Articular Space Research Articles

A time-course evaluation of inflammatory and oxidative markers following high-intensity exercise in horses: a pilot study.

Exercise is a physiological stress resulting in reactive oxygen species and inflammatory mediators, the accumulation of which are thought to contribute to degenerative articular diseases. The horse is of particular interest in this regard as equine athletes are frequently exposed to repetitive bouts of high-intensity exercise. The purpose of this study was to provide a detailed description of the response of articular and systemic oxidative and inflammatory biomarkers following high-intensity, exhaustive exercise in horses. A group of horses (Ex) underwent repeated bouts of high-intensity exercise, at a target heart rate of 180 beats/min, until voluntary exhaustion. Baseline plasma and synovial fluid (SF) samples were taken 24 h before exercise and then at 0.5, 1, 2, 4, 8, and 24 h following exercise cessation. This time course was repeated in a group of nonexercised control horses (Co). Plasma and SF samples were analyzed for prostaglandin E2 (PGE2), nitric oxide (NO), total antioxidant status (TAS), and glycosaminoglycans (GAG). The Ex group had significantly higher plasma NO at 0.5, 1, and 2 h; and higher plasma PGE2 at 0.5 and 1 h compared with Co. SF PGE2 and GAG were also higher in Ex horses at 8 h compared with Co. It is concluded that high-intensity exercise in horses results in a rapid increase in systemic oxidative and inflammatory markers from 0.5 to 2 h after exercise, which is followed by local articular inflammation and cartilage turnover at 8 h postexercise. NEW & NOTEWORTHY In horses, the influence of exercise systemically and within the articular space remains unclear and requires further detailed characterization. In this study, we identify that an acute bout of high-intensity exercise in horses induces systemic inflammation and oxidative stress within 30 min of exercise cessation, which lasts for ~2 h. Articular inflammation and cartilage turnover were also be observed within the equine carpal joint 8 h following exercise completion.

MRI Findings Consistent with Peripatellar Fat Pad Impingement: How Much Related to Patellofemoral Maltracking?

Peripatellar fat pads are intracapsular extrasynovial adipose cushions that accommodate the changing shape and volume of articular spaces during movement. Variations in bone geometry, passive and active stabilization mechanisms and/or functional demands may lead to peripatellar fat pad abnormalities. While peripatellar fat pads may be affected a variety of conditions such as synovial inflammation, tumor and fibrosis, a mechanical origin should also be considered. Commonly, the clinical term “impingement” is used synonymously in the radiological literature to refer to three distinct entities of structural peripatellar fat pad abnormalities: superolateral the infrapatellar fat pad (Hoffa fat pad) edema, suprapatellar fat pad edema, and prepatellar fat pad edema, implying a mechanical origin of these conditions. The aim of this pictorial review is to describe the normal anatomy of the extensor mechanism of the knee, and discuss the relation of patellofemoral maltracking to the above-mentioned peripatellar fat pad conditions based on current evidence.

Distraction of the temporomandibular joint condyle in patients with unilateral non-reducing disc displacement: Fact or fiction?

Objectives: This study investigated the distractive effect of a unilateral pivot splint on patients with unilateral disc displacement without reduction.Methods: The study group was comprised of 18 patients who had no history of treatment with removable prosthetic restorations of molars, premolars, or canine teeth, and no previous treatment for temporomandibular disorder. Joint spaces measurements made on magnetic resonance images indicated the affected side to be narrower than the healthy side. Unilateral distraction splints were made for all patients. An ultrasonic motion analyzer was used to measure the vertical shift occurring on the affected side as patients closed their mouths with maximal force with the splint in their mouths.Results: Closing with maximal force on the unilateral distraction splint led to a noticeable downward movement of the affected condyle.Discussion: The findings of this study indicate that the TMJ condyle of patients with unilateral disc displacement without reduction may be unilaterally distracted if the articular space is narrowed.

Radionuclide imaging and therapy in a patient with coexistent diabetic foot syndrome and psoriatic arthritis.

