Intra-articular Injection Group Research Articles

Efficacy of stromal vascular fraction for knee osteoarthritis: A prospective, single-centre, non-randomized study with 2 years follow-up.

Current osteoarthritis (OA) treatments focus on symptom relief without addressing the underlying disease process. In regenerative medicine, current treatments have limitations. In regenerative medicine, more research is needed for intra-articular stromal vascular fraction (SVF) injections in OA, including dosage optimization, long-term efficacy, safety, comparisons with other treatments, and mechanism exploration. To compare the efficacy of intra-articular SVF with corticosteroid (ICS) injections in patients with primary knee OA. The study included 50 patients with Kellgren-Lawrence grades II and III OA. Patients were randomly assigned (1:1) to receive either a single intra-articular SVF injection (group A) or a single intra-articular ICS (triamcinolone) (group B) injection. Patients were followed up at 1, 3, 6, 12, and 24 months. Visual analog score (VAS) and International Knee Documentation Committee (IKDC) scores were administered before the procedure and at all follow-ups. The safety of SVF in terms of adverse and severe adverse events was recorded. Statistical analysis was performed with SPSS Version 26.0, IBM Corp, Chicago, IL, United States. Both groups had similar demographics and baseline clinical characteristics. Follow-up showed minor patient loss, resulting in 23 and 24 in groups A and B respectively. Group A experienced a notable reduction in pain, with VAS scores decreasing from 7.7 to 2.4 over 24 months, compared to a minor reduction from 7.8 to 6.2 in Group B. This difference in pain reduction in group A was statistically significant from the third month onwards. Additionally, Group A showed significant improvements in knee functionality, with IKDC scores rising from 33.4 to 83.10, whereas Group B saw a modest increase from 36.7 to 45.16. The improvement in Group A was statistically significant from 6 months and maintained through 24 months. Our study demonstrated that intra-articular administration of SVF can lead to reduced pain and improved knee function in patients with primary knee OA. More adequately powered, multi-center, double-blinded, randomised clinical trials with longer follow-ups are needed to further establish safety and justify its clinical use.

Is Ultrasound-guided or Landmark-guided Intra-articular Lidocaine Injection More Effective for Pain Control in Anterior Shoulder Dislocation Reduction? A Randomized Controlled Trial.

Effective pain control during reduction of shoulder dislocation is essential for patient comfort. However, there is a lack of comprehensive research comparing the efficacy of different pain management techniques, specifically landmark-guided and ultrasound-guided intra-articular analgesic injections. Among patients undergoing closed reduction of a shoulder dislocation, were there differences between an intra-articular shoulder injection placed using anatomic landmarks and an ultrasound-guided intra-articular injection in terms of (1) pain before versus after the injection and pain before injection versus after the reduction, or (2) length of stay in the emergency department and complications of the procedure? Between August 2021 and March 2023, 28 patients with anterior shoulder dislocation were treated at the emergency department of a tertiary referral care center. They were randomly assigned to either the landmark-guided or ultrasound-guided intra-articular lidocaine injection group. Differences in pain levels between preinjection and postinjection, preinjection and postreduction, length of hospital stay, and complications were assessed and compared between the two groups. Patients were followed for 2 weeks. There were no between-group differences in terms of age, gender, baseline pain score, and any other relevant factors. There were no differences between the groups in terms of pain reduction between preinjection and postinjection (landmark-guided: ΔVAS 2.8 ± 1.1, ultrasound-guided: ΔVAS 2.9 ± 1.0, mean difference -0.14 [95% confidence interval -0.97 to 0.68]; p = 0.72) or between preinjection and postreduction (landmark-guided: ΔVAS 6.6 ± 2.1, ultrasound-guided: ΔVAS 5.8 ± 1.8, mean difference 0.79 [95% CI -0.74 to 2.31]; p = 0.30). There were no differences in length of stay in the emergency department (landmark-guided: 162 ± 38 minutes, ultrasound-guided: 184 ± 73 minutes, mean difference 22 minutes [95% CI -67 to 24]; p = 0.33), and no complications were reported in either group during the 2-week follow-up period. The results of the landmark-guided technique were not different from those of ultrasound-guided injection in terms of lower pain levels, length of stay, and complications. These findings provide valuable guidance for orthopaedic surgeons, enabling them to make informed decisions based on their expertise and available resources. Level I, therapeutic study.

