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Article of the Month


Early Knee OA is evident one year following anterior cruciate ligament reconstruction.
Arthritis & Rheum 2015, 67, 4: 946-55


Prevalence of radiographic knee osteoarthritis (OA) is reported as high as 50-90% one decade after Anterior Cruciate Ligament Replacement (ACLR) irrespective of surgical vs conservative management. The goal of this study was to use while-joint semiquantitative approach to examine prevalence of OA. Secondary measures were to describe clinical factors associated with OA presence. 111 participants 1 year after ACLR had MRI obtained and compared to 20 age, sex and activity level-matched uninjured controls to determine presence of knee OA and specific features.


MRIs were read by MSK radiologist with 14 years’ experience in semiquantitative MRI evaluation of the knee. Following ACLR, medical and lateral tibiofemoral OA on MRI was observed in 7 (6%) and 12 (11%) respectively out of 111 participants while 19 had patellofemoral OA (17%). Femoral trochlea was the region most affected by bone marrow lesions (19%), cartilage lesions (31%) and osteophyte (37%). Meniscectomy at time of ACLR (OR 6.8) and BMI >25kg/m2 (OR 3.0) predicted MRI-defined tibeofemoral OA and osteophytes respectively.


OA 1 year following ACLR was more common that previously recognized, while being absent in uninjured control knees. The patellofemoral compartment (specifically the medial femoral trochlea) seems to be at particular risk for early OA after ACLR. Importantly, pathology in the patellofemoral joint included not only early features of OA, such as bone marrow lesions and partial thickness cartilage loss, but also frank osteophytes on MRI. Limitations include inability to access preoperative imaging.


Summary by: Ilya Igolnikov, MD, MS


Clinical Evolution of Parkinson’s Disease and Prognostic Factors Affecting Motor Progression


Previous studies have shown variable findings regarding predictors of Parkinson’s Disease impairment, motor function, and progression.  This cohort study investigated factors affecting progression and rate of progression of the disease.  The study sample included 576 patients who had a diagnosis of Parkinson’s disease.  Subjects were majority ethnic Chinese (86%), with average age of 63.67 years old.  Patients were assessed for age, motor score at baseline, Hoehn and Yahr (HY)


Scale at baseline, subtype of either akinetic-rigid (AR), tremor dominant (TD), or mixed (MX), Mini-Mental Status Exam (MMSE), and Unified Parkinson’s Disease Rating Scale (UPDRS).  Medications were recorded.  Patients were followed over 9 years and follow-up HY and UPDRS III (motor score) were taken.  This study demonstrated that Parkinson’s disease progresses in phases rather than linearly, as was previously reported.  Phase I showed improvement from baseline, phase II showed return to baseline and phase III showed progression from baseline.  This study supported previous reports that greater progression of disease and motor impairment is seen in males, older age at diagnosis, greater motor impairment at diagnosis, higher cognitive impairment, and AR subtype.


Conclusion:  This cohort study of patients with Parkinson’s disease demonstrated that the disease progresses in a non-linear fashion, and corroborated evidence of specific prognostic factors for greater rate of disease progression.


Reinoso, G., et. al. Clinical evolution of Parkinson’s disease and prognostic factors affecting motor progression: 9-year follow-up study.  E J of Neurology.   2015, 22: 457-463.


Summary by: Benjamin Leshin, MD


Early Spontaneous Recovery After Ischemic Stroke is Associated with Functional Independence


The current predictors of stroke prognosis are not sufficient.  Previous reports have shown a relationship between early neurological improvement and its predictive value of a good prognosis, however, a detailed relationship between the time of neurological improvement (TNI) and functional outcome has not been elucidated.  This is a study of 410 consecutive patients admitted for acute stroke not treated with tissue plasminogen activator, with their National Institute of Health Stroke Scale (NIHSS) tracked for 14 days.  Neurological improvement was defined as an improvement in the NIHSS by ≥2 points (NI2) or ≥4 points (NI4) or an NIHSS of 0.  Patients with Modified Rankin Scale (mRS) score of ≤ 2 were considered to have good outcome, measured at 3 months.   

Patients with earlier improvements had a higher probability of good outcome; 86% of TNI2 and 92% of TNI4 within 1 day had a good outcome.  The best threshold for predicting a good outcome was day 3 for TNI2 (sensitivity, 63%; specificity, 65%; positive predictive value, 81%; negative predictive value 43%) and day 14 of TNI4.  Univariate analysis revealed that good outcome was associated with TNI and lacunar-type stroke; and poor outcome with increased age, initial NIHSS, and presence of atrial fibrillation. 


Conclusion:  Earlier improvement is associated with a better 3-month mRS score and a higher likelihood of functional independence in patients who are not treated with thrombolytic agents. 


Song Y et al.  Timing of neurological improvement after acute ischemic stroke and functional outcome.  European Neurology.  2015; 73:  164-170.


Contributing author: Anthony Cuneo, MD/PhD



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