It is unclear how knee biomechanics in individuals with Sarcopenic Obesity and osteoarthritis (OA-SO) affect ambulation relative to those with knee osteoarthritis (OA) without SO. The primary objective of this study was to compare the knee kinematics and spatio-temporal gait parameters during treadmill walking using simulated terrain modifications in individuals with end-stage knee OA awaiting total knee arthroplasty (TKA) with SO and obesity (OA-SO group) versus those with knee OA without SO (OA group).

We performed a cross-sectional analysis of individuals with knee OA (with or without SO) awaiting TKA. Gait assessments using Computer-Assisted Rehabilitation Environment (CAREN) occurred within one month before TKA; each participant was asked to perform two trials of self-selected treadmill speed for each of the following six walking conditions: (1) level; (2) uphill; (3) downhill; (4) cross slope with the affected body side elevated; (5) cross slope with the unaffected side elevated; and (6) medial-lateral walking surface translations. Data analyses compared demographics, gait kinematics, spatio-temporal, and clinical outcome measures between the groups using a two-tailed independent t-test for continuous measures and Chi Square tests for categorical data.

The groups were similar in age and sex distribution (P = 0.90 and 0.37, respectively). Of the 18 participants with knee OA, eight were classified as with and ten without SO. On the affected side, the group-level knee flexion-extension range was significantly larger in the OA group compared to OA-SO group for all six walking conditions during the full gait cycle. The OA group walked significantly faster than the OA-SO group for all walking conditions. The stride length and step length were significantly longer in the OA group than in the OA-SO group during four of the six walking conditions.

Gait assessment for different walking conditions adds important information to level walking assessments. Individuals with knee OA and SO have less knee range of motion, are slower, and less stride and step length, compared to individuals with OA only. This study may indicate the need for preoperative and postoperative rehabilitation programs to address the needs of individuals with knee OA and SO.

A variety of minimal clinically important difference (MCID) estimates are available to distinguish subgroups with differing outcomes. When a true gold standard is absent, latent class growth curve analysis (LCGC) has been proposed as a suitable alternative for important change. Our purpose was to evaluate the performance of individual and baseline quartile-stratified MCIDs. The current study included data from 346 persons with baseline and 12-month postoperative outcome data from KASTPain, a no-effect randomized clinical trial conducted on persons with knee arthroplasty and pain catastrophizing. Subgroup trajectories from LCGC were used as a gold standard comparator. Minimal clinically important difference-specific trajectories of recovery were calculated for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain, Disability and EuroQol-5 Dimension Visual Analogue Scale of self-reported health. The latent Kappa (K l ) chance-corrected agreement between MCIDs and LCGCs were estimated to indicate which MCID method was best at detecting important change. For all 3 outcomes, the average latent class probabilities ranged from 0.90 to 0.99, justifying the use of LCGCs as a gold standard. The K l for LCGC and individual MCIDs ranged from 0.21 (95% CI = 0.13, 0.28) to 0.52 (95% CI = 0.41, 0.66). Baseline quartile-stratified K l for WOMAC Pain and Disability were 0.85 (95% CI = 0.78, 0.92) and 0.74 (95% CI = 0.68, 0.83), respectively. Classification errors in individual MCID estimates most likely result from ceiling effects. Minimal clinically important differences calculated for each baseline quartile are superior to individually calculated MCIDs and should be used when latent class methods are not available. Use of individual MCIDs likely contribute substantial error and are discouraged for clinical application.

To evaluate and compare the subjective knee function in patients undergoing revision and bilateral anterior cruciate ligament (ACL) reconstruction (ACLR) with those undergoing primary ACLR in a large cohort.

Patients without concomitant ligament injuries who underwent primary, revision or bilateral ACLR at the Capio Artro Clinic, Stockholm, Sweden, between 2005 and 2018 were identified. The Knee injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at 1, 2 and 5 years postoperatively from the Swedish National Knee Ligament Registry. Patients who underwent revision and bilateral ACLR were compared with those who underwent primary ACLR (control group) using Student's t test.

A total of 6831 patients (6102 with primary ACLRs, 343 with revision ACLRs and 386 with bilateral ACLRs) were included. Preoperatively, there were significant but nonclinically relevant differences in favour of the revision ACLR group for KOOS Symptoms, Pain, Activities of Daily Living (ADL) and Sport/Rec subscale scores compared with the primary ACLR group. Postoperatively, except for the 1-year Symptoms and ADL subscales, the revision ACLR group reported significantly lower scores on all KOOS subscales than the primary ACLR group, with clinically relevant differences (>8-10 points) for the 1-, 2- and 5-year Sport/Rec and Quality of Life (QOL) subscales. The bilateral ACLR group reported significantly, but not clinically relevant, inferior scores on the 1-year Symptoms and QOL subscales and the 5-year Sport/Rec and QOL subscales compared with the primary ACLR group.

Revision ACLR, but not bilateral ACLR, was associated with clinically relevant inferior subjective knee function compared with primary ACLR. It is important to counsel patients regarding their future subjective knee function after repeated ACLR. Compared to primary ACLR, inferior subjective results should be expected after revision ACLR, but not after bilateral ACLR.

Level III.

Many surgeons recommend weight loss for patients with obesity before total joint arthroplasty (TJA), but few studies have evaluated weight loss interventions. This study compared weight loss using a remote dietitian and a mobile application (app) with weight loss using standard care for patients with severe obesity before TJA.

This multicenter randomized controlled trial included 60 subjects with a body mass index (BMI) of 40 to 47 kg/m 2 who had been scheduled for primary total hip or knee arthroplasty from September 2019 to January 2023. The mean age was 61 years, 67% were women, and the mean BMI was 44 kg/m 2 . The control subjects (n = 29) received standard care; the intervention subjects (n = 31) completed video calls with dietitians and used a mobile app for 12 weeks preoperatively. Weights and surveys were collected at baseline and 12 weeks, with 87% follow-up. Weight loss, patient-reported outcomes, complications, revisions, and reoperations were compared. The mean follow-up was 1.8 years.

The intervention subjects lost more weight (-4.1 versus -2.1 kg, p = 0.22) and had larger decreases in BMI (-1.4 versus -0.9 kg/m 2 , p = 0.36 than the controls, but not significantly so. The intervention subjects had higher odds of achieving a BMI of <40 kg/m 2 (odds ratio = 1.9, p = 0.44), but not significantly so. There were no significant differences in the mean change in the Hip disability and Osteoarthritis Outcome Score, the Knee injury and Osteoarthritis Outcome Score, or the Lower Extremity Activity Scale score. At baseline, only 11% had seen a dietitian in the last 3 months. Most subjects (83%) felt that video calls were helpful. There were no differences in complications between the groups; there was a patellar fracture in the control group and a deep venous thromboembolism in the intervention group.

A preoperative weight loss intervention using a dietitian and a mobile app was feasible and viewed favorably among patients. Remote dietitians and mobile apps may address gaps in access to obesity treatment before TJA. While the intervention subjects lost more weight and were more likely to achieve a BMI of <40 kg/m 2 , the differences were not significant. More intensive interventions may be needed to achieve enough weight loss for clinically important improvements in TJA.

Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

Aerobic exercise is recommended for the management of knee osteoarthritis (OA), but knee pain is often a barrier for participation. Some types of aerobic exercise may be less painful to undertake than others, though little is known about which are the most "knee friendly," that is, unlikely to exacerbate knee pain to an unacceptable level. This study aimed to identify aerobic exercise activities that (1) are knee friendly and (2) meet requirements for targeting cardiovascular health.

