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Abstract Background People with knee osteoarthritis (OA) may have more thigh intermuscular and intramuscular adipose tissue (interMAT and intraMAT, respectively) compared to those without knee OA. Literature has not considered differences in body mass index (BMI) in the context of comparing intraMAT and interMAT between individuals with and without knee OA, matched for BMI (± 1 kg/m²). This study aims to compare interMAT and intraMAT, along with physical function (including knee extension strength), between individuals with and without knee osteoarthritis, matched by BMI. Methods Participants aged ≥ 40 years with symptomatic and radiological knee OA group (grade 2 and 3 on the Kellgren and Lawrence (KL) scale) were included in the affected group, while those with no knee pain and no radiological knee OA changes were included in the unaffected group. No participants were lost to assessment, ensuring complete data analysis for all participants. We used independent t-test and mean difference (95% CI) to compare thigh intraMAT and interMAT volume, self-reported measures (WOMAC questionnaire), physical function measures, and knee extension strength between groups. Results Forty-six participants were analyzed (23 in each group). The affected group had significantly higher intraMAT compared to the unaffected group (p

Abstract Meniscal tears, especially those in avascular regions, pose a significant risk for osteoarthritis if repair fails. While meniscal repair is the preferred method for preserving knee function, it often has a high failure rate in avascular zones. This study aimed to evaluate the safety and potential efficacy of silk-elastin (SE), an artificial protein with wound-healing properties, for enhancing meniscal repair. Eight patients with meniscal tears in avascular areas underwent arthroscopic repair followed by SE application, including cases of lateral and medial tears, discoid lateral meniscus, and bucket-handle tears. No adverse events or reactions were attributed to SE. At 3 months post-surgery, clinical outcomes and repair sites were evaluated using MRI and arthroscopy. Significant improvements were observed in Lysholm and visual analog scale scores (P

Abstract Background Osteoarthritis (OA) is a significant global health concern and is characterized by the degeneration of joint structures, leading to pain, stiffness, and functional limitations It is estimated that 654.1 million individuals are affected by osteoarthritis worldwide, with females, especially those older than 60 years of age, being the population most impacted. However, there remains a gap in understanding the awareness of knee osteoarthritis among specific populations, such as the Palestinian community in the West Bank, thus, highlighting the need for targeted research to address this health disparity. Methods A cross-sectional survey was conducted in the West Bank from August to September 2024. Participants were recruited from 11 cities and a validated questionnaire adapted from a previous study was used to collect the data. The reliability of the questionnaire was assessed using Cronbach’s alpha, yielding a value of standard alpha = 0.71, which is an acceptable value. The survey collected demographic data, clinical characteristics, knowledge of osteoarthritis risk factors, symptoms, and attitudes towards treatment options. R Statistical Software was used for data analysis, which included descriptive statistics, chi-square tests, and logistic regression to explore the relationships between demographic factors and osteoarthritis knowledge, whereby a p-value of ≤ 0.05 was set up as a significance level. Results A total of 725 valid responses were included in our study. Among the participants, 569 were female, predominantly aged 25 or younger (66%, n = 479), and 62% (n = 450) were single. Knowledge assessment revealed that 80% (n = 580) recognized knee osteoarthritis as a chronic disease, while only 51% (n = 369) understood its impact on joint involvement. The majority identified high BMI (87%, n = 632), advancing age (94%, n = 683), and previous knee injury (72%, n = 520) as risk factors, although only 42% (n = 306) acknowledged genetics as one. Most participants were aware of the management strategies, including analgesics (70%, n = 510) and physiotherapy (80%, n = 579). However, 66% (n = 478) scored low for overall knowledge regarding knee osteoarthritis. Conclusion This study emphasizes the critical importance of raising awareness and knowledge about osteoarthritis within the Palestinian community. Despite being widely known as a long-term issue, there are still noticeable gaps in the understanding of the joint impact, potential risks, and effective treatment methods for osteoarthritis. The use of informal sources highlights the importance of specific educational programs by healthcare providers.

This study presents a novel wearable solution integrating Polymer Optical Fiber (POF) sensors into a knee sleeve to monitor knee flexion/extension (F/E) patterns during walking. POF sensors offer advantages such as flexibility, light weight, and robustness to electromagnetic interference, making them ideal for wearable applications. However, when one integrates these sensors into a knee sleeve, they exhibit non-linearities, including hysteresis and mode coupling, which complicate signal interpretation. To address this issue, a Long Short-Term Memory (LSTM) network was implemented to model temporal dependencies in sensor output, hence providing accurate knee angle estimates. Data were collected from 31 participants walking at different speeds on a treadmill, using a camera-based motion capture system for validation. Configurations with multiple (up to five) sensors were considered. The best performance was achieved using three sensors, yielding a median root mean square error (RMSE) of 3.41° (interquartile range: 2.50° – $5.19^{\circ }\text {)}$ . Whereas using multiple sensors generally improved robustness, the inclusion of data from sub-optimally placed sensors negatively affected performance. The technology holds potential for clinical application in knee osteoarthritis (OA) management. Future work should focus on optimizing signal calibration and expanding the dataset to facilitate accounting for the different ways in which the knee sleeve conforms to the anatomy of different individuals.

ObjectiveTo evaluate long-term survival and clinical outcomes of patients with knee osteo-arthritis undergoing total knee arthroplasty (TKA) through long-term follow-up.MethodsThis study was based on a previous cohort study that had completed follow-up. We retrospectively collected clinical data of patients with knee arthropathy (including knee osteoarthritis and knee rheumatoid arthritis) who received the first TKA operation in Peking Union Medical College Hospital from 1993 to 2002 and were followed up for more than 20 years, and conducted a unified follow-up on them in November 10, 2024 (the last follow-up). Kaplan-Meier curve was used to evaluate the survival rate. Hospitals for special surgery (HSS) scores and joint range of motion (ROM) were compared before surgery, 10 years after surgery and at the last follow-up to evaluate the clinical efficacy of TKA. Likert scale was used to evaluate patient satisfaction at the last follow-up.ResultsA total of 226 patients (246 knees) received their first TKA in Peking Union Medical College Hospital from 1993 to 2002 and were followed up for more than 10 years. Among them, 104 patients (131 knees) were included in the study at the last follow-up, including 21 patients (24 knees) with prosthesis in place, 18 patients (18 knees) who underwent reoperation for various reasons, and 65 patients (89 knees) who died from non-TKA surgical causes. Up to the last follow-up, there were 29 patients (35 knees) with an average follow-up of more than 20 years, and 12 patients (16 knees) completed HSS score, ROM measurement and patient satisfaction evaluation. Kaplan-Meier curve showed that the 10-year, 15-year, 20-year, and 25-year survival rates were 93.6%, 92.4%, 89.8%, and 71.8%, respectively. The HSS score at the last follow-up was lower than that at 10- year postoperative follow-up[(84.69±11.03) scores vs. (95.25±13.32) scores, P < 0.05], but significantly improved compared with the preoperative[(84.69±11.03) scores vs. (58.75±7.19) scores, P < 0.05]. The ROM of knee joint were (93.44±17.30) °, (101.88±13.33) °, and (91.56±15.98) ° at preoperative, 10-year of postoperative and last follow-up, respectively, and there was no statistical significance between the groups (P > 0.05). In terms of patient satisfaction, the 10 knees (62.50%) scored 4 points (very satisfied), the remaining 6 knees (37.50%) scored 3 points (satisfied), and the satisfaction rate was 100%.ConclusionTKA treatment for knee arthropathy has high long-term prosthesis survival rate, significant improvement of knee joint function and high patient satisfaction.

Knee osteoarthritis (KOA) is a prevalent degenerative joint disease characterized by synovial inflammation, cartilage loss. Often manifesting as joint pain and limited mobility, it severely affects the quality of life of patients. Traditional treatment methods such as pharmacological injections and surgical interventions primarily aim to alleviate symptoms but have limited effects on cartilage repair. Human umbilical cord mesenchymal stem cells (hUC-MSCs), due to their anti-inflammatory and chondrogenic capabilities, is considered a new hope for the treatment of KOA. This article synthesizes the latest research findings from both domestic and international sources to discuss the theoretical basis for the clinical application of hUC-MSCs in treating KOA, clinical study design, and efficacy evaluation. It also addresses the challenges in the clinical application of hUC-MSCs and explores future directions, in the hope of providing feasible theoretical support for the treatment of KOA with hUC-MSCs.

