-analysis. The overall effect suggests that lateral wedge insoles resulted in a statistically significant reduction in the first peak (standardized mean difference [SMD] -0.25; 95% confidence interval [CI] -0.36, - 0.13; P < 0.001), second peak (SMD -0.26 [95% CI -0.48, - 0.04]; P = 0.02) and knee adduction angular impulse (SMD -0.17 [95% CI -0.31, - 0.03]; P = 0.02). The test of subgroups found no statistically significant differences. Conclusion Systematic review and meta-analysis suggests that lateral wedge insoles cause an overall slight reduction in the biomechanical parameters. Higher degrees do not show higher reductions than lower degrees. Prior analysis of biomechanical parameters may be a valid option for selecting the optimal angle of wedge that best fits in knee osteoarthritis patients with the lowest possible degree.
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Affiliation(s)
- Vitor Ferreira
- 1School of Health Sciences, ESSUA - School of Health, Edificio 30, University of Aveiro, 3810-193 Aveiro, Portugal
| | - Rita Simões
- Santa Casa da Misericórdia da Mealhada, Aveiro, Portugal
| | - Rui Soles Gonçalves
- 3Polytechnic Institute of Coimbra, Coimbra Health School, Coimbra, Portugal University of Coimbra, Centre for Health Studies and Research, Coimbra, Portugal
| | - Leandro Machado
- CIF2D, LABIOMEP, Faculdade de Desporto da Universidade do Porto, Coimbra, Portugal
| | - Paulo Roriz
- CIDESD-ISMAI, INESC-TEC, LABIOMEP, Coimbra, Portugal
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16
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Baker M, Stanish W, Rutherford D. Walking challenges in moderate knee osteoarthritis: A biomechanical and neuromuscular response to medial walkway surface translations. Hum Mov Sci 2019; 68:102542. [PMID: 31710922 DOI: 10.1016/j.humov.2019.102542] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 07/18/2019] [Accepted: 10/21/2019] [Indexed: 11/18/2022]
Abstract
Sensations of knee instability are self-reported in 60-80% of individuals with knee osteoarthritis. These sensations are most often reported during walking; however, it remains unclear how they affect knee joint biomechanics and muscle activation patterns as indicators of joint function. Perturbation paradigms may provide insight into how the knee joint responds to walking challenges. Thus, the purpose of this study was to determine how individuals with moderate medial compartment knee osteoarthritis respond to unexpected, 3 cm medial walkway surface translations during gait compared to an asymptomatic control group. It is hypothesized that individuals with knee osteoarthritis will demonstrate altered biomechanics, and elevated and prolonged muscle activation compared to the asymptomatic group. Twenty asymptomatic individuals and 20 individuals with knee osteoarthritis walked on a dual-belt instrumented treadmill. Participants experienced 24 unexpected medial/lateral, 1 cm/3 cm walkway translations during mid-stance on each leg. Joint motions, moments and maximal voluntary isometric contraction amplitude normalized muscle activations were analyzed for the 3 cm walkway translations. Discrete measures were extracted from each biomechanical waveform and Principal Component Analysis (PCA) was used to determine knee joint muscle activation patterns. PCA is a factorization method to reduce dimensionality of EMG envelopes into linearly uncorrelated principal patterns (PP1, PP2, PP3) that explain the largest possible variance in the dataset. PP1 is often interpreted as a feature that explains the overall amplitude, while PP2 and PP3 are features that explain the variance in temporal activation patterns (i.e. how activation patterns change over the gait cycle). Statistical significance was determined using Analysis of Covariance models (alpha = 0.05). In response to the medial 3 cm walkway translation, increased activation amplitudes in the hamstring and gastrocnemius, captured by PP1 were found in both groups, as well as alterations in temporal activation patterns (captured by combinations of PP2 and PP3 patterns) across all muscle sites (p < 0.05). No group differences were demonstrated in joint motion and moment discrete metrics (p > 0.05) in response to the 3 cm translation. These findings suggest that the medial 3 cm walkway translation posed a challenged to knee function, however the biomechanical and neuromuscular response was similar between individuals with moderate knee osteoarthritis and asymptomatic individuals.