We report a case of 67-year-old man suffering from psoriatic arthritis, type 2 diabetes and diabetic foot syndrome. The patient presented symptoms of inflammation of the right ankle joint. Scintigraphic imaging with radiolabeled white blood cells was performed to differentiate whether the inflammation was related to psoriatic arthritis or diabetic foot syndrome. After revealing that, the inflammatory process was restricted only to the articular space of subtalar joint, the patient was diagnosed with exacerbation of psoriatic arthritis and qualified for radionuclide synovectomy. In patients with coexistent diabetic foot syndrome and inflammatory arthritis of the foot it is of vital importance to accurately differentiate these two conditions. We conclude that this can be potentially achieved with radiolabeled white blood cells scintigraphic imaging.

Assessment of condyle position, fossa morphology, and disk displacement in symptomatic patients

The aim of the study was to determine whether there are any associations between the morphology of the glenoid fossa, articular spaces, and disk displacement by evaluating the magnetic resonance imaging (MRI) scans of symptomatic patients. Gender and age were also evaluated for any effect on the parameters. MRI scans of 199 temporomandibular joints were assessed for the morphology of the glenoid fossa and articular spaces in both sagittal and coronal views. The presence of disk displacement and its type in closed-mouth and open-mouth positions were also assessed. Analysis of variance (ANOVA), Tukey, and Student t tests or Mann-Whitney rank sum tests were used to investigate the associations among these variables. A total of 113 joints (56.8%) were presented with disk displacement. The articular spaces observed in sagittal and coronal views were, overall, significantly larger in males than in females in 3 of the 6 spaces (superior, posterior, and central spaces). Larger superior and medial articular spaces were associated with angled glenoid fossae. Higher mean values of the articular space sizes were associated with normal disk position (P<.001), except for the anterior articular space. When displacement was identified, higher values of the articular space sizes were also associated with disk reduction in the open-mouth position (P<.05). Condyles in the central position in the coronal view and slightly anteriorly positioned in the sagittal view are less likely to present disk displacement.

Comparison of Computed Tomography Articular Surface Geometry of Male Versus Female Thumb Carpometacarpal Joints

Given the predilection of first carpometacarpal (CMC) joint osteoarthritis in women compared with men, we aim to determine the differences in first CMC joint surface geometry and congruence between young healthy males and females. Wrist computed tomographic scan data of 11 men and 11 women aged 20 to 35 years were imported into 3-dimensional software programs. The first metacarpal and the trapezium were aligned in a standardized position according to landmarks at key points on Gaussian and maximum curvature maps. Measurements of joint congruence and surface geometry were analyzed, including joint space volume, distance between the bones at the articular surface edges, area of the joint space, and radii of curvature in the radial-ulnar and volar-dorsal planes. The mean thumb CMC articular space volume was 104.02 ± 30.96 mm3 for females and 138.63 ± 50.36 mm3 for males. The mean first metacarpal articular surface area was 144.9 ± 10.9 mm2 for females and 175.4 ± 25.3 mm2 for males. After normalizing for size, the mean thumb CMC articular space volume was 119.4 ± 24.6 mm3 for females and 117.86 ± 28.5 mm3 for males. There was also no significant difference for the articular space volume, articular surface distances, articular space, and mean radii of curvatures. This study found that there are sex differences in the first CMC joint articular volume without normalizing for size; however, there are no sex differences in first CMC joint articular volume, curvature characteristics, or joint congruence of young, healthy patients after normalizing for joint size.

