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de Sire A, Marotta N, Sconza C, Lippi L, Drago Ferrante V, Respizzi S, Invernizzi M, Ammendolia A. Oxygen-ozone therapy for pain relief in patients with trapeziometacarpal osteoarthritis: a proof-of-concept study. Disabil Rehabil 2024:1-7. [PMID: 38644616 DOI: 10.1080/09638288.2024.2342491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/05/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE Trapeziometacarpal osteoarthritis (TMC-OA) is a prevalent hand disorder affecting a growing number of people worldwide. While a multidisciplinary approach might provide additional advantages, the analgesic and anti-inflammatory role of intra-articular oxygen-ozone (O2O3) injections combined with physical therapy is still unknown. To assess the impact of a multimodal therapeutic approach combining O2O3 injections with physical therapy in patients with TMC-OA. MATERIALS AND METHODS A prospective open-label study conducted in the Physical and Rehabilitation Medicine Unit of the "Renato Dulbecco" University Hospital of Catanzaro. We assessed patients with TMC-OA who had not responded to standard medical therapy. Participants received O2O3 therapy and targeted physical therapy for 4 weeks. Pain relief, muscle strength, and physical functioning were assessed at baseline and after 4, 12 and 24 weeks (respectively T0, T1, T2, and T3). RESULTS Seventeen patients with a mean age of 67.1 ± 6.1 years were included in the study. Short-term improvements in pain intensity were observed (T0: 6.221 ± 1.514; T1: 3.172 ± 1.1451; p < .001) and were maintained over a 24-week follow-up period (T0: 6.221 ± 1.514; T3: 4.393 ± 1.438; p: 0.006). Significant changes were reported also in terms of muscle strength and physical functioning. O2O3 therapy was well-tolerated with no adverse effects. CONCLUSIONS A combination of O2O3 injections and physical therapy might be considered in patients with TMC-OA. Further investigation is warranted to assess the effectiveness of O2O3 therapy in managing TMC-OA.
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Affiliation(s)
- Alessandro de Sire
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Nicola Marotta
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Physical and Rehabilitative Medicine Unit, Department of Experimental and Clinical Medicine, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Cristiano Sconza
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Lorenzo Lippi
- Department of Scientific Research, Campus LUdeS Lugano (CH), Off-Campus Semmelweis University of Budapest, Budapest, Hungary
| | - Vera Drago Ferrante
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Stefano Respizzi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | - Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont "A. Avogadro", Novara, Italy
- Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Translational Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Antonio Ammendolia
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
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Lu YC, Ho TC, Huang CH, Yeh SI, Chen SL, Tsao YP. PEDF peptide plus hyaluronic acid stimulates cartilage regeneration in osteoarthritis via STAT3-mediated chondrogenesis. Bone Joint Res 2024; 13:137-148. [PMID: 38555936 PMCID: PMC10981997 DOI: 10.1302/2046-3758.134.bjr-2023-0179.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
Aims Pigment epithelium-derived factor (PEDF) is known to induce several types of tissue regeneration by activating tissue-specific stem cells. Here, we investigated the therapeutic potential of PEDF 29-mer peptide in the damaged articular cartilage (AC) in rat osteoarthritis (OA). Methods Mesenchymal stem/stromal cells (MSCs) were isolated from rat bone marrow (BM) and used to evaluate the impact of 29-mer on chondrogenic differentiation of BM-MSCs in culture. Knee OA was induced in rats by a single intra-articular injection of monosodium iodoacetate (MIA) in the right knees (set to day 0). The 29-mer dissolved in 5% hyaluronic acid (HA) was intra-articularly injected into right knees at day 8 and 12 after MIA injection. Subsequently, the therapeutic effect of the 29-mer/HA on OA was evaluated by the Osteoarthritis Research Society International (OARSI) histopathological scoring system and changes in hind paw weight distribution, respectively. The regeneration of chondrocytes in damaged AC was detected by dual-immunostaining of 5-bromo-2'-deoxyuridine (BrdU) and chondrogenic markers. Results The 29-mer promoted expansion and chondrogenic differentiation of BM-MSCs cultured in different defined media. MIA injection caused chondrocyte death throughout the AC, with cartilage degeneration thereafter. The 29-mer/HA treatment induced extensive chondrocyte regeneration in the damaged AC and suppressed MIA-induced synovitis, accompanied by the recovery of cartilage matrix. Pharmacological inhibitors of PEDF receptor (PEDFR) and signal transducer and activator of transcription 3 (STAT3) signalling substantially blocked the chondrogenic promoting activity of 29-mer on the cultured BM-MSCs and injured AC. Conclusion The 29-mer/HA formulation effectively induces chondrocyte regeneration and formation of cartilage matrix in the damaged AC.
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Affiliation(s)
- Yung-Chang Lu
- Department of Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Tsung-Chuan Ho
- Department of Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan
| | - Chang-Hung Huang
- Department of Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shu-I Yeh
- Department of Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Show-Li Chen
- Graduate Institute of Microbiology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yeou-Ping Tsao
- Department of Medical Research, Mackay Memorial Hospital, New Taipei City, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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Rogers CJ, Harman R, Sheinkop MB, Hanson P, Ambach MA, David T, Desai R, Sampson S, Aufierro D, Bowen J, Malanga G. Clinical Evaluation of Safety and Efficacy of a Central Current Good Manufacturing Practices Laboratory Produced Autologous Adipose-Derived Stromal Vascular Fraction Cell Therapy Product for the Treatment of Knee Osteoarthritis. Stem Cells Dev 2024; 33:168-176. [PMID: 38386505 PMCID: PMC11036882 DOI: 10.1089/scd.2024.0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/16/2024] [Indexed: 02/24/2024] Open
Abstract
Knee osteoarthritis (KOA) is a prevalent condition characterized by the progressive deterioration of the entire joint and has emerged as a prominent contributor to disability on a global scale. The nature of the disease and its impact on joint function significantly limit mobility and daily activities, highlighting its substantial influence on patients' overall well-being. Stromal vascular fraction (SVF) is a heterogenous, autologous cell product, containing mesenchymal stem cells, derived from the patient's subcutaneous adipose tissue with demonstrated safety and efficacy in the treatment of KOA patients. We conducted a single-arm, open-label, multisite, FDA approved clinical study in Kellgren-Lawrence severity grade 2-4 KOA patients. The cellular product was manufactured from patient-specific lipoaspirate in a centrally located FDA-compliant manufacturing facility. Twenty-nine subjects were treated with a quality tested single intra-articular injection of GMP manufactured SVF. Adverse events, laboratory values, vital signs, and physical examination findings were monitored during the study period. Robust tolerability, without any substantial safety issues, was demonstrated. Knee pain and function, assessed through the Knee Injury and Osteoarthritis Outcome Score (KOOS), demonstrated notable improvements. These positive benefits persisted for up to 12 months, and the majority of participants expressed satisfaction. SVF from each patient was stored in a liquid nitrogen freezer for future clinical treatments. Unique to this study of autologous cells is the shipment of lipoaspirate from the clinic to a central FDA-compliant manufacturing facility for cleanroom-controlled manufacturing. The cell product characterization data demonstrate that this method produces an equivalent product in terms of cell count and viability with the added benefit of further quality assurance testing, including sterility, endotoxin, and flow cytometry, before patient administration. Clinical Trial Registration Number: NCT04043819.
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Affiliation(s)
| | | | | | - Peter Hanson
- Grossmont Orthopedic Medical Group, La Mesa, California, USA
| | - Mary A. Ambach
- San Diego Orthobiologics Medical Group, Carlsbad, California, USA
| | - Tal David
- Synergy Orthopedics Specialist Group, San Diego, California, USA
| | | | | | | | - Jay Bowen
- New Jersey Regenerative Institute, Cedar Knolls, New Jersey, USA
| | - Gerard Malanga
- New Jersey Regenerative Institute, Cedar Knolls, New Jersey, USA
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Krez AN, Wu KA, Klifto KM, Pidgeon TS, Klifto CS, Ruch DS. Efficacy of Intra-Articular Corticosteroid Injection for Nonsurgical Management of Trapeziometacarpal Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Hand Surg Am 2024:S0363-5023(24)00055-8. [PMID: 38530683 DOI: 10.1016/j.jhsa.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 01/26/2024] [Accepted: 02/07/2024] [Indexed: 03/28/2024]
Abstract
PURPOSE As osteoarthritis (OA) of the trapeziometacarpal (TMC) joint leads to a high degree of disease burden with compromises in rudimentary and fine movements of the hand, intra-articular injections may be a desirable treatment option. However, because there are no evidence-based guidelines, the choice of intra-articular injection type is left to the discretion of the individual surgeon in collaboration with the patient. The purpose of our study was to perform a systematic review and meta-analysis using level I studies to compare outcomes following corticosteroid and alternative methods of intra-articular injections for the management of TMC OA. Our hypothesis was that intra-articular corticosteroid injections were no more effective than other methods of intra-articular injections for the management of TMC OA. METHODS A systematic literature search was performed. Eligible for inclusion were randomized control trials reporting on intra-articular corticosteroid injection for the management of TMC OA. Clinical outcomes were recorded. RESULTS The 10 included studies comprised 673 patients. The mean age was 57.8 ± 8.3 years, with a mean follow-up of 6.4 ± 2.7 months. There was no significant difference in visual analog scale scores, grip strength and tip pinch strength between corticosteroids and hyaluronic acid at short- and medium-term follow-up. Further, there was no difference in visual analog scale pain scores at rest at medium-term follow-up between corticosteroids and platelet-rich plasma. CONCLUSIONS Despite short-term improvement with intra-articular corticosteroid injections, there was no significant difference in pain and functional outcomes following intra-articular corticosteroid injections compared to hyaluronic acid or platelet-rich plasma administration. Given the affordability, ease of administration, and efficacy associated with corticosteroids, they are a favorable option when considering the choice of intra-articular injection for the management of TMC OA. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic II.
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Affiliation(s)
- Alexandra N Krez
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Kevin A Wu
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Kevin M Klifto
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Missouri, Columbia, MO
| | - Tyler S Pidgeon
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - Christopher S Klifto
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - David S Ruch
- Division of Hand Surgery, Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC.
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Xu J, Ruan Z, Guo Z, Hou L, Wang G, Zheng Z, Zhang X, Liu H, Sun K, Guo F. Inhibition of SAT1 alleviates chondrocyte inflammation and ferroptosis by repressing ALOX15 expression and activating the Nrf2 pathway. Bone Joint Res 2024; 13:110-123. [PMID: 38447596 PMCID: PMC10917474 DOI: 10.1302/2046-3758.133.bjr-2023-0250.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
Aims Osteoarthritis (OA) is the most common chronic pathema of human joints. The pathogenesis is complex, involving physiological and mechanical factors. In previous studies, we found that ferroptosis is intimately related to OA, while the role of Sat1 in chondrocyte ferroptosis and OA, as well as the underlying mechanism, remains unclear. Methods In this study, interleukin-1β (IL-1β) was used to simulate inflammation and Erastin was used to simulate ferroptosis in vitro. We used small interfering RNA (siRNA) to knock down the spermidine/spermine N1-acetyltransferase 1 (Sat1) and arachidonate 15-lipoxygenase (Alox15), and examined damage-associated events including inflammation, ferroptosis, and oxidative stress of chondrocytes. In addition, a destabilization of the medial meniscus (DMM) mouse model of OA induced by surgery was established to investigate the role of Sat1 inhibition in OA progression. Results The results showed that inhibition of Sat1 expression can reduce inflammation, ferroptosis changes, reactive oxygen species (ROS) level, and lipid-ROS accumulation induced by IL-1β and Erastin. Knockdown of Sat1 promotes nuclear factor-E2-related factor 2 (Nrf2) signalling. Additionally, knockdown Alox15 can alleviate the inflammation-related protein expression induced by IL-1β and ferroptosis-related protein expression induced by Erastin. Furthermore, knockdown Nrf2 can reverse these protein expression alterations. Finally, intra-articular injection of diminazene aceturate (DA), an inhibitor of Sat1, enhanced type II collagen (collagen II) and increased Sat1 and Alox15 expression. Conclusion Our results demonstrate that inhibition of Sat1 could alleviate chondrocyte ferroptosis and inflammation by downregulating Alox15 activating the Nrf2 system, and delaying the progression of OA. These findings suggest that Sat1 provides a new approach for studying and treating OA.
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Affiliation(s)
- Jingting Xu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhaoxuan Ruan
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhou Guo
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liangcai Hou
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Genchun Wang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zehang Zheng
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiong Zhang
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haigang Liu
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Kai Sun
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fengjing Guo
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Schipper JAM, Tuin AJ, van Dongen JA, van Bakelen NB, Harmsen MC, Spijkervet FKL. Intra-Articular Injection of Adipose-Derived Stromal Vascular Fraction in Osteoarthritic Temporomandibular Joints: Study Design of a Randomized Controlled Clinical Trial. Bioengineering (Basel) 2024; 11:171. [PMID: 38391657 PMCID: PMC10886020 DOI: 10.3390/bioengineering11020171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 02/01/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION Temporomandibular joint (TMJ) osteoarthritis is a degenerative disease of the TMJ. It is characterized by progressive degradation of the extracellular matrix components of articular cartilage, with secondary inflammatory components leading to pain in the temporomandibular region and reduced mouth opening. Current treatments do not halt disease progression, hence the need for new therapies to reduce inflammation and, consequently, improve symptoms. The aim of our randomized controlled clinical trial protocol is to investigate the efficacy of adjuvant intra-articular injections of autologous tissue-like stromal vascular fraction (tSVF), compared to arthrocentesis alone, in reducing pain and improving mouth opening in TMJ osteoarthritis patients. MATERIALS AND METHODS The primary endpoint analysis will consist of the visual analogue scale (VAS) for pain. The secondary endpoint analyses will include maximal interincisal mouth opening measurements; assessment of oral health and mandibular function based on the oral health impact profile (OHIP) questionnaire and mandibular functional impairment questionnaire (MFIQ); complications during the follow up; synovial cytokine analysis at baseline and after 26 weeks; and nucleated cells and tSVF (immuno)histochemistry analyses of the intervention group. DISCUSSION Our randomized clinical trial protocol will be applied to evaluate the efficacy of a new promising tSVF injection therapy for TMJ osteoarthritis. The safety of intra-articular injections of tSVF has been proven for knee osteoarthritis. However, since a tSVF injection is considered a heterologous application of cell therapy, the regulatory requirements are strict, which makes medical ethical approval challenging.
