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1.
Phys Ther Sport ; 41: 1-8, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31678754

RESUMO

OBJECTIVES: To determine whether knee confidence, fear of movement, psychological readiness to return-to-sport or pain are associated with patient-reported and performance-based function and return to pivoting sport in individuals one-year after anterior cruciate ligament reconstruction (ACLR). DESIGN: Cross-sectional study. SETTING: University-laboratory. PARTICIPANTS: 118 individuals one-year post-ACLR. MAIN OUTCOME MEASURES: The KOOS-sport/recreation and IKDC and three hopping tasks were used to assess patient-reported and performance-based function, respectively. Questions regarding return to pivoting sport assessed return-to-sport status. Fear of movement (Tampa Scale), knee confidence (an item from KOOS, Visual Analogue Scale-VAS confidence during hopping tasks), knee pain (KOOS-pain, VAS pain during hopping tasks) and psychological readiness to return-to-sport (ACL-RSI) were also assessed. RESULTS: Worse fear of movement (p = 0.019), KOOS-pain (p < 0.001), ACL-RSI (p < 0.001), task-specific knee confidence and pain were associated with poorer patient-reported function. Worse task-specific knee confidence (p < 0.001) and pain (p < 0006) and ACL-RSI (p < 0.016) were associated with poorer performance-based function. Higher ACL-RSI scores were associated with higher odds of returning to pivoting sport one-year post-ACLR (p < 0.001). CONCLUSION: Individual's fear of movement, knee confidence, psychological readiness to return-to-sport and pain are related to function. Evaluating and considering knee confidence, fear of movement, and psychological readiness should be an important part of comprehensive post-ACLR rehabilitation.

2.
Best Pract Res Clin Rheumatol ; 33(1): 48-65, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-31431275

RESUMO

Patellofemoral pain is one of the most common knee complaints, particularly among physically active young individuals. Although once thought to be self-limiting, prospective studies have demonstrated the propensity towards the chronicity of patellofemoral pain (PFP). The pathogenesis of PFP is complex, with multiple interactive pathways suggested to contribute to its onset and persistence. Quadriceps weakness is one of the few risk factors of PFP, with at least moderate evidence from prospective studies, although limited clinical trials of lower limb strengthening have generally not been successful in preventing PFP. The challenge of managing PFP is reflected by a lack of evidence-based clinical guidelines. International consensus and current evidence recommends exercise therapy, focussed on hip and knee strengthening, as a cornerstone of management to reduce PFP. Rethinking management approaches beyond exercise therapy to incorporate movement retraining, education and psychosocial aspects provides potential avenues to enhance outcomes for patients with PFP.

3.
Artigo em Inglês | MEDLINE | ID: mdl-31343500

RESUMO

OBJECTIVE: To investigate whether muscle strength declines prior to or concurrent with incident knee pain in subjects with and without radiographic knee osteoarthritis (RKOA). DESIGN: Osteoarthritis Initiative participants with incident knee pain (occurrence of infrequent/frequent knee pain during the past 12 months at two consecutive follow-up time points [either years[Y] 3+4 or Y4+5]) were compared to controls (no incident knee pain) with 2-year changes in knee extensor strength during BL➔Y2 (prior) and Y2➔Y4 (concurrent). RESULTS: 202 knees (49% women; 40% RKOA) displayed incident pain, 439 did not (46% women; 23% RKOA). Women with RKOA displayed a significantly greater (p=0.04) reduction in knee extensor strength concurrent with incident pain compared with controls (mean -17.6 Newton vs +4.5Newton), but men did not. A similar trend was observed in women without RKOA - but this was not statistically significant (p=0.08). There was no significant relationship with change in extensor strength prior to incident pain (p≥0.43). CONCLUSION: These results suggest that, in women, incident knee pain is accompanied by a concurrent reduction in knee extensor strength, whereas loss in strength does not precede incident knee pain. The findings encourage interventional studies that attempt to attenuate a decline in extensor strength once knee symptoms occur.

