A finite element analysis of patellofemoral joint biomechanics: Exploring potential causes of postoperative anterior knee pain following unicompartmental knee arthroplasty.

Purpose: Anterior knee pain is a common complication following unicompartmental knee arthroplasty (UKA). This study aimed to elucidate the mechanism of anterior knee pain after UKA by examining the biomechanical characteristics of the patellofemoral joint. Methods: This study employs the finite element analysis method. A healthy model of the right lower limb was created using CT scans of an intact right lower limb from a healthy woman. Based on this model, a preoperative pathological model was generated by removing the meniscus and part of the articular cartilage. The UKA prosthesis was then applied to this model with five different bearing thicknesses: 5 mm, 7 mm, 10 mm, 11 mm, and 13 mm. To simulate various degrees of knee joint flexion, the femur was rotated relative to the knee joint's rotational axis, producing lower limb models at flexion angles of 0°, 30°, 60°, 90°, and 120°. We applied a constant force from the center of the femoral head to the center of the ankle joint to simulate lower limb loading during squatting. The simulations were conducted using Ansys 17.0. Results: Both overstuffing and understuffing increased the peak stress on the patellar cartilage, with overstuffing having a more pronounced effect. Compared to healthy and balanced models, overstuffed and understuffed models exhibited abnormal stress distribution and stress concentration in the patellar cartilage during knee flexion. Conclusion: Overstuffing and understuffing lead to residual varus or valgus deformities after UKA, causing mechanical abnormalities in the patellofemoral joint. These abnormalities, characterized by irregular stress distribution and excessive stress, result in cartilage damage, exacerbate wear in the patellofemoral joint and consequently lead to the occurrence of anterior knee pain.

Global Rating of Change for Better or Worse-What Does It Mean When Patients Who Are Treated for Patellofemoral Pain Rate Their Change?

OBJECTIVE: To investigate how a global rating of change (GROC) score corresponds to change in Knee injury and Osteoarthritis Outcome Score (KOOS) subscales in people with patellofemoral pain (PFP). DESIGN: Secondary analysis of data from 3 clinical trials. METHODS: Four hundred ninety adolescents (10-18 years old) and adults (19-40 years old) with PFP completed KOOS (5 subscales, 0-100) at baseline and 3-month follow-up as well as GROC at 3-month follow-up. GROC category descriptors were mapped to 5 categories: worse, no change, a bit better, better, and much better. Gaussian approximation was then used to calculate the change in KOOS scores for each GROC category. RESULTS: Due to overlap between KOOS scores in "no change" and "a bit better," all analyses were performed on 4 categories. For all KOOS subscales, patients who reported being "worse" had negative KOOS scale change scores (≤ -2); patients reporting "no change" had KOOS scale change scores that ranged from -5 to 14; and patients feeling "better" or "much better" had positive KOOS scale change scores that ranged from 4 to 26 and ≥16, respectively. CONCLUSION: When patients with PFP reported feeling "worse," "better," or "much better," there was a small-to-substantial change across the different KOOS scales. This is in contrast to no difference between reporting "a bit better" or "no change" in KOOS. When patients say they feel a little better, clinicians should be less confident about whether change has truly occurred. J Orthop Sports Phys Ther 2024;54(10):657-671. Epub 25 July 2024. doi:10.2519/jospt.2024.12120.

Synovial Hemangioma: An Overlooked Cause of Chronic Knee Pain in Children.

Introduction: Synovial hemangioma of the knee is a benign vascular malformation that is often misdiagnosed due to its non-specific symptoms. Case Report: We present a case involving a 7-year-old male child with chronic knee pain and swelling in the left knee, which remained undiagnosed for over 3 years. Magnetic resonance imaging revealed a synovial vascular malformation. Surgical excision of the lesion and partial synovectomy were performed, and histopathological analysis confirmed the diagnosis of synovial hemangioma. After 18 months of follow-up, there were no signs of recurrence or recurrent joint effusion. Conclusion: Synovial hemangioma of the knee, although uncommon, should be considered as a differential diagnosis in cases of chronic knee pain and swelling. En-bloc excision is the treatment of choice to prevent recurrence, yielding good clinical outcomes.

Partial excision of infrapatellar fat pad for the treatment of knee osteoarthritis.

