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Osteoarthritis & Arthritis

Foot & ankle OA (hallux valgus/rigidus, ankle PTOA, Charcot) – diagnosis, staging, and medical/surgical management options.

Overview

Osteoarthritis is a prevalent condition with established management pathways across multiple joints. Patients with scaphoid non-union should be advised that osteoarthritis will most likely develop [1]. In the thumb, nonsurgical treatment of carpometacarpal (CMC-1) osteoarthritis yields positive outcomes at >5 years of follow-up, with no worsening of pain or limitations in activities of daily living (ADL) after 12 months [6]. For shoulder osteoarthritis, nonoperative modalities should be utilized before surgical options, particularly for patients with moderate-to-mild disease [13]. Surgical treatments like arthroplasty are considered effective for severe cases [13]. Early results of glenohumeral joint preservation procedures indicate satisfactory short-term outcomes, yet these procedures have yet to show they can halt arthritic progression [5].

Joint preservation and replacement strategies vary by indication and disease stage. Joint replacement procedures relieve pain and improve function more than other current operative treatments for osteoarthrosis, but they are limited by the inability of synthetic materials to duplicate the properties of articular cartilage [26]. Consequently, procedures that restore rather than replace the joint may offer advantages for young patients or those with less advanced disease [26]. Arthroscopic treatment may help patients with mild to moderate osteoarthritis, less than 5 degrees of varus or valgus malalignment, and mechanical symptoms, although the preponderance of literature does not support the routine use of arthroscopic treatment for osteoarthritis [29]. For proximal row diseases, proximal-row carpectomy should be considered after conservative measures fail; mild degenerative arthritis is not a contraindication, and progressive degenerative arthritis of the radial capitate articulation did not occur following the procedure [18].

Specific populations and etiologies present distinct prognostic considerations. Articular cartilage repair techniques appear to be safe in children and adolescents, with no differences in complication rates reported between these groups and adult patients [51]. Biological treatments for osteoarthritis must meet three crucial milestones: safety, reasonable cost, and improved effectiveness compared with alternatives [8]. The handbook on diagnosis and nonsurgical management of osteoarthritis offers an overview of epidemiology, evaluation methods, and non-operative treatment [4]. Additionally, arthritis following nonoperative treatment of osteochondritis dissecans (OCD) lesions has an estimated 30% cumulative incidence at 35 years after diagnosis, though the long-term rate of arthroplasty following such treatment is low [15]. Outcomes from the FORT randomised controlled trial will help to inform clinical guidelines and practice about the use of foot orthoses for managing symptoms in first metatarsophalangeal joint osteoarthritis [49].

Anatomy & Pathophysiology

Osseous Alignment and Deformity

In the majority of patients with ankle osteoarthritis, the average tibiotalar alignment is varus regardless of the underlying etiology [23]. Patients with unilateral medial femoral condyle osteochondritis dissecans (OCD) lesions are more likely to have varus alignment in the affected extremity [69]. Hallux valgus deformity and its severity are positively associated with the magnitude of anteroposterior postural sway [45]. There is a significant correlation between hallux interphalangeus (HIA) and forefoot abduction-related parameters in juveniles with juvenile-onset hallux valgus [63].

Soft Tissue and Joint Mechanics

Dysfunction of the windlass mechanism is associated with hallux rigidus, evidenced by significantly decreased navicular elevation and altered joint rotations during dorsiflexion compared with healthy feet [60]. The exact aetiology and pathophysiology of non-insertional Achilles tendinopathy are not fully known [76]. Measurement of individual finger forces can provide more accurate biomechanical models of the hand and determine the effect of disease on hand functions [39].

Inflammatory and Metabolic Pathophysiology

Small but clinically important changes in foot function are detected in rheumatoid arthritis patients with disease duration less than 2 years [14]. Structural properties of footwear may affect forefoot loading patterns in people with gout [33]. Elevated peak plantar pressures are present in patients who have Charcot arthropathy [71].

Classification

Scaphoid Non-Union: Patients with established scaphoid non-union should be advised that osteoarthritis will most likely develop [1].