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Affiliation(s)
- Matthew Baker
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada.
| | - William Stanish
- Department of Surgery, Division of Orthopaedics, Dalhousie University, Halifax, NS, Canada.
| | - Derek Rutherford
- School of Physiotherapy, Faculty of Health, Dalhousie University, Halifax, NS, Canada; School of Biomedical Engineering, Faculty of Engineering, Dalhousie University, Halifax, NS, Canada.
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17
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Mohd Sharif NA, Usman J, Wan Safwani WKZ, Siew Li G, Abdul Karim S, Mohamed NA, Khan SS, Khan SJ. Effects of simple knee sleeves on pain and knee adduction moment in early unilateral knee osteoarthritis. Proc Inst Mech Eng H 2019; 233:1132-1140. [PMID: 31597554 DOI: 10.1177/0954411919874614] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Knee sleeves are often prescribed to alleviate pain in people with early knee osteoarthritis. However, the biomechanics underlying their pain-relieving effect are still not well understood. This pre-post study aims at evaluating and comparing the effects of two different types of knee sleeves on knee adduction moment. Patients with clinically diagnosed knee osteoarthritis were recruited from the University of Malaya Medical Centre and were randomly assigned to two test groups using (1) a simple knee sleeve and (2) a simple sleeve with patella cutout. Knee adduction moment was collected using the Vicon motion capture system with two Kistler force plates. Pain, stiffness and physical functions were recorded using the Western Ontario and McMaster Universities Osteoarthritis Index. All measurements were taken before, immediately after and at the completion of 6 weeks of application (primary time point). In total, 17 participants with early unilateral knee osteoarthritis (47.7 (9.7) years) completed the study. Overall results show significant reduction in pain, early stance and late stance knee adduction moment and increased walking speed after 6 weeks of both knee sleeves application. This study results suggest that knee sleeves can reduce knee adduction moments in early unilateral knee osteoarthritis by 14.0% and 12.1% using the simple sleeve and the sleeve with patella cutout, respectively, and can potentially delay disease progression. In addition, knee sleeve with patella cutout does not provide additional benefits when compared to the simple knee sleeve.
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Affiliation(s)
| | - Juliana Usman
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.,Centre for Applied Biomechanics, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | | | - Goh Siew Li
- Sports Medicine Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Samihah Abdul Karim
- Sports Medicine Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Nur Anisah Mohamed
- Institute of Mathematical Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Soobia Saad Khan
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia
| | - Saad Jawaid Khan
- Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, Kuala Lumpur, Malaysia.,Department of Biomedical Engineering, Faculty of Engineering Science and Technology, Ziauddin University, Karachi, Pakistan
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18
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Sharma M, Singh A, Kaur S, Dhillon MS. Consensus on non-pharmacological interventions for mild and moderate knee osteoarthritis among stakeholders/experts of various disciplines is still elusive -A preliminary report. J Clin Orthop Trauma 2019; 10:S174-S178. [PMID: 31695278 PMCID: PMC6823712 DOI: 10.1016/j.jcot.2018.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/06/2018] [Accepted: 12/13/2018] [Indexed: 10/27/2022] Open
Affiliation(s)
| | - Amarjeet Singh
- Department of Community Medicine, PGIMER, Chandigarh, India
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19
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WU TSUNGCHIAO, YEN CHUANHSIN, LYU SHAWRUEY, HUNG SHUOSUEI. MODIFICATION IN FOOT PRESSURE AND GAIT PATTERN AFTER ARTHROSCOPIC CARTILAGE REGENERATION FACILITATING PROCEDURES (ACRFP) IN PATIENTS WITH OSTEOARTHRITIS OF KNEE. J MECH MED BIOL 2019. [DOI: 10.1142/s0219519419400268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Arthroscopic cartilage regeneration facilitating procedure (ACRFP) has been reported with satisfactory results, yet there is limited research on the biomechanics in these patients. The purpose of this study is to assess the change on the biomechanics after ACRFP, in terms of foot pressure and gait pattern. Patients with chronic knee pain due to osteoarthritis and received ACRFP were recruited, and the knee joints in each patient were divided into either study or control group according to radiographical or symptomatic severity. Assessments were done with Knee injury and Osteoarthritis Outcome Score (KOOS) and dynamic foot pressure at the time before surgery, three months and six months postoperatively. A total of 24 patients completed the study. Significant improvement was found of KOOS, at both three and six months postoperatively. No much change in the gait parameters was noted, but there was a significant decrease of foot pressure over lateral side of hindfoot at six months postoperatively. In conclusion, significant clinical improvements could be achieved with surgical results of ACRFP, and shifting of the foot pressure medially may be related to decrease in the knee adduction moment, which is more favorable for the knee joints.
