Intra-articular Infiltration Research Articles

Use of Reticulated Hyaluronic Acid Alone or Associated With Ozone Gas in the Treatment of Osteoarthritis Due to Hip Dysplasia in Dogs.

This study aimed to evaluate reticulated hyaluronic acid alone or associated with ozone gas in the treatment of osteoarthritis due to hip dysplasia in dogs. Fourteen client-owned dogs were randomly assigned into two groups: Group 1—single intra-articular injection of hyaluronic acid; Group 2—single intra-articular infiltration injection of hyaluronic acid associated with ozone gas. Each hip joint received an average of 0.75 mL of reticulated hyaluronic acid ultrasound-guided. Ozone gas at a dose of 45 μg/mL was incorporated into hyaluronic acid by insufflation. Dogs were evaluated for body condition scoring, orthopedic examination and radiographic scores of the hip joints, goniometric measurements of the hip joints, visual gait score, and kinetic analysis. The evaluations were conducted immediately before treatments (M0), and at days 30 (M1), 60 (M2), and 90 (M3) after treatments. There were no significant differences in body mass and body condition scoring (5-point scale) in each group in all evaluation moments. The scores of orthopedic examination of the hip joints showed statistical differences in each group between moments (M0 > M3), but differences were not observed between groups. No statistical differences were found for radiographic scores in each group between moments, but differences were observed between groups immediately prior to treatments (G1 > G2) and 90 (G1 > G2) after treatments. Goniometric measurements of hip flexion and extension showed no significant differences in each group between moments or between groups. No statistical differences between groups were found concerning the lameness score. There were significant differences for lameness score among moments in Group 1, being M0 > M2 and M0 > M3, and Group 2 in which M0 > M1, M0 > M2, and M0 > M3. The mean percentage of change of PVF and VI between M3 and M0 in Group 1 was almost null and in Group 2 was positive, being 31.1 ± 29.4 and 10.6 ± 25.4, respectively. In conclusion, the intra-articular viscosupplementation alone or associated with ozone gas allowed improvement of lameness scores and orthopedic examination score. In Group 2 the association of ozone gas had better results on kinetic analysis.

Injection therapy in hip osteoarthritis: one year in review

Hip osteoarthritis affects a substantial and growing number of people worldwide. Its incidence and prevalence are increasing due to ageing and obesity. It is estimated that it affects between 10 and 18% of individuals over 60 years of age and up to 1 in 3 patients over the age of 85 with a substantial proportion of them experiencing persistent pain, loss of function and decline in health-related quality of life. Our work was aimed at updating the latest data on this field. We searched the following terms on PubMed: ‘injection therapy’, ‘osteoarthritis’ and ‘hip’. We limited our search to the period from 1-1-2018 until 22-6-2019 and to the English language. We retrieved 31 works. We decided to divide the works into three groups: hyaluronic acid in hip OA, other therapies in hip OA and emerging radiological techniques to measure the efficacy of injection therapy. So far, in the literature there is no solid evidence that supports the efficacy of intra-articular infiltration therapies in hip osteoarthritis. The international guidelines reflect this lack of solid scientific evidence. We believe that only original works that show high-level evidence can highlight the benefits of these therapies.

Intra-articular infiltration of adipose-derived stromal vascular fraction cells slows the clinical progression of moderate-severe knee osteoarthritis: hypothesis on the regulatory role of intra-articular adipose tissue