AIMS: Knee osteoarthritis (KOA) is a common degenerative joint disease characterized by pain and functional limitations. Current treatments offer symptomatic relief but do not address the underlying pathology. This study explores the role of the infrapatellar fat pad (IFP) in KOA and evaluates the efficacy of its partial arthroscopic excision. METHODS: A retrospective review was conducted on 37 KOA patients who underwent partial IFP excision. Pain and function were assessed using the WOMAC and VAS scores, while MRI evaluations focused on cartilage health. RESULTS: Significant postoperative improvements were observed in both pain and functional outcomes, with substantial reductions in WOMAC and VAS scores (P < 0.001). MRI findings demonstrated notable enhancements in cartilage integrity, reflected in significantly improved WORMS scores (P < 0.001). CONCLUSIONS: Partial excision of the IFP significantly reduces pain and improves function in KOA patients, while also promoting cartilage health. These findings support the IFP's role in KOA pathology and highlight the potential benefits of targeted surgical intervention.

Inflammatory markers in early knee joint osteoarthritis differ from well-matched controls and are associated with consistent, rather than intermittent knee pain.

BACKGROUND: Osteoarthritis (OA) is characterised by the failure of normal biological processes to repair following damage. Traditionally, OA was considered a "wear and tear" disorder; however, it is now a recognised inflammatory condition, preceded by molecular modifications. The aim of this study was to evaluate inflammatory markers among individuals with early knee OA (eKOA) and well-matched asymptomatic controls. METHODS: Twenty six eKOA (females, n = 13; age = 60.2 ± 5.4 yrs, height = 1.73 ± 0.11 m, body mass = 77.8 ± 12.8 kg, body fat = 33.9 ± 8.5%) and twenty-three asymptomatic individuals (females, n = 14; age = 59.9 ± 5.5yrs, height = 1.71 ± 0.09 m, body mass = 72.6 ± 11.3 kg, body fat = 30.4 ± 8.2%) were recruited. The Timed Up and Go, and the 6 Minute Walk Tests evaluated physical function in addition to pain specific questionnaires (KOOS and ICOAP). Serum levels of IL-1α, IL-1ß, IL-2, IL-4, IL-6, IL-8(CXCL8), IL-10, hsCRP and TNF-α were quantified using a multiplex assay via V-plex®Sector Imager 2400. RESULTS: As hypothesised, only KOOS and EQ-5D-5L metrics differed between the groups for non-blood derived measures (p < 0.04). Only IL-6 was higher in eKOA (P = 0.02; 95% CI = 0.202; by 0.197 pg/mL; 34.5%). Among eKOA, IL-6 did not relate to severity of KOOS pain (P = 0.696, r = -0.088), but had a positive relationship with ICOAP consistent (r = 0.469, P = 0.045) rather than intermittent pain. There was a moderate correlation between 6MWD and IL-8 (r = 0.471, P = 0.012). CONCLUSION: Our results illustrate the potential for IL-6 as a biomarker for eKOA, and introduce the proposition for particular consideration in those with consistent pain. Further, for the first time the present data showed greater walking distance in eKOA with lower circulating IL-8. Future work should seek to verify these results and further investigate IL-6 and IL-8 related molecular pathways in eKOA, and their potential relationships with consistent knee pain and physical function.

The efficacy of patellar denervation on prognosis and kneeling capacity after unicompartmental knee arthroplasty: a randomized clinical trial.

OBJECTIVE: The aim of this study was to investigate the effect of patellar denervation (PD) on pain, function and ability to kneel after unicompartmental knee arthroplasty (UKA). METHODS: Patients with medial knee osteoarthritis who underwent UKA were prospectively selected. Patients were randomly divided into PD and non-PD groups based on whether patellar denervation was performed. Clinical assessment was performed using the Hospital for Special Surgery (HSS) knee score, Kujiala score, visual analogue scale (VAS) and forgotten joint score (FJS-12), as well as postoperative complications were recorded. The patients' postoperative self-perception and actual ability to perform different kneeling positions were assessed in the two groups. RESULTS: UKA patients treated with PD achieved better Kujiala scores and FJS-12 scores, reduced anterior knee pain and improved kneeling ability postoperatively, validating the effectiveness of PD in UKA. Perception and actual performance of kneeling remained mismatched in PD patients, but performance during different kneeling activities was generally better than in non-PD patients. TRIAL REGISTRATION: Clinical Trial Registration: ChiCTR1900025669. CONCLUSION: Patellar denervation can safely and effectively improve patellofemoral joint function, pain and kneeling ability in the early postoperative period after UKA.