Tarsometatarsal Joint Complex: Posttraumatic osteoarthritis occurs substantially on radiographs after surgical treatment of these injuries, although the occurrence of symptomatic OA is lower [3].

Carpometacarpal (CMC) Osteoarthritis: Objective measures of CMC osteoarthritis severity do not fully capture the way patients experience the condition [9]. There is a paucity of literature to measure CMC osteoarthritis progression, with a lack of uniformly accepted imaging modality, scoring system, or follow-up interval [16].

Patellofemoral Osteoarthritis: A novel MRI scoring system for patellofemoral osteoarthritis requires validation in patients with and without the condition and correlation with clinical outcomes [64].

Rheumatoid Arthritis: Revised diagnostic criteria for rheumatoid arthritis were introduced to aid in obtaining more uniformity in the classification of patients with the disease [38].

Achilles Disorder: There is no clear consensus on what defines a chronic Achilles disorder or a uniform classification and treatment scheme [46].

Other Considerations: None of the currently available OA-related biomarkers can be considered a surrogate marker of clinical and imaging features for the diagnosis or prognosis of the disease [2]. Understanding subchondral vascular physiology is key to better MRI classification of osteoarthritis [10]. Differential expression of genes in rheumatoid arthritis compared with osteoarthritis indicates potential targets for molecular diagnosis [54]. Subchondral bone remodelling is a key aspect of osteoarthritis pathogenesis relevant to surgical management [68]. Machine learning models are feasible for predicting osteoarthritis progression, but critical limitations currently restrict their clinical applicability [24]. Demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scores on numerous scoring systems devised to evaluate patients with knee symptoms [40].

Clinical Presentation

Diagnostic Markers and Imaging: No biomarker is currently considered a surrogate marker of clinical and imaging features for the diagnosis or prognosis of osteoarthritis [2]. Posttraumatic osteoarthritis occurs substantially on radiographs, although the occurrence of symptomatic osteoarthritis is lower [3]. Joint space width evaluation has potential diagnostic value in the work-up of patients with suspected pisotriquetral osteoarthritis [19]. Understanding subchondral vascular physiology is key to better MRI classification and prevention, control, prognosis, and treatment of osteoarthritis [10]. Expected imaging appearances of common operative procedures are illustrated in the setting of posttraumatic ankle and hindfoot osteoarthritis [11].

Gout and Crystal Arthropathy: There is no association between gout and radiographic osteoarthritis [21]. People with gout appear more likely to have small joint osteoarthritis and less likely to have large joint osteoarthritis [21]. Specific exfoliative cytological patterns can be readily recognized in synovial fluid aspirated from joints in a variety of arthritides, supporting the technique as a valuable diagnostic aid [37].

Inflammatory and Systemic Arthritides: Palindromic rheumatism requires ruling out other arthritic disorders and observing a protracted, non-destructive course over time for final diagnosis [7]. Small but clinically important changes in foot function are detected in rheumatoid arthritis patients with disease duration less than 2 years [14]. The diagnosis of familial Mediterranean fever is clinical, based on the association of monoarticular arthritis with recurrent fever and abdominal pain, as there are no specific laboratory aids [32]. Permanent joint damage can occur in familial Mediterranean fever, particularly in older children at onset, despite typically transient joint involvement [22].

Neuropathic and Structural Patterns: Physicians should be aware of Charcot joint disease presentation in patients with insensate joints to avoid overtreatment [17]. In the majority of patients with ankle osteoarthritis, the average tibiotalar alignment is varus regardless of the underlying etiology [23]. Objective measures of carpometacarpal osteoarthritis severity do not fully capture the way patients experience the condition [9].

Model Systems and Prognostication: The horse provides a consistently predictable model of osteoarthritis to study early pathobiological events, define targets for therapeutic intervention, and test putative therapies [12]. Machine learning models are feasible for predicting osteoarthritis progression, but critical limitations currently restrict their clinical applicability [24].