BackgroundThe infiltration of the stromal vascular fraction (SVF) of autologous adipose tissue to treat osteoarthritis has been used for several years demonstrating its safety and noticeable efficacy. This article presents clinical data from patients afftected by moderate and severe knee osteoarthritis demonstrating safety and clinical efficacy of the treatment when this autologous cell product is injected in the knee joint and patients evaluated post-operatively after 1 year. However, what do we know about the mechanism that underlies this clinical improvement? This article proposes, for the first time in our opinion, a hypothesis of the mode of action that involves structural and molecular interactions between SVF and infrapatellar fat pad (IFP). As consequence, there would be a re-education of intra-articular adipose tissue, which we consider a key player for the clinical effect observed in the mid and long term mainly due to immuno-regulatory mechanisms.MethodsThis is a retrospective and not controlled study that evaluated 50 patients (100 joints) ranging from 50 to 89 years old, separated by age cohorts. Clinical efficacy was assessed using the Lequesne, WOMAC, and VAS scales, by ultrasound control and quantification of the biochemical profiles of synovial fluid.ResultsThere were no serious adverse effects. All the indexes studied showed a significant clinical improvement after 1-year follow-up for all ages and OA degree groups. This finding was correlated with the ultrasound observations and biochemical data, which show a marked decrease in catabolic and pro-inflammatory molecules (MMP-2, IL-1B, IL-6, and IL-8) and significant increase for anabolic and anti-inflammatory molecules (IGF-1 and IL-10).ConclusionsWe conclude that intra-articular SVF infiltration for knee OA treatment is safe and effective during 1 year. We propose that applied SVF cells cause a cascade of molecular and structural events that, through complex interactions between IFP and SVF, re-educating the intra-articular fatty tissue towards a homeostatic, protective, and anti-inflammatory function, which will ultimately promote the restructuring and regeneration of damaged tissues.

Complementary Saphenous Nerve Block to Intra-Articular Analgesia Reduces Pain After Total Knee Arthroplasty: A Prospective Randomized Controlled Trial

BackgroundNumerous strategies exist for pain management after total knee arthroplasty (TKA), with a fast recovery and early ambulation required for full function. Currently, there is no universal standard of care to facilitate this management. We assessed pain management safety and efficacy after TKA, using intra-articular infiltration associated with peripheral saphenous nerve block (SNB) vs intra-articular infiltration alone. MethodsWe performed a controlled, double-blinded, and randomized trial to evaluate postoperative pain in TKA. One group was treated with intra-articular analgesia associated with SNB, whereas a second group received the same intra-articular cocktail, associated with placebo. Efficacy was evaluated according to average pain, pain-free time, and morphine rescue indices. Safety was assessed by intervention complications and surgery. ResultsAbout 70 patients were recruited. At time 0 (immediately postoperative), 51.43% of the intra-articular analgesia + placebo group presented pain <3, whereas in the intra-articular analgesia + SNB group, 8.82% (P = .001) presented with pain. This difference was maintained at 6, 12, and 24 hours, postoperatively. After 24 hours, the placebo group received an average 0.66 morphine rescues (standard deviation, 0.86), when compared with the SNB group that received 0.14 rescues (standard deviation, 0.43), (P = .002). We recorded a paresis of the external popliteal sciatic nerve, with spontaneous recovery without other complications. ConclusionComplementary SNB to intra-articular analgesia was more effective in reducing average pain and the amount of pain-free time in the first 24 hours after TKA, with fewer requests for morphine rescue analgesia.

Arthrocentesis and Sodium Hyaluronate Infiltration in Temporomandibular Disorders Treatment. Clinical and MRI Evaluation.

Arthrocentesis in temporomandibular joint disorders can be associated with the intra-articular infiltration of various drugs with the objective of increase treatment efficacy. The aim of this study was to evaluate the clinical indexes variation in patients affected by temporomandibular joint disorders treated with arthrocentesis and sodium hyaluronate (SH) injections. A total of 28 patients suffering from temporomandibular joint disorders underwent one cycle of five arthrocentesis and infiltrations of sodium hyaluronate. Spontaneous mouth opening improved from 36.3 ± 7.5 mm to 45.1 ± 1.9 mm at six months follow-up. A significant reduction in the pain at rest and during mastication mean values emerged at follow-up (p < 0.0001). The mean masticatory efficiency, evaluated through a visual analogic scale, showed improvement at the follow-up period, highlighted by the increase of mean value from a baseline of 3.1 ± 1.2 to a mean value of 8.5 ± 1.2 (p < 0.0001). The mean severity of the joint damage at baseline time was 2.4 ± 0.9 and decreased to 0.4 ± 0.3 at the end of the follow-up period. The decrease in values is confirmed by statistical test (p < 0.05). Our data show how arthrocentesis integrated with sodium hyaluronate infiltrations performed under local anesthesia is a valid method of treating temporomandibular joint disorders.