A multi-center, single-blinded, randomized, parallel-group, superiority study to compare the efficacy of manipulation under anesthesia versus intra-articular steroid injection in the treatment of patients with frozen shoulder and a diagnosis of rotator cuff injury or tear by MRI: study protocol for a randomized controlled trial

BackgroundFrozen shoulder (FS) is a common condition that can cause severe pain and limited range of motion in the shoulder joint. While intra-articular steroid injection has been shown to be an effective treatment for FS, manipulation under anesthesia (MUA) is an alternative treatment that has gained popularity in recent years. However, there is a lack of evidence regarding the effectiveness of MUA on FS patients with concomitant rotator cuff injury or tear. Though a few studies have shown that MUA is not associated with rotator cuff tears, and will not exacerbate the injury, more high-quality studies with bigger sample sizes are needed. Therefore, the aim of this multi-center, single-blinded, randomized, parallel-group, superiority study is to compare the efficacy of MUA versus intra-articular steroid injection in the treatment of FS patients with a diagnosis of rotator cuff injury or tear by MRI.MethodsA parallel, single-blinded, multi-center randomized controlled trial of 320 patients will be conducted at three hospitals of China. Eligible patients with frozen shoulder and rotator cuff injury or tear diagnosed by MRI will be randomly assigned to, in equal proportions, the manipulation under anesthesia group and the intra-articular steroid injection group via a central randomization system, undergoing a corresponding operation on day one and a sequent physical exercise for 14 days. The primary outcome is the comprehensive efficacy evaluation (total effective rate) and the change of Constant-Murley Score. Outcome assessors and data analysts will be blinded, and participants will be asked not to reveal their allocation to assessors.DiscussionThis study aims to explore the superiority of manipulation under anesthesia in reducing pain and improving shoulder function in frozen shoulder patients accompanied with rotator cuff injury. To provide a scientific basis for the dissemination and application of manipulation under anesthesia, and a better knowledge for the role of MUA in the treatment of frozen shoulder accompanied with rotator cuff injury.Trial registrationChictr.org.cn ChiCTR2200067122. Registered on 27 December 2022. ChiCTR is a primary registry of the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) network and includes all items from the WHO Trial Registration data set in Trial registration.

Ultrasound-guided PENG block versus intraarticular corticosteroid injection in hip osteoarthritis: a randomised controlled study.

This study aimed to compare the effectiveness of the pericapsular nerve group (PENG) block and intra-articular injection (IAI) of steroid-bupivacaine in the treatment of hip osteoarthritis (OA). After randomization, patients received either a PENG block or IAI under ultrasound-guidance. Clinical evaluations were recorded at baseline, day 1, and weeks 1, 4, and 8 post-intervention. The numerical rating scale (NRS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Harris Hip Scale (HHS) scores, pain medication use determined by a quantitative analgesic questionnaire, and patient satisfaction were evaluated. Sixty patients were included in this study. NRS scores improved significantly for both groups during the follow-up compared to pretreatment (P < 0.001), with better pain scores for the PENG group (P < 0.001) at day 1 with larger effect size (Cohen's d = 4.62), and IAI group at 4 (Cohen's d = 5.15) and 8 (Cohen's d = 4.33) weeks (P < 0.001). There was no significant difference in pain medication consumption (P = 0.499) and patient satisfaction (P = 0.138) between groups. Patients in the IAI group experienced significant improvement in HHS (Cohen's d = 2.16, P = 0.007) and WOMAC (Cohen's d = 1.02, P = 0.036) scores at 8 weeks compared to the PENG group. The ultrasound-guided PENG block provides effective pain relief which improves functionality and quality of life in hip OA patients up to 2 months. The PENG block can be considered an easy, safe, and useful alternative treatment modality for hip OA.

Comparison between peri-articular injection and intra-articular injection of tranexamic acid during total knee arthroplasty: A meta-analysis.

In this meta-analysis, we aimed to compare the efficacy and safety of peri-articular injection (PAI) and intraarticular injection (IAI) of tranexamic acid (TXA) in total knee arthroplasty (TKA). We performed a comprehensive literature search from electronic databases such as Springer, Web of Science, PubMed, Cochrane Library databases, and ScienceDirect up to October 2021. The language of identified articles was not restricted. The keywords used for the search strategy included: "tranexamic acid", "total knee arthroplasty", "peri-articular injection" and "intra-articular injection". Two randomized-controlled trials (RCTs) and four non-RCTs with a total of 491 patients met the inclusion criteria. Of the patients, 242 patients were in the PAI group and 249 patients were in the IAI group. No significant difference was observed between the two groups in hemoglobin drop, postoperative drainage volume, total blood loss, blood transfusion requirements, or units of blood transfused. There was no significant difference between the two groups regarding postoperative infection or deep venous thrombosis. The PAI of TXA is comparable to IAI of TXA in decreasing postoperative blood loss during TKA.