Shoulder Osteoarthritis Management: Nonoperative modalities should be utilized before surgical options for shoulder osteoarthritis, particularly for patients with moderate-to-mild disease [13]. Surgical treatments like arthroplasty are considered effective for severe cases of shoulder osteoarthritis [13].

Investigations

Plain radiography: Patients with established scaphoid non-union should be advised that osteoarthritis will most likely develop [1]. Posttraumatic osteoarthritis occurs substantially on radiographs after surgical treatment of tarsometatarsal joint complex injuries, although symptomatic occurrence is lower [3]. Joint space width evaluation has potential diagnostic value in the work-up of patients with suspected pisotriquetral osteoarthritis [19]. There is no association between gout and radiographic osteoarthritis; however, people with gout are more likely to have small joint osteoarthritis and less likely to have large joint osteoarthritis [21]. Significant differences in surface roughness (Sa) between KL0 and KL2 femurs indicate the sensitivity of this technique to subtle changes in early osteoarthritis [80].

MRI: Understanding subchondral vascular physiology is key to better MRI classification and prevention, control, prognosis, and treatment of osteoarthritis [10]. Imaging of hyaline cartilage involves consideration of technique, accuracy of diagnosis, and concepts for future imaging techniques, with the knee as the prototype joint [59]. 3 T T2 maps are similar in repaired and native cartilage after microfracture for osteochondral defects of the talus, with good inter-observer reliability [78]. Imaging illustrates expected appearances of common operative procedures performed in the setting of posttraumatic ankle and hindfoot osteoarthritis [11].

Aspiration: Synovial fluid concentrations of two biomarkers differ significantly based on the extent of radiographic osteoarthritis present in the knee [73].

Laboratory: No osteoarthritis-related biomarker is currently considered a surrogate marker of clinical and imaging features for the diagnosis or prognosis of the disease [2]. Inflammatory polyarthritis has a potentially adverse effect on the skeleton as evidenced by quantitative heel ultrasound measurements [28].

Other Considerations: Early results of glenohumeral joint preservation procedures in young, active patients with osteoarthritis indicate satisfactory short-term outcomes, but these procedures have not been shown to halt arthritic progression [5]. Final diagnosis of palindromic rheumatism requires ruling out other arthritic disorders and observing a protracted, non-destructive course over time [7]. Objective measures of thumb carpometacarpal (CMC) osteoarthritis severity do not fully capture patient experience [9]. There is a paucity of literature to measure CMC osteoarthritis progression, with a lack of uniformly accepted imaging modality, scoring system, or follow-up interval [16]. Physicians should be aware of Charcot joint disease presentation in patients with insensate joints to avoid overtreatment [17]. Progressive local osteoarthritis may be caused by fracture of subchondral bone due to osteoporosis [30]. Calcitonin presents a promising agent for the treatment of osteoarthritis, with potential greater than in rheumatoid arthritis, based on preclinical data [58].

Treatment

Non-Operative Management

Nonoperative management is the standard initial approach for primary and posttraumatic elbow arthritis, with surgery reserved for cases refractory to conservative care [41]. For shoulder osteoarthritis, nonoperative modalities are utilized before surgical options, particularly in moderate-to-mild disease, while arthroplasty is considered effective for severe cases [13]. In thumb carpometacarpal (CMC-1) osteoarthritis, nonsurgical treatment yields positive outcomes at >5 years of follow-up, with no worsening of pain or limitations in activities of daily living (ADL) after 12 months [6]. A program of joint mobilization combined with specific myofascial trigger point (MTrP) therapy can decrease pain and improve function in individuals with CMC OA [55].

For ankle arthritis, no evidence indicates that non-surgical treatments change the course of the disease, although arthroscopic treatment may help patients with mild to moderate osteoarthritis, less than 5 degrees of varus or valgus malalignment, and mechanical symptoms; however, the preponderance of literature does not support its routine use [20], [29]. In osteochondritis dissecans, lesions can be successfully managed nonoperatively with a locked knee brace, allowing return to full activity without complication [52]. Treatment for osteochondritis dissecans with spontaneous healing should involve non-weight-bearing for at least six months, reserving surgery for cases without clinical and roentgenographic improvement or with displacement [61]. Physical therapy management of osteochondritis dissecans can incorporate a full spectrum of conservative, nonoperative, and postoperative care [42].

