The Effect of Lipedema on Knee Osteoarthritis

Western Ontario and McMaster Universities (WOMAC) score

The WOMAC Osteoarthritis Index questionnaire, consisting of 5 questions using a Likert scale, is provided in the attached case report form to assess pain, stiffness, and daily living functions. The WOMAC Osteoarthritis Index consists of 24 questions covering three subscales: pain (5 questions), stiffness (2 questions), and function (17 questions). The scoring system consists of the WOMAC pain score, WOMAC stiffness score, WOMAC function score, and WOMAC total score. A Turkish validity and reliability study has been conducted.

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Visual analog scale

Visual analog scale measures pain as it is subjectively perceived. It uses a 0-10 cm scale, the most commonly used tool for quantitatively determining pain intensity, with one end representing no pain and the other end representing the most severe pain possible. '0' indicates no pain, while '10' indicates the most severe pain. The individual is asked to select the numerical value that best represents their condition. This marked value is used as numerical data to determine the level of pain perception. A higher score indicates a higher level of pain.

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Joint Range of Motion measurement

Knee flexion and extension will be measured bilaterally using universal goniometry to assess patients' joint range of motion, and the angles will be recorded.

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Kellgren-Lawrence Classification

The Kellgren and Lawrence system is a widely used method that classifies the severity of knee osteoarthritis into five grades.

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Assessment of osteophytes via ultrasonography

During osteophyte assessment, participants will be positioned in the supine position with the knee flexed approximately 30 degrees; the probe will be placed along the medial and lateral joint lines in the longitudinal and transverse planes to examine bony projections. Osteophytes will be scored according to the Outcome Measures in Rheumatology knee osteoarthritis scale criteria as small (\<2 mm - Grade 1), moderate (2-4 mm - Grade 2), and large (\>4 mm - Grade 3).

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Assessment of synovial hypertrophy via ultrasonography

In the ultrasound assessment of synovial hypertrophy, the thickness of hypoechoic tissue in the suprapatellar region that does not shift upon probe compression will be measured, and values exceeding 2 mm will be recorded as synovial hypertrophy.

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Assessment of synovial effusion via ultrasonography

Ultrasonographic assessment of joint effusion will be performed at the suprapatellar recess level; participants will be positioned in the supine position with the knee in near-extension or slight flexion. During the longitudinal plane examination, anechoic fluid collections will be measured, and values of 4 mm or greater will be considered pathological synovial effusions.

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Assessment of meniscal protrusions via ultrasonography

During the ultrasound assessment of meniscus protrusion, the knee will be positioned with approximately 30 degrees of flexion, and the extent to which the meniscus tissue extends beyond the tibial margin will be evaluated in measurements taken in the longitudinal plane along the medial joint line; protrusions exceeding 3 mm will be considered pathological meniscus protrusions.

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Ultrasonography-based measurements of quadriceps muscle thickness

For ultrasonographic measurements of quadriceps muscle thickness, participants will be positioned in the supine position with the knee extended and the muscles fully relaxed; measurements taken in the transverse plane at the midpoint between the anterior superior iliac spine and the superior pole of the patella will assess the thicknesses of the rectus femoris and vastus intermedius muscles together.

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Ultrasonography-based measurements of quadriceps tendon thickness

Ultrasonographic measurements of the quadriceps tendon will be taken in the longitudinal plane immediately proximal to the superior pole of the patella while the knee is flexed to approximately 30 degrees, and the average of the measurements taken 5, 10, and 15 mm proximal to this point will be recorded

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Ultrasonography-based measurements of patellar tendon thickness

Ultrasonographic assessment of the patellar tendon is performed with the knee flexed to 30 degrees, in the longitudinal plane from the apex of the patella distally, and the anteroposterior thickness is measured approximately 5 mm distal to the apex.

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