Background: This paper aimed to investigate the expression of CXCL12 and S100A12 in peripheral blood (PB) and synovial fluid (SF) of patients with knee osteoarthritis (OS) and to analyze the correlation between them and the severity of knee OS. Methods: Sixty patients with knee OS treated in our hospital from January 2020 to December 2022 were selected as the experimental group, and 60 healthy knee joints with similar ages were selected as the control group. The fasting venous blood of 120 subjects was drawn in the early morning, and the SF was extracted during joint operation or sodium hyaluronate injection. Put the collected PB and SF in the refrigerator at -80 °C. The levels of CXCL12 and S100A12 in PB and SF were detected by enzyme-linked immunosorbent assay (Elisa). Results: The correlation between the levels of CXCL12 and S100A12 in PB and SF and Kmurl L grade and WOMAC score. The levels of CXCL12 and S100A12 in PB and SF in the observation group were higher than those in the control group. There were significant differences in the levels of CXCL12 and S100A12 in PB and SF in the experimental group. The higher the Kmurl grade of knee OS, the higher the concentration of CXCL12 and S100A12 in PB and SF. The levels of CXCL12 and S100A12 in PB of knee OS were positively correlated with WOMAC score (r=0.767, 0.521, respectively, P

Abstract Background Mesenchymal stem cells have great potential for repairing articular cartilage and treating knee osteoarthritis (KOA). Nonetheless, little is known about the efficacy of human adipose-derived mesenchymal stem cells (haMSCs) for KOA in large animal models. Methods This study evaluated the therapeutic efficacy of haMSCs in knee articular cartilage repair in a sheep model of KOA. haMSCs were isolated, cultured, and characterized. KOA was surgically induced by anterior cruciate ligament transection and medial meniscectomy, followed by intra-articular injection of saline (negative control group) or haMSCs (haMSC group) into the right knee joint at 6 and 9 weeks after surgery. Sheep were sacrificed 21 weeks after surgery, and samples (whole knee joints, femoral condyles, and tibias) were collected, processed, and analyzed. Changes in knee articular cartilage were assessed by magnetic resonance imaging, micro-computed tomography, macroscopic analysis, histology, and immunohistochemistry. Results KOA caused the degeneration of the medial femoral condyle in the sheep model of KOA. Conversely, haMSCs repaired chondral defects and increased the thickness of knee articular cartilage. Conclusions These data suggest that the intra-articular injection of haMSCs can effectively repair articular cartilage defects in the knee.

Abstract Background Patients with knee osteoarthritis (KOA) often experience persistent pain and functional impairment after total knee arthroplasty (TKA), which presents challenges for pain management. Accurate preoperative assessment of pain characteristics is crucial for tailoring individualized treatment plans. The PainDETECT Questionnaire has been widely used to identify neuropathic components in chronic pain and has been validated for its reliability and validity across various cultural contexts. However, a culturally adapted version tailored to Chinese patients is currently lacking. This study aims to translate and culturally adapt PainDETECT for Chinese patients and evaluate its validity in TKA patients in China. Methods This study followed international guidelines to translate and adapt the PainDETECT Questionnaire (PDQ) into Chinese (PDQ-CV). A cohort of 241 knee osteoarthritis (KOA) patients completed the PDQ-CV, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), EuroQol-5 Dimensions-5 Levels (EQ-5D-5 L), and Central Sensitization Inventory Chinese Version (CSI-CV). We assessed internal consistency using Cronbach’s alpha and test-retest reliability via intraclass correlation coefficient (ICC). Construct and structural validity were evaluated through Pearson correlations and factor analyses. Results The PDQ-CV demonstrated good acceptability among KOA patients, with no floor or ceiling effects observed. Internal consistency was high (Cronbach’s α = 0.896), and test-retest reliability was excellent (ICC = 0.994; 95% CI: 0.943–1.045). The PDQ-CV total score showed significant positive correlations with WOMAC (r = 0.589, P

Abstract Background Knee osteoarthritis (KOA) is a prevalent degenerative joint disease. The primary pathological manifestations of KOA include articular cartilage degeneration, joint space narrowing, and osteophyte formation, leading to a spectrum of symptoms, including joint pain, stiffness, reduced mobility, diminished muscle strength, and severe disability. We aimed to utilize a meta-analysis to evaluate the efficacy of isokinetic muscle strengthening training (IMST) as a rehabilitation treatment for KOA in lowland areas. Methods The study conducted a comprehensive search of the CNKI, WanFang Data, VIP Database, PubMed, Ovid MEDLINE (1946–), Cochrane Library, Embase, and CBM databases. The databases were conducted from establishing each database to September 31, 2024. The studies included were randomized controlled trials (RCTs) with participants from the plains who met the diagnostic criteria for KOA as outlined in the 2019 edition, with no restrictions on gender, age, or disease course, and no patients with advanced disease; studies where in the control group was either a non-intervention group or a group receiving treatment, other than IMST, and the experimental group received IMST alone or in addition to the treatment administered to the control group; and studies with at least two of the following outcome indicators: (i) knee flexors (Flex)/extensors (Ext) peak torque (PT), (ii) knee Flex/Ext total work (TW), (iii) knee Flex/Ext max rep total work (MRTW), (iv) knee Flex/Ext average power (AP), (v) visual analogue scale (VAS) for pain, (vi) Lequesne index (LI), (vii) Western Ontario and McMaster University Osteoarthritis Index (WOMAC), (viii) Lysholm Knee Scoring Scale (LKSS), (ix) range of motion (ROM) of the knee joint, and (x) 6-min walk test. We systematically reviewed the RCTs in both Chinese and English and evaluated the quality of the included literature. Data were processed and analyzed using ROB 2, RevMan 5.4, Stata17, and GRADEpro. The study protocol was registered on PROSPERO (CRD42024607528). Results Thirty-three (46 studies, 2,860 patients) had low-to-some concerns risk. IMST significantly improved physical therapy outcomes, including knee Flex PT and knee Ext PT at an angular velocity of 60°/second (standardized mean difference 13.19 [95% confidence interval 6.44, 19.94], P = 0.0001 and 16.34 [11.47, 21.22], P

Abstract Introduction Lorecivivint (LOR), a CDC-like kinase/dual-specificity tyrosine kinase (CLK/DYRK) inhibitor thought to modulate inflammatory and Wnt pathways, is being developed as a potential intra-articular knee osteoarthritis (OA) treatment. The objective of this trial was to evaluate long-term safety of LOR within an observational extension of two phase 2 trials. Methods This 60-month, observational extension study (NCT02951026) of a 12-month phase 2a trial (NCT02536833) and 6-month phase 2b trial (NCT03122860) was administratively closed after 36 months as data inferences became limited. Participants received a single intra-articular LOR or placebo (PBO) injection at their parent-trial baseline. The primary outcome was the comparative incidence of serious adverse events (SAEs), with AEs and similar safety measures comprising secondary outcomes. A post hoc baseline-adjusted analysis of covariance (ANCOVA) compared changes from baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain and Function subscores and medial joint space width (JSW) between LOR 0.07 mg and PBO groups in a subpopulation of participants with unilateral knee pain and widespread pain low enough to allow participants to differentiate their target knee pain. Results The safety analysis set for the extension study included 495 LOR-treated and 208 control participants, with 409 (82.6%) and 175 (84.1%) remaining at study close, respectively. There were 68 SAEs reported in 38 (5.4%) patients; none were considered treatment-related by investigators. The incidence of AEs was similar between groups. In the post hoc subgroup efficacy analyses, LOR 0.07 mg demonstrated greater mean improvements from baseline compared with PBO in WOMAC pain and function scores out to 12 months post-injection. No between-group differences in medial JSW were observed out to 18 months. Conclusions LOR appeared generally safe and well tolerated. Efficacy analyses on the subset of completer patients demonstrated durable symptom improvements in WOMAC pain and function for at least 12 months compared to PBO after a single injection of LOR. Clinical Trial Registration Number NCT02951026.

Yi-Yang Sun,1 Ming-Lin Wang,2 Ruo-Han Zhao,1 Ming-Yao Hao,3 Shuai Song,3 Yue Zhou,3 Na Zhang1 1Department of Acupuncture-Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People’s Republic of China; 2Traditional Chinese Medicine Comprehensive Treatment Center, Shengli Oilfield Central Hospital, Jinan, Shandong, People’s Republic of China; 3External Treatment Center of Traditional Chinese Medicine, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People’s Republic of ChinaCorrespondence: Na Zhang, Email zhangna2008zhentui@163.comPurpose: Knee osteoarthritis (KOA) is a prevalent degenerative bone and joint disease observed in clinical practice. While acupuncture has demonstrated efficacy in treating KOA, the central mechanisms underlying its effects remain ambiguous. Recently, functional magnetic resonance imaging (fMRI) has been extensively applied in studying the brain mechanisms of acupuncture analgesia. Currently, network analysis based on brain connectomics is a focal point in acupuncture imaging research. Therefore, this study uses KOA as the research vehicle, focuses on the abnormal connectivity patterns of brain functional networks, and integrates clinical pain assessments to thoroughly investigate the central mechanisms of acupuncture therapeutic effects on KOA.Patients and Methods: In this parallel, randomized, sham-controlled neuroimaging trial, 60 KOA patients will be randomly divided into the acupuncture group and sham acupuncture group in a 1:1 ratio, treated three times weekly for a total of 12 sessions. Patients will undergo clinical symptom assessments and cranial fMRI scans at baseline (− 1– 0 weeks), post-treatment (4 weeks), and at the follow-up (16 weeks). Forty healthy subjects will be recruited for observation, with a single MRI scan conducted only at baseline (− 1– 0 week). The primary efficacy indicator will be the change in NRS score after four weeks of treatment, with secondary outcomes including WOMAC, STAI, and safety assessments. fMRI observations will employ independent component analysis, brain network construction, and functional connectivity, complemented by Pearson correlation analysis to explore the relationship between brain responses and clinical improvements.Conclusion: This study will initially uncover how acupuncture intervention for chronic KOA pain centrally regulates and exerts therapeutic effects through the modulation of abnormal brain network functional connectivity patterns, with a demonstrated long-term effect.Ethics and Dissemination: This study has been approved by the ethics committee of Shandong University of Traditional Chinese Medicine Affiliated Hospital ((2024) Lunshen No. (028) - KY).Clinical Trial Registration: This study has been approved by registered in the Chinese Clinical Trial Registry (ChiCTR2400083695).Keywords: acupuncture, knee osteoarthritis, neuroimaging, RCT, protocol