Regarding hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint, treatment options range from non-operative measures to various surgical procedures, with selection depending on disease stage and patient factors [56]. Patients with established scaphoid non-union should be advised that osteoarthritis will most likely develop [1]. Existing literature demonstrates anti-inflammatory properties of orthobiologics, but no treatment has clearly demonstrated significant joint preservation properties, including the ability to reverse progression of osteoarthritis [25]. Biological treatments for osteoarthritis must meet three crucial milestones: safety, reasonable cost, and improved effectiveness compared with alternatives [8]. Targeted therapies on how to slow down the primary osteoarthritis process by regulating macrophage polarization are yet to be developed [57]. Indications for the use of steroids must be clearly delineated, probably more narrowly than has been done in the past [43]. Anterior medial (AM), anterior lateral (AL), and superior lateral (SL) injections into arthritic knees without effusion seem to provide similar clinical benefit across a broad range of clinical experiences [47].

Operative Management

Indications: Early results indicate satisfactory short-term outcomes for glenohumeral joint preservation procedures in young, active patients with osteoarthritis, though these procedures have yet to show they can halt arthritic progression [5]. Proximal-row carpectomy should be considered after conservative measures fail for diseases of the proximal row, as mild degenerative arthritis is not a contraindication and progressive degenerative arthritis of the radial capitate articulation did not occur [18]. Arthroscopic ankle arthrodesis is considered the new gold standard for patients with isolated ankle osteoarthritis and no/minimal deformity [50].

Surgical Approach / Technique: Joint replacement procedures relieve pain and improve function more than other current operative treatments but are limited by the inability of synthetic materials to duplicate the properties of articular cartilage [26]. Procedures that restore rather than replace the joint may offer advantages for young patients or those with less advanced disease [26]. Autologous osteochondral grafts for degenerated cartilage improved clinical outcomes of early knee osteoarthritis even if the recipient had cartilage degeneration and not trauma [53].

Complications

Osteoarthritis Progression: Osteoarthritis is a likely development in patients with established scaphoid non-union [1]. Posttraumatic osteoarthritis occurs substantially on radiographs following surgical treatment of tarsometatarsal joint complex injuries, although symptomatic osteoarthritis occurs at a lower rate [3]. Early results for glenohumeral joint preservation procedures in young, active patients with osteoarthritis show satisfactory short-term outcomes, but these procedures have not been shown to halt arthritic progression [5]. Progressive local osteoarthritis may be caused by fracture of subchondral bone due to osteoporosis [30]. Osteoarthritis consists of a retrogressive sequence of changes in cells and matrix accompanied by repair and remodeling reactions that vary in rate and may stabilize or decrease spontaneously [75].

Arthritis Following Nonoperative Management: Arthritis following nonoperative treatment of osteochondritis dissecans lesions has an estimated 30% cumulative incidence at 35 years after diagnosis [15]. The long-term rate of arthroplasty following nonoperative treatment of osteochondritis dissecans is low [15]. There is no evidence that nonsurgical treatments change the course of ankle arthritis [20]. Nonsurgical treatment of thumb carpometacarpal osteoarthritis yields positive outcomes at greater than 5 years of follow-up, with no worsening of pain or limitations in activities of daily living after 12 months [6].

Inflammatory and Systemic Arthritis Complications: Synovectomy is indicated to prevent abnormal growth from rheumatoid inflammation, especially in children with unilateral knee involvement [44]. Inflammatory polyarthritis may have an adverse effect on the skeleton, as evidenced by quantitative heel ultrasound measurements [28]. Palindromic rheumatism is characterized by a protracted, non-destructive course over time, requiring the ruling out of other arthritic disorders for final diagnosis [7]. Permanent joint damage can occur in familial Mediterranean fever, particularly in cases with onset in older children [22].

