Longitudinal Trajectories of Depressive Symptoms Among Patients With Knee Osteoarthritis: The Role of Pain Intensity

BackgroundPain is the primary symptom of knee osteoarthritis (KOA), significantly associated with depressive symptoms. Whether the early pain intensity could distinguish different trajectories of depressive symptoms is not well understood among patients with KOA.AimsTo identify heterogeneous depressive symptoms trajectories among patients with KOA, and investigate the association between depressive symptoms subgroups and pain intensity.DesignSecondary analysis of a cohort sample.SettingThree waves of data from the China Health and Retirement Longitudinal Study was collected in 28 provinces across China.Participants702 patients with KOA aged ≥ 45 years completed the Center for Epidemiologic Studies Depression Scale biennially from 2011 to 2015.MethodsLatent class growth analysis was performed to identify the optimal trajectory shape and number of classes. Multinomial logistic regression analysis was conducted to compare pain intensity across the trajectories.ResultsFour distinct trajectories were identified as follows: no depressive symptoms, highly stable, decreasing, and increasing. In multivariate analysis, compared with the “no depressive symptoms” class, patients in the “highly stable” class and “increasing” class were more likely to report moderate pain (p < 0.05) and severe pain (p < 0.05). In addition, there was no significant difference in pain intensity between “no depressive symptoms” class and “decreasing” class (p > 0.05).ConclusionsThese results suggest important heterogeneity in depressive symptom trajectories among patients with KOA. Pain intensity could predict different depressive symptom trajectories in patients with KOA. Efforts to improve the depressive symptoms in patients with KOA must incorporate strategies to address pain.     

Prehabilitation before total knee arthroplasty: A systematic review on the use and efficacy of stratified care

BackgroundPreoperative rehabilitation (hereafter called “prehabilitation”) has been proposed as a potentially effective treatment to target preoperative risk factors to prevent insufficient outcome after total knee arthroplasty (TKA).PurposeWe aimed to assess whether previous clinical trials of non-surgical, non-pharmacological prehabilitation in individuals with knee osteoarthritis (KOA) awaiting TKA focused on specific clinical phenotypes or specific individual characteristics and whether the content of the prehabilitation was stratified accordingly. Second, we aimed to summarize and compare the long-term effects of stratified and non-stratified care on pain, satisfaction, function and quality of life.MethodsA systematic literature search of PubMed, Web of Science, Scopus and Embase was performed. All relevant articles published up to April 19, 2021 reporting “(randomized controlled) clinical trials or prospective cohort studies” (S) related to the key words “total knee arthroplasty” (P), “preoperative conservative interventions” (I), “pain, function, quality of life and/or satisfaction” (O) were included.ResultsAfter screening 3498 potentially eligible records, 18 studies were assessed for risk of bias. Twelve studies had low, 2 moderate, 3 serious, and one high risk of bias. The latter study was excluded, resulting in 17 included studies. Five studies investigated a“stratified prehabilitation care” and 12 “non-stratified prehabilitation care”. Stratified prehabilitation in 4 studies meant that the study sample was chosen considering a predefined intervention, and in the fifth study, the prehabilitation was stratified to individuals’ needs. No direct comparison between the 2 approaches was possible. We found weak evidence for a positive effect of biopsychosocial prehabilitation compared to no prehabilitation on function (stratified studies) and pain neuroscience education prehabilitation compared to biomedical education on satisfaction (non-stratified studies) at 6 months post-TKA. We found strong evidence for positive effects of exercise prehabilitation compared to no prehabilitation on pain at 6 months and on function at 12 months post-TKA (non-stratified studies).ConclusionMore research is needed of stratified prehabilitation care focusing on individual characteristics in people with KOA awaiting TKA.Registration numberThis systematic review was prospectively registered at PROSPERO on March 22, 2021 (no. CRD42021221098).     

