Hyaluronic Injection Research Articles

Do corticosteroids or hyaluronic acid intra-articular injections impact the risk of total knee replacement? Real-life data from the khoala cohort

Do corticosteroids or hyaluronic acid intra-articular injections impact the risk of total knee replacement? Real-life data from the khoala cohort

Rapamycin Inhibited Photoreceptor Necroptosis and Protected the Retina by Activation of Autophagy in Experimental Retinal Detachment

ABSTRACTPurpose: After experimental retinal detachment (RD), the applications of caspase inhibitor z-vad-fmk (a pan-caspase inhibitor) could inhibit apoptosis, but increased receptor interacting protein (RIP)-mediated necroptosis. In this study, we investigated whether rapamycin could inhibit necroptosis and cooperate with z-vad-fmk to protect the retina after RD.Methods: RD animal models were established in Sprague–Dawley rats by subretinal injection of sodium hyaluronate and treated with subretinal injections of z-vad-fmk or z-vad-fmk combined with rapamycin. On day 3 after RD, retinas were collected and analyzed by transmission electron microscopy (TEM), ROS assay, and western blot (for beclin-1, LC-3, RIP-1, AIF). On day 7 after RD, retinas were observed by H&E staining. Vision-dependent behavior of rats was tested by the modified Morris water maze.Results: TEM and H&E staining indicated that rapamycin combined with z-vad-fmk could reduce photoreceptor necrosis and preserve the ONL thickness after RD. The modified Morris water maze test showed that vision-dependent behavior was also significantly improved in the rapamycin + z-vad-fmk group.Western Blotting results demonstrated that rapamycin promoted the activation of autophagy by promoting beclin-1 and LC-3 induction and inhibited z-vad-fmk-induced necroptosis by inhibiting RIP-1 expression. In addition, rapamycin could also inhibit ROS production and AIF release.Conclusions: These findings indicated that rapamycin is a promising therapeutic agent that inhibits z-VAD-induced necroptosis, and protects photoreceptors and improves functional outcome in combination with z-vad-fmk.

Temporomandibular joint dysfunction – sequential infiltration protocol of sodium hyaluronate at different molecular weights

Introduction: The temporomandibular dysfunction (TMD) it’s a collective expression that encompasses clinical alterations in chewing muscles, temporomandibular joints (TMJ), and/or associated estructures. The viscosuplementation (VS) is a minimally invasive technique which consistis of intra-articular injection of sodium hyaluronate (SH) for the improvement of lubrification and joint biomechanics and elimination or decrease of pain. The aim of this study was to evaluate, through a series of cases, the efficacy of a viscosupplementation protocol with SH in different molecular weights, in the signs and syntptoms of joint TMJ and in patients’quality of life [1–3]. Materials and methods: this study was approved by the Ethics Committee of Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (CAAE-24911314.3.0000.5149) and registered in the Brazilian Registry of Clinical Trials (RBR-6759yz). Is a case series that describes the efficacy of a viscosupplementation protocol in intra-articular temporomandibular disorders. Ten patients with a diagnosis of disc displacement and/or osteoarthritis according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were submitted to four monthly injections of low or medium molecular weight HA. Pain, mandibular function, image analysis by tomography and magnetic resonance, and quality of life were assessed at baseline and follow-ups (1 and 6 months). Results: Pain, jaw range-of-motion, mandibular function, and quality of life improved at follow-up evaluations. Osteoarthritis changes decreased, and 20% of patients improved mandibular head excursion after treatment. Resolution of effusion and improvement in disc morphology were observed for most patients. This viscosupplementation protocol reduced pain and symptoms associated with internal derangement of temporomandibular joint, improved quality of life, and showed benefits from both low and medium molecular weight HA in alternate cycles. Discussion and conclusions: These results suggest the effectiveness of the VS protocol in the control and relief of the signs and symptoms of TMD, and the great therapeutic potential of this technique.

