Quantificative evaluation of joint space width in femorotibal osteoarthritis: comparison of three radiographic views

113

Objective. Individuals with medial knee osteoarthritis (OA) experience knee laxity and instability. Strategies aimed at muscle stabilization may influence the long-term integrity of the joint. This study sought to determine how individuals with medial knee OA respond to a rapid valgus knee movement, to investigate the relationship between muscle-stabilization strategies and knee instability.Methods. Twenty-one subjects with medial knee OA and genu varum and 19 control subjects were tested. Subjects stood with the test limb on a movable platform, comprising a plate that translated laterally to rapidly stress the knee's medial periarticular structures and create a potentially destabilizing sensation at the knee joint. Knee motion and muscle responses were recorded. Subjects rated the condition of their knee with a selfreport questionnaire about knee instability during daily activities.Results. Prior to plate movement, the OA subjects demonstrated more medial muscle co-contraction than did controls (P‫؍‬ 0.014). Following plate movement, the OA subjects shifted less weight off the test limb (P ‫؍‬ 0.013) and had greater medial co-contraction (P ‫؍‬ 0.037). OA subjects without knee instability had higher co-contraction of the vastus medialis medial hamstrings than did those who reported having instability that affected their daily activities (P ‫؍‬ 0.038). More knee stability correlated positively with higher co-contraction of the vastus medialis medial hamstrings prior to plate movement (r ‫؍‬ 0.459, P ‫؍‬ 0.042).Conclusion. Individuals with medial knee OA attempt to stabilize the knee with greater co-contraction of the medial muscle in response to laxity that appears on the medial side of the joint only. This strategy presumably contributes to higher joint compression and could exacerbate joint destruction, and therefore needs to be altered to slow or stop the progression of the OA disease process.

Section: Resultsmentioning

confidence: 94%

Section: Methodsmentioning

confidence: 99%

Knee stabilization in patients with medial compartment knee osteoarthritis

Lewek¹,

Ramsey²,

Snyder‐Mackler³

et al. 2005

113

“…While extended radiographs were the standard technique at the planning and start of the study, we used both extended radiographs and the partial flexion view as described by Dieppe et al in 1995 (23). The partial flexion view is now generally considered to be superior to extended views (37,38), and it has been refined using different specifications for the positioning of the foot (37) and the use of fluoroscopy (25). However, none of the reported protocols appears to be uniformly superior to the others (39).…”

Section: Discussionmentioning

confidence: 99%

Chondroitins 4 and 6 sulfate in osteoarthritis of the knee: A randomized, controlled trial

Michel

Stucki²,

Frey

et al. 2005

Self Cite

250

171

Objective. To determine whether chondroitin sulfate (CS) is effective in inhibiting cartilage loss in knee osteoarthritis (OA).Methods. In this randomized, double-blind, placebo-controlled trial, 300 patients with knee OA were recruited from an outpatient clinic, from private practices, and through advertisements. Study patients were randomly assigned to receive either 800 mg CS or placebo once daily for 2 years. The primary outcome was joint space loss over 2 years as assessed by a posteroanterior radiograph of the knee in flexion; secondary outcomes included pain and function.Results. Of 341 patients screened, 300 entered the study and were included in the intent-to-treat analysis. The 150 patients receiving placebo had progressive joint space narrowing, with a mean ؎ SD joint space loss of 0.14 ؎ 0.61 mm after 2 years (P ‫؍‬ 0.001 compared with baseline). In contrast, there was no change in mean joint space width for the 150 patients receiving CS (0.00 ؎ 0.53 mm; P not significant compared with baseline). Similar results were found for minimum joint space narrowing. The differences in loss of joint space between the two groups were significant for mean joint space width (0.14 ؎ 0.57 mm; P ‫؍‬ 0.04) and for minimum joint space width (0.12 ؎ 0.52 mm; P ‫؍‬ 0.05). CS was well tolerated, with no significant differences in rates of adverse events between the two groups. Conclusion.While there was no significant symptomatic effect in this study, long-term treatment with CS may retard radiographic progression in patients with OA of the knee. However, the clinical relevance of the observed structural results has to be further evaluated, and further studies are needed to confirm the structural effects of CS.

“…For many years, clinical studies of drug interventions in symptomatic knee OA have focused specifically on clinical parameters, such as pain and joint function, without assessing the effect of treatment on structural changes caused by the disease or the role of treatment in preventing cartilage degradation. Serial radiographs of affected joints appear to be a logical means of documenting the progression of OA over time (1), provided that a validated, reliable, and easily reproducible technique is used (2)(3)(4)(5).…”

mentioning

confidence: 99%

Quantitative magnetic resonance imaging evaluation of knee osteoarthritis progression over two years and correlation with clinical symptoms and radiologic changes

Raynauld¹,

Martel‐Pelletier²,

Berthiaume³

et al. 2004

239

Objective. To evaluate the change in osteoarthritic (OA) knee cartilage volume over a two-year period with the use of magnetic resonance imaging (MRI) and to correlate the MRI changes with radiologic changes.Methods. Thirty-two patients with symptomatic knee OA underwent MRI of the knee at baseline and at 6, 12, 18, and 24 months. Loss of cartilage volumes were computed and contrasted with changes in clinical variables for OA and with standardized semiflexed knee radiographs at baseline at 1 and 2 years.Results. Progression of cartilage loss at all followup points was statistically significant (P < 0.0001), with a mean ؎ SD of 3.8 ؎ 5.1% for global cartilage loss and 4.3 ؎ 6.5% for medial compartment cartilage loss at 6 months, 3.6 ؎ 5.1% and 4.2 ؎ 7.5% at 12 months, and 6.1 ؎ 7.2% and 7.6 ؎ 8.6% at 24 months. Discriminant function analysis identified 2 groups of patients, those who progressed slowly (<2% of global cartilage loss; n ‫؍‬ 21) and those who progressed rapidly (>15% of global cartilage loss; n ‫؍‬ 11) over the 2 years of study. At baseline, there was a greater proportion of women (P ‫؍‬ 0.001), a lower range of motion (P ‫؍‬ 0.01), a greater circumference and higher level of pain (P ‫؍‬ 0.05) and stiffness in the study knee, and a higher body mass index in the fast progressor group compared with the slow progressor group. No statistical correlation between loss of cartilage volume and radiographic changes was seen.Conclusion. Quantitative MRI can measure the progression of knee OA precisely and can help to identify patients with rapidly progressing disease. These findings indicate that MRI could be helpful in assessing the effects of treatment with structure-modifying agents in OA.In people over the age of 60 years, osteoarthritis (OA) is a common cause of disability. Assessment of cartilage damage is important for monitoring disease progression and evaluating therapeutic response in OA. For many years, clinical studies of drug interventions in symptomatic knee OA have focused specifically on clinical parameters, such as pain and joint function, without assessing the effect of treatment on structural changes caused by the disease or the role of treatment in preventing cartilage degradation. Serial radiographs of affected joints appear to be a logical means of documenting the progression of OA over time (1), provided that a validated, reliable, and easily reproducible technique is used (2-5).