Musculoskeletal Ultrasound for Diagnosis and Treatment in Juvenile Idiopathic Arthritis

Among users of musculoskeletal ultrasound (MSUS), the benefits of real-time imaging of patients with juvenile idiopathic arthritis (JIA) are widely appreciated. Yet to the larger pediatric rheumatology public, these advantages may be easily overlooked. MSUS enhances the routine clinical examination, allowing for detection of subclinical disease and an accurate determination of the location and extent of disease activity. Ultrasound visualizes synovitis and tenosynovitis, enthesitis, erosions, and cartilage changes, enabling one to monitor the response to treatment and assisting in the determination of remission. MSUS is particularly suited for guidance for intraarticular corticosteroid injections. The ability to review images at the bedside with patients and their caregivers can be reassuring, to both the patient and the practitioner. Understanding of the normal, healthy sonoanatomy, however, can be challenging and remains a topic of ongoing research. The significance of subclinical synovitis (US-detected features of synovitis in the context of clinically healthy joint) remains unclear. As a better understanding of normal/physiologic sonographic appearance of the growing joint emerges, in particular, the presence of Doppler signal in the developing articular space, the predictive value and prognostic significance of subclinical synovitis will become more evident. What constitutes subclinical disease, too, is somewhat controversial as many healthy joints can demonstrate physiologic fluid, and it is unknown how long synovial thickening can remain after active inflammation has been treated. In my experience, sonographic evidence of synovial thickening/proliferation with a high degree of Doppler activity (more than a few areas of intermittent pixilations) should be considered an actively diseased joint and be incorporated in therapeutic decisions. This review aims to provide an evidence-based update on recent advances and insights into the healthy sonoanatomy of children and the use of ultrasound in the assessment and treatment of juvenile idiopathic arthritis disease manifestations.

Pharmacokinetics of intravenous continuous rate infusions of sodium benzylpenicillin and ceftiofur sodium in adult horses.

OBJECTIVE To determine plasma drug concentrations after IV administration of a bolus followed by continuous rate infusion (CRI) of sodium benzylpenicillin and ceftiofur sodium to healthy adult horses. ANIMALS 6 Thoroughbred mares (3 to 9 years old; mean ± SD body weight, 544 ± 55 kg) with no history of recent antimicrobial treatment. PROCEDURES Horses were used in 2 experiments conducted 14 days apart. For each experiment, horses were housed individually in stables, and catheters were placed bilaterally in both jugular veins for drug administration by CRI (left catheter) and for intermittent collection of blood samples (right catheter). Synovial fluid samples were obtained from carpal joints following ceftiofur administration to evaluate drug diffusion into articular spaces. RESULTS Plasma concentrations above accepted minimum inhibitory concentrations for common pathogens of horses were achieved within 1 minute after bolus administration and remained above the minimum inhibitory concentration for 48 (ceftiofur) or 12 (benzylpenicillin) hours (ie, the duration of the CRI). Mean synovial fluid ceftiofur free acid equivalent concentrations were approximately 46% (range, 25.4% to 59.8%) of plasma concentrations at the end of infusion. CONCLUSIONS AND CLINICAL RELEVANCE Compared with intermittent bolus administration, the loading dose and CRI used less drug but maintained high plasma concentrations for the duration of infusion. By use of pharmacological parameters derived in this study, a loading dose of 2.5 mg/kg and CRI of 200 μg/kg/h should achieve plasma ceftiofur concentrations of 4 μg/mL; a loading dose and CRI of 1.3 mg/kg and 2.5 μg/kg/h, respectively, should achieve plasma benzylpenicillin concentrations of 2 μg/mL.

Tips to avoid nerve injury in elbow arthroscopy.

Elbow arthroscopy is a technical challenging surgical procedure because of close proximity of neurovascular structures and the limited articular working space. With the rising number of elbow arthroscopies being performed nowadays due to an increasing number of surgeons performing this procedure and a broader range of indications, a rise in complications is foreseen. With this editorial we hope to create awareness of possible complications of elbow arthroscopy, particularly nerve injuries, and provide a guideline to avoid complications during elbow arthroscopy.

Tenascin-C Prevents Articular Cartilage Degeneration in Murine Osteoarthritis Models.

