Zobel Isabelle, Erfani Tahereh, Bennell Kim L, Makovey Joanna, Metcalf Ben, Chen Jian Sheng, March Lyn, Zhang Yuqing, Eckstein Felix, Hunter David J
Institute of Anatomy, Paracelsus Medical University Salzburg, Salzburg, Austria.
Interact J Med Res. 2016 Jun 24;5(2):e17. doi: 10.2196/ijmr.5452.
Knee osteoarthritis (OA) is one of the most frequent causes of limited mobility and diminished quality of life. Pain is the main symptom that drives individuals with knee OA to seek medical care and a recognized antecedent to disability and eventually joint replacement. Evidence shows that patients with symptomatic OA experience fluctuations in pain severity. Mechanical insults to the knee such as injury and buckling may contribute to pain exacerbation.
Our objective was to examine whether knee injury and buckling (giving way) are triggers for exacerbation of pain in persons with symptomatic knee OA.
We conducted a case-crossover study, a novel methodology in which participants with symptomatic radiographic knee OA who have had knee pain exacerbations were used as their own control (self-matched design), with all data collected via the Internet. Participants were asked to log-on to the study website and complete an online questionnaire at baseline and then at regular 10-day intervals for 3 months (control periods)-a total of 10 questionnaires. They were also instructed to go to the website and complete pain exacerbation questionnaires when they experienced an isolated incident of knee pain exacerbation (case periods). A pain exacerbation "case" period was defined as an increase of ≥2 compared to baseline. At each contact the pain exacerbation was designated a case period, and at all other regular 10-day contacts (control periods) participants were asked about knee injuries during the previous 7 days and knee buckling during the previous 2 days. The relationship of knee injury and buckling to the risk of pain exacerbation was examined using conditional logistic regression models.
The analysis included 157 participants (66% women, mean age: 62 years, mean BMI: 29.5 kg/m(2)). Sustaining a knee injury was associated with experiencing a pain exacerbation (odds ratio [OR] 10.2, 95% CI 5.4, 19.3) compared with no injury. Knee buckling was associated with experiencing a pain exacerbation (OR 4.0, 95% CI 2.6, 6.2) compared with no buckling and the association increased with a greater number of buckling events (for ≥ 6 buckling events, OR 20.1, 95% CI 3.7, 110).
Knee injury and buckling are associated with knee pain exacerbation. Reducing the likelihood of these mechanical events through avoidance of particular activities and/or appropriate rehabilitation programs may decrease the risk of pain exacerbation.
膝关节骨关节炎（OA）是导致活动受限和生活质量下降的最常见原因之一。疼痛是促使膝关节OA患者寻求医疗护理的主要症状，也是导致残疾并最终进行关节置换的公认先兆。有证据表明，有症状的OA患者的疼痛严重程度会出现波动。膝关节受到的机械性损伤，如受伤和打软腿，可能会导致疼痛加剧。
我们的目的是研究膝关节损伤和打软腿（突然无力）是否会引发有症状的膝关节OA患者的疼痛加剧。
我们进行了一项病例交叉研究，这是一种新颖的方法，将有症状的膝关节OA且有过疼痛加剧的参与者作为自身对照（自我匹配设计），所有数据均通过互联网收集。参与者被要求登录研究网站，在基线时完成一份在线问卷，然后在3个月内每隔10天完成一次（对照期）——总共10份问卷。他们还被指示在经历孤立的膝关节疼痛加剧事件时（病例期）访问网站并完成疼痛加剧问卷。疼痛加剧的“病例”期定义为与基线相比增加≥2。在每次联系时，将疼痛加剧指定为病例期，在所有其他定期的10天联系（对照期）中，询问参与者在前7天的膝关节损伤情况和在前2天的膝关节打软腿情况。使用条件逻辑回归模型研究膝关节损伤和打软腿与疼痛加剧风险的关系。
分析包括157名参与者（66%为女性，平均年龄：62岁，平均BMI：29.5kg/m²）。与未受伤相比，遭受膝关节损伤与疼痛加剧相关（优势比[OR]10.2，95%CI 5.4，19.3）。与未打软腿相比，膝关节打软腿与疼痛加剧相关（OR 4.0，95%CI 2.6，6.2），且随着打软腿事件数量的增加，这种关联增强（对于≥6次打软腿事件，OR 20.1，95%CI 3.7，110）。
膝关节损伤和打软腿与膝关节疼痛加剧相关。通过避免特定活动和/或适当的康复计划降低这些机械性事件的发生可能性，可能会降低疼痛加剧的风险。