Comparison of efficacy of intra articular steroid injection versus manipulation under anesthesia (MUA) in idiopathic frozen Shoulder.

Objective: To compare efficacy of intra-articular steroid (IAS) injection with manipulation under anesthesia (MUA) in idiopathic FS. Study Design: Randomized Control Trail. Setting: Department of Orthopedic, Independent University Hospital, (IMC) Faisalabad. Period: 1st January 2021 to 30th June 2021. Material &amp; Methods: Diagnosis of FS was based upon detailed history and proper physical. Group A (n=50) included intra-articular injection patients and Group B (n=50) was patients receiving MUA. Pain was measured by VAS and disability was measured by Disability Index (SPADI) scale. Results: Mean age of sample was 37 ± 10.52 in group A and 39.14± 9.48 in group B. Age of patients ranges from 35 to 50 years. Female patients were greater in both the groups. Most of the patients have duration of disease for more than 1 month. The ratio of patients with right side disease was more than 50% in both the groups as compared to left side. In group A. there was a significant decrease in mean pain from 3.45 ± 1.12 to 2.16 ± 0.8 In group B, mean pain score decreased from 3.65 ± 0.88 to 2.35 ± 0.68 1. Overall group A was more effective as compared to group B but the results were not significant statistically. Conclusion: The intra-articular injection method was superior to MUA because it was easier, safer, and less expensive, and it produced early results.

Effectiveness of intra-articular hyaluronic acid versus corticosteroids in knee osteoarthritis: a comparative study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Osteoarthritis (OA) is the largest cause of disability worldwide and the most common cause of knee discomfort. OA is a chronic, progressive joint disease marked by articular cartilage deterioration and secondary hyperosteogeny. OA affects 35 percent of those over the age of 65 and produces considerable pain in the knee joint. The patient with OA not only suffers from chronic pain, stiffness, and reduced movement, physical and/or mental co-morbidity, but also has a direct impact on their quality of life.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 72 patients with symptomatic osteoarthritis of unilateral knee joint (pain &amp;gt;3 months) were included in the present study. They were randomly divided into two groups; group A (n=36) included patients who were given intra-articular injection hyaluronic acid and group B (n=36) included those who were given intra-articular corticosteroid injection. All the data was compared both within the group as well as with one another at different follow up time.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; There was no significant difference in the basic demographic distribution in both groups. Female sex predilection was seen in the present study. In patients receiving hyaluronic acid (HA), mean baseline visual analog scale (VAS) score was noted to be 7.45±1.4. Then at 2 weeks, 6 weeks, 3 months and 6 months follow up the mean VAS score was 3.4±1.3, 2.78±1.1, 3.71±1.4 and 3.90±1.2; p&amp;lt;0.05).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Steroids provide an acute symptomatic relief but their benefits are short lasting. On the other hand, HA provides long lasting therapeutic pain relief.&lt;/p&gt;

Comparative study of intra articular autologous platelet rich plasma and hyaluronic acid viscosupplementation in osteoarthritis of knee

Background: Osteoarthritis, the most common form of degenerative arthroses, affects the elderly resulting in physical, mental and social distress. In this study we are comparing the two different intra articular injections (Platelet Rich Plasma vs Hylan G-F 20) efficacy on osteoarthritis management. Aims and Objectives: To compare the outcomes of intra articular injection of autologous platelet rich plasma versus hyaluronic acid viscosupplementation in osteoarthritis of knee.Materials and Methods: In this study of 60 patients with OA knee who presented to CIO OPD, Safdarjung hospital after getting their informed consent, one group treated with PRP (group1, n= 30) and the other with Hylan GF 20(group 2,n = 30). In group 1, patients received 3 Intra articular injections of PRP at 4 weeks interval and in group 2, patients received a single Intra articular injection of Hylan GF 20 (Synvisc one). Institutional ethical committee approval obtained. SPSS version 17.0 was used for analysis. Results: Baseline characteristics like age, sex, BMI of both groups were indifferent and comparable. Intra articular injections of PRP and Hylan GF 20 depicted improvement in both VAS and WOMAC index. PRP had a statistically significant better outcome than Hylan GF 20 from the fourth month of follow up in both sexes, in both age groups and in OA grade II and III. PRP was significantly better than hylan G-F 20 from the 6th month in BMI group of 18.5 to 24.99 and from the 5th month of follow up in patients with BMI more than 24.99.Conclusion: Patients in both treatment group showed improvement whereas Intra articular PRP injection group had a statistically significant better outcome than Hylan G-F 20 from the fourth month of follow up.

