Relationship of Patellofemoral Osteoarthritis to Changes in Performance-based Physical Function Over 7 Years: The Multicenter Osteoarthritis Study.

OBJECTIVE: To determine the relationship of patellofemoral osteoarthritis (PFOA) to changes in performance-based function over 7 years. METHODS: There were 2666 participants (62.2 ± 8.0 yrs, BMI 30.6 ± 5.9 kg/m2, 60% female) from the Multicenter Osteoarthritis Study with knee radiographs at baseline who completed repeated chair stands and a 20-meter walk test (20MWT) at baseline, 2.5, 5, and 7 years. Generalized linear models assessed the relation of radiographic PFOA and radiographic PFOA with frequent knee pain to longitudinal changes in performance-based function. Analyses were adjusted for age, sex, BMI, tibiofemoral OA, and injury/surgery. RESULTS: Linear models demonstrated a significant group-by-time interaction for the repeated chair stands (P = 0.04) and the 20MWT (P < 0.0001). Those with radiographic PFOA took 1.01 seconds longer on the repeated chair stands (P = 0.02) and 1.69 seconds longer on the 20MWT (P < 0.0001) at 7 years compared with baseline. When examining the relation of radiographic PFOA with frequent knee pain to performance-based function, there was a significant group-by-time interaction for repeated chair stands (P = 0.05) and the 20MWT (P < 0.0001). Those with radiographic PFOA with frequent knee pain increased their time on the repeated chair stands by 1.12 seconds (P = 0.04) and on the 20MWT by 1.91 seconds (P < 0.0001) over 7 years. CONCLUSION: Individuals with radiographic PFOA and those with radiographic PFOA with frequent knee pain have worsening of performance-based function over time. This knowledge may present opportunities to plan for early treatment strategies for PFOA to limit functional decline over time.

Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review.

Patellofemoral pain (PFP) and patellofemoral osteoarthritis (PFOA) are common, persistent conditions that may lie along a pathological spectrum. While evidence supports exercise-therapy as a core treatment for PFP and PFOA, primary care physicians commonly prescribe medication, or refer for surgical consults in persistent cases. We conducted a systematic review of medical interventions (pharmaceutical, nutraceutical, and surgical) for PFP and PFOA to inform primary care decision making. METHODS: Following protocol registration, we searched seven databases for randomized clinical trials of our target interventions for PFP and PFOA. Our primary outcome was pain. We assessed risk of bias, calculated standardized mean differences (SMDs) and determined the level of evidence for each intervention. RESULTS: We included 14 publications investigating pharmaceutical or nutraceutical interventions, and eight publications investigating surgical interventions. Two randomized control trials (RCTs) provided moderate evidence of patellofemoral arthroplasty having similar pain outcomes compared to total knee arthroplasty in isolated PFOA, with SMDs ranging from -0.3 (95% CI -0.8, 0.2, Western Ontario McMaster Pain Subscale, 1 year post-surgery) to 0.3 (-0.1, 0.7, SF-36 Bodily Pain, 2 years post-surgery). Remaining studies provided, at most, limited evidence. No efficacy was demonstrated for oral nonsteroidal anti-inflammatories or arthroscopic surgery. CONCLUSIONS: Pharmaceutical and nutraceutical prescriptions, and surgical referrals are currently being made with little supporting evidence, with some interventions showing limited efficacy. This should be considered within the broader context of evidence supporting exercise-therapy as a core treatment for PFP and PFOA.

Mismatch between expectations and physical activity outcomes at six months following hip-arthroscopy: A qualitative study.

OBJECTIVE: To explore factors influencing participation in physical activity for young to middle-aged patients at six months post-hip arthroscopy. DESIGN: Qualitative study. SETTING: Three specialist surgical centres in Australia. PARTICIPANTS: Seventeen adults aged 18-50 years. MAIN OUTCOME MEASURES: Individual semi-structured interviews were undertaken and transcribed verbatum. Inductive analysis of the data was undertaken, with themes identified through an iterative coding process. RESULTS: Four key themes emerged from the analysis: 1) an evident mismatch between expectations and actual progress of physical activity during the first six months post-arthroscopy; 2) physical activity levels vary widely at six months post-operatively; 3) evidence of suboptimal psychological readiness to return to sport and an associated emotional toll; and 4) the influence of available support and information on post-operative physical activity. CONCLUSIONS: This qualitative study has provided in-depth perspectives on recovery after hip arthroscopy. Clear opportunities exist to: 1) help patients develop realistic post-operative goals; 2) provide timely patient education and support; and 3) facilitate an effective transition to desired physical activity.

