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Randomized Controlled Trial
. 2017 Aug 10;18(1):347.
doi: 10.1186/s12891-017-1691-1.

With a biomechanical treatment in knee osteoarthritis, less knee pain did not correlate with synovitis reduction

Vikram Swaminathan  1   2 , Matthew J Parkes  3   4 , Michael J Callaghan  3   4   5   6 , Terence W O'Neill  3   4   7 , Richard Hodgson  8 , Andrew D Gait  8 , David T Felson  3   4   9
Affiliations
Randomized Controlled Trial

With a biomechanical treatment in knee osteoarthritis, less knee pain did not correlate with synovitis reduction

Vikram Swaminathan et al. BMC Musculoskelet Disord. .

Abstract

Background: Braces are used to treat pain in patellofemoral joint osteoarthritis (PFJOA). In a trial, we previously reported pain improvement after 6-weeks brace use. The pain reduction did not correlate with changes in Magnetic Resonance Imaging (MRI) assessed Bone Marrow Lesion volume or static synovial volume. Studies show that changes in the synovium on dynamic contrast enhanced (DCE) MRI are more closely associated with symptom change than static synovial volume changes. We hypothesised change in synovitis assessed using dynamic imaging could explain the reduction in pain.

Method: One hundred twenty-six men and women aged 40-70 years with painful radiographically confirmed PFJOA were randomised to either brace wearing or no brace for 6-weeks. Pain assessment and DCE-MRI were performed at baseline and 6 weeks. DCE data was analysed using Tofts's equation. Pain measures included a VAS of pain on nominated aggravating activity (VASNA), and the KOOS pain subscale. Paired t-tests were used to determine within person change in outcome measures and Spearman's correlation coefficients were used to determine the correlation between change in pain and change in the DCE parameters.

Results: Mean age of subjects was 55.5 years (SD = 7.5) and 57% were female. There was clear pain improvement in the brace users compared to controls (VASNA - 16.87 mm, p = <0.001). There was no significant change to the dynamic synovitis parameters among brace users nor was pain change correlated with change in dynamic synovitis parameters.

Conclusion: The reduction in knee pain following brace wearing in patients with PFJOA is not explained by changes in synovitis.

Trial registration: Trial registration number UK. ISRCTN50380458 /Registered 21.5.2010.

Keywords: Brace; Dynamic contrast enhanced; Magnetic resonance imaging; Osteoarthritis; Patellofemoral; Synovitis.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Central Manchester Local Research Ethics Committee (Ethics number 09/H1012/35) and Wellcome Trust Clinical Research Facility, Scientific Advisory Board. Subjects provided written consent before randomisation. (UK. ISRCTN50380458.)

Datasets analysed from the study are available from the corresponding author on request.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
An example of a typical enhancement curve of a voxel of synovium during and post the administration of contrast agent. Three dynamic enhancement parameters are calculated from analysis of the enhancement curve; these variables (RER, REmax and RElate) are labelled on the curve. The x-axis is time in seconds. There are 22 s between each plotted point on the enhancement curve. The y-axis shows signal intensity, starting at zero
Fig. 2
Fig. 2
CONSORT Diagram for the BRACE trial’s 6 week period
See this image and copyright information in PMC

References

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