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Affiliation(s)
- Jan Aart M Schipper
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands
| | - Aartje Jorien Tuin
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands
| | - Joris A van Dongen
- Department of Plastic Surgery, University Medical Center Utrecht, University of Utrecht, 3584 Utrecht, The Netherlands
- Department of Pathology & Medical Biology, University Medical Center Groningen, University of Groningen, 9712 Groningen, The Netherlands
| | - Nico B van Bakelen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands
| | - Martin Conrad Harmsen
- Department of Pathology & Medical Biology, University Medical Center Groningen, University of Groningen, 9712 Groningen, The Netherlands
| | - Fred K L Spijkervet
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, 9713 Groningen, The Netherlands
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Takada S, Nodera R, Yoshioka K. Effects of Diclofenac Etalhyaluronate (SI-613/ONO-5704) on Cartilage Degeneration in Arthritic Rats and Inflammatory Cytokine-Stimulated Human Chondrocytes. Cartilage 2024:19476035231224050. [PMID: 38317317 DOI: 10.1177/19476035231224050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVE Cartilage degeneration is a key feature of osteoarthritis (OA) and rheumatoid arthritis and is thought to negatively impact patients' quality of life. Diclofenac etalhyaluronate (DEH, SI-613/ONO-5704) is a hyaluronic acid (HA) derivative chemically bound to diclofenac (DF) that has been reported to improve OA symptoms; however, its effect on cartilage degeneration remains unknown. In the present study, we investigated the chondroprotective effect of DEH in rats with collagen-induced arthritis and interleukin-1β-stimulated human chondrocytes. DESIGN Rats with collagen-induced arthritis were administered DEH and HA intra-articularly, and DF orally. Knee joint swelling, histological scores of articular cartilage, and inflammatory (Il1b) and catabolic (Mmp3 and Mmp13) gene expression in the synovial tissue and cartilage were evaluated. In vitro direct effects of DEH on matrix metalloproteinase (MMP)-3 and MMP-13 expression were examined in interleukin-1β-stimulated human chondrocytes. RESULTS In a rat model of collagen-induced arthritis, a single intra-articular dose of DEH inhibited knee joint inflammation and cartilage degeneration. Daily oral administration of DF had similar effects. Conversely, HA administered as a single intra-articular dose had no effect. Only DEH inhibited Mmp3 gene expression in the cartilage, whereas DEH and DF inhibited Mmp3 and Mmp13 mRNA expression in the synovial tissue. In interleukin-1β-stimulated human chondrocytes, DEH and HA inhibited MMP-3 and MMP-13 production, whereas DF had no effect. CONCLUSIONS In this study, we demonstrated the chondroprotective effect of DEH in rats with collagen-induced arthritis and in interleukin-1β-stimulated human chondrocytes. Thus, DEH may suppress cartilage degeneration in patients with musculoskeletal diseases, such as OA.
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Affiliation(s)
- Shuhei Takada
- Central Research Laboratory, Research & Development Division, Seikagaku Corporation, Tokyo, Japan
| | - Risa Nodera
- Central Research Laboratory, Research & Development Division, Seikagaku Corporation, Tokyo, Japan
| | - Keiji Yoshioka
- Central Research Laboratory, Research & Development Division, Seikagaku Corporation, Tokyo, Japan
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Long B, Bridwell RE, Gottlieb M. Analgesic Techniques for Managing Orthopedic Injuries: A Review for the Emergency Clinician. J Emerg Med 2024; 66:211-220. [PMID: 38278679 DOI: 10.1016/j.jemermed.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/11/2023] [Accepted: 10/01/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Orthopedic injuries are commonly managed in the emergency department (ED) setting. Fractures and dislocations may require reduction for proper management. There are a variety of analgesic and sedative strategies to provide patient comfort during reduction. OBJECTIVE This narrative review evaluates hematoma block, intra-articular injection, intravenous regional analgesia (IVRA) (also known as the Bier block), and periosteal block for orthopedic analgesia in the ED setting. DISCUSSION Analgesia is an essential component of management of orthopedic injuries, particularly when reduction is necessary. Options in the ED setting include hematoma blocks, intra-articular injections, IVRA, and periosteal blocks, which provide adequate analgesia without procedural sedation or opioid administration. When used in isolation, these analgesic techniques decrease complications from sedation and the need for other medications, such as opioids, while decreasing ED length of stay. Emergency clinicians can also use these techniques as analgesic adjuncts. However, training in these techniques is recommended prior to routine use, particularly with IVRA. CONCLUSIONS Knowledge of analgesic techniques for orthopedic procedures can assist clinicians in optimizing patient care.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, San Antonio, Texas
| | - Rachel E Bridwell
- Department of Emergency Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, Washington
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
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Jia-Wei H, Jing W, Li C, Xiao-Gang Z, Guo-Qing L, Bo-Yong X, Bao-Chao J, Jun-Jie H, Jun Z. Two-dimensional liquid chromatography measurement of meropenem concentration in synovial fluid of patients with periprosthetic joint infection. Biomed Chromatogr 2024; 38:e5778. [PMID: 38073142 DOI: 10.1002/bmc.5778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 10/23/2023] [Accepted: 10/25/2023] [Indexed: 01/26/2024]
Abstract
Periprosthetic joint infection (PJI) is a catastrophic complication following joint replacement surgery. One potential treatment approach for PJI could be the combination of one-stage revision and intra-articular infusion of antibiotics. Meropenem is one of the commonly used intra-articular antibiotics in our institution. Determining the concentration of meropenem in the joint cavity could be crucial for optimizing its local application, effectively eradicating biofilm infection, and improving PJI treatment outcomes. In this study, we developed a simple, precise, and accurate method of two-dimensional liquid chromatography (2D-LC) for determining the concentration of meropenem in human synovial fluid. The method was then validated based on the guidelines of the Food and Drug Administration and the Chinese Pharmacopoeia. Meropenem showed good linearity in the range of 0.31-25.01 μg/mL (r ≥ .999). Selectivity, intra-day and inter-day precision and accuracy, extraction recovery, and stability validation results were all within the acceptance range. This method has been successfully applied to the determination of synovial fluid samples from PJI patients, providing a useful detection method for meropenem therapeutic drug monitoring (TDM) in PJI patients.
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Affiliation(s)
- He Jia-Wei
- Department of Pharmacy, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Wang Jing
- Department of Pharmacy, The Eighth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Cao Li
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhang Xiao-Gang
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Li Guo-Qing
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Xu Bo-Yong
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Ji Bao-Chao
- Department of Orthopaedics, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Huang Jun-Jie
- College of Pharmacy, Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zhao Jun
- Department of Pharmacy, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Dıracoglu D, Sezikli S, Dernek B, Yildirim MA, Sen EI. Different doses of hyaluronic acid injections in patients with knee osteoarthritis: A multicenter, randomized, prospective, single-blind, clinical study. J Back Musculoskelet Rehabil 2023:BMR230097. [PMID: 38160332 DOI: 10.3233/bmr-230097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Many formulations and dosing regimens are available for hyaluronic acid (HA). OBJECTIVE To compare different doses of linear, high-molecular weight (HMW) HA injections among patients with knee osteoarthritis (OA). METHODS Hundred patients were included in this randomized, single-blinded trial and randomly divided into three HA injection groups. The first group received five weekly 20 mg HA injections, the second group received three weekly 32 mg HA injections, and the third group received a single 48 mg HA injection. Patients were evaluated at baseline, 1, 3, and 6 months after the last injection for pain, stiffness, and function using the visual analog scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire. Quality of life, patient's global assessment, and Timed Up and Go (TUG) test scores were also evaluated. RESULTS There was significant improvement in the WOMAC, VAS-pain, quality of life, patient's global assessment, and TUG test mean scores at all follow-up time points (p< 0.001). However, the groups showed no significant differences in WOMAC, VAS-activity pain, and patient global scores at any follow-up point. CONCLUSION Intra-articular injections of different doses of linear HMW HA can improve pain, stiffness, function, and quality of life in patients suffering from knee OA over a six-month period.
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Affiliation(s)
- Demirhan Dıracoglu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Selim Sezikli
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Bahar Dernek
- Istanbul Physical Medicine and Rehabilitation Education Research Hospital, Department of Physical Medicine and Rehabilitation, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Aziz Yildirim
- Department of Physical Medicine and Rehabilitation, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
| | - Ekin Ilke Sen
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Khoury MA, Chamari K, Tabben M, Alkhelaifi K, Papacostas E, Marín Fermín T, Laupheimer M, D′Hooghe P. Knee Osteoarthritis: Clinical and MRI Outcomes After Multiple Intra-Articular Injections With Expanded Autologous Adipose-Derived Stromal Cells or Platelet-Rich Plasma. Cartilage 2023; 14:433-444. [PMID: 37350015 PMCID: PMC10807730 DOI: 10.1177/19476035231166127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/09/2023] [Accepted: 03/12/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVE To directly compare clinical and MRI outcomes of multiple intra-articular injections of adipose-derived stromal cells (ASCs) or platelet-rich plasma (PRP) in patients with knee osteoarthritis (OA). DESIGN We retrospectively compared 24-month outcomes in (1) 27 patients receiving 3-monthly intra-articular injections with a total of 43.8 million ASCs and (2) 23 patients receiving 3-monthly injections of 3-ml preparation of PRP. All patients had Kellgren-Lawrence grade 1, 2, or 3 knee OA with failed conservative medical therapy. The Numeric Pain Rating Scale (NPRS) scores; Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, 6, 12, and 24 months after the first injection; and the MRI Osteoarthritis Knee Score (MOAKS) at 12 and 24 months were considered as outcomes. RESULTS No major complications occurred in any patient. Both groups significantly improved in pain NPRS score and KOOS at 6 months. At 12- and 24-month evaluations, the ASC group significantly decreased scores to a greater degree (P < 0.001) than the PRP group. MOAKS scores indicated a decrease in disease progression in the ASC group. CONCLUSION Both ASCs and PRP were safe and resulted in clinical improvement in patients with knee OA at 6 months; however, at 12 and 24 months, ASCs outperformed leukocyte-poor PRP in clinical and radiological outcomes.
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Affiliation(s)
| | - Karim Chamari
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | | | | | | | | | - Pieter D′Hooghe
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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12
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Verron R, Zhang L, Bisseriex H, Grimandi R, Verrando A, Verdaguer C, Thomas M, Facione J, Borrini L. SAS-PRP Study: A Real-Life Satisfaction Assessment in Patients with Cartilage Lesions of the Knee Treated by Platelet-Rich Plasma. Bioengineering (Basel) 2023; 10:1276. [PMID: 38002400 PMCID: PMC10669872 DOI: 10.3390/bioengineering10111276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023] Open
Abstract
Platelet-rich plasma (PRP) is a rising therapy treating locomotor system lesions such as knee osteoarthritis. The objective of this study was to evaluate patients' satisfaction 6 to 12 months after a PRP injection for cartilage lesions of their knee under real-life conditions. Patients' satisfaction was assessed by a specific questionnaire named SATMED-Q©, which explores six different dimensions of a given treatment. In addition, pain and function were assessed thanks to VAS pain, WOMAC, and IKDC scores. Responders were identified through the OMERACT-OARSI criteria. We observed excellent satisfaction after a PRP injection with a SATMED-Q© score of 80.81% 6 to 12 months after the procedure. Even when there was no significant improvement in pain and function scores, 52% of the evaluated population fulfilled the OMERACT-OARSI criteria and were considered responders. According to the sub-group analysis, patients with less osteoarthritis damage (i.e., Kellgren-Lawrence grades 1-2) and older study subjects (i.e., >40 years old) with focal chondropathy had benefited most from their PRP injection. Thus, platelet-rich plasma seems to be a well-tolerated and efficient therapy for cartilage lesions of the knee.
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Affiliation(s)
- Romain Verron
- Physical and Rehabilitation Department, HIA Percy, 92140 Clamart, France; (A.V.); (C.V.); (M.T.); (J.F.); (L.B.)
| | - Lucie Zhang
- Pneumology Department, HIA Clermont-Tonnerre, 29200 Brest, France;
| | - Hélène Bisseriex
- Physical and Rehabilitation Department, HIA Clermont-Tonnerre, 29200 Brest, France (R.G.)
| | - Ronan Grimandi
- Physical and Rehabilitation Department, HIA Clermont-Tonnerre, 29200 Brest, France (R.G.)
- ORPHY, EA4324, University of Brest, 29238 Brest, France
| | - Alix Verrando
- Physical and Rehabilitation Department, HIA Percy, 92140 Clamart, France; (A.V.); (C.V.); (M.T.); (J.F.); (L.B.)
| | - Claire Verdaguer
- Physical and Rehabilitation Department, HIA Percy, 92140 Clamart, France; (A.V.); (C.V.); (M.T.); (J.F.); (L.B.)
| | - Marie Thomas
- Physical and Rehabilitation Department, HIA Percy, 92140 Clamart, France; (A.V.); (C.V.); (M.T.); (J.F.); (L.B.)
| | - Julia Facione
- Physical and Rehabilitation Department, HIA Percy, 92140 Clamart, France; (A.V.); (C.V.); (M.T.); (J.F.); (L.B.)
| | - Leo Borrini
- Physical and Rehabilitation Department, HIA Percy, 92140 Clamart, France; (A.V.); (C.V.); (M.T.); (J.F.); (L.B.)
