x Mexico's Children Hosp. Federico Gomez, Mexico City, MexicoPurpose: Malalignment plays a major role in knee osteoarthritis (OA) and one therapy that is designed to modify malalignment in the context of knee OA is bracing. We hypothesize that the effect of bracing in persons with knee OA will be dependent on the extent of malalignment. Methods: Participants from the Osteoarthritis Chronic Care Program (OACCP) were followed for up to 52 weeks from March 2012 to March 2013 as part of a multidisciplinary approach to knee OA. The multidisciplinary approach consists of a physiotherapist, medical officer, rheumatologist, social worker, occupational therapist, orthotist, and dietician providing individually tailored interventions to participants. Participants with radiographic evidence of unicompartmental femorotibial OA and evidence of genu varum, plus or minus adductor thust through stance phase of gait were referred to the orthotist. X-rays of participants with femorotibial OA referred to an orthotist for consideration of bracing (Unloader One Knee Brace from Ossur) were analyzed. Radiographic measurements including the anatomical axis, condylar angle, tibial plateau angle and condylar plateau angle (Figure 1) were obtained from the initial knee x-rays before the participants knees were braced. In participants who had a knee brace, we tested if malalignment from the x-rays before bracing took place for was associated with the change in KOOS pain score at week 26. Results: The 72 participants had a mean age of 66 years, were 57% female and had a BMI of 30.6 kg/m 2 . 47 participants had complete data at week 26 and are the focus of this analysis. Multiple regression was used with change in pain at 26 weeks as the dependent variable, tibial plateau angle and condylar plateau angle were used as co-variables and the model was adjusted for age. The greater the tibial plateau angle, the greater the pain response (b¼2.27, SE¼0.94, p¼0.019), and the greater the condylar plateau angle the lower the pain response was SE¼1.22, p¼0.022). When the 72 patients who underwent bracing were analyzed for week 26 pain response, the greater the anatomical axis angle, the greater the pain response (b¼1.81, SE¼0.63, p¼0.01). There was no trend suggestive of a relationship to condylar angle. Conclusions: In our cohort, participants who were eligible for bracing had improved knee pain from week 0 to 26. Tibial plateau, condylar plateau and anatomical axis angles in participants with varus malalignment who undergo bracing were associated with improvement in pain. These measures may assist in identifying those most likely to redeem an effect from knee bracing.
Osteoarthritis Cartilage, 2014). In the present study, we focused on the meniscus change and osteophyte formation in early-stage knee osteoarthritis (OA). We examined whether there were any associations between the meniscus changes and the osteophyte formations, and also examined, if so, there were any site-specific differences for the associations in early-stage knee OA by using the magnetic resonance imaging (MRI)-based analyses. Methods: A total of 50 patients (mean age 59.7 years) who visited our outpatient clinic for knee pain between May and December 2012 were enrolled in this study. The severity of knee OA was classified by Kellgren-Lawrence (K/L) grading scale based on standing extended-knee Xray images. All patients showed either K/L grade 0, 1 or 2, and were also performed 3TMRI for the affected knee. Diagnosis of knee OA for the subjects with K/L 0 was conducted using 3TMRI according to the method by Shama et al (ARD 2013). Patients who showed less than 174 of femoro-tibial tibial angle (FTA) were excluded from the study. Compartments of the knee joint was divided into 14 places of areas according to WORMS using sagittal and coronal two dimensional (2D) fat suppressed and T2 weighted image fast spin-echo sequence (TR ¼ 5000ms, TE¼ 70ms, FOV 160mm, matrix ¼ 384Â307, Slice thickness ¼ 3mm, turbo-factor ¼ 17, Flip-angle ¼ 150, scan time ¼ 3:00). The severity of osteophyte and meniscus tear were semi-quantitatively evaluated according to the WORMS method. The medial meniscus extrusion distance (MMED) was also measured. Interrelatioships between the osteophyte scores in medial femoral condyle (MFC) and medial tibia plateau (MTP) and the medial meniscus (MM) tear and MMED were examined. Results: The patients showed the radiographic OA severities for K/L grade 0 (n¼3), 1 (n¼27) and 2 (n¼20), respectively. Twenty-three of fifty patients were male, while remaining twenty-seven patients were female. No significant differences of FTA were observed between the patients with three different K/L grades. While the MMEDs were not associated with the osteophyte scores in MTP, the MMEDs were associated with the osteophyte scores in MFC (r¼0.39, p<0.01). When the patients were divided into two groups in terms of the MMEDs by the cutline of 3 mm, the osteophyte scores in MFC in group 1 (MMEDs S3mm; 3.14) were significantly higher than those in group 2 (MMEDs <3mm; 1.50)(p¼0.03). On the other hand, the MM tear scores were associated with the osteophyte scores in MTP (r¼0.32, p¼0.03), while those were not associated with the osteophyte scores in MFC. In addition, when the patients were divided into two groups by the presence or absence of the MM tear, the osteophyte scores in MTP of the patients with MM tear (2.86) were significantly increased in comparison to those of the patients without MM tear (0.64, p¼0.02). Conclusions: The meniscus changes (MME and meniscus tear) were associated with the osteophyte formation in early-stage of medial knee OA. The associations were site-specific, that is; the MME were associated with t...
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