A systematic review and network meta-analysis on the optimal wavelength of low-level light therapy (LLLT) in treating knee osteoarthritis symptoms.

OBJECTIVES: To compare the efficacy of the various wavelengths of low-level light therapy (LLLT) in alleviating knee pain, dysfunction, and stiffness in patients with knee osteoarthritis (KOA), and to compare the effectiveness of LLLT versus sham treatment in reducing knee pain, dysfunction, and stiffness. METHODS: PubMed, Web of Science, EMBASE, and Cochrane Library were searched from inception to 12 December 2023. Randomized controlled trials that assessed the effects of different wavelengths of LLLT on alleviating pain of patients with KOA were included. A conventional meta-analysis and network meta-analysis were preformed, and standardized mean differences (SMD) with 95% confidence interval (CI) were calculated. RESULTS: Thirteen studies involving 673 participants with KOA met inclusion criteria. Overall, LLLT was superior to sham LLLT for relieving pain (SMD = 0.96, 95% CI 0.31-1.61) but not for improving function (SMD = 0.21, 95% CI - 0.11 to 0.53) or stiffness (SMD = 0.07, 95% CI - 0.25 to 0.39). Surface under the cumulative ranking curve (SUCRA) value ranking showed the most effective wavelength of LLLT in reducing KOA pain was 904-905 nm (SUCRA, 86.90%), followed by multi-wavelengths (MWL) (SUCRA, 56.43%) and 785-850 nm (SUCRA, 54.97%). Compared to sham LLLT, L2 (SMD = 1.42, 95% CI = 0.31-2.53) and L1 (SMD = 0.82; 95% CI = 0.11-1.50) showed a significant reduction in KOA pain. However, MWL (SMD = 0.83; 95% CI = - 0.06 to 1.72) showed similar KOA pain reduction compared to sham LLLT. The certainty of evidence showed that the quality of evidence regarding the effectiveness of overall LLLT versus sham, and 904-905 nm versus sham were low, while the quality of evidence for MWL versus sham, and 785-850 nm versus sham was very low. CONCLUSION: While the 904-905 nm wavelength showed potential benefits in reducing KOA pain, the overall quality of the evidence was low. LLLT with 904-905 nm or 785-850 nm wavelengths yielded significantly better reduction in KOA pain compared to sham LLLT, but further high-quality research is warranted to validate these findings.

Diagnostic Complexities and Management of Gouty Arthritis With Suspected Seronegative Rheumatoid Arthritis and Malignancy in an Elderly Male.

Rheumatoid arthritis (RA) and gout are two distinct types of inflammatory arthritis with significant morbidity. While RA is characterized by autoimmune synovitis, gout is defined by the deposition of urate crystals. Diagnosing these conditions becomes particularly challenging in patients with negative serological markers for RA, compounded by the patient's advanced age and potential for malignancy. This case involves a 77-year-old male with chronic gout, hypertension, chronic atrial fibrillation on edoxaban, diastolic congestive heart failure, and chronic kidney disease stage 3B, presenting with left knee pain and limited mobility. Despite negative serology for RA (rheumatoid factor (RF) <20.0 IU/ml, anti-CCP2 antibodies 1.2 U/mL), the clinical presentation raised suspicion for RA. Imaging revealed significant synovial hypertrophy and multiple periarticular lesions suggestive of chronic gouty tophi rather than RA or malignancy. The patient was managed with allopurinol, prednisolone, and colchicine and referred to rheumatology for further evaluation. Approximately 30% of RA patients may present with negative serological markers, complicating the diagnosis. Differentiating RA from gout is crucial due to differences in management strategies. Imaging modalities such as MRI and CT are essential in identifying characteristic changes of both conditions, such as synovial hypertrophy in RA and tophi in gout. In elderly patients, the possibility of malignancy should also be considered. This case highlights the complexity of diagnosing gouty arthritis mimicking seronegative RA, especially in elderly patients where the risk of malignancy must be considered. It underscores the need for comprehensive clinical and imaging evaluations and personalized treatment plans in managing patients with multiple comorbidities.

Influence of Knee Osteoarthritis Severity, Knee Pain, and Depression on Physical Function: A Cross-Sectional Study.