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Affiliation(s)
- TSUNG-CHIAO WU
- Department of Orthopedics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd, Xindian Dist. New Taipei City 23142, Taiwan
| | - CHUAN-HSIN YEN
- Department of Physical Therapy and Assistive Technology, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei, 112 Taiwan
| | - SHAW-RUEY LYU
- Joint Center, Dalin Tzu Chi General Hospital, Buddhist Tzu Chi Medical Foundation Road, Dalin Town, Chia-Yi, Taiwan
- School of Medicine, Tzu Chi University, No. 701, Sec. 3, Jhongyang Rd. Hualien 97004, Taiwan
| | - SHUO-SUEI HUNG
- Department of Orthopedics, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd, Xindian Dist. New Taipei City 23142, Taiwan
- School of Medicine, Tzu Chi University, No. 701, Sec. 3, Jhongyang Rd. Hualien 97004, Taiwan
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Alessandro C, Rellinger BA, Barroso FO, Tresch MC. Adaptation after vastus lateralis denervation in rats demonstrates neural regulation of joint stresses and strains. eLife 2018; 7:38215. [PMID: 30175959 PMCID: PMC6150696 DOI: 10.7554/elife.38215] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 08/22/2018] [Indexed: 12/14/2022] Open
Abstract
In order to produce movements, muscles must act through joints. The translation from muscle force to limb movement is mediated by internal joint structures that permit movement in some directions but constrain it in others. Although muscle forces acting against constrained directions will not affect limb movements, such forces can cause excess stresses and strains in joint structures, leading to pain or injury. In this study, we hypothesized that the central nervous system (CNS) chooses muscle activations to avoid excessive joint stresses and strains. We evaluated this hypothesis by examining adaptation strategies after selective paralysis of a muscle acting at the rat’s knee. We show that the CNS compromises between restoration of task performance and regulation of joint stresses and strains. These results have significant implications to our understanding of the neural control of movements, suggesting that common theories emphasizing task performance are insufficient to explain muscle activations during behaviors. Although most of us will never achieve the grace and dexterity of professional ballerina Misty Copeland, we each make sophisticated, complex movements every day. Even simple movements often involve coordinating many muscles throughout the body. Moreover, because we have so many muscles, there are often multiple ways that we could use them to make the same movement. So which ones do we use, and why? Many studies into muscle control focus on how the muscles activate to perform a task like kicking a soccer ball. But muscles do more than just move the limbs; they also act on joints. Contracting a muscle exerts strain on bones and the ligaments that hold joints together. If these strains become excessive, they may cause pain and injury, and over a longer time may lead to arthritis. It would therefore make sense if the nervous system factored in the need to protect joints when turning on muscles. The quadriceps are a group of muscles that stretch along the front of the thigh bone and help to straighten the knee. To investigate whether the nervous system selects muscle activations to avoid joint injuries, Alessando et al. studied rats that had one particular quadriceps muscle paralyzed. The easiest way for the rats to adapt to this paralysis would be to increase the activation of a muscle that performs the same role as the paralyzed one, but places more stress on the knee joint. Instead, Alessando et al. found that the rats increase the activation of a muscle that minimizes the stress placed on the knee, even though this made it more difficult for the rats to recover their ability to use the leg in certain tasks. The results presented by Alessando et al. may have important implications for physical therapy. Clinicians usually work to restore limb movements so that a task is performed in a way that is similar to how it was done before the injury. But sometimes repairing the damage can change the mechanical properties of the joint – for example, reconstructive surgery may replace a damaged ligament with a graft that has a different strength or stiffness. In those cases, performing movements in the same way as before the surgery could place abnormal stress on the joint. However, much more research is needed before recommendations can be made for how to rehabilitate rats after injury, let alone humans.
