The Role of High Resolution Ultrasound In Comparison To MRI In The Evaluation Of Painful Knee

Background The knee joint is one of the most commonly injured joints in the body. Because of its complex structure, the joint is subjected to numerous pathologies and due to the recent increase in various sport activities; there has been a parallel increase in sport-induced internal derangements of the knee. Ultrasound is emerging as a viable imaging modality in the assessment of the musculoskeletal system lesions especially in experienced hands Objective To evaluate the role of high resolution dynamic ultrasonography as a diagnostic tool in the assessment of different causes of knee joint pain compared to MR imaging. Patients and Methods This study included 50 patients with painful knee joints as 32 females and 18 males, 16 patients had bilateral knee examination. Their ages ranged between 5-66 years. The cases was referred to a private radiological center, some of them referred to assess the knee joint pain by ultrasound as a fast and cheapest modality, yet most of the cases referred to evaluate the knee joint by MRI and the ultrasound was done as complementary study. Results Comparing between ultrasound and MRI in evaluation of painful knee joints, although the ultrasound has role in evaluation of bursal, synovial and peri-articular soft tissue lesions, the MRI is advised as a primary imaging tool for cruciates, meniscal and ligamentous lesions when clinically suspected. Conclusion Ultrasonography is a safe, cheap and efficient tool in the evaluation of the peri articular soft tissues with limited screening role at the internal knee joint cruciate / meniscal derangements as well as some bony lesions involving the bony cortex. It has no role in the intramedullary bony lesions. At this point, we concluded that ultrasonography has an important complementary role with MRI examination in the evaluation of the knee pain of different causes yet it is operator dependent and needs experience.

AB0605 ACTIGRAPHY-BASED PHYSICAL ACTIVITY MONITORING IN PATIENTS WITH KNEE OSTEOARTHRITIS AND COMORBID FIBROMYALGIA

Background:Low physical activity (PA) levels are common in patients with diseases associated with pain syndrome, such as osteoarthritis (OA) of the knee joints. Recent studies show that OA may be accompanied by concomitant fibromyalgia (FM) – a chronic pain syndrome associated with sedentary behavior [1]. As far as low PA levels are associated with poor quality of life and higher all-cause mortality, PA measurement in patients with knee OA and concomitant FM is of considerable interest [2,3].Objectives:The aim of this study was to investigate and compare physical activity measured by an actigraph in knee OA patients with and without comorbid FM.Methods:A total of 70 patients with painful knee osteoarthritis (OA) – 35 subjects - (30 females and 5 males) with concomitant fibromyalgia (FM) aged 59.8±14.9 (M±SD) years and 35 patients (30 females and 5 males) without concomitant FM aged 58.5±15.7 (M±SD) years were enrolled in the study. 35 healthy controls of the same age and gender underwent the same investigation. OA diagnosis was established according to ACR 1986 Osteoarthritis Knee Criteria. FM was diagnosed if both modified 2010 ACR diagnostic criteria and 2016 Fibromyalgia Diagnostic Criteria were met. All participants wore an actigraph (GT3X model accelerometer) on the wrist for the period of 5 working days. Average daily minutes in light, moderate and vigorous PA were calculated.Results:All OA patients with and without FM spent significantly less time in vigorous PA compared to controls. Obtained results did not indicate significant difference between time in vigorous activity in OA patients with and without FM. Patients with OA alone showed insignificant decrease in time in moderate activity in comparison with healthy subjects. OA patients with comorbid FM showed significantly less time in moderate activity compared to OA patients without FM and healthy individuals.Conclusion:Our study results revealed that patients with painful knee OA and comorbid FM have greater activity limitations than patients with painful knee OA alone and healthy individuals.References:[1]Mahgoub MY, Elnady BM, Abdelkader HS, Abdelhalem RA, HassanWA. Comorbidity of Fibromyalgia in Primary Knee Osteoarthritis: Potential Impact on Functional Status and Quality of Life. Open Access Rheumatol. 2020;12: 55—63.[2]Ali K. Q. Al-Rubaye, Klara Johansson, Laith Alrubaiy. The association of health behavioral risk factors with quality of life in northern Sweden—A cross-sectional survey. J Gen Fam Med. 2020 Sep; 21(5): 167–177.[3]GBD 2017 Mortality Collaborators. Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1684–735. pmid:30496102Disclosure of Interests:None declared.

Cross-cultural adaptation, reliability and validity of the Fremantle Knee Awareness Questionnaire in Italian subjects with painful knee osteoarthritis

Background and aim Growing attention is being given to utilising physical function measures to better understand and manage knee osteoarthritis (OA). The Fremantle Knee Awareness Questionnaire (FreKAQ), a self-reported measure of body-perception specific to the knee, has never been validated in Italian patients. The aims of this study were to culturally adapt and validate the Italian version of the FreKAQ (FreKAQ-I), to allow for its use with Italian-speaking patients with painful knee OA. Methods The FreKAQ-I was developed by means of forward–backward translation, a final review by an expert committee and a test of the pre-final version to evaluate its comprehensibility. The psychometric testing included: internal structural validity by Rasch analysis; construct validity by assessing hypotheses of FreKAQ correlations with the knee injury and osteoarthritis outcome score (KOOS), a pain intensity numerical rating scale (PI-NRS), the pain catastrophising scale (PCS), and the Hospital anxiety and depression score (HADS) (Pearson’s correlations); known-group validity by evaluating the ability of FreKAQ scores to discriminate between two groups of participants with different clinical profiles (Mann–Whitney U test); reliability by internal consistency (Cronbach’s alpha) and test–retest reliability (intraclass correlation coefficient, ICC2.1); and measurement error by calculating the minimum detectable change (MDC). Results It took one month to develop a consensus-based version of the FreKAQ-I. The questionnaire was administered to 102 subjects with painful knee OA and was well accepted. Internal structural validity confirmed the substantial unidimensionality of the FreKAQ-I: variance explained was 53.3%, the unexplained variance in the first contrast showed an eigenvalue of 1.8, and no local dependence was detected. Construct validity was good as all of the hypotheses were met; correlations: KOOS (rho = 0.38–0.51), PI-NRS (rho = 0.35–0.37), PCS (rho = 0.47) and HADS (Anxiety rho = 0.36; Depression rho = 0.43). Regarding known-groups validity, FreKAQ scores were significantly different between groups of participants demonstrating high and low levels of pain intensity, pain catastrophising, anxiety, depression and the four KOOS subscales (p ≤ 0.004). Internal consistency was acceptable (α = 0.74) and test–retest reliability was excellent (ICC = 0.92, CI 0.87–0.94). The MDC95 was 5.22 scale points. Conclusion The FreKAQ-I is unidimensional, reliable and valid in Italian patients with painful knee OA. Its use is recommended for clinical and research purposes.