Abstract Background Osteoarthritis (OA) is prevalent, yet its management remains challenging. This meta-analysis aims to evaluate the efficacy of acupuncture combined with moxibustion versus other standard treatments in patients with knee osteoarthritis (KOA) based on randomized controlled trials (RCTs). Methods Searches were conducted in Ovid MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to retrieve relevant RCTs. Data on baseline characteristics, treatment efficacy, and adverse events were extracted. The analysis utilized pooled weighted mean differences (WMD) and risk ratios (RR) with 95% confidence intervals (CIs) to assess the superior treatment modality. Results A total of 18 RCTs were included. Acupuncture combined with moxibustion demonstrated significant improvement in the visual analog scale (VAS) for pain and the long-term (> 60 weeks) Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for pain, stiffness, and physical function compared to other treatments. In contrast, short- (

Abstract Background Low-value care refers to the provision of health services that confer little or no benefit to patients, or have the potential to incur unwarranted harms. A breadth of literature exists investigating geographical variations in rates of potential low-value interventions for musculoskeletal pain. This scoping review aimed to examine the provision of low-value care for osteoarthritis and lower back pain by degree of rurality (e.g., urban, rural and remote areas). Methods This scoping review followed the Joanna Briggs Institute (JBI) methodology. Electronic searches were performed on five literature databases with no time frame, language or terminology restrictions. Two independent reviewers screened titles and abstracts, reviewed full papers and extracted data from selected studies using a COVIDENCE-developed data extraction tool. Results After screening, 21 papers were selected. Two of the papers explicitly referenced low-value care while 19 investigated the provision of potential low-value interventions. Hip and knee arthroplasty, knee arthroscopy, inappropriate pharmacotherapy and complementary and alternative medicine, were more common in rural compared to urban areas. Hip and knee arthroplasty (in women), lumbar spinal fusion, spinal imaging and glucosamine use, were less common in remote compared to regional and urban areas. Conclusions There is a higher report of multiple low-value interventions for osteoarthritis and lower back pain in rural compared to urban areas and lower reporting in remote areas. The lack of healthcare services in rural areas may promote low-value care, while geographical isolation in remote areas may limit utilization of both low- and high-value interventions.

Abstract Introduction In 2020, 368 million people globally were affected by knee osteoarthritis, and prevalence is projected to increase with 74% by 2050. Relatively high rates of dissatisfactory results after total knee arthroplasty (TKA), as reported by approximately 20% of patients, may be caused by sub-optimal knee alignment and balancing. While mechanical alignment has traditionally been the goal, patient-specific alignment strategies are gaining interest. Robotic assistance could potentially facilitate implementation of these alignment strategies through data-based surgical planning, accurate execution of the surgical plan and validation. The clinical value of surgical assistance in diverging from mechanical alignment remains to be investigated. In the present study, robotic-assisted TKA will be performed to pursue inverse kinematic alignment (iKA) within predefined boundaries, focusing on restoring native tibia joint line. Methods This randomized controlled trial evaluates clinical effectiveness of robotic-assisted TKA (ROSA® Knee System, Zimmer Biomet, Montreal, Quebec, Canada) aiming for iKA compared to conventional TKA aiming for mechanical alignment. A total of 150 participants will be randomized (1:1) to either treatment to provide an 80% power for a 4.8-point clinically important difference in the primary outcome measure, the Oxford Knee Score (OKS) 12 months after surgery. Allocation was achieved using computer-based randomization. Outcomes will be analyzed using linear mixed models with time and group as main factors and interaction-term. Secondary outcomes include clinical metrics (leg alignment, implant and patient survival), surgical parameters (adverse events, surgery duration, blood loss, hospital stay length, medication use), patient-reported outcomes (symptoms, quality of life, pain), mobility and physical activity measurements, metabolic syndrome, cost-efficacy, and gait and continuous glucose monitoring. Ethics and dissemination This study has been approved by the Medical Ethical Committee Zuyd and Zuyderland Medical Centre (NL79161.096.21/METCZ20220006), September 2022. Trial registration number NCT05685693 (clinicaltrials.gov).

OBJECTIVE: Knee pain is highly prevalent and disabling among the general and working population. This systematic review explored the effectiveness of workplace-based interventions on knee pain among workers. METHODS: A PICO-guided systematic search was performed in PubMed and Web of Science Core Collection for articles published from 2003 until January 2023. Eligible articles included randomized and non-randomized controlled trials assessing the effect of workplace-based interventions on knee pain among currently employed adult workers. The quality assessment and evidence synthesis adhered to the systematic review approach, which the Institute for Work & Health developed, and was focused on developing practical recommendations for stakeholders. RESULTS: Of the 13 identified studies, 11 medium- and high-quality studies were entered into the evidence synthesis. Importantly, none of the included studies specifically aimed at reducing of knee pain. Still, among the included studies, a strong level of evidence suggested no benefit of workplace-based physical exercise/activity intervention on knee pain. The level of evidence was deemed too uncertain to guide current policy/practices for ergonomic and multifaceted interventions. No intervention types were associated with negative effects on knee pain. CONCLUSIONS: The current evidence-base pertaining to workplace-based prevention and management of knee pain is insufficient to guide effective preventive workplace practice or policy development. Considering the global prevalence and health impact of knee pain, development and implementation of effective workplace interventions aimed at prevention and management of knee pain is needed.

Chao Zhang,1,2,&ast; Man Yu,3,&ast; Longyao Zhang,1,2 Xin Zhou,1,2 Jinchang Han,1,2 Bifeng Fu,1,2 Hongfei Xue,1,2 Chao Zhang1,2 1Orthopedics Department, The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300380, People’s Republic of China; 2National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300380, People’s Republic of China; 3Department of Nephrology and Rheumatology, Second Hospital Affiliated to Tianjin University of Traditional Chinese Medicine, Tianjin, 300250, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Hongfei Xue; Chao Zhang, The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300380, People’s Republic of China, Email 2538287036@qq.com; zhangchao2004.love@163.comBackground: Acupuncture is an effective treatment for knee osteoarthritis (KOA), reducing pain and improving function. While melatonin (MLT) has notable pain relief benefits, the analgesic mechanism of acupuncture in KOA and its relationship with melatonin are still unknown. This study aims to explore this mechanism.Methods: In this work, the KOA rabbit model was constructed using the traditional Hulth method, and the therapeutic effect was assessed by the Lequesne MG score and Pain assessment by hot plate test. The pathological alterations of cartilage tissue were observed using hematoxylin and eosin (H&E) staining, Safranin O-fast green and MASSON staining to observe the pathological changes in cartilage tissue, and the efficacy was evaluated according to the principles of Mankin score and Osteoarthritis Research Society International (OARSI) score. Meanwhile, MLT in serum, cyclic adenosine monophosphate (cAMP) in cartilage, and matrix metalloproteinase-3 (MMP-3) in joint fluid were detected by enzyme-linked immunosorbent assay. In addition, the expression of aromatic L-amino acid N-acetyltransferase (AANAT), melatonin receptor 1 (MT1) and 2 (MT2) mRNAs in cartilage was determined by real-time quantitative reverse transcription-polymerase chain reaction, and the levels of proteins related to PKA/CREB signaling pathway were detected by Western blotting.Results: Based on the results of Lequesne MG score and Pain assessment by hot plate test experimental data, the treatment group presented significant improvements in knee pain and overall function relative to OA (Osteoarthritis) group. Besides, according to results of histologic staining, Mankin and OARSI scores, articular cartilage degeneration of treatment group remarkably improved. In addition, acupuncture significantly reduced the expression of the inflammatory factor MMP-3 in knee joint fluid and significantly increased the levels of MLT, AANAT, MT1, MT2, cAMP, PKA and CREB.Conclusion: By regulating sympathetic excitability, acupuncture may activate the MLT/cAMP/PKA/CREB signaling pathway, decrease inflammatory factor expression and slow down degradation of articular cartilage, resulting in the relief of knee pain.Keywords: acupuncture, knee osteoarthritis, MLT/cAMP/PKA/CREB pathway, melatonin

