Arthroscopy Association of Canada Position Statement on Exercise for Knee Osteoarthritis: A Systematic Review of Guidelines

Background: Exercise is widely regarded to improve pain and function in patients with knee osteoarthritis (OA) through building supportive muscle mass, facilitating weight loss, and through the other beneficial effects associated with it. Purpose: To explore literature that presents clinical guidelines for the use of exercise in the treatment of knee OA to inform an evidence-based position statement for the Arthroscopy Association of Canada. Study Design: Position statement. Methods: PubMed, MEDLINE, Embase, and Cochrane databases were searched for guidelines commenting on the role of exercise for knee OA. The search was limited to guidelines published in the last 10 years. Articles were screened for relevance, focusing on recently published research with clinical guidelines. Inclusion criteria involved all articles providing clinical guidelines for exercise and knee OA. Results: Eight guidelines were identified. All eight recommended exercise as an important component of treatment for knee OA, with 6/8 strongly recommending it. Conclusion: Exercise is an effective and important component of the non-pharmacological management of knee OA. The Arthroscopy Association of Canada strongly recommends the use of exercise in the management of knee OA.

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Can Ultrasound Therapy Be an Environmental-Friendly Alternative to Non-Steroidal Anti-Inflammatory Drugs in Knee Osteoarthritis Treatment?

Materials ◽

10.3390/ma14112715 ◽

2021 ◽

Vol 14 (11) ◽

pp. 2715

Author(s):

Rodica Ana Ungur ◽

Viorela Mihaela Ciortea ◽

Laszlo Irsay ◽

Alina Deniza Ciubean ◽

Bogdana Adriana Năsui ◽

...

Keyword(s):

Ultrasound Therapy ◽

Negative Effects ◽

Beneficial Effects ◽

Knee Oa ◽

Environmental Friendly ◽

Chemical Pollutants ◽

Osteoarthritis Treatment ◽

Inflammatory Drugs ◽

Anti Inflammatory ◽

And Function

The non-steroidal anti-inflammatory drugs (NSAIDs) are the most used drugs in knee OA (osteoarthritis) treatment. Despite their efficiency in pain and inflammation alleviation, NSAIDs accumulate in the environment as chemical pollutants and have numerous genetic, morphologic, and functional negative effects on plants and animals. Ultrasound (US) therapy can improve pain, inflammation, and function in knee OA, without impact on environment, and with supplementary metabolic beneficial effects on cartilage compared to NSAIDs. These features recommend US therapy as alternative for NSAIDs use in knee OA treatment.

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Small Noncoding RNAs in Knee Osteoarthritis: The Role of MicroRNAs and tRNA-Derived Fragments

International Journal of Molecular Sciences ◽

10.3390/ijms22115711 ◽

2021 ◽

Vol 22 (11) ◽

pp. 5711

Author(s):

Julian Zacharjasz ◽

Anna M. Mleczko ◽

Paweł Bąkowski ◽

Tomasz Piontek ◽

Kamilla Bąkowska-Żywicka

Keyword(s):

Knee Osteoarthritis ◽

Noncoding Rnas ◽

Pathological Process ◽

Joint Disease ◽

Limited Information ◽

Genetic Changes ◽

Small Noncoding Rnas ◽

Knee Oa ◽

Cartilage Homeostasis

Knee osteoarthritis (OA) is a degenerative knee joint disease that results from the breakdown of joint cartilage and underlying bone, affecting about 3.3% of the world's population. As OA is a multifactorial disease, the underlying pathological process is closely associated with genetic changes in articular cartilage and bone. Many studies have focused on the role of small noncoding RNAs in OA and identified numbers of microRNAs that play important roles in regulating bone and cartilage homeostasis. The connection between other types of small noncoding RNAs, especially tRNA-derived fragments and knee osteoarthritis is still elusive. The observation that there is limited information about small RNAs different than miRNAs in knee OA was very surprising to us, especially given the fact that tRNA fragments are known to participate in a plethora of human diseases and a portion of them are even more abundant than miRNAs. Inspired by these findings, in this review we have summarized the possible involvement of microRNAs and tRNA-derived fragments in the pathology of knee osteoarthritis.