Other Considerations: No currently available osteoarthritis-related biomarkers serve as surrogate markers for the diagnosis or prognosis of clinical and imaging features of the disease [2]. Recurrence of pain is considered a determinant of failure when discussing the survivorship of any arthroplasty [27]. The horse model provides a consistently predictable framework for studying early pathobiological events and therapeutic interventions in naturally occurring osteoarthritis [12]. Blind-loop arthritis syndrome symptoms can resolve with indomethacin treatment [77].

Recovery

Light activity (weeks): Evidence does not provide specific week ranges for light activity or desk work return in the context of scaphoid non-union, tarsometatarsal injuries, or glenohumeral preservation. For thumb carpometacarpal (CMC-1) osteoarthritis, nonsurgical treatment yields positive outcomes with no worsening of pain or limitations in activities of daily living after 12 months [6].

Full activity (months): No specific month ranges for full activity return are provided for the cited conditions. For lateral elbow tendinopathy, ultrasound-guided percutaneous tenotomy demonstrates sustained functional recovery at 7.5 years [74].

Complete recovery / outcome plateau (months): Long-term outcomes vary by pathology. Arthritis following nonoperative treatment of osteochondritis dissecans (OCD) lesions has an estimated 30% cumulative incidence at 35 years after diagnosis, with a low long-term rate of arthroplasty [15]. Posttraumatic osteoarthritis occurs substantially on radiographs after surgical treatment of tarsometatarsal joint complex injuries, although symptomatic occurrence is lower [3]. Early results of glenohumeral joint preservation procedures indicate satisfactory short-term outcomes, but these procedures have not shown they can halt arthritic progression [5].

Rehabilitation protocol: Specific rehabilitation protocols, including PT phasing, immobilisation duration, or weight-bearing progression, are not detailed in the provided evidence.

Functional milestones: Validated PROM trajectories are not explicitly defined in the evidence. However, small but clinically important changes in foot function are detected in rheumatoid arthritis patients with disease duration <2 years [14]. Recurrence of pain must be considered a determinant of failure when discussing survivorship of any arthroplasty in patients with rheumatoid arthritis [27].

Other Considerations: Patients with established scaphoid non-union should be advised that osteoarthritis will most likely develop [1]. No OA-related biomarker is currently considered a surrogate marker of clinical and imaging features for the diagnosis or prognosis of the disease [2]. There is a paucity of literature to measure CMC OA progression, with a lack of uniformly accepted imaging modality, scoring system, or follow-up interval [16]. Existing literature demonstrates anti-inflammatory properties of orthobiologics, but no treatment has clearly demonstrated significant joint preservation properties or the ability to reverse osteoarthritis progression [25]. Further studies with long-term follow-up are needed to determine whether the grafted area maintains structural and functional integrity over time following autologous matrix-induced chondrogenesis for focal cartilage defects in the knee [79]. Minimal treatment of rheumatoid arthritis with one non-biologic DMARD results in deterioration of joint structure in patients with or without a history of inadequate response to non-biologic DMARDs [82]. The progressive nature of cervical rheumatoid disease resulted in the recurrence of long-tract symptoms in three patients due to further subaxial subluxation distal to the original fusion site [81]. The horse provides a consistently predictable model of osteoarthritis to study early pathobiological events, define targets for therapeutic intervention, and test putative therapies [12]. The final diagnosis of palindromic rheumatism requires ruling out other arthritic disorders and observing a protracted, non-destructive course over time [7].