Ye Ji Lee,1,&ast; Chang-Hyun Han,2,3,&ast; Ju Hyun Jeon,1 Eunseok Kim,4,5 Ki Hyun Park,6 Ae Ran Kim,7 Young Il Kim1 1Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea; 2KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea; 3Korean Convergence Medicine, University of Science and Technology (UST), Campus of Korea Institute of Oriental Medicine, Daejeon, Republic of Korea; 4Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea; 5Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea; 6KM Data Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea; 7Clinical Research Coordinating Team, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea&ast;These authors contributed equally to this workCorrespondence: Young Il Kim, Department of Acupuncture and Moxibustion Medicine, College of Korean Medicine, Daejeon University, Daejeon, Republic of Korea, Email omdkim01@dju.krPurpose: This study aimed to evaluate the effectiveness and safety of combination treatment with thread-embedding acupuncture (TEA) and electroacupuncture (EA) in patients with persistent knee pain after arthroscopic surgery, autologous chondrocyte implantation, or autologous osteochondral transplantation.Patients and Methods: Twelve patients with knee osteoarthritis (KOA) who experienced postoperative pain were randomized to either the treatment group (TG) or control group (CG) in a 1:1 ratio. The TG received TEA once a week for four sessions and EA twice a week for eight sessions while continuing usual care, defined as standard conventional treatments. The CG received only usual care for four weeks. The primary outcome was the visual analogue scale (VAS) score at week 4 compared with the baseline. The secondary outcomes were the VAS scores at weeks 2, 6, and 8, the Korean version of the Western Ontario and McMaster Universities Osteoarthritis Index (K-WOMAC), the EuroQol 5-Dimension 5-Level (EQ-5D-5L), and rescue medication consumption at weeks 2, 4, 6, and 8. Adverse events were assessed at each visit.Results: The TG showed significant improvement in the VAS scores at weeks 4, 6, and 8 compared with the CG (week 4: − 24.5; p = 0.0106, week 6: − 19.667; p = 0.0228, week 8: − 28.667; p = 0.0036). In the TG, significant differences were observed in K-WOMAC total scores at weeks 2, 4, 6, and 8 (week 2: 17.167; p = 0.0083, week 4: 23; p = 0.0018, week 6: 29.833; p = 0.0009, week 8: 30.5; p = 0.0006); however, there were no differences between the two groups. The two groups had no significant differences in the EQ-5D-5L and rescue medication consumption. No adverse events were observed in either groups during the study period.Conclusion: This feasibility study suggests that adding combination treatment with TEA and EA to usual care might relieve pain in patients with KOA. Large-scale clinical trials are needed to confirm the long-term effects of combination treatment.Keywords: thread-embedding acupuncture, electroacupuncture, osteoarthritis, knee, randomized controlled trial

Abstract Background Osteoarthritis (OA) often leads to pain and functional limitations, impacting work and daily life. Physical activity (PA) is an important part of the treatment. Wearable activity trackers (WATs) offer a novel approach to promote PA but could also aid in finding a sustainable PA level over time. The aim of this secondary analysis was to examine the effects of self-monitoring PA with a WAT on perceived joint function and health-related quality of life in people with hip and knee OA. Method A two-armed cluster-randomized controlled trial (C-RCT) was conducted in southern Sweden including 160 individuals with hip or knee OA. The participants were cluster-randomized to a Supported Osteoarthritis Self-management Program (SOASP) with the addition of self-monitoring PA using a commercial WAT for 12 weeks (n = 86), or only the SOASP (n = 74). The outcomes include perceived joint function measured with HOOS/KOOS and health-related quality of Life (HRQoL) measured with EQ-5D-3L index and EQ VAS. Participants responded to the questionnaires at baseline and at follow-up after 3, 6 and 12 months. Statistical analyses involved linear mixed models, ANCOVA and paired t-test. Results Participants with data from baseline and at least one follow-up were included in the analyses (n = 124). The analyses showed no statistically significant differences in changes between the groups in perceived joint function or HRQoL throughout the study period. Both groups improved in pain and symptoms, but the changes were small. Conclusion The addition of WAT-use did not have any effect on perceived joint function or HRQoL. The participants’ relatively high baseline scores might have influenced the outcomes of this study. We suggest that future WAT-interventions target inactive people with OA and use devices that also captures other activities such as cycling or aquatic exercise. Trial registration ClinicalTrials.gov, NCT03354091. Registered 15/11/2017.

Abstract Background Physiotherapy has emerged as an important health strategy to deliver lifestyle, exercise and physical activity for people with knee osteoarthritis. However, little is known about the extent to which physiotherapists adhere to clinical practice guidelines. This study aimed to explore the perspectives and care patterns of physiotherapists in Sydney, Australia on their delivery of knee osteoarthritis care and how this aligns with the 2019 Osteoarthritis Research Society International (OARSI) guidelines. Methods We invited thirty-three physiotherapists from nine private practices in metropolitan Sydney to partake in a semi-structured interview. The interviews were digitally recorded and transcribed verbatim. The data collected were analysed deductively using content analysis, comparing guidelines to current care patterns, while their perspectives were inductively analysed through thematic analysis. Results Thirty physiotherapists participated (age range 22–63 years, 17 male and 13 female). Interview responses indicated that most physiotherapists were satisfied with their care of knee osteoarthritis patients. Most physiotherapists delivered “core” guideline-based care of education and land-based exercise. Recommendations of modalities of exercise, including hydrotherapy and manual therapy, were discussed and were perceived to be beneficial despite not being “core” clinical guideline recommendations. Current treatment strategies focussed on disease severity, symptom presentation and/or patient exercise history with little emphasis on education about osteoarthritis pathophysiology and drug-based pain relief. The thematic analysis identified two over-arching themes; (1) capacity to deliver and awareness of evidence-based care and (2) perceived recommendations for future physiotherapy management. Participants identified notable areas of potential service improvement including developing stronger and more effective reimbursement models, increased consult times and improved patient access. Conclusion The study provided unique insights towards physiotherapists’ current usual knee osteoarthritis care and their perceived barriers to delivering guideline-based care. Thus, informing a need for future studies to focus on developing specific and detailed guidelines if physiotherapists are to align more closely to the core guideline-based recommendations. Trial registration This study was part of a larger study, with the full protocol published and registered at ClinicalTrials (ACTRN12620000188932, ACTRN12620000218998) 19/02/2020).

Abstract Background Cryotherapy is a non-pharmacological option that complements drug therapy to achieve the most comprehensive multimodal analgesia. Various techniques are currently available, including the conventional gel cold pack, the cryo-cuff, and a novel mobile cold compression device (MCCD). This study aimed to evaluate and compare three cryotherapy techniques in terms of efficacy and patient satisfaction in patients undergoing total knee arthroplasty (TKA). Methods This prospective randomized study included 108 patients who were scheduled for primary unilateral TKA. The patients were allocated to 3 groups for postoperative cryotherapy techniques: gel cold pack, cryo-cuff, and MCCD. Scores on the visual analog scale (VAS) for pain intensity, morphine consumption, knee range of motion (ROM), knee swelling, length of hospital stay, and patient satisfaction were collected. Results Postoperative VAS scores showed a significant difference among the groups at 8 and 72 h after surgery (P = 0.002 and 0.026, respectively). At the earliest postoperative time point, post hoc analysis demonstrated that patients in the MCCD group had lower pain scores than those in the gel cold pack (P

Abstract Knee osteoarthritis (KOA) represents a progressive degenerative disorder characterized by the gradual erosion of articular cartilage. This study aimed to develop and validate biomarker-based predictive models for KOA diagnosis using machine learning techniques. Clinical data from 2594 samples were obtained and stratified into training and validation datasets in a 7:3 ratio. Key clinical features were identified through differential analysis between KOA and control groups, combined with least absolute shrinkage and selection operator (LASSO) regression. The SHapley Additive Planning (SHAP) method was employed to rank feature importance quantitatively. Based on these rankings, predictive models were constructed using Logistic Regression (LR), Random Forest (RF), eXtreme Gradient Boosting (xGBoost), Naive Bayes (NB), Support Vector Machine (SVM), and Decision Tree (DT) algorithms. Models were developed for subsets of variables, including the top 5, top 10, top 15, and all identified features. Receiver operating characteristic (ROC) curves were applied to compare diagnostic performance across models. Additionally, a risk stratification framework for KOA prediction was designed using recursive partitioning analysis (RPA). Using difference analysis and LASSO, 44 critical clinical features were identified. Among these, age, plasma prothrombin time, gender, body mass index (BMI), and prothrombin time and international normalized ratio (PTINR) emerged as the top five features, with SHAP values of 0.1990, 0.0981, 0.0471, 0.0433, and 0.0422, respectively. Machine learning analysis demonstrated that these variables provided robust diagnostic performance for KOA. In the training set, area under the curve (AUC) values for LR, RF, xGBoost, NB, SVM, and DT models were 0.947, 0.961, 0.892, 0.952, 0.885, and 0.779, respectively. Similarly, in the validation dataset, these models achieved AUC values of 0.961, 0.943, 0.789, 0.957, 0.824, and 0.76. Among them, RF consistently exhibited superior diagnostic accuracy for KOA. Additionally, RPA analysis indicated a higher prevalence of KOA among individuals aged 54 years and older. The integration of the top five clinical variables significantly enhanced the diagnostic accuracy for KOA, particularly when employing the RF model. Moreover, the RPA model offered valuable insights to assist clinicians in refining prognostic assessments and optimizing clinical decision-making processes.