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Affiliation(s)
| | - Benjamin A Rellinger
- Department of Biomedical Engineering, Northwestern University, Evanston, United States
| | | | - Matthew C Tresch
- Department of Physiology, Northwestern University, Chicago, United States.,Department of Biomedical Engineering, Northwestern University, Evanston, United States.,Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, United States.,Shirley Ryan AbilityLab, Chicago, United States
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21
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Scarvell JM, Galvin CR, Perriman DM, Lynch JT, van Deursen RW. Kinematics of knees with osteoarthritis show reduced lateral femoral roll-back and maintain an adducted position. A systematic review of research using medical imaging. J Biomech 2018; 75:108-122. [DOI: 10.1016/j.jbiomech.2018.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 10/16/2022]
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22
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Sritharan P, Lin YC, Richardson SE, Crossley KM, Birmingham TB, Pandy MG. Lower-limb muscle function during gait in varus mal-aligned osteoarthritis patients. J Orthop Res 2018; 36:2157-2166. [PMID: 29473665 DOI: 10.1002/jor.23883] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/15/2018] [Indexed: 02/04/2023]
Abstract
This study quantified the contributions by muscular, gravitational and inertial forces to the ground reaction force (GRF) and external knee adduction moment (EKAM) for knee osteoarthritis (OA) patients and controls walking at similar speeds. Gait data for 39 varus mal-aligned medial knee OA patients and 15 controls were input into musculoskeletal models to calculate the contributions of individual muscles and gravity to the fore-aft (progression), vertical (support), and mediolateral (balance) GRF, and the EKAM. The temporal patterns of contributions to GRF and EKAM were similar between the groups. Magnitude differences in GRF contributions were small but some reached significance. Peak GRF contributions were lower in patients except hamstrings in early-stance progression (p < 0.001) and gastrocnemius in late-stance progression (p < 0.001). Both EKAM peaks were higher in patients, due mainly to greater adduction contribution from gravity (p < 0.001) at the first peak, and lower abduction contributions from soleus (p < 0.001) and gastrocnemius (p < 0.001) at the second peak. Gluteus medius contributed most to EKAM in both groups, but was higher in patients during mid-stance only (p < 0.001). Differences in GRF contributions were attributed to altered quadriceps-hamstrings action as well as compensatory adaptation of the ankle plantarflexors to reduced gluteus medius action. The large effect of varus mal-alignment on the frontal-plane moment arms of the gravity, soleus, and gastrocnemius GRF contributions about the knee explained greater patient EKAM. Our results shed further light on how the EKAM contributes to altered knee-joint loads in OA and why some interventions may affect different portions of the EKAM waveform. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Prasanna Sritharan
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, 3086, Australia
- Department of Mechanical Engineering, University of Melbourne, Victoria, Australia
| | - Yi-Chung Lin
- Department of Mechanical Engineering, University of Melbourne, Victoria, Australia
| | - Sara E Richardson
- Faculty of Health Sciences, University of Western Ontario, Ontario, Canada
| | - Kay M Crossley
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, 3086, Australia
| | | | - Marcus G Pandy
- Department of Mechanical Engineering, University of Melbourne, Victoria, Australia
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Ng JL, Kersh ME, Kilbreath S, Knothe Tate M. Establishing the Basis for Mechanobiology-Based Physical Therapy Protocols to Potentiate Cellular Healing and Tissue Regeneration. Front Physiol 2017; 8:303. [PMID: 28634452 PMCID: PMC5460618 DOI: 10.3389/fphys.2017.00303] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Accepted: 04/27/2017] [Indexed: 12/17/2022] Open
Abstract
Life is mechanobiological: mechanical stimuli play a pivotal role in the formation of structurally and functionally appropriate body templates through mechanobiologically-driven cellular and tissue re/modeling. The body responds to mechanical stimuli engendered through physical movement in an integrated fashion, internalizing and transferring forces from organ, through tissue and cellular length scales. In the context of rehabilitation and therapeutic outcomes, such mechanical stimuli are referred to as mechanotherapy. Physical therapists use mechanotherapy and mechanical interventions, e.g., exercise therapy and manual mobilizations, to restore function and treat disease and/or injury. While the effect of directed movement, such as in physical therapy, is well documented at the length scale of the body and its organs, a number of recent studies implicate its integral effect in modulating cellular behavior and subsequent tissue adaptation. Yet the link between movement biomechanics, physical therapy, and subsequent cellular and tissue mechanoadaptation is not well established in the literature. Here we review mechanoadaptation in the context of physical therapy, from organ to cell scale mechanotransduction and cell to organ scale extracellular matrix genesis and re/modeling. We suggest that physical therapy can be developed to harness the mechanosensitivity of cells and tissues, enabling prescriptive definition of physical and mechanical interventions to enhance tissue genesis, healing, and rehabilitation.