Successful temporomandibular viscosupplementation protocol in a 47 year-old woman with a 10- year history of temporomandibular pain and impaired function- case report

Introduction: Temporomandibular disorders (TMD) are a group of conditions that cause pain and dysfunction in the joint and muscles that control jaw movement. The etiology of TMD is multifactorial and multidisciplinary approaches are important for differential diagnosis and treatment planning [1–3]. This case report describes a viscosupplementation protocol with 4 cycles of sodium hyaluronate with different molecular weights to control osteoarthritis, disk displacement with reduction and intermittent closed lock of a 47-year-old woman with a 10-year history of temporomandibular pain and impaired function. Materials and methods: Careful anamnesis and detailed clinical examination showed several signs and symptoms, such as facial pain, joint click and discomfort in chewing. Diagnosis consisted of disk displacement with reduction and synovitis. Osteoarthritis of temporomandibular joint (TMJ) and bone structures was confirmed by computed tomography (CT).Treatment was performed in a multidisciplinary group involving experts in orofacial pain, physiotherapist and psychologist. Four monthly intra-articular injections of sodium hyaluronate (Polireumin®: molecular weight 500–730 kDa and Osteonil®: molecular weight 1.000–2.000 kDa) were applied in both temporomandibular joints followed by physical therapy during 4 consecutive months. Protocol consisted of Polireumin® injection in first and third applications and Osteonil® in second and forth months. Results: At end of treatment, patient showed great improvement in internal articular derangement and full restoration of function by clinical examination , control of all joint and bone changes by CT, and complete abolition of pain. After a 3- years follow-up, patient remained without pain or dysfunction in TMJ biomechanics and the osteoarthritis was under control. Discussion and conclusions: This case report demonstrates a successful protocol of viscosupplementation with an excellent control of TMD signs and symptoms. Further studies are necessary to assess the results of this protocol under a controlled clinical trial model.

Premaxillary Injection for Perioral Rejuvenation and Lip Enhancement.

This is the first study to evaluate the effect of premaxillary filler injection on nasal tip projection, upper lip projection, and upper lip vermilion height. The primary objective of this study was to analyze the change in nasal tip projection (measured by the Goode ratio) and the change in upper lip projection (measured by the Z angle) following premaxillary hyaluronic acid injection. A secondary objective was to measure the change in upper lip vermilion height. We hypothesized that treated subjects will show an increase in nasal tip projection, upper lip projection, and upper lip vermilion height. Twenty volunteer patients with signs of perioral aging or poor upper lip projection were enrolled in this prospective cohort study and underwent premaxillary hyaluronic acid filler injection between November 2017 and June 2018. Nasal tip projection, upper lip projection, and upper lip vermilion height were assessed from baseline and posttreatment photographs based on the Goode ratio, Z angle, and lip vermilion height ratio, respectively. No significant change was noted between pre- and posttreatment Goode ratio measurements (P = 0.841). There was a significant decrease in Z angle and therefore significant increase in upper lip projection with treatment (P < 0.001). The lip vermilion height ratio demonstrated a trend of increased upper lip vermilion height but this did not achieve statistical significance (P = 0.561). Premaxillary filler treatment resulted in a significant increase in upper lip projection. Premaxillary filler injection when performed in a safe manner is a valuable treatment option for perioral rejuvenation.

Evaluation of the role of unconjugated hyaluronic acid repetitive injection during the primary repair of flexor tendons in no man’s land: a randomized control trial

Zone 2 flexor tendon injuries are prone to poor results following repair due to adhesions. Different repair methods and physiotherapy protocols have been devised to improve outcomes, with variable results. Hyaluronic acid (HA) is a polysaccharide produced by the innermost layer of the tendon sheath that facilitates gliding in zones where the sheath is continuous. Sixty-two flexor tendons that were repaired using a double-stranded core suture were divided between groups A (n = 32) and B (n = 30). In the former, non-cross-linked HA was repeatedly instilled at the repair site, with a total of three injections per digit. The repair outcomes were assessed using the Strickland criteria, the ratio of total active motion to total passive motion (TAM/TPM), and active range of motion (AROM) for individual joints. A total of 31.1% of group A patients had excellent to good outcomes in contrast to 13.3% in group B. The mean difference in TAM was 105° in group A and 71° in group B (p value ˂ 0.05). The mean TAM/TPM was 0.65 in group A and 0.56 in group B (p value = 0.06). HA significantly improves the results of flexor tendon repair in zone 2. Level of Evidence: I.

