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Bruder AM, Culvenor AG, King MG, Haberfield M, Roughead EA, Mastwyk J, Kemp JL, Ferraz Pazzinatto M, West TJ, Coburn SL, Cowan SM, Ezzat AM, To L, Chilman K, Couch JL, Whittaker JL, Crossley KM. Let's talk about sex (and gender) after ACL injury: a systematic review and meta-analysis of self-reported activity and knee-related outcomes. Br J Sports Med 2023; 57:602-610. [PMID: 36889918 DOI: 10.1136/bjsports-2022-106099] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVE Investigate sex/gender differences in self-reported activity and knee-related outcomes after anterior cruciate ligament (ACL) injury. DESIGN Systematic review with meta-analysis. DATA SOURCES Seven databases were searched in December 2021. ELIGIBILITY CRITERIA Observational or interventional studies with self-reported activity (including return to sport) or knee-related outcomes after ACL injury. RESULTS We included 242 studies (n=123 687, 43% females/women/girls, mean age 26 years at surgery). One hundred and six studies contributed to 1 of 35 meta-analyses (n=59 552). After ACL injury/reconstruction, very low-certainty evidence suggests females/women/girls had inferior self-reported activity (ie, return to sport, Tegner Activity Score, Marx Activity Scale) compared with males/men/boys on most (88%, 7/8) meta-analyses. Females/women/girls had 23%-25% reduced odds of returning to sport within 1-year post-ACL injury/reconstruction (12 studies, OR 0.76 95% CI 0.63 to 0.92), 1-5 years (45 studies, OR 0.75 95% CI 0.69 to 0.82) and 5-10 years (9 studies, OR 0.77 95% CI 0.57 to 1.04). Age-stratified analysis (<19 years) suggests female athletes/girls had 32% reduced odds of returning to sport compared with male athletes/boys (OR 0.68, 95% CI 0.41 to 1.13, I2 0.0%). Very low-certainty evidence suggests females/women/girls experienced inferior knee-related outcomes (eg, function, quality of life) on many (70%, 19/27) meta-analyses: standardised mean difference ranging from -0.02 (Knee injury and Osteoarthritis Outcome Score, KOOS-activities of daily living, 9 studies, 95% CI -0.05 to 0.02) to -0.31 (KOOS-sport and recreation, 7 studies, 95% CI -0.36 to -0.26). CONCLUSIONS Very low-certainty evidence suggests inferior self-reported activity and knee-related outcomes for females/women/girls compared with males/men/boys after an ACL injury. Future studies should explore factors and design targeted interventions to improve outcomes for females/women/girls. PROSPERO REGISTRATION NUMBER CRD42021205998.
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Affiliation(s)
- Andrea M Bruder
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia .,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Matthew G King
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Melissa Haberfield
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Eliza A Roughead
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - John Mastwyk
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Marcella Ferraz Pazzinatto
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Thomas J West
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Sally L Coburn
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Sallie M Cowan
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,Clifton Hill Physiotherapy, Melbourne, Victoria, Australia
| | - Allison M Ezzat
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Laura To
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,Clifton Hill Physiotherapy, Melbourne, Victoria, Australia
| | - Karina Chilman
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Jamon L Couch
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia.,Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
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2
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Guo Y, Li D, Wu YB, Sun X, Sun XY, Yang YP. Mobile health-based home rehabilitation education improving early outcomes after anterior cruciate ligament reconstruction: A randomized controlled clinical trial. Front Public Health 2023; 10:1042167. [PMID: 36711410 PMCID: PMC9877440 DOI: 10.3389/fpubh.2022.1042167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/21/2022] [Indexed: 01/13/2023] Open
Abstract
Objective This study aimed to assess changes in joint range of motion (ROM) and knee joint function between patients who received the mobile health-based intervention and those who received regular care at 2 and 6 weeks after anterior cruciate ligament (ACL) reconstruction to provide better interventions in the future. Methods Patients who underwent ACL reconstruction were randomized into the experimental [Mobile health-based intervention (MHI); n = 62] and control (CON) groups (n = 63). The CON group underwent home-based rehabilitation exercise following the paper rehabilitation schedule, while the intervention group received additional mobile health-based education at weeks 1-6 after surgery. ROM, thigh circumference difference, and flexion pain were the primary outcomes. The secondary outcomes were the international knee documentation committee knee evaluation form (IKDC) scores and rehabilitation compliance scores. All the outcomes were measured 1 day before surgery as references and at 2 and 6 weeks after surgery. Results There was no statistical difference in the patients' ROM, thigh circumference difference, and VAS scores at the 2-week follow-up. At the 6-week follow-up, the ROM of the affected leg was (118.1 ± 20.5)° in the CON group and (126.6 ± 20.5)° in the MHI group, and the difference was statistically significant (P = 0.011). The difference in thigh circumference was 3.0 (2.0, 3.5) cm in the CON group and 2.5 (1.0, 3.0) cm in the MHI group. The difference was statistically significant (P < 0.001). The VAS score in the CON group was 3.0 (2.0, 4.0), and the MHI group was 2.5 (1.0, 3.0). The difference was statistically significant (P < 0.05). At the 6-week follow-up, the compliance score of patients in the MHI group was significantly higher than that in the CON group (P = 0.047, β = 2.243, 95%CI: 0.026-4.459). There is no statistically significant difference in IKDC scores. Conclusion Mobile health-based intervention positively affected patients undergoing ACL reconstruction surgery, particularly in improving the clinical outcome indicators of the knee joint.
