Comparison of the Effects of Two Different Exercise Programs on Femoral Cartilage Thickness and Clinical Parameters in Individuals With Knee Osteoarthritis

Официальное название

Comparison of the Effects of Two Different Home Exercise Programs on Femoral Cartilage Thickness and Clinical Parameters in Individuals With Knee Osteoarthritis: A Randomized Controlled Trial

Обзор

Knee osteoarthritis (OA) is one of the most common joint disorders worldwide and is a leading cause of pain, limited mobility, and functional disability, particularly in the elderly population. According to 2020 data, approximately 654 million individuals aged 40 years and older are affected by knee OA worldwide, with a global prevalence of 22.9% in this age group. In our country as well, OA is reported as the second most common rheumatologic disease. The disease not only negatively affects individuals' quality of life but also creates a significant socioeconomic burden through work loss, hospital admissions, and the need for surgical interventions. The pathogenesis of knee OA is a complex process involving articular cartilage degeneration, subchondral bone sclerosis, synovial tissue proliferation, and osteophyte formation. Once cartilage damage begins, its capacity for spontaneous healing is extremely limited; therefore, early interventions aimed at slowing or halting disease progression are of critical importance. In this context, non-pharmacological interventions, particularly exercise programs that may contribute to maintaining cartilage integrity, are strongly recommended as first-line treatment options in current clinical guidelines. The beneficial effects of exercise therapy on pain and function in patients with knee OA are well documented. However, the structural effects of exercise on femoral cartilage thickness have been relatively less investigated. Tuna et al. evaluated femoral cartilage thickness using ultrasonography in 40 patients with knee OA following a 12-week quadriceps strengthening program and reported statistically significant increases in cartilage thickness in the medial condyle, lateral condyle, and intercondylar region at 3 months. This pioneering study suggests that muscle strengthening programs may have not only symptomatic but also structural benefits. Similarly, Bozan et al. reported a strong positive correlation between quadriceps muscle thickness (rectus femoris + vastus intermedius) and femoral cartilage thickness, supporting the idea that muscle loss parallels cartilage degeneration. However, these studies focused exclusively on the quadriceps muscle, and the effects of hip musculature on femoral cartilage thickness have not been investigated. Recent biomechanical studies indicate that hip abductor and adductor muscles play a critical role in knee joint loading patterns. Hip abductor muscles provide pelvic stability during gait and directly influence knee adduction moments. Weakness of the gluteus medius leads to contralateral pelvic drop, increasing medial compartment loading on the ipsilateral knee and accelerating medial tibiofemoral cartilage wear. Indeed, Segal et al., using data from the Multicenter Osteoarthritis Study (MOST), demonstrated via MRI that greater hip abductor strength significantly reduces the risk of progression of medial patellofemoral and lateral tibiofemoral cartilage damage. On the other hand, hip adductor muscles are also thought to contribute to knee adduction moments by eccentrically controlling femoral varus motion; however, this relationship has been studied far less compared to quadriceps and abductors. Systematic reviews and meta-analyses have shown that individuals with knee OA have up to 24% lower isometric hip abductor strength compared to healthy controls. Randomized controlled trials investigating combined hip and quadriceps strengthening programs have reported significant improvements in pain and function. However, none of these studies have used femoral cartilage thickness measured by ultrasonography as a primary outcome. A review of the current literature reveals that although studies exist examining the effects of quadriceps strengthening on femoral cartilage thickness, no randomized controlled trial has compared hip abductor and adductor strengthening exercises with a quadriceps strengthening program, using ultrasonographic femoral cartilage thickness as the primary outcome measure. This study aims to address this gap. All interventions will be applied as non-invasive home exercise programs, and all measurements will be performed using ultrasonography. Baseline, 1-month, and 3-month assessments will also allow evaluation of the temporal effects of exercise on cartilage structure. The findings are expected to provide scientific evidence regarding the structural protective effects of hip exercises in knee OA rehabilitation and serve as pilot data for future large-scale multicenter studies. The aim of this study is to compare patients with knee OA receiving quadriceps strengthening exercises alone with those receiving additional hip abductor/adductor strengthening exercises in terms of changes in femoral cartilage thickness, and to evaluate whether there is a correlation between femoral cartilage thickness and the thickness of the rectus femoris, gluteus medius,

Вмешательства

• Другое Quadriceps Plus Hip Strengthening Exercises
  quadriceps strengthening exercises combined with hip abductor and adductor strengthening exercises
• Другое Quadriceps Strengthening Exercises
  quadriceps strengthening exercise program

Первичные конечные точки

• Medial femoral condyle cartilage thickness (mm) [Срок оценки: Participants receiving treatment will be evaluated at baseline (T0), at Month 1 (T1), and at Month 3 (T2).]