The impact of cricothyroid involvement on adductor recovery in unilateral vocal fold paralysis.

Wide variation in postinjury functional recovery is a hallmark of unilateral vocal fold paralysis (UVFP), ranging from zero to full recovery. The present study examined the impact of cricothyroid (CT) muscle involvement on recovery using quantitative laryngeal electromyography (LEMG) of the thyroarytenoid-lateral cricoarytenoid (TA-LCA) muscle complex at multiple times postinjury. Prospective cohort study in a medical center. Eighty-one patients with UVFP (37 males and 44 females) received an initial assessment of quantitative LEMG, stroboscope, acoustic voice analysis and 36-Item Short Form Survey quality-of-life questionnaire at 3 to 6 months after UVFP onset and a follow-up assessment at 12 months after UVFP onset. The initial and follow-up assessments were performed at 4.3 ± 1.9 and 12.5 ± 1.3 months after UVFP onset, respectively. The peak turn frequency of the TA-LCA muscle complex on the lesion side was improved at the follow-up (470 ± 294 Hz) compared with the initial assessment (300 ± 204 Hz) (P < .001). Patients were also divided into two groups with (n = 27) and without (n = 54) CT involvement, respectively. TA-LCA muscle complex turn frequency improved in patients without CT involvement (from 277 ± 198 to 511 ± 301 Hz; P < .001), but not in those with CT involvement (from 345 ± 211 to 386 ± 265 Hz; P = .46). Seventy-one of all patients received early intervention with intracordal hyaluronate injection, showing similar therapeutic effects in those with and without CT involvement. Acute UVFP with combined TA-LCA muscle complex and CT muscle involvement has a poor prognosis, with poorer recovery of TA-LCA muscle complex recruitment. Early interventions should be considered in patients with UVFP with CT involvement. 2 Laryngoscope, 130:139-145, 2020.

Differences in the molecular weight of sodium hyaluronate for osteoarthritis: benefits and mechanisms

Sodium hyaluronate is one of the natural components of articular cartilage and synovial fluid, which plays important roles in maintaining the structure and physiological functions of joints. Abnormal change of the content and physicochemical properties of sodium hyaluronate in the joints is one of the common pathological causes of osteoarthritis. Supplementation of exogenous sodium hyaluronate, which has similar physical and chemical properties as those in normal joints, has been considered as an effective strategy for clinical treatment of osteoarthritis. However, the benefits of intra-articular injection of sodium hyaluronate are still under debates. Moreover, different recommendations for clinical use were developed in several clinical guidelines. Several guidelines suggested that molecular weight of sodium hyaluronate was an important factor influencing the clinical benefits in osteoarthritis. Diverse products of sodium hyaluronate present different physicochemical and biological characteristics, which may lead to differences in clinical efficacy and safety. High-molecular-weight sodium hyaluronate, with highly modified and cross-linked sugar chains, potentially differ from those with low molecular weight in physicochemical properties, rheological characteristics, and physiological activities. In general, high-molecular-weight sodium hyaluronate have higher viscosity and elasticity. The exogenous hyaluronate, of which the molecular weight is similar to those in normal joints, probably have the similar rheological characteristics. A large number of clinical studies demonstrated that sodium hyaluronate products with high-molecular weight significantly relieved joint pain and improved joint functions in patients with osteoarthritis. In contrast, the clinical efficacy of the low-molecular-weight hyaluronate is still controversial, because several studies could not establish the superiority in osteoarthritis when comparing with the placebo. Studies on molecular mechanisms revealed that some physiological functions of sodium hyaluronate were molecular-weight dependent. High-molecular-weight sodium hyaluronate may have more pronounced impacts on the regulation of inflammation and maintaining the homeostasis of extracellular matrix. This review focused on the effects of sodium hyaluronate with different molecular weight in treating osteoarthritis. Evidence based on clinical studies related to the molecular-weight differences of sodium hyaluronate were presented. Furthermore, the optimal use of various products of sodium hyaluronate with different molecular weight was discussed.