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Affiliation(s)
- Yi Guo
- Beijing Key Laboratory of Sports Medicine and Joint Injuries, Department of Sports Medicine, Peking University Third Hospital, Peking University Institute of Sports Medicine, Beijing, China,School of Public Health, Peking University Health Science Center, Beijing, China
| | - Dai Li
- School of Public Health, Peking University Health Science Center, Beijing, China
| | - Yi-bo Wu
- Beijing Key Laboratory of Sports Medicine and Joint Injuries, Department of Sports Medicine, Peking University Third Hospital, Peking University Institute of Sports Medicine, Beijing, China
| | - Xin Sun
- Beijing Key Laboratory of Sports Medicine and Joint Injuries, Department of Sports Medicine, Peking University Third Hospital, Peking University Institute of Sports Medicine, Beijing, China
| | - Xin-ying Sun
- Beijing Key Laboratory of Sports Medicine and Joint Injuries, Department of Sports Medicine, Peking University Third Hospital, Peking University Institute of Sports Medicine, Beijing, China,*Correspondence: Xin-ying Sun ✉
| | - Yu-ping Yang
- School of Public Health, Peking University Health Science Center, Beijing, China,Department of Sports Medicine, Peking University Third Hospital, Beijing, China,Yu-ping Yang ✉
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3
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Mao B, Pan Y, Zhang Z, Yu Z, Li J, Fu W. Efficacy and Safety of Hyaluronic Acid Intra-articular Injection after Arthroscopic Knee Surgery: A Systematic Review and Meta-analysis. Orthop Surg 2022; 15:16-27. [PMID: 36411508 PMCID: PMC9837239 DOI: 10.1111/os.13602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Hyaluronic acid (HA) intra-articular injection after arthroscopic knee surgery has been widely applied but its efficacy and safety remain controversial. The aim of this systematic review is to analyze the efficacy and safety of HA intra-articular injection after arthroscopic knee surgery, and to compare the efficacy of HA with different molecular weights. METHODS We conducted a systematic literature search in PubMed, Embase, Google scholar and the Cochrane library from inception to 16 September 2022 for English-written articles, in order to identify randomized controlled trials that evaluated the clinical efficacy and/or safety of HA intra-articular injection after arthroscopic knee surgery. Then we meta-analyzed the outcomes of patients given intra-articular HA injections postoperatively and control patients. We also evaluated the influence of HA with different molecular weights. In every calculation, sensitive analysis was performed. The visual analogue scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and adverse events were selected as the primary outcome measurements, while Lysholm, International Knee Documentation Committee (IKDC) and Tegner score were selected as the secondary outcome measurements. Publication bias of every outcome was evaluated using egger test. RESULTS Fifteen studies involving 951 knees were included and 12 of them were used to performed the meta-analysis. The results showed no significant difference between the HA group and control group according to VAS, whether assessed at less (P = 0.90) or more than 6 months (P = 0.55). Besides, there were no statistical differences between the HA group and control group according to subgroup analysis (Ps = 0.77, 0.91 and 0.81 in anterior cruciate ligament reconstruction, meniscectomy and overall groups, respectively). Compared to control group, the overall effect of WOMAC score showed no significant differences (P = 0.25), nor did in two subgroups (P = 0.37 and P = 0.22). Outcomes measured by Lysholm (P = 0.13), IKDC (P = 0.86) and Tegner (P = 0.42) scores showed no significant differences, either. The analysis of the risk of adverse events indicated no increase in HA groups (P = 0.06). We found no significant differences between high- and low-molecular-weight HA at 6 (P = 0.96) or 12 months (P = 0.93) postoperatively. Two studies failed to pass the sensitive analysis and the reasons were discussed detailly and acceptable publication bias was observed. CONCLUSIONS Although HA injection after arthroscopic knee surgery is safe, the available evidence does not support its efficacy in pain relief and functional recovery. Therefore, the application of HA injection after arthroscopic knee surgery is not recommended.