We conducted a three-phase international survey. In phase 1, persons living with knee OA provided descriptions of knee friendly exercise types, defined as activities that would cause shortness of breath and difficulty talking without worsening symptoms to an unacceptable level (cause severe symptoms and/or lasting more than 24 hours). In phase 2, exercise physiologists identified exercise activities meeting requirements for increasing aerobic fitness, which were grouped into broader aerobic exercise activities. In phase 3, participants nominated each aerobic exercise activity for "knee friendliness."

In phase 1, 487 respondents (Denmark: 259; the Netherlands: 144; Australia: 57; and North America: 15) provided a total of 1,590 exercise descriptions. In phase 2, 154 exercise activities were identified and grouped into a list of 30 broader aerobic exercise activities. In phase 3, 349 participants (Denmark: 195; the Netherlands: 114; Australia: 32; and North America: 8) nominated indoor biking and water exercise as most knee friendly (82% and 70%, respectively). Participants were predominantly women (60.7%), the mean ± SD age was 68.4 ± 8.81 years, the mean ± SD body mass index was 27.5 ± 5.8, the mean ± SD self-efficacy score was 7.3 ± 3.0 (0-10 scale), the mean ± SD symptom duration was 11.7 ± 9.05 years, and the mean ± SD current knee pain was 4.5 ± 2.2 (0-10 scale).

A catalog of 30 knee friendly aerobic exercise activities was generated for individuals living with knee OA. The catalog aims to empower individuals living with knee OA, offering suitable aerobic exercise options without exacerbating knee pain.

Despite extensive validation, the impact of medical comorbidities on the outcomes of the Hip Disability and Osteoarthritis Outcome Score (HOOS), Knee Injury Osteoarthritis Outcome Score (KOOS), and Foot and Ankle Outcome Score (FAOS) remains underexplored. This study aimed to evaluate the effect of medical comorbidities on HOOS, KOOS, and FAOS subscales using a large, nationally representative sample.

This national register-based cohort study invited 26,877 participants to complete HOOS, KOOS, or FAOS questionnaires. Medical comorbidities-including diabetes, chronic obstructive pulmonary disease/asthma, rheumatological diseases, osteoporosis, stroke, obesity, and heart disease-were identified through the Danish National Patient Register.

A total of 7850 participants (29%) responded, with 1863 (24%) having medical comorbidities. HOOS/KOOS/FAOS subscale scores were significantly worse in patients with comorbidities, particularly in the Sport/Rec, ADL, and QOL subscales. Mean score differences between participants with and without comorbidities were pain (- 5.7, 95% CI - 6.6 to - 4.7), symptoms (- 4.6, 95% CI - 5.5 to - 3.6), ADL (- 7.1, 95% CI - 8.0 to - 6.1), Sport/Rec (- 10.4, 95% CI - 11.9 to - 8.9), and QOL (- 6.9, 95% CI - 8.2 to - 5.7). Diabetes, rheumatological diseases, and obesity were associated with the greatest complaints.

Patients with medical comorbidity reported significantly lower HOOS/KOOS/FAOS subscale scores compared to participants without medical comorbidity. Diabetes, chronic rheumatological diseases, and adiposities were observed with the most complaints. Key Points • Medical comorbidity predicts considerably lower HOOS/KOOS/FAOS subscale scores. • Diabetes, rheumatological diseases, and obesity exerted the most pronounced negative effects on the HOOS/KOOS/FAOS. • Findings underscore the importance of considering comorbidities when interpreting HOOS/KOOS/FOAS subscale scores.

Genicular artery embolization (GAE) is an emerging minimally invasive procedure for managing knee osteoarthritis (OA), a condition affecting 365 million individuals globally. Initially developed to treat hemarthrosis, GAE selectively embolizes abnormal genicular vasculature, targeting synovial inflammation and reducing neoangiogenesis. This process alleviates pain and improves joint function, providing an alternative for patients with mild-to-moderate OA who are not candidates for surgical interventions due to comorbidities or other factors. Current evidence supports the use of GAE for patients with mild-to-moderate OA who experience persistent symptoms despite conservative treatments such as physical therapy, weight management, or intra-articular injections. The procedure effectively reduces pain, improves functionality, and provides sustained benefits. This review highlights the anatomical principles, procedural techniques, and patient selection criteria for GAE, as well as the clinical evidence supporting its safety and efficacy. It also explores potential future directions for research, including optimizing patient selection, evaluating long-term outcomes, and integrating GAE into routine OA management pathways.

There is uncertainty over whether robotic-assisted surgery (RAS) or kinematic alignment (KA) improves outcomes in total knee arthroplasty (TKA). The Robotic-Assisted Surgery and Kinematic ALignment in TKA trial (RASKAL) is a registry-nested, multicentre, randomized, blinded, 2 × 2 factorial trial involving approximately 300 TKA patients. RASKAL will assess the effectiveness of RAS, KA, or both to improve clinical, operative, functional, radiological, and survivorship outcomes when compared to computer-assisted surgery (CAS) and mechanical alignment (MA), respectively. We describe the statistical analysis plan (SAP) for the RASKAL trial to ensure transparency of this study. Our purpose is to minimize analysis bias to bolster the internal validity of our findings.

We created a SAP for the RASKAL trial to define the analysis of primary and secondary outcomes. The SAP will also state our approach to protocol deviations, withdrawals, management of missing data, and any loss to follow-up. General statistical analysis principles are outlined for the main outcomes, along with statistical tests required for each outcome.

The RASKAL SAP pre-specifies the statistical plan for the primary outcome of knee-specific function using the Knee injury and Osteoarthritis Outcome Score-12 comparing RAS to CAS and KA to MA up to one year postoperatively. The primary outcome will be reported as a modified intention-to-treat analysis, with secondary per-protocol analyses. Secondary outcomes will include other patient-reported outcome measures, early recovery, operative outcomes, functional outcomes, radiological precision, prosthetic survivorship, and cost-effectiveness analyses.

Background and Objectives: There is evidence of decreasing knee pain in patients with knee osteoarthritis when knee mechanical traction is performed surgically. Our aim was to measure the effects of standard physiotherapy with the addition of knee mechanical traction on pain, physical activity and quality of life in patients with knee osteoarthritis. Materials and Methods: A clinical observational study with intervention and without a control group was conducted at three outpatient health clinics on a primary level of the health care system. Twenty-three patients with knee osteoarthritis voluntarily participated in the study. Standard physiotherapy included education, therapeutic and aerobic exercise, conventional TENS, low-intensity laser and manual soft tissue techniques. Mechanical traction of 150 N continuous force for 15 min with the knee joint at 25° flexion was added to standard physiotherapy. The following outcome measures were used: VAS, Knee Injury and Osteoarthritis Outcome Score and a 30 s sit-to-stand test. Results: The pain measured for the VAS at rest (p < 0.001) and during movement (p < 0.001) as well as for the Knee Injury and Osteoarthritis Outcome Score pain part decreased (p < 0.05). The quality of life did not improve (p > 0.05), but the physical activity of the patients did (p < 0.05). A decrease in pain correlated with body mass (p < 0.05). Conclusions: Standard physiotherapy with the addition of mechanical traction had an effect on reducing pain and improving physical activity.

Osteoarthritis (OA) is associated with lost range of motion in the affected joint(s). Evidence suggests that this may be due to increased activity of posterior capsule fibroblasts, cells in turn derived from mesenchymal stromal cells (MSCs).

To test the hypotheses that (1) MSCs are more numerous in the posterior capsule of patients with knee flexion contracture (FC) and (2) in OA participants with knee FC, the MSC population in the posterior capsule differentiates toward a fibrotic phenotype. In order to complete these objectives, we looked for associations between capsule histologic and MSC outcomes with clinical outcomes.