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The Relationship Between Early-Stage Knee Osteoarthritis and Lower-Extremity Alignment, Joint Laxity, and Subjective Scores of Pain, Stiffness, and Function

Journal of Sport Rehabilitation ◽

10.1123/jsr.2014-0170 ◽

2016 ◽

Vol 25 (3) ◽

pp. 213-218

Author(s):

Charlie A. Hicks-Little ◽

Richard D. Peindl ◽

Tricia J. Hubbard-Turner ◽

Mitchell L. Cordova

Keyword(s):

Knee Joint ◽

Lower Extremity ◽

Knee Osteoarthritis ◽

Outcome Measures ◽

Early Stage ◽

Joint Laxity ◽

Knee Oa ◽

Lower Extremity Alignment ◽

Knee Joint Laxity ◽

And Function

Context:Knee osteoarthritis (OA) is a debilitating disease that affects an estimated 27 million Americans. Changes in lowerextremity alignment and joint laxity have been found to redistribute the medial and/or lateral loads at the joint. However, the effect that changes in anteroposterior knee-joint laxity have on lower-extremity alignment and function in individuals with knee OA remains unclear.Objective:To examine anteroposterior knee-joint laxity, lower-extremity alignment, and subjective pain, stiffness, and function scores in individuals with early-stage knee OA and matched controls and to determine if a relationship exists among these measures.Design:Case control.Setting:Sports-medicine research laboratory.Participants:18 participants with knee OA and 18 healthy matched controls.Intervention:Participants completed the Western Ontario McMaster (WOMAC) osteoarthritis questionnaire and were tested for total anteroposterior knee-joint laxity (A-P) and knee-joint alignment (ALIGN).Main Outcome Measures:WOMAC scores, A-P (mm), and ALIGN (°).Results:A significant multivariate main effect for group (Wilks’ Λ = 0.30, F7,26 = 8.58, P < .0001) was found. Knee-OA participants differed in WOMAC scores (P < .0001) but did not differ from healthy controls on ALIGN (P = .49) or total A-P (P = .66). No significant relationships were identified among main outcome measures.Conclusion:These data demonstrate that participants with early-stage knee OA had worse pain, stiffness, and functional outcome scores than the matched controls; however, ALIGN and A-P were no different. There was no association identified among participants’ subjective scores, ALIGN, or A-P measures in this study.

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Knee Osteoarthritis: A Review of Pathogenesis and State-Of-The-Art Non-Operative Therapeutic Considerations

Genes ◽

10.3390/genes11080854 ◽

2020 ◽

Vol 11 (8) ◽

pp. 854

Author(s):

Dragan Primorac ◽

Vilim Molnar ◽

Eduard Rod ◽

Željko Jeleč ◽

Fabijan Čukelj ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Platelet Rich Plasma ◽

Treatment Options ◽

Stromal Vascular Fraction ◽

Disease Stage ◽

Knee Oa ◽

Marrow Mesenchymal Stem Cells ◽

The Moment ◽

And Function ◽

Orthopedic Patients

Being the most common musculoskeletal progressive condition, osteoarthritis is an interesting target for research. It is estimated that the prevalence of knee osteoarthritis (OA) among adults 60 years of age or older is approximately 10% in men and 13% in women, making knee OA one of the leading causes of disability in elderly population. Today, we know that osteoarthritis is not a disease characterized by loss of cartilage due to mechanical loading only, but a condition that affects all of the tissues in the joint, causing detectable changes in tissue architecture, its metabolism and function. All of these changes are mediated by a complex and not yet fully researched interplay of proinflammatory and anti-inflammatory cytokines, chemokines, growth factors and adipokines, all of which can be measured in the serum, synovium and histological samples, potentially serving as biomarkers of disease stage and progression. Another key aspect of disease progression is the epigenome that regulates all the genetic expression through DNA methylation, histone modifications, and mRNA interference. A lot of work has been put into developing non-surgical treatment options to slow down the natural course of osteoarthritis to postpone, or maybe even replace extensive surgeries such as total knee arthroplasty. At the moment, biological treatments such as platelet-rich plasma, bone marrow mesenchymal stem cells and autologous microfragmented adipose tissue containing stromal vascular fraction are ordinarily used. Furthermore, the latter two mentioned cell-based treatment options seem to be the only methods so far that increase the quality of cartilage in osteoarthritis patients. Yet, in the future, gene therapy could potentially become an option for orthopedic patients. In the following review, we summarized all of the latest and most important research in basic sciences, pathogenesis, and non-operative treatment.