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Affiliation(s)
- Joanna L. Ng
- Graduate School of Biomedical Engineering, University of New South WalesSydney, NSW, Australia
| | - Mariana E. Kersh
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-ChampaignChampaign, IL, United States
| | - Sharon Kilbreath
- Faculty of Health Sciences, University of SydneySydney, NSW, Australia
| | - M. Knothe Tate
- Graduate School of Biomedical Engineering, University of New South WalesSydney, NSW, Australia
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Sritharan P, Lin YC, Richardson SE, Crossley KM, Birmingham TB, Pandy MG. Musculoskeletal loading in the symptomatic and asymptomatic knees of middle-aged osteoarthritis patients. J Orthop Res 2017; 35:321-330. [PMID: 27088430 DOI: 10.1002/jor.23264] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Accepted: 04/08/2016] [Indexed: 02/04/2023]
Abstract
This study quantified the contributions by muscles, gravity, and inertia to the tibiofemoral compartment forces in the symptomatic (SYM) and asymptomatic (ASYM) limbs of varus mal-aligned medial knee osteoarthritis (OA) patients, and compared the results with healthy controls (CON). Muscle forces and tibiofemoral compartment loads were calculated using gait data from 39 OA patients and 15 controls aged 49 ± 7 years. Patients exhibited lower knee flexion angle, higher hip abduction, and knee adduction angles, lower internal knee flexion torque but higher external knee adduction moment. Muscle forces were highest in CON except hamstrings, which was highest in SYM. ASYM muscle forces were lowest for biceps femoris short head and gastrocnemius but otherwise intermediate between SYM and CON. In all subjects, vasti, hamstrings, gastrocnemius, soleus, gluteus medius, gluteus maximus, and gravity were the largest contributors to medial compartment force (MCF). Inertial contributions were negligible. Highest MCF was found in SYM throughout stance. Small increases in contributions from hamstrings, gluteus maximus, gastrocnemius, and gravity at the first peak; soleus and rectus femoris at the second peak; and soleus, gluteus maximus, gluteus medius, and gravity during mid-stance summed to produce significantly higher total MCF. Compared to CON, the ASYM limb exhibited similar peak MCF but higher mid-stance MCF. In patients, diminished non-knee-spanning muscle forces did not produce correspondingly diminished MCF contributions due to the influence of mal-alignment. Our findings emphasize consideration of muscle function, lower-limb alignment, and mid-stance loads in developing interventions for OA, and inclusion of the asymptomatic limb in clinical assessments. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:321-330, 2017.
