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Context: Girls' high school volleyball is a popular sport with a high rate of overuse injuries and sport specialization. Health professionals perceive that high school athletes are reluctant to follow treatment plans involving sport activity reduction. This study's purpose was to describe high school girls' volleyball athletes' self-reported shoulder and knee pain, the likelihood of adhering to medical advice, and the association of factors that influence the likelihood of reporting overuse injuries and sport specialization. Study Design: Cross-sectional. Methods: Participants completed an online survey (demographics, sport participation measures, shoulder and knee pain information, medical adherence likelihood [4-point Likert: not at all likely to extremely likely], and factors influencing overuse injury reporting intentions). A 2 × 2 chi-square analysis compared factors that influence athletes' intentions to "not report an overuse injury" (eg, I thought my coach would get mad; yes/no) and sport specialization (nonhighly specialized/highly specialized athletes). Results: There were 150 participants (highly specialized = 56%, grade: ninth = 33%, 10th = 28%, 11th = 22%, 12th = 17%). At least 60% reported shoulder and knee pain related to an overuse mechanism. Most reportedly did not seek rehabilitation led by a medical provider (shoulder pain = 66%, knee pain = 60%). Only 11% of athletes reported they were "extremely likely" to rest from sporting activity during the regular season if advised by a medical professional. Highly specialized athletes were more likely to report the pursuit of a college scholarship as a factor that influences their intention to report an overuse injury compared to nonhighly specialized athletes (13% vs 3%, respectively, P =.04). Conclusions: Most girls' volleyball athletes did not treat their pain with guided rehabilitation, which may increase their risk of a worse overuse injury or even acute injury. Clinicians, athletes, parents, and coaches need to work together to create a sport culture that empowers athletes to discuss their pain and overuse injuries with medical professionals. [ABSTRACT FROM AUTHOR]

Context: The persistence and the recurrence of posterior medial knee pain (PKP) after anterior cruciate ligament reconstruction (ACLR) using hamstring tendon graft are often overlooked during rehabilitation. Design: Cross-sectional observational study. Methods: The study aimed (1) to evaluate the prevalence of these types of PKP before 4 months post-ACLR, (2) to measure their consequences on the knee flexors strength, and (3) to evaluate the role of the type of ACLR. From a cohort of patients operated on with hamstring tendon procedures, the persistent and the recurrent PKP were sought at 4 months post-ACLR. The evolution of isokinetic muscle strength recovery in PKP subjects was compared with those of nonpainful subjects. The functional deficit was measured at 6/7 months post-ACLR by a hop test. Results: Three hundred seventeen subjects (25.8 [6.0] y) were included. At 4 months post-ACLR, 2 populations were identified based on the recurrent onset of PKP (PKP+, n = 40) or the absence of knee pain (PKP−, n = 277). The prevalence of PKP was 8.3%. At the fourth month post-ACLR, the PKP+ group had a higher flexor strength deficit compared with the PKP− group (limb symmetry index at 60°/s: 67.2% [12.4%] vs 84.3% [12.6%]; P <.05). At 6/7 months, the loss of strength persisted (limb symmetry index at 60°/s: 82.3% [13.4%] vs 87.7% [12.8%]; P <.05). The hop test deficit was comparable, and no difference was shown according to the type of graft. Conclusions: Persistent and recurrent PKP during the rehabilitation period were not uncommon and were associated with a worsening of flexors strength loss on the ACLR side. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to develop an evidence-based algorithm for the management of symptomatic bipartite patella in the pediatric and adolescent population based on a systemic review of the published literature. Methods: A systematic review of the literature was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines on PubMed and Embase, selecting for studies discussing the management of symptomatic bipartite patella. Results: Five studies met criteria, involving 315 knees (314 patients, average age 15.8 years). All patients presented with symptomatic bipartite patella and underwent an initial trial of conservative management. Seventy-six percent (239 knees) achieved full resolution of symptoms after conservative management at a median of 1.9 months. The remaining 76 knees (24.12%) had persistent symptoms requiring operative intervention. Surgical techniques included surgical excision, screw fixation, synchondrosis drilling, lateral release, and both arthroscopic and open interventions (92.1%). Most patients (90.79%) who underwent surgical intervention had partial or complete resolution of their symptoms. Seven of 76 knees (9.21%) needed management postoperatively for pain due to trauma, residual symptomatic ossicles, and hardware complications. Of these, four patients required reoperations (average 2 years). The remaining three patients had satisfactory outcomes with an additional course of conservative management and oral analgesics. Conclusion: Management of symptomatic bipartite patella should begin with a trial of conservative management. With refractory symptoms lasting greater than 3 months, surgical intervention may be considered with positive outcomes of partial or complete resolution of symptoms. The proposed algorithm is provided to guide physician management of symptomatic BPP in pediatric or adolescent patients. [ABSTRACT FROM AUTHOR]

Background and Aims: The femoral nerve (FN) is commonly blocked using ropivacaine to provide postoperative analgesia after knee surgery. However, the minimal required concentration has not yet been defined. The aim of this study was to estimate the minimal ropivacaine concentration required to achieve adequate analgesic FN block in 90% of cases (EC90). Methods: This study included 50 patients who were scheduled for knee ligament reconstruction under combined nerve block and general anaesthesia. The FN block was performed using 15 mL of ropivacaine with varying concentrations and considered adequate when associated with pain-free recovery. The sciatic, obturator, and lateral femoral cutaneous nerves were blocked to negate other knee pain generators, and their block success was confirmed. We used the biased-coin design up–down sequential method where the adequacy of an FN block altered the ropivacaine concentration used for the next block. The adequacy of the analgesic block or lack of it was analysed to calculate the analgesic EC90. The quadriceps motor power and morphine requirement were also recorded. Results: The recommended analgesic ropivacaine EC90 was 0.05% w/v. The associated quadriceps weakness and morphine requirement were minimal. Conclusion: FN block using ropivacaine 0.05% w/v may provide adequate analgesia in 90% of patients. [ABSTRACT FROM AUTHOR]

Introduction: A higher prevalence of knee pain in Southeast Asian countries, compared with non-Asian countries, is an established fact. This article hypothesizes that this fact, combined with personal, cultural, and environmental factors, may influence attitudes toward illness and treatment-seeking behavior and adherence. Objective: This study aimed to determine current attitudes, stigma, and barriers of women to the management of chronic knee pain and treatment in two Southeast Asian countries. Methods: Fourteen semi-structured interviews explored female lived perceptions of chronic knee pain in Southeast Asia. Using a phenomenological reduction process, open-ended questions allowed participants to voice their perceptions of their experience of this knee condition. Particular foci were potential stigma associated with the perceptions of others, health-seeking attitudes, and attitudes toward exercise. Results: The shared experiences of managing chronic knee pain revealed the impact of their condition on participants' normality of life and their struggles with pain, limitations, and fear for the future. Key individual, interpersonal, organizational and community barriers and facilitators impacted the health seeking attitudes and engagement with conservative rehabilitation programmes. Conclusion: Improved socio-cultural competency and consideration for an individuals' intersectional identity and interpersonal relationships are key to designing rehabilitation and conservative management solutions. Co-creating alternative pathways for rehabilitation for individuals that are more distant from health facilities may help reduce socio-cultural barriers at a community level. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated the three year clinical outcomes and predictors of success for unicompartmental knee arthroplasty (UKA) in an Indian population. Methods: Twenty patients with medial compartment osteoarthritis (≥ Ahlbäck grade 2) underwent UKA. American Knee Society Score (AKSS), Oxford Knee Score (OKS), and Visual Analogue Scale Score (VAS) were assessed at baseline, two weeks, six weeks, three months, and three years. Postoperative Hip Knee Ankle angle (HKA) and the Knee Joint Line Obliquity angle (KJO) were measured. Results: At three years, UKA led to significant improvements in knee health, function, and pain. AKKS improved from 62.20 ± 5.27 to 90.60 ± 3.81, OKS from 37.00 ± 1.55 to 19.15 ± 1.93, and VAS from 8.45 ± 0.69 to 2.40 ± 0.59 (all P < 0.05). Preoperative VAS was significantly correlated with both preoperative and postoperative outcomes of knee health and function (preoperative and three year AKSS and OKS), and limb alignment (HKA and KJO). Preoperative AKSS correlated with postoperative knee health and functional outcomes (3-year AKSS and OKS), pain levels (3-year VAS), and limb alignment (KJO). Conclusions: In this study of an Indian population, UKA demonstrated significant, sustained clinical improvements over three years, with no implant-related complications. In our cohort, preoperative pain and knee health significantly predicted outcomes. These findings suggest that preoperative assessment and optimization of both pain and knee health may potentially enhance the postoperative outcomes after UKA. [ABSTRACT FROM AUTHOR]