Physical Activity Following Hip Arthroscopy in Young and Middle-Aged Adults: A Systematic Review.

BACKGROUND: Hip arthroscopy is a common surgical intervention for young and middle-aged adults with hip-related pain and dysfunction, who have high expectations for returning to physical activity following surgery. The purpose of this review was to evaluate the impact of hip arthroscopy on physical activity post-arthroscopy. METHODS: A systematic search of electronic databases was undertaken in identifying studies from January 1st 1990 to December 5th 2019. The search included English language articles reporting physical activity as an outcome following hip arthroscopy in adults aged 18-50 years. Quality assessment, data extraction and synthesis of included studies were undertaken. RESULTS: Full text articles (n = 234) were assessed for eligibility following screening of titles and abstracts (n = 2086), yielding 120 studies for inclusion. The majority (86%) of the studies were level 4 evidence. No studies reported objective activity data. The most frequently occurring patient-reported outcome measure was the Hip Outcome Score-sport-specific subscale (HOS-SS, 84% of studies). Post--arthroscopy improvement was indicated by large effect sizes for patient-reported outcome measures (standard paired difference [95% confidence interval] -1.35[-1.61 to -1.09] at more than 2 years post-arthroscopy); however, the majority of outcome scores for the HOS-SS did not meet the defined level for a patient-acceptable symptom state. CONCLUSION: The current level of available information regarding physical activity for post arthroscopy patients is limited in scope. Outcomes have focused on patients' perceived difficulties with sport-related activities with a paucity of information on the type, quality and quantity of activity undertaken. LEVEL OF EVIDENCE: Level IV, systematic review of Level 2 through to Level 4 studies.

Step Rate and Worsening of Patellofemoral and Tibiofemoral Joint Osteoarthritis in Women and Men: The Multicenter Osteoarthritis Study.

OBJECTIVE: To determine the association of self-selected walking step rate with worsening of cartilage damage in the patellofemoral (PF) joint and tibiofemoral (TF) joint compartments at a 2-year follow-up visit. METHODS: The Multicenter Osteoarthritis Study (MOST) is a prospective cohort of men and women with or at risk of knee osteoarthritis. Self-selected step rate was measured using an instrumented GAITRite walkway (CIR Systems) at the 60-month visit. Cartilage damage was semiquantitatively graded on magnetic resonance images at the 60- and 84-month visits in the medial and lateral PF and TF compartments. Step rate was divided into quartiles, and logistic regression was used to determine the association of step rate with the risk of worsening cartilage damage in men and women separately. Analyses were adjusted for age, body mass index, and knee injury/surgery. RESULTS: A total of 1,089 participants were included. Mean ± SD age was 66.9 ± 7.5 years, mean ± SD body mass index was 29.6 ± 4.7 kg/m2 , and 62.3% of the participants were women. Women with the lowest step rate had increased risk of lateral PF (risk ratio [RR] 2.1 [95% confidence interval (95% CI) 1.1-3.8]) and TF (RR 1.8 [95% CI 1.1-2.9]) cartilage damage worsening 2 years later compared to those with the highest step rate. Men with the lowest step rate had increased risk of medial TF cartilage damage worsening 2 years later (RR 2.1 [95% CI 1.1-3.9]). CONCLUSION: Lower step rate was associated with increased risk of cartilage damage worsening in the lateral PF and TF compartments in women and worsening medial TF joint damage in men. Future research is necessary to understand the influence of step rate manipulation on joint biomechanics in women and men.

Psychometric Properties of the Hip-Return to Sport After Injury Scale (Short Form) for Evaluating Psychological Readiness to Return to Sports After Arthroscopic Hip Surgery.

