المؤلفون: Gottreich, Julia R., Katz, Jeffrey N., Jones, Morgan H.

المصدر: Orthopaedic Journal of Sports Medicine; Mar2024, Vol. 12 Issue 3, p1-12, 12p

مصطلحات موضوعية: KNEE anatomy, KNEE physiology, EFFECT sizes (Statistics), ANTERIOR cruciate ligament surgery, DATA analysis, SYNOVIAL fluid, ARTHROSCOPY, POSTOPERATIVE pain, PREOPERATIVE care, TREATMENT effectiveness, SYNOVITIS, SYSTEMATIC reviews, MEDLINE, REOPERATION, STATISTICS, ONLINE information services, CHEMOKINE receptors, KNEE surgery, INTERLEUKINS

مستخلص: Background: Biomarkers collected in synovial tissue and fluid have been identified as potential predictors of outcomes after arthroscopy. Purpose: To provide a narrative review of the current literature that assesses the associations between preoperative biomarkers in the synovial fluid or synovial tissue and patient outcomes after knee arthroscopy. Study Design: Narrative review. Methods: We searched the PubMed database with keywords, "biomarkers AND arthroscopy," "biomarkers AND anterior cruciate ligament reconstruction," and "biomarkers AND meniscectomy." To be included, studies must have collected synovial fluid or synovial tissue from patients before or during arthroscopic knee surgery and analyzed the relationship of biomarkers to postoperative patient outcomes. Biomarkers were classified into 4 main categories: metabolism of aggrecan in cartilage, metabolism of collagen in cartilage (type II collagen), noncollagenous proteins in the knee, and other. When biomarker levels and outcomes were expressed with continuous variables, we abstracted the Pearson or Spearman correlation coefficients as the effect measure. If the biomarker values were continuous and the outcomes binary, we abstracted the mean or median biomarker values in those with favorable versus unfavorable outcomes. We calculated effect sizes as the difference between means of both groups divided by the standard deviation from the mean in the group with better outcomes. Results: Eight studies were included in the review. Each study reported different patient outcomes. Biomarkers associated with metabolism of aggrecan, type II collagen metabolism, and noncollagenous proteins as well as inflammatory biomarkers had statistically significant associations with a range of patient outcomes after knee arthroscopy. Difference across studies in sample size and outcome measures precluded choosing a single biomarker that best predicted patient outcomes. Conclusion: The findings suggest that biomarkers associated with metabolism of aggrecan, type II collagen metabolism, noncollagenous proteins, as well as inflammatory biomarkers may help surgeons and their patients anticipate surgical outcomes. [ABSTRACT FROM AUTHOR]

: Copyright of Orthopaedic Journal of Sports Medicine is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Williams, Emma E., Katz, Jeffrey N., Leifer, Valia P., Collins, Jamie E., Neogi, Tuhina, Suter, Lisa G., Levy, Bruce, Farid, Alexander, Safran‐Norton, Clare E., Paltiel, A. David, Losina, Elena

المصدر: ACR Open Rheumatology; Oct2022, Vol. 4 Issue 10, p853-862, 10p

مصطلحات موضوعية: KNEE osteoarthritis, DISEASE progression, PHYSICAL therapy, ARTHROSCOPY, MENISCECTOMY, MEDICAL care costs, RISK assessment, TREATMENT effectiveness, COST effectiveness, DESCRIPTIVE statistics, SENSITIVITY & specificity (Statistics), MENISCUS injuries, QUALITY-adjusted life years

