A Comprehensive, Multidisciplinary Assessment for Knee Osteoarthritis Following Traumatic Unilateral Lower Limb Loss in Service Members.

Autor:	Wasser JG; Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA., Hendershot BD; Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA.; Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20814, USA.; Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA., Acasio JC; Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20817, USA., Krupenevich RL; Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA., Pruziner AL; Research and Development Section, Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA.; Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20814, USA.; Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA., Miller RH; Department of Kinesiology, University of Maryland, College Park, MD 20742, USA., Goldman SM; Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20814, USA.; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA., Valerio MS; Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20814, USA.; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA., Senchak LT; Department of Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA., Murphey MD; Department of Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA.; American Institute for Radiologic Pathology, Silver Spring, MD 20910, USA., Heltzel DA; Department of Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA., Fazio MG; Department of Diagnostic Radiology, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA., Dearth CL; Research & Surveillance Division, DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20814, USA.; Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA., Hager NA; Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.
Jazyk:	angličtina
Zdroj:	Military medicine [Mil Med] 2024 Feb 27; Vol. 189 (3-4), pp. 581-591.
DOI:	10.1093/milmed/usac203
Abstrakt:	Introduction: Knee osteoarthritis (KOA) is a primary source of long-term disability and decreased quality of life (QoL) in service members (SM) with lower limb loss (LL); however, it remains difficult to preemptively identify and mitigate the progression of KOA and KOA-related symptoms. The objective of this study was to explore a comprehensive cross-sectional evaluation, at the baseline of a prospective study, for characterizing KOA in SM with traumatic LL. Materials and Methods: Thirty-eight male SM with traumatic unilateral LL (23 transtibial and 15 transfemoral), 9.5 ± 5.9 years post-injury, were cross-sectionally evaluated at initial enrollment into a prospective, longitudinal study utilizing a comprehensive evaluation to characterize knee joint health, functionality, and QoL in SM with LL. Presences of medial, lateral, and/or patellofemoral articular degeneration within the contralateral knee were identified via magnetic resonance imaging(for medically eligible SM; Kellgren-Lawrence Grade [n = 32]; and Outerbridge classification [OC; n = 22]). Tri-planar trunk and pelvic motions, knee kinetics, along with temporospatial parameters, were quantified via full-body gait evaluation and inverse dynamics. Concentrations of 26 protein biomarkers of osteochondral tissue degradation and inflammatory activity were identified via serum immunoassays. Physical function, knee symptoms, and QoL were collected via several patient reported outcome measures. Results: KOA was identified in 12 of 32 (37.5%; KL ≥ 1) SM with LL; however, 16 of 22 SM presented with patellofemoral degeneration (72.7%; OC ≥ 1). Service members with versus without KOA had a 26% reduction in the narrowest medial tibiofemoral joint space. Biomechanically, SM with versus without KOA walked with a 24% wider stride width and with a negative correlation between peak knee adduction moments and minimal medial tibiofemoral joint space. Physiologically, SM with versus without KOA exhibited elevated concentrations of pro-inflammatory biomarker interleukin-7 (+180%), collagen breakdown markers collagen II cleavage (+44%), and lower concentrations of hyaluronic acid (-73%) and bone resorption biomarker N-telopeptide of Type 1 Collagen (-49%). Lastly, there was a negative correlation between patient-reported contralateral knee pain severity and patient-reported functionality and QoL. Conclusions: While 37.5% of SM with LL had KOA at the tibiofemoral joint (KL ≥ 1), 72.7% of SM had the presence of patellofemoral degeneration (OC ≥ 1). These findings demonstrate that the patellofemoral joint may be more susceptible to degeneration than the medial tibiofemoral compartment following traumatic LL. (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
Databáze:	MEDLINE
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