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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EBone marrow lesions may represent a viable target in the treatment of osteoarthritis (OA). This article discusses a randomized clinical trial in which a patellofemoral (PF) knee brace reduced both the volume of bone marrow lesions in the PF joint and PF-related knee pain.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArthritis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMetabolic Bone Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatology\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ERheumatology Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EArthritis\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EMetabolic Bone Disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EBone marrow lesions may represent a viable target in the treatment of osteoarthritis (OA). David T. Felson, MD, University of Manchester, Manchester, United Kingdom, described a randomized clinical trial in which a patellofemoral (PF) knee brace reduced both the volume of bone marrow lesions in the PF joint and PF-related knee pain.\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EBone marrow lesions represent lesions in subchondral bone caused in part by focal stress in the OA knee joint. Focal contact stress across the joint during weight bearing can cause bone trauma that leads to bone marrow lesions. Bone marrow lesions predict later cartilage loss at the same anatomic location and correlate with pain and pain severity. For these reasons, and because bone marrow lesion volumes fluctuate substantially in as little as 6 weeks [Felson DT et al. \u003Cem\u003EOsteoarthritis Cartilage\u003C\/em\u003E 2012], bone marrow lesion volume appears to be a good short-term structural outcome measure in OA trials, said Prof. Felson. PF bracing can increase contact area in the PF joint [Powers CM et al. \u003Cem\u003EClin J Sports Med\u003C\/em\u003E 2004], with the potential to reduce contact stress and shrink bone marrow lesions, he said, in explaining the rationale for a study of bracing in the disease.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EPatients aged 40 to 70 old (n=126) with daily knee pain \u226540 mm on a 1- to 100-mm visual analog scale (VAS) during a PF activity (eg, climbing or descending stairs, kneeling, prolonged sitting or squatting) for 3 months, a radiographic Kellgren-Lawrence Grade 2 or worse in the PF joint or PF OA worse than tibiofemoral disease, and confirmed PF joint tenderness on clinical examination were randomized to 6 weeks of treatment with a PF brace or no treatment.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EThe primary symptom outcome was the change in pain as measured on the VAS during nominated aggravating activity. The primary structural outcome was bone marrow lesion volume in the PF joint as assessed on contrast-enhanced magnetic resonance imaging. Tibiofemoral bone marrow lesion volume served as an untreated control region. In the treatment group, braces were worn for a mean of 7.35 hours per day. Five patients in the bracing group and one in the no-treatment group withdrew from the trial before completion.\u003C\/p\u003E\u003Cp id=\u0022p-6\u0022\u003EIn the bracing group, pain on the VAS during the nominating activity decreased by 18.16 mm, compared with a 1.29-mm reduction in the no-treatment group (p\u0026lt;0.001). Improvements in the Knee Injury and Osteoarthritis Outcome Score pain subscale and activities of daily living subscale were also significantly superior in the bracing group (p=0.02 for each vs no treatment; \u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E).\u003C\/p\u003E\u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/13838\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/13838\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/13838\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003ERandomized Trial Results\u003C\/p\u003E\n         \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-9\u0022\u003EPF bone marrow lesion volume decreased by a mean of 554.92 mm\u003Csup\u003E3\u003C\/sup\u003E in the bracing group, compared with a mean increase of 102.66 mm\u003Csup\u003E3\u003C\/sup\u003E in the no-treatment group (p=0.02). There was no significant difference between groups in the mean change in tibiofemoral bone marrow lesion volume or in synovitis volume.\u003C\/p\u003E\u003Cp id=\u0022p-10\u0022\u003EThe reduction in the size of bone marrow lesion volumes in the PF but not the tibiofemoral joint is consistent with a compartment-specific effect of the brace, concluded Prof. Felson.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2013 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/13\/18\/17.2.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzo6c1\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzo6c1\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}