Purpose The goal of this pilot study was to compare and evaluate the efficacy of extracorporeal shock wave therapy (ESWT) and dexamethasone sodium phosphate (DEX-P) iontophoresis in patients who have unilateral symptomatic knee OA (KOA). Methods Pre-post single-blind randomised experimental trial. The therapeutic program was performed twice per week for 4 weeks. Sixty patients with unilateral symptomatic KOA were randomly divided into three groups. Intensity of pain, pressure threshold for pain, knee function, and knee range of motion (ROM) were measured before and after therapy in all three groups. Results The improvement in the shock wave group was significantly greater than the iontophoresis group. Conclusions ESWT has a superior therapeutic effect in patients with symptomatic KOA.

ObjectiveTo explore the feasibility of the International Classification of Functioning, Disability and Health Rehabilitation Set (ICF-RS) in evaluating the overall functional level, rehabilitation treatment effects, and the relationship between rehabilitation efficacy and cost-effectiveness of patients with knee osteoarthritis (KOA) in the northwest Gobi region.MethodsA total of 50 patients with KOA who were hospitalized in the Acupuncture and Moxibustion Department of Jimsar County Hospital of Traditional Chinese Medicine from March 2022 to March 2023 were selected. A total of eight cases discontinued or dropped out due to comprehension deviation and low assessment compliance, and finally 42 cases were included. Personalized rehabilitation programs were formulated according to the severity of functional disorders referring to the "Clinical Practice Guidelines of Traditional Chinese Medicine Rehabilitation for Knee Osteoarthritis". The treatment was conducted once a day, six days a week for two weeks. The ICF-RS was used to evaluate the overall functional level, rehabilitation efficacy and rehabilitation treatment costs.ResultsThe main body functional impairments of patients with KOA were b280 pain sensation, b455 exercise tolerance, b130 energy and drive function, and b134 sleep function in sequence; the main activity limitations were d410 changing basic body postures, d455 moving around, and d415 maintaining a body posture; the main participation dysfunctions were d850 remunerative employment and d920 recreation and leisure. There was no statistically significant difference in the composition ratio of the frequency of the limit values in all categories of ICF-RS (except d240 handling stress and other psychological needs) between Han and ethnic minority patients with KOA (P>0.05). The ICF-RS assessment results showed that, all categories of the body function, activities and participation in patients with KOA increased significantly after treatment (P

ObjectiveTo explore the reliability and validity of the International Classification of Functioning, Disability and Health Rehabilitation Set (ICF-RS) in assessing the body function, activities and social participation of patients with knee osteoarthritis (KOA).MethodsA total of 60 KOA patients in the Outpatient Department of Orthopedic Rehabilitation in the Fifth Hospital of Xiamen and the Xiangyang Central Hospital from October to December 2022 were recruited. The ICF-RS was used to assess the patients' function; the criterion-related validity between the ICF-RS scale and the commonly used clinical scales for knee joints [visual analogue scale (VAS) for pain, hospital for special surgery (HSS) knee score, modified Barthel index (MBI) and 36-item short form health survey (SF-36)] was used to evaluate the effectiveness of ICF-RS scale in assessing the function and activity performance of patients with KOA. Internal consistency and item discriminant validity were used to evaluate reliability and validity of the ICF-RS.Results(1) ICF-RS functional status: about 60% of KOA patients had no or mild functional impairments. The most common moderate to severe impairments in body function domain included b280 sensation of pain (54 cases, 90.00%), b455 exercise tolerance (44 cases, 73.33%), and b134 sleep function (28 cases, 46.67%); the most common moderate to severe impairments in activities included d455 moving around (52 cases, 86.67%) and d410 changing basic body position (30 cases, 50.00%); the most common moderate to severe impairments in participation included d660 assisting others (38 cases, 63.33%), d850 remunerative employment (32 cases, 53.33%) and d920 recreation and leisure (38 cases, 63.33%). (2) Criterion-related validity: the ICF-RS body function score was negatively correlated with HSS score (|r|>0.4, Pr|>0.6, Pr|>0.6, PPr|>0.8 could effectively distinguish KOA patients with high and low score function, including d420 changing body position, d510 washing oneself, d640 doing household chores and d470 using transportation.ConclusionICF-RS could be used to assess the functional status of KOA patients with good reliability, validity and criterion-related validity.

Abstract Background Total knee arthroplasty (TKA) is a treatment option for osteoarthritis of the knee. After undergoing TKA, patients can be treated with continuous passive motion (CPM); however, inconsistent results have been reported on the effectiveness of CPM as part of a rehabilitation strategy. This discrepancy may be due to the difference between the set-arc of CPM and real arcs of knee motion. In this randomized controlled trial, we compared the efficacy of the sitting-type CPM, which can apply a more fitted arc of motion, to that of the conventional CPM. Methods We performed a prospective, multicenter, single-blind, three-arm, randomized controlled trial. Patients who underwent unilateral TKA were recruited and randomly allocated to three groups (151 participants; Group 1, conventional type; Group 2, mixed; and Group 3, sitting type). All participants underwent 10 days of CPM management. Passive and active ranges of motion (ROMs), pain, lower-extremity edema, patient-reported outcomes, and functional assessments were evaluated at four time points. Results Passive and active ROMs and pain significantly improved during and after the intervention in all groups; however, no significant differences were noted between the groups. Compared with the conventional type, the sitting-type CPM devices were rated higher in participant’s satisfaction questionnaires. Conclusion The sitting-type CPM had equivalent efficacy to that of the conventional-type CPM but provided higher satisfaction to patients after TKA. Therefore, the sitting-type CPM may be a useful tool in post-TKA rehabilitation. Clinical trial registration This clincial trial was registed with the Clinical Research Information Service of Republic of Korea, KCT0005520, Registered on 21 October 2020, date of first enrollment at 10/11/2020 https://cris.nih.go.kr/cris/search/detailSearch.do/21750 .

Abstract Background Patellofemoral joint (PFJ) diseases are chronic degenerative conditions that contribute to knee joint symptoms. Unicompartmental knee arthroplasty (UKA) is widely regarded as an effective treatment for knee osteoarthritis (KOA); however, its specific indications remain a subject of debate. Hypothesis Patients with PFJ disease are expected to experience outcomes post-UKA comparable to those of patients without PFJ disease. Methods We conducted this meta-analysis following the guidelines outlined by the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). A comprehensive search of PubMed, Embase, and Web of Science databases was conducted for studies examining the association between PFJ disease and UKA, including publications up to September 2024. Extracted data encompassed author, publication year, country, disease type, prosthesis type, sample size, mean patient age, gender distribution, follow-up duration, PFJ disease prevalence at surgery, diagnostic methods, and whether PFJ disease was considered a contraindication for UKA. To maintain objectivity, only studies in which PFJ diseases were visually identifiable were included in the meta-analysis. Statistical analyses were performed using Stata 15.0 and Review Manager 5.4.1. A random-effects meta-analysis was conducted to evaluate the Oxford Knee Score (OKS), Knee Society Score (KSS), flexion range of motion (ROM), Forgotten Joint Score (FJS), Tegner activity score, and prosthesis survival rate, with outcomes stratified by PFJ disease type (PFJ degeneration or patella cartilage injury). Mean differences, confidence intervals, and P values were calculated for comparisons between the PFJ disease and non-PFJ disease groups. The Methodological Index for Non-Randomized Studies (MINORS) criteria and the Newcastle–Ottawa Scale (NOS) were applied to evaluate the risk of bias. To address heterogeneity, sensitivity analyses were performed, and publication bias was assessed using funnel plots and Egger's test. Results A total of 14,866 knees from 48 relevant studies were included in this systematic review. Methodological quality was assessed using the MINORS criteria, with case series scoring 11.0/16 and cohort studies scoring 18.2/24. PFJ degeneration emerged as the most studied condition, followed by patella cartilage injury. Clinical outcomes assessments indicated that medial PFJ degeneration, anterior knee pain, patella cartilage damage, and patella baja did not significantly impact UKA outcomes or prosthesis survival. However, severe lateral PFJ degeneration, lateral patellar subluxation, lateral trochlear osteophytes, and patellar bone marrow edema did influence results. Fifteen high-quality studies were included in the meta-analysis, involving 6080 patients-1338 in the PFJ disease group and 4,742 in the non-PFJ disease group. With an average NOS score of 7.2, the studies were generally of high quality. Meta-analysis results showed no significant differences between groups in final follow-up OKS, FJS, Tegner activity score, or prosthesis survival rate. However, the PFJ disease group had lower KSS and reduced flexion ROM compared to the non-PFJ disease group. Subgroup analysis further revealed that the PFJ degeneration group scored lower than the patella cartilage injury group on OKS, KSS, and flexion ROM following UKA. Conclusion In summary, PFJ disease was found to have limited impact on UKA outcomes; however, caution is recommended for cases involving severe lateral PFJ degeneration due to potential restrictions in postoperative knee function, particularly affecting flexion ROM in UKA patients.