Cross-sectional translational research design using data from the Ottawa Knee Osteoarthritis (OKOA) database.

A total of 71 OKOA database participants and their relevant clinical and laboratory outcomes were included. Associations were first tested with bivariate correlation, then for p < 0.10, tested using a linear model.

No lab-based differences between FC and no-FC groups we discovered. In the posterior capsule, there was an association between knee flexion and adipogenic capacity (p = 0.001), osteogenic capacity (p < 0.001), KL grade and percent "other" (mainly neurovascular) tissue (p = 0.039), visual analog scale pain, and percent fibrous tissue (p = 0.014). For the anterior capsule, there was an association between knee flexion (p = 0.002) and extension (p = 0.005) with MSC enumeration, KL grade with MSC fibrogenic capacity (p = 0.002), and Knee Injury and Osteoarthritis Outcome Score quality of life with chondrogenic capacity (p < 0.001).

Joint capsule composition, MSC enumeration, and function were associated with important clinical OA outcomes. These findings suggest that the entire joint capsule may play an important role in OA-related morbidity and progression and could represent an underappreciated target for OA treatment.

Clinicians use imaging studies to help gauge the degree to which structural factors within the knee account for patients' pain and symptoms. We aimed to determine the degree to which commonly used structural features predict a patient's knee pain and symptoms.

Using Osteoarthritis Initiative data, a 10-year study of 4,796 patients with knee osteoarthritis (KOA), participants' KOA was characterized by radiographs and MRI scans of the knee. Salient features were quantified with two established grading systems: (1) individual radiographic features (IRFs) and (2) MRI Osteoarthritis Knee Scores (MOAKS) from MRI scans. We paired participants' IRFs (24,256 readings) and MOAKS (2,851 readings) with side-specific Knee Injury and Osteoarthritis Outcome Scores (KOOS). We trained generalized linear models to predict KOOS from features measured in IRF and MOAKS. We repeated the analysis on four subsets of the cohort. The models' predictive performance was evaluated using root mean square errors and coefficient of determination (R2).

Neither radiographic features used to determine IRF grades nor MOAKS were predictive of patient pain or symptoms. MOAKS's performance was slightly more predictive of KOOS than IRF's. IRF's prediction of KOOS achieved a maximum R2 of 0.15 and 0.28 for MOAKS, indicating a low level of accuracy in predicting the target variable.

Commonly used structural features from radiographs and MRI scans cannot predict KOA pain and symptoms-even when imaging features are codified by established grading systems like IRF or MOAKS. The predictive performance of these models is even worse as symptom severity worsens.

IV.

Knee osteoarthritis (KOA) is a leading cause of global disability with conventional exercise yielding only modest improvements. Here we aimed to investigate the benefits of integrating blood flow restriction (BFR) into traditional exercise programmes to enhance treatment outcomes.

The Vascular Occlusion for optimizing the Functional Improvement in patients with Knee Osteoarthritis randomised controlled trial enrolled 120 patients with KOA at Ghent University Hospital, randomly assigning them to either a traditional exercise programme or a BFR-enhanced programme over 24 sessions in 12 weeks. Assessments were conducted at baseline, 6 weeks, 12 weeks and 3 months postintervention using linear mixed models with Dunn-Sidak corrections for multiple comparisons. Primary outcome was the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire at 3 months follow-up with knee strength, Pain Catastrophizing Scale questionnaire and functional tests as secondary outcomes. Analysis followed an intention-to-treat approach (NCT04996680).

The BFR group showed greater improvements in KOOS pain subscale (effect size (ES)=0.58; p=0.0009), quadriceps strength (ES=0.81; p<0.0001) and functional tests compared with the control group at 12 weeks. At 3 months follow-up, the BFR group continued to exhibit superior improvements in KOOS pain (ES=0.55; p=0.0008), symptoms (ES=0.59; p=0.0004) and quality of life (QoL) (ES=0.66; p=0.0001) with sustained benefits in secondary outcomes. Drop-out rates were similar in both groups.

Incorporating BFR into traditional exercise programmes significantly enhances short-term and long-term outcomes for patients with KOA demonstrating persistent improvements in pain, symptoms, QoL and functional measures compared with conventional exercise alone. These findings suggest that BFR can provide the metabolic stimulus needed to achieve muscle strength and functional gains with lower mechanical loads. Reduced pain and increased strength support a more active lifestyle, potentially maintaining muscle mass, functionality and QoL even beyond the supervised intervention period.

NCT04996680.

Chemical neurolysis of the genicular nerves is a treatment option for intractable non-cancer knee pain. This scoping review synthesizes the available literature on the effectiveness, adverse events, and procedural techniques of chemical neurolysis of genicular nerves for the management of knee pain.

Scoping review.

All clinical and research settings.

Adult participants with chronic non-cancer knee pain undergoing chemical neurolysis of genicular nerves.

A literature search in MEDLINE, EMBASE, and Cochrane Library was conducted up to September 4, 2023. Articles were searched via terms and keywords relating to "knee," "pain," "knee osteoarthritis," "ablation," "alcohol," "phenol," and "chemical neurolysis." Included articles were full-text primary studies and in English. Data were extracted by 2 independent reviewers using an electronic database.

Eight studies were included in this review (including 1 randomized controlled trial), comprising 192 patients. Of the 8 studies, 4 used phenol, 3 used alcohol, and 1 used either alcohol or phenol for chemical neurolysis. Fluoroscopy, ultrasound guidance, or both were used for nerve target identification. All studies demonstrated that chemical neurolysis resulted in improved pain or functional outcomes, with no serious adverse events reported.

Chemical neurolysis of the genicular nerves is a promising treatment strategy for chronic knee pain. Interpretation of the available studies is limited by study heterogeneity and small sample sizes. High-quality randomized controlled trials are required to clarify the selection of appropriate nerve targets and choice of image guidance and to compare with other ablative modalities.

Open Science Framework (https://osf.io/jg8wh).

To investigate whether the pivot-shift test reflects patient-reported outcomes 1 year after anterior cruciate ligament (ACL) reconstruction based on a multicentre prospective cohort study.

This study included patients who underwent primary ACL reconstruction using the hamstring tendons. The pivot-shift test grades were determined according to the International Knee Documentation Committee (IKDC) form as 0, 1+, 2+ or 3+. In addition, patients' subjective apprehension during the pivot-shift test were classified as 0 (no-apprehension), 1+ (mild-apprehension), 2+ (moderate-apprehension) or 3+ (severe-apprehension). In this study, a positive pivot-shift test was defined as grade 1+ or higher.

A total of 837 patients were enroled in this study. One year postoperatively, there was no significant difference in the Knee injury and Osteoarthritis Outcome Score (KOOS), IKDC score, Lysholm knee scale and Tegner activity scale between the positive (118 patients) and negative (719 patients) groups of the conventional IKDC grading of the pivot-shift test. However, when divided into two groups based on the apprehension grading of the pivot-shift test after surgery, the postoperative scores were significantly lower in the apprehension-positive group (114 patients) than those in the apprehension-negative group (723 patients) on the Tegner activity scale and KOOS Symptom, Sports/Rec and Quality of Life subscales.

Patients' subjective apprehension during the pivot-shift test after ACL reconstruction was significantly associated with the postoperative Tegner activity scale and three subscales of the KOOS. However, there was no association between the conventional IKDC grading of the pivot-shift test and any patient-reported outcomes postoperatively.

Level II.