Hip MRI findings and outcomes following imaging-guided hip injections.

To determine if MRI findings prior to intra-articular corticosteroid hip infiltration are related to treatment outcomes. This prospective outcome study with retrospective MRI evaluation includes 100 consecutive patients with MRI within 6 months before a therapeutic intra-articular hip injection. Labrum, bone marrow, acetabular and femoral cartilage abnormalities were assessed by two radiologists blinded to patient outcomes: the proportion reporting "improvement" on the Patient's Global Impression of Change (PGIC) scale at 1 day, 1 week and 1 month follow-up were compared based on MRI findings using χ2. The t-test was used to compare pain change scores with MRI abnormalities. Patients with a normal labrum in the posterosuperior quadrant were more likely to report PGIC "improvement" at 1 week compared to labral degeneration (p = 0.048). Significant differences in pain change scores were found at all time points for the labral anteroinferior quadrant (p = 0.001, 1 day; p = 0.010, 1 week; p = 0.034, 1 month) with the highest reduction in patients with labral degeneration. Females were 2.80 times more likely to report clinically relevant "improvement" at 1 day (p = .049) and 2.90 times more likely to report clinically relevant "improvement" at 1 month (p = .045). Cartilage defects and marrow abnormalities were not associated with outcomes. Patients with a normal labrum in the posterosuperior quadrant had better outcomes at 1 week. Patients with labral degeneration of the anteroinferior quadrant had higher levels of pain reduction at all time points. Females were significantly more likely to report PGIC "improvement". A significant treatment outcome was observed amongst gender, although there were no significant differences in the MRI findings.

Comparative study of the effect of suprascapular nerve block under ultrasound guidance and blind shoulder infiltration (Using lignocaine and methylprednisolone acetate) in chronic shoulder pain

Introduction: Shoulder joint is very important joint for day to day activities and pain in shoulder results in leads to increased functional disability with poor quality-of life. Chronic shoulder pain common complaints encountered by treating physicians all over world. The incidence of chronic shoulder pain is approximately 15-30% with variations among different population and age groups. The treatment modalities available for alleviating chronic shoulder pain varies from simple anti-inflammatory drugs to interventional procedures like intra-articular steroid injections, supra-scapular nerve block (SSNB).AIM: To compare the pain relief and return of function in shoulder joint using suprascapular nerve block under ultrasound guidance (lignocaine and methylprednisolone acetate) versus shoulder infiltration (lignocaine and methylprednisolone acetate) in chronic shoulder pain.Study Design: Prospective, randomised study, data was collected from patients with chronic shoulder pain in the age group of 18-60 years coming to orthopedic outpatient department at Yenepoya Medical College Hospita with chronic shoulder pain.Materials and Methods: Suprascapular nerve block group: 2ml of 40mg methyl prednisolone +2ml of lignocaine given, supervision of anesthetist under ultrasound guidance. Intra articular steroid group: 2ml of 40mg methyl prednisolone acetate +2ml 2% lignocaine hydrochloride given through posterior approach to shoulder. Eligible participants was randomly assigned to receive the same combination of medications either by supra scapular nerve block under ultrasound guidance or blind shoulder infiltration and compare the effect of lignocaine and corticosteroid in suprascapular nerve block and shoulder infiltration in chronic shoulder pain by assessing DASH score, Constant-Murley score, SPADI score and VAS pain score on day 7 and day 28 of the procedure.Results: There were no significant differences between the groups in terms of pain, demographic variables, Range of movement and disability scores when compared to baseline. (p >0.05). However suprascapular nerve block showed slight better improvement in pain, range of movement and disability score at initial (i.e. at 1week) and at 4 week follow up when compared with that of intra-articular steroid infiltration but scores were not statistically significant. Parameters obtained in both groups were significant at final assessments when compared to the baseline scores.Conclusion: Suprascapular nerve block can be considered as a safe, effective, well tolerated treatment and alternative line of treatment in patient suffering from chronic shoulder pain.