本体感觉神经肌肉促进技术对膝骨关节炎患者本体感觉及平衡能力的影响

目的 探讨本体感觉神经肌肉促进（PNF）技术训练对膝骨关节炎（KOA）患者膝关节本体感觉及平衡能力的影响。 方法 选取符合入组标准的KOA患者40例,按随机数字表法分为实验组和对照组,每组20例。实验组接受PNF技术锻炼,包括等张组合、节律性稳定和动态逆转技术;对照组接受规范的患侧股四头肌肌力训练。采用膝关节再成角试验评估本体感觉,采用单腿站立测试（OLS）和5次坐立试验（FTSST）评估患者的平衡能力。 结果 实验组治疗前后的膝关节30°、60°、110°主动成角误差与被动成角误差差异有统计学意义（P<0.05）,对照组治疗前后的膝关节各角度主动成角误差与被动成角误差差异无统计学意义（P>0.05）。治疗后,实验组的膝关节各角度主动成角误差及被动成角误差明显小于对照组治疗后（P<0.05）。实验组治疗后的OLS与FTSST时间亦明显优于组内治疗前（P<0.05）;但对照组治疗后的OLS时间与治疗前相比,差异无统计学意义（P>0.05）,而FTSST时间明显短于组内治疗前（P<0.05）。实验组治疗后的OLS与FTSST时间明显优于对照组治疗后（P<0.05）。 结论 PNF技术可显著改善KOA患者膝关节本体感觉及平衡能力。     

A new strategy to tackle severe knee osteoarthritis: Combination of intra-articular and intraosseous injections of Platelet Rich Plasma

ABSTRACT

Introduction: Knee osteoarthritis (KOA) is a mechanically induced, cytokine and enzyme-mediated disorder involving all the joint tissue of the knee. Rebuilding a physiological-homeostatic network at the tissue level following knee organ failure, such as in severe KOA, is a daunting task with therapeutic targets encompassing the articular cartilage, synovium and subchondral bone. Intraarticular infiltration of plasma rich in growth factors (PRP) has emerged as a promising symptomatic approach, although it is insufficient to reach the subchondral bone.

Areas covered: This review addresses current molecular and cellular data in joint homeostasis and osteoarthritis pathophysiology. In particular, it focuses on changes that subchondral bone undergoes in knee osteoarthritis and evaluates recent observations on the crosstalk among articular cartilage, subchondral bone and synovial membrane. In addition, we review some mechanistic aspects that have been proposed and provide the rationale for using PRP intraosseously in KOA.

Expert opinion: The knee joint is a paradigm of autonomy and connectedness of its anatomical structures and tissues from which it is made. We propose an innovative approach to the treatment of severe knee osteoarthritis consisting of a combination of intraarticular and intraosseous infiltrations of PRP, which might offer a new therapeutic tool in KOA therapy.     

No specific effect of whole-body vibration training in chronic stroke: a double-blind randomized controlled study

Brogårdh C, Flansbjer UB, Lexell J. No specific effect of whole-body vibration training in chronic stroke: a double-blind randomized controlled study.ObjectiveTo evaluate the effects of whole-body vibration (WBV) training in individuals after stroke.DesignA double-blind randomized controlled study with assessments pre- and posttraining.SettingA university hospital rehabilitation department.ParticipantsParticipants (N=31; mean age ± SD, 62±7y; 6–101mo poststroke) were randomized to an intervention group or a control group.InterventionsSupervised WBV training (2 sessions/wk for 6wk; 12 repetitions of 40–60s WBV per session). The intervention group trained on a vibrating platform with a conventional amplitude (3.75mm) and the control group on a “placebo” vibrating platform (0.2mm amplitude); the frequency was 25Hz on both platforms. All participants and examiners were blinded to the amplitudes of the 2 platforms.Main Outcome MeasuresPrimary outcome measures were isokinetic and isometric knee muscle strength (dynamometer). Secondary outcome measures were balance (Berg Balance Scale), muscle tone (Modified Ashworth Scale), gait performance (Timed Up &; Go, comfortable gait speed, fast gait speed, and six-minute walk tests), and perceived participation (Stroke Impact Scale).ResultsThere were no significant differences between the 2 groups after the WBV training. Significant but small improvements (P<.05) in body function and gait performance were found within both groups, but the magnitude of the changes was in the range of normative variation.ConclusionsSix weeks of WBV training on a vibration platform with conventional amplitude was not more efficient than a placebo vibrating platform. Therefore, the use of WBV training in individuals with chronic stroke and mild to moderate disability is not supported.     