Trochlear dysplasia is a major risk factor for recurrent patellar instability, reduced quality of life and osteoarthritis of the patellofemoral joint. Patellar instability in patients with trochlear dysplasia can be treated by trochleoplasty, usually in combination with medial patellofemoral ligament reconstruction (MPFL-R). An à la carte treatment algorithm, which also addresses patella alta, lateralisation of the tibial tuberosity and valgus or torsional malalignment when present has been standard in one clinic for treatment of patellar instability patients since 2009, based on the hypothesis that it results in optimal subjective and clinical outcome, normalisation of the lateral trochlea inclination (LTI) angle and a low rate of patellar redislocation.

This prospective study reports the 5-year results for consecutive patients with high-grade trochlea dysplasia operated according to the algorithm 2010-2017, evaluated preoperatively and 1, 2 and 5 years postoperatively. Clinical information on previous surgery and postoperative patellar stability, range-of-motion (ROM) and subsequent surgery were registered. Subjective outcome was evaluated by four patient-reported outcome measures (PROMs): Kujala, Lysholm, International Knee Documentation Committee and Knee injury and Osteoarthritis Outcome Score. The LTI angle was measured pre- and postoperatively on magnetic resonance imaging scans.

There were 131 patients (87 females) with a median age of 22 years (range: 14-38). All had a trochleoplasty and an MPFL-R. Additional procedures (tibial tuberosity medialisation/distalisation and/or femoral/tibial osteotomy) were performed in 52%. All PROM scores improved from preoperatively to 1-year follow-up with further improvement at 2 and 5 years after surgery (p < 0.05). Three patients (2%) had a traumatic patellar dislocation 9, 12 and 24 months postoperatively and 38% underwent subsequent surgery (hardware removal, arthroscopically assisted brisement force, knee arthroscopy). A normalisation of the LTI angle (≥11°) was achieved in 76%.

Treatment according to the à la carte algorithm for patients with patellar instability and high-grade trochlear dysplasia resulted in significant clinical and subjective improvement in all PROM scores and a very low redislocation rate (2%) 5 years after surgery.

Level II.

The study of pain at rest (PAR) and movement-evoked pain (MEP) in persons with musculoskeletal pain has received substantial attention. Despite strong interest, relatively little attention has been directed to the psychometric development of these constructs. Our purpose was to explore the relationship between PAR and MEP and to examine the prognostic utility of these measures in persons with knee arthroplasty.

We used prospectively collected data from persons scheduled for knee arthroplasty who had moderate to high levels of pain catastrophizing. Preoperative latent variables for PAR and MEP were developed and used to determine if they were associated with a binary latent variable of good versus poor pain and function outcome trajectories. Factor correlations were used to determine the extent to which the variance for PAR and MEP was overlapping.

PAR and MEP are significant predictors of good versus poor pain and function classes. Odds ratios ranged from 1.21 to 1.64 (p < 0.001) indicating a significant increase in the likelihood of poor outcome. Correlation between PAR and MEP latent variables was high (r = 0.89; 95% CI: 0.86-0.92) indicating substantially overlapping variance.

PAR and MEP, as defined in our study, can be used to make prognostic judgements regarding risk of poor postoperative outcome trajectory following knee arthroplasty. However, PAR and MEP showed substantially overlapping variance indicating that measurements of both are not necessary when making prognostic assessments.

Preoperative PAR and MEP latent variables, as defined in our study, had prognostic significance for 1 year pain and function outcome trajectories. PAR and MEP latent variables had substantially overlapping variance which suggested that only one is needed to make prognostic judgements. The prognostic significance of PAR and MEP as well as their substantially overlapping variance is new to the field prognostic research in knee arthroplasty.

To perform a systematic review of clinical outcomes in patients who underwent treatment with micro-fragmented aspirated tissue for symptoms of knee osteoarthritis.

Medline, Embase, Scopus, and Google Scholar were screened for studies from 2000 to 2023. Risk of bias (ROB) was assessed using the Cochrane Collaboration's tools and the Risk Of Bias In Non-randomised Studies-of Interventions tool. Study quality was assessed with the modified Coleman Methodology Score and Methodological Index for Non-Randomized Studies score. Heterogeneity was assessed using χ2 and I2 statistics.

Twenty-one studies were included. One study had a high ROB, 1 had a critical ROB, 3 had serious ROB, and 16 had a moderate ROB. The mean Coleman score was 58, demonstrating fair study quality; the Methodological Index for Non-Randomized Studies score had a mean value of 13, indicating overall fair quality. Best evidence synthesis revealed moderate evidence. The visual analog scale score improved from 5.2 to 3.2 at 6 and 12 months. Knee injury and Osteoarthritis Outcome Score (KOOS) activities of daily living subscore improved from 58.8 to 70.2 at 6 months and 67.5 at 12 months. KOOS pain subscore improved from 54.3 to 70.2 at 6 months and 72.4 at 12 months. KOOS quality of life subscore improved from 33.1 to 43.6 at 6 months and 42.9 at 12 months. KOOS sports subscore improved from 23.7 to 43.6 at 6 months and 57.4 at 12 months. KOOS symptoms subscore improved from 55.3 to 70.1 at 6 months and 67.9 at 12 months. The Western Ontario and McMaster Universities Osteoarthritis Index score steadily increased from 61.8 at baseline to 78.4 at 12 months.

micro-fragmented aspirated tissue injection therapy for the treatment of symptomatic knee osteoarthritis is effective and improves pain and functional outcomes. Moderate study quality combined with a moderate risk of bias, moderate certainty of evidence, and moderate best synthesis evidence reduces external validity. Therefore, the results should be interpreted with a degree of caution.

Level IV, systematic review of Level I-IV studies.

To determine the diagnostic performance of dual-energy CT (DECT) virtual noncalcium (VNCa) technique in the detection of bone marrow lesions (BMLs) in knee osteoarthritis, and further analyze the correlation between the severity of BMLs on VNCa image and the degree of knee pain. 23 consecutive patients with clinically diagnosed knee osteoarthritis were underwent DECT and 3.0T MRI between August 2017 and November 2018. Evaluation of two pain assessment scales (WOMAC and KOOS) were collected. VNCa images and MRI were independently scored by three readers using a four-level scoring system over 15 anatomical subregions in each knee joint. Spearman correlation coefficient was used for total BML scores on DECT and MRI correlation with WOMAC and KOOS. Specificity, Sensitivity, NPV and PPV of reader 1 and reader 2 were 99.4%/99.2%, 89.4%/87.2%, 98.6%/98.3% and 95.5%/93.2%. A cutoff value of - 41.5 HU/- 46.5 HU provided sensitivities of 93.2%/90.9% and specificities of 100.0%/93.9% for diagnosing BMLs with AUC of 0.970/0.996. A stronger correlation was observed between the WOMAC and total BML score compared to the KOOS. DECT possessed excellent diagnostic performance in the detection of BMLs in knee osteoarthritis. And the pain degree increased with the severity of BMLs on VNCa images.

Knee osteoarthritis (KOA) is the most common form of arthritis in adults and a leading cause of years lived with disability, representing a significant burden on healthcare worldwide.

Describe the structure and educational elements of the Knee-SCHOOL, a brief patient-centered multidisciplinary educational program for patients with KOA.

Observational prospective study.

Academically affiliated rehabilitation outpatient center in Brazil.