The article in Skeletal Radiology presents a case study of a 35-year-old male with left knee pain, without a history of trauma or injury. The patient exhibited tenderness over the proximal lateral tibia, with intact range of motion and ligament stability. Various imaging techniques were used to diagnose the condition, leading to successful treatment. The authors obtained informed consent for publishing anonymized images and declared no conflicts of interest. [Extracted from the article]

Introduction: Lorecivivint (LOR), a CDC-like kinase/dual-specificity tyrosine kinase (CLK/DYRK) inhibitor thought to modulate inflammatory and Wnt pathways, is being developed as a potential intra-articular knee osteoarthritis (OA) treatment. The objective of this trial was to evaluate long-term safety of LOR within an observational extension of two phase 2 trials. Methods: This 60-month, observational extension study (NCT02951026) of a 12-month phase 2a trial (NCT02536833) and 6-month phase 2b trial (NCT03122860) was administratively closed after 36 months as data inferences became limited. Participants received a single intra-articular LOR or placebo (PBO) injection at their parent-trial baseline. The primary outcome was the comparative incidence of serious adverse events (SAEs), with AEs and similar safety measures comprising secondary outcomes. A post hoc baseline-adjusted analysis of covariance (ANCOVA) compared changes from baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain and Function subscores and medial joint space width (JSW) between LOR 0.07 mg and PBO groups in a subpopulation of participants with unilateral knee pain and widespread pain low enough to allow participants to differentiate their target knee pain. Results: The safety analysis set for the extension study included 495 LOR-treated and 208 control participants, with 409 (82.6%) and 175 (84.1%) remaining at study close, respectively. There were 68 SAEs reported in 38 (5.4%) patients; none were considered treatment-related by investigators. The incidence of AEs was similar between groups. In the post hoc subgroup efficacy analyses, LOR 0.07 mg demonstrated greater mean improvements from baseline compared with PBO in WOMAC pain and function scores out to 12 months post-injection. No between-group differences in medial JSW were observed out to 18 months. Conclusions: LOR appeared generally safe and well tolerated. Efficacy analyses on the subset of completer patients demonstrated durable symptom improvements in WOMAC pain and function for at least 12 months compared to PBO after a single injection of LOR. Clinical Trial Registration Number: NCT02951026. Lay Summary: Knee osteoarthritis (OA) is the most common degenerative joint disease and significantly impairs patients' function and quality of life. Lorecivivint (LOR) is a drug candidate undergoing clinical trials as an injectable treatment for knee OA. It inhibits molecules in joint cells (called CLKs and DYRKs) that regulate inflammatory (affecting pain) and Wnt (affecting cartilage and bone turnover) pathways; abnormalities of both contribute to OA. We report data from patients with knee OA who completed two randomized, placebo (PBO)-controlled trials and who chose to continue to be observed for up to 3 years. They did not receive any new LOR injections but continued to get regular exams and annual X-rays by their clinicians and to report any (new / ongoing) health problems. An analysis was performed matching patients with similar clinical features (especially regarding their knee pain) from both trials, to see if a 0.07 mg dose of LOR was safe and if it affected knee pain and function. LOR appeared to be well tolerated, with few side effects that were similar in number to those receiving the placebo. More patients in the LOR-treated group reported feeling less knee pain and improved function than those in the PBO group; however, because knee x-rays of patients in both LOR and PBO groups showed no worsening of their OA over this time period, the evidence remained inconclusive. The profound need for safe, disease-modifying OA treatments and the encouraging results from this study support the continued development of LOR as a treatment for knee osteoarthritis. [ABSTRACT FROM AUTHOR]

Background: While one-legged and two-legged bodyweight squats on unstable and stable surfaces are commonly used during patellofemoral rehabilitation, patellofemoral loading during these exercises is unknown. Understanding how patellofemoral force and stress magnitudes affects different squat variations will aid clinicians in determining how and when to prescribe and progress these squatting types of exercises in patients with patellofemoral pain. Hypothesis/Purpose: To quantify patellofemoral force and stress between two squat type variations (BOSU squat versus floor squat) and between two leg variations (one-legged squat versus two-legged squat). It was hypothesized that patellofemoral force and stress would be greater in BOSU squat than floor-squat, and greater in one-legged squat than two-legged squat. Study Design: Controlled laboratory biomechanical, repeated-measures, counterbalanced design. Methods: Sixteen healthy participants performed one-legged and two-legged BOSU and floor squats. Kinematic and ground-reaction force data were used to calculate resultant knee force and torque using inverse-dynamics, with electromyographic data employed in a knee muscle model to predict resultant knee force and torque at every 10° between 10°-100° knee-angles during the squat-descent and squat-ascent. Repeated-measures 2-way ANOVA (p < 0.01) was employed for statistical analyses. Results: Collapsed across one-legged and two-legged conditions, patellofemoral joint force and stress were significantly greater during floor squats than BOSU squats at 40°, 50°, and 70° knee-angles during squat descent and 60° and 50° knee-angles during squat ascent. Collapsed across BOSU and floor squats, patellofemoral joint force and stress were significantly greater for one-legged squats than two-legged squats at all knee-angles. Significant interactions between squat types and leg conditions were found at 30°, 40°, 50°, 60°, and 100° knee-angles during squat-descent, and 100°, 90°, 80°, and 70° knee-angles during squat-ascent, with patellofemoral joint force and stress significantly greater in two-legged floor-squat than two-legged BOSU squat, but no significant differences between one-legged floor-squat and one-legged BOSU squat. Conclusions: Squatting progression employing lower to higher patellofemoral loading over time during PFP rehabilitation may be considered: 1) two-legged BOSU squats at lower knee angles (0° - 50°); 2) two-legged floor squats at lower knee angles (0° - 50°); 3) one-legged BOSU and floor squats at lower knee angles (0° - 50°); 4) two-legged BOSU squats at lower and higher knee angles (0° - 100°); 5) two-legged floor squats at lower and higher knee angles (0° - 100°); 6) one-legged BOSU and floor squats at lower and higher knee angles (0° - 100°). Level of Evidence: 2 [ABSTRACT FROM AUTHOR]

Giant meniscus cysts combined with mixed tears are relatively uncommon in clinical practice. The primary objective of rehabilitation is to restore knee joint function and prevent cyst recurrence. In this article, we discuss a series of rehabilitation strategies implemented for a patient who experienced both a giant meniscus cyst and a mixed tear. [ABSTRACT FROM AUTHOR]