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Das G, Das S, Sahoo R, Shreyas S, Kanthi B, Sharma VS. Efficacy of cryoneurolysis versus intra-articular steroid in sacroiliac joint pain: A retrospective, case-control study. Indian J Anaesth 2023; 67:1004-1008. [PMID: 38213683 PMCID: PMC10779969 DOI: 10.4103/ija.ija_938_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 01/13/2024] Open
Abstract
Background and Aims Intra-articular steroids provide significant pain relief in sacroiliac joint pain (SIJP), but their action is short-lived. Cryoneurolysis is reported to produce prolonged pain relief in various pain conditions. However, its efficacy has not been evaluated in patients with SIJP. Thus, we compared the efficacy of cryoneurolysis with steroid injections in adult patients with SIJP. Methods This retrospective healthcare records review-based study involved 83 patients with SIJP. Patients were divided into two groups: cases (sacroiliac joint [SIJ] cryoneurolysis, n = 39) and controls (SIJ steroid injection, n = 44). An 11-point numeric pain rating scale (NPRS) was used to assess the pain severity at baseline and immediately, 1, 3 and 6 months post-intervention. A reduction of ≥50% in NPRS score immediately following SIJ cryoneurolysis and steroid injection was considered a successful outcome. The difference between the treatment groups was assessed with a Chi-square test, and P < 0.05 was considered statistically significant. Results Both cases and controls showed significantly decreased NPRS scores from baseline to immediately, 1 month, 3 months and 6 months postintervention (P < 0.001). However, compared to controls, cases had significantly lower NPRS scores at all time points (all P < 0.001). Moreover, a significantly greater proportion of cases had ≥50% decrease in NPRS score from baseline, that is, 1 month (97.44% vs. 75%, P = 0.004), 3 months (100% vs. 47.73%, P < 0.001) and 6 months (69.23% vs. 27.27%, P < 0.001). Conclusion Although both cryoneurolysis and intra-articular steroid injections provide significant pain relief immediately, 1, 3 and 6 months postintervention, cryoneurolysis resulted in significantly greater pain relief.
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Affiliation(s)
- Gautam Das
- Daradia Pain Hospital, Kolkata, West Bengal, India
| | - Suspa Das
- Daradia Pain Hospital, Kolkata, West Bengal, India
| | - Rajendra Sahoo
- Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Makaram NS, Simpson AHRW. Disease-modifying agents in osteoarthritis: where are we now and what does the future hold? Bone Joint Res 2023; 12:654-656. [PMID: 37839796 PMCID: PMC10577043 DOI: 10.1302/2046-3758.1210.bjr-2023-0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2023] Open
Abstract
Cite this article: Bone Joint Res 2023;12(10):654–656.
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Affiliation(s)
- Navnit S. Makaram
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- University of Edinburgh, Edinburgh, UK
| | - A. H. R. W. Simpson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- University of Edinburgh, Edinburgh, UK
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15
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Damjanov N, Zekovic A. Intra-articular autologous conditioned serum and triamcinolone injections in patients with knee osteoarthritis: a controlled, randomized, double-blind study. J Int Med Res 2023; 51:3000605231203851. [PMID: 37818751 PMCID: PMC10566289 DOI: 10.1177/03000605231203851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE This study was performed to assess the impact of autologous conditioned serum (ACS) when added to preceding intra-articular glucocorticoid therapy on pain, function, and quality of life outcomes over 24 weeks. METHODS In this single-center, randomized controlled trial involving 40 patients with advanced knee osteoarthritis (Kellgren-Lawrence grades III and IV), ACS or saline placebo was injected after 40 mg triamcinolone acetonide (TA) intra-articular injection. Numerical rating scale (NRS) pain scores and Knee Injury and Osteoarthritis Outcome Score (KOOS) assessments were conducted at baseline and at weeks 3, 6, 12, and 24. The primary endpoint was the change in KOOS Pain at 24 weeks. Patient safety events were also monitored. RESULTS At week 24, TA + ACS significantly improved KOOS Pain, Symptoms, Activities of Daily Living, Quality of Life, and KOOS Sport scores. TA + ACS also outperformed TA + placebo in NRS pain scores (average and maximum intensity) at week 24 and NRS pain score (at rest) at weeks 12 and 24. The TA injection followed by ACS or placebo was well-tolerated. CONCLUSION ACS adds long-term pain relief and functional improvement to the short-term pain relief provided by glucocorticoids.
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Affiliation(s)
- Nemanja Damjanov
- University of Belgrade School of Medicine, Institute of Rheumatology, Belgrade, Serbia
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Howlader MAA, Almigdad A, Urmi JF, Ibrahim H. Efficacy and Safety of Hyaluronic Acid and Platelet-Rich Plasma Combination Therapy Versus Platelet-Rich Plasma Alone in Treating Knee Osteoarthritis: A Systematic Review. Cureus 2023; 15:e47256. [PMID: 38022237 PMCID: PMC10655493 DOI: 10.7759/cureus.47256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
Knee osteoarthritis (KOA) is a chronic degenerative disease of the joint characterized by biochemical and biomechanical alterations of articular cartilage, degradation of the joint edge, and subchondral bone hyperplasia. Nowadays, intra-articular hyaluronic acid (HA) or platelet-rich plasma (PRP) has become a popular treatment modality for treating KOA. Each treatment can be used independently or in combination. However, the efficacy and safety of combination treatment are still inconclusive, and there is a lack of high-quality level 1 studies that support using combination therapy over PRP alone. Consequently, we conducted a systematic review to examine the effectiveness and safety of combining HA and PRP therapy versus using PRP therapy alone in KOA patients. Based on the most up-to-date evidence, the dual approach of PRP and HA therapy yields outcomes similar to PRP therapy alone in the short term, up to 12 months. Nonetheless, when considering longer-term results, particularly in the 24-month follow-up, dual therapy holds the potential to produce superior outcomes compared to PRP alone therapy. Additionally, in terms of safety, dual therapy has been associated with slightly fewer adverse events.
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Affiliation(s)
- Md Al Amin Howlader
- Department of Trauma and Orthopaedics, Royal Berkshire NHS Foundation Trust, Reading, GBR
| | - Ahmad Almigdad
- Department of Orthopaedics, Royal Medical Services, Amman, JOR
| | | | - Hassan Ibrahim
- Department of Internal Medicine, Darent Valley Hospital, Dartford, GBR
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Sambe HG, Yasir M, Man RK, Gogikar A, Nanda A, Janga LSN, Hamid P. Comparing Intra-articular Platelet-Rich Plasma With Hyaluronic Acid for the Treatment of Hip Osteoarthritis: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e47919. [PMID: 37905161 PMCID: PMC10613513 DOI: 10.7759/cureus.47919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 10/28/2023] [Indexed: 11/02/2023] Open
Abstract
Hip osteoarthritis (HOA), a prevalent condition among those aged 55 years and above, is a significant cause of joint pain and functional impairment and it contributes to the overall burden of chronic pain experienced by the elderly population. While platelet-rich plasma (PRP) and hyaluronic acid (HA) injections have emerged as innovative therapeutic approaches for managing osteoarthritis, their effectiveness in HOA remains a subject of contention. Therefore, the objective of this review was to assess the efficacy of PRP versus HA in terms of pain relief and functional outcomes for the management of HOA. We searched PubMed, Cochrane Library, and Google Scholar databases from 2013 to 2023 to identify pertinent randomized controlled trials (RCTs). A total of seven trials (478 participants) were included. The selected studies underwent quality assessment using the updated Cochrane risk of bias tool. The pain and functional outcomes were examined using measures of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale, visual analog scale (VAS), and Harris hip score (HHS). In the meta-analysis, standard mean differences (SMDs) along with 95% confidence intervals (CIs) to estimate overall effect magnitudes for continuous outcomes were extracted. Statistical significance was determined using p-values below 0.05. At six months, the PRP group experienced a significantly lower standard mean WOMAC pain score (SMD = -0.38, CI = -0.64 - 0.13; p = 0.03). No significant differences in WOMAC pain scores were noted at one to two months (SMD = 0.09, CI = -0.24, 0.43; p = 0.59), and at 12 months (SMD = -0.85, CI = -1.81, 0.12; p = 0.09). Similarly, for VAS, patients on PRP showed a slight improvement in their VAS scores at six months (SMD = -0.50, CI = -0.89, -0.12; p < 0.01). However, no significant differences in VAS between the PRP groups and the HA groups were observed at one to two months (SMD = -0.22, CI = -0.49, 0.04; p = 0.10) and at 12 months (SMD = -0.22, CI: -0.63, 0.19; p = 0.29). In terms of hip dysfunction, there was no statistically significant standard mean difference in HHS between the PRP and HA groups at six months (SMD = 0.02, CI = -0.40, 0.44; p = 0.93), and at 12 months (SMD = -0.31, CI = -0.32, 0.22; p = 0.73). This review and meta-analysis provide insights into emerging treatments for HOA, especially considering that PRP shows potential benefits and safety for patients with HOA during mid-term follow-up in a 12-month period. Nevertheless, it is necessary to conduct research that includes high-quality designs and larger sample sizes to validate the comparative efficacy of these treatments.
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Affiliation(s)
- Hembashima G Sambe
- Surgery, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Mohamed Yasir
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Ruzhual K Man
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Amaresh Gogikar
- Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | - Ankita Nanda
- Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
| | | | - Pousette Hamid
- Neurology, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA
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Ahn Y, Moon YS, Park GY, Cho SC, Lee YJ, Kwon DR, Lee SC. Efficacy of Intra-articular Triamcinolone and Hyaluronic Acid in a Frozen Shoulder Rat Model. Am J Sports Med 2023; 51:2881-2890. [PMID: 37551671 DOI: 10.1177/03635465231188524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
BACKGROUND Intra-articular corticosteroid or hyaluronic acid (HA) is commonly prescribed for frozen shoulder. However, few studies have investigated histological and molecular changes after injection. PURPOSE To compare the effectiveness of intra-articular injections of triamcinolone and HA in a frozen shoulder rat model and verify a greater effect of triamcinolone in passive shoulder abduction compared with HA. STUDY DESIGN Controlled laboratory study. METHODS Twenty male Sprague-Dawley rats were randomly allocated into 4 groups (n = 5 in each): control group, which did not receive cast immobilization or injection, and 3 experimental groups, which received 3 weeks of unilateral shoulder immobilization followed by intra-articular injections (normal saline, triamcinolone, or HA) at the immobilized shoulder. Passive shoulder abduction angle, histological and immunohistochemical staining, and Western blotting results were assessed 2 weeks after injection. The intensity and extent of staining were converted to semiquantitative scores for further analysis. RESULTS Shoulder abduction angles before sacrifice were 153.0°± 2.7° (control group), 107.0°± 5.7° (saline group), 139.0°± 9.6° (triamcinoline group), and 110.0°± 10.6° (HA group), showing significant differences between control and saline groups, control and HA groups, saline and triamcinoline groups, and triamcinoline and HA groups (P < .001) but not between control and triamcinoline groups (P = .053). Histologic evaluation revealed an increase in synovial folds and thickening of the capsular membrane in the saline and HA groups; this change was not evident in the triamcinolone group. A comparison of semiquantitative scores revealed greater expression levels of proteins involved in fibrosis and angiogenesis in the saline and HA groups compared with the control and triamcinolone groups. In Western blotting, the expression of inflammatory cytokines and the receptor for advanced glycation end products was significantly lower in the triamcinolone and HA groups than in the saline group. CONCLUSION Triamcinolone injection was more effective than normal saline or HA injection in improving range of motion and reversing fibrotic and angiogenic features of frozen shoulder. Both triamcinolone and HA injections elicited anti-inflammatory effects. CLINICAL RELEVANCE The antifibrotic and antiangiogenic properties of triamcinolone and the anti-inflammatory properties of both triamcinolone and HA should be considered when performing injections in clinical settings.
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Affiliation(s)
- Yongjin Ahn
- Department and Research Institute of Rehabilitation Medicine, Yonsei University, College of Medicine, Seoul, Republic of Korea
| | - Yong Suk Moon
- Department of Anatomy, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Gi-Young Park
- Department of Rehabilitation Medicine, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Sung Cheol Cho
- Department of Rehabilitation Medicine, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Yoon-Jin Lee
- Department of Biochemistry, College of Medicine, Soonchunhyang University, Cheonan, Republic of Korea
| | - Dong Rak Kwon
- Department of Rehabilitation Medicine, School of Medicine, Catholic University of Daegu, Daegu, Republic of Korea
| | - Sang Chul Lee
- Department and Research Institute of Rehabilitation Medicine, Yonsei University, College of Medicine, Seoul, Republic of Korea
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Silvestre A, Lintingre PF, Pesquer L, Meyer P, Moreau-Durieux MH, Dallaudiére B. Retrospective Analysis of Responders and Impaired Patients with Knee Osteoarthritis Treated with Two Consecutive Injections of Very Pure Platelet-Rich Plasma (PRP). Bioengineering (Basel) 2023; 10:922. [PMID: 37627807 PMCID: PMC10451974 DOI: 10.3390/bioengineering10080922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/26/2023] [Accepted: 08/01/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVES To assess the effectiveness of two consecutive intraarticular injections of PRP to treat knee osteoarthritis (KOA), discriminating between responders and impaired patients. METHODS This retrospective study included 73 consecutive patients who were referred for two intra-articular PRP injections (one week apart) for treating symptomatic moderate/severe KOA. Biological characterization of the PRP, including platelets, leukocytes and erythrocytes, was evaluated. Patient's subjective symptoms were recorded before the treatment and 1 year after the second injection using pain VAS and WOMAC scores. Responders were defined by an improvement of 10 points on WOMAC. RESULTS At a 1-year follow up, we found 36 (49.3%) patients who fulfilled the criteria of responders, and 21 (28.8%) patients were impaired. A statistically and clinically significant global improvement of -29.2 ± 14.3 (p < 0.001) points in WOMAC score was observed 1 year after treatment in the responder group, with a higher response rate in patients with KL 2 (57.7%) compared to KL IV (28.6%). The percentage of patients with KL IV was higher in the impaired group (48.0%) compared to the responders (16.6%). As expected, the evaluation of the functionality of the knee in the impaired group indicates that it significantly worsened after one year from treatment (p = 0.027). However, the average pain score remained stable with no significant differences after 1 year (p = 0.843). No clinical complications or severe adverse events after the PRP injections were reported. CONCLUSION The present study suggests that two intra-articular injections of 10 mL of very pure PRP provide pain and functional improvement in symptomatic KOA.
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Affiliation(s)
| | | | | | | | | | - Benjamin Dallaudiére
- Clinique du Sport de Bordeaux Mérignac, 33700 Mérignac, France; (A.S.); (P.-F.L.); (L.P.); (P.M.); (M.-H.M.-D.)