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Does the Conservative Non-pharmacological Management of Knee Osteoarthritis in Switzerland Reflect the Clinical Guidelines? A Survey Among General Practitioners, Rheumatologists, and Orthopaedic Surgeons

Frontiers in Rehabilitation Sciences ◽

10.3389/fresc.2021.658831 ◽

2021 ◽

Vol 2 ◽

Author(s):

Lea Ettlin ◽

Irina Nast ◽

Erika O. Huber ◽

Karin Niedermann

Keyword(s):

Knee Osteoarthritis ◽

General Practitioners ◽

Treatment Options ◽

Barriers And Facilitators ◽

First Line ◽

Pharmacological Management ◽

Physically Active ◽

Knee Oa ◽

Diagnostic Measures ◽

Active Patient

Introduction: The International Guidelines recommend exercise, education and weight management (if appropriate) as the first-line conservative treatment for patients with knee osteoarthritis (OA) to enhance their self-management. The aim of this study was to investigate the current state of conservative non-pharmacological management of patients with knee OA in Switzerland and to explore the perceived barriers and facilitators to the application of the guideline recommendations.Materials and methods: Eleven semi-structured interviews with selected general practitioners (GPs), rheumatologists and orthopaedic surgeons were performed. Based on these results, an online survey was developed and sent to the members of three scientific medical societies. Questions addressed the frequency of diagnostic measures, treatment options, reasons for referral to exercise and also barriers and facilitators.Results: A total of 234 members responded. They indicated that patients normally present due to pain (n = 222, 98.2%) and functional limitations of the knee (n = 151, 66.8%). In addition to clinical assessment, X-ray (n = 214, 95.5%) and MRI (n = 70, 31.3%) were the most frequently used diagnostic measures. Treatment options usually involved patient education for diagnosis (n = 223, 98.6%) and suitable activities (n = 217, 96%), pharmacological treatment (n = 203, 89.8%) and referral to physiotherapy (n = 188, 83.2%). The participants estimated that they had referred 54% of their patients with knee OA for a specific exercise. The referral to exercise was driven by “patient expectation/high level of suffering” (n = 73, 37.1%) and their “own clinical experience” (n = 49, 24.9%). The specialists rated the most important barriers to referral to exercise as “disinterest of patient” (n = 88, 46.3%) and “physically active patient” (n = 59, 31.1%). As the most important facilitators, they rated “importance to mention exercise despite the short time of consultation” (n = 170, 89.4%) and “insufficiently physically active patient” (n = 165, 86.9%).Discussion: A substantial evidence–performance gap in the management of patients with knee OA appears to exist in Switzerland. For the systematic referral to exercise as the first-line intervention, it might be useful for medical doctors to suggest a structured exercise programme to patients with knee OA, rather than just advising general exercise.

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Neuromuscular exercises: A new perspective in knee osteoarthritis

Romanian Journal of Neurology ◽

10.37897/rjn.2021.3.8 ◽

2021 ◽

Vol 20 (3) ◽

pp. 311-316

Author(s):

Jyoti Sabharwal ◽

◽

Shabnam Joshi ◽

Keyword(s):