4.
Eur J Radiol ; 113: 32-38, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30927957

RESUMO

PURPOSE: We described patellofemoral alignment and trochlear morphology at one and five years after anterior cruciate ligament reconstruction (ACLR), and evaluated the associations between alignment and trochlear morphology (at one year) and worsening patellofemoral osteoarthritis (OA) features by five years. We also evaluated the associations between alignment and morphology to self-reported pain and function (Knee injury and Osteoarthritis Outcome Score, KOOS) at five years. MATERIALS AND METHODS: In this longitudinal observational study, we followed 73 participants (mean age 29[9] years, 40% women) from one- to five-years after ACLR. Using MRI, we measured alignment and morphology, and scored cartilage and bone marrow lesions at both time points. We used mixed effects and linear regression models to achieve our stated aims. RESULTS: Greater lateral patella displacement increased risk of cartilage worsening (Odds Ratio [95% CI]: 1.09 [1.01, 1.16]); while less lateral tilt (0.91 [0.83, 0.99]) and greater trochlear angle (0.88 [0.77, 1.00]) were protective. Greater medial trochlear inclination increased risk of bone marrow lesion worsening (1.12 [1.04, 1.19]); while greater trochlear angle was protective (0.80 [0.67, 0.96]). Greater lateral displacement was associated with worse self-reported KOOS sport and recreation scores (ß [95% CI]: -11.0 [-20.9, -1.2]) and quality of life scores (-10.5 [-20.4, -0.7]). CONCLUSIONS: Lateral displacement, lateral tilt, and morphology at 1 year post-ACLR altered the risk of worsening patellofemoral OA features four years later. Lateral displacement was the only measure associated with worse self-reported symptoms at five years. These findings may lead to novel treatment strategies for secondary prevention after ACLR.


Assuntos
Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Mau Alinhamento Ósseo/patologia , Osteoartrite do Joelho/patologia , Adulto , Lesões do Ligamento Cruzado Anterior/patologia , Doenças das Cartilagens/patologia , Criança , Feminino , Humanos , Traumatismos do Joelho/patologia , Estudos Longitudinais , Imagem por Ressonância Magnética/efeitos adversos , Masculino , Pessoa de Meia-Idade , Patela/patologia , Complicações Pós-Operatórias/patologia , Prognóstico , Qualidade de Vida , Adulto Jovem
5.
Br J Sports Med ; 53(18): 1168-1173, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30737199

RESUMO

OBJECTIVES: To evaluate changes in patellofemoral cartilage thickness over 5 years after anterior cruciate ligament (ACL) injury and to determine the impact of treatment strategy. METHODS: 121 adults (ages 18-35 years, 26% women) had an ACL injury and participated in the KANON randomised controlled trial. Of those, 117 had available MRIs at baseline (<4 weeks post-ACL rupture) and at least one follow-up measurement (2, 5 years). Patellofemoral cartilage thickness was analysed by manual segmentation (blinded to acquisition order). Patellar, trochlear and total patellofemoral cartilage thickness changes were compared between as-randomised (rehabilitation+early ACL reconstruction (ACLR) (n=59) vs rehabilitation+optional delayed ACLR (n=58)) and as-treated groups (rehabilitation+early ACLR (n=59) vs rehabilitation +delayed ACLR (n=29) vs rehabilitation alone (n=29)). RESULTS: Patellofemoral cartilage thickness decreased -58 µm (95% CI -104 to -11 µm) over 5 years post-ACL rupture, with the greatest loss observed in trochlea during the first 2 years. Participants randomised to rehabilitation+early ACLR had significantly greater loss of patellar cartilage thickness compared with participants randomised to rehabilitation+optional delayed ACLR over the first 2 years (-25 µm (-52, 1 µm) vs +14 µm (-6 to 34 µm), p=0.02) as well as over 5 years (-36 µm (-78 to 5 µm) vs +18 µm (-7, 42 µm), p=0.02). There were no statistically significant differences in patellofemoral cartilage thickness changes between as-treated groups. CONCLUSION: Patellofemoral (particularly trochlear) cartilage thickness loss was observed in young adults following acute ACL rupture. Early ACLR was associated with greater patellofemoral (particularly patellar) cartilage thickness loss over 5 years compared with optional delayed ACLR, indicating that early surgical intervention may be associated with greater short-term structural patellofemoral cartilage deterioration compared with optional delayed surgery. TRIAL REGISTRATION NUMBER: ISRCTN84752559; Post-results.