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Affiliation(s)
- BeiNi Mao
- Department of Orthopaedics SurgeryOrthopaedic Research Institute, West China Hospital, Sichuan UniversityChengduChina,Department of Orthopaedics SurgeryShenzhen Hospital, Southern Medical UniversityShenzhenChina
| | - YunLong Pan
- Department of RadiologyWest China Hospital, Sichuan UniversityChengduChina
| | - Zhong Zhang
- Department of Orthopaedics SurgeryOrthopaedic Research Institute, West China Hospital, Sichuan UniversityChengduChina,Department of Orthopaedics SurgeryNO. 3 People's Hospital of ChengduChengduChina
| | - ZePing Yu
- Department of Orthopaedics SurgeryOrthopaedic Research Institute, West China Hospital, Sichuan UniversityChengduChina
| | - Jian Li
- Department of Orthopaedics SurgeryOrthopaedic Research Institute, West China Hospital, Sichuan UniversityChengduChina
| | - WeiLi Fu
- Department of Orthopaedics SurgeryOrthopaedic Research Institute, West China Hospital, Sichuan UniversityChengduChina
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4
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Tripathy SK, Varghese P, Behera H, Balagod R, Rao P, Sahoo AK, Panda A. Intraarticular viscosupplementation following arthroscopic anterior cruciate ligament reconstruction: A systematic review. J Clin Orthop Trauma 2022; 28:101847. [PMID: 35378776 PMCID: PMC8976131 DOI: 10.1016/j.jcot.2022.101847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/04/2022] [Accepted: 03/23/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Pain, swelling and joint stiffness are the major problems following arthroscopic ACL reconstruction (ACLR) surgery that restrict early return to sports and athletic activities. The patients often receive prolonged analgesic medications to control the inflammatory response and resume the pre-injury activities. This systematic review aims to evaluate the safety and efficacy of intraarticular (IA) hyaluronic acid (HA) injection following ACLR. MATERIAL AND METHODS A literature search of electronic databases and a manual search of studies reporting clinical effectiveness of IA HA following ACLR was performed on 1st November 2020. The quality of the methodology and risk of bias was assessed using the Cochrane Collaboration Risk of Bias Tool and Newcastle-Ottawa scale for randomized-controlled trial and prospective cohort studies, respectively. RESULTS Of 324 studies retrieved, four studies (3 RCTs and one prospective cohort study) were found to be suitable for inclusion in this review. These studies had a low to moderate risk of bias. There were 182 patients in the HA group and 121 patients in the control group. The demographic characteristics of the patients were similar in all studies. The pooled analysis of studies evaluating pain at different follow up periods (2-week, 4-6 weeks, 8-12 weeks) after ACLR revealed no significant difference between the HA and control groups (p > 0.05). The knee swelling was significantly less in the HA group at two weeks (MD -7.85, 95% CI: [-15.03, -0.68], p = 0.03, I2 = 0%), but no such difference was noted after 4-6 weeks and 8-12 weeks. The functional outcome score was not significantly different between the groups (SMD 0.00, 95% CI: 0.38 to 0.38, p = 0.99, I2 = 0%). CONCLUSIONS Although the individual study demonstrated a short-term positive response regarding pain control and swelling reduction, the pooled analysis did not find any clinical benefit of IA HA injection following ACLR surgery. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Sujit Kumar Tripathy
- Dept. of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, India
- Corresponding author. Dept. of Orthopedics, All India Institute of Medical Sciences, 751019, Bhubaneswar, India.