Role of biologics – Platelet-rich plasma in treatment of moderate osteoarthritis of the knee

Background: Osteoarthritis is a degenerative disease of the joints which involves cartilage. Osteoarthitis of the knees is the most common joint disease. It is a chronic progressive degenerative disease. It affects 30% of the people having an age more than 50 years. Various studies have shown that osteoarthritis leads to a major burden on the economy of many developing countries. The basis for biologics such as platelet-rich plasma (PRP) therapy in osteoarthritis of knees is the stimulation of the natural healing and regeneration due to the presence of large number of platelet-derived growth factors directly at the site of treatment. There is a lack of clarity regarding the number and frequency of injections for proper effectiveness as well as the ideal treatment for different stages of In our study, we have tried to analyze PRP as a treatment modality in osteoarthritis of the knee. Materials and Methods: Thirty patients of osteoarthritis of bilateral knees and who fulfilled inclusion criteria and were managed with two sessions of intra-articular PRP infiltration 3 months apart between the duration May 2018 and May 2020 were included in our study. Maximum follow-up was done for 8 months. Functional assessment was done with the help of the Western Ontario and McMaster Universities (WOMAC) score and Visual Analogue Scale (VAS) score. Results: The mean age group of the patients in our study was 53.9 years. Out of 30 patients, 13 (43.333%) were males and 17 (56.666%) were females. Out of 30 patients, 9 patients (30%) had Grade I osteoarthritis of knees according to Kelgren-Lawrence grading, while 16 (53.333%) had Grade II and 5 (16.666%) had Grade III osteoarthritis, i.e., majority of the patients had Grade II osteoarthritis. The mean ± 2 standard deviation WOMAC scores before intervention, at 1-month follow-up, 3-month follow–up, and 8-month follow-up are 49.833 ± 5.854, 40.103 ± 8.08, 30.033 ± 6.976, and 19.666 ± 4.26, respectively. The mean VAS scores before intervention, at 1-month follow-up, 3-month follow–up, and 8-month follow-up are 4.4, 3.2, 2.9, and 2.5, respectively. There were no major complications in our study. The complication rate of our study was 6.6667%, i.e., only two patients had complications. Out of 30 patients, 24 (80%) were satisfied with this treatment modality, 3 (10%) were partially satisfied, and 3 (10%) were not satisfied. Discussion: Even though the results and observations of our study are comparable with other studies on this subject, there are some limitations in our study like short duration of follow-up, lack of radiological modalities for judging functional outcome, and small sample size. Conclusion: Multiple (2) intra-articular PRP injections are a new modality in the treatment of early osteoarthritis. In our study, symptomatic and functional improvement was seen in cases of bilateral early osteoarthritis. This technique is cost-friendly and has very low complications rates. Hence, this modality can be used in the treatment of early osteoarthritis as an alternative to other established modalities.

Therapeutic Effect of Sodium Hyaluronate and Corticosteroid Injections on Pain and Temporomandibular Joint Dysfunction: A Quasi-experimental Study

The aim was to evaluate and compare the therapeutic effect of sodium hyaluronate (SH) and corticosteroids (CS) on pain and temporomandibular dysfunction (TMD). Thirty patients with TMD [characterized by painful symptoms, affectations, and limitations of the mandibular movement and noises or clicks in the temporomandibular joint (TMJ)] were selected and divided into two equal groups nonrandomized. The clinical questionnaire was applied to each patient before performing the clinical procedures and included a visual analog scale with progressive values from 0 to 10 for the measurement of pain and clinical examination: maximum oral aperture (MOA), mandibular laterotrusive movement (MLM), and maximum protrusion (MP), before and after infiltration intra-articular with SH and CS up to 2 months. Both groups described benefits from treatment at the 1st and 2nd weeks, and at 1 and 2 months of follow-up, presenting a reduction in TMJ pain, and improvement in mandibular mobility with an increase of the MOA, lateralities, and protrusion. No statistically significant difference was found among these variables between the two drugs. However, SH showed a greater therapeutic effect in relation to a reduction in joint noises compared to CS. Intra-articular infiltration with SH and CS in TMD is effective for the relief of TMJ pain and also reduces joint noises and improves mandibular mobility. Both drugs can be used with similar optimal results in the treatment of TMD. This research allows to know what is the therapeutic impact of injectable CS on the TMJ.