Modulation of α-adrenoceptor signalling protects photoreceptors after retinal detachment by inhibiting oxidative stress and inflammation.

Currently available treatments do not halt progression of photoreceptor death and subsequent visual impairment related to retinal detachment (RD) which is observed in various retinal disorders. This study investigated the neuroprotective effects of two adrenoceptor ligands, the α1 -adrenoceptor antagonist doxazosin and the α2 -adrenoceptor agonist guanabenz, against photoreceptor cell death in RD. We used a model of experimental RD in Brown-Norway rats induced by subretinal injection of sodium hyaluronate. Oxidative stress biomarkers and cytokine production were quantified with elisa. Protein expression levels and immunofluorescent labelling were determined in rats with RD and controls for mechanistic elucidation. The effects of systemic (i.p.) administration of doxazosin or guanabenz on photoreceptor apoptosis, retinal histology and electroretinography were evaluated in rats with RD and compared to the effects in vehicle controls. Photoreceptors were the major source of RD-induced ROS overproduction in the rat retina through the regulation of NADPH oxidase. Systemic administration of doxazosin or guanabenz decreased the RD-induced production of ROS and proinflammatory cytokines, including IL-1β and the chemokine CCL2, and suppressed retinal gliosis, resulting in attenuation of photoreceptor death and preservation of retinal structures and functions in RD. Our findings point to α-adrenoceptors as novel therapeutic targets to provide photoreceptor protection and suggest that both doxazosin and guanabenz, two FDA-approved drugs, could be further explored to treat retinal diseases.

Hyaluronic gel injection into the vesicovaginal septum for high-dose-rate brachytherapy of uterine cervical cancer: an effective approach for bladder dose reduction.

PurposeThe purpose of this study was to report our initial experience of hyaluronic acid gel injection (HGI) in the vesicovaginal septum (VVS) for bladder dose reduction in brachytherapy (BT) for uterine cervical carcinoma.Material and methodsBetween September 2016 and May 2018, 15 uterine cervical cancer patients received HGI in the VVS as a part of their definitive radiotherapy (RT) treatment consisting of external beam radiation therapy (EBRT) with additional BT. Of those, 9 patients received BT both with and without HGI, and remaining 6 patients were excluded because these 6 patients received HGI in the VVS for all BT fractions. All 9 patients received HGI in the rectovaginal septum. For these patients, the dosimetric parameters bladder D2cc, HR-CTV D90, and rectum D2cc were selected, and two groups were generated (BT with vs. without HGI in the VVS) for dosimetric comparison.ResultsThe median cumulative EQD2 for HR-CTV, rectum D2cc, and bladder D2cc for the 9 patients were 73.3, 52.8, and 67.1, respectively. While no statistical difference could be detected for rectal dose reduction, bladder dose was significantly less in the group with HGI in the VVS compared to that without (449 cGy [range, 416-566, 1SD = 66.1] vs. 569 cGy [range, 449-647, 1SD = 59.5], p = 0.033), with no compromising of target coverage. Although it did not reach statistically significance, there was a trend toward better HR-CTV D90 in the group with HGI compared to that without HGI in the VVS (713 cGy vs. 706 cGy, p = 0.085). No severe bleeding, hematuria, bladder wall injury, or urethral injury requiring hospitalization was experienced in association with HGI in the VVS.ConclusionsHGI in the VVS can be performed safely and can effectively reduce the bladder dose in BT for uterine cervical cancer patients.

A Case of Sterile Abscess Induced by Hyaluronic Acid Filler Injection.

A Case of Sterile Abscess Induced by Hyaluronic Acid Filler Injection.

Comparison of efficacy of sodium hyaluronate and normal saline arthrocentesis in the management of internal derangement of temporomandibular joints - A prospective study.