Abstract Background This study aimed to address research gap concerning the perception of the care pathway for knee osteoarthritis (KOA) patients, focusing on both the patient and health professional perspectives in countries with inefficient health systems, such as Slovenia, by examining patient satisfaction with conservative treatment, assessing the perceptions of both patients and health professionals regarding the latter’s involvement, and justifying the chosen KOA treatment approaches. Methods A mixed-methods approach was employed, combining quantitative surveys and qualitative interviews with KOA patients (n = 82) and healthcare professionals (n = 68). Results The care pathway for conservative KOA treatment in Slovenia begins with general practitioners (GPs), who conduct initial examinations, prescribe analgesics, and refer patients to radiologists and orthopaedic surgeons. GPs received high satisfaction ratings (μ = 4.32). Orthopaedic surgeons, who confirm diagnoses and create treatment plans involving physiotherapy, medication, or joint injections, also received high satisfaction scores (μ = 4.47), despite long waiting times. Consultations with radiologists, mentioned less frequently, again received high satisfaction scores (μ = 4.67). Physiotherapists, consulted later, received high satisfaction scores (μ = 4.16) but long waiting times resurfaced. Referrals to rheumatologists occur for systemic diseases or ineffective conservative treatments. Psychologists, occupational therapists, and dieticians are rarely consulted, indicating limited integration into the treatment pathway. A comparison of health professionals’ involvement showed that health professionals consider GP involvement less necessary (μ = 2.47) than patients do (μ = 2.82, p = 0.015). The same applies to radiologists (μ = 2.47 vs. μ = 2.87, p = 0.004), reflecting different views on diagnostic imaging. Our qualitative investigation revealed that, due to long waiting times, an alternative care pathway is developing with orthopaedic surgeons as the initial point of contact, bypassing GPs, and highlighted that patients and healthcare professionals differently perceive the latter’s treatment roles. Conclusions The current conservative KOA care pathway lacks initial lifestyle change advice from the GP, referrals for conservative treatments, and a multidisciplinary team engaged in regular treatment monitoring and adjustment. Our mixed-methods research approach highlighted significant differences in perceptions of the treatment process and the roles of health professionals; the knowledge supplied of those differences should support experts and policymakers to optimise care pathways in Slovenia.

Abstract Objective To use routine demographic and clinical data to develop an interpretable individual-level machine learning (ML) model to diagnose knee osteoarthritis (KOA) and to identify highly ranked features. Methods In this retrospective, population-based cohort study, anonymized questionnaire data was retrieved from the Wu Chuan KOA Study, Inner Mongolia, China. After feature selections, participants were divided in a 7:3 ratio into training and test sets. Class balancing was applied to the training set for data augmentation. Four ML classifiers were compared by cross-validation within the training set and their performance was further analyzed with an unseen test set. Classifications were evaluated using sensitivity, specificity, positive predictive value, negative predictive value, accuracy, area under the curve(AUC), G-means, and F1 scores. The best model was explained using Shapley values to extract highly ranked features. Results A total of 1188 participants were investigated in this study, among whom 26.3% were diagnosed with KOA. Comparatively, XGBoost with Boruta exhibited the highest classification performance among the four models, with an AUC of 0.758, G-means of 0.800, and F1 scores of 0.703. The SHAP method reveals the top 17 features of KOA according to the importance ranking, and the average of the experience of joint pain was recognized as the most important features. Conclusions Our study highlights the usefulness of machine learning in unveiling important factors that influence the diagnosis of KOA to guide new prevention strategies. Further work is needed to validate this approach.

Importance: Knee osteoarthritis (OA) is a common degenerative joint disease in aging populations. Knee OA is difficult to cure and requires ongoing management. Thread embedding acupuncture (TEA) is a popular Korean medical treatment for knee OA. However, clinical evidence of its effectiveness and safety is insufficient. Objective: This study aims to evaluate the effectiveness and safety of TEA compared with acupuncture for knee OA. Design, Setting, and Population: A two-group, two-arm, parallel, single-center, randomized, controlled, and assessor-blinded pilot trial will be conducted. A total of sixty patients aged between 40 and 85 years old will be recruited. Exposures: The TEA group will receive four sessions of TEA treatment over 4 weeks. The acupuncture group will receive eight sessions of acupuncture treatment over 4 weeks. A follow-up assessment will be conducted in week 8 for both groups. Main Outcomes and Measures: Assessments will be performed at baseline, 2 weeks, 4 weeks, and 8 weeks. The primary outcome will be the mean change in the visual analog scale between the two groups at 4 weeks. The secondary outcomes will be the mean change in the Korean Western Ontario and McMaster Universities Osteoarthritis Index, knee range of motion, EuroQol 5-Dimension, patient global impression of change, and dosage of rescue medication. Statistical analysis will be conducted and the level of significance will be achieved in each variables. Results: The results will be published in a peer-reviewed journal. Conclusions and Relevance: This study provides a rationale for the effectiveness and safety of TEA for knee OA by comparing TEA treatment with acupuncture.

Abstract Background Exercise has been reported to be beneficial in reducing pain and fatigue, as well as improving mood, in patients with knee osteoarthritis (KOA). However, long bouts of exercise have been linked to an increase in fatigue and pain level in elderly adults. Currently, there are very few investigations into the immediate effects of breaking exercise into shorter and frequent bouts, otherwise known as exercise snacking on physical fatigue, mood, and pain in elderly adults with KOA. The aim of this study was to investigate the immediate impact of exercise snacking versus continuous exercise on physical fatigue, mood, and pain level in elderly adults with KOA. Methods This was a randomized experimental study, with 37 participants aged 60 years and above with KOA. Participants were recruited and randomly assigned into a five bouts of 2-min exercise snacking and 10-min continuous exercise groups, with the bicycle ergometer as the exercise mode. Physical fatigue, mood, and pain of participants were assessed at baseline and immediately after the exercise using Numerical Fatigue Rating Scale (NFRS), Visual Analog Mood Scale (VAMS), and Numerical Pain Rating Scale (NPRS) respectively. Descriptive statistics and inferential statistics of Wilcoxon Rank test, Mann–Whitney U, and ANCOVA were used to analyze the data with p value set at 0.05. Results There were significant differences (p

Abstract Objectives This study aims to identify predictors of knee osteoarthritis (KOA) risk in middle-aged population, construct and validate a nomogram for KOA in this demographic. Methods From June to December 2020, we conducted a cross-sectional survey on 5,527 middle-aged individuals from Changsha and Zhangjiajie cities in Hunan Province, selected using a stratified multi-stage random sampling method. Data collection involved a structured questionnaire encompassing general demographic, physical condition, and lifestyle behaviors dimensions. The dataset was randomly split into a training set (n = 3868) and a validation set (n = 1659) at a 7:3 ratio via computerized randomization. We analyzed the prevalence of self-reported KOA and identified its influencing factors using logistic regression. A nomogram was constructed based on these "three-dimensional" factors. Subsequent validation was conducted, and the nomogram's performance was further evaluated through ROC curves, C-index, Hosmer–Lemeshow test, and calibration curves. Results The self-reported prevalence of KOA in the middle-aged population was 11.4% (632/5527). The risk factor with the greatest impact is: diagnosed with osteoporosis(95% CI 2.269–3.568, OR = 2.845), followed by age between 51 to 60 years (95% CI 2.176–3.151, OR = 2.619), diagnosed with hypertension(95% CI 1.633–2.499, OR = 2.02), diagnosed with diabetes (OR = 1.689), ethnic Han Chinese (OR = 1.673), exercise according to physical condition (OR = 1.643), pay attention to keeping the knee joint warm (OR = 1.535), eating habits are mainly light vegetables (OR = 1.374), male gender (OR = 1.343), drink occasionally in small amounts (OR = 1.286); a higher level of education (OR = 0.477) and frequently or always apply an external or plaster to relieve symptoms after knee discomfort (OR = 0.377; OR = 0.385) are protective factors. The C-index of the training set model was 0.8107 (95% CI: 0.8102–0.8111), with a statistically significant area under the ROC curve (AUC = 0.818), and the calibration curve showed a good fit. The C-index for the validation set was 0.8124 (95% CI: 0.8109–0.8140), with an AUC of 0.812. The Hosmer–Lemeshow test resulted in a P-value of 0.46 (P ≥ 0.05)indicating good calibration of the model. Conclusion The three dimensions nomogram generated in this study was a valid and easy-to-use tool for assessing the risk of KOA in middle-aged population, and helped healthcare professionals to screen the high-risk population.

Knee osteoarthritis (OA) is one of the most prevalent degenerative conditions among the elderly, significantly impacting both mental and physical health, including an elevated risk of depression. This study aims to assess the prevalence of depression distribution among patients with knee osteoarthritis attending the geriatric polyclinic at a Regional General Hospital in Indonesia. A descriptive cross-sectional study design was employed. Data were collected through medical record reviews and structured interviews. The findings revealed that 61.3% of patients experienced mild depression, 35.3% were categorized as having no depression, and 3.3% had moderate depression, with no cases of severe depression identified. The majority of patients were classified as older adults (aged 75–90 years, 60%) and predominantly female (78.7%). In conclusion, knee osteoarthritis is most commonly observed in the older age group and among females. Most patients present with mild depression, which tends to worsen with advancing age, influenced by chronic pain and functional limitations.

