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Age and Disease Severity Interactions with Hyaluronic Acid (HA) Viscosupplementation on Synovial Fluid Inflammatory Proteins in Knee Osteoarthritis
PM&R
Disclosures: K. Lee, No Disclosures: I Have Nothing To Disclose. Objective: The purpose of this study was to evaluate the effect of hamstring stretching exercise on gait pattern. Setting: Thirty healthy male adults were tested for hamstring flexibility and gait pattern before and after intermittent hamstring stretching exercise (stretching and resting for 30 seconds each, alternatively, 3 times). The hamstring flexibility was measured with four different methods including straight leg raise test (SLRT), popliteal angle test (PA), modified popliteal angle test (MPA) and sitting popliteal angle test (SPA). We analyzed gait pattern by measuring peak plantar pressures and ground contact times during walking by EMEDÒ system. Results or Clinical Course: There were significant increases in hamstring flexibility in all 4 methods after stretching exercise (p<.05). In gait pattern analysis, there were significant decreases in the ground contact time that takes from the leaving point of center of pressure from hindfoot to the end of heel off (p<.05). Also, the peak plantar pressure of the end of heel off was also significantly decreased (p<.05). Conclusions: When we analyzed gait patterns after the stretching exercise, there were significant reduction in mid stance duration and peak plantar pressure. We assumed that changes in the gait patterns are caused by eased ankle dorsiflexion in mid stance, and it might be related to improved flexibility of gastrocnemius as well as hamstring. Poster 231 Novel Evaluating Method of Hamstring Flexibility. Sang Won Kong, MD (Hanyang Univ. Hospital, Seoul, Korea, Republic of); Junho Kim, MD; Taikon Kim, MD, PhD; Kyu Hoon Lee, MD; Do Hyun Yoon, MD; Seung Hoon Han, MD, PhD; Si Bog Park, MD, PhD. Disclosures: S. Kong, No Disclosures: I Have Nothing To Disclose. Objective: Many tests to evaluate hamstring flexibility are usually subjective and done manually. The results of these tests can be easily changed by rater’s condition. Thus, we made a novel equipment to assess objectively hamstring flexibility and examined the intra-rater reliability of it. Setting: Thirty female subjects in twenties and thirties were tested to assess hamstring flexibility in four different methods; Sitting popliteal angle measurement, straight leg raising test, passive knee extension test and modified popliteal angle measurement. Novel equipment was used in terms of sitting popliteal angle. It consists of sitting chair, leg-raising device, speed controller, two pieces of sliding boards with different sensors. This machine raised the leg at three different angular velocities (500, 1,000 and 1,500 revolutions per minute (RPM)). Each test was repeated three times and the intraclass correlation coefficient (ICC) and standard error of measurement (SEM) were calculated. Results or Clinical Course: The ICC of sitting popliteal angle measurement showed excellent reliability (0.927) at angular velocity of 1000 RPM with the right leg and also showed excellent reliability (0.867) in 1500 RPM with the left leg. The SEM was 5.9 in 1000 RPM with the right and 11.6 in 1500 RPM with the left. The ICC of straight leg raising test was 0.993 with the left leg and 0.992 with the right leg. Passive knee extension test showed 0.994 and 0.993, and modified popliteal angle measurement showed 0.996 and 0.993 in ICC. The SEM of passive knee extension test
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was 2.6 with the left leg and 10.1 with the right leg. Straight leg raising test showed 2.7 and 3 , and modified popliteal angle measurement showed 2.2 and 2.9 in SEM. Conclusions: The newly invented equipment for assessing popliteal angle in sitting position showed excellent intrarater reliability. Poster 232 Age and Disease Severity Interactions with Hyaluronic Acid (HA) Viscosupplementation on Synovial Fluid Inflammatory Proteins in Knee Osteoarthritis. Heather K. Vincent, PhD (University of Florida, Gainesville, FL, United States); Susan Percival, PhD; Bryan Conrad, PhD; Amanda Seay, BS; Cindy Montero, MS; Kevin R. Vincent, MD, PhD. Disclosures: H. K. Vincent, Research grants, NIH, Obesity Society. Objective: This study examined