The program consisted of three in-person educational sessions (4.5 hr each) for 55 community dwelling adults, aged ≥50 years, with primary KOA-related pain. Study measures included demographic data (age, sex, and educational level), pain duration (years), pain intensity (visual analogue scale), affected knee (right, left, or both knees), comorbidities (presence of hypertension, diabetes, and hypercholesterolemia), Body Mass Index (BMI), Bristol Stool Scale, Adapted Healthy Eating Index (AHEI), bioelectrical impedance, daytime sleepiness, and the impact of the KOA on pain, symptoms, activities of daily living, recreation, and quality of life. Participants attended educational sessions delivered by a multidisciplinary team (two physicians, two nurses, two physical therapists, one occupational therapist, one dietitian, one psychologist, one social worker, and one physical educator) addressing several aspects of KOA. They also participated in supervised exercise practice and a home exercise program.

Fifty-five subjects completed the study. The mean age was 67.73 (± 7.73) years; most were females (70.9%), 92.7% had bilateral KOA, with mean pain duration of 12.41 (± 10.17) years. The mean BMI was 32.52 (± 5.99), 65.5% were obese, and 96.4% reported an inadequate diet. KOA had a more negative impact on sports, recreation and quality of life. Daytime sleepiness was uncommon. The mean pain intensity, measured with visual analogue scale, score reduced from 5.52 (± 2.11) at baseline to 4.04 (± 2.38) after the program (week 2). The effect size was 0.7 (95% CI 0.32 to 1.07). All participants received the program well, with no drop-out rates or reported adverse events.

The Knee-SCHOOL utilized a multidisciplinary educational approach and an exercise practice addressing multiple aspects of KOA pain. While more studies are needed to assess the longitudinal impact of the program, it was promising in managing pain.

To characterize the ultrasonographic findings of patients with early knee osteoarthritis (KOA) and determine which findings were associated with the Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale.

The study included 98 knees (35 men, 63 women, 60.3 ± 11.5 years) diagnosed with early KOA with no major deformity radiographically, but with pain during activity and tenderness in the medial knee. Synovial hyperplasia in the suprapatellar bursa, knee joint effusion, horizontal tear of the medial meniscus (MM), osteophytes of the medial condyle of the femur and tibia, blood flow signals in the synovium of the suprapatellar bursa, medial collateral ligament bursa, infrapatellar fat pad, MM extrusion (MME) in the supine and upright positions, and the amount of change in MME were observed using ultrasonography.

Correlations (p < 0.05) were found between the presence of synovial hyperplasia of the suprapatellar bursa (r<-0.20) and amount of MME in the upright position (r< - 0.24) and all KOOS subscales. Presence of joint effusion and the four KOOS subscales except quality of life (QOL) were correlated (p < 0.05). Partial correlation coefficients showed correlations (p < 0.05) between knee joint effusion and symptoms (r = 0.299) and activities of daily living (ADL) (r = 0.254) of the KOOS subscales, and between MME in the upright position and symptoms (r= - 0.263), pain (r= - 0.256), and ADL (r= - 0.212).

Quality and difficulty of life of patients with early KOA may be influenced by synovial hyperplasia in the suprapatellar bursa, joint effusion, and MME values in the upright position. Among them, synovial hyperplasia of the suprapatellar bursa and amount of MME in the upright position were independently associated with the KOOS subscales.

Bone marrow aspirate concentrate (BMAC) is considered one of the biological treatments for knee osteoarthritis (KOA). Patient selection remains a key factor to ensure that optimal treatment benefit and body mass index (BMI) are one of the key factors to be considered. This study aims to evaluate the influence of obesity on the duration of treatment benefit of BMAC for KOA.

This prospective cohort study enrolled 68 patients who underwent a single BMAC injection for early stage KOA. The patients were categorized based on their BMI into normal, overweight, and obese groups. Visual Analog Scale (VAS) for pain and Knee Injury and Osteoarthritis Outcome Score (KOOS) were the outcomes analysed. The duration of treatment benefit is estimated by Kaplan-Meier survival analysis.

Sixty-eight patients (normal BMI = 43, overweight BMI = 15, obese BMI = 10) were enrolled in the study for analysis. While significant improvement in the outcome scores was noted compared to the baseline throughout the study period in the normal BMI and overweight group, the obese group returned to baseline parameters at 3 months follow-up. Patients in the normal BMI group demonstrated significant improvement in VAS (p < 0.001) and KOOS (p < 0.001) outcomes compared to the overweight and obese group. Survival analysis demonstrated a significant decline in the mean treatment benefit of 9.8 (95%CI [6.151-13.431], p = 0.027) months in normal BMI group to 6.6 (95%CI [3.473-9.727]) months and 4.1 (95%CI [2.760-5.440]) months in overweight and obese groups, respectively.

BMI is a significant factor that influences the benefit of BMAC injection for early knee OA. Hence, BMAC injection must be used with caution in individuals with high BMI.

This pilot trial examined a Physical Activity and Symmetry (PAS) intervention focused on common deficits of physical inactivity and joint loading asymmetry following total knee arthroplasty (TKA).

Participants (n ​= ​60) were enrolled during routine physical therapy (PT) following TKA and randomized to the PAS intervention or an attention (ATT) control group. The PAS intervention included physical activity counseling and balance exercise to address joint loading symmetry; content was delivered during 2 sessions at the end of routine PT plus supplemental sessions 4-weeks and 8-weeks following PT. The ATT control condition included supplemental sessions at 4-weeks and 8-weeks focused on general evaluation of surgical recovery benchmarks. Primary outcomes were weekly minutes of moderate to vigorous physical activity (MVPA), measured with an accelerometer, and peak force loading symmetry (limb symmetry index; LSI) during a 10 ​m walk, measured with a 3-sensor in-shoe device. General linear mixed models compared changes in outcomes between randomized groups at 3-month and 6-month follow-up.

Both PAS and ATT groups increased MVPA, but there were no clinically meaningful between-group differences at 3- or 6-month follow-up (p ​> ​0.05). There were also no clinically meaningful between-group differences LSI at 3- or 6-month follow-up (p ​> ​0.05).

The PAS intervention did not yield improvements beyond ATT control. It is possible that PAS components were being delivered as part of routine PT, and a more intensive intervention (e.g., more visits, guidance for exercise progression) or targeted approach (e.g., those with deficits at end of routine care) may be needed to further improve outcomes.

The objective of this study is to outline the training of peer coaches in the Moving Well intervention, which was designed to reduce anxiety, depression, and pain catastrophizing in patients before and after total knee replacement (TKR).

Selected peer coaches had a history of knee osteoarthritis (KOA), a TKR of 12 months or more before training, and were 60 or older. Training was primarily conducted virtually, with a later addition of one in-person session. Training centered on developing skills in motivational interviewing (MoI), encompassing techniques like open-ended questions, affirmations, reflective listening, and summarization. It also covered the MoI processes of engagement, focus, evocation, and planning. Coaches were required to discuss at least 90% of session-specific topics, which were monitored using checklists for each certification, and to complete individual MoI training, which was not graded. The evaluation of peer coach training involved surveys and a focus group.

Three women and two men, averaging 75 years in age, completed the peer coach training for the Moving Well intervention. An in-person training session was added to address technology and MoI skill concerns, greatly enhancing their grasp of MoI skills and their ability to guide others through the program effectively. Peer coaches stressed the importance of live feedback, in-person training, and incorporating personal experiences into the program content during their training.

To effectively train older adults as peer coaches for the Moving Well intervention, flexibility in learning formats, personalized guidance, peer support, and regular evaluations were essential in building the necessary MoI competencies to guide research participants in the program.