Increased postural stiffness during challenging postural tasks in patients with knee osteoarthritis with high pain sensitization

BackgroundPostural stability is affected in knee osteoarthritis patients who present with pain but the link to pain sensitization is unclear.MethodsPatients with knee osteoarthritis completed the Knee Injury and Osteoarthritis Outcome Score and pressure pain thresholds were assessed bilaterally at the knee, lower leg and forearm prior to standing quietly (1 min) on a force platform in four conditions: Firm surface with open eyes, firm surface with closed eyes, soft surface with open eyes, and soft surface with closed eyes. Pain intensity during standing was assessed via numerical rating scale. Postural stability was assessed by the range, velocity, and standard deviation of the Center of Pressure (CoP) extracted from the force platform. The means of three repeated measures per standing condition were analysed. High-sensitization and low-sensitization groups were defined based on bilateral pressure pain thresholds from leg and arm.FindingsFifty-six patients were included. Compared with the low-sensitization group, the high-sensitization group demonstrated 1) smaller pressure pain thresholds at the knee (P < 0.05) although the Knee Injury and Osteoarthritis Outcome Score and pain intensity were not significantly different between groups, and 2) smaller range of the CoP in the anterior-posterior direction during the soft surface with closed eyes condition (P < 0.05).InterpretationSmaller CoP range suggest that patients with more widespread pain sensitivity have increased postural stiffness compared with the low-sensitization group. The greater stiffness found in high-sensitization patients under sensory restrictions (closed eyes and reduced proprioception) might relate to restricted integration of sensory information due to widespread pain sensitization.     

A systematic review and meta-analysis of lower limb neuromuscular alterations associated with knee osteoarthritis during level walking

Background

Neuromuscular alterations are increasingly reported in individuals with knee osteoarthritis (KOA) during level walking. We aimed to determine which neuromuscular alterations are consistent in KOA individuals and how these may be influenced by osteoarthritis severity, varus alignment and/or joint laxity.

Methods

Electronic databases were searched up to July 2012. Cross-sectional observational studies comparing lower-limb neuromuscular activity in individuals with KOA, healthy controls or with different KOA cohorts were included. Two reviewers assessed methodological quality. Effect sizes were used to quantify the magnitude of observed differences. Where studies were homogenous, effect sizes were pooled using a fixed-effects model.

Findings

Fourteen studies examining neuromuscular alterations in indices of co-contraction, muscle amplitude and muscle activity duration were included. Data pooling revealed that moderate KOA individuals exhibit increased co-contraction of lateral knee muscles (ES 0.64 [0.3 to 0.97]) and moderately increased rectus femoris (ES 0.73 [0.23 to 1.22]), vastus lateralis (ES 0.77 [0.27 to 1.27]) and biceps femoris (ES 1.18 [0.67 to 1.7]) mean amplitude. Non-pooled data indicated prolonged activity of these muscles. Increased medial knee neuromuscular activity was prevalent for those exhibiting varus alignment and medial knee joint laxity.InterpretationIndividuals with KOA exhibited increased co-contraction, amplitude and duration of lateral knee muscles regardless of disease severity, limb alignment or medial joint laxity. Individuals with severe disease, varus alignment and medial joint laxity demonstrate up-regulation of medial knee muscles. Future research investigating the efficacy of neuromuscular rehabilitation programs should consider the effect of simultaneous up-regulation of medial and lateral knee muscles on disease progression.     

高频彩色多普勒超声评价不同方法治疗膝关节骨性关节炎的疗效

目的 探讨高频超声评价不同方法治疗膝关节骨性关节炎(KOA)疗效的价值。方法 将60例KOA患者随机分为针刀治疗组和药物治疗组各30例,运用高频彩色多普勒超声分别测量两组治疗前、后关节腔积液、滑膜厚度,观察滑膜血供,并进行统计学分析。结果 60例KOA,治疗后关节腔积液减少、滑膜变薄、血供减少,与治疗前比较差异有统计学意义(P<0.05),且针刀治疗组较药物治疗组效果更明显(P<0.05)。结论 超声通过观察关节腔积液、滑膜厚度及血供情况,可为临床评价膝关节骨性关节炎治疗效果提供依据。     

Blood flow restriction training in patients with knee osteoarthritis: Systematic review of randomized controlled trials