the changes in synovial fluid levels of cytokines, oxidative stress and viscosity six months after intraarticular hyaluronic acid (HA) in older and elderly adults with knee osteoarthritis (OA). Design: This was a prospective, repeated-measures study design. Setting: Academic institution and research laboratories. Participants: Patients with knee OA (N¼28) were stratified by age (50-64 years and 65 years). Interventions: Three weekly knee intraarticular injections of 1% sodium hyaluronate. Main Outcome Measures: Ambulatory knee pain values and self-reported physical activity were collected at baseline and month six. Knee synovial fluid aspirates were collected at baseline and at six months. Fluid samples were analyzed for proinflammatory cytokines (interleukins 1b, 6,8,12, tumor necrosis factor-a, monocyte chemotactic protein), anti-inflammatory cytokines (interleukins 4, 10 13), oxidative stress (4-hydroxynonenal) and viscosity at two different physiological shear speeds 2.5Hz and 5Hz. Results or Clinical Course: HA improved ambulatory knee pain in both age groups by month six, but older patients reported less knee pain-related interference with participation in exercise than elderly adults. A greater reduction in TNF-a occurred in older patients compared to elderly patients (-95.8% 7.1% vs. 19.2% 83.8%, respectively; p¼.044). Fluid tended to improve at both shear speed in the older group compared to the elderly group. The reduction in pain severity correlated with the change in IL-1b levels by month six (r¼ -.566; p¼.044). Discussion: HA improved ambulatory knee pain in both age groups by month six, but older patients reported less knee painrelated interference with participation in exercise than elderly adults. A greater reduction in TNF-a occurred in older patients compared to elderly patients (-95.8% 7.1% vs. 19.2% 83.8%, respectively; p¼.044). Fluid tended to improve at both shear speed in the older group compared to the elderly group. The reduction in pain severity correlated with the change in IL-1b levels by month six (r¼ -.566; p¼.044). Conclusions: Reduction of knee pain might be due to improvements in synovial fluid viscosity and inflammation. Cartilage preservation may be dependent on how cytokine, oxidative stress profiles and viscosity change over time.
Disclosures: K. Lee, No Disclosures: I Have Nothing To Disclose. Objective: The purpose of this study was to evaluate the effect of hamstring stretching exercise on gait pattern. Setting: Thirty healthy male adults were tested for hamstring flexibility and gait pattern before and after intermittent hamstring stretching exercise (stretching and resting for 30 seconds each, alternatively, 3 times). The hamstring flexibility was measured with four different methods including straight leg raise test (SLRT), popliteal angle test (PA), modified popliteal angle test (MPA) and sitting popliteal angle test (SPA). We analyzed gait pattern by measuring peak plantar pressures and ground contact times during walking by EMEDÒ system. Results or Clinical Course: There were significant increases in hamstring flexibility in all 4 methods after stretching exercise (p<.05). In gait pattern analysis, there were significant decreases in the ground contact time that takes from the leaving point of center of pressure from hindfoot to the end of heel off (p<.05). Also, the peak plantar pressure of the end of heel off was also significantly decreased (p<.05). Conclusions: When we analyzed gait patterns after the stretching exercise, there were significant reduction in mid stance duration and peak plantar pressure. We assumed that changes in the gait patterns are caused by eased ankle dorsiflexion in mid stance, and it might be related to improved flexibility of gastrocnemius as well as hamstring. Poster 231 Novel Evaluating Method of Hamstring Flexibility. Sang Won Kong, MD (Hanyang Univ. Hospital, Seoul, Korea, Republic of); Junho Kim, MD; Taikon Kim, MD, PhD; Kyu Hoon Lee, MD; Do Hyun Yoon, MD; Seung Hoon Han, MD, PhD; Si Bog Park, MD, PhD. Disclosures: S. Kong, No Disclosures: I Have Nothing To Disclose. Objective: Many tests to evaluate hamstring flexibility are usually subjective and done manually. The results of these tests can be easily changed by rater’s condition. Thus, we made a novel equipment to assess objectively hamstring flexibility and examined the