BACKGROUND: Successful return to sports activity after surgery requires both physical and psychological readiness. The Hip-Return to Sport After Injury (Short Form) has been developed to assess psychological readiness to return to sports after hip injury and hip surgery, including hip arthroscopy. PURPOSE: To evaluate the reliability, validity, responsiveness, and interpretability of the scale for a cohort of patients after hip arthroscopy with a range of sports participation levels. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 2. METHODS: Invitations to participate were sent to 145 patients from 3 specialist surgeons. The study included 77 participants 1 to 24 months after hip arthroscopy (mean ± SD age, 35 ± 9 years; 62% women) and 33 healthy age-matched controls (age, 37 ± 7 years; 52% women). The scale was administered electronically on 3 occasions to patients: baseline (≥1 month postarthroscopy), 1 week later, and 6 months later. In addition to the scale, participants were asked about sports participation status and their global rating of postsurgical change. The scale was administered to healthy controls on 1 occasion. The minimal detectable difference, discriminant validity, floor and ceiling effects, responsiveness, and interpretability (minimally important change) were determined for the scale. RESULTS: Among the postarthroscopy group, excellent test-retest reliability was found (intraclass correlation coefficient = 0.869; 95% CI, 0.756-0.932) with a minimal detectable difference of 26 points out of 100 at the individual level and 4 points out of 100 at the group level. At baseline discriminant validity was evident between those who had returned to sports (median = 69, n = 35) and those who had not returned to sports (median = 30, n = 42; Mann-Whitney U score = 232.5, z = -5.141, P < .001) and between the returned-to-sports postarthroscopy group and healthy controls (median = 96, n = 33; Mann-Whitney U score = 165.500, z = 5.666, P < .001). No floor or ceiling effects were evident. Responsiveness was demonstrated for the scale in relation to sports status. With sports status as an anchor, a minimally important change of 26 points was identified. CONCLUSION: Assessment of the Hip-Return to Sport After Injury (Short Form) supports its use as a reliable and valid measure of psychological readiness to return to sports in patients after hip arthroscopy.

Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis.

BACKGROUND: Knee MRI is increasingly used to inform clinical management. Features associated with osteoarthritis are often present in asymptomatic uninjured knees; however, the estimated prevalence varies substantially between studies. We performed a systematic review with meta-analysis to provide summary estimates of the prevalence of MRI features of osteoarthritis in asymptomatic uninjured knees. METHODS: We searched six electronic databases for studies reporting MRI osteoarthritis feature prevalence (ie, cartilage defects, meniscal tears, bone marrow lesions and osteophytes) in asymptomatic uninjured knees. Summary estimates were calculated using random-effects meta-analysis (and stratified by mean age: <40 vs ≥40 years). Meta-regression explored heterogeneity. RESULTS: We included 63 studies (5397 knees of 4751 adults). The overall pooled prevalence of cartilage defects was 24% (95% CI 15% to 34%) and meniscal tears was 10% (7% to 13%), with significantly higher prevalence with age: cartilage defect <40 years 11% (6%to 17%) and ≥40 years 43% (29% to 57%); meniscal tear <40 years 4% (2% to 7%) and ≥40 years 19% (13% to 26%). The overall pooled estimate of bone marrow lesions and osteophytes was 18% (12% to 24%) and 25% (14% to 38%), respectively, with prevalence of osteophytes (but not bone marrow lesions) increasing with age. Significant associations were found between prevalence estimates and MRI sequences used, physical activity, radiographic osteoarthritis and risk of bias. CONCLUSIONS: Summary estimates of MRI osteoarthritis feature prevalence among asymptomatic uninjured knees were 4%-14% in adults aged <40 years to 19%-43% in adults ≥40 years. These imaging findings should be interpreted in the context of clinical presentations and considered in clinical decision-making.

Is quality of life reduced in people with patellofemoral osteoarthritis and does it improve with treatment? A systematic review, meta-analysis and regression.

Purpose: To determine if quality of life is reduced in individuals with patellofemoral osteoarthritis, whether it can be improved with treatment, and potential factors associated with quality of life in individuals with patellofemoral osteoarthritis.Materials and methods: Published articles were identified by using electronic and manual searches. Studies reporting quality of life in individuals with patellofemoral osteoarthritis relative to a comparator group (e.g., no osteoarthritis) and intervention studies reporting quality of life in patellofemoral osteoarthritis following treatment relative to baseline/control group were included.Results: Seventeen studies (seven cross-sectional, 10 intervention) were included in this systematic review. Relative to those without osteoarthritis, individuals with patellofemoral osteoarthritis had worse knee-related quality of life (five studies) and health-related quality of life (two studies). Non-surgical treatments appear to improve knee-related quality of life compared to pre-treatment (three studies) but not control (three studies). Surgical-treatments also improved knee-related quality of life compared to pre-treatment (five studies). Worse knee-related quality of life was associated with younger age, worse pain, symptoms, function in activities of daily living, and function in sport and recreation.Conclusions: Individuals with patellofemoral osteoarthritis had worse knee-related and health-related quality of life compared to those without knee osteoarthritis. Non-surgical and surgical interventions may be effective in improving knee-related quality of life in individuals with patellofemoral osteoarthritis, but the intervention results are based on limited studies, and further research is needed to determine optimal strategies.Implications for rehabilitationClinicians and researchers should consider knee-related and health-related quality of life when developing treatment strategies for patellofemoral osteoarthritis.Researchers investigating the effectiveness of a treatment should compare intervention to a control group.Addressing knee pain and functional limitations may aid in improving knee-related quality of life in individuals with patellofemoral osteoarthritis.