6.
Artigo em Inglês | MEDLINE | ID: mdl-30762314

RESUMO

OBJECTIVE: Persistent symptoms and poor quality of life (QoL) are common following anterior cruciate ligament reconstruction (ACLR). We aimed to determine the influence of a combined ACL injury (i.e., concomitant meniscectomy and/or arthroscopic chondral defect at the time of ACLR and/or secondary injury/surgery to ACLR knee) and MRI-defined cartilage defects, bone marrow lesions (BMLs) and meniscal lesions on patient-reported outcomes (PROs) 1- to 5-years post-ACLR METHODS: 80 participants (50 men) aged 32±14 years completed the Knee injury and OA Outcome Score (KOOS) and International Knee Documentation Committee (IKDC) questionnaire, and 3T MRI assessment at 1- and 5-years post-ACLR. Median PRO scores were compared between isolated and combined ACL injuries, and with published normative values. Multivariate regression evaluated the association between compartment-specific MRI cartilage, BMLs and meniscal lesions, and PROs at 1- and 5-years. RESULTS: Individuals with a combined injury had significantly worse KOOS-Sport, and IKDC scores at 1-year, and worse KOOS-Pain, KOOS-Symptoms, KOOS-QoL, and IKDC scores at 5-years, compared to those with an isolated injury. Whilst no feature on MRI was associated with PROs cross-sectionally at 1-year, patellofemoral cartilage defects at 1-year were significantly associated with worse 5-year KOOS-Symptoms (ß: -9.79; 95%CI:-16.67, -2.91), KOOS-Sport (ß: -7.94; 95%CI:-15.27, -0.61), KOOS-QoL (ß: -8.29; 95%CI:-15.28, -1.29) and IKDC (ß: -4.79; 95%CI:-9.34, -0.24). Patellofemoral cartilage defects at 5-years were also significantly associated with worse 5-year KOOS-Symptoms (ß: -6.86; 95%CI:-13.49, -0.24) and KOOS-QoL (ß: -11.71; 95%CI:-19.08, -4.33). CONCLUSION: Combined injury, and patellofemoral cartilage defects on MRI are associated with poorer long-term outcomes. Clinicians should be vigilant to these individuals, who may benefit from targeted interventions to improve QoL and optimise symptoms. This article is protected by copyright. All rights reserved.

7.
Artigo em Inglês | MEDLINE | ID: mdl-30295439

RESUMO

OBJECTIVE: Reports on quadriceps weakness as a risk factor for incident and progressive knee osteoarthritis are conflicting, potentially due to differing effects of muscle strength on patellofemoral and tibiofemoral compartments. This study aimed to examine the sex-specific relation of quadriceps strength to worsening patellofemoral and tibiofemoral cartilage damage over 84-months. METHODS: The Multicenter Osteoarthritis Study (MOST) is a cohort study of individuals with or at risk for knee osteoarthritis. Maximal quadriceps strength was assessed at baseline. Cartilage damage was semi-quantitatively assessed by magnetic resonance images (MRIs) at baseline and 84-month follow-up using the Whole-Organ MRI Score (WORMS). Worsening patellofemoral and tibiofemoral cartilage damage was defined as any WORMS score increase in each subregion within medial and lateral compartments separately. Logistic regression with generalised estimating equations was used to assess the sex-specific relation of quadriceps strength to worsening cartilage damage. RESULTS: 1,018 participants (mean age 61±8 years, and BMI 29.3±4.5 kg/m2 ; 64% female) were included. Quadriceps weakness increased the risk of worsening lateral patellofemoral cartilage damage in women (risk ratio for lowest vs. highest quartile of strength: 1.50 (95% confidence interval: 1.03, 2.20); linear trend p=0.007) but not in men. There was generally no association between quadriceps weakness and worsening cartilage damage in the medial or lateral tibiofemoral compartment for either women or men. CONCLUSION: Low quadriceps strength increased the risk of worsening cartilage damage in the lateral patellofemoral joint of women suggesting that optimising quadriceps strength may help prevent worsening of structural damage in the patellofemoral joint in women. This article is protected by copyright. All rights reserved.