Purpose:The aim of the present study was to evaluate the efficacy of arthrocentesis with and without sodium hyaluronate (SH) injection in the treatment of patients with temporomandibular joint (TMJ) internal derangement.Materials and Methods:The study consisted of 20 patients with chief complaints of limited mouth opening, TMJ pain, and jaw deviation. Patients with disc displacement with reduction and closed lock were randomly divided into two groups. In Group 1, only arthrocentesis was performed, and in Group 2, arthrocentesis plus intra-articular injection of SH was performed. Arthrocentesis was performed under aseptic conditions using normal saline. Clinical evaluation was done for maximum mouth opening (MMO), TMJ pain, and jaw deviation before the procedure and 1 week, 2 weeks, 1 month, and 3 months following arthrocentesis.Results:The mean visual analog scale (VAS) score change was statistically significant in Group 1 and Group 2 for within the group analysis. There was statistically significant difference in VAS score between Group 1 and Group 2 at all time intervals postoperatively. The increase in MMO from preoperative to 3 months postoperatively was statistically significant for within the group analysis. There was a reduction in mandibular deviation in both Group 1 and Group 2, but the difference was not statistically significant. There was no statistically significant difference in deviation between the two groups.Conclusion:Arthrocentesis with SH is superior to arthrocentesis alone in treating patients suffering with TMJ internal derangement, who are refractory to conservative treatment.

Hyaluronan Injections Show No Histologic Evidence of Adverse Tissue Effects.

Background:The safety of hyaluronan intra-articular injections is mostly based on animal studies and clinical evidence rather than histologic studies from human administration.Objective:This study analyzed the histologic effects of viscosupplementation with sodium hyaluronate on the synovium and articular cartilage of human knee specimen status post total knee arthroplasty within 3 years of viscosupplementation.Methods:Twenty-four specimens from total knee arthroplasties from April 2012 to August 2016 at NYU Winthrop Hospital were selected for microscopic analysis. All cases had a diagnosis of end-stage osteoarthritis at the time of surgery. Thirteen of the cases had 3 viscosupplementation injections of the knee with Euflexxa, a hyaluronate-based viscosupplementation agent, within 3 years preceding a total knee replacement. The remaining 11 did not receive viscosupplementation and were incorporated as controls. Upon histologic review, synovium was categorized by degree of hyperplasia and inflammation and the presence or absence of foreign material and giant cell reactions. Residual articular cartilage was categorized by staining intensity, and the presence or absence of crystals, foreign material, and giant cell reactions.Results:No significant difference was found between these groups for degree of synovial hyperplasia (P = .33) or for cartilage staining density (P = .42). None of the samples displayed evidence of foreign material, crystals, or giant cell reactions.Conclusion:In this cohort of patients, we demonstrated that Euflexxa was administered without any discernible microscopic adverse tissue effects.

Сравнительная эффективность внутрисуставных инъекций гиалуроната натрия в комбинации с хондроитина сульфатом и пероральных симптоматических препаратов медленного действия у пациентов с первичным и посттравматическим остеоартритом коленных суставов

Сравнительная эффективность внутрисуставных инъекций гиалуроната натрия в комбинации с хондроитина сульфатом и пероральных симптоматических препаратов медленного действия у пациентов с первичным и посттравматическим остеоартритом коленных суставов

A randomized controlled trial testing a hyaluronic acid spacer injection for skin toxicity reduction of brachytherapy accelerated partial breast irradiation (APBI): a study protocol

