Risk factors for anterior knee pain and the relation to future patellofemoral osteoarthritis

项目总结/摘要 在美国，骨关节炎（OA）每年花费超过810亿美元，这是一种类似于癌症的负担。OA 最常影响膝关节，并与死亡率增加有关。目前还没有有效 预防或治疗这种严重疾病的方法。髌股（PF）OA是指PF关节中的OA， 膝关节OA的一个独特亚组，发病率较高，39%的膝关节疼痛患者存在该亚组。 前膝关节疼痛（AKP）是整个生命周期中最常见的慢性疼痛状况之一。AKP是 持续并影响一个人的功能和生活质量。AKP和PFOA可能代表PF的连续体 疾病然而，缺乏关于AKP与PFOA之间关系的纵向数据。通过识别风险因素 对于AKP，我们不仅可以减轻这种常见疾病的负担，而且可能改变自然历史， 膝关节疼痛和骨关节炎目前的建议旨在了解AKP的危险因素以及AKP与 事件PFOA和功能限制。了解AKP的危险因素可以提高临床医生的能力 来解决这些症状并减缓其发展。我们将利用NIH资助的多中心研究的数据， 骨关节炎（MOST）研究，以回答我们提出的研究问题。在最近更新的社会变革管理计划中， 招募未确诊OA的队列。这为我们研究AKP和PFOA提供了巨大的机会 这是确定康复战略目标的第一个关键步骤。MOST是唯一一家大型 具有膝关节疼痛位置、功能限制、潜在 可能影响PF关节负荷的可修改风险因素，以及评估OA特征的PF关节成像， 利用这一丰富的资源使我们的建议切实可行。我们的具体目标如下：目标1：确定 可改变的风险因素（例如，下肢力量，步态力学，PF排列，身体 体重指数）与2年内AKP的流行和发病有关;目的2：确定AKP与 PFOA事件和功能限制超过2年。这项研究的重要性在于，它将 确定AKP发展及其下游效应的可改变的风险因素（例如，PFOA，胫股OA， TKR）。它的创新之处在于，它不是采取典型的疾病发生后管理方法， 目前的建议将使我们能够制定战略，在我们有最大潜力的时候进行干预。 影响改变PF疾病的自然史，并随后最大限度地减少OA的负担。

PROJECT SUMMARY/ABSTRACT Osteoarthritis (OA) costs more than $81 billion per year in the United States, a burden similar to cancer. OA most commonly affects the knee joint and is associated with increased mortality. There are currently no effective therapies to prevent or treat this serious disease. Patellofemoral (PF) OA, which refers to OA in the PF joint, is a distinct subgroup of knee OA with substantial morbidity and is present in 39% of individuals with knee pain. Anterior knee pain (AKP) is one of the most common chronic pain conditions across the lifespan. AKP is persistent and affects a person’s function and quality of life. AKP and PFOA may represent a continuum of PF disease. However, longitudinal data is lacking on the relation of AKP to incident PFOA. By identifying risk factors for AKP, we could not only reduce the burden of this common condition, but potentially alter the natural history of knee pain and OA. The current proposal aims to understand risk factors for AKP and the relation of AKP to incident PFOA and functional limitations. Understanding risk factors for AKP in can improve clinicians’ abilities to address these symptoms and slow their progression. We will leverage data from the NIH-funded Multicenter Osteoarthritis (MOST) study to answer our proposed research questions. In the recent renewal of MOST, a cohort without established OA was recruited. This offers us a tremendous opportunity to study AKP and PFOA development, which is the first key step in identifying targets for rehabilitation strategies. MOST is the only large cohort in the world that has the necessary longitudinal data on knee pain location, functional limitations, potential modifiable risk factors that may influence PF joint loading, and PF joint imaging with OA features assessed, making our proposal feasible by leveraging this rich resource. Our specific aims are as follows: Aim 1: Determine the extent to which modifiable risk factors (e.g., lower extremity strength, gait mechanics, PF alignment, body mass index) are associated with prevalent and incident AKP over 2 years; Aim 2: Determine the relation of AKP to incident PFOA and functional limitations over 2 years. The proposed research is highly significant in that it will identify modifiable risk factors for AKP development and its downstream effects (e.g., PFOA, tibiofemoral OA, TKR). It is innovative in that, instead of taking the typical approach of managing disease after it occurs, the current proposal will allow us to develop strategies to intervene when we have the potential for the greatest impact on changing the natural history of PF disease, and subsequently minimizing the burden of OA.