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Affiliation(s)
- Prasanna Sritharan
- Department of Mechanical Engineering, University of Melbourne, Victoria, Australia
| | - Yi-Chung Lin
- Department of Mechanical Engineering, University of Melbourne, Victoria, Australia
| | - Sara E Richardson
- Faculty of Health Sciences, University of Western Ontario, Ontario, Canada
| | - Kay M Crossley
- School of Allied Health, La Trobe University, Victoria, Australia
| | | | - Marcus G Pandy
- Department of Mechanical Engineering, University of Melbourne, Victoria, Australia
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Non-surgical treatments for the management of early osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2016; 24:1775-85. [PMID: 27043347 DOI: 10.1007/s00167-016-4089-y] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Accepted: 03/14/2016] [Indexed: 02/07/2023]
Abstract
Non-surgical treatments are usually the first choice for the management of knee degeneration, especially in the early osteoarthritis (OA) phase when no clear lesions or combined abnormalities need to be addressed surgically. Early OA may be addressed by a wide range of non-surgical approaches, from non-pharmacological modalities to dietary supplements and pharmacological therapies, as well as physical therapies and novel biological minimally invasive procedures involving injections of various substances to obtain a clinical improvement and possibly a disease-modifying effect. Numerous pharmaceutical agents are able to provide clinical benefit, but no one has shown all the characteristic of an ideal treatment, and side effects have been reported at both systemic and local level. Patients and physicians should have realistic outcome goals in pharmacological treatment, which should be considered together with other conservative measures. Among these, exercise is an effective conservative approach, while physical therapies lack literature support. Even though a combination of these therapeutic options might be the most suitable strategy, there is a paucity of studies focusing on combining treatments, which is the most common clinical scenario. Further studies are needed to increase the limited evidence on non-surgical treatments and their combination, to optimize indications, application modalities, and results with particular focus on early OA. In fact, most of the available evidence regards established OA. Increased knowledge about degeneration mechanisms will help to better target the available treatments and develop new biological options, where preliminary results are promising, especially concerning early disease phases. Specific treatments aimed at improving joint homoeostasis, or even counteracting tissue damage by inducing regenerative processes, might be successful in early OA, where tissue loss and anatomical changes are still at very initial stages.
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26
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O'Connell M, Farrokhi S, Fitzgerald GK. The role of knee joint moments and knee impairments on self-reported knee pain during gait in patients with knee osteoarthritis. Clin Biomech (Bristol, Avon) 2016; 31:40-6. [PMID: 26527453 DOI: 10.1016/j.clinbiomech.2015.10.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 10/02/2015] [Accepted: 10/05/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The association between high mechanical knee joint loading during gait with onset and progression of knee osteoarthritis has been extensively studied. However, less attention has been given to risk factors related to increased pain during gait. The purpose of this study was to evaluate knee joint moments and clinical characteristics that may be associated with gait-related knee pain in patients with knee osteoarthritis. METHODS Sixty-seven participants with knee osteoarthritis were stratified into three groups of no pain (n=18), mild pain (n=27), or moderate/severe pain (n=22) based on their self-reported symptoms during gait. All participants underwent three-dimensional gait analysis. Quadriceps strength, knee extension range of motion, radiographic knee alignment and self-reported measures of global pain and function were also quantified. FINDINGS The moderate/severe pain group demonstrated worse global pain (P<0.01) and physical function scores (P<0.01) compared to the no pain and the mild pain groups. The moderate/severe pain group also walked with greater knee flexion moments during the midstance phase of gait compared to the no pain group (P=0.02). Additionally, the moderate/severe pain group demonstrated greater varus knee malalignment (P=0.009), which was associated with higher weight acceptance peak knee adduction moments (P=0.003) and worse global pain (P=0.003) and physical function scores (P=0.006). INTERPRETATION Greater knee flexion moment is present during the midstance phase of gait in patients with knee osteoarthritis and moderate/severe pain during gait. Additionally, greater varus malalignment may be a sign of increased global knee joint dysfunction that can influence many activities of daily living beyond gait.