مستخلص: Objective: We examined the cost‐effectiveness of treatment strategies for concomitant meniscal tear and knee osteoarthritis (OA) involving arthroscopic partial meniscectomy surgery and physical therapy (PT). Methods: We used the Osteoarthritis Policy Model, a validated Monte Carlo microsimulation, to compare three strategies, 1) PT‐only, 2) immediate surgery, and 3) PT + optional surgery, for participants whose pain persists following initial PT. We modeled a cohort with baseline meniscal tear, OA, and demographics from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial of arthroscopic partial meniscectomy versus PT. We estimated risks and costs of arthroscopic partial meniscectomy complications and accounted for heightened OA progression post surgery using published data. We estimated surgery use rates and treatment efficacies using MeTeOR data. We considered a 5‐year time horizon, discounted costs, and quality‐adjusted life‐years (QALYs) 3% per year and conducted sensitivity analyses. We report incremental cost‐effectiveness ratios. Results: Relative to PT‐only, PT + optional surgery added 0.0651 QALY and $2,010 over 5 years (incremental cost‐effectiveness ratio = $30,900 per QALY). Relative to PT + optional surgery, immediate surgery added 0.0065 QALY and $3080 (incremental cost‐effectiveness ratio = $473,800 per QALY). Incremental cost‐effectiveness ratios were sensitive to optional surgery efficacy in the PT + optional surgery strategy. In the probabilistic sensitivity analysis, PT + optional surgery was cost‐effective in 51% of simulations at willingness‐to‐pay thresholds of both $50,000 per QALY and $100,000 per QALY. Conclusion: First‐line arthroscopic partial meniscectomy has a prohibitively high incremental cost‐effectiveness ratio. Under base case assumptions, second‐line arthroscopic partial meniscectomy offered to participants with persistent pain following initial PT is cost‐effective at willingness‐to‐pay thresholds between $31,000 and $473,000 per QALY. Our analyses suggest that arthroscopic partial meniscectomy can be a high‐value treatment option for patients with meniscal tear and OA when performed following an initial PT course and should remain a covered treatment option. [ABSTRACT FROM AUTHOR]

: Copyright of ACR Open Rheumatology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Collins, Jamie E., Shrestha, Swastina, Losina, Elena, Marx, Robert G., Guermazi, Ali, Jarraya, Mohamed, Jones, Morgan H., Levy, Bruce A., Mandl, Lisa A., Williams, Emma E., Wright, Rick W., Spindler, Kurt P., Katz, Jeffrey N.

المصدر: Arthritis & Rheumatology; Aug2022, Vol. 74 Issue 8, p1333-1342, 10p

مصطلحات موضوعية: KNEE osteoarthritis, RELATIVE medical risk, CARTILAGE, CONFIDENCE intervals, SYNOVITIS, ARTHROSCOPY, PHYSICAL therapy, TIME, MENISCECTOMY, REGRESSION analysis, TREATMENT effectiveness, DESCRIPTIVE statistics, MENISCUS injuries, SECONDARY analysis, POISSON distribution, EVALUATION

مستخلص: Objective: To estimate the risk of magnetic resonance imaging (MRI)–based structural changes in knee osteoarthritis (OA) among individuals with meniscal tear and knee OA, using MRIs obtained at baseline and 18 and 60 months after randomization in a randomized controlled trial of arthroscopic partial meniscectomy (APM) versus physical therapy (PT). Methods: We used data from the Meniscal Tear in Osteoarthritis Research (METEOR) trial. MRIs were read using the MRI OA Knee Score (MOAKS). We used linear mixed‐effects models to examine the association between treatment group and continuous MOAKS summary scores, and Poisson regression to assess categorical changes in knee joint structure. Analyses assessed changes in OA between baseline and month 18 and between months 18 and 60. We performed both intention‐to‐treat and as‐treated analyses. Results: The analytic sample included 302 participants. For both treatment groups, more OA changes were seen during the early interval than during the later interval. ITT analysis revealed that, between baseline and month 18, APM was significantly associated with an increased risk of having a worsening cartilage surface area score, involving both any worsening across all knee joint subregions (risk ratio [RR] 1.35 [95% confidence interval (95% CI) 1.14, 1.61]) and the number of subregions damaged (RR 1.44 [95% CI 1.13, 1.85]) having a worsening effusion‐synovitis score (RR 2.62 [95% CI 1.32, 5.21]), and having ≥1 additional subregion with osteophytes (RR 1.24 [95% CI 1.02, 1.50]). Significant associations were detected between months 18 and 60 only for having any subregion with a worsening osteophyte score (RR 1.28 [95% CI 1.04, 1.58]). Conclusion: These findings suggest that the association between APM and MRI‐based structural changes in knee OA is most apparent during the initial 18 months after surgery. The reason for attenuation of this association over longer follow‐up merits further investigation. [ABSTRACT FROM AUTHOR]