IntroductionKnee osteoarthritis (KOA) is one of the most common musculoskeletal disorders in the elderly. The patient experiences reduction in muscle strength, pain, joint stiffness and consequently a reduction in quality of life. Whereas high intensity training (HI-TR) is the most effective in the general elderly population, in KOA patients, painless alternatives might be more suitable, since pain can be a deterrent for exercising. Research interest has increased in blood flow restriction training (BFR-TR) due to the observation that, in this specific population, BFR-TR results in equal muscular adaptions to HI-TR but with less join discomfort/pain.ObjectiveWe aimed to: (1) determine the value of BFR-TR in patients with KOA and (2) examine which exercise guidelines applied to healthy elderly populations can be adopted for patients suffering from this knee pathology.MethodologyWe searched the literature from the database inception to 2019 through PubMed, Cochrane, and Medline (EBSCO). The inclusion criteria were determined using PICOS principles. We assessed methodology using the Risk of Bias 2 tool and the Pedro scale. Conclusions were extracted with the use of best evidence synthesis.ResultsThe literature search yielded 45 articles. After screening, three studies matched the inclusion criteria. The included studies were analyzed and discussed. All the included studies reported within group improvements for BFR-TR regarding pain and strength.ConclusionAlthough the evidence of BFR-TR efficacy on KOA remains scarce, the results favor its use for muscle strengthening and pain reduction in KOA. Further high-quality studies with larger samples are required.     

Neuromuscular joint function in knee osteoarthritis: A systematic review and meta-analysis

BackgroundNeuromuscular alterations are common in people with knee osteoarthritis (KOA). A comprehensive understanding of these alterations is important to enable targeted rehabilitation strategies.ObjectivesThis systematic review and meta-analysis aimed to comprehensively understand the neuromuscular alterations around the knee joint in people with KOA.MethodsModerate- and high-quality studies based on a modified version of the Downs and Black checklist, comparing neuromuscular function of peri?articular muscles between people with KOA and controls were retrieved from five databases from inception to October 2020. Outcomes included normalized isokinetic strength, muscle size, voluntary activation, cortical and spinal-reflex excitability, and torque-related outcomes. Data were pooled according to structural KOA severity with sensitivity analysis based on sex. Evidence levels are presented in evidence gap maps.ResultsA total of 7 high-quality and 22 moderate-quality studies were retained (1146 people with KOA and 1353 age- and sex-matched controls). Studies demonstrated quadriceps and hamstring strength deficits and increased hamstring-to-quadriceps strength ratios across KOA severities. Women presented lower quadriceps strength at early KOA (very limited evidence) and lower voluntary activation at end stage KOA (very limited evidence) as compared with controls, whereas men did not (moderate evidence). People with KOA also demonstrated lower quadriceps force control ability with no change in rapid force production (very limited evidence). Voluntary activation deficits for quadriceps were evident (moderate evidence), with no change in quadriceps cortical excitability (very limited evidence) or soleus spinal reflexes (very limited evidence). No muscle size change was demonstrated except for the vastus medialis (limited evidence). Evidence gaps were found for neural and torque-related measures and differences in hamstring, gastrocnemius, soleus, and popliteus.ConclusionsNeuromuscular deficits are evident across different structural KOA severities and are seen in muscle strength, voluntary activation, muscle size, and force control ability. Women may exhibit these alterations to a greater extent than men.Prospero registration numberCRD42019160845.     

Whole body vibration improves maximum voluntary isometric contraction of knee extensors in patients with chronic kidney disease: A randomized controlled trial

Background: Whole body vibration (WBV) training improves maximum voluntary isometric contraction (MVIC) of knee extensors, postural balance, functional capacity, and quality of life (QOL) in several diseases. The objective was to assess the efficacy of WBV training in patients with chronic kidney disease (CKD) on hemodialysis (HD) in the interdialytic period. Method: A randomized, controlled trial study with concealed allocation, intention-to-treat analysis, and triple blinding. Sixteen patients with CKD of both genders aged over 40 years were allocated in two groups, the WBV group or the sham group, training 2 times a week for 12 weeks. The primary outcome was knee extensor muscle strength, and the secondary outcomes were quadriceps thickness, distance walked, balance, and QOL. Results: The WBV group improved MVIC of knee extensors with a difference between groups in improvement of 117.29 N (95% CI, 32.25–202.24) at the end of training. The other outcomes were not different between groups. Practical applications: The WBV program has shown to be effective and may be able to help in prescribing the appropriate training program for CKD. Conclusion: WBV training improves MVIC of knee extensors in patients with CKD on HD in the interdialytic period. WBV training could be considered in the management of patients with CKD.     