8.
Artigo em Inglês | MEDLINE | ID: mdl-30339323

RESUMO

OBJECTIVE: To examine the impact of physical activity (PA) on cartilage thickness loss in knee osteoarthritis (KOA). METHODS: 689 participants with radiographic KOA (Kellgren/Lawrence grade ≥2) at baseline, from the Osteoarthritis Initiative completed the Physical Activity Scale for the Elderly (PASE) questionnaires at annual intervals over four years. Magnetic resonance imaging-based cartilage thickness change in the medial femorotibial compartment (MFTC) over four years was the main outcome. The impact of PASE tertiles (low, moderate, high) on changes in MFTC cartilage thickness was estimated using a mixed effect model adjusted for baseline characteristics. Furthermore, straficiation by sex was performed for secondary analyses. RESULTS: Structural progression of MFTC cartilage loss of -0.20 mm (95% confidence interval: -0.22 to -0.17mm) was observed in the entire cohort, with no statistically significant difference between PA levels after adjustment for baseline characteristics. A sex-by-physical activity interaction was observed in the adjusted analysis (p=0.02). Stratification by sex showed that women with low PA had a statistically greater cartilage loss than women with moderate PA level (adjusted between group difference -0.09 mm [-0.16 to -0.02 mm]), whereas no significant differences were observed in men. CONCLUSION: While physical activity was not associated with cartilage thickness loss in the whole cohort, this relationship significantly differed between sexes. In women, but not in men, moderate PA may slow down structural disease progression compared to low PA levels. For both men and women, high PA does not appear to be more detrimental than lower PA levels for cartilage thickness loss. This article is protected by copyright. All rights reserved.

9.
Artigo em Inglês | MEDLINE | ID: mdl-30293181

RESUMO

PURPOSE: Individuals with impaired knee function after anterior cruciate ligament reconstruction (ACLR) may be at greater risk of developing knee osteoarthritis related to abnormal knee joint movement and loading. The aim of this study was to assess the association between knee biomechanics and knee laxity during hopping and clinically assessed knee function (i.e., patient-reported knee function and hop tests) following ACLR. METHODS: Sixty-six participants (23 women, mean age 28 ± 6 years, mean 18 ± 3 months following ACLR) completed a standardized single-leg hopping task. Three-dimensional movement analysis was used to assess knee flexion excursion and body weight/height normalized knee flexion moments during landing for the involved limb. Anterior-posterior knee laxity was assessed with a KT-1000 knee arthrometer. Participants then completed a patient-reported knee function questionnaire and three separate hop tests (% of uninvolved limb) and were divided into poor and satisfactory knee function groups (satisfactory: ≥85% patient-reported knee function and ≥ 85% hop test symmetry). Associations between knee function and hop biomechanics/knee laxity were assessed using logistic regression and interquartile range scaled odds ratios (ORIQR). RESULTS: Greater knee flexion excursion (ORIQR 2.9, 95%CI 1.1-7.8), greater knee flexion moment (ORIQR 4.9, 95%CI 1.6-14.3) and lesser knee laxity (ORIQR 4.7, 95%CI 1.5-14.9) were significantly associated with greater odds of having satisfactory knee function (≥ 85% patient-reported knee function and ≥ 85% hop test symmetry). CONCLUSION: Greater knee flexion excursion/moment during hop-landing and lesser knee laxity is associated with better patient-reported knee function and single-leg hop test performance following ACLR. Patients with lower levels of knee function following ACLR demonstrated hop-landing biomechanics previously associated with early patellofemoral osteoarthritis. Therefore, interventions aimed at improving hop landing biomechanics in people with poor knee function are likely required. LEVEL OF EVIDENCE: III, Cross-sectional study.

10.
Am J Sports Med ; 46(12): 2873-2883, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30179520

RESUMO

BACKGROUND: An anterior cruciate ligament (ACL) injury is a well-established risk factor for the long-term development of radiographic osteoarthritis (OA). However, little is known about the early degenerative changes (ie, <5 years after injury) of individual joint features (ie, cartilage, bone marrow), which may be reversible and responsive to interventions. PURPOSE: To describe early degenerative changes between 1 and 5 years after ACL reconstruction (ACLR) on magnetic resonance imaging (MRI) and explore participant characteristics associated with these changes. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Seventy-eight participants (48 men; median age, 32 years; median body mass index [BMI], 26 kg/m2) underwent 3.0-T MRI at 1 and 5 years after primary hamstring autograft ACLR. Early tibiofemoral and patellofemoral OA features were assessed with the MRI Osteoarthritis Knee Score. The primary outcome was worsening (ie, incident or progressive) cartilage defects, bone marrow lesions (BMLs), osteophytes, and meniscal lesions. Logistic regression with generalized estimating equations evaluated participant characteristics associated with worsening features. RESULTS: Worsening of cartilage defects in any compartment occurred in 40 (51%) participants. Specifically, worsening in the patellofemoral and medial and lateral tibiofemoral compartments was present in 34 (44%), 8 (10%), and 10 (13%) participants, respectively. Worsening patellofemoral and medial and lateral tibiofemoral BMLs (14 [18%], 5 [6%], and 10 [13%], respectively) and osteophytes (7 [9%], 8 [10%], and 6 [8%], respectively) were less prevalent, while 17 (22%) displayed deteriorating meniscal lesions. Worsening of at least 1 MRI-detected OA feature, in either the patellofemoral or tibiofemoral compartment, occurred in 53 (68%) participants. Radiographic OA in any compartment was evident in 5 (6%) and 16 (21%) participants at 1 and 5 years, respectively. A high BMI (>25 kg/m2) was consistently associated with elevated odds (between 2- and 5-fold) of worsening patellofemoral and tibiofemoral OA features. CONCLUSION: High rates of degenerative changes occur in the first 5 years after ACLR, particularly the development and progression of patellofemoral cartilage defects. Older patients with a higher BMI may be at particular risk and should be educated about this risk.

