Patello-femoral cartilage damage: patients with grade 4 chondral defects of the patella have increased disability

s / Osteoarthritis and Cartilage 21 (2013) S63–S312 S151 282 PATELLO-FEMORAL CARTILAGE DAMAGE: PATIENTS WITH GRADE 4 CHONDRAL DEFECTS OF THE PATELLA HAVE INCREASED DISABILITY K.K. Briggs, J. Steadman. Steadman Philippon Res. Inst., Vail, CO, USA Purpose:Patello-femoral (PF) cartilagedamagecancauseseverekneepain and result in increasing disability. The purpose of this studywas to identify factors associated with grade 4 defects of the patello-femoral joint. Methods: A cohort of 2601 patients (average age1⁄445, range, 18 to 83) who underwent knee arthroscopy for knee pathology were studied prospectively. All patients had complete demographic data, surgical data, WOMAC scores, and health status (SF12) collected at initial exam and stored in a data registry. Patients with chondral defects of the knee were included. Patients less than 18 years of age were excluded. Results: Grade 4 PF chondral defects were seen in 23% (586) of knees, with 6% (150) patellar (PAT) defects, 10% (267) trochlear groove (TG) defects and 6% (169) combined PAT and TG defects. 29% of patients with grade 4 PF chondral defects had medial compartment chondral defects, while 14% of patients with no PF chondral defect had medial compartment chondral defects (p<0.001). 20% of patients with PF chondral defects had lateral compartment chondral defects, while 12% of knees with no PF chondral defect had lateral compartment chondral defects. PF chondral defects were 3.0 [95%CI: 2.1 to 4.3] times more likely to be chronic injuries. Knees without PF defects were 20 [95%CI: 15.7 to 26.2] times more likely to have ligament injuries than knees with PF defects. Patients with grade 4 TG defects were older (51 vs 45) and had increased stiffness (how was stiffness determined?) compared to other patients (p<0.001). Patients with grade 4 PAT defects were older (52 vs 45; p<0.001) and had increased pain compared to other patients. Patients with diffuse grade 4 PAT defects had increased age, increased WOMAC (increased disability) and decreased Lysholm scores. Conclusions: This study confirms that grade 4 defects of the PF compartment are common. They often occur with chondral defects in other compartments; however, they are not associated with ligament or meniscus injuries. Patients with PF defects are older than patients with other cartilage damage, and patients with grade 4 diffuse defects of the patella suffer the most disability and loss of function. These data confirm the importance of new treatment strategies for chondral defects of the patellofemoral compartment, especially since patellar resurfacing remains controversial. Figure 1. Comparison of cumulative survival in females according to joints affected with radiological osteoarthritis (OA) at baseline Log rank test P value <0.001 demonstrates significant differences between groups. Participants with hip and knee OA have a decreased survival time compared to controls (P value<0.00.1). 283 ARTHROCENTESIS TRAINING USING A KNEE SIMULATION MODEL J. Brodsky, E. Patton, H.D. Fischer. Beth Israel Med. Ctr., NY, USA Purpose: Arthrocentesis of the knee is one of the most commonly performed procedures in the evaluation and treatment of joint diseases. The American Board of Internal Medicine requires that all candidates demonstrate competency in arthrocentesis. Unfortunately, physicians may have limited exposure to patients requiring this procedure and alternative training methods may be needed. We studied the benefit of using a specialized knee mannequin for simulation training of arthrocentesis. Methods: We developed a program for simulation training in arthrocentesis. The goal was to assess whether such a program is beneficial in acquiring the skills needed to perform the procedure. Internal Medicine residents and medical students were given a didactic lecture on the principles of joint aspiration. Thiswas followedbyhands on trainingbyall participants using a simulated knee joint (Sawbones Pacific Research Labs Inc, Vashon Island,WA). This kneemodel is equippedwith anelectric buzzer. When the procedure is correctly performed, the buzzer provides immediate feedback. All participants completed an anonymous questionnaire on arthrocentesis before and after the training session. Results: 41 Internal Medicine residents, PGY1: 13, PGY2: 10, PGY3: 8, PGY4: 1, as well as 9 medical students participated. 64.4% were male and 36.4% were female. Only 9.8% of those surveyed felt that they were adequately trained in medical school in arthrocentesis. Preparedness to perform arthrocentesis was measured on a scale of 1, being the least prepared, to 10, being the most prepared. Preprogram preparedness averaged 3.36 and post program preparedness rose to 6.95 (p<0.001). Similarly, preprogram confidence in performing arthrocentesismeasured 2.75 and post program confidence rose to 6.82 (p<0.001). Prior to simulation training, 56.1% felt reluctant to perform a needed arthrocentesis, which decreased to 31.7% following the training (p-value1⁄40.0124). Conclusions: The use of a knee simulation model to train Internal Medical residents and medical students in the performance of arthrocentesis was studied. This training increased the participants’ confidence, preparedness, and comfort in performing the procedure. When there are a limited number of patients requiring arthrocentesis available to train residents in this procedure, the use of a simulation knee model appears to be a valuable alternative. 284 OSTEOARTHRITIS AND MORTALITY: META-ANALYSIS OF TWO PROSPECTIVE COHORTS M.C. Castano Betancourt, A. Dehghan, N. Campos, L. Oei, T. Hoeven, E. Oei, F. Rivadeneira, O. Franco, A. Hofman, A. Uitterlinden, S. Bierma-Zeinstra, J. van Meurs. ErasmusMC, Rotterdam, The