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Babu A, Channaveera C, Gupta A, Mittal MK, Johnson DS. Clinical and radiological efficacy of single-dose intra-articular high-molecular-weight hyaluronic acid in knee osteoarthritis. J Family Med Prim Care 2023; 12:1692-1696. [PMID: 37767433 PMCID: PMC10521855 DOI: 10.4103/jfmpc.jfmpc_486_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 09/29/2023] Open
Abstract
Context While visco-supplementation is being used for the treatment of knee osteoarthritis (OA), the published reports vary widely in benefits afforded by this treatment. It was therefore proposed to assess the objective parameters along with subjective outcomes. Aims Our study assessed the radiological and clinical efficacy of single-dose high-molecular-weight intra-articular hyaluronic acid (HMW-IAHA) injection in knee OA. Settings and Design This interventional cohort study was conducted in a calculated sample size of 44 patients with knee OA. Materials and Methods Visual analog scale (VAS) and knee OA and outcome score (KOOS) were used for clinical assessment, and whole organ magnetic resonance imaging score (WORMS) for radiological assessment. The subjects were given a single dose of HMW-IAHA injection, 90 mg/3 ml, and were assessed on day 0 and day 90. Statistical Analysis Statistical Package for Social Sciences (SPSS) software was used. Results At the day 90 follow-up, there was an improvement in mean ± standard deviation values of VAS score (day 0: 8.53 ± 0.81, day 90: 5.97 ± 0.87), KOOS score (day 0: 27.33 ± 15.18, day 90: 57.26 ± 14.26), and the cartilage signal and morphology in the medial femorotibial joint (day 0: 11.02 ± 6.26 and day 90: 10.91 ± 6.22) and patellofemoral joint (day 0: 10.35 ± 4.36 and day 90: 10.28 ± 4.39) compartments. There was a decrease in synovitis score from 2.3 ± 1.61 to 1.3 ± 1.3 in the medial femorotibial joint compartment and total WORMS score (day 0: 66.57 ± 36.06, day 90: 65.14 ± 35.62). Conclusions A single dose of intra-articular injection with high-molecular-weight hyaluronic acid produces improvement in the clinical symptoms and quality of life as well as is effective in maintaining the articular cartilage integrity and reducing synovial inflammation.
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Affiliation(s)
- Anjana Babu
- Department of Physical Medicine and Rehabilitation, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
| | - Chethan Channaveera
- Department of Physical Medicine and Rehabilitation, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, Delhi, India
| | - Ajay Gupta
- Department of Physical Medicine and Rehabilitation, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
| | - Mahesh K. Mittal
- Department of Radiodiagnosis, Subharti Medical College, Meerut, Uttar Pradesh, India
| | - Deepthi S. Johnson
- Department of Physical Medicine and Rehabilitation, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, Delhi, India
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Paul A, Borkar A, Bhalerao N, Wanjari D. A Comparative Evaluation of Intra-articular Bupivacaine vs Bupivacaine and Dexmedetomidine for Postoperative Analgesia in Arthroscopic Knee Surgeries. Cureus 2023; 15:e43956. [PMID: 37746467 PMCID: PMC10514739 DOI: 10.7759/cureus.43956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Background The study was done to determine the duration of postoperative analgesia brought on by incorporating intra-articular Bupivacaine with Dexmedetomidine as an adjuvant following knee arthroscopies. Methods A prospective randomized control study was conducted on 60 patients of ASA classes I and II, between the ages of 20 and 60 years, undergoing arthroscopic surgeries of the knee under spinal anaesthesia. The patients were divided into group B and group D, each containing 30 patients. The participants in group B were administered Inj. Bupivacaine 0.5% 19 mL + 1 mL of normal saline intra-articularly and the participants in group D were administered Inj. Bupivacaine 0.5% 19 mL, Inj. Dexmedetomidine 1 μg/kg and normal saline post-surgery. The number of analgesics used in the first 24 hours, pain levels using the visual analogue scale and the timing of administration of the first analgesic dose between the two study groups were evaluated. Results In comparison to the Bupivacaine group, the Dexmedetomidine group required fewer rescue analgesics. The visual analogue visual scale score in group B at four hours and six hours was 2.7 ± 1.39 and 2.9 ± 1.03, respectively, and in group D at four hours and six hours was 1.9 ± 1.09 and 1.83 ± 0.91. The visual analogue scale scores at these times were statistically significant. The visual analogue scale scores at 12 hours and 24 hours were statistically not significant. Conclusion Dexmedetomidine added to Intra-articular Bupivacaine provides an increased duration of postoperative analgesia in patients undergoing arthroscopic surgeries of the knee. The combination offers improved analgesia and reduces the overall dosage of rescue analgesics needed without causing substantial side effects.
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Affiliation(s)
- Amreesh Paul
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anjali Borkar
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nikhil Bhalerao
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Dnyanshree Wanjari
- Anaesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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22
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Kim KI, Lee MC, Lee JH, Moon YW, Lee WS, Lee HJ, Hwang SC, In Y, Shon OJ, Bae KC, Song SJ, Park KK, Kim JH. Clinical Efficacy and Safety of the Intra-articular Injection of Autologous Adipose-Derived Mesenchymal Stem Cells for Knee Osteoarthritis: A Phase III, Randomized, Double-Blind, Placebo-Controlled Trial. Am J Sports Med 2023; 51:2243-2253. [PMID: 37345256 DOI: 10.1177/03635465231179223] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023]
Abstract
BACKGROUND Intra-articular injection of autologous culture-expanded adipose-derived mesenchymal stem cells (ADMSCs) has introduced a promising treatment option for knee osteoarthritis. Although the clinical efficacy and safety of ADMSCs have been reported, the treatment remains controversial owing to the small sample sizes and heterogeneous osteoarthritis grades in previous studies. PURPOSE To assess the efficacy and safety of intra-articular injection of ADMSCs as compared with placebo in alleviating pain and improving functional capacity in a large sample of patients with knee osteoarthritis of Kellgren-Lawrence (K-L) grade 3. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS This phase III multicenter clinical trial was a double-blind randomized controlled study that included 261 patients with K-L grade 3 symptomatic knee osteoarthritis who were administered a single injection of autologous culture-expanded ADMSCs or placebo. Clinical data were assessed at baseline and at 3 and 6 months after the injection. The primary endpoints were improvements in 100-mm visual analog scale (VAS) for pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for function at 6 months after the injection. The secondary endpoints included clinical and radiologic examinations and safety after injection. The changes in cartilage defects after injection were assessed by magnetic resonance imaging at 6 months. RESULTS The ADMSC and control groups included 125 and 127 patients available for follow-up, respectively. At 6 months, the ADMSC group showed significantly better improvements in 100-mm VAS (ADMSC vs control, 25.2 vs 15.5; P = .004) and total WOMAC score (21.7 vs 14.3; P = .002) as compared with the control group. The linear mixed model analysis indicated significantly better improvements in all clinical outcomes in the ADMSC group after 6 months. At 6 months, the ADMSC group achieved significantly higher proportions of patients above the minimal clinically important difference in 100-mm VAS and WOMAC score. Radiologic outcomes and adverse events did not demonstrate significant differences between the groups. No serious treatment-related adverse events were observed. Magnetic resonance imaging revealed no significant difference in change of cartilage defects between the groups at 6 months. CONCLUSION Intra-articular injection of autologous culture-expanded ADMSCs provided significant pain relief and functional improvements in patients with K-L grade 3 osteoarthritis. Long-term results are needed to determine the disease-modifying effects of ADMSCs, such as structural changes, and the duration of effect of intra-articular injection of ADMSCs in knee osteoarthritis. REGISTRATION NCT03990805 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Kang-Il Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Korea; Department of Orthopaedic Surgery, School of Medicine, Kyung Hee University, Seoul, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Myung Chul Lee
- Department of Orthopedic Surgery, Seoul National University Hospital, Seoul National University School of Medicine, Seoul, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Ju Hong Lee
- Department of Orthopaedic Surgery, Jeonbuk National University Hospital, Jeonbuk National University School of Medicine, Jeonju, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Young-Wan Moon
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Woo-Suk Lee
- Department of Orthopedic Surgery, Gangnam Severance Hospital, Yonsei University School of Medicine, Seoul, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Han-Jun Lee
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sun-Chul Hwang
- Department of Orthopaedic Surgery, Institute of Health Science, Research Institute of Life Science, and School of Medicine, Gyeongsang National University, Jinju, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Yong In
- Department of Orthopaedic Surgery, Seoul St Mary's Hospital, Catholic University College of Medicine, Seoul, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Oog-Jin Shon
- Department of Orthopaedic Surgery, Yeungnam University Medical Center, Yeungnam University School of Medicine, Daegu, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Ki-Cheor Bae
- Department of Orthopaedic Surgery, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Sang-Jun Song
- Department of Orthopaedic Surgery, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Kwan Kyu Park
- Department of Orthopedic Surgery, Severance Hospital, Yonsei University School of Medicine, Seoul, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jun-Ho Kim
- Department of Orthopaedic Surgery, Center for Joint Diseases, Kyung Hee University Hospital at Gangdong, Seoul, Korea
- Investigation performed at Kyung Hee University Hospital at Gangdong, Seoul, Korea
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23
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Kim H, Kim AY, Kang BJ. Insertional biceps tendinopathy palliated successfully with intra-articular triamcinolone acetonide injection in a dog: A case report. Vet Med Sci 2023. [PMID: 37327466 DOI: 10.1002/vms3.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 04/05/2023] [Accepted: 05/29/2023] [Indexed: 06/18/2023] Open
Abstract
This report describes a dog diagnosed with insertional biceps tendinopathy that was palliated with intra-articular triamcinolone acetonide injections. The patient was a 6-year-old spayed female Chihuahua dog that had left thoracic limb lameness for 3 months before presentation. On physical examination, moderate pain was elicited by performing the biceps test and isolated full elbow extension on the left thoracic limb. Gait analysis showed asymmetrical peak vertical force and vertical impulse between thoracic limbs. Computed tomography (CT) revealed enthesophyte formation on the ulnar tuberosity of the left elbow joint. Ultrasonography showed a heterogeneous fibre pattern at the biceps tendon insertion site on the left elbow joint. These findings confirmed insertional biceps tendinopathy based on physical examination, CT and ultrasonography results. The dog received an intra-articular triamcinolone acetonide injection with hyaluronic acid in the left elbow joint. Clinical signs improved after the first injection, including a range of motion, pain and gait. A second injection was given in the same manner because of recurring mild lameness 3 months later. No clinical signs were observed during the follow-up period.
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Affiliation(s)
- Hyunsoo Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
- BK21 FOUR Future Veterinary Medicine Leading Education and Research Center, Seoul National University, Seoul, Republic of Korea
| | - Ah-Young Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
| | - Byung-Jae Kang
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine and Research Institute for Veterinary Science, Seoul National University, Seoul, Republic of Korea
- BK21 FOUR Future Veterinary Medicine Leading Education and Research Center, Seoul National University, Seoul, Republic of Korea
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24
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Zhao Y, Ou Q, Cai Y, Ruan G, Zhang Y, Ding C. Shedding light on experimental intra-articular drugs for treating knee osteoarthritis. Expert Opin Investig Drugs 2023. [PMID: 37310287 DOI: 10.1080/13543784.2023.2225214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Knee osteoarthritis (KOA) is a leading cause of disability among older adults without a curative therapy available. The development of disease-modifying OA drugs based on intra-articular injection (IA) is drawing extensive attention for its advantages in bioavailability and reduced systemic exposure. Based on the newly revealed pathogenesis of OA, several experimental IA drugs are successful in preclinical studies; moreover, some of them are in different phases of randomized clinical trials, bringing new opportunities for disease modification of OA. AREAS COVERED This is a targeted literature review to summarize experimental IA drugs targeting cartilage repair, cellular homeostasis, cellular senescence, and pain control. We also introduced targeted gene/oligonucleotide products. EXPERT OPINION Currently available therapeutics for KOA remain symptomatic relief and surgical replacement of damaged joints. Recently emerging experimental IA drugs are in different stages of development and are likely to enter practice in the near future and address many of the unmet needs. The major challenges for development of the new drugs are limited knowledge about the responsive subjects, heterogenicity of subjects and the complexity of the disease. Despite this, IA-based experimental drugs still hold great potential to be future disease-modifying treatments for their intrinsic advantages.
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Affiliation(s)
- Yang Zhao
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Qianhua Ou
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yu Cai
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Guangfeng Ruan
- Clinical Research Centre, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
| | - Yan Zhang
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Changhai Ding
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Clinical Research Centre, Guangzhou First People's Hospital, South China University of Technology, Guangzhou, China
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25
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Carneiro DDC, Araújo LTD, Santos GC, Damasceno PKF, Vieira JL, Santos RRD, Barbosa JDV, Soares MBP. Clinical Trials with Mesenchymal Stem Cell Therapies for Osteoarthritis: Challenges in the Regeneration of Articular Cartilage. Int J Mol Sci 2023; 24:9939. [PMID: 37373096 DOI: 10.3390/ijms24129939] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 06/29/2023] Open
Abstract
Osteoarthritis (OA) is a whole-joint disease primarily characterized by the deterioration of hyaline cartilage. Current treatments include microfracture and chondrocyte implantation as early surgical strategies that can be combined with scaffolds to repair osteochondral lesions; however, intra-articular (IA) injections or implantations of mesenchymal stem cells (MSCs) are new approaches that have presented encouraging therapeutic results in animal models and humans. We critically reviewed clinical trials with MSC therapies for OA, focusing on their effectiveness, quality, and outcomes in the regeneration of articular cartilage. Several sources of autologous or allogeneic MSCs were used in the clinical trials. Minor adverse events were generally reported, indicating that IA applications of MSCs are potentially safe. The evaluation of articular cartilage regeneration in human clinical trials is challenging, particularly in the inflammatory environment of osteoarthritic joints. Our findings indicate that IA injections of MSCs are efficacious in the treatment of OA and the regeneration of cartilage, but that they may be insufficient for the full repair of articular cartilage defects. The possible interference of clinical and quality variables in the outcomes suggests that robust clinical trials are still necessary for generating reliable evidence with which to support these treatments. We suggest that the administration of just-sufficient doses of viable cells in appropriate regimens is critical to achieve effective and durable effects. In terms of future perspectives, genetic modification, complex products with extracellular vesicles derived from MSCs, cell encapsulation in hydrogels, and 3D bioprinted tissue engineering are promising approaches with which to improve MSC therapies for OA.