This prospective diagnostic study aimed to assess the utility of machine learning-based quadriceps fat pad (QFP) radiomics in distinguishing patellofemoral osteoarthritis (PFOA) from non-PFOA using Q-Dixon MRI in patients presenting with anterior knee pain. This diagnostic accuracy study retrospectively analyzed data from 215 patients (mean age: 54.2 ± 11.3 years; 113 women). Three predictive models were evaluated: a proton density-weighted image model, a fat fraction model, and a merged model. Feature selection was conducted using analysis of variance, and logistic regression was applied for classification. Data were collected from training, internal, and external test cohorts. Radiomics features were extracted from Q-Dixon MRI sequences to distinguish PFOA from non-PFOA. The diagnostic performance of the three models was compared using the area under the curve (AUC) values analyzed with the Delong test. In the training set (109 patients) and internal test set (73 patients), the merged model exhibited optimal performance, with AUCs of 0.836 [95% confidence interval (CI): 0.762–0.910] and 0.826 (95% CI: 0.722–0.929), respectively. In the external test set (33 patients), the model achieved an AUC of 0.885 (95% CI: 0.768–1.000), with sensitivity and specificity values of 0.833 and 0.933, respectively (p < 0.001). Fat fraction features exhibited a stronger predictive value than shape-related features. Machine learning-based QFP radiomics using Q-Dixon MRI accurately distinguishes PFOA from non-PFOA, providing a non-invasive diagnostic approach for patients with anterior knee pain. [ABSTRACT FROM AUTHOR]

Introduction: Intramedullary tibial nailing is a standard treatment for tibial shaft fractures. Postoperative knee pain significantly impacts functional recovery; however, studies on this issue are limited. This study evaluated the effect of the parapatellar approach for intramedullary nailing on postoperative knee pain. Materials and methods: A total of 29 patients with tibial shaft fractures treated with intramedullary nails from March 2019 to January 2022 were divided into two groups based on the surgical approach: the semi-extended lateral parapatellar approach and the conventional subpatellar ligament split approach. Recorded metrics included operation time, intraoperative fluoroscopy count, intraoperative bleeding volume, Visual Analog Scale (VAS) scores for knee pain at 24 h, 72 h, 1 week, and 1 month postoperatively, fracture healing time and Lysholm knee functional scores at 12 months. Results: Both groups completed the operation without significant differences in operation time, intraoperative bleeding, fracture healing time, or intraoperative fluoroscopy (P > 0.05). The parapatellar group showed significantly better VAS scores for knee pain at 24 h, 72 h, and 1 week postoperatively compared to the control group (P < 0.05), with no significant difference at 1 month. After 12 months, Lysholm scores indicated no significant differences in knee support, locking, and swelling (P > 0.05); however, the parapatellar group showed significant improvements in lameness, instability, stair climbing, squatting, and pain (P < 0.05). Overall, the parapatellar group outperformed the control group (P = 0.01). Additionally, long-term follow-up revealed potential advantages of the parapatellar approach in improving long-term functional outcomes. Conclusions: Using the parapatellar approach for tibial intramedullary nailing avoids splitting the patellar ligament and entering the joint cavity, minimizing knee joint impact and effectively reducing postoperative knee pain, with potential benefits in long-term functional recovery. [ABSTRACT FROM AUTHOR]

Background: Dissatisfaction with Total Knee Arthroplasty (TKA) surgical outcomes remains between 10–20% and is associated with higher levels of societal costs. Expectations regarding post-surgical outcomes is considered as one of the major factors influencing satisfaction, however, there are no standardised methods for assessing patient's expectations regarding activities to be achieved following surgery. Objectives: The aims of this study were to identify patient expectations relating to activities of importance following TKA and to describe goal fulfillment at 3 months post-TKA. We hypothesised that activity expectation fulfillment would be associated with overall satisfaction with TKA outcomes. Methods: This study comprised secondary data analysis of findings from the SuPeR Knee study. Using conventional content analysis, a classification system of activities specific to our TKA patient cohort was created. At 3 months following TKA, patients rated satisfaction with fulfilling activity goals and pain attenuation. The average level of satisfaction achieved was used as our measure of goal fulfillment. Overall satisfaction of the outcomes of surgery was rated using a 5-point Likert scale and the association between goal fulfillment and overall surgery satisfaction was compared by Spearman's rank correlation. Results: Data were collected from 861 TKA patients. Recreation and sporting pursuits were found to be important activity types (43% of all activities). At 3 months after surgery, less impactful activities were more commonly satisfied (67%), including domestic and vocational activities, low impact hobbies and leisure activities. Goal fulfillment and improvement in knee pain were both significantly positively correlated to, and significant predictors of, overall patient satisfaction (p≤0.001). Conclusions: Our Australian cohort of TKA patients have a range of expectations for undertaking high-impact activities after surgery. However, at 3 months after surgery, higher rates of satisfaction were attained for lower-impact activities. Our findings support the importance of identifying activity expectations for each patient and that fulfillment of these goals contributes to overall satisfaction with the outcomes of TKA. [ABSTRACT FROM AUTHOR]

AbstractIntroductionMethodsResultsConclusionsKnee pain increases the risk of developing chronic widespread pain (CWP) and knee osteoarthritis (KOA). The prevalence of CWP and KOA has increased, and there is a need for early prevention. Therefore, the aim was to examine the associations of health-related quality of life (HRQoL) and lifestyle habits with chronic pain at a two-year follow-up in individuals with knee pain.A two-year longitudinal cohort study including 251 individuals aged 30–60 years reporting knee pain at baseline. HRQoL was measured via the Short-Form General Health Survey (SF-36), and lifestyle habits included questions on overweight, physical activity, diet, alcohol and tobacco use. Pain was assessed with a pain mannequin. Differences in health status and lifestyle habits over time in groups with unchanged no chronic pain (NCP), transitioned to less and more pain, and unchanged CWP were analysed using Wilcoxon’s, McNemar’s and Friedman’s tests. Multinominal regression analysis was performed to study associations with reporting chronic pain at follow-up.Reporting better HRQoL across various SF-36 concepts and normal weight at baseline was associated with reporting NCP after two years. A few changes were made regarding HRQoL and lifestyle habits over the course of two years, but an increase in general health was associated with transitioning to less pain.During primary care visits for knee pain with a combination of overweight or lower HRQoL, individuals should receive comprehensive attention to prevent the development of CWP. Future studies should investigate the associations further. [ABSTRACT FROM AUTHOR]

Objective: To determine whether 448 kHz capacitive-resistive monopolar radiofrequency (CRMR) after platelet-rich-plasma (PRP) injections can further reduce pain sensation within the first 72 h in an active population with patellar chondropathy. Methods: One-hundred fifty-three active patients with patellar chondropathy grade II-III were followed for three days after PRP injections with and without CRMR under a control–placebo study. They were clinically evaluated for pain sensation using a visual analog scale ranging from zero (no pain sensation) to ten (highest pain sensation). Pain sensation was described using medians and analyzed through the Friedman and Conover test for within-group comparison (pre-intervention, and 24, 48, and 72 h post-intervention) and the Mann–Whitney test for between-group comparisons (Intervention vs. Placebo) with α = 5% and 1−β = 80%. Results: The placebo group showed statistical significance between pre-intervention and 24 h (Δ = −2.0 pts, p < 0.001), baseline and 48 h (Δ = −2.0 pts, p < 0.001), baseline and 72 h (Δ = −3.0 pts, p < 0.001), 24 h and 48 h (Δ = 0.0 pts, p < 0.016), and 24 h and 72 h (Δ = −1.0 pts, p < 0.001). The radiofrequency group showed statistical significance between baseline and 24 h (Δ = −7.0 pts, p < 0.001), baseline and 48 h (Δ = −7.0 pts, p < 0.001), baseline and 72 h (Δ = −8.0 pts, p < 0.001), 24 h and 72 h (Δ = −1.0 pts, p < 0.001), and 48 h and 72 h (Δ = −1.0 pts, p < 0.001). The placebo and radiofrequency groups were significantly different at 24 h (Δ = 4.0 pts, p < 0.001), 48 h (Δ = 4.0 pts, p < 0.001), and 72 h (Δ = 4.0 pts, p < 0.001). Conclusions: CRMR therapy administered after knee intra-articular injections of PRP within the first 72 h in active populations with patellar chondropathy reduces pain sensation with a median difference of 8.0 pts compared to baseline and 4.0 pts compared to placebo group. [ABSTRACT FROM AUTHOR]