| | - Paulson Varghese
- Dept. of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Hrudeswar Behera
- Dept. of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Raghavendra Balagod
- Dept. of Orthopedics, All India Institute of Medical Sciences, Bhubaneswar, India
| | - P.Bhaskar Rao
- Dept. of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Alok Kumar Sahoo
- Dept. of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Aparajita Panda
- Dept. of Anaesthesia and Critical Care, All India Institute of Medical Sciences, Bhubaneswar, India
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Heard BJ, Barton KI, Abubacker S, Chung M, Martin CR, Schmidt TA, Shrive NG, Hart DA. Synovial and cartilage responsiveness to peri-operative hyaluronic acid ± dexamethasone administration following a limited injury to the rabbit stifle joint. J Orthop Res 2022; 40:838-845. [PMID: 34061360 DOI: 10.1002/jor.25108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/03/2021] [Accepted: 05/25/2021] [Indexed: 02/04/2023]
Abstract
Posttraumatic osteoarthritis (PTOA) can develop after an injury to the knee. Previous studies have indicated that an intra-articular (IA) injection of the potent glucocorticoid dexamethasone (DEX) may significantly prevent induction of PTOA. The aim of the present study was to investigate the effectiveness of a single IA injection of hyaluronic acid (HA), alone and in combination with DEX following a localized intra-articular injury as a PTOA-preventing treatment option. An established rabbit model of surgical injury consisting of dual intra-articular (IA) drill holes in a non-cartilaginous area of the femoral notch near the origin of the anterior cruciate ligament (ACL) to allow for bleeding into the joint space was used. Immediately following surgery, subjects were treated with HA, HA + DEX, or received no treatment. An uninjured control group was used for comparison (N = 5/group). Rabbits were sacrificed and investigated at 9 weeks post-injury. At 9 weeks post-injury, there was a significant protective capacity of the single IA treatment of DEX + HA on the histological grade of the synovial tissue, and some variable location-specific effects of HA alone and HA + DEX interactions on cartilage damage. Thus, it is possible that co-treatment with HA may interfere with the effectiveness of the DEX. In vitro friction testing indicated that DEX did not interfere with the lubricating ability of HA or synovial fluid on cartilage. These results suggest that a single IA administration of HA in combination with DEX following an IA injury is not recommended for inhibition of PTOA progression in this model.
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Affiliation(s)
- B J Heard
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - K I Barton
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - S Abubacker
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - M Chung
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada
| | - C R Martin
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada
| | - T A Schmidt
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Sculich School of Engineering, University of Calgary, Calgary, Alberta, Canada
| | - N G Shrive
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Sculich School of Engineering, University of Calgary, Calgary, Alberta, Canada
| | - D A Hart
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada.,Bone & Joint Health Strategic Clinical Network, Edmonton, Alberta, Canada
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Andreani L, Giuntoli M, Addevico F, Aringhieri G, Cosottini M, Marchetti S. The effect of viscosupplementation on early-stage knee osteoarthritis: Clinical evaluation and assessment of cartilage in vivo with 7 T MRI. J Clin Orthop Trauma 2021; 19:53-61. [PMID: 34046300 PMCID: PMC8144354 DOI: 10.1016/j.jcot.2021.04.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/31/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Viscosupplementation is a well-known strategy for managing early stages knee Osteoarthritis. However, despite its effectiveness in reducing symptoms, it has not yet been found to have an effect on joint cartilage. The aim of this study is to evaluate the clinical efficacy of a new product with gel-like behaviour and its in vivo effects on joint cartilage. METHODS 20 patients were treated by 2 consecutive injections of hyaluronan derivative Hymovis® at one-week interval. Clinical evaluation was performed before the treatment and at each time point during the follow-up using WOMAC and VAS. A 7 T magnet was used for cartilage evaluation at each MRI time point: T2 Relaxation Time (RT), T2∗ RT and cartilage parameters were evaluated before the first injection, after 45 days and at 6 months follow-up. Statistical analysis was obtained for each reported data. RESULTS We report significantly reduction in symptoms with an increase in knee and global activity functions. The T2 RT for lateral tibial compartment and T2∗ RT for Patello-Femoral compartment significantly decreased. A T2 RT reduction was observed in all knee compartments except for the medial tibial one, while a T2∗ RT reduction was observed in all knee compartments. We report an increase in cartilage volume and thickness in most of patients with a reduction of cartilage defects in 9 patients, but we didn't find MRI signals clearly referable to cartilage regeneration. CONCLUSIONS MRI results have confirmed the possibility to employ 7T magnets to evaluate early changes in cartilage structure in vivo. HA VS has provided good clinical outcomes and an improvement in the global assessment of the knee joint, but it doesn't seem to significantly modify the cartilage over the time.