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Affiliation(s)
| | - Lila Teixeira de Araújo
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador 40296-710, Bahia, Brazil
- SENAI Institute of Advanced Health Systems, University Center SENAI CIMATEC, Salvador 41650-010, Bahia, Brazil
| | - Girlaine Café Santos
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador 40296-710, Bahia, Brazil
| | | | | | - Ricardo Ribeiro Dos Santos
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador 40296-710, Bahia, Brazil
- SENAI Institute of Advanced Health Systems, University Center SENAI CIMATEC, Salvador 41650-010, Bahia, Brazil
| | | | - Milena Botelho Pereira Soares
- Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador 40296-710, Bahia, Brazil
- SENAI Institute of Advanced Health Systems, University Center SENAI CIMATEC, Salvador 41650-010, Bahia, Brazil
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26
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Wang L, Ding Y, Tang Q, Niu X. Preparation, Properties and Therapeutic Effect of a TPL Nanoparticle Thermosensitive Gel for Intra-Articular Injection. Molecules 2023; 28:4659. [PMID: 37375214 DOI: 10.3390/molecules28124659] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/05/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Most injectable preparations for the articular cavity are solution-type preparations that are frequently administered because of rapid elimination. In this study, triptolide (TPL), an effective ingredient in the treatment of rheumatoid arthritis (RA), was prepared in the form of a nanoparticle thermosensitive gel (TPL-NS-Gel). The particle size distribution and gel structure were investigated by TEM, laser particle size analysis and laser capture microdissection. The effect of the nanoparticle carrier material PLGA on the phase transition temperature was investigated by 1H variable temperature NMR and DSC. The tissue distribution, pharmacokinetic behavior, four inflammatory factors and therapeutic effect were determined in a rat RA model. The results suggested that PLGA increased the gel phase transition temperature. The drug concentration of the TPL-NS-Gel group in joint tissues was higher than that in other tissues at different time points, and the retention time was longer than that of the TPL-NS group. After 24 days of administration, TPL-NS-Gel significantly improved the joint swelling and stiffness of the rat models, and the improvement degree was better than that of the TPL-NS group. TPL-NS-Gel significantly decreased the levels of hs-CRP, IL-1, IL-6 and TNF-α in serum and joint fluid. There was a significant difference between the TPL-NS-Gel and TPL-NS groups on Day 24 (p < 0.05). Pathological section results showed that inflammatory cell infiltration was lower in the TPL-NS-Gel group, and no other obvious histological changes were observed. Upon articular injection, the TPL-NS-Gel prolonged drug release, reduced the drug concentration outside the articular tissue and improved the therapeutic effect in a rat RA model. The TPL-NS-Gel can be used as a new type of sustained-release preparation for articular injection.
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Affiliation(s)
- Lijuan Wang
- Department of Pharmacy, Chongqing Engineering Research Center of Pharmaceutical Sciences, Chongqing Medical and Pharmaceutical College, Chongqing 401331, China
| | - Yongliang Ding
- Department of Pharmacy, Chongqing Engineering Research Center of Pharmaceutical Sciences, Chongqing Medical and Pharmaceutical College, Chongqing 401331, China
| | - Qian Tang
- Department of Pharmacy, Chongqing Engineering Research Center of Pharmaceutical Sciences, Chongqing Medical and Pharmaceutical College, Chongqing 401331, China
| | - Xiaodong Niu
- Department of Pharmacy, Chongqing Engineering Research Center of Pharmaceutical Sciences, Chongqing Medical and Pharmaceutical College, Chongqing 401331, China
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27
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Nooh MH, Alshehri MS, Alzahrani ZS, Alsolami HM, Almutairi AO, AlOtaibi AS, Aljohani AN. The Efficacy and Safety of Intra-articular Low Molecular Weight Fraction of Human Serum Albumin for the Management of Moderate to Moderately Severe Knee Osteoarthritis: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e41240. [PMID: 37529519 PMCID: PMC10387823 DOI: 10.7759/cureus.41240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 08/03/2023] Open
Abstract
Osteoarthritis is a chronic degenerative joint disease that affects weight-bearing joints. Low molecular weight fraction of 5% (LMWF-5A) human serum albumin is an intra-articular injection that emerged for the treatment of knee osteoarthritis. The aim of this review is to assess the efficacy and safety of LMWF-5A versus placebo through a systematic review and meta-analysis. The Cochrane Central Register of Controlled Trials (CENTRAL), Medical Literature Analysis and Retrieval System Online (MEDLINE), EBSCO, and ClinicalTrials.gov registry databases were utilized to search for studies. Only randomized controlled trials (RCTs) that evaluated the efficacy of LMWF-5A versus placebo were included. Efficacy endpoints were represented by Western Ontario and McMaster Universities Arthritis Index (WOMAC) A and C scores for pain and function, respectively. Serious adverse events (SAEs), non-serious adverse events (NSAEs), and mortality rates were used to evaluate the safety of the drug. The revised Cochrane risk of bias tool was used for the risk of bias assessment. Seven RCTs (n=2939) that met the inclusion criteria were included. The meta-analysis did not find significant improvement in pain (WOMAC A) (standardized mean difference (SMD)= -0.01, 95% confidence interval (CI) -0.10 - 0.09, P=0.87, I²=30%). Additionally, no significant change in function was noted (WOMAC C) (SMD=0.01, 95% CI -0.08 - 0.10, P=0.87, I²=22%). The pooled analysis did not find a significant difference between LMWF-5A and placebo regarding the incidence of joint swelling (P=0.84), joint stiffness (P=0.53), arthralgia (P=0.53), extremity pain (P=0.45), NSAEs (P=0.21), SAEs (P=0.92), or mortality (P=1.00). However, the subgroup analysis showed a significant reduction of 42% in NSAEs upon administration of 10 mL of LMWF-5A (risk ratio (RR)=0.58, 95% CI 0.35-0.97, P=0.04). In summary, our meta-analysis did not find significant differences between LMWF-5A and placebo regarding the incidence of NSAEs, SAEs, or mortality. On the other hand, LMWF-5A did not demonstrate superiority over saline in terms of efficacy. Therefore, it is not an effective drug for managing knee osteoarthritis.
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Affiliation(s)
- Mohammad H Nooh
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mohammed S Alshehri
- Orthopaedic Surgery, King Abdulaziz Medical City, Jeddah, SAU
- Orthopaedic Surgery, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Ziyad S Alzahrani
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Hatem M Alsolami
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Amal O Almutairi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
| | | | - Abdulaziz N Aljohani
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Medical Research, King Abdullah International Medical Research Center, Jeddah, SAU
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28
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Ertilav E, Sarı S, Ertilav D, Aydın ON. Comparison of radiological and clinical results of knee intra-articular injections with two ultrasonography-guided approach techniques: A randomized controlled study. Arch Rheumatol 2023; 38:230-237. [PMID: 37680515 PMCID: PMC10481686 DOI: 10.46497/archrheumatol.2023.9382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/16/2022] [Indexed: 09/09/2023] Open
Abstract
Objectives The objective of this study was to evaluate the clinical and radiological results of intra-articular injections performed with two different ultrasound-guided approaches in knee osteoarthritis. Patients and methods The randomized controlled study was conducted on 80 knees of 40 patients (9 males, 31 females; mean age: 63.6±8.2 years; range, 46 to 78 years) with Grade 2-3 gonarthrosis that underwent ultrasound-guided intra-articular injections with suprapatellar (SP) or infrapatellar (IP) approaches between March 2020 and January 2021. After the injection, opaque material spread was fluoroscopically observed. Before the procedure and at the one and three months after the procedure, patients' Visual Analog Scale (VAS) scores for pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores for functional recovery were recorded. Results In both techniques, one- and three-month VAS and WOMAC scores were found to be significantly lower (p<0.001 and p<0.001, respectively). Of the patients with positive opaque spread, 63.3% were in the IP technique group, and 36.7% were in the SP technique group (p=0.003). In 69.2% of those with radiologically positive opaque spread, the VAS score was significantly higher with >50% regression (p=0.04). In the IP technique, >50% regression rate of the VAS was 86.7% in patients with positive opaque spread, while VAS regression was significantly higher than those without opaque spread (p=0.02). Conclusion Although the IP approach shows an early-positive opaque transition due to its proximity to the joint, both approach techniques are clinically effective under ultrasound guidance.
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Affiliation(s)
- Esra Ertilav
- Department of Algology, Mehmet Akif Ersoy State Hospital, Çanakkale, Türkiye
| | - Sinem Sarı
- Department of Anesthesiology and Reanimation, Adnan Menderes University Medical Faculty, Aydın, Türkiye
| | - Devran Ertilav
- Department of Orthopedics and Traumatology, Biga State Hospital, Çanakkale, Türkiye
| | - Osman Nuri Aydın
- Department of Algology, Adnan Menderes University Medical Faculty, Aydın, Türkiye
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29
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Sullivan JK, Gottreich JR, Imrey PB, Winalski CS, Li X, Spindler KP, Tomko PM, Cox CL, Wright RW, Jones MH. The Corticosteroid Meniscectomy Trial of Extended-Release Triamcinolone Injection After Arthroscopic Partial Meniscectomy: Protocol for a Double-Blind Randomized Controlled Trial. Orthop J Sports Med 2023; 11:23259671231150812. [PMID: 37113139 PMCID: PMC10126624 DOI: 10.1177/23259671231150812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 10/21/2022] [Indexed: 04/29/2023] Open
Abstract
Background Meniscal tear in older adults often accompanies knee osteoarthritis and is commonly treated with arthroscopic partial meniscectomy (APM) when patients have persistent pain after a trial of physical therapy. Cross-sectional evidence suggests that synovitis is associated with baseline pain in this patient population, but little is known about the relationship between synovitis and postoperative recovery or progression of knee osteoarthritis. Purpose/Hypothesis Intra-articular extended-release triamcinolone may reduce inflammation and thereby improve outcomes and slow disease progression. This article presents the rationale behind the Corticosteroid Meniscectomy Trial (CoMeT) and describes its study design and implementation strategies. Study Design Randomized controlled trial. Methods CoMeT is a 2-arm, 3-center, randomized placebo-controlled trial designed to establish the clinical efficacy of extended-release triamcinolone administered via intra-articular injection immediately after APM. The primary outcome is change in Knee injury and Osteoarthritis Outcome Score Pain subscore at 3-month follow-up. Synovial biopsy, joint fluid aspirate, and urine and blood sample analyses will examine the associations between various objective measures of baseline inflammation and pre- and postoperative outcome measures and clinical responses to triamcinolone intervention. Quantitative 3-T magnetic resonance imaging will evaluate cartilage and meniscal composition and 3-dimensional bone shape to detect early joint degeneration. Results We discuss methodologic innovations and challenges. Conclusion To our knowledge, this is the first randomized double-blind clinical trial that will analyze the effect of extended-release triamcinolone acetonide on pain, magnetic resonance imaging measures of structural change and effusion/synovitis, soluble biomarkers, and synovial tissue transcriptomics after APM.
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Affiliation(s)
- James K. Sullivan
- Cleveland Clinic Lerner College of
Medicine of Case Western Reserve School of Medicine, Cleveland, Ohio, USA
| | - Julia R. Gottreich
- Orthopaedic and Arthritis Center for
Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Peter B. Imrey
- Cleveland Clinic Lerner College of
Medicine of Case Western Reserve School of Medicine, Cleveland, Ohio, USA
- Department of Quantitative Health
Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Xiaojuan Li
- Imaging Institute, Cleveland Clinic,
Cleveland, Ohio, USA
- Department of Biomedical Engineering,
Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Kurt P. Spindler
- Department of Orthopaedic Surgery,
Sports Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Patrick M. Tomko
- Department of Orthopaedic Surgery,
Sports Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Charles L. Cox
- Department of Orthopaedic Surgery,
Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Rick W. Wright
- Department of Orthopaedic Surgery,
Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Morgan H. Jones
- Orthopaedic and Arthritis Center for
Outcomes Research, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Orthopedic Surgery,
Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Morgan H. Jones, MD, MPH,
Department of Orthopedic Surgery, Brigham and Women’s Hospital, 75 Francis St,
Hale 5016, Boston, MA 02115, USA (
)
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Yi YH, Chen G, Gong S, Han LZ, Gong TL, Wang YX, Xu WH, Jin X. Injectable Temperature-Sensitive Hydrogel Loaded with IL-36Ra for the Relief of Osteoarthritis. ACS Biomater Sci Eng 2023; 9:1672-1681. [PMID: 36796355 DOI: 10.1021/acsbiomaterials.2c01144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Osteoarthritis (OA) is an inflammatory disease accompanied by synovial joint inflammation, and IL-36 plays an important role in this process. Local application of IL-36 receptor antagonist (IL-36Ra) can effectively control the inflammatory response, thereby protecting cartilage and slowing down the development of OA. However, its application is limited by the fact that it is rapidly metabolized locally. We designed and prepared a temperature-sensitive poly(lactic-co-glycolic acid)-poly(ethylene glycol)-poly(lactic-co-glycolic acid) (PLGA-PEG-PLGA) hydrogel (IL-36Ra@Gel) system carrying IL-36Ra and evaluated its basic physicochemical characteristics. The drug release curve of IL-36Ra@Gel indicated that this system could slowly release the drug over a longer period. Furthermore, degradation experiments showed that it could be largely degraded from the body within 1 month. The biocompatibility-related results showed that it had no significant effect on cell proliferation compared to the control group. In addition, the expression of MMP-13 and ADAMTS-5 was lower in IL-36Ra@Gel-treated chondrocytes than in the control group, and the opposite results appeared in aggrecan and collagen X. After 8 weeks of treatment with IL-36Ra@Gel by joint cavity injection, HE and Safranin O/Fast green staining showed that the degree of cartilage tissue destruction in the IL-36Ra@Gel-treated group was less than those in other groups. Meanwhile, the joints of mice in the IL-36Ra@Gel group had the most intact cartilage surface, the smallest thickness of cartilage erosion, and the lowest OARSI and Mankins score among all groups. Consequently, the combination of IL-36Ra and PLGA-PLEG-PLGA temperature-sensitive hydrogels can greatly improve the therapeutic effect and prolong the drug duration time, thus effectively delaying the progression of degenerative changes in OA, providing a new feasible nonsurgical treatment for OA.