Background/Objectives: Knee pain in hemodialysis (HD) patients might affect health-related quality of life (HRQoL) and may be related to anxiety and depressive symptoms. The aim of this study was to assess the prevalence of knee pain in chronic HD patients and to determine its relationship with anxiety, depression, and HRQoL, Methods: This multicenter cross-sectional study was carried out on chronic HD patients. Sociodemographic, clinical, and therapeutic data were collected. The Knee Pain Screening Tool (KNEST) was used to screen for knee pain. Patients with knee pain were instructed to complete the visual analog scale (VAS) for pain and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The patients also completed an Arabic-language version of the Hospital Anxiety and Depression Scale (HADS) and the Kidney Disease Quality of Life-36 (KDQOL-36™) questionnaire. Results: This study included 271 chronic HD patients; the median age was 51 (IQR 21) years, and most of them were males (59%). Of them, 158 had knee pain. Those with knee pain were more likely to have anxiety compared to those without (p = 0.002) and significantly lower scores on the symptom/problem (p = 0.03) and burden of kidney disease domains (p = 0.047) and the physical health (p < 0.001) and mental health components (p = 0.001). Furthermore, those with moderate to severe knee pain were more likely to experience anxiety (p = 0.001) and depression (p = 0.005) and have a lower physical health composite (PHC) than those with mild knee pain (p = 0.046). Conclusions: HD patients have a significant prevalence of knee pain that is usually associated with anxiety and leads to worse HRQoL than those without knee pain. [ABSTRACT FROM AUTHOR]

Background: There are no studies that compare the outcomes and complications of single-versus two-stage revision anterior cruciate ligament reconstruction (ACLR) after primary ACLR failure. This purpose of this study is to examine clinical and functional outcomes and complications associated with single and two-stage revision ACLR after primary ACLR failure. Methods: All patients who underwent single or two-stage revision ACLR after primary ACLR failure between 2012 and 2021 with a minimum of a 2 year follow-up were included. Patients were excluded if they were not treated at our single academic institution, had inadequate follow-up, or had incomplete medical records. Revision intraoperative data, concomitant injuries, and complications were collected by chart review. Return to sport, numerical pain rating scale (NPRS) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and Veteran Rands 12-item health survey (VR-12 scores) were collected. Results: The final analysis included 176 patients. A total of 147 (83.5%) had a single-stage revision ACLR (87 male, 60 female), and 29 (16.5%) had a two-stage revision ACLR (13 male, 16 female). Two-stage revision ACLR was significantly associated with anterior knee pain [odds ratio (OR) 4.36; 95% confidence interval (CI) 1.5 to 12.65; P = 0.007] but with lower failure rates (OR 0.12, 95% CI 0.02 to 0.9; P = 0.04). On multivariate analysis, a two-stage revision ACLR reduced the risk of graft failure by 85% (OR 0.15; 95% CI 0.02 to 1.17; P = 0.07). Two-stage revision ACLR was significantly associated with a lower KOOS pain score (OR −11.7; 95% CI −22.35 to −1.04; P = 0.031), KOOS symptoms score (OR −17.11; 95% CI −28.85 to −5.36; P = 0.004), KOOS Activities of Daily Living (ADL) score (OR −11.15; 95% CI −21.71 to −0.59; P = 0.039) and Veterans RAND 12-Item Health Survey (VR-12) physical component score (OR −9.99; 95% CI −15.77 to −4.22; P = 0.001). Conclusions: The clinical outcomes and subjective patient scores significantly differed between the single-stage and two-stage revision ACLR after primary ACLR failure. Patients with a two-stage revision ACLR had a significantly reduced risk of revision graft failure but higher rates of postoperative anterior knee pain, lower pain scores, and lesser knee functional scores than single-stage revision patients. Study design: Retrospective cohort study; level of evidence, 3 [ABSTRACT FROM AUTHOR]

Background: Patellofemoral pain (PFP) is a common musculoskeletal disorder resulting in anterior knee pain. Physiotherapy is the current standard treatment, while surgical intervention (tibial tubercle transfer [TTT]) is reserved for chronic cases when nonoperative treatment has failed. TTT can result in clinically meaningful improvement in patients with patellofemoral maltracking without instability. However, to date, no randomised controlled trials (RCT) have compared TTT combined with a physiotherapy (PT) programme to PT alone as the initial treatment for PFP. Methods: A single-centre nonblinded RCT in 40 patients with chronic PFP (> 1 year) and tibial tubercle-trochlear groove (TT-TG) > 15 mm will be randomised to either TTT followed by PT or to PT alone in a 1:1 ratio in a concealed manner. The primary outcome is knee pain at 18 weeks for the TTT group (6 weeks splint phase + 12 weeks PT) and at 12 weeks for the PT group, measured by the visual analog scale (VAS). Secondary outcomes include Patient-Reported Outcome Measures (PROMs) using the Kujala score, International Knee Documentation Committee (IKDC) 'Subjective Knee Form', Tegner Activity score and EuroQol 5D-5 L for quality of life. Range of motion (ROM) is measured using the decline step-down test (DSDT). Between-group differences will be analysed using multivariable linear regression analysis, while longitudinal differences will be assessed with linear mixed models for repeated measures. The difference in direct medical costs will also be assessed. Discussion: The REVITALISE study is the first randomised study to compare surgical intervention (TTT) followed by PT to PT alone in patients with chronic PFP. This study will generate level-1 evidence on the most effective treatment for chronic PFP, which can be integrated into the national guideline to aid orthopaedic surgeons and physiotherapists in their decision-making and ultimately improve our care for patients with chronic PFP. Trial registration: Study Identifier NCT06227806, registered on 26 Jan 2024 on ClinicalTrials.gov. The study underwent independent peer review and received approval from the ethical review board (number NL80956.091.22). [ABSTRACT FROM AUTHOR]

Purpose Meniscal injuries are a common occurrence in sports-related activities, often leading to pain, reduced joint function, and impaired athletic performance. This study aimed to evaluate the role of ultrasound-guided intra-articular platelet-rich plasma (PRP)-rich fluid injection which was obtained through serial centrifugation in the treatment of meniscal injuries resulting from sports activities. Materials and Methods A prospective study was conducted involving 54 cases with grade I, II, and III meniscal injuries, aged 18 and 43 years. PRP-rich fluid was prepared by subjecting autologous blood samples to a two-step centrifugation process. Patients were assessed pretreatment and at regular intervals posttreatment. Results Patients reported reduced pain and improved joint functionality following treatment. Average age of the patients was 34.4 years, and average follow-up period was 275.1 days. It is noteworthy that no cases of bilateral meniscal injuries were identified; indicating that the focus was primarily on single knee injuries. Predominance of grade II injuries suggests that the PRP intervention might be particularly effective in addressing more severe meniscal tears. Conclusion The results of our study provide compelling evidence for the positive impact of PRP augmentation in meniscus repair. Our findings indicate that PRP therapy has the potential to bring about substantial benefits for individuals with meniscus tears of the knee, particularly in terms of pain relief and enhanced functional capabilities. [ABSTRACT FROM AUTHOR]