11.
Br J Sports Med ; 2018 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-29886437

RESUMO

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.

12.
Acta Orthop ; 89(4): 406-411, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29714070

RESUMO

Background and purpose - Knee extensor (KE) muscle weakness is a modifiable feature commonly observed in individuals with knee osteoarthritis (KOA) and constitutes a potential target for patient-specific interventions. Therefore, in this study, we explored whether KE weakness is associated with radiographic (medial and/or lateral) KOA progression and how this relationship differs depending on frontal plane knee alignment and sex. Patients and methods - We studied 3,075 knees (1,961 participants, 58% female) from the Osteoarthritis Initiative with radiographic Kellgren-Lawrence grade 1-3. Peak KE torque (Nm/kg) was assessed at baseline, and progression defined as fixed-location joint space width loss (≥ 0.7mm) in medial and lateral tibiofemoral compartments from baseline to 4-year follow-up. Knee-based generalized estimating equations, stratified by alignment (malaligned vs. neutral), estimated the relative risk (RR) of progression for those in the lowest (and middle) vs. highest KE torque group (split by tertiles). Secondary analyses explored whether this relationship was compartmental- or sex-specific. Results - Being in the lowest (or middle) compared with the highest torque group increased the risk of progression in neutrally aligned knees (relative risk [RR] 1.2 [95% CI 1.0-1.4]; and 1.2 [CI 1.0-1.4], respectively), but not after adjusting for age, sex, BMI, pain, and radiographic severity. In secondary analyses, women with neutral alignment in the lowest compared with the highest torque group had significantly increased risk of lateral compartment progression independent of age, BMI, disease severity, and pain (RR 1.3 [CI 1.0-1.8]). No association was observed between KE torque and KOA progression in men, irrespective of alignment. Interpretation - These results identify a potentially important clinical phenotype: KE weakness may be a more important risk factor for radiographic KOA progression in women without knee malalignment.

14.
Arthritis Rheumatol ; 70(2): 222-229, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28992394

RESUMO

OBJECTIVE: To determine whether loss in thigh muscle strength prior to knee replacement is caused by reductions of muscle strength in the anatomic cross-sectional area or by reductions of specific strength. METHODS: All 100 of the participants in the Osteoarthritis Initiative who underwent knee replacement and whose medical records included data on thigh isometric muscle strength and magnetic resonance imaging (MRI) (58 women, and 42 men, mean ± SD age 65 ± 8 years, mean ± SD body mass index [BMI] 29 ± 5 kg/m2 ) were matched with a control (no knee replacement) for age, sex, height, BMI, and radiographic severity. Thigh muscle anatomic cross-sectional area was determined by MRI at the research visit before knee replacement (time 0) and 2 years before time 0 (time -2). Specific strength (strength/anatomic cross-sectional area) was calculated, and the measures were compared by conditional logistic regression (i.e., odds ratio [OR] per standard deviation). ORs adjusted for pain (ORadj ) and 95% confidence intervals (95% CIs) were also calculated. RESULTS: Knee replacement cases had significantly smaller extensor (but not flexor) anatomic cross-sectional areas than controls at time 0 (women, ORadj 1.89 [95% CI 1.05-3.90]; men, ORadj 2.22 [95% CI 1.04-4.76]), whereas no significant differences were found at time -2. Women who had knee replacement showed lower levels of extensor specific strength than controls at time 0 (OR 1.59 [95% CI 1.02-2.50]), although this difference was not observed in men and did not maintain significance after adjustment for pain (ORadj 1.22 [95% CI 0.71-2.08]). Female cases lost significantly more extensor specific strength between time -2 and time 0 than controls (ORadj 3.76 [95% CI 1.04-13.60]), whereas no significant differences were noted at time -2, or in men. CONCLUSION: Prior to knee replacement, a significant reduction in knee extensor strength appears to occur in women through 2 mechanisms: one driven by pain (loss of specific strength) and one independent of pain (loss of muscle anatomic cross-sectional area). Men who underwent knee replacement showed significantly reduced levels of extensor anatomic cross-sectional area, but not significantly lower strength or specific strength.

