Differences in the radiological characteristics between post-traumatic and non-traumatic knee osteoarthritis.

Osteoarthritis (OA) of the knee can be defined as primary (non-traumatic) or secondary (post-traumatic). Both non-traumatic OA and post-traumatic OA have been described predominantly in the medial compartment of the knee. The objective of this study was to compare the location of structural radiographic changes in non-traumatic OA and post-traumatic OA. A non-traumatic cohort, consisting of 155 patients suffering from chronic knee pain without known major injuries, was compared with a post-traumatic cohort, consisting of 176 patients, all of whom had sustained an anterior cruciate ligament injury while playing soccer. A standardized weight-bearing knee radiography of the tibiofemoral joint was performed. Joint space narrowing (JSN) and osteophytes were graded according to the radiographic atlas of the Osteoarthritis Research Society International. JSN and osteophytes were located predominantly in the medial compartment in the non-traumatic cohort. In the post-traumatic cohort, structural changes were evenly distributed between the lateral and the medial compartments. We were thus able to demonstrate radiological differences between post-traumatic and non-traumatic OA.

The effect of eight weeks of exercise on knee adduction moment in early knee osteoarthritis--a pilot study.

OBJECTIVE: Reduced muscle function, causing greater knee joint load, is a potentially modifiable risk factor of knee osteoarthritis (OA). Exercise is an important treatment of knee OA, but the effect on joint load has not been determined. The aim of this study was to investigate the effect of exercise on knee adduction moment during one-leg rise and gait. DESIGN: Patients below age 65 with early signs of radiographic knee OA, from a population-based cohort on OA development, were invited to participate in the study. They defined their most symptomatic knee as the index knee. Knee adduction moment during one-leg rise from a stool (48cm), and during gait was assessed using a three-dimensional motion analysis system, before and after eight weeks of supervised exercise. RESULTS: Thirteen patients, seven women, mean age 54.5, 12/13 with Kellgren and Lawrence grade I or II, took part in the study. Peak knee adduction moment during one-leg rise was reduced by 0.08 (95% CI 0.01;0.16) Nm/kg, or 14%, for the index knee, and 0.05 (95% CI -0.04;0.14), or 8% for the opposite knee after eight weeks. The reductions in peak adduction moment during gait were smaller and not significant. CONCLUSIONS: This study indicates that peak knee adduction moment could be reduced by supervised, individualized exercise in middle-aged patients presenting early signs of knee osteoarthritis, suggesting further investigation of this area. Peak adduction moment during one-leg rise seems to be more sensitive to deviations and change than peak adduction moment during gait in this population.

Knee kinematics and kinetics during gait, step and hop in males with a 16 years old ACL injury compared with matched controls.

The objective of this study was to compare subjects who sustained an ACL injury during soccer 16 years ago with a control group with regard to knee kinematics and kinetics of gait, step activity and cross over hop. Secondly, in the injured subjects, the purpose was to study the impact on kinematics and kinetics of characteristics such as operative status, meniscal resection, being symptomatic, having knee extensor weakness and of having radiographic knee OA. Data from a 3-dimensional gait analysis system (VICON) were used to calculate kinetics and kinematics during gait, step activity and cross over hop of 12 male subjects who had an anterior cruciate ligament injury 16 years earlier. Twelve uninjured subjects matched for age, sex, BMI and activity level served as controls. No significant differences in knee kinematics and kinetics between the ACL group and the control group were found. The variability of some parameters of step and all parameters of hop activity was generally larger in the ACL injured subjects compared with the controls. The ACL injured subjects had a significantly worse clinical status compared with the controls. Reduced knee extension strength was associated with joint moment reductions especially during step activity and cross over hop. Despite a significantly worse clinical status, as determined by self-report and isokinetic strength testing, no significant differences were seen in knee joint kinetics and kinematics in an ACL injured group 16 years after injury compared with a matched control group. The variation was larger among the ACL injured subjects indicating the need for larger study groups in gait and movement analysis in long-term follow-up of ACL injury.

High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes.

OBJECTIVE: To identify the consequences of an anterior cruciate ligament (ACL) tear in a cohort of male soccer players 14 years after the initial injury with respect to radiographic knee osteoarthritis and patient relevant outcomes. METHODS: Of 219 male soccer players with an ACL injury in 1986, 205 (94%) were available for follow up after 14 years; 75% of the cohort (154/205) answered mailed questionnaires (KOOS, SF-36, and Lysholm knee scoring scale) and 122 of these consented to weight bearing radiographs. RESULTS: Radiographic changes were found in 95 (78%) of the injured knees, while more advanced changes, comparable with Kellgren-Lawrence grade 2 or higher, were seen in 50 (41%). In the uninjured knees more advanced changes, comparable with Kellgren-Lawrence grade 2 or higher, were seen in five knees (4%). No differences were seen between surgically and conservatively treated players. The patient relevant outcome was affected and did not differ between subjects with and without radiographic changes. Eighty per cent reported reduced activity level. CONCLUSIONS: A high prevalence of radiographic knee osteoarthritis was seen in male soccer players 14 years after an ACL disruption. The injury and the osteoarthritis, irrespective of the treatment provided to these patients, often result in knee related symptoms that severely affect the knee related quality of life by middle age.