Вторичные конечные точки (9)

• Lateral femoral condyle cartilage thickness (mm) [Срок оценки: Participants receiving treatment will be evaluated at baseline (T0), at Month 1 (T1), and at Month 3 (T2).]
• Intercondylar area cartilage thickness (mm) [Срок оценки: Participants receiving treatment will be evaluated at baseline (T0), at Month 1 (T1), and at Month 3 (T2).]
• Ultrasound Femoral Cartilage Degeneration Grade [Срок оценки: Participants receiving treatment will be evaluated at baseline (T0), at Month 1 (T1), and at Month 3 (T2).]
• Synovial Hypertrophy Grade [Срок оценки: Participants receiving treatment will be evaluated at baseline (T0), at Month 1 (T1), and at Month 3 (T2).]
• Rectus femoris muscle thickness (cm) [Срок оценки: Participants receiving treatment will be evaluated at baseline (T0), at Month 1 (T1), and at Month 3 (T2).]
• Gluteus medius (GMed) muscle thickness (cm) [Срок оценки: Participants receiving treatment will be evaluated at baseline (T0), at Month 1 (T1), and at Month 3 (T2).]
• Adductor longus muscle thickness (cm) [Срок оценки: Participants receiving treatment will be evaluated at baseline (T0), at Month 1 (T1), and at Month 3 (T2).]
• Visual Analog Scale (VAS) [Срок оценки: Participants receiving treatment will be evaluated at baseline (T0), at Month 1 (T1), and at Month 3 (T2).]
• WOMAC Osteoarthritis Index [Срок оценки: Participants receiving treatment will be evaluated at baseline (T0), at Month 1 (T1), and at Month 3 (T2).]

Критерии участия

Критерии включения

• Age ≥18 years
• Diagnosis of knee osteoarthritis according to ACR criteria, Kellgren-Lawrence grade 2-3
• Knee pain for at least 3 months
• Having the physical capacity to perform a home exercise program
• Willingness to provide written informed consent

Критерии исключения

• History of knee, hip, or spine surgery
• Active inflammatory arthritis (e.g., rheumatoid arthritis, gout, psoriatic arthritis)
• Intra-articular injection within the last 3 months
• Neurological or neuromuscular disorders
• Body mass index (BMI) > 40 kg/m²
• Pregnancy
• Cardiovascular or orthopedic contraindications preventing participation in a regular exercise program
• Cognitive impairment

Критерии приведены из реестра в оригинале (на английском). Окончательную оценку соответствия проводит исследовательский центр.

Здоровые добровольцы: Нет

Дизайн исследования

Распределение

Рандомизированное

Модель

Параллельные группы

Маскирование

Простое слепое

Основная цель

Лечение

Центры проведения

Turkey (Türkiye) · 1 центр

• Kütahya Physical Therapy and Rehabilitation Hospital — Kütahya

Публикации

• Lee CL, Huang MH, Chai CY, Chen CH, Su JY, Tien YC. The validity of in vivo ultrasonographic grading of osteoarthritic femoral condylar cartilage: a comparison with in vitro ultrasonographic and histologic gradings. Osteoarthritis Cartilage. 2008 Mar;16(3):352-8. doi: 10.1016/j.joca.2007.07.013. Epub 2007 Oct 24. PMID 17920940
• Karalilova R, Kazakova M, Batalov A, Sarafian V. Correlation between protein YKL-40 and ultrasonographic findings in active knee osteoarthritis. Med Ultrason. 2018 Feb 4;1(1):57-63. doi: 10.11152/mu-1247. PMID 29400369
• Tuzun EH, Eker L, Aytar A, Daskapan A, Bayramoglu M. Acceptability, reliability, validity and responsiveness of the Turkish version of WOMAC osteoarthritis index. Osteoarthritis Cartilage. 2005 Jan;13(1):28-33. doi: 10.1016/j.joca.2004.10.010. PMID 15639634
• Manske RC, Wolfe C, Page P, Voight M. Diagnostic Musculoskeletal Ultrasound in the Evaluation of Adductor Longus Injuries: Implications for Rehabilitation Providers. Int J Sports Phys Ther. 2025 Nov 1;20(11):1670-1674. doi: 10.26603/001c.146209. eCollection 2025. PMID 41185658
• Whittaker JL, Emery CA. Sonographic measures of the gluteus medius, gluteus minimus, and vastus medialis muscles. J Orthop Sports Phys Ther. 2014 Aug;44(8):627-32. doi: 10.2519/jospt.2014.5315. Epub 2014 Jul 16. PMID 25029916
• Tillquist M, Kutsogiannis DJ, Wischmeyer PE, Kummerlen C, Leung R, Stollery D, Karvellas CJ, Preiser JC, Bird N, Kozar R, Heyland DK. Bedside ultrasound is a practical and reliable measurement tool for assessing quadriceps muscle layer thickness. JPEN J Parenter Enteral Nutr. 2014 Sep;38(7):886-90. doi: 10.1177/0148607113501327. Epub 2013 Aug 26. PMID 23980134
• KELLGREN JH, LAWRENCE JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957 Dec;16(4):494-502. doi: 10.1136/ard.16.4.494. No abstract available. PMID 13498604
• Bennell KL, Hunt MA, Wrigley TV, Hunter DJ, McManus FJ, Hodges PW, Li L, Hinman RS. Hip strengthening reduces symptoms but not knee load in people with medial knee osteoarthritis and varus malalignment: a randomised controlled trial. Osteoarthritis Cartilage. 2010 May;18(5):621-8. doi: 10.1016/j.joca.2010.01.010. Epub 2010 Feb 6. PMID 20175973

Идентификаторы

NCT: NCT07657481 · PamukkaleU.ftr-MArbayCeltek-01

Первоисточники (государственные реестры)

• ClinicalTrials.gov (NIH, США)

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