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Affiliation(s)
- Yi-Hu Yi
- Department of Orthopaedics, Union Hospital, Tongji, Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Guo Chen
- Department of Orthopaedics, Union Hospital, Tongji, Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Song Gong
- Department of Orthopaedics, Union Hospital, Tongji, Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Li-Zhi Han
- Department of Orthopaedics, Union Hospital, Tongji, Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Tian-Lun Gong
- Department of Orthopaedics, Union Hospital, Tongji, Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yu-Xiang Wang
- Department of Orthopaedics, Union Hospital, Tongji, Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wei-Hua Xu
- Department of Orthopaedics, Union Hospital, Tongji, Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Xin Jin
- Department of Orthopaedics, Union Hospital, Tongji, Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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Patel A, Kumar D, Singh S, Mohan R, Mishra S, Gupta AK, Yadav G. Effect of Fluoroscopic-Guided Corticosteroid Injection in Patients With Sacroiliac Joint Dysfunction. Cureus 2023; 15:e36406. [PMID: 37090293 PMCID: PMC10115210 DOI: 10.7759/cureus.36406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
Background Sacroiliac joint dysfunction is a major cause of axial low back pain which can masquerade as pain from lumbar disc diseases. Treatment of axial back pain arising due to sacroiliac joint dysfunction remains a challenge. This study was conducted to evaluate the long and short-term effects of intra-articular corticosteroid injection in the relief of pain and disability caused by sacroiliac joint dysfunction. Methodology A total of 83 patients with sacroiliac joint dysfunction were included in this prospective randomized control study. Patients were randomized into two groups by a computer-generated randomization table. These two groups were treated with fluoroscopy-guided corticosteroid and local anesthetic injection (group A) and distilled water and local anesthetic injection (group B). Pre and post-intervention assessment of all patients was done based on the Numeric Pain Rating Scale (NPRS) for pain and Oswestry Disability Index (ODI) for disability. The outcome measures of the study were the NPRS and ODI assessed at the initial visit one (pre-injection), two weeks post-injection (visit 2), and four weeks post-injection (visit 3). Results Demographic data were comparable in both groups. There was no significant difference in pre-injection NPRS and ODI values in both groups. The changes in NPRS and ODI values were significant from pre-injection to two weeks to four weeks. Group A patients performed better in terms of a decrease in the perception of pain and a decrease in the perception of disability compared to group B patients in the second and fourth weeks of follow-up. Conclusions Fluoroscopy-guided corticosteroid injection is an effective measure for reducing pain and disability in patients with sacroiliac joint dysfunction.
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Affiliation(s)
- Anurag Patel
- Orthopaedics, Maa Vindhyawasini Autonomous State Medical College & Associated Divisional District Hospital, Mirzapur, IND
| | - Dileep Kumar
- Physical Medicine and Rehabilitation, King George's Medical University, Lucknow, IND
| | - Shailendra Singh
- Orthopaedic Surgery, King George's Medical University, Lucknow, IND
| | - Ravindra Mohan
- Orthopaedic Surgery, King George's Medical University, Lucknow, IND
| | - Sudhir Mishra
- Physical Medicine and Rehabilitation, King George's Medical University, Lucknow, IND
| | - Anil K Gupta
- Physical Medicine and Rehabilitation, King George's Medical University, Lucknow, IND
| | - Ganesh Yadav
- Physical Medicine and Rehabilitation, King George's Medical University, Lucknow, IND
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Aktaş İ, Sarı K, Ünlü Özkan F, Nedim Kahraman A, Vural A, Akgün K. Magnetic resonance imaging/ultrasound fusion-guided sacroiliac joint corticosteroid injection in patients with axial spondyloarthritis. Turk J Phys Med Rehabil 2023; 69:116-120. [PMID: 37201011 PMCID: PMC10186019 DOI: 10.5606/tftrd.2022.8858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 08/04/2021] [Indexed: 05/20/2023] Open
Abstract
Local glucocorticoid injections are used in the treatment of isolated sacroiliitis in patients with spondyloarthritis. Sacroiliac joint injections can be performed intraarticularly or periarticularly. Since the accuracy of blind injections is low, fluoroscopy, magnetic resonance imaging, computed tomography, or ultrasonography guidance are used to increase the accuracy of sacroiliac joint injections. Currently, imaging fusion software is successfully used in sacroiliac joint interventions with three-dimensional anatomic information added to ultrasonography. Herein, we present two cases of sacroiliac joint corticosteroid injections under ultrasonography-magnetic resonance imaging fusion guidance.
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Affiliation(s)
- İlknur Aktaş
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
| | - Kemal Sarı
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
| | - Feyza Ünlü Özkan
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
| | - Ahmet Nedim Kahraman
- Department of Radiology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
| | - Ahmet Vural
- Department of Radiology, University of Health Sciences, Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Türkiye
| | - Kenan Akgün
- Department of Physical Medicine and Rehabilitation, Istanbul University-Cerrahpaşa Cerrahpaşa Faculty of Medicine, Istanbul, Türkiye
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Huang L, Jin M, Gu R, Xiao K, Lu M, Huo X, Sun M, Yang Z, Wang Z, Zhang W, Zhi L, Meng Z, Ma J, Ma J, Zhang R. miR-199a-5p Reduces Chondrocyte Hypertrophy and Attenuates Osteoarthritis Progression via the Indian Hedgehog Signal Pathway. J Clin Med 2023; 12:jcm12041313. [PMID: 36835852 PMCID: PMC9959662 DOI: 10.3390/jcm12041313] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
Osteoarthritis (OA), the most common type of arthritis, is an age-associated disease, characterized by the progressive degradation of articular cartilage, synovial inflammation, and degeneration of subchondral bone. Chondrocyte proliferation is regulated by the Indian hedgehog (IHH in humans, Ihh in animals) signaling molecule, which regulates hypertrophy and endochondral ossification in the development of the skeletal system. microRNAs (miRNAs, miRs) are a family of about 22-nucleotide endogenous non-coding RNAs, which negatively regulate gene expression. In this study, the expression level of IHH was upregulated in the damaged articular cartilage tissues among OA patients and OA cell cultures, while that of miR-199a-5p was the opposite. Further investigations demonstrated that miR-199a-5p could directly regulate IHH expression and reduce chondrocyte hypertrophy and matrix degradation via the IHH signal pathway in the primary human chondrocytes. The intra-articular injection of synthetic miR-199a-5p agomir attenuated OA symptoms in rats, including the alleviation of articular cartilage destruction, subchondral bone degradation, and synovial inflammation. The miR-199a-5p agomir could also inhibit the Ihh signaling pathway in vivo. This study might help in understanding the role of miR-199a-5p in the pathophysiology and molecular mechanisms of OA and indicate a potential novel therapeutic strategy for OA patients.
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Affiliation(s)
- Lei Huang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China
- Translational Medicine Center, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China
| | - Meng Jin
- Translational Medicine Center, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China
| | - Ruiying Gu
- School of Basic Medical Science, Xi’an Jiaotong University Health Science Center, Xi’an 710049, China
| | - Kunlin Xiao
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China
- Translational Medicine Center, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China
| | - Mengnan Lu
- School of Basic Medical Science, Xi’an Jiaotong University Health Science Center, Xi’an 710049, China
| | - Xinyu Huo
- School of Basic Medical Science, Xi’an Jiaotong University Health Science Center, Xi’an 710049, China
| | - Mengyao Sun
- School of Basic Medical Science, Xi’an Jiaotong University Health Science Center, Xi’an 710049, China
| | - Zhi Yang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China
| | - Zhiyuan Wang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China
| | - Weijie Zhang
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China
| | - Liqiang Zhi
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China
| | - Ziang Meng
- Department of Mathematics and Computing Science, Simon Fraser University, Vancouver, BC V6B 5K3, Canada
| | - Jie Ma
- School of Basic Medical Science, Xi’an Jiaotong University Health Science Center, Xi’an 710049, China
| | - Jianbing Ma
- Department of Joint Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China
- Correspondence: (J.M.); (R.Z.)
| | - Rui Zhang
- Translational Medicine Center, Honghui Hospital, Xi’an Jiaotong University, Xi’an 710054, China
- Correspondence: (J.M.); (R.Z.)
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Acibadem E, Keskinruzgar A, Bozdag Z, Yavuz GY. Therapeutic effect of alendronate in an experimental temporomandibular joint osteoarthritis. J Oral Rehabil 2023; 50:113-121. [PMID: 36437587 DOI: 10.1111/joor.13396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/02/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Temporomandibular joint osteoarthritis is a common degenerative joint disease. This disease negatively affects the daily life, speech and chewing functions of patients. OBJECTIVE This study aimed to evaluate the effects of intra-articular injection of alendronate to osteoarthritis, which has a protective effect on bone and cartilage tissue and helps reduce inflammation in temporomandibular joint osteoarthritis. METHODS A total of 24 Wistar albino rats were used in the study. Rats were divided into four groups: study, saline, control and sham. In both saline and control groups, monosodium iodoacetate was injected intra-articularly to induce osteoarthritis. Alendronate was administered intra-articularly to the study group weekly for 4 weeks. In the saline group, saline was administered by intra-articular injection. At the end of the 12th week, all groups were sacrificed. Mandibular condyle tissues were examined histopathologically. RESULTS According to the results, osteoarthritic changes in the control group were higher than those in the study group (p < .05). No significant reduction in osteoarthritic changes was observed in the saline group (p > .05). Significant osteoarthritis findings were observed in all groups compared with the sham group (p < .05). CONCLUSION Intra-articular injection of alendronate was found to have positive results on TMJ osteoarthritis. In addition, it was seen that alendronate has effects on reducing cartilage tissue degeneration and loss of matrix proteins.
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Affiliation(s)
- Elif Acibadem
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adiyaman University, Adiyaman, Turkey
| | - Aydin Keskinruzgar
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adiyaman University, Adiyaman, Turkey
| | - Zehra Bozdag
- Department of Pathology, Faculty of Medicine, İnönü University, Malatya, Turkey
| | - Gunay Yapici Yavuz
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Adiyaman University, Adiyaman, Turkey
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Rodriguez-Merchan EC. Intra-articular injection of platelet-rich plasma in patients with hemophilia and painful knee joint cartilage degeneration. Expert Rev Hematol 2023:1-10. [PMID: 36609192 DOI: 10.1080/17474086.2023.2166922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Knee arthropathy causes pain to people with hemophilia (PWH). One of the current controversies is whether injections of intra-articular platelet-rich plasma (PRP) are effective in relieving the knee pain of PWH. AREAS COVERED A narrative literature review was conducted on the efficacy of PRP injections in the knees of PWH. EXPERT OPINION Intra-articular PRP knee injections are widely used in patients with knee osteoarthritis to relieve pain and delay total knee arthroplasty. Although numerous publications have supported the use of PRP in knee osteoarthritis, there is still major controversy regarding its true usefulness, given that a number of studies with a high degree of evidence have failed to show the efficacy of PRP. With respect to painful hemophilic arthropathy, the use of PRP injections is even more controversial, as there are only four publications on the subject supporting the use of PRP in hemophilia, all of them with a low degree of evidence. A publication with grade 1 evidence recommended against the use of PRP in hemophilic arthropathy because its efficacy has not been demonstrated. My opinion is that intra-articular PRP injections should not be used in hemophilia until there is more evidence of its benefits.
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Affiliation(s)
- E Carlos Rodriguez-Merchan
- Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain.,Osteoarticular Surgery Research, Hospital La Paz Institute for Health Research - IdiPAZ (La Paz University Hospital - Autonomous University of Madrid), Madrid, Spain
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Chen L, Jin S, Yao Y, He S, He J. Comparison of clinical efficiency between intra-articular injection of platelet-rich plasma and hyaluronic acid for osteoarthritis: a meta-analysis of randomized controlled trials. Ther Adv Musculoskelet Dis 2023; 15:1759720X231157043. [PMID: 36950089 PMCID: PMC10026092 DOI: 10.1177/1759720x231157043] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 01/27/2023] [Indexed: 03/19/2023] Open
Abstract
Background Platelet-rich plasma (PRP) and hyaluronic acid (HA) are non-surgical treatments for osteoarthritis (OA), but the comparison of their efficiency is still inconclusive. Objectives The objectives of this study were to compare the efficacy of PRP and HA in the treatment of OA by meta-analysis and to explore the effects of different injection times and leukocyte concentration on the efficacy of PRP. Design Meta-analysis and subgroup analysis were conducted. The data were analyzed by Review Manager v5.4.1. Data sources and methods Articles were retrieved and screened from PubMed, the Cochrane Library, Web of Science, and Embase. The outcome included the total Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the visual analog scale (VAS), adverse events (AEs), the International Knee Documentation Committee (IKDC), and the satisfaction rate. Results A total of 30 articles involving 2733 patients were included. The total WOMAC score and IKDC score of the PRP group were better than those of the HA group at the last follow-up time, while there was no significant difference in AEs, satisfaction rate, and VAS between the two groups. In our subgroup analysis, there was no significant difference between single-injection PRP and triple-injection PRP. Leukocyte-poor PRP (LP-PRP) was better than leukocyte-rich PRP (LR-PRP) in IKDC, but there was no significant difference between them in the other scores. Conclusions In the treatment of OA, compared with HA, PRP performed better in the improvement of the patient's function. There was no significant difference in VAS and AEs between the two groups, and the safety was comparable. LP-PRP looked to be superior to LR-PRP in functional recovery, but there appeared to be no significant difference in pain relief between them. There was no significant difference between single PRP and triple PRP in the subgroup analysis.
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Affiliation(s)
- Lili Chen
- Department of Orthopaedic Surgery, Third
Xiangya Hospital of Central South University, Changsha, China
| | - Shirong Jin
- Department of Orthopaedic Surgery, Third
Xiangya Hospital of Central South University, Changsha, China
| | - Yunheng Yao
- Department of Orthopaedic Surgery, Third
Xiangya Hospital of Central South University, Changsha, China
| | - Sixian He
- Department of Orthopaedic Surgery, Third
Xiangya Hospital of Central South University, Changsha, China
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Wei P, Bao R. Intra-Articular Mesenchymal Stem Cell Injection for Knee Osteoarthritis: Mechanisms and Clinical Evidence. Int J Mol Sci 2022; 24. [PMID: 36613502 DOI: 10.3390/ijms24010059] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/15/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Knee osteoarthritis presents higher incidences than other joints, with increased prevalence during aging. It is a progressive process and may eventually lead to disability. Mesenchymal stem cells (MSCs) are expected to repair damaged issues due to trilineage potential, trophic effects, and immunomodulatory properties of MSCs. Intra-articular MSC injection was reported to treat knee osteoarthritis in many studies. This review focuses on several issues of intra-articular MSC injection for knee osteoarthritis, including doses of MSCs applied for injection and the possibility of cartilage regeneration following MSC injection. Intra-articular MSC injection induced hyaline-like cartilage regeneration, which could be seen by arthroscopy in several studies. Additionally, anatomical, biomechanical, and biochemical changes during aging and other causes participate in the development of knee osteoarthritis. Conversely, appropriate intervention based on these anatomical, biomechanical, biochemical, and functional properties and their interactions may postpone the progress of knee OA and facilitate cartilage repair induced by MSC injection. Hence, post-injection rehabilitation programs and related mechanisms are discussed.