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Affiliation(s)
- Lorenzo Andreani
- Orthopaedic and Trauma Surgery Department, University of Pisa, Via Paradisa 2, 56100, Pisa, PI, Italy
| | - Michele Giuntoli
- Orthopaedic and Trauma Surgery Department, University of Pisa, Via Paradisa 2, 56100, Pisa, PI, Italy,Corresponding author.
| | - Francesco Addevico
- Orthopaedic and Trauma Surgery Department, University of Pisa, Via Paradisa 2, 56100, Pisa, PI, Italy
| | - Giacomo Aringhieri
- Radiology Department, University of Pisa, Via Paradisa 2, 56100, Pisa, PI, Italy
| | - Mirco Cosottini
- Neuroradiology Department, University of Pisa, Via Paradisa 2, 56100, Pisa, PI, Italy
| | - Stefano Marchetti
- Orthopaedic and Trauma Surgery Department, University of Pisa, Via Paradisa 2, 56100, Pisa, PI, Italy
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Beletsky A, Lu Y, Nwachukwu BU, Polce E, Maheshwer B, Chahla J, Forsythe B, Cole BJ, Verma NN. Preoperative psychometric properties of visual analog scale asessments for function, pain, and strength compared with legacy upper extremity outcome measures in glenohumeral osteoarthritis. JSES Int 2020; 4:443-448. [PMID: 32939466 PMCID: PMC7478988 DOI: 10.1016/j.jseint.2020.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background Patient-reported outcome measures (PROMs) are increasingly being used in orthopedic surgery; however, there is significant variability and burden associated with their administration. The visual analog scale (VAS) may represent an efficient, single-question method to establish functional baselines in a domain-specific manner for glenohumeral arthritis. Methods Single-question VAS measures assessing function, strength, and pain as a percentage of normal were administered alongside legacy PROMs in patients with primary glenohumeral arthritis in a preoperative setting between October 2015 and March 2017. PROM performance was assessed using Spearman correlation coefficients. Both absolute and relative floor and ceiling effects were examined. Results A total of 70 patients (age 66.09 ± 9.84 years, body mass index 28.8 ± 9.77, 57.1% male, 54.2% right-sided) were included. The VAS Pain instrument (r = 0.45-0.64) outperformed the VAS Function (r = 0.23-0.62) and VAS Strength (r = 0.21-0.65) in correlation to preoperative PROMs. The performance of VAS Pain was comparable to American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES; r = 0.47-0.84). None of the VAS instruments in our study demonstrated preoperative floor effects (7.1%-8.6%) or ceiling effects (0.0%-4.3%). The most efficient instruments were Single-Assessment Numerical Evaluation (SANE; 0.87 ± 0.41 minutes), Patient-Reported Outcome Measurement Information System Upper Extremity Computer Adaptive Test (PROMIS UE CAT; 1.27 ± 1.30 minutes), and the triad of VAS measures (1.51 ± 1.61 minutes). Conclusion VAS Pain outperformed VAS Strength and Function relative to legacy PROMs, while performing comparable to ASES. None of the VAS measures were susceptible to significant floor or ceiling effects preoperatively. The VAS instruments along with SANE and PROMIS UE were the most time-efficient measures. VAS instruments may have a role in establishing preoperative baselines in those with glenohumeral arthritis in a simple, efficient, and adoptable manner.