Understanding how forces are transmitted through the knee after TKA is essential, as it may explain why many patients experience pain or functional limitations during various activities. This study compared knee muscle forces and knee contact forces (KCF) during sit-to-stand in patients one year after unilateral total knee arthroplasty (TKA) with either a medial ball-and-socket (MBS) or posterior stabilized (PS) implant and compared them to a group of similarly healthy aged controls (CTRL). A musculoskeletal model and static optimization estimated lower limb kinematics, knee kinetics, muscle forces, and KCFs. The normalized sit-to-stand cycle was compared among the groups using statistical nonparametric mapping, and peak between-limb differences were compared using discrete statistics. The PS group required greater forward lean during the sit-to-stand task, causing greater spine flexion, posterior pelvic tilt, and decreased hip flexion on the operated limb. PS and MBS groups favoured their non-operated limb, resulting in less range of motion throughout the lower limb, lower knee kinetics, muscle forces, and KCFs on the operated limb. Compared to the controls, the MBS and PS groups had reduced medial compartment KCF. The control group did favour their dominant limb over their non-dominant limb. Post-operative rehabilitation should continue to promote greater use of the operated knee to have more symmetrical loading between operated and non-operated limbs and improve strength and mobility at the hip and ankle joints. One year after surgery, TKA patients remain with reduced muscle forces and KCF on their operated limb during a sit-to-stand task, regardless whether they received an MBS or PS implant.

There is concern that physiologic knee hyperextension may be associated with inferior outcomes after anterior cruciate ligament reconstruction (ACLR) using hamstring tendon (HT) autografts.

To assess whether there is an association between contralateral passive preoperative knee hyperextension (≤-5°) and postoperative anterior knee laxity, subjective knee function, or revision surgery after ACLR using HT autografts.

Cohort study; Level of evidence, 3.

Patients without concomitant ligament injuries who underwent primary ACLR using an HT autograft at Capio Artro Clinic, Stockholm, Sweden, between January 1, 2005, and December 31, 2018, were identified. The cohort was dichotomized into the hyperextension group (≤-5°) and the no hyperextension group (>-5°) depending on preoperative contralateral passive knee extension degree. Anterior knee laxity (KT-1000 arthrometer; 134 N) was assessed preoperatively and at 6 months postoperatively. The Knee injury and Osteoarthritis Outcome Score (KOOS) was collected preoperatively and at 1, 2, and 5 years postoperatively. Patients who underwent revision ACLR at any institution in Sweden within 5 years of the primary surgery were identified in the Swedish National Knee Ligament Registry.

A total of 6104 patients (53.5% male) for whom knee range of motion measurements were available were identified (hyperextension group [≤-5°]: 2350 [38.5%]; mean extension, -6.1°± 2.3° [range, -20° to -5°]; no hyperextension group [>-5°]: 3754 [61.5%]; mean extension, 0°± 1.4° [range, -4° to 15°]). There were no intergroup differences in anterior knee laxity preoperatively (hyperextension group, 3.6 ± 2.8 mm; no hyperextension group, 3.7 ± 2.7 mm; P = .24) or postoperatively (hyperextension group, 1.8 ± 2.3 mm; no hyperextension group, 1.8 ± 2.2 mm; P = .41). The only significant but nonclinically relevant intergroup differences were seen in the KOOS Symptoms subscale at the 1-year follow-up (hyperextension group, 81.4 ± 16.0; no hyperextension group, 80.3 ± 16.5; P = .03) and in the Sport and Recreation subscale at the 5-year follow-up (hyperextension group, 73.0 ± 25.6; no hyperextension group, 75.7 ± 24.3; P = .02). No other significant intergroup differences were noted preoperatively or at 1, 2, or 5 years postoperatively in any of the KOOS subscales. The overall revision ACLR rate at ≤5 years after the primary surgery was 4.9% (302 of 6104 patients). The hazard for revision ACLR in the no hyperextension group (4.5%; 170 of 3754 patients) was not significantly different from that in the hyperextension group (5.6%; 132 of 2350 patients) (hazard ratio, 0.89; 95% CI, 0.71 to -1.12; P = .34). A subsequent subanalysis showed that the hazard of revision ACLR in patients with no hyperextension was not significantly different from that of patients with ≤-10° of extension (5.8%; 27 of 467 patients) (hazard ratio, 0.91; 95% CI, 0.61 to 1.36; P = .65).

Preoperative passive contralateral knee hyperextension (≤-5°) was not associated with postoperative anterior knee laxity, subjective knee function, or revision surgery ≤5 years after ACLR using HT autografts. Therefore, the presence of knee hyperextension alone should not be considered a contraindication per se for the use of HT autografts in ACLR.

To identify the presence and distribution of histopathological features of synovial inflammation and tissue damage, and to test their associations with ultrasound (US) imaging measures of synovitis and patient-reported measures of pain in knee osteoarthritis (OA).

In the cross-sectional study of 122 patients undergoing surgery for painful late-stage (Kellgren-Lawrence Grade 3 or 4) knee OA, we compared US measures of synovitis (n = 118) and pain (Knee Injury and Osteoarthritis Outcome Score) to histopathological measures of inflammation vs. synovial tissue damage in synovial tissue biopsies. Associations of histopathological features with US measures of inflammation or pain were assessed using linear or logistic regression while controlling for covariates.

Histopathological features of inflammation were associated with higher odds of moderate/severe US synovitis (odds ratio [OR] = 1.34 [95%CI 1.04, 1.74), whereas features of synovial tissue damage were associated with lower odds of moderate/severe US synovitis (OR = 0.77 [95%CI 0.57, 1.03]). Worse histopathological scores for synovial tissue damage were associated with more pain (-1.47 [95%CI -2.88, -0.05]), even while adjusting for synovial inflammation (-1.61 [95%CI -3.12, -0.10]).

Synovial tissue damage is associated with pain in late-stage knee OA, independent from inflammation and radiographic damage. These novel findings suggest that preventing synovial tissue damage may be an important goal of disease-modifying OA therapy.

Sarcopenia and osteoarthritis are prevalent age-related diseases that mutually exacerbate each other, creating a vicious cycle that worsens both conditions. Exercise is key to breaking this detrimental cycle. Facing increasing demand for rehabilitation services within this patient demographic, ChatGPT-4 and wearable device may increase the availability, efficiency and personalization of such health care.

To evaluate the clinical efficacy and cost-effectiveness of a rehabilitation system implemented on mobile platforms, utilizing the integration of ChatGPT-4 and wearable devices.

The study design is a prospective randomized open blinded end-point (PROBE) non-inferiority trial. 278 patients diagnosed with osteoarthritis and sarcopenia will be recruited and randomly assigned to the intervention group and the control group. In the intervention group patients receive mobile phone-based rehabilitation service where ChatGPT-4 generates personalized exercise therapy, and wearable device guides and monitor the patient to implement the exercise therapy. Traditional clinic based face-to-face exercise therapy will be prescribed and implemented in the control group. All patients will receive three-months exercise therapies following the frequency, intensity, type, time, volume and progression (FITT-VP) principle. The patients will be assessed at baseline, one month, three months, and six months after initiation. Outcome measures will include ROM, gait patterns, Visual Analogue Scale (VAS) for pain assessment, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS) for functional assessment, Short-Form Health Survey 12 (SF-12) for quality of life, Minimal Clinically Important Difference (MCID), Patient Acceptable Symptom State (PASS), and Substantial Clinical Benefit (SCB) for clinically significant measures.

A rehabilitation system combining the capabilities of ChatGPT-4 and wearable devices potentially enhance the availability and efficiency of professional rehabilitation services, thus enhancing the therapeutic outcomes for a substantial population concurrently afflicted with sarcopenia and osteoarthritis.

