Chapter 1: Evidence-Based Management of Knee Osteoarthritis 4 Contact Hours
By: Joseph Zeni Jr., PT, PhD Learning objectives
After completing this course, the learner will be able to: Describe the anatomical structures of the lower extremity affected by knee osteoarthritis. Explain the disease process and epidemiology of knee osteoarthritis. Describe components of a physical therapy evaluation for patients with knee osteoarthritis. Course overview With aging of the general population and increase in body mass of the average individual, the incidence and prevalence of knee osteoarthritis (OA) has increased dramatically over the past 10 years. In the past several years, new evidence has emerged from several large epidemiological, interventional, and mechanistic studies that have expanded our understanding of OA initiation, progression, and treatment. Organizations such as the American College of Rheumatology and American Academy of Orthopaedic Surgeons have also synthesized recent evidence about how to manage this disease to provide updated recommendations for healthcare practitioners. Advancements in biomechanical technologies have revealed new details about how forces in our joints can contribute to both the incidence and progression of this OA. The information in this course will help to fill the expanding gap between research and clinical practice as this disease becomes more prevalent. People who complete
Discuss interventions commonly used by physical therapists to reduce symptoms and impairments associated with knee osteoarthritis. Identify factors that may make someone a candidate for surgical and conservative treatments of knee osteoarthritis.
this course will gain insight into risk factors that may lead to OA progression and develop a better understanding of the most effective treatment options. The purpose of this intermediate-level course is to provide physical therapists and physical therapist assistants with up-to- date, evidence-based information pertaining to the diagnosis, treatment, and prevention of knee OA. Although this course will be most applicable to physical therapists and physical therapist assistants who work with older individuals in outpatient settings, the increased incidence of OA makes the information in this course relevant to therapists in a variety of settings. Even therapists who specialize and treat patients in areas other than orthopaedic settings will likely encounter individuals whose OA affects their participation, mobility, or function.
WHAT IS OSTEOARTHRITIS?
Knee osteoarthritis (OA) is a common degenerative musculoskeletal condition. Although it is commonly thought of as a disorder of the hyaline cartilage at the ends of the tibia and femur, advances in imaging techniques have revealed that Relevant joint anatomy When discussing the pathogenesis, risk factors, and treatments for knee OA, it is necessary to have a solid understanding of the structures in and around the knee joint. Although OA is often considered a condition that solely affects the cartilage in the joint, there are direct and indirect changes to the ligaments, menisci, muscle, subchondral bone, and joint capsule as well. Damage to these structures can lead to the development of OA, and conversely, OA progression can lead to morphological changes within these supporting structures. The primary structures within this joint are shown in Figure 1 and will be discussed throughout this section. Bony articulations The knee consists of two primary articulations that are encased within a single joint capsule. The tibiofemoral articulation occurs between the tibial plateau and the femoral condyles. This is an important weight-bearing joint, and much of the force experienced by this portion of the knee joint during static and dynamic activities is a result of the body mass. Recent studies have shown that greater body mass index (BMI) is related to greater tibiofemoral joint contact forces in individuals with and without OA (Harding, Dunbar, Hubley-Kozey, Stanish, & Astephen Wilson, 2016). In the tibiofemoral compartment, the medial and lateral menisci help to distribute the load between the femur and tibia. Damage to the menisci can change the contact stress within the joint and ultimately increase the risk for cartilage breakdown and OA (Khan et al., 2016). The medial side of the tibiofemoral joint (the medial compartment) is the most common side for OA.
it also affects the bone, muscle, and ligaments in the knee. Pharmacological and physical therapy interventions should target all aspects of the joint that are affected by the disease.
Figure 1: Knee Joint Anatomy
Relevant structures within the knee joint include the bone, cartilage, ligaments, and menisci. Note . ©joshya/Adobe Stock. The patellofemoral joint is the articulation between the posterior side of the patella and the femoral condyles and femoral trochlea. Although this joint often is overlooked clinically in individuals with later stages of knee OA, cartilage deterioration is thought to occur first in the patellofemoral joint, with ultimate progression to other regions of the knee (Lankhorst et al., 2016). The patella is maintained in the center of the femoral trochlea by the strong contractions of the quadriceps muscle, as well the patella’s attachments to the medial and lateral retinaculum of
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Book Code: PTNC1023
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