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Affiliation(s)
- Megan O'Connell
- Solutions Physical Therapy & Sports Medicine, Alexandria, VA, USA
| | - Shawn Farrokhi
- Human Movement Research Laboratory, University of Pittsburgh, Pittsburgh, PA, USA; Departments of Physical Therapy and Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
| | - G Kelley Fitzgerald
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA; Physical Therapy and Clinical and Translational Research Center, University of Pittsburgh, Pittsburgh, PA, USA
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27
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Amiri P, Hubley-Kozey CL, Landry SC, Stanish WD, Astephen Wilson JL. Obesity is associated with prolonged activity of the quadriceps and gastrocnemii during gait. J Electromyogr Kinesiol 2015; 25:951-8. [PMID: 26559464 DOI: 10.1016/j.jelekin.2015.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/21/2015] [Accepted: 10/13/2015] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To examine the effect of obesity and its potential interaction with knee OA presence on the electromyography patterns of the major knee joint periarticular muscles during walking. SCOPE One hundred and eighteen asymptomatic adults and 177 adults with moderate knee osteoarthritis were subdivided into categories of healthy weight (n = 77; 20 kg/m(2) < BMI < 25 kg/m(2)), overweight (n = 117; 25 kg/m(2) ⩽ BMI < 30 kg/m(2)), and obese (n = 101; BMI ⩾ 30 kg/m(2) based on their body mass index (BMI). All individuals underwent a three-dimensional gait analysis. Surface electromyograms from the lateral and medial gastrocnemii, lateral and medial hamstrings, vastus lateralis, vastus medialis, and rectus femoris were recorded during self-selected speed walking. Principal component analysis was used to extract major features of amplitude and temporal pattern variability from the electromyograms of each muscle group (gastrocnemii, quadriceps, hamstrings separately). Analysis of variance models tested for main BMI category effects and interaction effects for these features (α = 0.05). Statistically significant BMI category (i.e. obesity) effects were found for features that described more prolonged activations of the gastrocnemii and quadriceps muscles during the stance phase of gait with obesity (P < 0.05). CONCLUSIONS Obesity was associated with prolonged activation of quadriceps and gastrocnemii, which can result in prolonged knee joint contact loading, and thereby may contribute to the predisposition of knee OA development and progression in obese individuals.
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Affiliation(s)
- P Amiri
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - C L Hubley-Kozey
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada; School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - S C Landry
- School of Kinesiology, Acadia University, Wolfville, NS, Canada; School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - W D Stanish
- Department of Surgery, Division of Orthopedics, Dalhousie University, Halifax, NS, Canada; School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada
| | - J L Astephen Wilson
- School of Biomedical Engineering, Dalhousie University, Halifax, NS, Canada.
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Ferreira GE, Robinson CC, Wiebusch M, Viero CCDM, da Rosa LHT, Silva MF. The effect of exercise therapy on knee adduction moment in individuals with knee osteoarthritis: A systematic review. Clin Biomech (Bristol, Avon) 2015; 30:521-7. [PMID: 25896448 DOI: 10.1016/j.clinbiomech.2015.03.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 03/12/2015] [Accepted: 03/16/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Exercise therapy is an evidence-based intervention for the conservative management of knee osteoarthritis. It is hypothesized that exercise therapy could reduce the knee adduction moment. A systematic review was performed in order to verify the effects of exercise therapy on the knee adduction moment in individuals with knee osteoarthritis in studies that also assessed pain and physical function. METHODS A comprehensive electronic search was performed on MEDLINE, Cochrane CENTRAL, EMBASE, Google scholar and OpenGrey. Inclusion criteria were randomized controlled trials with control or sham groups as comparator assessing pain, physical function, muscle strength and knee adduction moment during walking at self-selected speed in individuals with knee osteoarthritis that underwent a structured exercise therapy rehabilitation program. Two independent reviewers extracted the data and assessed risk of bias. For each study, knee adduction moment, pain and physical function outcomes were extracted. For each outcome, mean differences and 95% confidence intervals were calculated. Due to clinical heterogeneity among exercise therapy protocols, a descriptive analysis was chosen. FINDINGS Three studies, comprising 233 participants, were included. None of the studies showed significant differences between strengthening and control/sham groups in knee adduction moment. In regards to pain and physical function, the three studies demonstrated significant improvement in pain and two of them showed increased physical function following exercise therapy compared to controls. Muscle strength and torque significantly improved in all the three trials favoring the intervention group. INTERPRETATION Clinical benefits from exercise therapy were not associated with changes in the knee adduction moment. The lack of knee adduction moment reduction indicates that exercise therapy may not be protective in knee osteoarthritis from a joint loading point of view. Alterations in neuromuscular control, not captured by the knee adduction moment measurement, may contribute to alter dynamic joint loading following exercise therapy. To conclude, mechanisms other than the reduction in knee adduction moment might explain the clinical benefits of exercise therapy on knee osteoarthritis.