Treatment experiences of gonarthrosis by intra-articular infiltration of ozonated autologous blood

Knee arthrosis is a degenerative process with inflammatory characteristics that develops in the articular environment, resulting in irreversible alterations that tend to impair its functionality. In this study, we subjected 136 patients to a new infiltrative therapy by means of autologous ozonated blood. The study yielded positive results on pain symptoms and functional recovery.

„Fast-Track-Konzepte“ in der Knieendoprothetik: Einsatz von Tranexamsäure und Technik der lokalen intraartikulären Anästhesie

Fast track concepts are used to reduce the risk of perioperative and postoperative complications after total knee arthroplasty. The described concepts are used for patients with indications for the implantation of a total knee prosthesis. Contraindications for fast track concepts are aged patients, dementia, American Society of Anesthesiologists (ASA) grade IV and implantation of large revision or tumor prostheses. Contraindications for tranexamic acid are bleeding in the urinary tract, caution in cases of known epilepsy, individual risk assessment in existing thromboses or increased thrombosis risk, fresh myocardial infarction, conditions following fresh pulmonary embolism, percutaneous transluminal coronary angioplasty (PTCA) and stent implantation. Contraindications for ropivacaine are hypersensitivity (allergy) to ropivacaine and other amide type topical anesthetics and hypovolemia. Preoperative administration of 1 g tranexamic acid and intraoperative local infiltration anesthesia are carried out. After femoral and tibial bone resection and before cementing the femoral and tibial components, approximately 40 ml of ropivacaine (2%) is injected into the posterior capsule. This is followed by injection of the medial and lateral collateral ligaments with approximately 20 ml each and infiltration of Hoffa's fat pad and the extensor apparatus also with approximately 20 ml local anesthetic. After cementing, the subcutaneous tissue is infiltrated with approximately 50 ml ropivacaine solution. On the same day as the operation the patient is mobilized with the help of aphysiotherapist. The patient should, if possible, walk afew steps on crutches. Systemic analgesic treatment is carried out according to the World Health Organization (WHO) staged schemeII with a weak opioid and first stage non-opioid analgesic (nonsteroidal anti-inflammatory drug, NSAID and/or metamizole). Gabapentin can be used as an adjuvant comedication. Medicinal thrombosis prophylaxis is carried out with alow molecular weight heparin for 2weeks postoperatively. In 100 patients who preoperatively received 1 g tranexamic acid and intra-articular infiltration anesthesia, in the evening of the day of the operation the pain was on average 2.1 (±1.8) on the numeric pain rating scale (NPRS). In one patient, there was asensitive deficit of the lower leg and foot. Amotor deficit was not observed. A total of 90 patients were able to raise and straighten leg. On the day of surgery 68 patients were able to walk more than 10steps and 22patients could be mobilized to a standing position. The mean length of hospital stay was 6.6days (5-11days). No infections, thromboses or pulmonary embolisms occurred.

Place des gestes intra articulaires dans la coxarthrose ?

Osteoarthritis is responsible for pain and joint stiffness that cause significant functional impairment. To date, the only curative treatment is the surgery with total hip prosthesis. Nevertheless, this therapeutic option is only used in last course, when all of the other available therapies have been exhausted, including medical ones. The intra articular injection is often used to treat osteoarthritis. Several injectable therapeutic agents have been evaluated; the most commonly used are corticosteroids and hyaluronic acids. Intra-articular infiltration of corticoids provides a modest benefit on pain and only in the short term. Visco-supplementation at the hip is not superior to placebo in hip osteoarthritis, but studies evaluating its efficacy lacked of power. Its interest can be reconsidered with the results of complementary and better-designed therapeutic trials.

Prognostic factors in low back pain individuals undergoing steroid and anaesthetic intra-articular facet joint infiltration: a protocol for a prospective, longitudinal, cohort study

IntroductionLumbar pain of facet origin is a common problem worldwide. For those patients not responding to traditional treatment, one approach may be intra-articular infiltration of corticoid and anaesthetic. However, despite...

