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Obesity is a worldwide pandemic; however, no adaptations were made to the physical examination of obese patient's knees. The accuracy of the physical examination is critical for correct assessment and selection of treatment. We aimed to assess whether body mass index (BMI) affects the sensitivity and specificity of common provocative knee tests.We studied 210 patients who underwent knee arthroscopy to treat anterior cruciate ligament (ACL) and meniscal pathologies. BMI and the knee's physical examination were documented pre-operatively. Sensitivity, specificity, and accuracy of ACL and meniscal provocative tests in relation to BMI were evaluated using arthroscopy as a gold standard.The Anterior Drawer, Lachman, and Pivot-Shift tests for ACL tears were significantly less accurate and sensitive, yet more specific, in obese patients when compared to normal and overweight patients. The McMurray, Apley Grind, and Thessaly tests for medial meniscus tears showed greater sensitivity, but lower specificity, in patients with increased BMI. Above normal BMIs, independently of age and gender, were significantly associated with higher odds for positive ACL tests.Tests for ACL tears are less sensitive in obese patients and alternatives to the classic tests should be considered. Medial meniscus tests tend to be more sensitive and less specific in patients with greater BMIs. Their results should be carefully interpreted due to possible false positives. The physician should take into consideration the impact of patient BMI on the accuracy of their physical examination of the knee to optimize treatment decision-making.

Comparing symptoms of patients with focal cartilage defects of the knee to those with knee osteoarthritis. Prospectively maintained databases identified patients with focal cartilage defects (FCD group) who underwent osteochondral allograft transplantation and patients with osteoarthritis (OA group) undergoing arthroplasty. Patients between 18 and 55 years of age were included and matched based on age. Baseline patient demographics, symptoms, and patient-reported outcomes including the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), SF-12, and VR-12 questionnaires were recorded. Patient symptoms and individual responses of the KOOS JR were compared between groups. Regression analysis was used to evaluate the association between pre-operative factors that significantly differed between groups and the KOOS JR questionnaire. Sixty-four patients were included: 32 patients in each group. The FCD group had a significantly lower body mass index (BMI) (p = 0.04) and greater number of workers’ compensation cases (p = 0.027) when compared to the OA group. Patients in the OA group complained more frequently of medial-sided pain (p = 0.02) and knee swelling (p = 0.003). The OA cohort also had greater pain with fully straightening the knee (p = 0.012), pain with standing upright (p = 0.016), and pain with rising from sitting (p = 0.003). Patients in the FCD group had greater KOOS JR outcome scores (51.5 ± 12.9 vs. 41.5 ± 20.5; p = 0.023). When compared to patients with focal cartilage defects, adults with knee osteoarthritis scheduled for knee arthroplasty have a more severe presentation of symptoms, particularly medial-sided pain, swelling of the knee, pain associated with straightening the knee, standing upright, and rising from sitting.

Symptomatic knee osteoarthritis (OA) remains a substantial cause of pain and disability worldwide and effective management in young patients without indications for total knee arthroplasty remains challenging. Intra-articular injections represent a viable option in the non-operative treatment of knee OA. Hyaluronic acid (HA) and platelet-rich plasma (PRP) are two commonly utilized intra-articular treatment modalities that are of particular clinical interest in the current literature. The purpose of this manuscript is to provide a concise review of the current literature on the use of HA, PRP, and HA-PRP conjugates for the treatment of symptomatic knee OA. A review of the literature utilizing PubMed, OVID/Medline, and Cochrane databases on basic science and clinical literature pertaining to preparation, composition, and outcomes of HA, PRP, and HA-PRP conjugates in patients with symptomatic knee OA. Both HA and PRP have been shown to be efficacious for the treatment of symptomatic knee OA, with HA injections providing limited short-term improvement, while PRP may provide greater therapeutic relief, particularly with the use of leukocyte-poor (LP-PRP) formulations. Despite limited data, the combination of different formulations of HA-PRP conjugates may provide a synergistic effect, resulting in a clinically significant improvement in both pain and function. In patients with symptomatic knee OA, intra-articular HA and PRP provide short-term improvement in pain and function, while the efficacy of HA-PRP conjugates warrants further study.

Comparing symptoms of patients with focal cartilage defects of the knee to those with knee osteoarthritis.Prospectively maintained databases identified patients with focal cartilage defects (FCD group) who underwent osteochondral allograft transplantation and patients with osteoarthritis (OA group) undergoing arthroplasty. Patients between 18 and 55 years of age were included and matched based on age. Baseline patient demographics, symptoms, and patient-reported outcomes including the Knee Injury and Osteoarthritis Outcome Score for Joint Replacement (KOOS JR), SF-12, and VR-12 questionnaires were recorded. Patient symptoms and individual responses of the KOOS JR were compared between groups. Regression analysis was used to evaluate the association between pre-operative factors that significantly differed between groups and the KOOS JR questionnaire.Sixty-four patients were included: 32 patients in each group. The FCD group had a significantly lower body mass index (BMI) (p = 0.04) and greater number of workers' compensation cases (p = 0.027) when compared to the OA group. Patients in the OA group complained more frequently of medial-sided pain (p = 0.02) and knee swelling (p = 0.003). The OA cohort also had greater pain with fully straightening the knee (p = 0.012), pain with standing upright (p = 0.016), and pain with rising from sitting (p = 0.003). Patients in the FCD group had greater KOOS JR outcome scores (51.5 ± 12.9 vs. 41.5 ± 20.5; p = 0.023).When compared to patients with focal cartilage defects, adults with knee osteoarthritis scheduled for knee arthroplasty have a more severe presentation of symptoms, particularly medial-sided pain, swelling of the knee, pain associated with straightening the knee, standing upright, and rising from sitting.

Symptomatic knee osteoarthritis (OA) remains a substantial cause of pain and disability worldwide and effective management in young patients without indications for total knee arthroplasty remains challenging. Intra-articular injections represent a viable option in the non-operative treatment of knee OA. Hyaluronic acid (HA) and platelet-rich plasma (PRP) are two commonly utilized intra-articular treatment modalities that are of particular clinical interest in the current literature. The purpose of this manuscript is to provide a concise review of the current literature on the use of HA, PRP, and HA-PRP conjugates for the treatment of symptomatic knee OA.A review of the literature utilizing PubMed, OVID/Medline, and Cochrane databases on basic science and clinical literature pertaining to preparation, composition, and outcomes of HA, PRP, and HA-PRP conjugates in patients with symptomatic knee OA.Both HA and PRP have been shown to be efficacious for the treatment of symptomatic knee OA, with HA injections providing limited short-term improvement, while PRP may provide greater therapeutic relief, particularly with the use of leukocyte-poor (LP-PRP) formulations. Despite limited data, the combination of different formulations of HA-PRP conjugates may provide a synergistic effect, resulting in a clinically significant improvement in both pain and function.In patients with symptomatic knee OA, intra-articular HA and PRP provide short-term improvement in pain and function, while the efficacy of HA-PRP conjugates warrants further study.