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Affiliation(s)
- Giovanni E Ferreira
- Masters Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil.
| | - Caroline Cabral Robinson
- Doctoral Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil.
| | - Matheus Wiebusch
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil.
| | | | - Luis Henrique Telles da Rosa
- Masters Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil.
| | - Marcelo Faria Silva
- Masters Program in Rehabilitation Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil; Doctoral Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Brazil.
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29
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Fang MA, Heiney C, Yentes JM, Harada ND, Masih S, Perell-Gerson KL. Effects of contralateral versus ipsilateral cane use on gait in people with knee osteoarthritis. PM R 2014; 7:400-6. [PMID: 25305371 DOI: 10.1016/j.pmrj.2014.09.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 09/20/2014] [Accepted: 09/28/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the immediate effects of contralateral versus ipsilateral cane use on spatiotemporal gait parameters and peak vertical ground force in overweight or obese adults with symptomatic knee osteoarthritis (OA). DESIGN Prospective observational study. SETTING An academic tertiary Veterans Affairs Healthcare Center. PARTICIPANTS Thirty-eight overweight or obese subjects with symptomatic knee OA who had not used a cane for the past 30 days. METHODS Spatiotemporal gait data were obtained with an optical motion capture system while subjects walked without a cane, with a cane contralateral to the more painful lower limb, or with a cane ipsilateral to the more painful lower limb at self-selected speeds. An in-shoe dynamic pressure distribution system was used to measure the vertical ground reaction force. MAIN OUTCOME MEASUREMENTS Spatiotemporal measures of gait and peak vertical ground reaction force on both lower limbs were recorded for each walking condition: no cane, contralateral cane, and ipsilateral cane. RESULTS Walking with a cane either contralateral or ipsilateral to the more symptomatic limb led to significant reductions in gait velocity (14%-16%), cadence (12%-14%), and peak vertical ground reaction force (normalized for body weight; 11%-12%) on the more painful lower limb compared with walking unaided (P < .05). There were no significant differences in the peak vertical ground reaction force on either lower limbs when comparing walking with a cane contralateral to the more painful limb or walking with a cane ipsilateral to the more painful limb. Subjects also experienced a significant decrease in gait velocity with contralateral or ipsilateral cane use compared with walking without a cane; the lower walking speed was due to a decrease in cadence. CONCLUSIONS These results support the prescription of a single-point cane to offload a lower limb with painful knee OA by holding the cane either ipsilateral or contralateral to the more painful lower limb.
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Affiliation(s)
- Meika A Fang
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA(∗).
| | - Constance Heiney
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA(†)
| | - Jennifer M Yentes
- Nebraska Biomechanics Core Facility, University of Nebraska at Omaha, Omaha, NE(‡)
| | - Nancy D Harada
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA(§)
| | - Sulabha Masih
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA(¶)
| | - Karen L Perell-Gerson
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA; School of Science and Technology, Georgia Gwinnett College, Lawrenceville, GA(#)
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30
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Mills K, Hunter DJ. Patellofemoral joint osteoarthritis: an individualised pathomechanical approach to management. Best Pract Res Clin Rheumatol 2014; 28:73-91. [PMID: 24792946 DOI: 10.1016/j.berh.2014.01.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Patellofemoral joint integrity is maintained by an optimal interaction of passive, dynamic and structural restraints. Disruption of these mechanics can lead to structural joint damage and subsequent patellofemoral osteoarthritis, which is a prevalent and disabling condition with few effective conservative management strategies. Due to the influential role of biomechanics in this disease, targeting the specific pathomechanics exhibited by an individual is logical to improve their likelihood of a positive treatment outcome. This review summarises the effect of different pathomechanical factors on the presence and progression of patellofemoral osteoarthritis. It then presents a synthesis of mechanical effect of treatment strategies specifically addressing these pathomechanics. Identifying the pathomechanics and clinical characteristics of individuals with patellofemoral osteoarthritis that respond to treatment may assist in the development of individualised treatment strategies that alleviate symptoms and slow structural damage.
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Affiliation(s)
- Kathryn Mills
- Physiotherapy, Department of Human Sciences, Macquarie University, Sydney, Australia.
| | - David J Hunter
- Department of Rheumatology, Royal North Shore Hospital, Sydney, Australia; Kolling Institute, University of Sydney, Sydney, Australia.
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31
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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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