Background Knee joint osteoarthritis (OA) is among the most prevalent degenerative diseases of the joints in the body. Various scoring system exists for grading OA, such as (1) magnetic resonance imaging (MRI) Osteoarthritis Knee Score (MOAKS), (2) clinical grading by Western Ontario and McMaster Universities Arthritis Index (WOMAC), and (3) X-ray grading of the Kellgren–Lawrence grading system (K-L). Objectives To study MRI findings and MOAKS scoring of knee OA and correlation with WOMAC and K-L scoring. Setting and Design Cross-sectional study in hospital population. Materials and Methods A total 40 knee OA cases underwent an MRI of the knee. MOAKS scoring was done and compared with K-L grading and WOMAC scores. Statistical Analysis Collected data were compiled systematically and interpreted using IBM SPSS statistics software 25.0. A p -value of less than 0.05 was considered significant. Results The mean total WOMAC score was 9. K-L grade 2 was the most prevalent X-ray grade. Bone marrow lesion (BML) and cartilage loss in MOAKS score were greater in the medial femorotibial region. A moderate positive correlation was noted between the WOMAC score and K-L grade; full-thickness articular cartilage loss score at the medial femorotibial joint (MFTJ) and WOMAC score; partial-thickness articular cartilage loss score at lateral femorotibial joint (LFTJ) and WOMAC total pain score. No correlation was found between BML and pain severity score. Conclusion Higher WOMAC scores were associated with higher grades of K-L scoring and score of cartilage loss (partial and full thickness) of the MOAKS scoring system. The rest of the features of the MOAKS score (BML score, osteophyte, and synovitis) had no significant association with pain severity and K-L grading. [ABSTRACT FROM AUTHOR]

Purpose: This study aim was to analyze the joint temperature of patients affected by bilateral knee osteoarthritis (OA) using infrared thermography to investigate whether thermographic imaging patterns are influenced by the severity of symptoms and joint degeneration. Methods: Sixty-sixpatients ranging from 43 to 78 years old (63.3 ± 8.8 years) with bilateral knee OA and one symptomatic knee were enrolled. Thermograms of the two knees were captured using a thermographic camera FLIR T1020 and analyzed with the ResearchIR software to calculate the temperature of the overall knee and the four regions of interest (ROIs): patella, suprapatellar, medial, and lateral areas. Results: The temperature of knees affected by OA was influenced by joint degeneration level and symptoms: patients with higher OA grade in the symptomatic knees presented higher total knee temperatures compared to the asymptomatic ones (p = 0.002), as well as in the patellar (p = 0.005), lateral (p = 0.002), and medial (p = 0.001) areas. On the other hand, patients with the same OA level in the two knees presented a higher temperature in the symptomatic knee only in the medial area (p = 0.037). Symptomatic knees demonstrated a different pattern compared to asymptomatic knees, with the medial area presenting the highest temperature changes (p = 0.020). Patients reporting prevalent pain in the lateral knee area presented higher differences in total knee temperature (0.7 ± 0.7 °C) than patients with pain in the medial area (0.1 ± 0.5 °C) (p = 0.023). Conclusion: The temperature of knees affected by OA is influenced by the degree of joint degeneration and by the presence of symptoms, with higher temperatures found in symptomatic joints, especially with prevalent lateral knee pain, and in more severe OA. Symptomatic knees demonstrated a different pattern compared to asymptomatic knees, with the medial area presenting the highest temperature changes. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare the effectiveness of retrograde and antegrade intramedullary tibial nails (RTN and ATN) in managing extra-articular distal tibial fractures, addressing current controversies in surgical approaches. Patients and methods: A retrospective analysis included 56 patients treated between December 2019 and August 2022 with either RTN (n = 23) or ATN (n = 33). Data on baseline characteristics, operative specifics, fluoroscopy usage, hospitalization duration, fracture healing times, time to full weight-bearing, distal tibial alignment, American Orthopedic Foot and Ankle Society (AOFAS) scores at final follow-up, and complications were evaluated and compared. Results: Baseline characteristics were generally comparable and no significant differences except for fracture line lengths (RTN: 6.1 ± 1.9 cm vs. ATN: 7.8 ± 1.6 cm) were observed. Follow-up ranged from 12 to 20 months. No significant differences were observed in operative duration, hospital stays, coronal angulation of the distal tibial joint surface, or AOFAS scores at final follow-up. Intraoperative fluoroscopy was more frequent in the ATN group (9.5 ± 1.5) compared to RTN (8.3 ± 1.1) (P = 0.001). RTN showed shorter healing times (9.6 ± 1.2 weeks) and quicker return to full weight-bearing (12.9 ± 1.3 weeks) than ATN (10.6 ± 1.2 weeks and 13.9 ± 1.7 weeks, respectively). RTN complications included one delayed union, one superficial infection, and two ankle pain, while ATN complications comprised one delayed union, one superficial infection, seven anterior knee pain, and one malalignment. Despite higher complication rates with ATN, the differences were not statistically significant. Conclusion: For the treatment of extra-articular distal tibial fractures, both RTN and ATN are effective approaches. RTN may offer benefits such as reduced fluoroscopy use, accelerated healing, and earlier return to full weight-bearing compared to ATN. [ABSTRACT FROM AUTHOR]

Ultrasound therapy effectively treats a joint range of motion limitation and pain originating from soft tissue in knee osteoarthritis (OA). Few interventional studies have focused on the infrapatellar fat pad (IFP), and the effects of high-intensity continuous ultrasound (HICUS) on IFP stiffness and gliding have not been investigated. Therefore, we aimed to determine the effects of HICUS on IFP stiffness and gliding. This single-blind, randomized, controlled crossover study involved 24 healthy participants. The HICUS and placebo conditions were applied to the knee joint on 2 different days. HICUS was performed (1 MHz, 2.5 W/cm², duty cycle 100%, 5 min) using an ultrasound machine equipped with an applicator and adsorption-type fixed automatic rotation irradiation function. The main outcomes were IFP stiffness and gliding measured at 10 degrees and 120 degrees knee flexion. Gliding was measured as the difference between the patellar-tendon tibial angles at 10 degrees and 120 degrees knee flexion. Measurements were performed before (T1), immediately after (T2), and 15 min after (T3) treatment. Two-way repeated measures analysis of variance showed a significant interaction of IFP stiffness at 10 degrees knee flexion; post-test results showed that HICUS decreased stiffness at T2 and T3. There was no significant difference at 120 degrees. A significant interaction of gliding was observed under the HICUS condition. Post-tests showed that HICUS significantly improved gliding at T2 and T3. HICUS is a simple, safe intervention for improving IFP stiffness and gliding in healthy participants, with sustained effects. Further studies are needed to evaluate its efficacy in patients. [ABSTRACT FROM AUTHOR]

Introduction: Anterior knee pain is not an uncommon problem. A plethora of pathologies can cause anterior knee pain. Patellofemoral maltracking (trochlear dysplasia) is not an uncommon cause of anterior knee pain in adolescents and young adults. Aim: We hypothesize that there is an alteration of articular cartilage of the patella and trochlear in trochlear dysplasia. Materials and Methods: Magnetic resonance images of 86 knee joints were reviewed independently by two musculoskeletal radiologists. Standard magnetic resonance imaging (MRI) sequences were used in this study. Based on the Dejour classification for trochlear dysplasia, the patients were divided into normal, Type A, B, C, and D. The articular cartilage thickness of the patella and trochlea was measured and compared between the groups. Results: Out of the 86 MRI scans of the knees which were reviewed, 32 patients were male and 54 were female. The mean patient age was 21.9 years (range = 10–40). Sixty-six knee joints had trochlear dysplasia, with 15 patients classified into Dejour Type A, 13 in Type B, 31 in Type C, and 7 in Type D. There was no significant difference in the articular cartilage thickness of the lateral facet of the patella between all groups (ANOVA F = 1.43, P = 0.23). Conclusion: There was no significant difference in the articular cartilage thickness in the lateral facet of the patella and trochlea in patients with normal knee joints compared to those with trochlear dysplasia of Type A–D. [ABSTRACT FROM AUTHOR]