: Copyright of Arthritis & Rheumatology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Katz, Jeffrey N.^1,2,3,4 jnkatz@bwh.harvard.edu, Zimmerman, Zoe E.^1,2, Mass, Hanna^1,2, Makhni, Melvin C.^2,3

المصدر: JAMA: Journal of the American Medical Association. 5/3/2022, Vol. 327 Issue 17, p1688-1699. 12p.

مصطلحات موضوعية: *TREATMENT of backaches, *SPINAL stenosis treatment, *LUMBAR vertebrae surgery, *GLUCOCORTICOIDS, *LUMBAR pain, *SPINAL fusion, *SPINAL stenosis, *SURGICAL decompression, *BACKACHE, *TREATMENT effectiveness, *SPONDYLOLISTHESIS, *DISEASE complications

مستخلص: Importance: Lumbar spinal stenosis is a prevalent and disabling cause of low back and leg pain in older persons, affecting an estimated 103 million persons worldwide. Most are treated nonoperatively. Approximately 600 000 surgical procedures are performed in the US each year for lumbar spinal stenosis.Observations: The prevalence of the clinical syndrome of lumbar spinal stenosis in US adults is approximately 11% and increases with age. The diagnosis can generally be made based on a clinical history of back and lower extremity pain that is provoked by lumbar extension, relieved by lumbar flexion, and confirmed with cross-sectional imaging, such as computed tomography or magnetic resonance imaging (MRI). Nonoperative treatment includes activity modification such as reducing periods of standing or walking, oral medications to diminish pain such as nonsteroidal anti-inflammatory drugs (NSAIDs), and physical therapy. In a series of patients with lumbar spinal stenosis followed up for up to 3 years without operative intervention, approximately one-third of patients reported improvement, approximately 50% reported no change in symptoms, and approximately 10% to 20% of patients reported that their back pain, leg pain, and walking were worse. Long-term benefits of epidural steroid injections for lumbar spinal stenosis have not been demonstrated. Surgery appears effective in carefully selected patients with back, buttock, and lower extremity pain who do not improve with conservative management. For example, in a randomized trial of 94 participants with symptomatic and radiographic degenerative lumbar spinal stenosis, decompressive laminectomy improved symptoms more than nonoperative therapy (difference, 7.8 points; 95% CI, 0.8-14.9; minimum clinically important difference, 10-12.8) on the Oswestry Disability Index (score range, 0-100). Among persons with lumbar spinal stenosis and concomitant spondylolisthesis, lumbar fusion increased symptom resolution in 1 trial (difference, 5.7 points; 95% CI, 0.1 to 11.3) on the 36-Item Short Form Health Survey physical dimension score (range, 0-100), but 2 other trials showed either no important differences between the 2 therapies or noninferiority of lumbar decompression alone compared with lumbar decompression plus spinal fusion (MCID, 2-4.9 points). In a noninferiority trial, 71.4% treated with lumbar decompression alone vs 72.9% of those receiving decompression plus fusion achieved a 30% or more reduction in Oswestry Disability Index score, consistent with the prespecified noninferiority hypothesis. Fusion is associated with greater risk of complications such as blood loss, infection, longer hospital stays, and higher costs. Thus, the precise indications for concomitant lumbar fusion in persons with lumbar spinal stenosis and spondylolisthesis remain unclear.Conclusions and Relevance: Lumbar spinal stenosis affects approximately 103 million people worldwide and 11% of older adults in the US. First-line therapy is activity modification, analgesia, and physical therapy. Long-term benefits from epidural steroid injections have not been established. Selected patients with continued pain and activity limitation may be candidates for decompressive surgery. [ABSTRACT FROM AUTHOR]

المؤلفون: Lenhard, Nora K., Williams, Emma E., Lape, Emma C., MacFarlane, Lindsey A., Losina, Elena, Katz, Jeffrey N.