Comparative study of the influence of adductor canal block plus multimodal periarticular infiltration versus combined adductor canal block, multimodal periarticular infiltration and intra-articular epidural catheter ropivacaine infiltration on pain relief after total knee arthroplasty: a prospective study

A combined regimen of adductor canal block (ACB) and multimodal periarticular infiltration (MPI) with local anesthetic (ropivacaine) is a known effective method of controlling pain in the first 6-8h after total knee arthroplasty (TKA); however, managing breakthrough pain after their combined effect wears off can be challenging. We hypothesized that, by additionally leaving an intra-articular epidural catheter (IAEC) inside the knee with intermittent infiltration of local anesthetic in conjunction with ACB and MPI, it would help manage the breakthrough pain when their combined effect wears off. We did a prospective study in our institution between December 2015 and August 2016 on a total of 206 patients undergoing primary unilateral TKA. The initial consecutive 106 patients received ACB + MPI (Group 1, n = 106), and the subsequent 100 patients received ACB + MPI + IAEC (Group 2, n = 100). The primary outcome measure was pain using visual analogue scale (VAS) recorded at 6, 12, 24 and 48h, and the secondary outcome measures were requirement for rescue analgesics and repeat adductor canal block and length of hospital stay. There was no statistically significant difference in VAS scores between the two groups at 6h but at 12, 24 and 48h; there was a statistically significant difference between the two groups in terms of VAS scores, rescue analgesic requirements, repeat adductor canal block and shorter hospital stay favoring the ACB + MPI + IAEC group. Intermittent knee infiltration with ropivacaine is a safe, reproducible and effective method to control pain in the first 48h postoperative period after TKA.

A comparative study evaluating the role of adductor canal block catheter versus intraarticular analgesic infusion on knee pain and range of motion in the immediate postoperative period: a prospective multicenter trial

Postoperative pain after total knee arthroplasty (TKA) is an important determinant of hospital stay and rehabilitation and thereby functional outcome. Adductor canal block (ACB) and intraarticular analgesic infiltration through catheters (IAC) are techniques of multimodal analgesia which have shown to control postoperative pain satisfactorily. The aim of this study is to evaluate the efficacy of ACB versus IAC in reducing immediate postoperative pain and thereby allow early rehabilitation. A multicenter quasi-experimental study was conducted on 511 patients undergoing unilateral primary TKA from March 2016 to April 2017 who either received ACB with catheter (Group I, n = 350 patients) or IAC (Group II, n = 172 patients) for postoperative pain control. All the patients were assessed for severity of pain by Visual Analogue Scale at 8, 24, 48, 72h postoperatively and knee range of motion (ROM) on the day of discharge. There was no significant difference in pain scores on postoperative day (POD) 0 (1.09 ± 0.30 vs. 0.98 ± 0.46, p = 0.45) and POD 1 (1.21 ± 0.45 vs. 1.00 ± 0.00, p = 0.11) and in mean ROM on the day of discharge between ACB and IAC (88.40° ± 7.96° vs. 88.34° ± 5.74°; p = 0.93) groups. This study shows that both ACB and IAC provide satisfactory postoperative analgesia with sparing of quadriceps function and good knee ROM leading to early rehabilitation and reduced hospital with no advantage of one technique over another.

A prospective study of two methods of analgesia in shoulder arthroscopic procedures as day case surgery