BackgroundAccelerated partial breast irradiation (APBI) is a treatment option for selected early stage breast cancer patients. Some APBI techniques lead to skin toxicity with the skin dose as main risk factor. We hypothesize that a spacer injected between the skin and target volume reduces the skin dose and subsequent toxicity in permanent breast seed implant (PBSI) patients.MethodsIn this parallel-group, single-center, randomized controlled trial, the effect of a subcutaneous spacer injection on skin toxicity among patients treated with PBSI is tested. Eligibility for participation is derived from international guidelines for suitable patients for partial breast radiotherapy, e.g. women aged ≥ 50 years with a histologically proven non-lobular breast carcinoma and/or ductal carcinoma in situ (DCIS), tumor size ≤ 3 cm, node-negative, and PBSI technically feasible. Among exclusion criteria are neoadjuvant chemotherapy, lymphovascular invasion, and allergy for hyaluronic acid. For the patients allocated to receive spacer, after the PBSI procedure, 4–10 cc of biodegradable hyaluronic acid (Barrigel™, Palette Life Sciences, Santa Barbara, CA, USA or Restylane SubQ®, Galderma Benelux, Breda, the Netherlands) is injected directly under the skin using ultrasound guidance to create an extra 0.5–1 cm space between the treatment volume and the skin. The primary outcome is the rate of telangiectasia at two years, blindly assessed using Bentzen’s 4-point scale. Secondary outcomes include: local recurrence; disease-free and overall survival rates; adverse events (pain, redness, skin/subcutaneous induration, radiation dermatitis, pigmentation, surgical site infection); skin dose; cosmetic and functional results; and health-related quality of life.A Fisher’s exact test will be used to test differences between groups on the primary outcome.Previous studies found 22.4% telangiectasia at two years. We expect the use of a spacer could reduce the occurrence of telangiectasia to 7.7%. A sample size of 230 patients will allow for a 10% lost to follow-up rate.DiscussionIn this study, the effect of a subcutaneous spacer injection on the skin dose, late skin toxicity, and cosmetic outcome is tested in patients treated with PBSI in the setting of breast-conserving therapy. Our results will be relevant for most forms of breast brachytherapy as well as robotic radiosurgery, as skin spacers could protect the skin with these other techniques.Trial registrationNetherlands Trial Register, NTR6549. Registered on 27 June 2017.

Prolonged pain reducing effect of sodium hyaluronate-carboxymethyl cellulose solution in the selective nerve root block (SNRB) of lumbar radiculopathy: a prospective, double-blind, randomized controlled clinical trial

The pattern of linear graph schematized by visual analogue scale (VAS) score displaying pain worsening between 2 days and 2 weeks after selective nerve root block (SNRB) is called rebound pain. The purpose of this study was to determine if sodium hyaluronate and carboxymethyl cellulose solution (HA-CMC sol) injection could reduce the occurrence of rebound pain at 3 days to 2 weeks after SNRB in patients with radiculopathy compared with injection with corticosteroids and local anesthetics alone. Double blinded randomized controlled clinical trial. A total of 44 patients (23 of 24 patients in the Guardix group and 21 of 24 patients in the control group) who finished the follow-up session were subjects of this study. Patients were asked to write down their average VAS pain scores daily for 12 weeks. Functional outcomes were assessed by Oswestry Disability Index, Roland Morris Disability Questionnaire , and Short Form-36. A cocktail of corticosteroids, 1% lidocaine, 0.5% Bupivacaine, and 1 mL of normal saline was used for the control group whereas a cocktail of corticosteroids, 1% lidocaine, 0.5% Bupivacaine, and 1 mL of HA-CMC solution was used for the G group. Study participants were randomized into one of two treatment regimens. They were followed up for 3 months. VAS score at 2 weeks after the procedure was 4.19±1.32 in the control group, which was significantly (p<.05) higher than that (2.43±1.24) in the G group. VAS score at 6 weeks after the procedure was 4.00±1.23 in the control group and 3.22±1.45 in the G group, showing no significant (p=.077) difference between the two groups. There were no significant differences in functional outcomes at 6 or 12 weeks after the procedure. Compared with conventional cocktail used for SNRB, addition of HA-CMC sol showed effective control of rebound pain at 3 days to 2 weeks after the procedure.

Effectiveness and Safety of Acne Scar Treatment With Nonanimal Stabilized Hyaluronic Acid Gel.