Abstract Objective To explore the relationship between meniscus compression and the severity of knee osteoarthritis. Materials and methods A retrospective case-control study included 95 patients with knee osteoarthritis (OA) admitted to our hospital from April 2021 to July 2023, who were grouped into slight protrusion of meniscus group (n = 48) and severe protrusion of meniscus group (n = 47) according to the degree of meniscal extrusion. Various parameters, including Kellgren/Lawrence classification, imaging findings, cartilage damage grading, physical function assessments, and correlation analyses, were used to evaluate the relationship between meniscal extrusion and disease progression. Results The study revealed significant associations between severe meniscal extrusion and measures of disease severity, including reduced cartilage thickness(3.24 ± 0.61 versus 3.78 ± 1.45; P = 0.019), increased meniscus degeneration grade (2.86 ± 0.54 versus 2.23 ± 1.63; P = 0.013), diminished joint space width (4.56 ± 0.73 versus 4.86 ± 0.52; P = 0.025), elevated meniscal extrusion(3.68 ± 1.78 versus 2.85 ± 1.54; P = 0.018), greater bone marrow lesion volume(6.13 ± 1.85 versus 5.21 ± 1.58; P = 0.011), advanced cartilage damage(t = 0.016), and impaired physical functioning. Correlation analyses indicated a positive relationship between meniscal extrusion and disease severity(r > 0). While the predictive value of meniscal extrusion alone was modest (AUC = 0.617), a combined model integrating various parameters yielded a high predictive value for disease progression (AUC = 0.853). Conclusion Meniscal extrusion was associated with disease severity and functional decline in knee osteoarthritis patients and has potential predictive value for disease progression.

Abstract Knee osteoarthritis offers significant opportunities for prevention and the mitigation of its severity and associated symptoms through lifestyle modifications. This study aimed to investigate the efficacy of an educational intervention based on the Theory of Planned Behavior (TPB) in promoting preventive behaviors against knee osteoarthritis among women aged over 40 years residing in Fars, Iran. This research utilized a quasi-experimental design. The study population comprised 100 women over the age of 40 who were registered at health centers in Fasa, Iran. Data were collected using a questionnaire based on the Theory of Planned Behavior (TPB). The intervention was implemented through eight educational sessions specifically designed to promote TPB-informed preventive behaviors against knee osteoarthritis. The findings revealed statistically significant differences between the experimental and control groups regarding their scores on attitude, subjective norms, perceived behavioral control, intention, and behavior, both before and after the intervention. At 3 months post-intervention, the experimental group demonstrated significant improvements in all measured constructs, while the control group showed no substantial changes. This study demonstrates that implementing structured educational interventions grounded in behavioral theory, specifically the Theory of Planned Behavior (TPB), can effectively promote preventive behaviors against knee osteoarthritis, thereby potentially reducing its associated morbidity.

ObjectiveTo establish a rat model of moderate-to-severe knee osteoarthritis, laying the foundation for studying the pathogenesis of moderate-to-severe knee osteoarthritis and its prevention and treatment methods.MethodsThirty male SD rats were randomly divided into three groups: a sham surgery group, an 8-week model group, and a 20-week model group, with 10 rats in each group. Rats in the 8-week and 20-week model groups underwent surgery to cut the anterior and posterior cruciate ligaments and medial collateral ligament of the right knee joint, and remove the medial and lateral menisci. After surgery, the rats were allowed to move freely. The rats in the sham surgery group had only skin incisions to expose the joint without any surgical treatment. At 8 and 20 weeks post-surgery, Micro-CT scans were performed to analyze the femoral osteoporosis in the rats. After euthanizing the rats, gross observations of the knee joints were made, and the cartilage of the joint surface was scored using the Pelletier scoring system. The knee joints were collected for hematoxylin and eosin (HE) staining and safranin O-fast green staining to observe changes in cartilage morphology. The modified Mankin's scoring system was used to assess the tissue pathology of the joint surface. Immunohistochemical staining was used to detect the expression of type II collagen and matrix metalloproteinase 13 (MMP13), reflecting the anabolic and catabolic metabolism of the knee joint cartilage.ResultsThe knee joint cartilage in the 8-week and 20-week model groups was severely damaged, with Pelletier and modified Mankin's scores significantly higher than those in the sham surgery group (both P

Knee osteoarthritis is a degenerative disease that is often experienced by the elderly, causing pain and increasing the risk of falls, which has a significant impact on quality of life. This study aims to describe the risk of falls and pain levels in elderly people with knee osteoarthritis in general hospitals. This research uses a descriptive design with a cross sectional approach. Data collection was carried out by studying medical records and interviews from 150 elderly patients suffering from knee osteoarthritis. The risk of falling was measured using the Morse Falls Scale, while the level of pain was measured using the Numeric Rating Scale. The results showed that 49.3% of patients had a low risk of falling and 56.7% experienced mild pain. The majority of patients were aged 71-90 years, with 78.7% of them being women. This study shows that the majority of elderly patients with knee osteoarthritis have a low risk of falls and mild to moderate levels of pain, with age and gender playing an important role in the prevalence of this condition.

Knee osteoarthritis is a common degenerative condition among the elderly, leading to a significant decline in functional ability and increased dependency in daily activities. This study aimed to analyze the level of independence and pain distribution among elderly patients with knee osteoarthritis at the Geriatric Polyclinic of a General Hospital. A descriptive design was utilized, using secondary data from 150 elderly patients diagnosed with knee osteoarthritis. Independence levels were assessed using the Instrumental Activities of Daily Living (IADL) scale, while pain location data were retrieved from medical records. The findings revealed that 72.7% of patients maintained independence, while 27.3% required assistance, with bilateral pain reported in 87.3% of cases. Most patients were aged 71–90 years, with a predominance of females (78.7%). These results indicate that the majority of elderly patients with knee osteoarthritis remain functionally independent, although age and gender significantly influence the prevalence and severity of the condition.

Stress fracture of the lower extremity is a significant cause of decreased mobility in orthopedic patients. With repetitive stress on the bone tissue of the lower extremities, stress fractures occur in 50% of the cases, primarily involving the tibia. This article presents a method of managing the pseudoarthrosis of the tibia resulting from a stress fracture of the shinbone of a patient with advanced degenerative changes in both knee joints. This article presents the case of a 69-year-old woman with advanced degenerative changes in both knee joints and a significant varus deformity of both lower limbs. She developed a stress fracture in the proximal part of the left tibia, resulting in the formation of pseudoarthrosis. The authors describe a simultaneous left knee joint total knee replacement (TKR) procedure with limb axis correction using a long tibial stem (tibial extension) passing through the pseudoarthrosis and rotational stabilization of the tibia with an osteo-plate.

Abstract Background Pain management for knee osteoarthritis (KOA) patients is challenging. Pain arises from both physiological and psychological interactions, with anxiety and depression potentially contributing as risk factors that hinder effective pain management in KOA patients. Methods Before treatment(T1), A total of 206 elderly inpatients with KOA were enrolled based on initial screening criteria. After treatment (T2), patients were selected based on inclusion and exclusion criteria, and completed follow-up through phone or online questionnaires. The interval between T1 and T2 was three months. Outcome measures included the Visual Analogue Scale (VAS) for pain intensity, Beck Anxiety Inventory (BAI) for anxiety, and Geriatric Depression Scale (GDS) for depression. Descriptive and bivariate analyses were used to evaluate the pain, anxiety and depression of the participants. A cross-lagged model was used to examine the temporal and causal associations among pain, anxiety, and depression. Results 91% of elderly patients with KOA experienced at least mild depression. Furthermore, 31% of patients reported mild or higher levels of anxiety. At the same time, pain, depression, and anxiety were significantly correlated and mutually predictive(all p

Abstract Background The current literature lacks robust clinical data and evidence delineating the relationship between obesity measurement indexes and knee osteoarthritis (KOA). Consequently, this investigation seeks to elucidate the potential link between obesity measurement indexes and KOA among Chinese adults in a nationally representative study. Methods Firstly, this research performed an observational study in the China Health and Retirement Longitudinal Study (CHARLS). The variables were extracted from interviews and compared between KOA and non-KOA participants. The relationship between obesity measurement indexes and KOA was analyzed by multivariate logistic regression. Restricted cubic spline (RCS) regression tests the nonlinearity of the relationship between obesity measurement indexes and KOA. Subgroup analyses were performed by sex to verify the robustness of the findings. Results In this cross-sectional analysis, we found a positive association between obesity measurement indexes and KOA. These results did not change on multiple imputations(BMI: OR = 1.02, 95% CI, 1.01–1.04, P

Abstract Background The Q angle has a major impact on the lower limb’s static alignment in the frontal plane; also, the lever-arm distance between the hip and knee joint centers also changes the hip abductor muscles’ ability to produce torque. An association between Q angle and hip muscle strength has been investigated in different population. However, the relationship between Q angle and hip abductor muscle strength in early knee osteoarthritis has not been investigated. Therefore, the objective of the study was to investigate the correlation between Q angle and hip abductor muscle strength in patients with initial stage of knee osteoarthritis (OA). Study design This is a correlation study. Methodology Fifty-four involved OA knee among 32 patients (26 female and 6 male), with mean age of 49.38 ± 5.68 years, were included in the study. The Q angle was measured by universal goniometer, and the hip abductor muscle strength was measured by a hydraulic handheld dynamometer. Results Spearman’s correlation coefficient test showed that Q angle is significantly (weak negative) correlated (r = − 0.31; p