Objective The objective of this study was to determine whether intra-articular injections of tenascin-C (TNC) could prevent cartilage damage in murine models of osteoarthritis (OA). Design Fluorescently labeled TNC was injected into knee joints and its distribution was examined at 1 day, 4 days, 1 week, 2 weeks, and 4 weeks postinjection. To investigate the effects of TNC on cartilage degeneration after surgery to knee joints, articular spaces were filled with 100 μg/mL (group I), 10 μg/mL (group II) of TNC solution, or control (group III). TNC solution of 10 μg/mL was additionally injected twice after 3 weeks (group IV) or weekly after 1 week, 2 weeks, and 3 weeks (group V). Joint tissues were histologically assessed using the Mankin score and the modified Chambers system at 2 to 8 weeks after surgery. Results Exogenous TNC was maintained in the cartilage and synovium for 1 week after administration. Histological scores in groups I and II were better than scores in group III at 4 and 6 weeks, but progressive cartilage damage was seen in all groups 8 weeks postoperatively. Sequential TNC injections (groups IV and V) showed significantly better Mankin score than single injection (group II) at 8 weeks. Conclusion TNC administered exogenously remained in the cartilage of knee joints for 1 week, and could decelerate articular cartilage degeneration in murine models of OA. We also showed that sequential administration of TNC was more effective than a single injection. TNC could be an important molecule for prevention of articular cartilage damage.

Long-term follow-up study of Kocher-Langenbech approach for treatment of delayed acetebular posterior wall fractures

Objective To evaluate the long-term follow-up results of surgical treatment of delayed acetebular posterior wall fractures via the Kocher-Langenbech (K-L) approach. Methods A retrospective review was made on 22 patients with delayed acetabular posterior wall fractures treated surgically via the K-L approach from April 2001 to December 2010. Patient follow-up data was complete. The patients consisting of 16 males and 6 females showed an age of (34.1±8.9)years (range, 25-43 years). Causes of injury were traffic accidents in 18 patients and high falls in four patients. There were 14 patients accompanied with brain injuries, eight thorax-abdominal injuries and 12 other extremity injuries. Sciatic nerve paralysis was found in five patients preoperatively. Time interval from injury to surgery was (44.7±9.7)d (range, 27-182 d). Fracture reduction was evaluated using the Matta standard and hip function using the modified Merle D’Aubingne and Postel scoring system. Postoperative complications were detected. Results Period of follow-up was(102.1±11.3)months. According to the Matta standard, fracture reduction was anatomic in 16 patients, unsatisfactory in four and poor in two. According to the modified Merle D’Aubingne and Postel scoring system, the results were excellent in 15 patients, good in four, fair in two and poor in one, with the excellent-good rate of 86%. Heterotopic ossification developed in three patients (14%) and temporary paralysis of sciatic nerve in two patients (9%). Fourteen patients were found with slight stenosis of the articular space but there was no degeneration. Five patients were found with stenosis of the articular space as well as slight degeneration. Three were complicated with trauma arthritis, among which one had total hip arthroplasty after 3 years. Conclusions Delayed acetebular posterior wall fractures can be extensively exposed via the K-L approach and the congruity of the acetebular posterior wall can be restored after appropriate open reduction and internal fixation. Long-term follow-up study indicates satisfactory clinical results. Key words: Acetabulum; Hip injuries; Fracture fixation, internal

Influence of the interocclusal splint in condylar position of patients with tmd: computed cone beam

The aim of this study was to evaluate the condylar position in patients with intra-articular temporomandibular disorders (TMD) before and after treatment with interocclusal stabilization splint (ISS) through computerized tomography cone beams (CTCB). Twenty-two patients diagnosed with intra-articular TMD (Research Diagnostic Criteria for Temporomandibular Disorders - Group II) were submitted to the therapy with ISS during 90 days. Three CTCB exams were performed in three moments: T1 – Initial moment, before the ISS therapy, with the patient in dental occlusion; T2 (after 90 days of treatment, in occlusion on the ISS) and T3 (after 90 days of treatment, with the patient in dental occlusion). Afterwards the anterior (AS), superior (SS) and posterior articular space (PS) in sagittal sections were then measured and the data were statistically analyzed using the t-test. There was a statistically significant increase in the comparison between T1 and T2 for the AS and PS (p&lt; 0.0001), between T3 and T2 for AS (p= 0.0008) and PS (p&lt; 0.0001). In comparison T1/T3 there was a significant increase in AS (p= 0.01) and SS (p= 0.04), and non-significant in PS (p= 0.89). The interocclusal splint provides temporary changes in condylar position, with a tendency to increase the joint space, varying in accordance with individual characteristics. Therefore, it should not be used as a single therapy, but combined with other strategies that include the TMD multidimensionality. The interocclusal splint has proved to be reversible and conservative therapeutic modality, as it does not generate permanent changes in joint tissues.