Comparison of combined intra-articular and sub-acromial injection with intra-articular injection in adhesive capsulitis

Background: The pain and limitation of shoulder function can disrupt daily activities of patients for months to years. Adhesive capsulitis is considered a self-limiting disease but the duration remains uncertain. The brunt of the disease is focussed on the inflamed joint capsule. On this basis, use of corticosteroid injection is justified. However, injection method is not conclusive. Objectives: To compare clinical benefits of intra-articular injection alone versus combined intra-articular and subacromial injections in management of adhesive capsulitis. Methods: Fifty-nine patients with diagnostic criteria for adhesive capsulitis were included in the study from March 2019 to September 2020. Patients were divided into two groups; patients who underwent intra-articular (IA) injection alone (Group 1) and those who received both intra-articular and sub-acromial (IA+SA) injection (Group 2). The injections were landmark guided. Patients were followed up at three, six, and 12 weeks. Pain was recorded using visual analogue scale (VAS) and subjective function using Constant-Murley score. Results: Twenty-eight patients were included in Group 1 (IA) and 31 in Group 2 (IA+SA). Thirty-six patients were female (18 each in Group 1 and Group 2) and 23 patients were male (Group 1 = 13; Group 2 = 10). In the twelfth week, VAS score was reduced in both the groups. On comparing the mean value of Constant-Murley score between the two groups there is significant difference in value recorded at the sixth and twelfth week. Conclusion: The IA+SA injection provides significant reduction in pain and better function in the short term over the IA injection.

Effectiveness of Shock Wave Therapy versus Intra-Articular Corticosteroid Injection in Diabetic Frozen Shoulder Patients’ Management: Randomized Controlled Trial

Frozen shoulder is a major musculoskeletal illness in diabetic patients. This study aimed to compare the effectiveness of shock wave and corticosteroid injection in the management of diabetic frozen shoulder patients. Fifty subjects with diabetic frozen shoulder were divided randomly into group A (the intra-articular corticosteroid injection group) and group B that received 12 sessions of shock wave therapy, while each patient in both groups received the traditional physiotherapy program. The level of pain and disability, the range of motion, as well as the glucose triad were evaluated before patient assignment to each group, during the study and at the end of the study. Compared to the pretreatment evaluations there were significant improvements of shoulder pain and disability and in shoulder flexion and abduction range of motion in both groups (p &lt; 0.05). The shock wave group revealed a more significant improvement the intra-articular corticosteroid injection group, where p was 0.001 for shoulder pain and disability and shoulder flexion and abduction. Regarding the effect of both interventions on the glucose triad, there were significant improvements in glucose control with group B, where p was 0.001. Shock waves provide a more effective and safer treatment modality for diabetic frozen shoulder treatment than corticosteroid intra-articular injection.

A COMPARATIVE PROSPECTIVE STUDY TO EVALUATE THE RESULTS OF PHYSICAL THERAPY V/S INTRAARTICULAR STEROID INJECTION IN PERIARTHRITIS OF SHOULDER

Background: Frozen shoulder or adhesive capsulitis is a condition where the patient experience stiffness and pain in joint of the shoulder. It is an enigma as till now its etiology is unknown. It affects both the genders of the middle and elderly age. A retrospective, comparative study was to evaluate the effects of physical therapy versus intra-articular steroid injection in periarthritis of shoulder. Methods: 30 patients each with frozen shoulder who were treated either using physical therapy (Group 1) and intra-articular steroid injection (Group 2). The data was collected at baseline and at different follow-up periods and analyzed. Results: There were 3 lost to follow-up in physiotherapy group and 4 in intra-articular injection group. Slight male preponderance (51.9% vs. 48.1%) was seen in physiotherapy group. Left side more affected in both the groups. Literacy (p=0.064), socioeconomic status (p=0.22), occupation (p=0.866), comorbidities (p=0.974), abnormal x-ray (p=0.34) were all comparable between the two groups. Mean duration of shoulder pain and restriction of shoulder motion were also comparable (p&gt;0.05). Side effects– 46.2% were higher in intra-articular injection group. Response to treatment, disability score and SPADI index showed signicant reduction in both the groups, but signicantly more reduction in intra-articular injection was seen in comparison to the physiotherapy group. Conclusions: The overall treatment outcome in intra-articular injection group is much better in comparison to the physiotherapy group, but with higher side effects. Intra-articular injection of steroid will prove to be a boon after effective management of side effects.