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Affiliation(s)
- Alexander Beletsky
- Division of Sports Medicine, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Yining Lu
- Division of Sports Medicine, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Benedict U Nwachukwu
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Evan Polce
- Division of Sports Medicine, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Bhargavi Maheshwer
- Division of Sports Medicine, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Jorge Chahla
- Division of Sports Medicine, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Brian Forsythe
- Division of Sports Medicine, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Brian J Cole
- Division of Sports Medicine, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
| | - Nikhil N Verma
- Division of Sports Medicine, Department of Orthopedics, Midwest Orthopedics at Rush, Rush University, Chicago, IL, USA
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Vincent P. Injections intra articulaires (IA) d'acide hyaluronique (AH) dans le traitement symptomatique de la gonarthrose : une méta-analyse des injections uniques (mono-injections). Curr Ther Res Clin Exp 2019; 91:52-65. [PMID: 31871509 PMCID: PMC6911907 DOI: 10.1016/j.curtheres.2019.100569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 10/09/2019] [Indexed: 11/18/2022] Open
Abstract
Introduction La viscosupplémentation du liquide synovial par injections intra articulaires (IA) d'acide hyaluronique (AH), est un traitement symptomatique bien connu dans la gonarthrose. La question se pose de savoir si les traitements par injection unique (mono-injection) peuvent présenter autant d'efficacité que les multi-injections (3 à 5). Méthodes Une méta-analyse des résultats publiés pour les essais de mono-injections IA de AH a été réalisée. Le critère d'efficacité retenu a été le sous-score douleur de l'indice Western Ontario and MacMaster universities (WOMAC A). Toutes les conceptions d'études ont été admises, depuis les essais randomisés contrôlés jusqu'aux études observationnelles ouvertes à simple bras. Une recherche extensive a été effectuée à partir de PubMed, Google, Google Scholar, et des listes de références trouvées dans les méta-analyses récentes, pour obtenir tous les articles publiés avant fin avril 2018. Les profils des populations furent analysés en termes d'âge, de sexe, d'indice de masse corporelle (IMC) et de stade radiologique selon Kellgren-Lawrence (KL). Les résultats d'injection IA unique de placebo, ont été pris en compte pour créer une base permettant des comparaisons post-hoc. Chaque bras AH IA étudié a été comparé à un bras placebo IA (seul ou mixé), de manière à présenter un profil KL similaire, contrôlé à l'aide du test Chi2. Les tailles de l'effet (ES) avec intervalles de confiance (IC 95%) et p-valeurs furent calculées et synthétisées pour chacune des visites de contrôle à 1, 2, 3 et 6 mois. En parallèle, une approche globale a été utilisée afin de représenter les variations par rapport à la baseline, pour chacun des sous-groupes étudiés. Résultats En partant de 1 547 citations, 28 études ont été incluses dans la méta-analyse, décrivant 4 129 patients traités par mono-injection: 3 360 ont reçu de l'AH IA et 769 patients ont reçu du placebo IA. Le patient moyen (SD) traité par AH IA était âgé de 61,2 (9,6) ans dont 63% de femmes, avec un IMC de 28,0 (4,1) kg/m2, et un stade radiologique à 47% KL III pour 3% KL IV. Un bon appariement du profil KL a été obtenu pour 26 des 31 bras AH IA. Sur l'ensemble de la population AH IA, ES = 0,30 (0,25; 0,35) à 3 mois et ES = 0,39 (0,33; 0,44) à 6 mois. Dans une analyse restreinte, après élimination des cas aberrants, des KL mal appariés et des bras actifs < 30 patients, les résultats sont restés inchangés, ES = 0,29 (0,23; 0,34) et ES = 0,40 (0,34; 0,45) à 3 et 6 mois respectivement, tandis que l'hétérogénéité était améliorée. Discussion Il existe certainement des limites à la méthode de comparaison post-hoc versus placebo, appliquée à des essais individuels. Mais pour chaque synthèse par sous-groupe ou groupe, les résultats ont été confirmés en utilisant plusieurs approches statistiques et différentes méthodes de pondération. Cette méta-analyse suggère que les résultats des mono-injections sont similaires à ceux des multi-injections d'acide hyaluronique intra articulaire en termes de soulagement de la douleur, dans le traitement de la gonarthrose.