Distribution of branches of deep and common fibular nerves to extensor hallucis longus and extensor digitorum longus muscles. Application to the treatment of their hypertonia

The spastic hemiplegic patient often presents dystonia of extensor hallucis longus (EHL) and, more rarely, extensor digitorum longus (EDL). This dystonia is difficult to treat by tendon lengthening, because its primum movens is purely neurological without retraction musculo-tendinous. A hyponeurotisation by partial section of the branches of the common and deep fibular nerve(s) could be a therapeutic alternative to botulinum toxin injections. Its technique has never been described. Ten legs from formalin-preserved corpses were dissected. The number of branches to EHL and EDL, their level of emergence from the common and deep fibular nerves, and their entry point into the muscle have been measured from the lateral femoral-tibial articular space (LTF). There was always a common trunk to the EDL and the EHL, arisen on average at 10.3 cm (8.2–13.6) from the LTF line. Six times out of 10 in addition to this common one (3), two (2) or three (1) additional branches to the EDL, arisen between 4.6 and 12 cm downstream the LTF line. Six times out of 10 in addition to this common trunk existed one (4) or two (2) additional branches to the EHL, arisen between 13 and 26 cm downstream the LTF line. This first study allow establishing the surgical technique of the hyponeurotisation of muscles LEH and LEO. The first results are presented.

Distribution of the branches of common and superficial fibular nerves to peronei longus et brevis muscles. Use in the treatment of spasticity of fibular muscles

Beside the posterior leg compartment, spasticity of the hemiplegic patient can involve other muscle groups in the leg. Spasticity of the lateral compartment is responsible of a vertical clonus that may be confused with the clonus of the triceps surae (long fibular) or a transverse clonus (short fibular), and by the liveliness of the tendon reflex when striking their tendon. Beside recurrent botulinum toxin injections, this spasticity may be treated by a hyponeurotisation by partial section of the branches of the superficial fibular nerve to the muscle(s) concerned. Its technique has never been described. Twelve legs of formalin corpses have been dissected. The number of branches to PL and PB, their level of emergence from the common and deep fibular nerves, and their entry point into the muscle have been measured from the lateral femoral-tibial articular space (LTF). There was always a common trunk to the EDL and the EHL, arisen on average at 10.3 cm (8.2–13.6) from the LTF line. Six times out of 10 in addition to this common one (3), two (2) or three (1) additional branches to the EDL, arisen between 4.6 and 12 cm downstream the LTF line. Six times out of 10 in addition to this common trunk existed one (4) or two (2) additional branches to the EHL, arisen between 13 and 26 cm downstream the LTF line. This first study allow establishing the surgical technique of the hyponeurotisation of PL and PB muscles. The first results are presented.

Facet Joint Manipulation for Craniovertebral Junction Arthrodesis. Worth the Extra Effort?