المصدر: Arthritis Care & Research; Mar2022, Vol. 74 Issue 3, p410-419, 10p

مصطلحات موضوعية: KNEE osteoarthritis, PATIENTS' attitudes, TREATMENT effectiveness, MEDICAL decision making, UNCERTAINTY

مستخلص: Objective: Intraarticular (IA) injections are used frequently for knee osteoarthritis (OA), but little is known about patients' attitudes toward these therapies. We aimed to better understand patients' perceptions of the facilitators of and barriers to IA injections for knee OA. Methods: We conducted a qualitative, descriptive, exploratory study and held focus groups and individual interviews with participants with knee OA, including some who had and some who had not received IA injections. We conducted a thematic analysis to identify themes describing the factors that participants found influential when deciding whether to try an IA injection. Results: We held 3 focus groups with 12 participants and conducted 3 individual interviews (15 participants total). We identified the following 4 themes that shaped participants' decisions to receive a specific injection: 1) the impact of OA on participants' lives; 2) participants' attitudes and concerns, including desire to avoid surgery, willingness to accept uncertain outcomes, and concerns about side effects and dependence; 3) the way participants gathered and processed information from physicians, peers, and the internet; and 4) the availability of injectable products. Participants weighed the desire to regain function and delay surgery with concerns about side effects, uncertain efficacy, and costs. Conclusion: Participants were concerned about the effectiveness, toxicity, availability, and cost of injectable products. They balanced disparate sources of information, uncertain outcomes, limited product availability, and other injection‐related concerns with a desire to decrease pain. These findings can provide clinicians, investigators, and public health professionals with insights into challenges that patients face when making injection decisions. [ABSTRACT FROM AUTHOR]

: Copyright of Arthritis Care & Research is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Spindler, Kurt P., Imrey, Peter B., Yalcin, Sercan, Beck, Gerald J., Calbrese, Gary, Cox, Charles L., Fadale, Paul D., Farrow, Lutul, Fitch, Robert, Flanigan, David, Fleming, Braden C., Hulstyn, Michael J., Jones, Morgan H., Kaeding, Christopher, Katz, Jeffrey N., Kriz, Peter, Magnussen, Robert, McErlean, Ellen, Melgaard, Carrie, Owens, Brett D.

المصدر: Orthopaedic Journal of Sports Medicine; Jan2022, Vol. 10 Issue 1, p1-13, 13p

مصطلحات موضوعية: TRAUMA surgery, RESEARCH, CONFIDENCE intervals, MEDICAL cooperation, HEALTH outcome assessment, TREATMENT effectiveness, RANDOMIZED controlled trials, DESCRIPTIVE statistics, ANTERIOR cruciate ligament surgery, STATISTICAL sampling, EVALUATION