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Wang Z, Wang R, Xiang S, Gu Y, Xu T, Jin H, Gu X, Tong P, Zhan H, Lv S. Assessment of the effectiveness and satisfaction of platelet-rich plasma compared with hyaluronic acid in knee osteoarthritis at minimum 7-year follow-up: A post hoc analysis of a randomized controlled trial. Front Bioeng Biotechnol 2022; 10:1062371. [PMID: 36507262 PMCID: PMC9732106 DOI: 10.3389/fbioe.2022.1062371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022] Open
Abstract
Background: Knee osteoarthritis (KOA) can be effectively treated conservatively using platelet-rich plasma (PRP) injections into the affected joints. While the short-term therapeutic clinical benefits were well documented, the mid-term results remain undetermined. To clarify its efficacy, the mid-term clinical outcomes of intra-articular injections of either PRP or hyaluronic acid (HA) in KOA were compared. Methods: One hundred patients who complied with the inclusion criteria were randomized to undergo once a week 3 weeks, intra-articular injections of either PRP or HA. Patients were evaluated before the injection, at 3, 6, and a mean of 78.9 months of follow-up. Eighty-five patients reached the final evaluation. Data on survival, re-intervention, pain, function, imaging, and satisfaction were collected and analyzed. Results: With surgery for any reason as the endpoint, the cumulative survival rate of the PRP group was 90%, while that of the HA group was 74%. There was a significant difference between the two groups in the total re-intervention rate (56.7% vs 16.2%, p < 0.05). The comparative analyses showed significant intergroup differences in the visual analog scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) (p < 0.01, p < 0.05, respectively) at the final follow-up. And base on the regression analyses, the type of treatment, age, and Kellgren-Lawrence (K-L) grade served as statistically an independent determinants of VAS (p < 0.001, p = 0.034, p < 0.001, respectively). Likewise, those variables independently determined WOMAC in our study. However, no difference was observed in the imaging evaluation, containing the K-L grade and Cartilage Lesion Score, between the two groups (p > 0.05). Besides, the satisfaction treated by the PRP was 78.6%, with a superiority compared with HA (55.8%, p < 0.05), and no complications were noted in the whole treatment process among patients who participated. Conclusion: PRP was more effective than HA in survival and re-intervention rates, VAS, and WOMAC, although there were no significant differences in the imaging evaluation between the two groups. Furthermore, patients treated with PRP were associated with higher satisfaction compared with HA.
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Affiliation(s)
- Zhengming Wang
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China,Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China
| | - Rui Wang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Sicheng Xiang
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Yong Gu
- Zhangjiagang TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Zhangjiagang, Jiangsu, China
| | - Ting Xu
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Hengkai Jin
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Xinbo Gu
- Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Peijian Tong
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang, China
| | - Hongsheng Zhan
- Shi’s Center of Orthopedics and Traumatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China,Institute of Traumatology and Orthopedics, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China,*Correspondence: Shuaijie Lv, ; Hongsheng Zhan,
| | - Shuaijie Lv
- The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Chinese Medicine, Hangzhou, Zhejiang, China,*Correspondence: Shuaijie Lv, ; Hongsheng Zhan,
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Muacevic A, Adler JR. Quality Improvement of a Hip Injection Service. Cureus 2022; 14:e32063. [PMID: 36600858 PMCID: PMC9803253 DOI: 10.7759/cureus.32063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/02/2022] Open
Abstract
Background Osteoarthritis is a substantive burden on the population and National Health Service (NHS) in the United Kingdom. A recent systematic review suggests that intra-articular steroid injections are an efficacious conservative treatment modality. The NHS Constitution states that "patients should wait no longer than 18 weeks from GP referral to treatment." An NHS hospital trust failed to meet this standard in a quarter of patients waiting for an intra-articular steroid injection of the hip. Strategies were considered to improve the time from referral to treatment (RTT). The aim of this quality improvement project was to improve the efficiency and capacity of the injection list. Materials and methods Patients who underwent an injection on a list between January and April 2019 were identified. Data were retrospectively collected and included the sites of injection and waiting times. Proformas for documentation and discharge summaries were introduced. Time taken for each appointment pre- and post-intervention were compared with the aim to increase the number of patients per list. Results Thirty-six (26%) of 138 patients experienced delays beyond 18 weeks from RTT. The mean (standard deviation [SD]) number of weeks waiting for an injection from the time of referral was 14 (6). The mean (SD) time for each appointment was 12 minutes 36 seconds (7 minutes 36 seconds) pre-intervention and 8 minutes 36 seconds (3 minutes 12 seconds) post-intervention. Discussion and conclusion Our standardized proformas led to an improvement in efficiency by reducing the time taken for documentation and capacity by subsequently increasing the number of patients per list.
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Sax OC, Chen Z, Mont MA, Delanois RE. The Efficacy of Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis Symptoms and Structural Changes: A Systematic Review and Meta-Analysis. J Arthroplasty 2022; 37:2282-2290.e2. [PMID: 35537610 DOI: 10.1016/j.arth.2022.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/30/2022] [Accepted: 05/04/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Platelet-rich plasma (PRP) usage in orthopedics continues to rise, despite guidelines suggesting non-superiority to comparative cohorts. Therefore, we performed a systematic review and meta-analysis on PRP efficacy using two clinical assessments: (1) Visual Analog Scale and (2) Western Ontario and McMaster Universities Osteoarthritis Index. We assessed consistency and clinical relevancy by determining study heterogeneity (eg, sample sizes, ages, body mass index, arthritic severities, etc.). Comparative cohorts were: (A) hyaluronic acid (HA); (B) corticosteroid (CS); (C) normal saline (NS); and (D) exercise therapy. We performed sub-analyses of structural changes assessed on ultrasound, radiograph, or magnetic resonance imaging . METHODS We utilized PubMed, Cochrane Library, and Embase databases up to December 1, 2021, according to Preferred Reporting Items for Systematic-Reviews and Meta-Analyses guidelines. Twenty-four studies met criteria, with comparisons to: HA (n = 11); CS (n = 6); NS (n = 5); and exercise therapy (n = 3). Seven studies assessed structural changes. Evaluations utilized a methodological scoring system. I2 statistics and forest plots pooled analyses and delineated study results. RESULTS PRP led to Visual Analog Scale and Western Ontario and McMaster Universities Osteoarthritis Index improvements in most studies when compared to HA, CS, and NS (P ≤ .05). Comparison to exercise therapy resulted in inconclusive findings (P ≥ .05). However, substantial heterogeneity (I2 ≥ 76%) was reported due to study variability. No differences were found when assessing structural changes or cartilage thickness by magnetic resonance imaging (standardized mean difference -0.01 [-0.19, 0.18], P = .91). CONCLUSIONS PRP may be associated with pain and functional improvements but was not clinically relevant (inconsistent study- and patient-metrics). In addition, PRP did not confer superiority when assessing knee-related structural changes.
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Affiliation(s)
- Oliver C Sax
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Zhongming Chen
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
| | - Ronald E Delanois
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Moon JY, Kim J, Lee JY, Ko Y, Park HJ, Jeon YH. Comparison of polynucleotide, sodium hyaluronate, and crosslinked sodium hyaluronate for the management of painful knee osteoarthritis: a multi-center, randomized, double-blind, parallel-group study. Pain Med 2022; 24:496-506. [PMID: 36255262 DOI: 10.1093/pm/pnac155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the clinical effectiveness of sodium polynucleotide, classic hyaluronic acid, and crosslinked hyaluronic acid for the management of painful knee osteoarthritis. DESIGN Randomized, double-blind, parallel-group clinical trial. SETTING Multicenter study. SUBJECTS Patients with chronic painful knee osteoarthritis. METHODS Ninety patients were selected and randomized into polynucleotide, classic hyaluronic acid, and crosslinked hyaluronic acid groups (30 per group). Intra-articular injections of the viscosupplement for each group were administered to the patients three times at one-week intervals. The primary outcome was differences in changes of weight-bearing pain scores at 16 weeks between the groups. The secondary outcomes were changes in the intensity of knee pain during weight-bearing, walking, and rest, and functional disability, quality of life, and adverse events during the 16-week follow-up period. RESULTS At 16 weeks, the polynucleotide group showed a higher reduction in pain score using a Visual Analog Scale score (0-100) than the classic hyaluronic acid (-17.6 [95% CI = -35.1 to -0.1]; P = 0.048) and crosslinked hyaluronic acid (-22.4 [95% CI = -41.5 to -3.3]; P = 0.016) groups. The polynucleotide and crosslinked hyaluronic acid groups showed an early-onset reduction in knee pain during weight-bearing, walking, and rest. All three groups showed reductions in functional disability and improved quality of life at 16 weeks without inter-group differences. No severe adverse events were reported throughout the study period. CONCLUSION Polynucleotide significantly relieves pain more and relieves pain faster in patients with knee osteoarthritis than classic and crosslinked hyaluronic acid, with improved health-related quality of life. CLINICAL TRIAL NUMBER AND REGISTRY URL Clinical Research Information Service (https://cris.nih.go.kr/cris/index.jsp; Identifier: KCT0005308).
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Affiliation(s)
- Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeongsoo Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Young Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, Republic of Korea
| | - Youngkwon Ko
- Department of Anesthesiology and Pain Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Heu Jung Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Young Hoon Jeon
- Department of Anesthesiology and Pain Medicine, Kyugpook National University College of Medicine, Daegu, Republic of Korea
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42
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Chai YP, Han XQ, Cui JZ. Acupotomy combined with intra-articular injection of sodium hyaluronate in the treatment of knee osteoarthritis. Medicine (Baltimore) 2022; 101:e30225. [PMID: 36107551 PMCID: PMC9439732 DOI: 10.1097/md.0000000000030225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This retrospective study aimed to compare the effects of acupotomy combined with intra-articular injection of sodium hyaluronate (IA-SH) for the treatment of knee osteoarthritis (KOA). Eighty electronic medical records of patients with KOA were retrospectively analyzed. The patients were divided into an intervention group (n = 40, acupotomy plus IA-SH) and a control group (n = 40, IA-SH). Outcome measures included the visual analog scale, the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and adverse events. Outcome data were collected and analyzed before and after treatment. The results of this study showed that there was a greater reduction in the visual analog scale (P < .01) and WOMAC scores (pain, P < .01; stiffness, P < .01; function, P < .01; total, P < .01) in the intervention group than in the control group. In addition, there were no significant differences in adverse events between the 2 groups. In this study, the effects of acupotomy plus IA-SH were superior to those of IA-SH alone for the treatment of patients with KOA. Further prospective studies are required to confirm these findings.
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Affiliation(s)
- Ya-peng Chai
- Second Ward of Orthopedics Department, Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, China
| | - Xiao-qiang Han
- Second Ward of Orthopedics Department, Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, China
| | - Jun-zhi Cui
- Department of Orthopedics, High-tech Branch of Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, China
- *Correspondence: Jun-zhi Cui, MB, Department of Orthopedics, High-tech Branch of Ankang Hospital of Traditional Chinese Medicine, Cross of Wenjing Road East and Chuangxin Road South, High-tech District, Ankang, Shaanxi 725000, China (e-mail: )
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43
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Daneshian M, Montazemi M, Abbaskhani Davanloo A. Effect of intra-articular hyalase, Ketorolac, marcaine and triamcinolone, versus Ketorolac, marcaine and triamcinolone for reducing knee joint pain other than joint replacement. J Family Med Prim Care 2022; 11:5135-5139. [PMID: 36505594 PMCID: PMC9730945 DOI: 10.4103/jfmpc.jfmpc_1982_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/16/2022] [Accepted: 01/22/2022] [Indexed: 11/07/2022] Open
Abstract
Introduction Knee pain is one of the causes of physiological complications in patients with osteoarthritis of the knee. It is necessary to provide a solution to reduce pain in these patients. Our study aimed to compare the effect of intra-articular hyalase, ketorolac, marcaine, and triamcinolone versus ketorolac, marcaine, and triamcinolone for reducing knee joint pain after knee surgery. Methods This clinical study was performed on 30 candidates for knee surgery other than knee replacement from 2019 to 2020. The patients were randomly divided into two groups: hyalase, ketorolac, marcaine, and triamcinolone (group 1) and ketorolac, marcaine, and triamcinolone (group 2). The patient's pain score was recorded by the Numeric Rating Scale (NRS) and range of motion (ROM) at the end of the first week, the end of the first month, and the end of the third month as well as the sixth month and the twelfth month after surgery. Results The mean age of the patients was 42.3 years. On average, the group receiving hyalase (first group) received about 30% better scores and had less pain (P < 0.05). In the first week, first month, and third month, no significant difference was observed between the two groups. But the pain scores for the first and second groups were 3.1 and 4.5 during the sixth to twelfth months, respectively (P < 0.05). Moreover, the increase in ROM during the sixth to twelfth months was significantly higher in the group receiving hyalase (P < 0.05). Conclusion Adding hyalase to ketorolac, marcaine, and triamcinolone could improve pain control in the short and long term and this could be capable of reducing the need for additional drugs.
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Affiliation(s)
- Maryam Daneshian
- Professor of Anesthesiology, Mazandaran University of Medical Sciences, Mazandaran, Iran
| | - Maryam Montazemi
- Professor of Anesthesiology, Mazandaran University of Medical Sciences, Mazandaran, Iran
| | - Ali Abbaskhani Davanloo
- Professor of Anesthesiology, Mazandaran University of Medical Sciences, Mazandaran, Iran,Address for correspondence: Dr. Ali Abbaskhani Davanloo, Professor of Anesthesiology, Mazandaran University of Medical Sciences, Mazandaran, Iran. E-mail:
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纳米材料用于关节内靶向递送药物治疗骨关节炎的研究进展. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2022; 36. [PMID: 35848190 DOI: 10.7507/1002-1892.202203033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To review the research progress of intra-articular targeted delivery of nanomaterials in the treatment of osteoarthritis (OA). METHODS The domestic and foreign related literature on intra-articular targeted delivery of nanomaterials for the treatment of OA was extensively reviewed, and their targeting strategies were discussed and summarized. RESULTS Rapid drug clearance from the joint remains a critical limitation in drug efficacy. Nanocarriers can not only significantly improve the residence profiles of drugs in the joint, but also achieve targeted delivery of drugs to specific joint tissues through active or passive targeting strategies. CONCLUSION With the continuous development of various emerging tissue- or cell-specific drugs, the targeted delivery of drugs with nanomaterials promise to realize the clinical translation of these drugs in the treatment of OA.