Introduction The goal of arthrodesis is bone fusion, effected at the craniovertebral junction through onlay of either morselized iliac crest autograft (ICAG), or posterior structural unicortical ICAGbetween posterior elements. As an alternative, facet manipulation (FM) with C1-C2 or C0-C1 facet decortication and “jamming” of bone spacers into the articular space (C1-C2) has been described. We describe a series of 79 cases of surgical fusion of at least 1 component of the CVJ. FM was used in 65 cases requiring arthrodesis. Among these, we describe 14 cases using cages placed in the atlanto-axial joints (Cage assisted facet arthrodesis CAFA). To examine the efficacy of FM, we look specifically at CT documented fusion, and time to fusion using this technique. Material and Methods Retrospective review of medical records of 88 patients undergoing posterior arthrodesis of the craniovertebral junction (CVJ) at our unit from May 2004 to December 2013 was performed. 4 patients were excluded in case of early postoperative death (up to 30 days after the surgery). 5 patients had insufficient radiological follow-up data (follow-up &lt; 6 months). Construct length is detailed in Table 1 . Fusion – pseudarthrosis. Fusion was considered successful on CT if there was visible bridging trabeculations with or without bony remodeling and callus formation, across at least one of C1/C2 facets, and absence of pseudoarthrosis. Criteria for pseudoarthrosis were construct failure, or bone lucency around the screws. Time to fusion was defined as months between surgery and the earliest radiological assessment confirming solid fusion. Results Fusion rate and time to fusion. Sixteen patients were not considered for fusion analysis ( N = 6 not grafted), or insufficient follow-up ( N = 10). A solid fusion was achieved in 55 (87.3%) patients. Fusion rate was strongly associated with age. [Table: see text][Figure: see text] Conclusion Many techniques are used to achieve solid bony fusion in the upper cervical spine. Facet manipulation, first described by Goel should be the ideal fusion bed but has not been widely used. We report our experience using FM as a fusion technique to highlight its usefulness as a primary means of achieving fusion. It exploits the weight bearing part of the spine, the volume of bone graft materiel is very small compared with other techniques, it can be used when there are no posterior elements. Cage assisted facet arthrodesis (CAFA) may accelerate time to fusion, and may enhance fusion rates.

Corticosteroids for septic arthritis in children

Background: Septic arthritis is an acute infection of the joints characterised by erosive disruption of the articular space. It is the most common non-degenerative articular disease in developing countries. The most vulnerable population for septic arthritis includes infants and preschoolers, especially boys. Septic arthritis disproportionately affects populations of low socioeconomic status. Systemic corticosteroids and antibiotic therapy may be beneficial for treatment of septic arthritis. Even if the joint infection is eradicated by antibiotic treatment, the inflammatory process may produce residual joint damage and sequelae. Objectives: To determine the benefits and harms of corticosteroids as adjunctive therapy in children with a diagnosis of septic arthritis. Search methods: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library, Latin American Caribbean Health Sciences Literature (LILACS), the World Health Organization (WHO) trials portal (www.who.int/ictrp/en/), ClinicalTrials.gov (www.ClinicalTrials.gov), and Google Scholar. We searched all databases from their inception to 17 April 2018, with no restrictions on language of publication. Selection criteria: We included randomised controlled trials (RCTs) with patients from two months to 18 years of age with a diagnosis of septic arthritis who were receiving corticosteroids in addition to antibiotic therapy or as an adjuvant to other therapies such as surgical drainage, intra-articular puncture, arthroscopic irrigation, or debridement. Data collection and analysis: Two review authors independently assessed eligibility, data extraction, and evaluation of risk of bias. We considered as major outcomes the presence of pain, activities of daily living, normal physical joint function, days of antibiotic treatment, length of hospital stay, and numbers of total and serious adverse events. We used standard methodological procedures expected by Cochrane. We assessed the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and created a 'Summary of findings' table. Main results: We included two RCTs involving a total of 149 children between three months and 18 years of age who were receiving antibiotics for septic arthritis. The most commonly affected joints were hips and knees. These studies were performed in Costa Rica and Israel. In both studies, dexamethasone administered intravenously (ranging from 0.15 to 0.2 mg/kg/dose every six to eight hours) during four days was the corticosteroid, and the comparator was placebo. Trials excluded patients with any degree of immunodeficiency or immunosuppression. The longest follow-up was one year. Trials did not report activities of daily living nor length of hospital stay. Both studies used adequate processes for randomisation, allocation concealment, and blinding, and review authors judged them to have low risk of selection and performance bias. Losses to follow-up were substantive in both studies, and we judged them to have high risk of attrition bias and of selective outcome reporting. We graded all outcomes as low quality due to concerns about study limitations and imprecision. The risk ratio (RR) for absence of pain at 12 months of follow-up was 1.33, favouring corticosteroids (95% confidence interval (CI) 1.03 to 1.72; P = 0.03; number needed to treat for an additional beneficial outcome (NNTB) = 13, 95% CI 6 to 139; absolute risk difference 24%, 95% CI 5% to 43%). The RR for normal function of the affected joint at 12 months of follow-up was 1.32, favouring corticosteroids (95% CI 1.12 to 1.57; P = 0.001; NNTB = 13, 95% CI 7 to 33; absolute risk difference 24%, 95% CI 11% to 37%). We found a reduction in the number of days of intravenous antibiotic treatment favouring corticosteroids (mean difference (MD) -2.77, 95% CI -4.16 to -1.39) based on two trials with 149 participants. Researchers did not report length of hospital stay. One trial (49 participants) reported that treatment with dexamethasone was associated with a shorter duration of IV antibiotic treatment, leading to a shorter hospital stay, and although duration of hospitalisation was a primary outcome of the study, study authors did not provide data on the duration of hospitalisation. We downgraded the quality by one level for concerns about study limitations (high risk of attrition bias and selective reporting), and by another level for imprecision. In one trial of 49 participants, researchers followed 29 children for 12 months, and parents reported that no children demonstrated adverse effects of the intervention. Authors' conclusions: Evidence for corticosteroids as adjunctive therapy in children with a diagnosis of septic arthritis is of low quality and is derived from the findings of two trials (N = 149). Corticosteroids may increase the proportion of patients without pain and the proportion of patients with normal function of the affected joint at 12 months, and may also reduce the number of days of antibiotic treatment. However, we cannot draw strong conclusions based upon these trial results. Additional randomised clinical trials in children with relevant outcomes are needed.