Purpose: Decreased physical function with increasing life expectancy is a public health concern worldwide. Knee osteoarthritis (KOA) is considered one of the primary illnesses causing decreased physical function. Depression affects decreased physical function and is closely related to knee pain in KOA. However, the effect of these interacting factors on physical function is not clear. Patients and Methods: We conducted a cross-sectional analysis of the baseline data of 1106 subjects of the 2009 Locomotive Syndrome and Health Outcome in Aizu Cohort Study (LOHAS). We determined the association between their Timed Up and Go test (TUG) scores and radiographic KOA, knee pain, and depression in a multivariate analysis. Results: Severe knee pain was significantly associated with decreased physical function (the odds ratio [OR] was 2.13, 95% confidence interval [CI]: 1.32-4.89), as was depression (OR 2.64, 95% CI 1.61-4.33). Only Kellgren-Lawrence (KL) grade 4 was significantly associated with decreased physical function in the radiographic KOA severity (OR 6.58, 95% CI 1.75-24.68). Conclusion: Severe knee pain and depression were significantly associated with decreased physical function, but not radiographic KOA severity except for KL grade 4. The limitations of using radiographic KOA severity alone as the indicator of assessment for physical function were suggested. When assessing decreased physical function, the clinical focus tends to be on radiographic KOA severity, but it is important to consider the patient's knee pain and psychological factors.

Effectiveness of Brassica juncea (Mustard) Plaster on Reduction of Knee Pain and Inability among Geriatrics with Osteoarthritis.

Pre-experimental one-group pretest posttest research design was adopted to investigate the effectiveness of Brassica juncea (mustard) plaster on reduction of knee pain and inability among 60 geriatrics with osteoarthritis. The inability was assessed using the Western Ontario McMaster University (WOMAC) Index, which includes 24 parameters under three major headings: joint pain, joint stiffness, and difficulty in performing daily activities, and the severity of pain level was assessed using a numerical pain rating scale. Mustard plaster is applied against the knee for 15 minutes once a day for seven days. On day 8, study participants were re-assessed using the WOMAC Osteoarthritis Index in the interventional group. The pretest mean score of pain was 77.80 ± 5.65, and the posttest mean score was 38.88 ± 11.76. The mean difference score was 38.92. The calculated paired 't' test value of t = 24.428 was statistically significant at P < 0.001 level.

9. Chronic knee pain.

INTRODUCTION: Chronic knee pain is defined as pain that persists or recurs over 3 months. The most common is degenerative osteoarthritis (OA). This review represents a comprehensive description of the pathology, diagnosis, and treatment of OA of the knee. METHODS: The literature on the diagnosis and treatment of chronic knee pain was retrieved and summarized. A modified Delphi approach was used to formulate recommendations on interventional treatments. RESULTS: Patients with knee OA commonly present with insidious, chronic knee pain that gradually worsens. Pain caused by knee OA is predominantly nociceptive pain, with occasional nociplastic and infrequent neuropathic characteristics occurring in a diseased knee. A standard musculoskeletal and neurological examination is required for the diagnosis of knee OA. Although typical clinical OA findings are sufficient for diagnosis, medical imaging may be performed to improve specificity. The differential diagnosis should exclude other causes of knee pain including bone and joint disorders such as rheumatoid arthritis, spondylo- and other arthropathies, and infections. When conservative treatment fails, intra-articular injections of corticosteroids and radiofrequency (conventional and cooled) of the genicular nerves have been shown to be effective. Hyaluronic acid infiltrations are conditionally recommended. Platelet-rich plasma infiltrations, chemical ablation of genicular nerves, and neurostimulation have, at the moment, not enough evidence and can be considered in a study setting. The decision to perform joint-preserving and joint-replacement options should be made multidisciplinary. CONCLUSIONS: When conservative measures fail to provide satisfactory pain relief, a multidisciplinary approach is recommended including psychological therapy, integrative treatments, and procedural options such as intra-articular injections, radiofrequency ablation, and surgery.

Study of knee pain, fear of falling, and quality of life among community-dwelling older adults, Northern Thailand.