Knee Osteoarthritis ◽

Functional Performance ◽

Thigh Muscle ◽

Intervention Programme ◽

Limb Weakness ◽

Knee Oa ◽

Increased Risk ◽

New Perspective ◽

Training Programmes

Background. Knee osteoarthritis (OA) is the most prevalent arthropathy across the world. It presents with swelling, pain, decreased range of motion (ROM) and instability. Patients also complain of thigh muscle weakness and lower limb weakness resulting in poor joint shielding and joint overload. Owing to these presenting features patients are prone to increased risk of morbidity and are forced to live with functional impairment. Exercises are one of the vital intervention programme used in knee OA. Exercises lead to improvement in physical function, strengthening of the muscles and reduction in pain. Neuromuscular exercises have effects on functional performance, biomechanics and activation pattern of surrounding musculatures of the patient. Therefore, neuromuscular exercises may prove to be beneficial in enhancing the efficacy of exercise training programmes in such patients due to functional instability and disturbed neuromuscular function. Purpose. This article intends to review the effect and role of neuromuscular exercises in the management of knee osteoarthritis. Method. Comprehensive computerized search was performed on Google Scholar, Pubmed and Cochrane. Conclusion. By evaluating various articles on neuromuscular exercises in knee osteoarthritis the present review suggest that neuromuscular exercises are helpful in the treatment of knee osteoarthritis.

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Inflammatory potential of diet and risk of incident knee osteoarthritis: a prospective cohort study

10.21203/rs.3.rs-31057/v2 ◽

2020 ◽

Author(s):

Qiang Liu ◽

James R. Hebert ◽

Nitin Shivappa ◽

Jianjun Guo ◽

Ke Tao ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Estimating Equation ◽

Mediation Analyses ◽

Knee Oa ◽

Inflammatory Index ◽

Symptomatic Knee ◽

Osteoarthritis Initiative ◽

Reduce Risk

Abstract Background To examine the relation between inflammatory potential of diet and incident knee osteoarthritis (OA) and the role of BMI in the association of interest. Methods In the Osteoarthritis Initiative, the energy-adjusted dietary inflammatory index (E-DIITM) scores were calculated based on the Block Brief 2000 Food Frequency Questionnaire and categorized into sex-specific quartiles. Outcomes were incident: (1) radiographic knee OA (ROA) (i.e., a KL grade ≥2), (2) symptomatic knee OA (SxOA) (i.e., a combination of a frequent knee pain and ROA). We fitted generalized estimating equation models to examine the association between E-DII scores and incident knee OA. We performed mediation analyses to assess potential mediation by BMI in the DII-OA relation. Results Over a 48-month follow-up period, 232 and 978 knees developed ROA and SxOA, respectively. Compared with the lowest (most anti-inflammatory) E-DII quartile, the odds ratio (OR) of incident ROA for the highest (most pro-inflammatory) E-DII quartile was 1.73 (95% confidence interval (CI): 1.15 to 2.62, Ptrend= 0.007). The corresponding OR for SxOA was 1.43 (95% CI: 1.16 to 1.76, Ptrend = 0.001). The DII-OA association was significantly mediated via BMI with an indirect effect of 1.08 (95% CI: 1.04,1.13) for ROA and 1.13 (95% CI: 1.09, 1.16) for SxOA, accounting for 20.4% and 44.5% of total effect, respectively. Conclusions A higher inflammatory potential of diet increased the risk of knee OA. The association was significantly mediated via BMI. Targeting inflammatory potential of diet may be beneficial to reduce risk of knee OA.

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Magnesium, Zinc, and Chromium Nutrition and Athletic Performance

Canadian Journal of Applied Physiology ◽

10.1139/h2001-038 ◽

2001 ◽

Vol 26 (S1) ◽

pp. S13-S22 ◽

Cited By ~ 27

Author(s):

Henry C. Lukaski

Keyword(s):

Mineral Elements ◽

Optimal Performance ◽

Beneficial Effects ◽

Cardiorespiratory Function ◽

Genetic Potential ◽

And Performance ◽

And Function ◽

Study Designs ◽

Advance Knowledge

Magnesium, zinc and chromium are mineral elements required in modest amounts for health and optimal performance. Accumulating evidence supports the hypothesis that magnesium and zinc play significant roles in promoting strength and cardiorespiratory function in healthy persons and athletes. Differences in study designs, however, limit conclusions about recommendations for intakes of magnesium and zinc needed for optimal performance and function. The role of chromium in supporting performance is not well established. There is a compelling need to confirm and extend findings of beneficial effects of magnesium and zinc function and performance of humans. Suggestions for an experimental model and specific topics for research to advance knowledge of mineral nutrition to promote attainment of genetic potential for optimal performance are provided.