15.
Knee Surg Sports Traumatol Arthrosc ; 26(2): 391-398, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29185004

RESUMO

PURPOSE: Poor knee function after anterior cruciate ligament reconstruction (ACLR) may increase the risk of future knee symptoms and knee osteoarthritis via abnormal knee joint loading patterns, particularly during high-impact activity. This study aimed to assess the relationship between poor self-reported or clinically measured knee function and knee moments/vertical ground reaction force (vGRF) in individuals following ACLR. METHODS: 61 participants (mean 16.5 ± 3 months following ACLR, 23 women) completed a patient-reported knee function questionnaire and three hop tests (% of uninvolved limb). Participants were divided into satisfactory and poor knee function groups (poor < 85% patient-reported knee function and/or < 85% hop test symmetry). The knee biomechanics of both groups were assessed with three-dimensional motion analysis during the stance phase of overland running at self-selected speeds, and the association between knee function and knee moments was assessed using analysis of covariance with running speed as a covariate. RESULTS: Participants with poor knee function (n = 30) ran with significantly smaller peak knee flexion moments (moderate effect size 0.7, p = 0.03) and significantly smaller peak vGRFs (large effect size 1.0, p = 0.002) compared to those with satisfactory knee function (n = 31). No significant differences were observed for knee adduction and knee external rotation moments or knee kinematics. CONCLUSION: Individuals following ACLR with poor self-reported knee function and/or hop test performance demonstrate knee moments during running that may be associated with lower knee joint contact forces. These findings provide greater understanding of the relationship between knee biomechanics during running and clinical assessments of knee function. LEVEL OF EVIDENCE: III. Cross-sectional study.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Articulação do Joelho/fisiopatologia , Corrida/fisiologia , Adolescente , Adulto , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Fenômenos Biomecânicos , Estudos Transversais , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento , Adulto Jovem
16.
Arthritis Care Res (Hoboken) ; 70(4): 550-557, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28704603

RESUMO

OBJECTIVE: Inflammation is known to be strongly associated with knee pain in osteoarthritis. The infrapatellar fat pad represents a potential source of proinflammatory cytokines. Yet the relationship between infrapatellar fat pad morphology and osteoarthritis symptoms is unclear. METHODS: Here we investigate quantitative imaging parameters of infrapatellar fat pad morphology between painful versus contralateral pain-free legs of subjects with unilateral knee pain and patients with chronic knee pain versus those of matched pain-free control subjects. A total of 46 subjects with strictly unilateral frequent knee pain and bilateral radiographic osteoarthritis (Kellgren/Lawrence grade 2/3) were drawn from the Osteoarthritis Initiative. Further, 43 subjects with chronic knee pain over 4 years and 43 matched pain-free controls without pain over this period were studied. Infrapatellar fat pad morphology (volume, surface area, and depth) was determined by manual segmentation of sagittal magnetic resonance images. RESULTS: No significant differences in infrapatellar fat pad morphology were observed between painful versus painless knees of persons with strictly unilateral knee pain (mean difference -0.7% (95% confidence interval [95% CI] -0.6, 0.9; P = 0.64) or between chronically painful knees versus matched painless controls (-2.1% [95% CI -2.2, 1.1]; P = 0.51). CONCLUSION: Independent of the ambiguous role of the infrapatellar fat pad in knee osteoarthritis (a potential source of proinflammatory cytokines or a mechanical shock absorber), the size of the infrapatellar fat pad does not appear to be related to knee pain.