Background & purposeThe recent advances in anaesthesia and analgesia have significantly improved the early recovery and effective post-operative pain control in day care surgery e.g. shoulder arthroscopic procedures. Adequate analgesia improves the early rehabilitation for a better outcome. We prospectively evaluated the post-operative pain relief following the two methods of analgesia i.e. regional Inter-scalene block (ISB) vs Intra-articular (IA) injection using 0.5% Chirocaine in various therapeutic arthroscopic shoulder procedures. MethodsA prospective comparative study was performed on a group of 105 patients (ASA grade I or II) who underwent the following procedures at two different hospitals: diagnostic arthroscopy, subacromial decompression (SAD) alone, SAD in combination with mini open cuff repairs or distal clavicle excision, anterior stabilization (Bankart's repair) and inferior capsular shift. A successful Inter-scalene block (0.5% Chirocaine-30mls) preceded the general anaesthesia (Group 1–52 patients). Local intra-articular infiltration (0.5% Chirocaine - 20 mls) was given postoperatively (Group 2–53 patients). Post operatively visual analogue scores (VAS) from 0 (no pain) to 10 (severe pain) were assessed in post-anaesthesia care unit (PACU), at 4hrs, at 24hrs and at 48 h. The amount of morphine consumption for the first 2 days after surgery was recorded. ResultsPatient characteristics were similar in both groups at both the hospitals. The median postoperative pain score of VAS <3 was observed in both groups. Significant difference (p < 0.0001) was observed in the VAS scores between the two groups at all the time intervals. The mean length of adequate sensory block in group 1 was significantly higher than in group 2 [20.5 h: 4.2 h] (p < 0.001). The mean analgesic (morphine) consumption was lower in Group 1 as compared to Group 2 [4.6 mg/24 h: 18.8mg/24 h](p < 0.0001). Bone shaving procedures e.g. SAD, SAD + Rotator Cuff repair, SAD + Lateral clavicular excision required significantly higher analgesia in both groups compared to the soft tissue procedures. ConclusionSingle dose ISB provided longer and effective postoperative analgesia. The bone shaving procedures required more analgesia in IA Group as compared to ISB Group.

Tramadol as an adjunct to intra-articular local anaesthetic infiltration in knee arthroscopy: a systematic review and meta-analysis.

Arthroscopic knee surgery is a common technique used in Australia. Post-operative pain is common and can lead to delayed discharge and impair early mobilization. Use of local anaesthesia can reduce pain while avoiding systemic side effects. This systematic review and meta-analysis aimed to establish the use of tramadol as an adjunct to intra-articular local anaesthetic infiltration in knee arthroscopy in the current literature. Two independent reviewers performed a systematic search of four databases, where 24 articles were identified with six studies (four high-quality and two low-quality randomized controlled trials), with a total of 334 patients were included for analysis. RevMan 5.3 software (The Nordic Cochrane Centre, Copenhagen, Denmark) was used to perform the data analysis. The studies included focused on outcomes such as pain scores, breakthrough analgesia, total analgesia, time to discharge and adverse events related to the use of tramadol as an adjunctive therapy. This study found that using tramadol as an adjunct to intra-articular local anaesthetic infiltration in arthroscopic knee surgery reduced post-operative pain and increased time to breakthrough analgesia without an increase in side effects. This meta-analysis suggests that tramadol is an efficacious adjunct for use in intra-articular local anaesthetic infiltration following arthroscopic knee surgery.

Viscosupplementation improves pain, function and muscle strength, but not proprioception, in patients with knee osteoarthritis: a prospective randomized trial

OBJECTIVES:This study aimed to evaluate the clinical outcomes of intra-articular infiltration with hyaluronic acid and dexamethasone alone and in combination in the treatment of knee osteoarthritis (OA).METHOD:This prospective randomized trial evaluated 44 patients undergoing treatment for OA. Patients were selected through clinical and radiological analysis using the American College of Rheumatology criteria. We included patients aged between 50 and 70 years who presented with K-L stage ≤2 knee OA and normal limb alignment. Patients with a previous history of knee injury (ligamentous, meniscal or traumatic), infection, patellofemoral OA or chondroprotective drug use in the previous year were excluded. Participants were randomized into 3 groups and underwent treatment with viscosupplementation (VS, n=16), viscosupplementation plus dexamethasone (VD, n=16) or dexamethasone (DX, n=12). All patients were evaluated before and 6 weeks, 3 months and 6 months after infiltration. Analysis included a physical examination, the Western Ontario and McMaster Universities Arthritis Index (WOMAC) questionnaire (total score and domain subscores) and an evaluation of knee extensor and flexor strength and proprioception using an isokinetic dynamometer.RESULTS:VS significantly improved the WOMAC total score and subscores for pain, stiffness and function for up to 6 months after infiltration. It also improved knee extensor and flexor strength during the same period. Proprioception was not affected by any of the treatments.CONCLUSIONS:VS alone improved pain, stiffness and function according to the WOMAC total score and subscores and improved knee extensor and flexor strength, but not proprioception, for up to six months after infiltration. These findings suggest that VS has a positive effect on quadriceps arthrogenic inhibition.