Background: Multiligament knee injuries (MLKIs) are heterogeneous, and bicruciate knee ligament injuries are considered a serious form of this injury. The current literature tends not to distinguish between single and bicruciate MLKI when reporting outcomes. Purpose: To investigate patient-reported outcomes after surgical treatment of MLKI comparing single cruciate MLKI with bicruciate MLKI. The secondary aim was to investigate the influence of different factors on patient-reported outcomes after surgery. Study Design: Cohort study; Level of evidence, 3. Methods: This study was designed as a cross-sectional cohort study. Patients who underwent surgical treatment for MLKI at a single level 1 trauma center between January 2013 and December 2020 were included in this study. Patient-reported outcomes included the Tegner score, Lysholm score, International Knee Documentation Committee (IKDC) subjective knee form, Knee injury and Osteoarthritis Outcome Survey (KOOS), and a visual analog scale for pain. Results: Of the 191 patients meeting the inclusion criteria, 124 (65%) agreed to participate and had a complete data set with a follow-up time at a mean 74 ± 27 months. Patients with single cruciate MLKI (type I) had significantly higher scores for IKDC (P =.007), Lysholm (P =.012), KOOS Pain (P =.04), KOOS Activities of Daily Living (P =.01), KOOS Sport and Recreation (P =.005), KOOS Quality of Life (P =.04), KOOS4 (which considers the subscales of Pain, Symptoms, Sport and Recreation, and Quality of Life) (P =.01), Tegner (P =.04), and visual analog scale for pain during activity (P =.004) when compared with patients with bicruciate MLKI (type II-type IV). Furthermore, age was significantly associated with a lower IKDC (P =.001), and an increased severity of injury was significantly associated with IKDC (P =.015), KOOS4 (P =.022), and Lysholm (P =.029) scores. Conclusion: MLKIs involving a single cruciate ligament had significantly higher patient-reported postoperative outcome measures compared with bicruciate MLKIs. Age and type of injury were important predictors for outcomes. Patients presenting with dislocated knees had lower patient-reported outcomes; however, there was no significant difference in outcomes between bicruciate MLKIs and patients presenting with dislocated knees. [ABSTRACT FROM AUTHOR]

The timing of growth plate fusion is a key indicator for age estimation and is primarily used in forensic investigations. On the other hand, non-ionizing techniques such as MRI are being developed to provide safer and more ethical evaluations in forensic casework. This study aims to evaluate the closure process of growth plates in the distal femoral and proximal tibial epiphyses using Multiple Echo Recombined Gradient Echo (MERGE) MRI sequences and provide age estimation data based on staging methods for forensic purposes. We retrospectively analyzed 559 patients (294 males, 265 females, aged 8–25 years) diagnosed with trauma and knee pain at Tepecik Training and Research Hospital from 2016 to 2019. MRI scans were performed using a 1.5-T system with MERGE sequences and evaluated by two observers using a new staging system. Observer agreement was assessed using Cohen's κ test, yielding high agreement values (κ > 0.8). Positive correlations were found between age and ossification stages (p < 0.001). Minimum age thresholds for stages 5a and 5b of the distal femoral epiphysis were 16 and 18 years for females and 17 and 19 years for males, respectively. For the proximal tibial epiphysis, the minimum ages for stages 5a and 5b were 15 years for females and 17 years for males. The MERGE sequence provides a viable method for assessing skeletal maturity in living individuals with significant ethical advantages due to non-ionizing radiation. This study supports the potential application of the MERGE sequence in forensic age estimation, demonstrating high observer agreement and consistency. Future research should focus on comparing different sequences and populations to enhance the methodology's applicability. [ABSTRACT FROM AUTHOR]

ABSTRACT: Background: This qualitative study aimed to explore the early experiences of individuals with patellofemoral arthritis in the Indian context. Method: The study was conducted in Gujarat, India, with 14 participants, recruited from regional orthopedic outpatient departments. They were interviewed either in person or online using the Zoom platform, with an expert clinician using a semistructured interview guide in the vernacular language. Results: A scoping review was conducted to find the reported symptoms of the condition, which were identified as anterior knee pain, crepitus, pain while sitting down, walking uphill, and kneeling. Thematic analysis was used to analyze the qualitative data, where four domains of initial symptoms of patellofemoral arthritis were identified: pain, crepitus, stiffness, and difficulty in functional activity. The findings suggest that pain was the primary concern for participants in the Indian context, and initial symptoms are highly affected by individual preferences. Conclusion: Acknowledging initial symptoms and measuring their severity must be taken into consideration to improve the prognosis of the condition. [ABSTRACT FROM AUTHOR]

Objective: The aim of the study is to explore the relationship between 2-yr changes in muscle strength and cartilage according to knee pain in mild and moderate knee osteoarthritis. Design: Two hundred seventy-nine participants were retrospectively obtained from the Osteoarthritis Initiative. Western Ontario McMaster University and Knee Injury and Osteoarthritis Outcome Score were used to assess pain and function. Five muscles strength (maximum extensor and flexor, normalized maximum extensor and flexor, and extensor/flexor ratio) were measured from isometric strength test. Menisci and cartilage volumes were measured from magnetic resonance imaging to assess 2 yr of osteoarthritis progression. Results: Mild and moderate knee osteoarthritis progression was characterized by patellofemoral cartilage loss and meniscal degeneration. For WOMAC pain >2 participants, decrease in extensor strength and normalized extensor strength were positively correlated with medial meniscus volume loss (r = 0.261, P = 0.021; r = 0.232, P = 0.041, respectively). The extensor/flexor ratio changes were positively associated with Western Ontario McMaster University function changes (r = 0.291, P = 0.013) over 2 yrs. Conclusions: The study observed a positive correlation between quadriceps strength decrease and medial meniscus degeneration in mild and moderate knee osteoarthritis patients with Western Ontario McMaster University pain >2. These findings suggested quadriceps-hamstrings balance possibly plays a protective role in knee function for participants with weaker quadriceps and severe pain. To Claim CME Credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME Objectives: Upon completion of this article, the reader should be able to: 1): Determine the effect of knee extensor muscle strength changes on the medial and lateral meniscus, tibia, and medial and lateral femoral cartilage over 2 yrs in mild to moderate knee osteoarthritis patients; 2): Describe the correlation of knee extensor strength with the medial and lateral meniscus, tibia, and medial and lateral femoral cartilage at different WOMAC-pain levels; and 3): Discuss the relationship between changes in muscle strength and changes in meniscus and cartilage volume and WOMAC pain scores over 2 yrs in mild to moderate knee osteoarthritis patients. Level: Advanced Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity. [ABSTRACT FROM AUTHOR]

Total knee arthroplasty (TKA) is performed on approximately 790,000 patients annually in the United States and is projected to increase to 1.5 million by 2050. This study aimed at assessing the use of preoperative cryoneurolysis on patients undergoing TKA by analyzing: (1) pain severity; (2) opioid use; (3) functional status; and (4) sleep disturbance (SD) over 6 months following discharge. Patients enrolled in the Innovations in Genicular Outcomes Registry between September 2021 and February 2024 were followed for 6 months. Our analyses included patients undergoing unilateral primary TKA with no preoperative opioid prescription, who either received cryoneurolysis, or did not. Baseline patient demographics were collected before TKA and tabulated. Pain management was assessed via the Brief Pain Inventory-Short Form instrument for pain severity. SD was measured using the patient-reported outcomes measurement information system questionnaire. Each outcome measure was assessed prior to TKA, weekly, and at monthly follow-up. Data were analyzed by a generalized linear mixed-effect regression model to compare cryoneurolysis versus control patients, with a P <.05 as significant. There were 80 patients who were treated with preoperative cryoneurolysis, while 60 control patients did not have treatment. Patients receiving cryoneurolysis experienced significantly lower pain severity and SD over the 6-month follow-up than control patients (P =.046). Cryoneurolysis was also associated with a trend toward greater functional improvement that did not reach statistical significance (P =.061). Further, patients who underwent cryoneurolysis were 72% less likely than control group patients to take opioids over 6 months following discharge (P <.001). Preoperative cryoneurolysis therapy in opioid-naive patients undergoing TKA is associated with improved pain, decreased opioid use, and improved SD for 6 months postoperatively. Cryoneurolysis, a nonopioid pain relief modality administered preoperatively, demonstrated substantial benefits in patients who underwent TKA. [ABSTRACT FROM AUTHOR]