intra-rater reliability of it. Setting: Thirty female subjects in twenties and thirties were tested to assess hamstring flexibility in four different methods; Sitting popliteal angle measurement, straight leg raising test, passive knee extension test and modified popliteal angle measurement. Novel equipment was used in terms of sitting popliteal angle. It consists of sitting chair, leg-raising device, speed controller, two pieces of sliding boards with different sensors. This machine raised the leg at three different angular velocities (500, 1,000 and 1,500 revolutions per minute (RPM)). Each test was repeated three times and the intraclass correlation coefficient (ICC) and standard error of measurement (SEM) were calculated. Results or Clinical Course: The ICC of sitting popliteal angle measurement showed excellent reliability (0.927) at angular velocity of 1000 RPM with the right leg and also showed excellent reliability (0.867) in 1500 RPM with the left leg. The SEM was 5.9 in 1000 RPM with the right and 11.6 in 1500 RPM with the left. The ICC of straight leg raising test was 0.993 with the left leg and 0.992 with the right leg. Passive knee extension test showed 0.994 and 0.993, and modified popliteal angle measurement showed 0.996 and 0.993 in ICC. The SEM of passive knee extension test
Vol. 5, Iss. 9S, 2013
S219
was 2.6 with the left leg and 10.1 with the right leg. Straight leg raising test showed 2.7 and 3 , and modified popliteal angle measurement showed 2.2 and 2.9 in SEM. Conclusions: The newly invented equipment for assessing popliteal angle in sitting position showed excellent intrarater reliability. Poster 232 Age and Disease Severity Interactions with Hyaluronic Acid (HA) Viscosupplementation on Synovial Fluid Inflammatory Proteins in Knee Osteoarthritis. Heather K. Vincent, PhD (University of Florida, Gainesville, FL, United States); Susan Percival, PhD; Bryan Conrad, PhD; Amanda Seay, BS; Cindy Montero, MS; Kevin R. Vincent, MD, PhD. Disclosures: H. K. Vincent, Research grants, NIH, Obesity Society. Objective: This study examined the changes in synovial fluid levels of cytokines, oxidative stress and viscosity six months after intraarticular hyaluronic acid (HA) in older and elderly adults with knee osteoarthritis (OA). Design: This was a prospective, repeated-measures study design. Setting: Academic institution and research laboratories. Participants: Patients with knee OA (N¼28) were stratified by age (50-64 years and 65 years). Interventions: Three weekly knee intraarticular injections of 1% sodium hyaluronate. Main Outcome Measures: Ambulatory knee pain values and self-reported physical activity were collected at baseline and month six. Knee synovial fluid aspirates were collected at baseline and at six months. Fluid samples were analyzed for proinflammatory cytokines (interleukins 1b, 6,8,12, tumor necrosis factor-a, monocyte chemotactic protein), anti-inflammatory cytokines (interleukins 4, 10 13), oxidative stress (4-hydroxynonenal) and viscosity at two different physiological shear speeds 2.5Hz and 5Hz. Results or Clinical Course: HA improved ambulatory knee pain in both age groups by month six, but older patients reported less knee pain-related interference with participation in exercise than elderly adults. A greater reduction in TNF-a occurred in older patients compared to elderly patients (-95.8% 7.1% vs. 19.2% 83.8%, respectively; p¼.044). Fluid tended to improve at both shear speed in the older group compared to the elderly group. The reduction in pain severity correlated with the change in IL-1b levels by month six (r¼ -.566; p¼.044). Discussion: HA improved ambulatory knee pain in both age groups by month six, but older patients reported less knee painrelated interference with participation in exercise than elderly adults. A greater reduction in TNF-a occurred in older patients compared to elderly patients (-95.8% 7.1% vs. 19.2% 83.8%, respectively; p¼.044). Fluid tended to improve at both shear speed in the older group compared to the elderly group. The reduction in pain severity correlated with the change in IL-1b levels by month six (r¼ -.566; p¼.044). Conclusions: Reduction of knee pain might be due to improvements in synovial fluid viscosity and inflammation. Cartilage preservation may be dependent on how cytokine, oxidative stress profiles and viscosity change over time.