مستخلص: Background: BEAR (bridge-enhanced anterior cruciate ligament [ACL] restoration), a paradigm-shifting technology to heal midsubstance ACL tears, has been demonstrated to be effective in a single-center 2:1 randomized controlled trial (RCT) versus hamstring ACL reconstruction. Widespread dissemination of BEAR into clinical practice should also be informed by a multicenter RCT to demonstrate exportability and compare efficacy with bone--patellar tendon–bone (BPTB) ACL reconstruction, another clinically standard treatment. Purpose: To present the design and initial preparation of a multicenter RCT of BEAR versus BPTB ACL reconstruction (the BEAR: Multicenter Orthopaedic Outcomes Network [BEAR-MOON] trial). Design and analytic issues in planning the complex BEAR-MOON trial, involving the US National Institute of Arthritis and Musculoskeletal and Skin Diseases, the US Food and Drug Administration, the BEAR implant manufacturer, a data and safety monitoring board, and institutional review boards, can usefully inform both clinicians on the trial's strengths and limitations and future investigators on planning of complex orthopaedic studies. Study Design: Clinical trial. Methods: We describe the distinctive clinical, methodological, and operational challenges of comparing the innovative BEAR procedure with the well-established BPTB operation, and we outline the clinical motivation, experimental setting, study design, surgical challenges, rehabilitation, outcome measures, and planned analysis of the BEAR-MOON trial. Results: BEAR-MOON is a 6-center, 12-surgeon, 200-patient randomized, partially blinded, noninferiority RCT comparing BEAR with BPTB ACL reconstruction for treating first-time midsubstance ACL tears. Noninferiority of BEAR relative to BPTB will be claimed if the total score on the International Knee Documentation Committee (IKDC) subjective knee evaluation form and the knee arthrometer 30-lb (13.61-kg) side-to-side laxity difference are both within respective margins of 16 points for the IKDC and 2.5 mm for knee laxity. Conclusion: Major issues include patient selection, need for intraoperative randomization and treatment-specific postoperative physical therapy regimens (because of fundamental differences in surgical technique, initial stability construct, and healing), and choice of noninferiority margins for short-term efficacy outcomes of a novel intervention with evident short-term advantages and theoretical, but unverified, long-term benefits on other dimensions. [ABSTRACT FROM AUTHOR]

: Copyright of Orthopaedic Journal of Sports Medicine is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: MacFarlane, Lindsey A., Cook, Nancy R., Kim, Eunjung, Lee, I‐Min, Iversen, Maura D., Gordon, David, Buring, Julie E., Katz, Jeffrey N., Manson, JoAnn E., Costenbader, Karen H.

المصدر: Arthritis & Rheumatology; Nov2020, Vol. 72 Issue 11, p1836-1844, 9p

مصطلحات موضوعية: DIETARY supplements, LIFE skills, OMEGA-3 fatty acids, OSTEOARTHRITIS, QUESTIONNAIRES, STATISTICAL sampling, VITAMIN D, RANDOMIZED controlled trials, TREATMENT effectiveness, REPEATED measures design, BLIND experiment, KNEE pain

مصطلحات جغرافية: UNITED States

مستخلص: Objective: Knee pain from osteoarthritis is frequent in the adult population. Prior trials have had conflicting results concerning the therapeutic effects of vitamin D on knee pain, and few trials have investigated marine Omega‐3 fatty acids (n‐3 FA). Methods: In the double‐blind, placebo‐controlled Vitamin D and Omega‐3 Trial (VITAL), 25,871 US adults were randomized in a 2‐by‐2 factorial design to receive vitamin D or n‐3 FA. We identified a subgroup with chronic knee pain prior to randomization and assessed knee pain at baseline and annually during follow‐up using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (graded on a 0–100 scale, where 100 indicates worst symptoms). Repeated measures modeling was used to test the effect of randomized treatment on WOMAC pain scores over follow‐up after adjustment for age and sex. Analyses were repeated for WOMAC function and stiffness. Results: This study included 1,398 participants who returned at least one knee pain questionnaire. The mean age was 67.7 years, 66% were women, and the mean ± SD WOMAC pain score was 37 ± 19. The mean ± SD follow‐up time was 5.3 ± 0.7 years. WOMAC pain did not differ between the active vitamin D group and the vitamin D placebo group or between the active n‐3 FA group and the n‐3 FA placebo group at any time point during follow‐up. Linear time‐by‐treatment interactions were not significant for either treatment (vitamin D, P = 0.41; n‐3 FA, P = 0.77). Vitamin D and n‐3 FA supplementation did not significantly affect WOMAC function or stiffness scores over time. Conclusion: Our findings indicate that vitamin D and n‐3 FA supplementation for a mean of 5.3 years does not reduce knee pain or improve function or stiffness in a large sample of US adults with chronic knee pain. [ABSTRACT FROM AUTHOR]

