الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
steoarthritis is the most common arthritic disease worldwide leading to debilitating pain (which is the hallmark symptom of the disease) and destruction of joint tissues. The exact etiopathogenesis of Knee osteoarthritis pain is unclear, but clinical, imaging and biochemical observations indicate that inflammation may contribute to both structural disease progression and pain.
In the recent past, knee osteoarthritis was considered as a pathologic condition that affects cartilage and bone, but now realized that all joint tissues, including the synovium, menisci, ligaments, periarticular muscles and the joint capsule are involved. In addition to these structures, the knee joint also contains adipose tissue called the infrapatellar fat pad or Hoffa fat pad.
The infrapatellar fat pad is an intra-capsular, yet extra-synovial, adipose structure in the anterior part of the knee joint closely related to the articular cartilage, bone, and synovium , It contains adipocytes, macrophages, and immune cells capable of producing inflammatory cytokines and several studies suggest that inflammatory processes occur in the infrapatellar fat pad. In addition, nociceptive nerve fibers are present in it, and it has been shown that inflammatory cytokines lower the threshold of such joint nociceptors, inducing and worsening pain, so the severe inflammation in infrapatellar fat pad is associated with severe pain in knee osteoarthritis.
Ultrasonography (US) has been considered as an indispensable tool for primarily evaluating a variety of musculoskeletal disorders. Hence, it offers certain advantages over other imaging modalities: it is a readily available, noninvasive, and cost-effective method. In the setting of a superficial soft tissue mass, US offers higher spatial resolution than magnetic resonance imaging (MRI) and allows both static and dynamic assessments.
The aim of the study was to assess inflammation of infrapatellar fat pad by musculoskeletal Doppler US in knee osteoarthritis patients and its contribution to anterior knee pain severity and different lines of treatment.
This case-control study was conducted on 30 knee osteoarthritis patients and 30 patients with anterior knee pain without osteoarthritis. Diagnosis of knee osteoarthritis is based on American College of Rheumatology clinical and radiographic classification criteria for knee osteoarthritis. Each group of patients was divided into 2 subgroups: 15 patients were subjected to weight reduction, NSAID for 2 weeks, and physiotherapy in the form of US, Trans cutaneous electrical nerve stimulation (TENS), and strengthening exercises for quadriceps muscles. Fifteen patients were subjected to US guided local steroid and anesthetic injection in the infrapatellar fat pad under sterile conditions. The injectate was 40 mg methylprednisolone acetate and 1.8 ml of mepivacaine HCl 3% every 4 weeks for a maximum 3 injections.
Flexion ROM and extension ROM before treatment were insignificantly different between group 1B and group 1A and between group 2B and group 2A while were significantly higher in 2B and 2A than 1A and 1B. Flexion ROM and extension ROM after treatment were insignificantly different between group 1B and group 1A and between group 2B and group 2A while were significantly higher in group 2B than 1B and in group 1B than group 2A and in group 2A than group 1A.
The lateral recess effusion before treatment was significantly different among the studied groups and after treatment was insignificantly different among the studied groups.
Medial femorotibial joint osteophytes before and after treatment was insignificantly different among the studied groups.
Femoral cartilage assessment before and after treatment was insignificantly different among the studied groups.
Echogenicity of Hoffa fat pad before and after treatment was significantly different among the studied groups.
Hoffa fat pad width before treatment was insignificantly different among the studied groups. Hoffa fat pad width after treatment was significantly different among the studied groups. The Hoffa fat pad width after treatment was significantly lower in group 2B than 1B and in group 1B than group 2A and in group 2A than group 1A.
Largest fat lobule width before treatment was insignificantly different among the studied groups. Largest fat lobule width after treatment was significantly different among the studied groups. Largest fat lobule was significantly higher in group 2B than 1B and in group 1B than group 2A and in group 2A than group 1A.
Largest fat lobule motion before and after treatment was insignificantly different among the studied groups.
The WOMAC index before and after treatment was significantly different among the studied groups. The WOMAC index before treatment was insignificantly different between group 1A and group 2A, and in group 1B and group 2B while was statistically significant lower in group 2B and 1B than group 1A and in group 1B and 2B group than 2A group . The WOMAC index after treatment was statistically significant different among the studied groups. WOMAC index was significantly lower in group 2B than 1B and in group 1B than group 2A and in group 2A than group 1A.
The VAS scale before treatment was insignificantly different among the studied groups. The VAS scale after treatment was significantly different among the studied groups. The VAS was statistically significant lower in group 2B than 1B and in group 1B than group 2A and in group 2A than 1A.