Altered tibiofemoral joint contact mechanics and kinematics in patients with knee osteoarthritis and episodic complaints of joint instability

Background

To evaluate knee joint contact mechanics and kinematics during the loading response phase of downhill gait in knee osteoarthritis patients with self-reported instability.

Methods

Forty-three subjects, 11 with medial compartment knee osteoarthritis and self-reported instability (unstable), 7 with medial compartment knee osteoarthritis but no reports of instability (stable), and 25 without knee osteoarthritis or instability (control) underwent Dynamic Stereo X-ray analysis during a downhill gait task on a treadmill.

Findings

The medial compartment contact point excursions were longer in the unstable group compared to the stable (P = 0.046) and the control groups (P = 0.016). The peak medial compartment contact point velocity was also greater for the unstable group compared to the stable (P = 0.047) and control groups (P = 0.022). Additionally, the unstable group demonstrated a coupled movement pattern of knee extension and external rotation after heel contact which was different than the coupled motion of knee flexion and internal rotation demonstrated by stable and control groups.

Interpretation

Our findings suggest that knee joint contact mechanics and kinematics are altered during the loading response phase of downhill gait in knee osteoarthritis patients with self-reported instability. The observed longer medial compartment contact point excursions and higher velocities represent objective signs of mechanical instability that may place the arthritic knee joint at increased risk for disease progression. Further research is indicated to explore the clinical relevance of altered contact mechanics and kinematics during other common daily activities and to assess the efficacy of rehabilitation programs to improve altered joint biomechanics in knee osteoarthritis patients with self-reported instability.     

Screening serum biomarker of knee osteoarthritis using a phage display technique

ObjectivesTo screen serum biomarker of knee osteoarthritis (OA) using a phage random peptide library.Design and methodsA phage random peptide library of random peptide 12-mers was screened with purified immunoglobulin G (IgG) from sera of knee OA patients. Patients with knee rheumatoid arthritis (RA), hip OA, non-erosive hand OA or erosive hand OA, and healthy volunteers were used as controls.ResultsA phage clone with inserted peptide TGLESGHGPGDS (named KOA1) showed 90% positive reaction rate with the knee OA patients, significantly higher than that with the knee RA patients (27.8%), the non-erosive hand OA patients (34.3%), the erosive hand OA patients (31.3%) and the healthy controls (12.0%), but not the hip OA patients (82.5%).ConclusionsThe novel knee OA mimic peptide KOA1 identified with a random phage display peptide library and sera from knee OA patients could be a potential serum biomarker for knee OA.     

Hip strength,quadriceps strength and dynamic balance are lower in people with unilateral knee osteoarthritis compared to their non-affected limb and asymptomatic controls

BackgroundThere is insufficient literature on multi-directional hip strength differences and dynamic balance between people with knee osteoarthritis (KOA) and healthy controls.ObjectiveIn people with unilateral KOA, determine if hip/knee strength and dynamic balance differs (i) between sides, and (ii) compared to controls.MethodsThirty-six participants (17 women; 65.5 ± 8.9 years) with unilateral KOA and 36 age- and sex-matched controls were included in a cross-sectional study. Outcomes included hip strength, quadriceps strength, and dynamic balance (three directions) during the Star Excursion Balance Test. Mixed ANOVA analysis was completed to investigate differences between Limbs and Groups. Mean differences (MD) and 95% confidence intervals (CI) were calculated.ResultsQuadriceps and hip adduction strength were 16% (95%CI:10, 22) and 9% [95%CI: 3, 16) lower on the affected compared to non-affected side. Quadriceps and hip abduction, adduction, flexion, and extension strength (MD varying from 16%, 95%CI: 8, 25; to 34%, 95%CI: 17, 50) were weaker bilaterally in individuals with KOA compared to control. Posteromedial balance was 4% (95%CI: 2, 6) lower for affected compared to non-affected limbs in those with KOA and 13% (95%CI: 6, 21) lower in the affected limb compared to controls. Individuals with KOA had lower balance bilaterally in the anterior 11% (95%CI: 7, 15) and posterolateral 21% (95%CI: 13, 30) directions.ConclusionHip/knee strength (especially in the sagittal and frontal planes) and dynamic balance are lower bilaterally in people with KOA compared to controls. Hip adduction strength is lower on the affected than non-affected limbs of people with KOA. Clinicians should consider that knee extension strength, hip strength, and dynamic balance are lower bilaterally in people with unilateral KOA.     