This study explored the longitudinal relationship between the presence of knee pain and knee osteoarthritis (OA) symptoms with risk of sarcopenia, hospitalization, and mortality. Data from Malaysian Elders Longitudinal Research (MELoR) study was utilized. The presence of knee pain and knee OA symptoms was determined at baseline between 2013 and 2015, whereas sarcopenia was determined in 2019 using SARC-F with telephone interviews. Hospitalization status was identified by asking participants "Have you been admitted to hospital since you enrolled into the MELoR study?" Death Registry data were obtained from the National Registry Department. Data from 577 individuals, mean age (SD) = 68.214 (7.095), range = 54 to 97 years, and 55.5% women at baseline, were included. Knee pain and knee OA symptoms were associated with increased risk of probable sarcopenia at follow-up, odds ratios (95% confidence interval) =2.71 [1.61, 4.58] and 2.73 [1.59, 4.71], respectively, after adjustment for confounders. Knee pain and knee OA symptoms were not associated with hospitalization and mortality. Knee pain and knee OA symptoms were associated with increased risk of probable sarcopenia at five-year follow-up in an urban older population in Kuala Lumpur. Future studies should seek to identify modifiable risk factors for the development of sarcopenia in individuals with knee OA. [ABSTRACT FROM AUTHOR]

Background: Patellofemoral pain (PFP) significantly affects patients' daily activities and consequently reduces their quality of life. Custom-made foot orthoses (FOs) are a common method of medical treatment that positively influences biomechanical factors such as the kinematics of the lower extremity and reduces pain perception in patients. However, there is a gap in research regarding the influence of different FO treatments on knee pain. Therefore, this study addresses the impact of biomechanical foot orthoses (BMFOs) and sensorimotor foot orthoses (SMFOs) on patients with foot deformity and PFP. Methods: A total of 26 participants (9 men, 17 women; 27.7 ± 10.7 years; 175.0 ± 0.1 cm; 75.7 ± 18.8 kg; BMI: 24.7 ± 5.6) took part in this randomized controlled clinical trial. In the pre-test, knee pain was evaluated using the Kujala Anterior Knee Pain Scale after the physician's anamnesis and plantar pressure measurement. A 3-month intervention with SMFO and BMFO was performed, and weekly development was evaluated using 11-item visual analog scales (VASs). Repeated measures analyses of variance were used to assess differences between time of measurements (ToMs) and the interaction effect between ToMs and treatment groups (SMFO, BMFO). Results: Statistical analysis revealed no statistically significant interaction between ToMs and treatment groups but a significant main effect on Kujala anterior knee pain scores (MDiff = 10.189; p = 0.014) and 12-week VAS (p = 0.001). Conclusions: The findings indicate that both treatment approaches effectively alleviated perceived knee pain in the PFP sample with foot deformity, with neither approach demonstrating superior efficacy. This trial was registered in the WHO International Clinical Trials Registry Platform (ICTRP) and German Clinical Trials Register (DRKS00035082). [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis aimed to determine whether manual therapy (MT) and strengthening exercises (SE) reduce pain in patients with knee osteoarthritis (KO). Clinical trials were identified through a search of PubMed, PEDro, Scopus, and Ovid databases up to April 2024. Two independent reviewers screened articles, removing duplicates, and conducted full-text evaluations. Nineteen studies were included, with eight incorporated into the meta-analysis. Of these, seven addressed MT and twelve focused on SE. Although the studies included a variety of outcomes and follow-up periods, both interventions were shown to reduce pain immediately after the intervention, with MT providing superior short-term outcomes. Improvements were noted in the VAS scale for the MT group (effect size = 0.799; Z = 2.495; p = 0.013; IC 95%= 0.171 to 1.427; Q-value = 17.721; p = 0.001) and in the WOMAC pain score for the SE compared to controls (effect size = 0.364; Z = 1.993; p = 0.046; IC 95%= 0.006 to 0.722; Q-value = 2.4; p = 0.301). Both results showed high evidence according to GRADE. However, long-term effects are inconclusive, with low/very low levels of evidence. Both MT and SE are effective interventions in reducing pain in the short term. However, more clinical trials are needed to determine the best doses and the long-term effects. [ABSTRACT FROM AUTHOR]

Objective: The objective was to examine potential pathways linking neighborhood disadvantage to pain severity in individuals with knee pain consistent with or at risk for knee osteoarthritis (KOA). Methods: The current investigation is a cross‐sectional analysis. Data were collected from 140 middle‐aged to older non‐Hispanic White and non‐Hispanic Black adults from the Understanding Pain and Limitations in Osteoarthritic Disease Study 2 (UPLOAD‐2). Relationships among neighborhood disadvantage, sleep efficiency, pain catastrophizing, and pain severity were assessed. Neighborhood disadvantage was quantified using the Area Deprivation Index, and actigraphy data were used to assess sleep efficiency. The Coping Strategies Questionnaire–Revised catastrophizing subscale and the Western Ontario and McMaster Universities Osteoarthritis Index pain severity scale were used to assess pain catastrophizing and pain severity, respectively. A serial mediation model assessed the neighborhood–sleep–catastrophizing–pain pathway, as well as the neighborhood–sleep–pain and the neighborhood–catastrophizing–pain pathways. Results: Greater neighborhood disadvantage was associated with worse sleep efficiency, ultimately contributing to greater pain severity. Although neither neighborhood disadvantage nor sleep efficiency were associated with pain catastrophizing, pain catastrophizing itself was associated with greater KOA pain. Conclusion: Neighborhood disadvantage impacts KOA pain outcomes through sleep efficiency but not pain catastrophizing, thereby highlighting environmental aspects that impact sleep as potential targets for intervention. [ABSTRACT FROM AUTHOR]