Acne scarring affects most patients with acne and have a negative impact on quality of life. New effective treatment options offering minimal downtime are therefore needed. To evaluate improvement in overall facial appearance after hyaluronic acid (HA) treatment of atrophic acne scars. Twelve subjects with moderate-to-severe acne scars were treated at 3 sessions 4 weeks apart. At each session, up to 2-mL HA gel was injected into each side of the face. Acne scar severity, global facial aesthetic improvement, and subject satisfaction were assessed up to 36 weeks after treatment. Safety assessments included subject diaries and adverse events. The overall facial appearance and the appearance of atrophic acne scars improved after treatment. Scar severity and subject satisfaction with the overall facial appearance and with the sensation and perception of the skin improved in most subjects. Subjects' self-esteem and self-confidence also improved. Adverse events were typically mild to moderate, expected, and procedure-related. Hyaluronic acid gel injections were effective and safe for treatment of moderate-to-severe atrophic acne scars. The treatment effect developed gradually over time with the highest improvement observed at the end of the study.

Effects of Viscosupplementation on Knee Joint Arthrokinematics - Pilot Study.

Osteoarthritis is one of the most common dysfunctions of the musculoskeletal system and viscosup-plementation is becoming an increasingly popular treatment in OA. However, current knowledge regarding biomechanical changes in synovial joints reveals many discrepancies. Therefore, the aim of our study was to evaluate the effect of visco-supplementation on knee joint arthrokinematics as analyzed by vibroarthrography. Seventeen individuals diagnosed with moderate knee osteoarthritis (VSC) were examined before and after a single injection of hyaluronate. A control group consisted of 30 asymptomatic individuals. During alter-nating extension/flexion of the knee joint, a 6-second vibroarthrographic signal was recorded using an accelerometer. The following parameters were calculated: variance (VMS), amplitude (R4), and spectral power density in the 50-250 Hz (P1) and 250-450 Hz (P2) bands. Statistical analysis showed significant differences (p&lt;0.05) in the values of R4 and P2, which were higher in the VSC group than among the controls. After viscosupplementation, the values of R4, P1 and P2 in the VSC group de-creased to a level not significantly different from that seen among the controls. 1. After a single intra-articular HA injection, joint motion-related vibrations were reduced, which was recorded as a decreased intensity of vibroacoustic emission. 2. This suggests that the use of viscosupplementation in pa-tients with moderate knee osteoarthritis may improve qualitative aspects of arthrokinematics.

Pretarsal roll augmentation with dermal hyaluronic acid filler injection

Pretarsal roll augmentation with dermal hyaluronic acid filler injection focuses on restoring pretarsal fullness. This study aimed to introduce a method of pretarsal roll augmentation with dermal hyaluronic acid filler injection and establish the level of difficulty, safety, and effectiveness of this method. Eighty female patients were enrolled in this study. Hyaluronic acid filler was used to perform pretarsal roll augmentation. Physician and patient satisfaction at 1 month and 4 months after surgery was investigated. The level of satisfaction was graded from points 1 to 5. The patient satisfaction and physician scores were 4.7 ± 1.1 (mean ± standard deviation) points at 1 month and 4.8 ± 0.9 points at 4 months and 4.6 ± 0.9 points at 1 month and 4.8 ± 1.0 points at 4 months, respectively. No major complications were observed. Our technique provided a natural and younger appearance with pretarsal fullness. This technique was easy to perform for the restoration of pretarsal fullness, and it improved periorbital contouring, rejuvenated the pretarsal roll, and provided excellent esthetic results. Level of Evidence: Level V, therapeutic study.

Viscosupplementation for knee osteoarthritis: a focus on Hylan G-F 20.

Knee osteoarthritis is a chronic degenerative joint disease characterized by destruction of articular cartilage with resultant para-articular bone changes. It is a major cause of disability in older persons and is managed by surgical and nonsurgical interventions. Pharmacotherapy includes acetaminophen, nonsteroidal anti-inflammatory agents, and intra-articular steroids. Another treatment option is viscosupplementation with intra-articular injection of hyaluronan (HA). The full mechanism of action of exogenous HA is uncertain, but studies indicate that it may promote endogenous HA production, reduce inflammation, prevent degeneration of cartilage and promote cartilage regeneration. Clinically, HA may improve symptoms of osteoarthritis and delay time to total knee replacement surgery. However, clinical studies are heterogenous and of varying quality, and thus there is a need for more robust studies to determine the place of viscosupplementation in the management of knee osteoarthritis.