Fall is the leading cause of disability and mortality due to unintentional injury in older adults. The aim of this study was to determine the prevalence and risk factors associated with knee pain, fear of falling, and quality of life among community-dwelling older adults in Northern Thailand. A cross-sectional study was conducted among older adults aged 60 and over. A total of 369 participants were enrolled from April to May 2024. Oxford knee score, a short version of the Falls Efficacy Scale International (FES-I) and World Health Organization quality of life-BREF-Thai, was measured. The results showed that the mean age was 69.4 years and 47 (12.7%) had a history of falls in the previous year. The prevalence of fear of falling was 39.3% for low, 22.5% for moderate, and 38.2% for high concern. Age, marital status, alcohol, history of falls, hypertension, arthritis, and osteoporosis were associated with fear of falling. After adjusting to age, gender, body mass index, education, marital status, smoking, alcohol, history of falls, and chronic disease, osteoarthritis of the knee was positively associated with increasing fear of falling (ß: 0.361; p<0.001), while quality of life was negatively associated with fear of falling (ß: -0.064; p<0.011). In conclusion, the identified determinants of fear of falling among the elderly indicated the need for fear of falling prevention programs targeting not only individual lifestyles but also chronic diseases. This study provides useful information that might help to develop and adopt effective policies for fear of falling control in Thailand.

Pain Is Modulated Differently Between Females with and without Patellofemoral Pain: Factors Related to Sensitization.

CONTEXT: Patellofemoral pain (PFP) has poor long-term recovery outcomes. Central sensitization describes central nervous system changes altering pain modulation, which can complicate recovery (poorer prognosis, worse function). Signs of central sensitization include amplified pain facilitation, pain hypersensitivity, and impaired pain inhibition, which can be measured with temporal summation of pain (TSP), pressure pain thresholds (PPTs) and conditioned pain modulation (CPM), respectively. Sex differences exist for these test responses, but female-only PFP investigations of sensitization are uncommon. Understanding pain modulation in females with PFP could improve treatment protocols. OBJECTIVE: To determine whether females with PFP exhibit signs of central sensitization (greater TSP, lower PPTs, reduced CPM) compared to pain-free females. DESIGN: Cross-sectional Setting: Laboratory Patients or Other Participants: Thirty-three females [(20 PFP, 13 pain-free); Age: PFP 29.2 ± 7 years, pain-free 28 ± 7 years; Height: PFP 166.7 ± 5.9cm, pain-free 166 ± 9.5cm, Mass: PFP 66.7 ± 9.6kg, pain-free 69.3 ± 7.5kg). MAIN OUTCOME MEASURES: TSP was assessed with ten punctate stimuli applied to the knee and calculated by the difference in pain intensity between beginning and end responses. PPTs were tested at four sites [3 for local hypersensitivity (knee), 1 for widespread hypersensitivity (hand)]. CPM was conducted by comparing PPTs during two conditions (baseline, ice immersion). CPM response was defined as the percent difference between conditions. Between-group differences in TSP response were analyzed with a Welch's test. Separate Welch's tests analyzed group comparisons of PPTs and CPM responses at four sites. RESULTS: Females with PFP exhibited greater TSP response (P=0.019) and lower CPM response at patella center (P=0.010) and hand sites (P=0.007) than pain-free females. PPT group differences were not observed at any site (P>0.0125). CONCLUSIONS: Females with PFP modulate pain differently than pain-free females. Clinicians should recognize signs of central sensitization and their potential impact on treatment options.

The association of payer type on genicular radiofrequency neurotomy treatment outcomes: Results of a cross-sectional study.

Background: Genicular radiofrequency neurotomy (GRFN) is an effective treatment for a subset of individuals with chronic knee pain. Previous studies demonstrate that Medicare and Medicaid beneficiaries report worse outcomes following various interventional procedures compared with commercially insured patients. Objective: Evaluate the association of payer type on GRFN treatment outcomes. Methods: Consecutive patients who underwent GRFN at a tertiary academic center were contacted for participation. Demographic, clinical, and procedural characteristics were collected from electronic medical records. Outcome data were collected by standardized telephone survey at 6-12 months, 12-24 months and ≥24 months. Treatment success was defined as ≥50% numerical pain rating scale (NPRS) score reduction from baseline. Data were analyzed using descriptive statistics for demographic, clinical, and procedural characteristics. Logistic and Poisson regression analyses were performed to examine the association of variables of interest and pain reduction. Results: One hundred thirty-four patients treated with GRFN (mean 65.6 ± 12.7 years of age, 59.7% female) with a mean follow-up time of 23.3 ± 11.3 months were included. Payer type composition was 48.5% commercial (n = 65), 45.5% Medicare (n = 61), 3.7% Medicaid (n = 5), 1.5% government (n = 2), and 0.8% self-pay (n = 1). Overall, 47.8% of patients (n = 64) reported ≥50% NPRS score reduction after GRFN. After adjusting for age, follow-up duration, Kellgren-Lawrence osteoarthritis grade, baseline opioid use, antidepressant/antianxiety medication use, history of knee replacement, and number of RFN lesions placed, the logistic regression model showed no statically significant association between payer type and treatment outcome (OR = 2.11; 95% CI = 0.87, 5.11; p = 0.098). Discussion/conclusion: In this study, after adjusting for demographic, clinical, and procedural characteristics, we found no association between payer type and treatment success following GRFN. This observation contrasts findings from other interventional studies reporting an association between payer category and treatment success.