Changes in gait characteristics of women with early and established medial knee osteoarthritis: Results from a 2-years longitudinal study

BackgroundDespite the large number of cross-sectional studies on gait in subjects with knee osteoarthritis, there are scarcely any longitudinal studies on gait changes in knee osteoarthritis.MethodsGait analysis was performed on 25 women with early and 18 with established medial knee osteoarthritis, as well as a group of 23 healthy controls. Subjects were asked to walk at their comfortable speed. Kinematic and kinetic data were measured at baseline and after 2 years follow-up.FindingsResults indicated that the early osteoarthritis group, similar to established osteoarthritis group, showed significantly higher maximum knee adduction angles compared to the controls during the early stance phase of gait. None of the kinematic or kinetic measures, changed over two years in the early osteoarthritis group. In the established osteoarthritis group, at the time of entry, an increased first and second peak knee adduction moment, as well as higher mid-stance knee adduction moment and knee adduction moment impulse, were present compared to the control and the early osteoarthritis groups. Mid-stance knee adduction moment and knee adduction moment impulse, further increased over two years only in the established osteoarthritis group. For all three groups, the peak knee flexion angle during the stance phase decreased significantly over time.InterpretationIncreased maximum knee adduction angle during stance phase was the only alteration in the gait pattern of subjects with early knee osteoarthritis compared to the controls. This suggests that, unlike in the later stages of the disease, gait is rather stable over two years in early osteoarthritis.     

Adaptive Patterns of Movement during Downward Reach and Pick-up Movements in Knee Osteoarthritis Patients with Mild Low Back Pain

[Purpose] Patients with severe bilateral knee osteoarthritis (KOA) often suffer from low back pain (LBP). However, few studies have examined the relationship between LBP and KOA in downward reach and pick-up movements. [Subjects] Eight KOA patients with LBP (LBP group), 8 KOA patients without LBP (NLBP group), and 7 healthy participants (Control group), without osteoarthritis or low back pain, were recruited for this study. [Methods] All subjects were asked to pick up a bottle with one hand, placed at the diagonal on the opposite side of the body. A 3D motion analysis system was used to record trunk and lower limb movements. [Results] The knee flexion angle on the side ipsilateral to the bottle was significantly smaller in both KOA groups than in the controls in the downward reach and pick-up movements. KOA patients showed a significantly lower trunk flexion angle and greater pelvis anterior tilt angle than the controls. In addition, no significant differences were found between the LBP and NLBP group. [Conclusion] We suspect that severe knee pain due to OA determines the priority of movement in strategic planning for the execution of pick-up movements. The knee strategy was abandoned by our severe knee OA patients, even when they had mild LBP.Key words: Knee osteoarthritis, Low back pain, Pick-up movement     

The Osteoarthritis Knee Model: Psychophysical Characteristics and Putative Outcomes

The knee osteoarthritis (KOA) model is a convenient and coherent archetype that is frequently used in pharmaceutical trials of drugs with analgesic and/or anti-inflammatory properties; yet, little is known about its specific pathophysiology. The presumed chronic inflammatory etiology of osteoarthritis suggests that nociceptive processes and neurogenic inflammation predominate in this condition. However, most chronic pain conditions are associated with changes in peripheral and central processing. Recent data corroborate this as an important mechanism in KOA. We compared psychophysical characteristics (including thermal Quantitative Sensory Testing); thermal, mechanical, and functional wind-up; thermal and mechanical aftersensations; and pressure algometry of 37 subjects with KOA with 35 age- and sex-matched controls. A third of the KOA subjects demonstrated hypoesthesia to vibration and the 4.56 von Frey fiber, yet few showed allodynia in their worse knee. The majority of subjects had abnormalities to pinprick (41% were hyperalgesic and 27% were hypoesthetic). Compared to controls, the more painful knee was hypoesthetic to cold detection and had greater thermal wind-up, lower pressure-pain thresholds, thermal and mechanical aftersensations, and twice the pain ratings of controls after stair climb. Substantial intraindividual differences were found in KOA subjects and controls for mechanical wind-up and algometric thresholds.PerspectiveThese results develop the KOA model and suggest mechanistic hypotheses. Certain of these tests may ultimately prove to be responsive, quasi-objective, and quantitative outcomes for research and lend empirical support to the notion of measurable sensitization in osteoarthritis.     