Central sensitization has a significant effect on pain after osteotomy around the knee (OAK). The central sensitization inventory (CSI) score is considered disease specific, and the appropriate cut-off values for OAK are unclear. The purpose of this study was to establish the optimal CSI cut-off value affecting the postoperative outcomes of OAK based on the postoperative knee injury and osteoarthritis outcome score (KOOS).

Patients who underwent OAK for medial compartment knee osteoarthritis were included. The postoperative KOOS symptoms, pain, and activities of daily living (ADL) were categorized into two groups (score ≥80 each for symptoms, pain, and ADL, and score <80 for any of the three) and were used as factors to calculate receiver operating characteristic curves and the area under the curve with the CSI score. Cut-off values were calculated using the Youden index and the threshold value closest to the upper left corner. Subsequently, logistic multivariate analysis was performed using the KOOS and the obtained CSI cut-off values and other variables.

A total of 173 patients were included in this study. The area under the curve of the model was 0.801 (95 % confidence interval, 0.74-0.87), and a CSI score of 12 was determined as the cut-off value. Logistic multivariate analysis based on the cut-off value showed that only the CSI score (odds ratio, 9.79; 95 % CI, 4.47-21.4; P < 0.01) was significant.

The optimal CSI cut-off value affecting the postoperative outcomes of OAK calculated using the postoperative KOOS was 12, which was supported by multivariate analysis results. Central sensitization assessment with an appropriate cut-off value would allow a more personalized treatment approach and may contribute to a better postoperative outcome.

The impact of untreated medial meniscus posterior root (MMPR) tear (MMPRT) during opening-wedge high tibial osteotomy (OWHTO) on patient-reported outcomes (PROs) remains poorly understood. This retrospective cohort study aimed to investigate the association between the presence of MMPRT and post-operative PROs in patients who underwent OWHTO.

A total of 83 knees that underwent OWHTO that were followed up for 6.6 years were included. Post-operative PROs were assessed using the knee injury and osteoarthritis outcome score (KOOS) subscales. Medial meniscus extrusion (MME) was measured by magnetic resonance imaging (MRI). MMPRT was diagnosed based on preoperative MRI and intraoperative arthroscopy findings. The participants were categorized into the MMPRT and MMPR intact (MMPRI) groups, and their KOOS subscales were compared. Additionally, logistic regression analysis was conducted to explore the correlation between KOOS and MMPRT presence.

In total, 29 out of 80 (36.3%) knees were classified into the MMPRT group, while three knees underwent total knee arthroplasty. Preoperative MME was 3.5 ± 1.9 (range 0-8.9) mm, showing correlation with the presence of MMPRT (p = 0.004) by regression analysis. The post-operative KOOS subscales of the MMPRT group were lower than the MMPRI group for pain (p = 0.017), activities of daily living (ADLs) (p = 0.001), sports (p < 0.001) and quality of life (QOL) (p < 0.001). Additionally, regression analysis showed the presence of MMPRT was correlated with lower KOOS subscale scores for pain (p = 0.041), ADLs (p = 0.011), sports (p < 0.001) and QOL (p = 0.002).

Preoperative MMPRT correlated with a reduction in mid-term post-operative PROs, as assessed using the KOOS, among patients who underwent OWHTO. Surgeons should consider addressing an MMPRT at the time of OWHTO.

Level IV.

The aim was to translate and adapt The Anterior Cruciate Ligament Return to Sport after Injury Scale (ACL-RSI) to Spanish and provide evidence of its psychometric properties and responsiveness in a both sexes multisport sample.

ACL-RSI Spanish version (SP ACL-RSI) was obtained by forward-back-translation method. Internal consistency, test-retest reliability, construct validity and responsiveness were assessed. Standardized response mean (SRM), smallest detectable change (SDC) and minimally important change (MIC) were obtained by anchor-based method. The sample consisted of n = 132 multisport patients who underwent ACL-RSI. Sixty-seven patients (Group A) completed test-retest of the SP ACL-RSI within 15 days and 65 patients (Group B) fulfilled SP ACL-RSI, the Tampa Scale of Kinesiophobia (TSK-11), the International Knee Documentation Committee-Subjective Knee Form (IKDC-SF 2000), the Knee Osteoarthritis Outcome Score (KOOS) preoperative, 6 and 12 months.

The SP ACL-RSI shows satisfactory internal consistency (Cronbach's α = 0.95) and test-retest reliability (ICC = 0.92), with acceptable floor (9%) and ceiling (6%) effects. Convergent validity was supported with moderate positive correlations with KOOS and IKDC-SF 2000 dimensions, and a negative correlation with the TSK (p < 0.001). For SDC responsiveness, a high effect was observed with SRM = 0.97 at 12 months, and the MIC for SP ACL-RSI was 15.

The SP ACL-RSI is as valid and reliable as the original for measuring emotions, confidence in performance, and re-injury risk on return to sport after ACL-R in Spanish-speaking multisport practitioners of both sexes. Moreover, it shows acceptable responsiveness, performing better at the group level than the individual level.

A cohort study (diagnosis); Level II of evidence.

No established definition for early-stage knee osteoarthritis (KOA) is available, nor classification criteria. Identifying the characteristics of individuals presenting with early-stage KOA symptoms can enhance diagnosis to prevent progression. This study aimed to describe clinical and structural features of individuals presenting with knee complaints within two years after their first consultation, while exploring differences in the duration of knee complaints.

Baseline data was used from the LITE randomized controlled trial, assessing the effectiveness of a lifestyle intervention for individuals with knee complaints and overweight in primary care. Baseline assessments included questionnaires, clinical assessment, and MRI of the most symptomatic knee. Differences between groups with varying durations of knee complaints (<12, ≥12-<24, ≥24 months) were evaluated.

Participants (N ​= ​218, 65% female, mean age 59 ​± ​6 years, mean BMI 32 ​± ​5 ​kg/m2) had a median knee complaint duration of 14 months, with an average KOOS pain score of 60 ​± ​17.46% reported their symptoms as unacceptable. Structural MRI-defined KOA was observed in 71% of participants. There were no significant differences in clinical or structural MRI features between different durations of knee complaints.

Within 24 months of initial consultation, over two-thirds of participants displayed MRI-defined structural KOA, and nearly half reported unacceptable symptom states. This study found no association between the duration of knee complaints and symptoms severity or structural KOA presence, underscoring the complexity of identifying stages of KOA among individuals with overweight. Future studies should explore additional features beyond current considerations to facilitate early-stage KOA diagnosis, specifically for individuals with overweight.

Bone-patellar tendon-bone (BPTB) and double-looped semitendinosus and gracilis (hamstring) grafts are commonly used for anterior cruciate ligament (ACL) reconstruction. Short-term and midterm studies show little or no differences between the 2 grafts; however, there are only a few long-term studies to compare results between the 2 grafts.

To compare the results after using either BPTB grafts or hamstring tendon grafts 18 years after ACL reconstruction.

Randomized controlled trial; Level of evidence 2.

A total of 114 patients with ACL rupture between 2001 and 2004 were randomized to reconstruction with either a BPTB graft or a hamstring tendon graft. Patients were operated on at 4 major hospitals. The 18-year follow-up evaluation included anterior knee laxity measured with a KT-1000 arthrometer, defined as the primary outcome, while clinical examination (Lachman and pivot-shift tests), isokinetic testing of muscle strength, patient-reported outcome measures, and an assessment of radiographic osteoarthritis using the Kellgren-Lawrence classification were defined as secondary outcomes.

