The relationship between real-time ultrasound-detected extra-articular soft tissue pathologies and knee pain in osteoarthritis: a cross-sectional study - Report - MDSpire
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The relationship between real-time ultrasound-detected extra-articular soft tissue pathologies and knee pain in osteoarthritis: a cross-sectional study
Correlation of Ultrasound-Detected Extra-Articular Abnormalities with Knee Pain in OA
Overview
This cross-sectional study investigated the association between real-time ultrasound-identified extra-articular soft tissue abnormalities and knee pain severity and location in patients with moderate to severe knee osteoarthritis. Findings revealed that specific extra-articular pathologies, particularly semimembranosus tendon hypoechogenicity, were common and correlated with pain patterns, suggesting a role for periarticular tissues in OA pain.
Background
Knee osteoarthritis (OA) pain is multifactorial and poorly correlated with radiographic changes. While MRI studies have focused on intra-articular structures related to pain, musculoskeletal ultrasound (US) offers a non-invasive method to assess periarticular soft tissues in real time. The contribution of extra-articular soft tissue abnormalities to OA knee pain remains underexplored. This study aimed to clarify associations between US-detected extra-articular pathologies and both pain severity and location in patients with knee OA.
Data Highlights
Characteristic
Value
Participants (n)
54
Mean age (years)
64.07 (SD 8.03)
Mean BMI (kg/m2)
31.45 (SD 5.42)
Sex (M/F)
26/28
Kellgren–Lawrence grade 2 or 3
94%
Mean NRS pain (0–10)
5.41 (SD 1.66)
Medial pain reported
36 participants
Lateral pain reported
16 participants
Anterior pain reported
10 participants
Posterior pain reported
5 participants
Diffuse pain reported
5 participants
SMT hypoechogenicity prevalence
53%
Key Findings
Semimembranosus tendon (SMT) hypoechogenicity was the most frequent ultrasound abnormality, present in 53% of knees scanned.
Medial compartment OA was highly prevalent (53/54 participants), with medial knee pain reported by 36 participants.
Ultrasound assessment included multiple extra-articular structures: quadriceps tendon, patellar tendon, bursae, collateral ligaments, iliotibial band, SMT, and Baker’s cyst.
Pain location was categorized into anterior, medial, lateral, posterior, or diffuse, with half of participants reporting pain in only one region.
Multivariable regression models adjusted for age, sex, and BMI explored associations between presence of US pathologies and pain severity.
Clinical Implications
Musculoskeletal ultrasound can identify extra-articular soft tissue abnormalities that may contribute to knee pain in osteoarthritis, particularly in the medial compartment. Recognizing these periarticular pathologies, such as SMT hypoechogenicity, may improve pain localization and guide targeted management strategies. Sono-palpation combined with US imaging offers a dynamic approach to correlate tenderness with structural abnormalities.
Conclusion
This study provides preliminary evidence that extra-articular soft tissue abnormalities detected by ultrasound are common in knee OA and associate with pain severity and location. These findings support further research into periarticular tissues as contributors to OA pain and potential therapeutic targets.
References
Authors/Black Country Research Ethics Committee/2021-2022 -- Examining the Correlation Between Real-Time Ultrasound Identified Extra-Articular Soft Tissue Abnormalities and Knee Pain in Osteoarthritis
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