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Key Words
- AH, Acide Hyaluronique (ou hyaluronate de sodium)
- ES, Taille d'effet (« d » de Cohen)
- IA, Intra articulaire
- IC, Intervalle de Confiance
- IMC, Indice de Masse Corporelle (Kg/m2)
- KL, Kellgren-Lawrence (Echelle radiologique de l'arthrose)
- La viscosupplémentation
- MCID, Différence Minimale Cliniquement Importante
- MD, Différence Moyenne
- MSC, Cellules Souche Mésenchymateuses
- NA, Non disponible (donnée manquante)
- NS, Non significatif
- OA, Ostéoarthrose
- PRGF, Plasma Riche en Facteurs de Croissance
- PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses
- PRP, Plasma Riche en Plaquettes
- RCT, Essai Contrôlé Randomisé
- SD, Ecart-type
- SDD, Plus Petite Différence Détectable
- SE, Erreur-type
- SMD, Différence Moyenne Standardisée
- UE, Union Européenne
- VS, Viscosupplémentation
- WOMAC, Western Ontario & McMaster universities
- la gonarthrose
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Affiliation(s)
- Patrice Vincent
- Correspondence to: Patrice Vincent, 9 allée Prométhée, 28000 Chartres, France
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Vincent P. Intra-Articular Hyaluronic Acid in the Symptomatic Treatment of Knee Osteoarthritis: A Meta-Analysis of Single-Injection Products. Curr Ther Res Clin Exp 2019; 90:39-51. [PMID: 31289603 PMCID: PMC6591794 DOI: 10.1016/j.curtheres.2019.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 02/25/2019] [Indexed: 01/06/2023] Open
Abstract
Background Viscosupplementation of the synovial fluid with intra-articular hyaluronic acid (IA HA) is a well-known symptomatic treatment of knee osteoarthritis. The question arises whether a monoinjection (ie, single injection) could be as efficient as multi-injection (ie, 3-5 injections) regimens. Methods A meta-analysis of published studies relating to IA HA monoinjection trials was performed. The efficacy criterion was the Western Ontario and MacMaster Universities pain subscore. Any study design was accepted, from randomized control trials to single-arm observational open-label studies. An extensive search was performed using PubMed, Google, Google Scholar, and references found in recent meta-analyses, for all articles published before end of April 2018. Population profiles were analyzed in terms of age, sex, body mass index (BMI), and Kellgren-Lawrence (KL) radiology grades. Results of intra-articular single injection of placebo were collected to create a database allowing post hoc comparisons. Each IA HA study arm was compared to an IA placebo arm (either pooled or not), to present a similar KL profile controlled with the χ2 test. The effect size (ES) (95% CI) and P values were calculated and synthesized for each follow-up visit at 1, 2, 3, and 6 months. In parallel, a global approach was used to represent the variations from baseline for each group or subgroup studied. Results From 1547 citations, 28 studies were included in the meta-analysis, representing 4129 patients treated with monoinjection: 3360 received IA HA and 769 patients received IA placebo. The mean (SD) IA HA patient was 61.2 (9.6) years, 63% women, BMI 28.0 (4.1), 47% KL III, and 3% KL IV. A good placebo KL profile matching was obtained for 26 of the 31 IA HA arms. For the whole IA HA population, ES = 0.30 (95% CI, 0.25-0.35) at 3 months and ES = 0.39 (95% CI, 0.33-0.44) at 6 months. In a restricted analysis, after removal of outliers, poorly KL matched and active arms <30 patients, results remained unchanged, ES = 0.29 (95% CI, 0.23-0.34) and ES = 0.40 (95% CI, 0.34-0.45) at 3 and 6 months respectively, whilst heterogeneity was improved. Conclusions There are certainly limits to the post hoc placebo comparison method, for individual studies. But for each synthesis per subgroup or group, the results were properly confirmed using multiple statistical approaches and weighing methods. This meta-analysis suggests that monoinjections produce results similar to multi-injections of IA HA in terms of pain relief in the treatment of knee osteoarthritis. (Curr Ther Res Clin Exp. 2019; 80:XXX-XXX).
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Affiliation(s)
- Patrice Vincent
- LCA Pharmaceutical, 9 allée Prométhée, 28000 Chartres, France
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Bone bruise in anterior cruciate ligament rupture entails a more severe joint damage affecting joint degenerative progression. Knee Surg Sports Traumatol Arthrosc 2019; 27:44-59. [PMID: 29869683 PMCID: PMC6510815 DOI: 10.1007/s00167-018-4993-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 05/30/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE During anterior cruciate ligament (ACL) injury, the large external forces responsible for ligament rupture cause a violent impact between tibial and femoral articular cartilage, which is transferred to bone resulting in bone bruise detectable at MRI. Several aspects remain controversial and await evidence on how this MRI finding should be managed while addressing the ligament lesion. Thus, the aim of the present review was to document the evidence of all available literature on the role of bone bruise associated with ACL lesions. METHODS A systematic review of the literature was performed on bone bruise associated with ACL injury. The search was conducted in September 2017 on three medical electronic databases: PubMed, Web of Science, and the Cochrane Collaboration. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were used. Relevant articles were studied to investigate three main aspects: prevalence and progression of bone bruise associated with ACL lesions, its impact on the knee in terms of lesion severity and joint degeneration progression over time and, finally, the influence of bone bruise on patient prognosis in terms of clinical outcome. RESULTS The search identified 415 records and, after an initial screening according to the inclusion/exclusion criteria, 83 papers were used for analysis, involving a total of 10,047 patients. Bone bruise has a high prevalence (78% in the most recent papers), with distinct patterns related to the mechanism of injury. This MRI finding is detectable only in a minority of cases the first few months after trauma, but its presence and persistence have been correlated to a more severe joint damage that may affect the degenerative progression of the entire joint, with recent evidence suggesting possible effects on long-term clinical outcome. CONCLUSION This systematic review of the literature documented a growing interest on bone bruise associated with ACL injury, highlighting aspects which could provide to orthopaedic surgeons evidence-based suggestions in terms of clinical relevance when dealing with patients affected by bone bruise following ACL injury. However, prospective long-term studies are needed to better understand the natural history of bone bruise, identifying prognostic factors and targets of specific treatments that should be developed in light of the overall joint derangements accompanying ACL lesions. LEVELS OF EVIDENCE IV, Systematic review of level I-IV studies.