A total of 96 patients (84%, 47 BPTB and 49 hamstring grafts) were available for follow-up, 71 of these for clinical examination. Seven of 96 patients were excluded for ACL revision (n = 5) or knee replacement (n = 2) surgery. In total, 25 patients (10 BPTB and 15 hamstring grafts) had undergone additional surgery other than ACL revision or total knee arthroplasty. There were no significant differences between the groups in terms of anterior laxity test with KT-1000 arthrometer (primary outcome). In secondary outcomes, no significant differences between groups were reported regarding clinical examination, patient-reported outcome scores, or radiographic osteoarthritis (Kellgren-Lawrence grade 2-4 for patellofemoral joint [18 hamstring and 14 BPTB] or tibiofemoral joint [20 hamstring and 19 BPTB]), while isokinetic testing revealed that the hamstring group had a 10.7% reduction in mean peak flexion torque compared with the BPTB group at 60 deg/s (df = 59; P = .011). At 60 deg/s the mean total flexion work in the hamstring group was reduced by 17.2% compared with the BPTB group (df = 59; P = .002).

The flexion strength in the hamstring group was significantly reduced in the operated knee after 18 years. There were no significant differences between the groups regarding subjective outcomes, patient-reported outcomes, range of motion, clinical and instrumented knee laxity, and the development of osteoarthritis.

NCT05876013 (ClinicalTrials.gov identifier).

To assess the safety and efficacy of an allogeneic adipose-derived mesenchymal stem cell preparation (MAG200) in the treatment of knee osteoarthritis over 12 months.

A single-centre, double-blind, ascending dose, randomised controlled trial. 40 participants with moderate knee osteoarthritis were randomised to receive a single intra-articular injection of MAG200 (dose cohorts:10, 20, 50, 100 ​× ​106 ​cells) or placebo. Primary objectives were safety and efficacy according to a compound responder analysis of minimal clinically important difference in pain (numerical pain rating scale [NPRS]) and function (Knee Injury and Osteoarthritis Outcome Score - Function in Daily Living subscale [KOOSADL]) at month 12. Secondary efficacy outcomes included changes from baseline in patient reported outcome measures and evaluation of disease-modification using quantitative MRI.

Treatment was well tolerated with no treatment-related serious adverse events. MAG200 cohorts reported a greater proportion of responders than placebo and demonstrated clinical and statistically significant improvement in pain and clinically relevant improvement in all KOOS subscales. MAG200 demonstrated a reproducible treatment effect over placebo, which was clinically relevant for pain in the 10 ​× ​106 dose cohort (mean difference NPRS:-2.25[95%CI:-4.47,-0.03, p ​= ​0.0468]) and for function in the 20 ​× ​106 and 100 ​× ​106 dose cohorts (mean difference KOOSADL:10.12[95%CI:-1.51,21.76, p ​= ​0.0863] and 10.81[95%CI:-1.42,23.04, p ​= ​0.0810] respectively). A trend in disease-modification was observed with improvement in total knee cartilage volume in MAG200 10, 20, and 100 ​× ​106 dose cohorts, with progression of osteoarthritis in placebo, though this was not statistically significant. No clear dose response was observed.

This early-phase study provides supportive safety and efficacy evidence to progress MAG200 to later-stage trial development.

ACTRN12617001095358/ACTRN12621000622808.

To determine, in a head-to-head comparison, which of two RAND-based knee replacement appropriateness criteria is optimal based on comparison to an externally validated method of judging good versus poor outcome.

Longitudinal data from the Osteoarthritis Initiative (OAI) and the Multicenter Osteoarthritis Study (MOST) were combined to produce a dataset of 922 persons with knee arthroplasty, 602 of which had adequate data for RAND classification and had their surgery within one year prior to a study visit. Data were used to determine appropriateness classification (i.e., Appropriate, Inconclusive, Rarely Appropriate) using modified versions of the first-generation and second-generation Escobar system. Growth curve analyses and multivariable regression were used to compare the two systems.

Neither system associated with the gold standard measure of good versus poor outcome. Distributions of appropriateness categories for the second-generation system were inconsistent with current evidence for knee arthroplasty outcome. For example, 16% of participants were classified as Appropriate and 64% as Rarely Appropriate for pain outcome. Distributions for the first-generation system aligned with current evidence.

The first-generation modified version of the Escobar appropriateness system is superior to the newer version but neither version associated with our gold standard growth curve analyses. Both systems only differentiate between patient classification groups preoperatively and up to ten months following surgery. Reliance on appropriateness criteria to inform long-term outcome is not warranted.

Mobile applications (apps) may be beneficial to promote self-management strategies to mitigate the risk of developing post-traumatic osteoarthritis in military members following a traumatic knee injury. This study investigated the efficacy of a mobile app in facilitating behavior modification to improve function and symptomology among military members.

This is a preliminary pre and post hoc analysis of a randomized control trial. The MARX scale, Intermittent and Constant Osteoarthritis Pain (ICOAP) questionnaire, and the Knee Injury and Osteoarthritic Outcome Score Readiness to Manage Osteoarthritis Questionnaire were completed at baseline, 6-week, 6-month, and 12-month follow-up. Participants in the treatment arm completed the System Usability Scale. Data were analyzed using descriptive statistics, the Wilcoxon sum of ranks test, the Wilcoxon signed-rank test, and Cohen's d effect size.

A total of 28 participants were included. Between-group differences for baseline and 6-week follow-up were significantly improved in the injured knee ICOAP constant pain score for the treatment group (treatment: -4.2 ± 12, 95% CI: -11.5, 3.1; control: 5.5 ± 9.9, 95% CI: 0.9, 10.1; P = .035, effect size = 0.905). Within-group differences for baseline and 6-week follow-up demonstrated a significant decline in the injured knee ICOAP constant pain score among the control group (signed-rank: 16.0, P = .031, Cohen's d = 0.339). No other significant differences were observed. A good System Usability Scale score for usability was found (76.6 ± 8.8).

These results indicate that the mobile app is easy to use and may contribute to improved constant pain symptomology for patients at risk for post-traumatic osteoarthritis.

Recurrent patellar dislocation is a debilitating musculoskeletal condition, affecting mainly adolescents and adults under the age of 30. It can persist for many decades, causing pain and cartilage and soft-tissue damage, potentially leading to osteoarthritis. Recurrent patellar dislocation can be managed with physiotherapy or surgery. However, it is not known which treatment is most effective.

Recurrent Patellar Dislocation: Personalised Therapy or Operative Treatment (REPPORT) is a pragmatic, multicentre, two-arm, superiority, randomised controlled trial. It will compare the clinical and cost-effectiveness of an initial management strategy of personalised, phased and progressive rehabilitation, termed personalised knee therapy versus surgery for recurrent patellar dislocation.The trial's target sample size is 276 participants who will be recruited from approximately 20 sites across the UK. Participants will be randomly allocated to the two treatment groups via a central computer-based minimisation system. Treatment allocation will be in a 1:1 ratio, stratified by age, presence of patella alta and recruitment site.The primary outcome is participant-reported function using the Knee injury and Osteoarthritis Outcome 4-domain score at 18 months post randomisation. Health economic evaluation will be conducted from a healthcare system and personal social services perspective. Secondary outcome data including patellar instability, health utility, work/education status, satisfaction with social roles and treatment, health resource use and adverse events will be collected at 6, 12, 18 and 24 months. Analysis will be on an intention-to-treat basis and reported in-line with the Consolidated Standards of Reporting Trials statement.

The trial was approved by the East Midlands-Nottingham 2 Research Ethics Committee on 30 March 2023.Results will be disseminated via peer-reviewed publications, presentations at national and international conferences, in lay summaries, and using the REPPORT website and social media channels.

ISRCTN17972668.