: Copyright of Arthritis & Rheumatology is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Katz, Jeffrey N.¹ jnkatz@bwh.harvard.edu, Shrestha, Swastina¹, Losina, Elena¹, Jones, Morgan H.², Marx, Robert G.³, Mandl, Lisa A.³, Levy, Bruce A.⁴, MacFarlane, Lindsey A.¹, Spindler, Kurt P.², Silva, Genevieve S.¹, Collins, Jamie E.¹, Brophy, Robert, Cole, Brian J., Stuart, Michael J., Matava, Matthew J., Wright, Rick W., Safran‐Norton, Clare E.

المصدر: Arthritis & Rheumatology. Feb2020, Vol. 72 Issue 2, p273-281. 9p.

مصطلحات موضوعية: *ARTHROSCOPY, *CONFIDENCE intervals, *MATHEMATICAL models, *MENISCECTOMY, *MENISCUS injuries, *OSTEOARTHRITIS, *PAIN, *PHYSICAL therapy, *TOTAL knee replacement, *THEORY, *TREATMENT effectiveness, *DISEASE incidence, *PROPORTIONAL hazards models, *MIDDLE age

مستخلص: Objective: To determine the 5‐year outcome of treatment for meniscal tear in osteoarthritis. Methods: We examined 5‐year follow‐up data from the Meniscal Tear in Osteoarthritis Research trial (METEOR) of physical therapy versus arthroscopic partial meniscectomy. We performed primary intent‐to‐treat (ITT) and secondary as‐treated analyses. The primary outcome measure was the Knee Injury and Osteoarthritis Outcome Score (KOOS) pain scale; total knee replacement (TKR) was a secondary outcome measure. We used piecewise linear mixed models to describe change in KOOS pain. We calculated 5‐year cumulative TKR incidence and used a Cox model to estimate hazard ratios (HRs) for TKR, with 95% confidence intervals (95% CIs). Results: Three hundred fifty‐one participants were randomized. In the ITT analysis, the KOOS pain scores were ~46 (scale of 0 [no pain] to 100 [most pain]) at baseline in both groups. Pain scores improved substantially in both groups over the first 3 months, continued to improve through the next 24 months (to ~18 in each group), and were stable at 24–60 months. Results of the as‐treated analyses of the KOOS pain score were similar. Twenty‐five participants (7.1% [95% CI 4.4–9.8%]) underwent TKR over 5 years. In the ITT model, the HR for TKR was 2.0 (95% CI 0.8–4.9) for subjects randomized to the arthroscopic partial meniscectomy group, compared to those randomized to the physical therapy group. In the as‐treated analysis, the HR for TKR was 4.9 (95% CI 1.1–20.9) for subjects ultimately treated with arthroscopic partial meniscectomy, compared to those treated nonoperatively. Conclusion: Pain improved considerably in both groups over 60 months. While ITT analysis revealed no statistically significant differences following TKR, greater frequency of TKR in those undergoing arthroscopic partial meniscectomy merits further study. [ABSTRACT FROM AUTHOR]

المؤلفون: Alves, Kristin^1,2 kalves@partners.org, Katz, Jeffrey N.², Sabatini, Coleen S.³

المصدر: Journal of Bone & Joint Surgery, American Volume. 2/20/2019, Vol. 101 Issue 4, p361-368. 8p.

