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Mu S.,University of Florida | Moro-Oka T.,University of Florida | Moro-Oka T.,Kyushu University | Johal P.,University College London | And 4 more authors.
Clinical Biomechanics | Year: 2011

Background: There long has been debate whether static knee kinematics measured using magnetic resonance imaging are the same as knee kinematics in dynamic weight-bearing motion. Magnetic resonance imaging provides excellent volumetric detail but is static. Fluoroscopic imaging provides for dynamic observation of knee kinematics but provides no direct observation of the soft-tissue structures. We attempted to answer the question 'Are knee kinematics the same during static and dynamic squatting?' Methods: Knee kinematics data from two previously reported studies of healthy knee kinematics during squatting from 0° to 120° were obtained. The results of the dynamic fluoroscopic study were reformatted to perform a direct comparison of femoral anteroposterior translation and internal-external rotation with the static magnetic resonance imaging study. Findings: Comparison of internal-external rotations and lateral femoral condyle anteroposterior translations did not reveal significant differences between static and dynamic data. The medial femoral condyle demonstrated 0 (SD = 3) mm posterior translation during dynamic squatting from 0° to 120° flexion compared to 5 (SD = 3) mm posterior translation during static squatting (P = 0.01, Cohen's d = 1.7). Interpretation: For squatting types of motions, static and dynamic study protocols appear to produce equivalent knee kinematics with no functionally important differences. Differences in medial condyle translations can be attributed to differences in foot position during the study. Investigators can choose the modality that best fits their goals and resources with the knowledge that the results for squatting activities are comparable. © 2010 Elsevier Ltd.


Reginster J.-Y.,University of Liege | Cooper C.,University of Southampton | Cooper C.,University of Oxford | Hochberg M.,University of Maryland Baltimore County | And 12 more authors.
Current Medical Research and Opinion | Year: 2015

Despite the near concurrent publication by influential scientific organizations, there are important differences in interpretation of the evidence base and the conclusions derived from the recent Osteoarthritis Research Society International (OARSI) guidelines for the management of knee osteoarthritis, the American College of Rheumatology (ACR) guidelines (concerning also hip and hand osteoarthritis) and the algorithm recommendations by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). This is particularly evident for the drug class of symptomatic slow-acting drugs in osteoarthritis. In this paper, we highlight these differences and try to understand where they derive from, proposing an evidence-based interpretation. © 2015 All rights reserved: reproduction in whole or part not permitted.


Reginster J.-Y.,University of Liege | Reiter-Niesert S.,Federal Institute for Drugs and Medical Devices BfArM | Bruyere O.,University of Liege | Berenbaum F.,University Pierre and Marie Curie | And 11 more authors.
Osteoarthritis and Cartilage | Year: 2015

Objective: The European Society on Clinical and Economic aspects of Osteoporosis and Osteoarthritis (ESCEO) organised a working group to evaluate the need for updating the current European guideline on clinical investigation of drugs used in the treatment of osteoarthritis (OA). Design: Areas of potential attention were identified and the need for modifications, update or clarification was examined. Proposals were then developed based on literature reviews and through a consensus process. Results: It was agreed that the current guideline overall still reflects the current knowledge in OA, although two possible modifications were identified. The first relates to the number and timing of measurements required as primary endpoints during clinical trials of symptom-relieving drugs, either drugs with rapid onset of action or slow acting drugs. The suggested modifications are intended to take into consideration the time related clinical need and expected time response to these drugs - i.e., a more early effect for the first category in addition to the maintenance of effect, a more continuous benefit over the long-term for the latter - in the timing of assessments.Secondly, values above which a benefit over placebo should be considered clinically relevant were considered. Based on literature reviews, the most consensual values were determined for primary endpoints of both symptom-relieving drugs (i.e., pain intensity on a visual analogue scale (VAS)) and disease-modifying drugs (i.e., radiographic joint-space narrowing). Conclusions: This working document might be considered by the European regulatory authorities in a future update of the guideline for the registration of drugs in OA. © 2015 The Authors.


Reginster J.-Y.,University of Liege | Reiter-Niesert S.,Federal Institute for Drugs and Medical Devices BfArM | Bruyere O.,University of Liege | Berenbaum F.,University Pierre and Marie Curie | And 12 more authors.
Osteoarthritis and Cartilage | Year: 2015

Objective: The European Society on Clinical and Economic aspects of Osteoporosis and Osteoarthritis (ESCEO) organised a working group to evaluate the need for updating the current European guideline on clinical investigation of drugs used in the treatment of osteoarthritis (OA). Design: Areas of potential attention were identified and the need for modifications, update or clarification was examined. Proposals were then developed based on literature reviews and through a consensus process. Results: It was agreed that the current guideline overall still reflects the current knowledge in OA, although two possible modifications were identified. The first relates to the number and timing of measurements required as primary endpoints during clinical trials of symptom-relieving drugs, either drugs with rapid onset of action or slow acting drugs. The suggested modifications are intended to take into consideration the time related clinical need and expected time response to these drugs - i.e., a more early effect for the first category in addition to the maintenance of effect, a more continuous benefit over the long-term for the latter - in the timing of assessments.Secondly, values above which a benefit over placebo should be considered clinically relevant were considered. Based on literature reviews, the most consensual values were determined for primary endpoints of both symptom-relieving drugs (i.e., pain intensity on a visual analogue scale (VAS)) and disease-modifying drugs (i.e., radiographic joint-space narrowing). Conclusions: This working document might be considered by the European regulatory authorities in a future update of the guideline for the registration of drugs in OA. © 2015 The Authors.


Bruyere O.,University of Liege | Cooper C.,University of Southampton | Cooper C.,University of Oxford | Arden N.,University of Southampton | And 15 more authors.
Drugs and Aging | Year: 2015

Osteoarthritis is a syndrome affecting a variety of patient profiles. A European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis and the European Union Geriatric Medicine Society working meeting explored the possibility of identifying different patient profiles in osteoarthritis. The risk factors for the development of osteoarthritis include systemic factors (e.g., age, sex, obesity, genetics, race, and bone density) and local biomechanical factors (e.g., obesity, sport, joint injury, and muscle weakness); most also predict disease progression, particularly joint injury, malalignment, and synovitis/effusion. The characterization of patient profiles should help to better orientate research, facilitate trial design, and define which patients are the most likely to benefit from treatment. There are a number of profile candidates. Generalized, polyarticular osteoarthritis and local, monoarticular osteoarthritis appear to be two different profiles; the former is a feature of osteoarthritis co-morbid with inflammation or the metabolic syndrome, while the latter is more typical of post-trauma osteoarthritis, especially in cases with severe malalignment. Other biomechanical factors may also define profiles, such as joint malalignment, loss of meniscal function, and ligament injury. Early- and late-stage osteoarthritis appear as separate profiles, notably in terms of treatment response. Finally, there is evidence that there are two separate profiles related to lesions in the subchondral bone, which may determine benefit from bone-active treatments. Decisions on appropriate therapy should be made considering clinical presentation, underlying pathophysiology, and stage of disease. Identification of patient profiles may lead to more personalized healthcare, with more targeted treatment for osteoarthritis. © 2015, The Author(s).

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