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Felli L, Revello S, Burastero G, Gatto P, Carletti A, Formica M, Alessio-Mazzola M. Single Intravenous Administration of Tranexamic Acid in Anterior Cruciate Ligament Reconstruction to Reduce Postoperative Hemarthrosis and Increase Functional Outcomes in the Early Phase of Postoperative Rehabilitation: A Randomized Controlled Trial. Arthroscopy 2019; 35:149-157. [PMID: 30611343 DOI: 10.1016/j.arthro.2018.07.050] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effect of tranexamic acid (TXA) in patients undergoing anterior cruciate ligament (ACL) reconstruction in reducing intra-articular effusion and affecting clinical outcomes 3 months after surgery. METHODS Eighty consecutive patients undergoing ACL reconstruction were prospectively assessed from 2014 to 2016. Patients were randomly allocated to 1 of 2 groups: The test group received an intravenous infusion of 15 mg/kg of TXA, and the control group did not receive TXA. The patellar circumference, range of motion (ROM), Coupens and Yates (CY) value, visual analog scale score for pain assessment, and quadriceps strength (QS) were considered on postoperative day (PD) 1, PD 7, and PD 15 and at 1 month and 3 months after surgery. Blood volume in the intra-articular drainage was recorded on PD 1. Any adverse effect, such as fever onset (>37.5°C), hemarthrosis, or infection, was also considered. RESULTS We found a statistically significant reduction in drainage blood volume (P < .001) and CY value (P = .0044) on PD 1 in patients in the test group compared with those in the control group. On PD 7, a significant improvement was found for mean CY values (P = .0057), ROM (P = .0031), and QS (P = .015). On PD 15, we noted significant improvements in CY values (P < .001), patellar circumference (P = .0019), QS (P = .0089), and visual analog scale values (P = .0032) in the test group. We noted 13 fever episodes in the control group and 2 fever episodes in the study group (P = .047). No differences for any outcomes or complications were found at 3 months. CONCLUSION TXA administration reduced hemarthrosis and the amount of suction drainage blood volume, improved ROM and QS, and reduced fever episodes during the first 2 weeks after surgery. TXA use improved early-phase outcomes in the postoperative period after ACL reconstruction. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Lamberto Felli
- Orthopaedic Clinic, Department of Surgical Sciences, Policlinico San Martino IST, Genoa, Italy
| | - Stefano Revello
- Orthopaedic Clinic, Department of Surgical Sciences, Policlinico San Martino IST, Genoa, Italy
| | - Giorgio Burastero
- Orthopedic and Traumatology Unit 2, Santa Corona Hospital, Pietra Ligure, Italy
| | - Pietro Gatto
- Orthopaedic Clinic, Department of Surgical Sciences, Policlinico San Martino IST, Genoa, Italy
| | - Antonio Carletti
- HAN, Anesthesiology Service, Department of Emergency and Acceptance, Policlinico San Martino IST, Genoa, Italy
| | - Matteo Formica
- Orthopaedic Clinic, Department of Surgical Sciences, Policlinico San Martino IST, Genoa, Italy
| | - Mattia Alessio-Mazzola
- Orthopaedic Clinic, Department of Surgical Sciences, Policlinico San Martino IST, Genoa, Italy.
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