Analysis of Balance Ability Dependent on the Angle of the Knee Joint in Females in Their 20s

The aim of this study was to investigate how balance ability according to angle of the knee joint changes in young female adults wearing a knee orthosis. [Methods] This study was conducted with 11 healthy female adults. The subjects used a knee brace that could be set to angles of 0°, 15°, and 30° of knee flexion. The ability to balance was evaluated by balance assessment. A total of four postures were used for measurements: a forward-facing posture with the eyes open on a stable surface (NO), a forward-facing posture with the eyes closed on a stable surface (NC), a forward-facing posture with the eyes open on an unstable surface (PO), and a forward-facing posture with the eyes closed on an unstable surface (PC). [Results] Regarding the weight distribution index and stability index on a stable surface, there was no interaction according to whether there was visual deprivation or not or according to knee flexion angle. Furthermore, the stability index on an unstable surface showed no interaction according to whether there was visual deprivation or not or according to knee flexion angle. But the WDI on a stable surface showed no interaction according to whether there was visual deprivation or not or according to knee flexion angle. [Conclusion] There were significant differences in the knee extension range of motion of normal elderly people and knee osteoarthritis, and the quadriceps femoris played an important role in knee function in individuals with knee osteoarthritis.Key words: Osteoarthritis, Knee orthosis, Balance     

关节置换与关节镜清理联合玻璃酸钠注射治疗膝骨性关节炎

背景:膝骨性关节炎的保守治疗为关节腔注射玻璃酸钠;手术治疗主要有关节镜清理、人工膝关节置换.目前关于骨关节炎治疗的研究多为各种单独治疗的疗效比较,而关于综合治疗的疗效尚少见.目的:观察膝关节置换与关节镜清理结合关节腔注射玻璃酸钠治疗膝骨性关节炎的效果.方法:选择符合膝骨性关节炎诊断标准的患者55例,年龄50～83岁.根据患者病情告知患者各种治疗的优缺点,由患者考虑后选择治疗方式.其中联合组23例,置换组32例.联合组采用关节镜清理联合关节腔注射玻璃酸钠治疗,1次,周,连续5周;置换组采用膝关节置换治疗.随访6-30个月,治疗前后均采用HSS膝关节评分评价膝骨性关节炎治疗效果.结果与结论:两组疗效综合评估,联合组优8例,良8例,优良率70%;置换组优23例,良7例,优良率94%.两组膝关节的活动度、疼痛、关节功能都有明显改善,但膝关节置换的疗效优于关节镜清理结合关节腔注射玻璃酸钠治疗(P<0.05).     

The Influence of Exercise on an Unstable Surface on the Physical Function and Muscle Strength of Patients with Osteoarthritis of the Knee

[Purpose] This study investigated the influence of exercise on an unstable surface on ROM of the knee, muscle strength and the physical function of patients with osteoarthritis of the knee. [Subjects] The subjects were 30 patients diagnosed with degenerative osteoarthritis of the knee, they were divided into an experimental group (n=15) and a control group (n=15). [Methods] The experimental group performed exercise using an aero step XL (TOGU, Germany) 3 times a week, for 6 weeks. A control group performed the same exercise on a stable surface and without aero step XL. [Results] After the intervention, the experimental group showed statistically significant improvements in active knee flexion, knee joint manual muscle test (MMT), knee joint MMT hamstring and WOMAC score. [Conclusion] Exercise on the unstable surface improved the symptoms of patient with osteoarthritis. Exercise on an unstable surface might be helpful for improving the muscle strength and alignment of lower extremities as well as improving physical function related to the knee joint.Key words: Osteoarthritis, Manual muscle test, Range of motion