مصطلحات موضوعية: *FIBROSIS, *CATHETER ablation, *NATURAL history, *OPERATIVE surgery, *META-analysis, *BUTTOCKS, *CONTRACTURE (Pathology), *RESEARCH funding, *SURGICAL complications, *TREATMENT effectiveness, *SKELETAL muscle

مستخلص: Background: The objective of this study was to analyze the literature regarding the diagnosis, pathogenesis, and prevalence of gluteal fibrosis (GF) and the outcomes of treatment.Methods: We searched PubMed, Embase, and Cochrane literature databases, from database inception to December 15, 2016. We used the following search terms including variants: "contracture," "fibrosis," "injections," "injections, adverse reactions,' "gluteal," and "hip." All titles and abstracts of potentially relevant studies were scanned to determine whether the subject matter was potentially related to GF, using predefined inclusion and exclusion criteria. If the abstract had subject matter involving GF, the paper was selected for review if full text was available. Only papers including ≥10 subjects who underwent surgical treatment were included in the systematic analysis. Data abstracted included the number of patients, patient age and sex, the type of surgical treatment, the method of outcome measurement, and outcomes and complications.Results: The literature search yielded 2,512 titles. Of these, 82 had a focus on GF, with 50 papers meeting the inclusion criteria. Of the 50 papers reviewed, 18 addressed surgical outcomes. The surgical techniques in these papers included open, minimally invasive, and arthroscopic release and radiofrequency ablation. Of 3,733 operatively treated patients in 6 reports who were evaluated on the basis of the criteria of Liu et al., 83% were found to have excellent results. Few papers focused on the incidence, prevalence, and natural history of GF, precluding quantitative synthesis of the evidence in these domains.Conclusions: This study provided a systematic review of surgical outcomes and a summary of what has been reported on the prevalence, diagnosis, prognosis, and pathogenesis of GF. Although GF has been reported throughout the world, it requires further study to determine the exact etiology, pathogenesis, and appropriate treatment. Surgical outcomes appear satisfactory.Level Of Evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

المؤلفون: Losina, Elena, Michl, Griffin L., Smith, Karen C., Katz, Jeffrey N.

المصدر: Arthritis Care & Research; Aug2017, Vol. 69 Issue 8, p1164-1170, 7p

مصطلحات موضوعية: COMPARATIVE studies, INTERNET, KNEE diseases, RESEARCH methodology, MEDICAL cooperation, OSTEOARTHRITIS, PATIENT education, SENSORY perception, RESEARCH, RESEARCH funding, RISK assessment, EVALUATION research, RANDOMIZED controlled trials, TREATMENT effectiveness, EARLY medical intervention, PREVENTION

مستخلص: Objective: Young adults, in general, are not aware of their risk of knee osteoarthritis (OA). Understanding risk and risk factors is critical to knee OA prevention. We tested the efficacy of a personalized risk calculator on accuracy of knee OA risk perception and willingness to change behaviors associated with knee OA risk factors.Methods: We conducted a randomized controlled trial of 375 subjects recruited using Amazon Mechanical Turk. Subjects were randomized to either use a personalized risk calculator based on demographic and risk-factor information (intervention), or to view general OA risk information (control). At baseline and after the intervention, subjects estimated their 10-year and lifetime risk of knee OA and responded to contemplation ladders measuring willingness to change diet, exercise, or weight-control behaviors.Results: Subjects in both arms had an estimated 3.6% 10-year and 25.3% lifetime chance of developing symptomatic knee OA. Both arms greatly overestimated knee OA risk at baseline, estimating a 10-year risk of 26.1% and a lifetime risk of 47.8%. After the intervention, risk calculator subjects' perceived 10-year risk decreased by 12.9 percentage points to 12.5% and perceived lifetime risk decreased by 19.5 percentage points to 28.1%. Control subjects' perceived risks remained unchanged. Risk calculator subjects were more likely to move to an action stage on the exercise contemplation ladder (relative risk 2.1). There was no difference between the groups for diet or weight-control ladders.Conclusion: The risk calculator is a useful intervention for knee OA education and may motivate some exercise-related behavioral change. [ABSTRACT FROM AUTHOR]

: Copyright of Arthritis Care & Research is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)