Effectiveness comparison of genicular nerve ablation for knee osteoarthritic versus post-total knee arthroplasty pain.

Background: Genicular nerve radiofrequency ablation (GNRFA) is a popular and effective procedure to treat arthritic knee pain. For refractory arthritic pain that fails conservative treatment, total knee arthroplasty (TKA) has been an excellent option. Unfortunately, 15-30% of people who undergo a TKA continue to experience pain and stiffness in the knee. The treatment options for post-TKA knee pain are limited. Pain providers have been trialing GNRFA on this pain condition. However, convincing evidence of its efficacy in treating post-TKA pain is still lacking. Methods: This is a retrospective study of 73 patients who had undergone genicular nerve RFA, 46 (63.01%) with osteoarthritic pain, and 27 (36.99%) with post-TKA pain. We compared the outcomes (pain relief, function, and complications) between these two groups at 3 months and 6 months after RFA. Results: Before RFA, there was no significant difference in initial pain and functional level between these two groups. After RFA, the two groups had comparable pain relief at 3 months (p = 0.68) and 6 months (p = 0.53), and similar functionality at 3 months (p = 0.36) and 6 months (p = 0.65).The overall success rate (≥50% pain relief after RFA) was 80.82%, 95% CI: 70.34%-88.22% (osteoarthritic group 80.43%, 95% CI: 66.83%-89.35%, post-TKA 81.48%, 95% CI: 63.30%-91.82%, P = 0.91) at 3-month follow-up and 56.16%, 95% CI: 44.76%-66.95% (osteoarthritic group 56.52%, 95% CI: 42.25%-69.79%, post-TKA 55.56%, 95% CI: 37.31%-72.41%, P = 0.94) at 6-month follow-up.There were no reported complications in either group. Conclusions: Genicular Nerve Radiofrequency Ablation (GNRFA) holds the potential to be equally effective for both post-TKA knee pain and osteoarthritic knee pain.

Obesity aggravates the role of C-reactive protein on knee pain: A cross-sectional analysis with NHANES data.

OBJECTIVE: To examine the relationship between C-reactive protein (CRP) and knee pain, and further explore whether this association is mediated by obesity. METHODS: The population was derived from 1999 to 2004 National Health and Nutrition Examination Survey. Logistic regression was used to analyze the relationship between CRP and knee pain in three different models, and the linear trend was analyzed. A restricted cubic spline model to assess the nonlinear dose-response relationship between CRP and knee pain. Mediation analyses were used to assess the potential mediating role of obesity. Subgroup analyses and sensitivity analyses were performed to ensure robustness. RESULTS: Compared with adults with lower CRP (first quartile), those with higher CRP had higher risks of knee pain (odds ratio 1.39, 95% confidence interval 1.12-1.72 in third quartile; 1.56, 1.25-1.95 in fourth quartile) after adjusting for covariates (except body mass index [BMI]), and the proportion mediated by BMI was 76.10% (p < .001). BMI and CRP were linear dose-response correlated with knee pain. The odds ratio for those with obesity compared with normal to knee pain was 2.27 (1.42-3.65) in the first quartile of CRP, 1.99 (1.38-2.86) in the second, 2.15 (1.38-3.33) in the third, and 2.92 (1.72-4.97) in the fourth. CONCLUSION: Obesity mediated the systemic inflammation results in knee pain in US adults. Moreover, higher BMI was associated with higher knee pain risk in different degree CRP subgroups, supporting an important role of weight loss in reducing knee pain caused by systemic inflammation.