CT-Guided Lumbar Facet Joint Infiltration: Accessibility, Accuracy and Functional Outcome

Background: Pain generated from lumbar facet joint affection is considered a common cause of low back pain. Image-guided facet joint infiltration is performed to reduce pain severity and to confirm its source. Aim: The objective of this study is to assess the accessibility, and accuracy and to evaluate the functional outcome of the CT-guided lumbar facet joint infiltration in management of low back pain. Subjects and Methods: This retrospective study included thirty four patients. All patients were diagnosed with low back pain due to lumbar facet syndrome. Adequate conservative therapy failed to improve the patient’s symptoms. Totally, 81 lumbar facet joints were treated by CT-guided intra-articular infiltration. Mean time of hospital stay was 6 - 8 hours. In the procedure technique, measures were applied to reduce the patients’ radiation exposure. The response to treatment was evaluated by the visual analogue scale (VAS) before procedure and at follow-up visits. Results: Among 34 adult patients included in this study, 26 were males and 8 were females. The mean age was 49.5 ± 8.5 years. Mean Duration of low back pain on admission was 8.2 ± 3.5 months. Bilateral CT-guided intra-articular infiltration was performed in 23 patients (67.5%). Assessing the response after facet joint infiltration, 82.4% of the patients showed immediate pain improvement after the procedure; 85.3% of the patients reported pain relief after 1 month and 67.6% at 12 month follow up. There was a statistically significant relief of pain after the intervention at 12 month follow up (p < 0.001). Conclusion: Lumbar Facet joint infiltration guided with CT scanning seems to be a reliable and safe procedure for low back pain management. Beside immediate and long term pain relief achieved using this minimally invasive technique; CT guidance provides an accessible and accurate route for the needle with low radiation dose exposure.

Iodine contrast agents do not influence Platelet-Rich Plasma function at an early time point in vitro

BackgroundIodine contrast agents (ICAs) are routinely used by radiologists to help guide intra-articular infiltrations. The aim of this study was to assess the in vitro effects of ICA on platelet function of human autologous Platelet-Rich Plasma (PRP).MethodsOne hundred thirty-seven consecutive patients with symptomatic femoral-patellar osteoarthritis were included. All were addressed to our institution for a fluoroscopy-guided intra-articular PRP infiltration of the pathological femoral-patellar joint. For each patient, 500 μl of PRP were sampled before intra-articular injection. First, PRP samples were mixed with 50 μl of 2 widely used ICA: Visipaque270® (Iodixanol, n = 58) and Iopamiron200® (Iopamidol, n = 69). PRP concentration ([PRP]) was measured at different delays of incubation (t = 0, 5, 10, 15, 20 and 30 min) enabling to calculate PRP ratio (defined as [PRP](t)/[PRP](0mn)) at each delay, for each mixture, in order to quantitatively assess the influence of ICA on PRP ratio. Second, the PRP samples of 10 additional patients were mixed with Visipaque270®, Visipaque270®, Iopamiron200® and phosphate buffer saline (PBS: control solution) in order to qualitatively assess the influence of ICA on platelet aggregation, using ADP, Collagen, Arachidonic acid and TRAP tests. The surface expression of human P-selectin, a marker of α-granule release, in the PRP + Visipaque270® and PRP + Iopamiron200® mixtures was finally compared. Repeated-measures ANOVA, classical 2-way ANOVA and Wilcoxon matched-pairs test were used to study the influence of ICA on PRP quality.ResultsThere was no significant change in PRP ratio during the first 30mn of incubation (p = 0.991) whatever the ICA (p = 0.926). Whatever the aggregation test, there was no significant difference in the percentage of platelet aggregation between PRP + PBS, PRP + Visipaque270® and PRP + Iopamiron200® (p = 0.998), nor between PRP + PBS and PRP + Visipaque320® (p = 0.470). Finally, there was no significant difference in P-selectin expression between the PRP + Visipaque270® and PRP + Iopamiron200® mixtures (p = 0.500).ConclusionAt early delays of incubation, Visipaque® and Iopamiron®, which are two widely used ICA for intra-articular infiltrations, did not influence the in vitro platelet function nor the quality of PRP.