Key Evidence

  • [L4] Patients with established scaphoid non-union should be advised that osteoarthritis will most likely develop. (10.2106/00004623-198567030-00013)
  • [L5] Although many OA-related biomarkers are currently available, none can be considered as a surrogate marker of clinical and imaging features for the diagnosis or prognosis of the disease at this time. (10.1186/1471-2474-16-s1-s2)
  • [L4] However, there was a substantial occurrence of posttraumatic OA, as evident on radiographs, albeit the occurrence of symptomatic OA was lower. (10.2106/jbjs.15.00623)
  • [L5] The handbook is an excellent source of information on the essential facts about osteoarthritis, offering an impressive overview of epidemiology, evaluation methods, and non-operative treatment, and is strongly recommended for orthopaedic surgeons. (10.2106/00004623-199802000-00026)
  • [L4] Early results indicate satisfactory short-term outcomes, though these procedures have yet to show they can halt arthritic progression. (10.1155/2012/160923)
  • [L2] We found positive outcomes at >5 years of follow-up for nonsurgical treatment of CMC-1 OA, with no worsening of pain or of limitations in ADL after 12 months. (10.2106/jbjs.22.01116)
  • [L5] Biological treatments for osteoarthritis must meet three crucial milestones: safety, reasonable cost, and improved effectiveness compared with alternatives. (10.1016/j.arthro.2019.04.020)
  • [L4] It is becoming clearer that objective measures of CMC OA severity do not fully capture the way patients experience this condition. (10.1016/j.jhsg.2025.01.011)
  • [L4] Understanding subchondral vascular physiology will be key to better MRI classification and prevention, control, prognosis and treatment of osteoarthritis and other bone diseases. (10.1530/eor-23-0002)
  • [L5] This review article aims to familiarize the reader with treatment rationale, provide a brief review of surgical techniques, and illustrate expected imaging appearances of common operative procedures performed in the setting of posttraumatic ankle and hindfoot osteoarthritis. (10.3390/jcm10245848)
  • [L5] The article provides an overview of available treatments for shoulder osteoarthritis, noting that nonoperative modalities should be utilized before surgical options, particularly for patients with moderate-to-mild disease, while surgical treatments like arthroplasty are considered effective for severe cases. (10.1155/2013/370231)
  • [L4] Analysis detected small but clinically important changes in foot function in a small cohort of RA patients with disease duration <2 years. (10.1186/1471-2474-7-102)
  • [L3] Arthritis following nonoperative treatment of OCD lesions is a challenging problem with an estimated 30% cumulative incidence at 35 years after diagnosis, while the long-term rate of arthroplasty is low. (10.1177/2325967117s00342)
  • [L3] A paucity of literature exists to measure CMC OA progression; there is a lack of uniformly accepted imaging modality, scoring system, or follow-up interval. (10.1016/j.jhsg.2020.09.001)
  • [Case_report] Physicians should be aware of this presentation in patients with insensate joints to avoid overtreatment. (10.2106/00004623-199274090-00017)
  • [L4] It should be considered after conservative measures fail, as mild degenerative arthritis is not a contraindication and progressive degenerative arthritis of the radial capitate articulation did not occur. (10.2106/00004623-197759040-00004)
  • [L4] These results suggest that joint space width evaluation has a potential diagnostic value in the work-up of patients with suspected pisotriquetral osteoarthritis. (10.1177/1558944716677542)
  • [L3] There was no association between gout and radiographic OA, however, people with gout appeared to be more likely to have small joint OA and less likely to have large joint OA. (10.1186/s12891-016-1032-9)
  • [L4] While joint involvement is typically transient, this report emphasizes that permanent joint damage can occur, particularly in older children at onset. (10.2106/00004623-197557020-00023)
  • [L2] Our systematic review demonstrates the feasibility of ML models in predicting OA progression, but also uncovers critical limitations that currently restrict their clinical applicability. (10.1302/0301-620x.106b11.bjj-2024-0453.r1)
  • [L5] Existing literature demonstrates anti-inflammatory properties of orthobiologics, but no treatment has clearly demonstrated significant joint preservation properties, including the ability to reverse progression of osteoarthritis. (10.1136/jisakos-2019-000377)