Accuracy of Needle Placement into the Intra-Articular Space of the Knee in Osteoarthritis Patients for Viscosupplementation.

Knee osteoarthritis is characterized by inflammation in the intra-articular space or synovial membrane, breakdown of articular cartilage, and sclerosis of the subchondral bone. Intra-articular injections of Sodium hyaluronate which have viscoelastic and protective effect on articular cartilage and restores normal articular homeostasis. The efficacy of these injections is diminished when they are placed inadvertently outside the joint. For the maximum benefit, injection of hyaluronic acid derivatives needs to be placed accurately into the knee joint. The study was performed to know the correct placement of needle inside the knee joint prior to Viscosupplementation by fluoroscopy using a contrast material. The accurate placement of needle was evaluated in a prospective series of 94 consecutive injections in patients without clinical knee effusion. All the injections were performed by single orthopaedic surgeon using a 5 cm 21-gauge needle through anterolateral, and lateral midpatellar portals. The needle placement in the knee joint was confirmed with fluoroscopy using the contrast material. The accuracy rates through Lateral midpatellar and Anterolateral portals were lower than expected rate (100%). A total of 43 out of 47 injections were intra-articular, indicating accuracy of 91.5% through lateral midpatellar portal, 41 out of 47 injections were intra-articular through anterolateral portal with accuracy of 87.4%. Study showed that the accuracy of needle placement was higher through Lateral midpatellar than the Anterolateral portal.