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A single intraarticular platelet-rich plasma improves pain and function for patients with early knee osteoarthritis: Analyses by radiographic severity and age

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-200193 ◽

2021 ◽

pp. 1-10

Author(s):

Shu-Fen Sun ◽

Chien-Wei Hsu ◽

Huey-Shyan Lin ◽

I-Hsiu Liou ◽

Yi-Chun Chou ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Platelet Rich Plasma ◽

Age Group ◽

Radiographic Severity ◽

Knee Oa ◽

Patients Satisfaction ◽

Younger Age ◽

Subgroup Analyses ◽

The Mean ◽

And Function

BACKGROUND: Most studies use platelet-rich plasma (PRP) requiring multiple intraarticular injections for knee osteoarthritis (OA). OBJECTIVE: To investigate the efficacy of a single intraarticular PRP injection for patients with early knee OA and consider subgroup analyses of radiographic severity and age, respectively. METHODS: Forty-one patients with knee OA (Kellgren-Lawrence grade 1–2) received a single PRP injection into the target knee and were assessed at baseline and 1, 3, and 6 months postinjection. The primary outcome was the mean change from baseline in the visual analog scale (VAS) pain (0–100 mm) at 6 months postinjection. Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index, single leg stance test (SLS), use of rescue analgesics and patients’ satisfaction. RESULTS: Thirty-eight patients completed the study. The mean pain VAS decreased significantly from 45.6 ± 13.0 mm at baseline to 16.9 ± 13.4 mm, 14.0 ± 13.1 mm and 15.5 ± 14.0 mm at 1, 3 and 6-month follow-ups (p< 0.001 for all). Significant improvements in WOMAC, Lequesne index, SLS and consumption of analgesics from baseline (p< 0.001 for all) were noted at each follow-up. Patients’ satisfaction was high. No serious adverse events occurred. Subgroup analyses revealed that patients with grade 1 OA showed significantly greater VAS pain reduction at 3 months (p= 0.006) and 6 months (p= 0.005) than patients with grade 2 OA. The older-age group (age > 60) showed significantly greater improvements in VAS pain, WOMAC function subscale scores and total scores at 6-month postinjection, compared with the younger age-group (age ≤ 60). The younger-age group reported better satisfaction at 1 and 3-month postinjection. CONCLUSIONS: One injection of PRP improved pain and function for 6 months for patients with early knee OA. This study supports putting the one-injection regimen into clinical practice. Further research is needed for more definite conclusions.

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Two-Year Results of the PHANTOM High Flex Trial: A Single-Arm Study on the Atlas Unicompartmental Knee System Load Absorber in Patients With Medial Compartment Osteoarthritis of the Knee

Clinical Medicine Insights Arthritis and Musculoskeletal Disorders ◽

10.1177/1179544119877170 ◽

2019 ◽

Vol 12 ◽

pp. 117954411987717

Author(s):

Konrad Slynarski ◽

Jacek Walawski ◽

Robert Smigielski ◽

Willem van der Merwe

Keyword(s):

Knee Osteoarthritis ◽

Invasive Surgery ◽

Young Patients ◽

Osteoarthritis Of The Knee ◽

Normal Range ◽

Medial Knee ◽

Medial Compartment Osteoarthritis ◽

Knee Oa ◽

And Function ◽

Post Implantation

The Atlas Knee System was designed to fill the gap between no longer effective conservative treatments and more invasive surgery for young patients with medial knee osteoarthritis (OA). This article reports on the 2-year results of a single-arm study of 26 subjects who previously reported favorable clinical outcomes 1 year post implantation. Western Ontario and McMaster Universities Osteoarthritis Index pain and function scores improved by a clinically meaningful amount relative to baseline, and subjects had a return to normal range of motion. This study confirmed that the benefit of a joint unloading device in the management of young patients with medial knee OA is maintained over 2 years. This trial was registered with ClinicalTrials.gov (NCT02711254).

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