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Ramot Y, Dolkart O, Steiner M, Jahn S, Goldberg R, Cacical O, Lavie Y, Ezov N, Agar G, Nyska A. Preclinical In Vivo Safety of Poly-Phosphorylated Superlubrication Vectors for the Treatment of Osteoarthritis. Toxicol Pathol 2022; 50:787-792. [PMID: 35726637 DOI: 10.1177/01926233221105393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Osteoarthritis (OA) can lead to a significant functional disability. Poly[2-(methacryloyloxy)ethyl phosphorylcholine] (pMPC) liposomes are a novel treatment modality for OA, intended to restore the natural lubrication properties of articular cartilage. Here, we report on two studies aimed to assess the local and systemic safety and toxicity of pMPCylated liposomes in comparison with physiological saline, in Sprague-Dawley (SD) rats and in sheep after a single intra-articular (IA) injection. The animals were sacrificed after 1 and 6 weeks (rats) and 3 and 6 weeks (sheep). No signs of toxicity or abnormal clinical findings were observed. Histopathological evaluation revealed no signs of reactivity or abnormal findings in the injected joints or in any other organs. In conclusion, a single IA injection of the pMPCylated liposomes demonstrated an excellent safety profile and did not result in local reactivity or systemic toxicity, thus supporting its further development for use in humans.
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Affiliation(s)
- Yuval Ramot
- The Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.,The Department of Dermatology, Hadassah Medical Center, Jerusalem, Israel
| | | | | | | | | | | | | | - Nati Ezov
- Envigo CRS (Israel), Ness Ziona, Israel
| | - Gabi Agar
- Liposphere Ltd., Givat-Shmuel, Israel
| | - Abraham Nyska
- Consultant in Toxicologic Pathology, Tel Aviv, Israel.,Tel Aviv University, Tel Aviv, Israel
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Li X, Xie C, Xiao F, Su H, Li Z, Weng J, Huang Y, He P. Circular RNA circ_0000423 regulates cartilage ECM synthesis via circ_0000423/miRNA-27b-3p/MMP-13 axis in osteoarthritis. Aging (Albany NY) 2022; 14:3400-3415. [PMID: 35439733 PMCID: PMC9085232 DOI: 10.18632/aging.204018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 03/28/2022] [Indexed: 12/03/2022]
Abstract
Circular RNA (circRNA) is related to many human diseases including osteoarthritis (OA). Our research purpose was to show that functional circRNAs have a role in the pathogenesis of OA, while also identifying potential circRNA that bind to miRNA-27b-3p. Microarray analysis was used to evaluate the expression of CircRNA in OA and normal cartilage. The role and functional mechanism of Circ_0000423 up-regulation were detected in OA and verified in vitro and in vivo. RNA transfection, qRT-PCR, Western blot analysis, immunofluorescence, and dual-luciferase assays were used to investigate the interaction between Circ_0000423 and miRNA-27b-3p in vitro. The roles of Circ_0000423 were discussed in vivo. Our results discovered 11 down-regulated circRNAs and 101 up-regulated circRNAs between control and OA tissues, and confirmed that Circ_0000423 an increase significantly in OA tissues by evaluating the different circRNAs expressions. Meanwhile, luciferase analysis confirmed Circ_0000423 can be directly targeted by miRNA-27b-3p and act as a miRNA-27b-3p sponge. Circ_0000423 can influence MMP-13 and collagen II expression by targeting miRNA-27b-3p expression as ceRNA in OA. Furthermore, AAV-shRNA-Circ 0000423 intra-articular injection slows the progression of OA by decreasing articular cartilage destruction and erosion, joint surface fibrosis, osteophyte formation, MMP-13 expression, and increasing collagen II expression in the articular cartilage of ACLT-induced OA mice model. These findings confirmed that the Circ_0000423-miRNA-27b-3p-MMP-13 axis could affect the pathogenesis of OA which might lead to a novel target for diagnostic molecular biological indicators and potential OA treatments.
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Affiliation(s)
- Xing Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Lingnan Medical Research Center of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Chaofan Xie
- Department of Orthopedic Surgery, The Eighth Affiliated Hospital of Sun Yat-Sen University, Shenzhen, Guangdong, China
| | - Fangjun Xiao
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Lingnan Medical Research Center of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Haitao Su
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Lingnan Medical Research Center of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhen Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Lingnan Medical Research Center of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jiaxian Weng
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Lingnan Medical Research Center of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yongming Huang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.,Lingnan Medical Research Center of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Peiheng He
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China
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Chavda S, Rabbani SA, Wadhwa T. Role and Effectiveness of Intra-articular Injection of Hyaluronic Acid in the Treatment of Knee Osteoarthritis: A Systematic Review. Cureus 2022; 14:e24503. [PMID: 35651409 PMCID: PMC9135165 DOI: 10.7759/cureus.24503] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2022] [Indexed: 12/30/2022] Open
Abstract
Osteoarthritis (OA) is a degenerative joint disease that causes persistent joint pain and stiffness of mainly the large peripheral weight-bearing joints. It is a leading cause of functional disability and poor quality of life. Various modalities of therapy are recommended by different research organizations at different stages of OA including non-pharmacological, pharmacological, and surgical interventions. Intra-articular injections of hyaluronic acid (HA) is widely used for over three decades in the treatment of OA. However controversies exist regarding its safety and efficacy, the number of injections and courses, type of preparation, duration of its effects, and combining it with other drugs or molecules. This study aimed to review the most recent data available in the published literature to address these. Electronic databases like Medline, Embase, ProQuest, and Google Scholar were searched for articles using keywords, intraarticular injections, hyaluronic acid, and osteoarthritis knee. The review was carried out as per PRISMA guidelines. Thirty-eight randomized control trials (RCTs) investigating the efficacy and safety of intra-articular injection of HA were included in the systematic review. Out of the 38 studies, 22 (57.9%) were double-blind, eight (21%) single-blind, three (7.9%) non-blind, four (10%) with simple randomization, and one (2.7%) was open-labeled. Total 5,025 patients were included in these studies. The mean age of the patients was 60.28 years and the osteoarthritis grade of the knee joint was 1 to 3. HA was studied as a test preparation in 19 (50%) while in another 19 (50%) it was studied as a control. In 24 (63.2%) studies, HA was used as high molecular weight preparation in eight (21%) as low molecular weight preparation while in six studies the information was not available. HA was used as a standalone preparation in 31 studies, in two studies it was injected with platelet-rich plasma (PRP) and with either low-level laser therapy (LLLT), triamcinolone (TA), betamethasone (CS), poly deoxyribonucleotide (PDRN) or dexamethasone (DX) in one study each. In the majority of the studies, HA was given as a single injection (52.6% studies) or weekly three injections (28.9% studies). In 13.2 %, it was given as weekly 5 injections and in 5.3% as weekly two injections. IA-HA injections have a limited role in the treatment of knee osteoarthritis in those patients who do not have sufficient pain relief with topical or oral medication and physical therapy. It is safe and effective except for minor side effects such as local pain and swelling lasting for a few days. Severe allergic reactions are extremely rare. They provide adequate pain relief and functional improvement for up to six months irrespective of a number of injections and type of preparations used. The combination formulations with corticosteroids or PRP or MSCs show better results than HA alone. Combining HA with newer molecules such as peptides or diclofenac for sustained and disease-modifying effects requires more studies in the future.
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Affiliation(s)
- Sumant Chavda
- Orthopedics, Ras Al Khaimah (RAK) Medical and Health Sciences University, Ras Al Khaimah, ARE
| | - Syed Arman Rabbani
- Pharmacology, Ras Al Khaimah (RAK) Medical and Health Sciences University, Ras Al Khaimah, ARE
| | - Tarun Wadhwa
- Clinical Pharmacy, Ras Al Khaimah (RAK) Medical and Health Sciences University, Ras Al Khaimah, ARE
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Lee GW, Kwak WK, Lee KB. Effects and Safety of Intra-Articular Sodium Hyaluronate Injection for the Treatment of Ankle Osteoarthritis: A Prospective Clinical Trial. J Foot Ankle Surg 2022; 61:345-349. [PMID: 34801379 DOI: 10.1053/j.jfas.2021.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/11/2021] [Accepted: 09/08/2021] [Indexed: 02/03/2023]
Abstract
Various nonoperative treatments have been implemented to reduce pain and improve the quality of life in patients with ankle osteoarthritis. Among these treatments, intra-articular hyaluronate injection has proven efficacy and safety in patients with knee osteoarthritis. The purpose of this study was to evaluate the efficacy and complications of hyaluronate injection using various clinical scoring systems. This study included 37 patients with unilateral ankle osteoarthritis (grade 2 or 3 according to the Takakura classification) who did not respond to previous pharmacological treatment. 3 weekly hyaluronate injections (2 mL Hyruan Plus®) were administered. The efficacy of intra-articular hyaluronate injection was evaluated on the basis of patient-reported foot and ankle clinical assessment at a mean follow-up of 13.8 ± 8.3 (range 6-33) months. Ankle Osteoarthritis Scale scores for pain and disability, American Orthopedic Foot and Ankle Society ankle-hindfoot scores, and visual analog scale for pain significantly improved at the final follow-up compared to that before intra-articular hyaluronate injection (p ≤ .05). When patients were dichotomized according to age, sex, body mass index, symptom duration, and Takakura classification, all these factors were not related to clinical outcomes. This study suggests that 3 weekly intra-articular hyaluronate injections can be performed safely to reduce pain and improve function without serious complications in patients with early or intermediate-grade ankle osteoarthritis when patients inadequately respond to medication. Larger controlled studies are needed to clarify the effects of hyaluronate injection and identify patients who can benefit most from hyaluronate injection.
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Affiliation(s)
- Gun-Woo Lee
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Woo Kyoung Kwak
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea
| | - Keun-Bae Lee
- Department of Orthopedic Surgery, Chonnam National University Medical School and Hospital, Gwangju, Republic of Korea.
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Yongvikul A, Kim JY, Ku JK, Jung JH, Huh JK. Needle orientation for temporomandibular joint arthrocentesis in Koreans. Cranio 2022:1-7. [PMID: 35261328 DOI: 10.1080/08869634.2022.2047509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To investigate the highest opportunity skin puncture point and needle orientation according to facial asymmetry and classification. METHODS Computed tomography of 136 patients was analyzed. Horizontal and vertical angles and distances from the canthal-tragal line were investigated to determine the puncture point and needle's angle. RESULT All patients' average points were 7.39 (±2.85) mm anterior to the tragus and 3.44 (±4.18) mm below the canthal-tragal line with an angle of 8.53 (±6.90)° anteriorly and 32.26 (±7.23)° superiorly. Regarding asymmetry, there was a statistical difference in horizontal angle, depth, and canthal-tragal distance between the deviated and non-deviated sides. Especially, vertical distances were 4.44 (±4.66) mm and 2.59 (±4.11) mm in the deviated and non-deviated sides, respectively (p < 0.001). CONCLUSION In closed-mouth, the puncture point was closer to the tragus and lower than the conventional point. The point in the deviated side should be considered lower than the non-deviated side.
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Affiliation(s)
- Atapol Yongvikul
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Jae-Young Kim
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Jeong-Kui Ku
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Joon-Ho Jung
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
| | - Jong-Ki Huh
- Department of Oral and Maxillofacial Surgery, Gangnam Severance Hospital, Yonsei University College of Dentistry, Seoul, Korea
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50
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Sibillin O, Mitchell D, Harris G, Harvey J, Spencer P, Spencer L. The use of intra-articular platelet rich plasma for the symptomatic management of osteoarthritis of the knee: a pilot study. ANZ J Surg 2022; 92:1178-1183. [PMID: 35254716 DOI: 10.1111/ans.17565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/23/2021] [Accepted: 01/29/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Osteoarthritis of the knee is a chronic inflammatory condition resulting in significant patient disability, with intra-articular platelet rich plasma (PRP) injections having shown potential to improve symptomatic outcomes. This retrospective cohort pilot study aimed to observe whether PRP injections were beneficial in the symptomatic management of knee osteoarthritis in an Australian population, based on patient reported outcomes. An additional aim was to observe for an association between the number of injections and patient characteristics, such as body mass index, age, sex and radiologically determined severity of the disease. METHODS The cohort was drawn from those who attended Ballarat Orthopaedic and Sports Medicine for PRP injections and who had completed the appropriate pre- and post-injection Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire. WOMAC scores were analysed to observe for any difference following a course of PRP injections. RESULTS The data suggest that the use of PRP improved patient reported WOMAC scores. Additionally, it was shown that two injections had a greater effect than one injection, with a third injection providing no further benefit. Finally, there was an association with lower WOMAC scores post PRP therapy amongst male participants compared to female participants. CONCLUSION These results suggest two PRP injections are optimal for the symptomatic management of knee osteoarthritis, identifying a need for further prospective research in this Australian population.
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Affiliation(s)
- Olivia Sibillin
- Department of Orthopaedics, Ballarat Orthopaedics and Sports Medicine Clinic, Lake Wendouree, Victoria, Australia
| | - David Mitchell
- Department of Orthopaedics, Ballarat Orthopaedics and Sports Medicine Clinic, Lake Wendouree, Victoria, Australia.,Department of Orthopaedics, NOVAR MUSCULOSKELETAL RESEARCH INSTITUTE, Ballarat, Victoria, Australia
| | - Greg Harris
- Department of Orthopaedics, Ballarat Orthopaedics and Sports Medicine Clinic, Lake Wendouree, Victoria, Australia
| | - Jack Harvey
- School of Science, Psychology and Sport, Federation University, Australia, Institute for Health and Sport, Victoria University, Ballarat, Victoria, Australia
| | - Polly Spencer
- Department of Anaesthetics, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Luke Spencer
- Department of Orthopaedics, Ballarat Orthopaedics and Sports Medicine Clinic, Lake Wendouree, Victoria, Australia.,Department of Orthopaedics, NOVAR MUSCULOSKELETAL RESEARCH INSTITUTE, Ballarat, Victoria, Australia
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