Abstract Knee osteoarthritis (KOA) is a major cause of disability in the elderly, with its pain primarily driving medical consultations. Despite numerous studies, the role of Vitamin D in managing KOA pain remains inconclusive. This study seeks to explore the association between serum Vitamin D levels and WOMAC pain scores, providing new insights into potential treatment strategies for KOA. Utilizing data from the Osteoarthritis Initiative (OAI) database, we conducted a cross-sectional analysis involving 524 participants. Serum levels of 25-hydroxyvitamin D were measured using liquid chromatography-tandem mass spectrometry. WOMAC pain scores served as the dependent variable. Multivariable linear regression models and restricted cubic splines were employed to assess the relationship between Vitamin D levels and KOA pain, with subgroup analyses stratified by sex. Higher Vitamin D levels were significantly associated with lower WOMAC pain scores in males across all models. For females, no significant associations were observed. The analysis suggests a nonlinear relationship between Vitamin D levels and KOA pain in the general cohort, which becomes non-significant after adjustment for covariates. Our findings indicate that Vitamin D is associated with reduced pain in male patients with KOA, highlighting a potential sex-specific therapeutic approach. The results warrant further investigation through longitudinal studies and randomized controlled trials to substantiate Vitamin D supplementation as a viable treatment for reducing KOA pain in males.

Abstract This study aimed to investigate the factors influencing the decision of patients with severe knee osteoarthritis, who are covered by universal health insurance, to undergo total knee replacement (TKR) surgery, as recommended by orthopedic physicians. A questionnaire survey was used to collect participants’ demographics, socio-economic status, medical history, baseline Oxford Knee Score (OKS), and EuroQol-5 Dimension Questionnaire (EQ-5D). We included 704 patients with severe knee osteoarthritis, of which 487 underwent TKR (surgery group), while 217 did not (non-surgery group). Descriptive statistics was used to compare the characteristics of patients in the two groups, while logistic regression identified the factors influencing patients’ choice for TKR. Patients aged 75–79 or older were less likely to undergo TKR; those with poorer OKS (OR = 0.83, 95% CI: 0.79–0.86) and lower EQ-5D VAS scores (OR = 0.97, 95% CI: 0.95–0.99) were more likely to undergo TKR. Household income did not significantly affect the decision of the patients to undergo surgery. In conclusion, for patients with severe knee osteoarthritis, the impact of joint discomfort on function and quality of life is the primary factor influencing their decision to undergo TKR, while economic factors do not have a significant impact under the provision of universal health insurance coverage.

Objectives Research on the distribution of and the variation in coronal plane alignment of the knee (CPAK) in the Chinese osteoarthritis population is limited. We aimed to establish the CPAK classification based on the characteristics of lower limb alignment in the Chinese osteoarthritis population. We also investigated variations in lower limb alignment parameters and CPAK phenotypes based on gender, body mass index (BMI), and age. Methods A retrospective study was conducted on a total of 944 knees diagnosed with osteoarthritis in 479 patients from January 2017 to December 2023. A scatterplot was used to describe the distribution of the CPAK classification, and the differences in lower limb alignment parameters and the CPAK classification were compared across genders (male, female), ages (middle‐aged/ 0.05). Although there were variations in alignment parameters across different genders and BMI categories in the knee osteoarthritis population, the predominant CPAK classifications were type I (38.03%), followed by type II (20.02%) and type IV (17.06%). Conclusion The most common CPAK types were I, II, and IV, and they were not influenced by gender, BMI, or age, indicating that the CPAK classification can reliably reflect constitutional alignment. A better understanding of native alignment variability can aid in providing patient‐specific recommendations when considering orthopedic alignment strategies.

Introduction: Administration of adipose-derived stem cells (ADSCs) into the joint cavity has been shown to alleviate the symptoms of knee osteoarthritis (OA) by releasing exosomes and anti-inflammatory cytokines. However, the therapeutic effect of these cells is limited by their rapid disappearance after administration. Thus, it is necessary to prolong cell survival in the joint cavity. This study aimed to investigate the potential application of ADSCs adhered to atelocollagen microspheres (AMSs) for cell therapy of knee OA. Methods: ADSCs were cultured for 2, 4, and 7 days in AMS suspension or adherent culture dishes. The supernatants were analyzed for IL-10 and exosome secretion via enzyme-linked immunosorbent assay and Nanosight. The effect of AMS was compared with that of adherent-cultured ADSCs (2D-cultured ADSCs) using transcriptome analysis. Moreover, the solubility of AMS and viability of ADSCs were evaluated using synovial fluid (SF) from patients with knee OA. Results: Compared with 2D-cultured ADSCs, AMS-cultured ADSCs exhibited a significant increase in secretion of exosomes and IL-10, and the expression of several genes involved in extracellular matrix and immune regulation were altered. Furthermore, when AMS-cultured ADSCs were cultured in SF from knee OA patients to mimic the intra-articular environment, the SF dissolved the AMSs and released viable ADSCs. In addition, AMS-cultured ADSCs showed significantly higher long-term cell viability than 2D-cultured ADSCs. Conclusion: Increased survival of AMS-adhered ADSCs was observed in the intra-articular environment, and AMSs were found to gradually dissipate. These results suggest that AMS-adhered ADSCs are promising source for cell therapy of knee OA.

Introduction: This study aimed to determine the association between the baseline magnetic resonance imaging (MRI) findings and clinical outcomes after articular injection of adipose-derived mesenchymal stem cells (ASCs) for knee osteoarthritis (KOA). Methods: This retrospective study included 149 patients with varus-type KOA treated with a single intraarticular ASC injection. All patients underwent a MRI evaluation before treatment. Patients were categorized following the MRI Osteoarthritis Knee Score (MOAKS) system cartilage score into the mild, moderate, or severe KOA groups. Additionally, joint effusion and synovitis, bone marrow lesions (BMLs), and meniscal extrusions were graded with the MOAKS. Knee Osteoarthritis Outcome Score (KOOS) was obtained at baseline, 1-, 3-, 6-, and 12-month posttreatment. The responder rate in the Outcome Measures in Arthritis Clinical Trials-Osteoarthritis Research Society International was assessed with the KOOS. Multivariate logistic regression analyses were conducted to determine factors associated with the responder rate. Results: All KOOS subscales significantly enhanced with the greatest improvement from baseline to 6 months which plateaued between 6 and 12 months. The responder rate was 65.4 % in the mild/moderate KOA compared to 35.2 % in the severe KOA at 12 months. Lower OA grade (odds ratio [OR]: 0.52; 95 % confidence interval (CI): 0.31–0.88; P = 0.015), smaller BMLs in medial femoral condyle (OR: 0.36; 95 % CI: 0.14–0.94; P = 0.037), and less meniscal extrusion (OR: 0.31; 95 % CI: 0.11–0.89; P = 0.029) were associated with higher responder rate at 6 months in multivariable logistic regression analysis. The factors associated with higher responder rate at 12 months included lower OA grade (OR: 0.42; 95 % CI: 0.25–0.73; P = 0.002) and younger age (OR: 1.04; 95 % CI: 1.00–1.08; P = 0.042). Conclusions: ASC treatment for KOA enhanced short-term clinical outcomes. MRI findings, including cartilage lesions, BMLs, and meniscal extrusion, were associated with responder rate, helping physicians identify which patients may benefit from this therapy.

Purpose: This 10-year longitudinal cohort study aimed to investigate the annual rate of development of radiographic knee osteoarthritis (drKOA) and its predictive symptoms in the general Japanese population. Methods: A total of 263 volunteers (154 women) from the Iwaki Health Promotion Project were followed up over 10 years. Standing anteroposterior knee radiographs were obtained and the Kellgren–Lawrence grade was evaluated. drKOA was defined as a change from grade 0 or 1 to ≥2 over 10 years. Knee symptoms were evaluated using the Knee injury and Osteoarthritis Outcome Score at baseline. Logistic regression analyses were performed to identify symptoms related to drKOA, and a predictive formula was created based on the associated symptoms. Results: The overall incidence of drKOA was 52.9% (annual rate, 4.34%). Regression analysis revealed that predictive symptoms for drKOA were stiffness [p ​= ​0.033; odds ratio (OR) ​= ​1.89], frequent pain (p ​= ​0.024; OR ​= ​1.38), difficulty in ascending stairs, jumping, twisting, and kneeling (p ​= ​0.009–0.046; OR ​= ​1.71–2.78), and poor knee-related quality of life (p ​

Background: This study investigated the molecular mechanism by which the combination of platelet-rich plasma (PRP) and isometric contraction of the quadriceps (ICQ) intervention regulates autophagy in chondrocytes to prevent and treat knee osteoarthritis (KOA). Methods: Thirty Sprague-Dawley rats were divided into a control group (CG, n = 6) and a model group (n = 24). After one week, the model group was randomly divided into a joint intervention group (JIG), a rapamycin group (RAG), an MHY1485 group (MYG), and a model blank group (MBG), with JIG, RAG, and MYG receiving the same combined intervention. Results: The trend of cartilage lesions in each group was CG