  • [L5] Joint replacement procedures relieve pain and improve function more than other current operative treatments but are limited by the inability of synthetic materials to duplicate the properties of articular cartilage; procedures that restore rather than replace the joint may offer advantages for young patients or those with less advanced disease. (10.2106/00004623-199409000-00019)
  • [L3] The author believes that recurrence of pain must be considered to be a determinant of failure when survivorship of any arthroplasty is discussed. (10.1007/s11999-008-0462-6)
  • [L3] In this general population derived cohort of individuals with inflammatory polyarthritis there is evidence from ultrasound of a potentially adverse effect on the skeleton. (10.1186/1471-2474-13-133)
  • [L1] Arthroscopic treatment may help patients with mild to moderate osteoarthritis, less than 5 degrees of varus or valgus malalignment, and mechanical symptoms, but the preponderance of literature does not support its routine use. (10.5435/jaaos-d-16-00148)
  • [L5] The report emphasizes that there may be cases of progressive local osteoarthritis caused by fracture of subchondral bone due to osteoporosis. (10.1155/2014/514058)
  • [L4] The diagnosis is clinical, based on the association of monoarticular arthritis with recurrent fever and abdominal pain, as there are no specific laboratory aids. (10.2106/00004623-196547080-00016)
  • [L4] These changes to the structural properties of the footwear may affect forefoot loading patterns in people with gout. (10.1186/s12891-021-04370-x)
  • [L4] Specific exfoliative cytological patterns can be readily recognized in fluids aspirated from joints in a variety of arthritides, supporting the technique as a valuable diagnostic aid. (10.2106/00004623-197658030-00019)
  • [L5] The revised criteria are hoped to aid in obtaining more uniformity in the classification of patients with rheumatoid arthritis and should be reviewed in two or three years. (10.2106/00004623-195941040-00023)
  • [L4] Measurement of individual finger forces can provide more accurate biomechanical models of the hand and determine the effect of disease on hand functions. (10.1016/j.jht.2020.04.002)
  • [L4] Numerous scoring systems have been devised to evaluate patients who have symptoms related to the knee, but demographic variables such as advanced age, low family income, and multiple medical conditions significantly affect scores. (10.2106/00004623-199706000-00009)
  • [L5] Nonoperative treatment is almost always initiated although surgical treatment may be indicated in cases refractory to conservative management. (10.1155/2013/473259)
  • [Paper] Physical therapy management of osteochondritis dissecans can incorporate a full spectrum of conservative, nonoperative, and postoperative care. (10.1016/j.csm.2014.01.001)
  • [Case_report] The indications for use of steroids must be clearly delineated, probably more narrowly than has been done in the past. (10.2106/00004623-198264010-00020)
  • [L5] Short-term results in children are no less favorable than in adults, and the danger of abnormal growth from rheumatoid inflammation is an indication for synovectomy, especially in children with unilateral knee involvement. (10.2106/00004623-197153040-00001)
  • [L4] Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway. (10.1186/s12891-021-04385-4)
  • [L5] There is no clear consensus on what defines a chronic Achilles disorder or a uniform classification and treatment scheme. (10.5435/00124635-200901000-00002)
  • [L1] AM, AL, and SL injections into arthritic knees without effusion seem to provide similar clinical benefit across a broad range of clinical experiences. (10.1177/2325967115600687)
  • [L2] Outcomes will help to inform clinical guidelines and practice about the use of foot orthoses for managing symptoms in this under-researched group of people with OA. (10.1186/s12891-020-03809-x)
  • [L4] It is considered the new gold standard for patients with isolated ankle osteoarthritis and no/minimal deformity. (10.1530/eor-2023-0100)
  • [L5] Articular cartilage repair techniques appear to be safe in children and adolescents, with no differences in complication rates reported when compared with adult patients. (10.1177/2325967118760190)
  • [Case_report] The patient was successfully managed nonoperatively with a locked knee brace and returned to full activity in 5 months without complication. (10.1155/2021/9776362)
  • [L4] Autologous osteochondral grafts for degenerated cartilage improved clinical outcomes of early knee osteoarthritis even if the recipient had cartilage degeneration and not trauma. (10.1016/j.asmr.2021.12.016)
  • [L4] The differential expression of genes in RA compared with OA indicates potential targets for molecular diagnosis and treatment. (10.1186/s12891-022-05277-x)
  • [L5] A program of joint mobilization combined with specific MTrP therapy can decrease pain and improve function in individuals with CMC OA. (10.1016/j.jht.2015.10.005)
