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The short term pain relief observed with brace therapy in symptomatic PFJOA patients is not related to changes in synovitis; no reduction found in the observed DCE-MRI parameters of knee synovitis.
Osteoarthritis (OA) is one of the leading cause of pain and physical disability worldwide. Over 40 million people suffer from OA in Europe alone, and around 130 million Europeans will suffer from OA by 2050. It has been estimated that approximately 5% of patients with osteoarthritis (OA) of the knee has symptomatic patellofemoral joint osteoarthritis (PFJOA) in the absence of tibiofemoral arthritis.
The causes of arthritis are distributed among patellar dislocation, fracture, and primary OA equally. Braces are commonly used for pain management in (PFJOA). Pain improvement was noted in a trial comprising 6-weeks brace use. The pain reduction did not correspond to changes in Magnetic Resonance Imaging (MRI) assessed Bone Marrow Lesion volume or static synovial volume. According to studies, the changes in the synovium on dynamic contrast-enhanced (DCE) MRI is more closely related to symptom change than static synovial volume changes. Dynamic imaging was used to postulate the shift in synovitis which could be helpful in understanding the decrease in pain.
A total of 126 men and women in the age group 40–70 years with painful radiographically affirmed PFJOA were randomised to either brace wearing or no brace for 6-weeks. At baseline and six weeks, the pain assessment and DCE-MRI were executed. The Tofts’s equation was used to examine the DCE data. The pain measures comprised of VAS of pain on nominated aggravating activity (VASNA), and the KOOS pain subscale. The person change in outcome measures was revealed with the help of paired t-tests. Spearman’s correlation coefficients determined the correlation between change in pain and change in the DCE specifications.
The mean age of patients was 55.5 years (SD = 7.5), and 57% were female. Definite pain improvement was observed in the brace users as compared to controls (VASNA − 16.87 mm, p = <0.001). No substantial change in the dynamic synovitis parameters was noted among brace users nor was pain change concerned with a change in dynamic synovitis specifications.
Changes in synovitis do not elucidate the reduction in knee pain after brace wearing in PFJOA patients.
BMC Musculoskelet Disord. 2017; 18: 347.
With a biomechanical treatment in knee osteoarthritis, less knee pain did not correlate with synovitis reduction
Vikram Swaminathan et al.
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