Exploring the relationship between trunk muscles and lower limb injuries in Australian badminton players.

Due to its dynamic nature, lower limb injuries are common in badminton. Overuse injuries of the knee, including tendon related conditions, are the most common. During jumping and landing, force transference and dissipation through the trunk is required, with the trunk muscles playing a vital role. However, the relationship between knee pain and the ability to voluntarily contract the trunk muscles has not yet been explored in badminton players. A cross-sectional study of Australian badminton players was therefore conducted. Players performed a single leg decline squat to identify those with knee pain. Ultrasound imaging was used to image and measure the size of the multifidus and quadratus lumborum, and the ability to contract the abdominal and multifidus muscles. Voluntary contraction of the trunk muscles was conducted with the subjects lying down. Independent samples T-Tests were performed to test for between group differences. Badminton players with knee pain had larger quadratus lumborum muscles and demonstrated a greater change in muscle thickness from the rested to contracted state. While we cannot comment on causation or direction, over co-contraction of trunk muscles has been shown in other studies to be associated with increased ground reaction forces on landing. Motor control training has been successfully used in other conditions to modify trunk muscle recruitment patterns and may therefore potentially represent a useful approach for badminton players.

The Role of Magnetic Resonance Imaging in the Evaluation of Knee Pain.

Objectives This study aimed to characterize and compare the features of traumatic and non-traumatic lesions causing knee pain through magnetic resonance imaging (MRI). Method The study was conducted at a tertiary care center, with data sourced from patients visiting the outpatient and in-patient departments. It involved a descriptive cross-sectional research design focusing on patients referred for knee MRI scanning. The sample size was calculated using Cochran's formula as 112 for symptomatic patients with knee pain with a 95% confidence interval. The MRI findings in 112 patients were analyzed and associated with a history of trauma. Results The average age recorded was 35.38 years. Females made up 41.07% (n=46) of the sample, while males accounted for 58.93% (n=66). Among the participants, the majority (n=82; 71.43%) had a history of trauma, and the most common MRI finding was joint effusion (n=74; 66.1%). The second most common was anterior cruciate ligament (ACL) injuries (n=71; 63.4%), followed by meniscus injury (n=40; 35.71%). The study confirms that those with history of trauma are at a higher risk (p<0.05) of sustaining injuries like meniscus and ACL tears, collateral ligament damage, bone contusions, chondromalacia patella, and joint effusion. Conclusion In conclusion, the consistency of our findings with existing studies reinforces the pivotal role of MRI in the evaluation of knee pain. Despite its limitations, including cost and accessibility, MRI remains a gold standard for diagnosing a wide range of knee pathologies, offering unparalleled detail and accuracy that significantly enhance clinical decision-making and patient outcomes.

Influence of Pain, Risk Factors, and Functional Ability on Physical Activity Levels in Women with Anterior Knee Pain: A Cross-Sectional Study.

Background and Objectives: Anterior knee pain (AKP) refers to chronic prepatellar pain and is one of the most common knee complaints in physically active women. This condition can significantly affect daily activities and overall quality of life. This study aims to assess the impact of pain, risk factors, and functional ability on different levels of physical activity (comparing low versus moderate activity) in women with AKP. Materials and Methods: This cross-sectional study involved fifty-six women diagnosed with AKP (aged 20-45 years) who were equally allocated into low and moderate physical activity groups. Their AKP and functional ability were assessed using the visual analog scale (VAS) and double squats and step-down tests, respectively. Possible risk factors were assessed using the Q-angle, modified Thomas test, sit and reach test, and patellar glide test. A person's correlation coefficient and independent t-tests were used to determine the relationship and the differences between these variables while keeping the confidence interval level at 95%. Result: Women with moderate activity levels showed significantly higher scores on the VAS than those with low activity levels (p = 0.040). However, both groups had no significant difference in their functional ability or potential risk factors (p > 0.05). Additionally, their functional ability (double squat) showed a positive association with hamstring flexibility (Pearson correlation coefficient [r]:0.3; p = 0.006). Conclusions: Women with AKP who were engaged in moderate physical activity experienced higher levels of pain compared to those with low activity levels. These findings underscore the urgent need for further investigation into different levels of physical activity to develop appropriate prevention and treatment strategies for women with AKP.