18.
Knee Surg Sports Traumatol Arthrosc ; 26(9): 2622-2629, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28488001

RESUMO

PURPOSE: Patellofemoral osteoarthritis (PFOA) occurs in approximately half of anterior cruciate ligament (ACL)-injured knees within 10-15 years of trauma. Risk factors for post-traumatic PFOA are poorly understood. Patellofemoral alignment and trochlear morphology may be associated with PFOA following ACL reconstruction (ACLR), and understanding these relationships, particularly early in the post-surgical time period, may guide effective early intervention strategies. In this study, patellofemoral alignment and trochlear morphology were investigated in relation to radiographic features of early PFOA 1-year post-ACLR. METHODS: Participants (aged 18-50 years) had undergone ACLR approximately 1 year prior to being assessed. Early PFOA was defined as presence of a definite patellofemoral osteophyte on lateral or skyline radiograph. Sagittal and axial plane alignment and trochlear morphology were estimated using MRI. Using logistic regression, the relationship between alignment or morphology and presence of osteophytes was evaluated. RESULTS: Of 111 participants [age 30 ± 8.5; 41 (37%) women], 19 (17%) had definite osteophytes, only two of whom had had patellofemoral chondral lesions noted intra-operatively. One measure of patellar alignment (bisect offset OR 1.1 [95% confidence interval 1.0, 1.2]) and two measures of trochlear morphology (sulcus angle OR 1.1 [1.0, 1.2], trochlear angle OR 1.2 [1.0, 1.5]) were associated with patellofemoral osteophytes. CONCLUSIONS: Patellofemoral malalignment and/or altered trochlear morphology were associated with PFOA 1 year following ACLR compared to individuals post-ACLR without these features. Clarifying the role of alignment and morphology in post-traumatic PFOA may contribute to improving early intervention strategies aimed at secondary prevention. LEVEL OF EVIDENCE: IV.


Assuntos
Lesões do Ligamento Cruzado Anterior/complicações , Reconstrução do Ligamento Cruzado Anterior , Articulação do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/etiologia , Complicações Pós-Operatórias/etiologia , Adulto , Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior/cirurgia , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico por imagem , Osteófito/diagnóstico por imagem , Patela/patologia , Radiografia , Fatores de Risco , Adulto Jovem
19.
PM R ; 10(4): 349-356, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28919498

RESUMO

BACKGROUND: A timely return to competitive sport is a primary goal of anterior cruciate ligament reconstruction (ACLR). It is not known whether an accelerated return to sport increases the risk of early-onset knee osteoarthritis (KOA). OBJECTIVE: To determine whether an accelerated return to sport post-ACLR (ie, <10 months) is associated with increased odds of early KOA features on magnetic resonance imaging (MRI) 1 year after surgery and to evaluate the relationship between an accelerated return to sport and early KOA features stratified by type of ACL injury (isolated or concurrent chondral/meniscal injury) and lower limb function (good or poor). DESIGN: Cross-sectional study. SETTING: Private radiology clinic and university laboratory. PARTICIPANTS: A total of 111 participants (71 male; mean age 30 ± 8 years) 1-year post-ACLR. METHODS: Participants completed a self-report questionnaire regarding postoperative return-to-sport data (specific sport, postoperative month first returned), and isotropic 3-T MRI scans were obtained. OUTCOME MEASURES: Early KOA features (bone marrow, cartilage and meniscal lesions, and osteophytes) assessed with the MRI OA Knee Score. Logistic regression analyses evaluated the odds of early KOA features with an accelerated return to sport (<10 months post-ACLR versus ≥10 months or no return to sport) in the total cohort and stratified by type of ACL injury and lower limb function. RESULTS: Forty-six (41%) participants returned to competitive sport <10 months post-ACLR. An early return to sport was associated with significantly increased odds of bone marrow lesions (odds ratio [OR] 2.7, 95% confidence interval [CI] 1.3-6.0) but not cartilage (OR 1.2, 95% CI 0.5-2.6) or meniscal lesions (OR 0.8, 95% CI 0.4-1.8) or osteophytes (OR 0.6, 95% CI 0.3-1.4). In those with poor lower limb function, early return to sport exacerbated the odds of bone marrow lesions (OR 4.6, 95% CI 1.6-13.5), whereas stratified analyses for type of ACL injury did not reach statistical significance. CONCLUSION: An accelerated return to sport, particularly in the presence of poor lower limb function, may be implicated in posttraumatic KOA development. LEVEL OF EVIDENCE: IV.

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