Background: Exercise has been reported to be beneficial in reducing pain and fatigue, as well as improving mood, in patients with knee osteoarthritis (KOA). However, long bouts of exercise have been linked to an increase in fatigue and pain level in elderly adults. Currently, there are very few investigations into the immediate effects of breaking exercise into shorter and frequent bouts, otherwise known as exercise snacking on physical fatigue, mood, and pain in elderly adults with KOA. The aim of this study was to investigate the immediate impact of exercise snacking versus continuous exercise on physical fatigue, mood, and pain level in elderly adults with KOA. Methods: This was a randomized experimental study, with 37 participants aged 60 years and above with KOA. Participants were recruited and randomly assigned into a five bouts of 2-min exercise snacking and 10-min continuous exercise groups, with the bicycle ergometer as the exercise mode. Physical fatigue, mood, and pain of participants were assessed at baseline and immediately after the exercise using Numerical Fatigue Rating Scale (NFRS), Visual Analog Mood Scale (VAMS), and Numerical Pain Rating Scale (NPRS) respectively. Descriptive statistics and inferential statistics of Wilcoxon Rank test, Mann–Whitney U, and ANCOVA were used to analyze the data with p value set at 0.05. Results: There were significant differences (p < 0.001) in physical fatigue, mood, and pain between baseline and post-intervention values within groups. Between-group comparisons revealed significant reductions in physical fatigue (p < 0.001) and pain levels (p = 0.048) in the exercise snacking group compared to the continuous exercise group. However, no significant between-group differences were found for mood. Conclusion: Exercise snacking yielded significant improvements in physical fatigue and pain in elderly with KOA. However, both exercise snacking and continuous aerobic exercise were comparable in their immediate effects on mood in elderly adults with KOA. Trial registration: PACTR202308724795310 Registered 28th September 2023, https://www.edctp.org/pan-african-clinical-trials-registry/. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusion Level of Evidence High‐grade femoral trochlear dysplasia is associated with anterior knee pain, patellar maltracking, instability and the development of osteoarthritis. Scientific studies have signified the importance of trochlear resection on the knee extensor mechanism, and dysplasia can be addressed by a groove‐deepening trochleoplasty. Alternatively, tibial tubercle anteriorisation has been proposed to reduce patellofemoral joint (PFJ) pressure and alleviate pain from osteoarthritis. However, the relative contributions of articular changes in the sagittal and axial planes remain unknown. This study aimed to better understand the effect of these different osteotomies, that alter the sagittal plane geometry, on PFJ biomechanics.Seven cadaveric knees were used to measure the following factors: (1) PFJ contact pressure; (2) Knee extension torque (KET); and (3) Patellar kinematics at 60°, 45°, 30°, 15° and 0° of knee flexion among four different osteotomy states: native, anteriorised trochlea, combined anteriorised trochlea and anteriorised tibial tubercle, and anteriorised tibial tubercle. Analysis was made using a two‐way repeated‐measures analysis of variance.Anteriorising the trochlea increased mean PFJ contact pressures ×2.9 at 0° (p = 0.024) and ×2.2 (p = 0.029) at 15° flexion compared to the native state. Peak pressures increased ×4.9 at 0° and ×3.3 at 15° (n.s.). Anteriorising the trochlea reduced KET 18% (p = 0.001) at 40° flexion and 19% (p = 0.009) at 50°. The patella was anteriorised 8 mm in the extended knee (p < 0.001) and flexed 8° at 45° knee flexion (p < 0.001) compared to the native state. Elevating the tibial tubercle, alone or combined with an anteriorised trochlea, did not have a significant effect on the respective outcome measurements.An anteriorised trochlea elevated PFJ contact pressure, reduced KET and altered patellar position during knee flexion/extension movement, while a tibial tubercle anteriorisation had a negligible opposite effect. These findings indicate that symptoms associated with high grade trochlear dysplasia may be addressed better at the trochlea, rather than at the tibial tubercle.Basic science. [ABSTRACT FROM AUTHOR]

Background: High tibial osteotomy (HTO) is an effective treatment option for deformity correction after fracture. However, performing precise corrective osteotomy for cases with a severe varus deformity and a significant posterior slope poses a significant challenge. Three-dimensional (3D) bone model construction and patient-specific instrumentation (PSI) created from preoperative Computed tomography (CT) may be useful tools in achieving successful outcome for such cases. The present technique describes a hybrid closing-wedge distal tuberosity tibial osteotomy (Hybrid CWDTO) using two PSIs. Methods: Preoperative planning was performed in 3D with reference to the contralateral normal lower extremity CT taken preoperatively, which was then mirrored for analysis. A full-scale bone model and two PSIs were constructed based on this plan to allow for complex correction. During surgery, osteotomy was performed using these sterilized PSIs as guides. Results: Radiographic imaging showed that medial proximal tibial angle (MPTA) improved from 68 to 84 degrees and posterior tibial slope (PTS) improved from 19 to 6 degrees. The standing leg radiograph showed a mechanical varus alignment improvement from 12 to 3 degrees. The 2011 Knee Society Scoring system (2011 KSS) improved from 31 to 95 in objective knee indicators, from 10 to 24 in symptoms, from 14 to 40 in patient satisfaction and from 51 to 95 in activities. Conclusion: Hybrid CWDTO using PSIs is a useful surgical technique for alignment correction post-malunion while also achieving high patient satisfaction. This can assist surgeons in treating complex deformities that are otherwise difficult to treat. [ABSTRACT FROM AUTHOR]

PURPOSE: Job profiles such as heavy vehicle drivers and transportation office workers that involve prolonged static and inappropriate postures and forceful exertions often impact an individual's health, leading to various disorders, most commonly musculoskeletal disorders (MSDs). In the present study, various individual risk factors, such as age, weight, height, BMI, sleep patterns, work experience, smoking status, and alcohol intake, were undertaken to see their influence on MSDs. METHODS: The modified version of the Nordic Questionnaire was administered in the present cross-sectional study to collect data from 48 heavy vehicle drivers and 40 transportation office workers. RESULTS: The analysis revealed low back pain (LBP), knee pain (KP), and neck pain (NP) to be the dominant pains suffered by the participants from both occupational groups. LBP, KP, and NP were suffered by 56%, 43.75%, and 39% heavy vehicle drivers and 47.5%, 40%, and 27.5% transport office workers, respectively. From the insignificant value of Chi-square, it can be inferred that the participants from both occupations experience similar levels of LBP, KP, and NP. The Bayesian model applied to the total sample showed that NP influenced KP, which further influenced the LBP of the workers. Age was predicted as LBP's most significant risk factor by the logistic regression model when applied to the total sample, while NP was found to decrease with an increase in per unit sleep. CONCLUSIONS: The overall results concluded that heavy vehicle drivers and office workers, irrespective of their different job profiles, endured pain similarly. [ABSTRACT FROM AUTHOR]

Patellofemoral pain syndrome (PFPS) ranks among the most prevalent factors causing anterior knee pain. Quadriceps exercises such as forward lunges are important to treat PFPS. Aim: We investigated whether there is a difference in muscle activity between the vastus medialis oblique (VMO) and vastus lateralis (VL) muscles and the center of pressure (CoP) among three hip positions, namely, hip adduction forward lunge (HADF), hip neutral forward lunge (HNEF), and hip abduction forward lunge (HABF), in healthy subjects. Method: This was a randomized controlled pilot study that included twenty healthy (age: 23.7 ± 2.51) volunteers. The CoP was measured using a "Wii Balance Board" from Nintendo, and VMO and VL muscle activity were measured via wireless surface electromyography. Results: The CoP outcomes showed significant differences among the three positions in terms of position (p < 0.001), sum distance (p < 0.001), range (p < 0.001), and max distance (p < 0.001). VMO (p < 0.000), and VL (p < 0.005) muscle activity and the ratio of VMO/VL (p < 0.000) significantly differed among the three positions. Conclusions: Although VMO and VL muscle activity increased in the HADF and HABF, excessive changes in the CoP occurred in the two positions. The change in the CoP during the HADF and HABF may result in valgus, varus, and loading of the knee joint, which may worsen PFPS. The HNEF is recommended for quadriceps strengthening in healthy subjects and PFPS patients. [ABSTRACT FROM AUTHOR]

AbstractA machine-learning system is constructed to alleviate chronic knee pain through exercise and muscle strengthening. Three user-focused features are offered: video-based exercise demonstrations, real-time posture analysis and feedback, and performance and progress tracking. This system, which functions as an artificially-intelligent “technological surrogate physiotherapist,” applies human-computer incentive compatibility and joint learning-by-doing to reify and strengthen motivation, trust and acceptance and to increase effectiveness and efficacy, initial exacerbation of knee pain notwithstanding. In a 3-week experiment involving 60 individuals carrying chronic knee pain, positive and statistically significant outcomes were recorded regarding the Western Ontario and McMaster Universities Osteoarthritis Index physical function (p = 0.001), quality of life (EQ-5D-5L: < 0.001; EQ VAS: p = 0.004), exercise engagement (p < 0.001), system usability, and system acceptance. Technology-based solutions hold significant promise for improving future clinical practice by reducing professional resource demand and increasing the accessibility and caregiver-patient incentive compatibility under physiological healthcare. [ABSTRACT FROM AUTHOR]