Intra-articular Morphine and Ropivacaine Injection Provides Efficacious Analgesia As Compared With Femoral Nerve Block in the First 24 Hours After ACL Reconstruction: Results From a Bone-Patellar Tendon-Bone Graft in an Adolescent Population.

Background:Opioid consumption and patient satisfaction are influenced by a surgeon’s pain-management protocol as well as the use of adjunctive pain mediators. Two commonly utilized adjunctive pain modifiers for anterior cruciate ligament (ACL) reconstruction are femoral nerve blockade and intra-articular injection; however, debate remains regarding the more efficacious methodology.Hypothesis:We hypothesized that intra-articular injection with ropivacaine and morphine would be found to be as efficacious as a femoral nerve block for postoperative pain management in the first 24 hours after bone–patellar tendon–bone (BTB) ACL reconstruction.Study Design:Cohort study; Level of evidence, 3.Methods:Charts were retrospectively reviewed for BTB ACL reconstructions performed by a single pediatric orthopaedic surgeon from 2013 to 2019. Overall, 116 patients were identified: 58 received intra-articular injection, and 58 received single-shot femoral nerve block. All patients were admitted for 24 hours. Pain scores were assessed every 4 hours. Morphine milligram equivalents (MMEs) consumed were tabulated for each patient.Results:Opioid use was 24.3 MMEs in patients treated with intra-articular injection versus 28.5 MMEs in those with peripheral block (P = .108). Consumption of MMEs was greater in the intra-articular group in the 0- to 4-hour period (7.1 vs 4.6 MMEs; P = .008). There was significantly less MME consumption in patients receiving intra-articular injection versus peripheral block at 16 to 20 hours (3.2 vs 5.6 MMEs; P = .01) and 20 to 24 hours (3.8 vs 6.5 MMEs; P < .001). Mean pain scores were not significantly different over the 24-hour period (peripheral block, 2.7; intra-articular injection, 3.0; P = .19).Conclusion:Within the limitations of this study, we could identify no significant difference in MME consumption between the single-shot femoral nerve block group and intra-articular injection group in the first 24 hours postoperatively. While peripheral block is associated with lower opioid consumption in the first 4 hours after surgery, patients receiving intra-articular block require fewer opioids 16 to 24 hours postoperatively. Given these findings, we propose that intra-articular injection is a viable alternative for analgesia in adolescent patients undergoing BTB ACL reconstruction.

Intra-articular Along with Subacromial Corticosteroid Injection in Diabetic Patients With Adhesive Capsulitis

Background: To compare intra-articular plus subacromial corticosteroid injection with a single intra-articular injection in diabetics with adhesive capsulitis. Materials and Methods: A total of fifty-four diabetic patients were randomized into corticosteroid injection in both intra-articular and subacromial sites (group A) and one intra-articular injection (group B). Pain by a visual analog scale (VAS), shoulder range of motion, and functional state by the American Shoulder and Elbow Score was assessed before injection, and at follow-up months. Results: The pain VAS scores of group A were considerably lower than group B at the first-month follow-up visit (P=0.01). The range of motion in forward-elevation and internal rotation at three-month follow-up visits was significantly higher in group A than in group B (P=0.035, P=0.04, respectively). No notable differences in the range of motion in forward-elevation, internal rotation, and external rotation between groups at the final follow-up visit were seen. Though a significant difference in the ASES between groups at the third-month follow-up visit (P=0.03), the ASES score at the final sixth-month follow-up was similar in both groups (P=0.7). Conclusion: In diabetic adhesive capsulitis of the shoulder, subacromial combined with intra-articular steroid injections has superior subjective outcomes compared to single intra-articular corticosteroid injection.