  • [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
  • [L5] Targeted therapies on how to slow down the primary OA process by regulating macrophage polarization are yet to be developed. (10.1186/s13018-024-05052-9)
  • [L1] Given these effects, CT presents a promising agent for the treatment of both diseases, although the potential seems to be greater in OA. (10.1530/eor-23-0133)
  • [Paper] This article reviews the imaging of hyaline cartilage, including consideration of technique, accuracy of diagnosis, and concepts for future imaging techniques, with the knee as the prototype joint. (10.1016/j.csm.2004.08.008)
  • [L3] Dysfunction of the windlass mechanism is associated with hallux rigidus, as evidenced by significantly decreased navicular elevation and altered joint rotations during dorsiflexion compared with healthy feet. (10.2106/jbjs.24.00437)
  • [L4] Treatment should involve non-weight-bearing for at least six months, reserving surgery for cases without clinical and roentgenographic improvement or with displacement. (10.2106/00004623-195234010-00015)
  • [L3] The significant correlation between HIA and forefoot abduction-related parameters in juveniles highlights the need for a comprehensive assessment and treatment of combined deformities in managing juvenile-onset hallux valgus. (10.1186/s13018-024-05408-1)
  • [L4] Future studies should validate this system in patients with and without patellofemoral arthritis and correlate scores with clinical outcomes. (10.1177/2325967123s00275)
  • [L4] This review gives an overview of the current thoughts on subchondral bone remodelling in osteoarthritis that is aimed at orthopaedic surgeons to help in the understanding of the pathogenesis of osteoarthritis and the role of surgical management. (10.1302/2058-5241.4.180102)
  • [L4] This study demonstrated a relationship between lower extremity mechanical weightbearing axis and femoral condyle OCD location, with patients having unilateral medial femoral condyle OCD lesions more likely to have varus alignment in the affected extremity. (10.1177/2325967124s00064)
  • [L3] The measurement of plantar pressures coupled with evaluation of protective sensation may be an effective means of screening patients. (10.2106/00004623-199803000-00009)
  • [L3] The synovial fluid concentrations of two synovial fluid biomarkers were found to differ significantly based on the extent of radiographic OA present. (10.1016/j.arthro.2020.12.163)
  • [L4] At long term follow up, ultrasound-guided percutaneous tenotomy demonstrates good sustainability of pain relief and functional recovery that was previously achieved, accompanied with sonographic evidence of tissue healing at 7.5 years. (10.1177/2325967120s00420)
  • [L5] Osteoarthritis is not simply the result of aging and mechanical wear from joint use, nor is primary osteoarthritis caused by inflammation; it consists of a retrogressive sequence of changes in cells and matrix accompanied by repair and remodeling reactions that vary in rate and may stabilize or decrease spontaneously. (10.2106/00004623-199704000-00022)
  • [L5] The exact aetiology and pathophysiology of non-insertional Achilles tendinopathy are not fully known and warrant further studies. (10.1136/jisakos-2017-000164)
  • [Case_report] The diagnosis of blind-loop arthritis syndrome was established based on the patient's history of an intestinal-bypass operation and laboratory findings, and symptoms resolved with indomethacin treatment. (10.2106/00004623-199072090-00023)
  • [L4] 3 T T2 maps were similar in repaired and native cartilage with good inter-observer reliability. (10.1007/s00167-014-2913-9)
  • [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
  • [L4] Significant differences in Sa between KL0 and KL2 femurs indicate sensitivity of this technique to subtle changes in early OA. (10.1177/2325967116s00134)
  • [L4] The progressive nature of cervical rheumatoid disease resulted in the recurrence of long-tract symptoms in three patients due to further subaxial subluxation distal to the original fusion site. (10.2106/00004623-198163080-00003)
  • [L1] Minimal treatment of RA with one non-biologic DMARD results in deterioration of joint structure in patients with or without a history of inadequate response to non-biologic DMARDs. (10.1186/s12891-016-1195-4)

See Also

References

[1] The natural history of scaphoid non-union. A review of fifty-five cases.. The Journal of Bone & Joint Surgery. 1985. DOI: 10.2106/00004623-198567030-00013

[2] Biomarkers of prognosis and efficacy of treatment in OA. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/1471-2474-16-s1-s2

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