Effectiveness of Ozone in Osteoarthritis of the Knee

Osteoarthritis (OA) is a degenerative disease that is very prevalent, and it usually increases exponentially with age [1]. OA affects weight bearing articulations as the knee, and is very common in women [1]. Knee OA affects negatively the function and autonomy of older people [2], decreasing patient’s quality of life [3]. OA produces a great use of limited health resources [3]. The normal knee is composed by cartilage, subchondral bone, synovial tissue and articular capsule. Knee OA produces destruction of articular cartilage and sclerosis of subchondral bone [2]. Knee OA diminishes the articular space, and it favours the formation of osteophyte and subchondral cysts [2]. To date, there is neither effective treatment nor cure for OA. The objectives on treating Knee OA are to ameliorate pain, rigidity, inflammation and to avoid articular damage and joint destruction [2]. Recently, OA is related to chronic inflammation, besides mechanical and biological factors. In that scenario, future OA treatments must regulate inflammation to avoid OA progression. Fernandez-Cuadros et al state that Ozone acts on the modulation of inflammation [2], based on several studies and years of clinical experience. It is believed that Ozone acts on the articulation as a stimulator, repairing the fibroblastic tissue. Moreover, Ozone could reduce inflammation and promote growth of new cartilage [2]. We present the case of an 83 years-old female, with Kellgren-Lawrence 3rd degree, and with joint narrowing space and subchondral cyst, and moderate-severe pain on the knee. After a two series of ozone therapy (20 cc of a mixture of OxygenOzone 95-5%, at 20 ug concentration, 4 weekly sessions) separated by six months, the recovering of the joint space and of the subchondral cyst and a decrease in pain is been observed (Figures 1-3). This case report and many years of experience demonstrate that Ozone is capable of diminishing pain and inflammation. Ozone acts on the repair of articular cartilage and subchondral bone, because it increases vascularisation of the articular cartilage [2].

Reduction of joint nociception induced by formalin in rats treated ith low level laser therapy 670 or 830 nm

Study design: experimental study of cross-cutting nature. Objective: To evaluate the low level laser therapy (LLLT) effects, with a wavelength of 670 and 820nm, in nociception of Wistar rats submitted to hypernociception in his right knee. Methods: 18 Wistar rats, separated into 3 groups: G1 – untreated; G2 – treated with LBP 670 nm; G3 – treated with LBP 830 nm. For the hypernociception induction was injected into the tibiofemoral articular space 100 µL of 5% formalin. To evaluate nociception was used digital von Frey filament, both with pressure on the knee, as in the plantar region. The evaluations occurred: pre-injury (EV1), 15 (EV2), 30 (EV3) and 60 (EV4) minutes after hypernociception induction. For the treatment with LBP was used to 8 J/cm2, after EV2. Results: the withdrawal threshold, when the pressure was held at the knee, showed that 670 nm produced threshold elevation in EV3 and EV4, returning to values similar to those of EV1. For the plantar region, only 830 nm showed restoration of values in EV4, and was higher in EV3 when comparing with G1. Conclusion: Both wavelengths produced raising the paw withdrawal threshold in rats with knee hypernociception

Intraarticular Injection of Allogenic Mesenchymal Stem Cells has a Protective Role for the Osteoarthritis.

Background:Researchers initially proposed the substitution of apoptotic chondrocytes in the superficial cartilage by injecting mesenchymal stem cells (MSCs) intraarticularly. This effect was termed as bio-resurfacing. Little evidence supporting the treatment of osteoarthritis (OA) by the delivery of a MSC suspension exists. The aim of this study was to investigate the effects of injecting allogenic MSCs intraarticularly in a rat OA model and to evaluate the influence of immobility on the effects of this treatment.Methods:We established a rat knee OA model after 4 and 6 weeks and cultured primary bone marrow MSCs. A MSC suspension was injected into the articular space once per week for 3 weeks. A subgroup of knee joints was immobilized for 3 days after each injection, while the remaining joints were nonimmobilized. We used toluidine blue staining, Mankin scores, and TdT-mediated dUTP-biotin nick end labeling staining to evaluate the therapeutic effect of the injections. Comparisons between the therapy side and the control side of the knee joint were made using paired t-test, and comparisons between the immobilized and nonimmobilized subgroups were made using the unpaired t-test. A P value < 0.05 was considered significant.Results:The three investigative approaches revealed less degeneration on the therapy sides of the knee joints than the control sides in both the 4- and 6-week groups (P < 0.05), regardless of immobilization. No significant differences were observed between the immobilized and nonimmobilized subgroups (P > 0.05).Conclusions:Therapy involving the intraarticular injection of allogenic MSCs promoted cartilage repair in a rat arthritis model, and 3-day immobility after injection had little effect on this therapy.