THE EFFECT OF SINGLE VERSUS MULTIPLE INTRA-ARTICULAR INJECTION OF SYNOVIAL FLUID MESENCHYMAL STEM CELLS ON RAT TEMPOROMANDIBULAR JOINT WITH INDUCED ARTHRITIS. BIOCHEMICAL AND HISTOLOGIC ANALYSIS

Introduction: Osteoarthritis (OA) is the most common chronic musculoskeletal disorder. Nowadays, the role of synovial fluid mesenchymal stem cells (SF MSCs) is increasingly attributed to the treatment of Temporomandibular joint osteoarthritis. This study aimed to compare single versus multiple intra-articular injection of SFMSCs in terms of macroscopic, biochemical, and histological analysis. Material & methods: 18 young adult male 200–300 grams albino rats were used in the current study divided randomly into 3 equal groups. Group (A) comprised control in which OA was induced with no treatment, group (B) comprised MSCs single intra-articular injection group, and group (C) comprised MSCs multiple intra-articular injection group. Biochemical and histologic analysis were performed. Results: histological findings showed that both groups B, C showed regeneration of meniscus and retrodiscal tissues, but group C was superior in regeneration compared to group B. Biochemical analysis showed that TNF-α and IL-1B had the highest value in the control group, followed by the single injection group, while the lowest value was found in multiple injections group respectively. Conclusion: Multiple Intra-articular SF MSCs is a potential disease-modifying therapy for patients suffering from TMJ-OA.

Is arthrocentesis plus hyaluronic acid superior to arthrocentesis alone in the treatment of disc displacement without reduction in patients with bruxism?

PurposeThis study was designed to investigate the efficacy of arthrocentesis with and without intra-articular injection of hyaluronic acid (HA) in the treatment of disc displacement without reduction (DDwoR) in patients with bruxism. Materials and methodsA retrospective cohort study was conducted using the files of patients with DDwoR, limited mouth opening, and bruxism. Patients were divided into two groups according to the treatment method: arthrocentesis alone (group 1) and arthrocentesis plus intra-articular HA injection (group 2). To evaluate the clinical outcomes for the groups, maximum mouth opening (MMO) and visual analog scale (VAS) values before treatment, immediately after the operation, and at 1, 3, 6, 9, and 12 months postoperatively were analyzed. ResultsThe study consisted of 40 patients (34 female and 6 male, mean age 36.0 ± 11.95 years). MMO values increased and VAS scores decreased in both groups at all follow-ups after the treatment compared with pretreatment values (p < 0.001). The increase in MMO in group 2 was greater than in group 1 only at 3 and 6 months postoperatively (p = 0.013 and 0.009, respectively). ConclusionsIntra-articular HA injection is not a relevant addition when arthrocentesis is performed and a stabilizing splint is used.

Postoperative analgesia after arthroscopic anterior cruciate ligament reconstruction: A comparison between intra-articular ropivacaine injection and adductor canal block, A prospective cohort study

Background: Postoperative pain in arthroscopic acl reconstruction causing delay in rehabilitation protocol resulting in significant morbidity.opiod medications may have significant pain control but systemic adverse effects are of main concern. Delivering Ropivacaine either intraarticularly or by saphenous nerve block in adductor canal will reduce systemic adverse effects or are more effective in pain control.our study focuses on comparing effectiveness of adductor canal block versus intraarticular injection of ropivacaine in postoperative pain control. Materials and Methods: 60 patients undergoing arthroscopic acl reconstruction by same operating surgeon under spinal anaesthesia are divided into three groups. group A patients were given adductor canal block with 30 ml 0.2 % ropivaciane under ultrasound guidance postoperatively, group B patients were given intraarticular injection with 30 ml 0.2 % ropivaciane postoperatively, group c or control patients receiving routine analgesia. Visual Analogue Score (VAS), Amount of morphine consumption,post op knee range of movement achieved was recorded at intervals of 6, 12, 24, 48 hours after the procedure. Results: The intraatrticular group, adductor canal block had lower vas at 6,12,24 hours (p 0.05) compared to control group. The intraaticular group required 30mg less total morphine consumption compared to control group at 48 hours,required 10mg less total morphine consumption compared to adductor canal block at 48 hours.post op knee rom improved in both the groups compared to control group (p >0.05) but statistically not significant. Conclusion: Both Intraarticular ropivacaine injection & adductor canal block are equally efficacious in pain control during first 24 hours after arthroscopic acl reconstruction compared to control group. However intraarticular injection group requires less amount of morphine consumption than adductor canal block group Because intraarticular injection is easy and does not require technical expertise as in nerve blocks and also does not require special equipment like ultrasound, So we recommend intraarticular ropivacaine injection as an effective pain control solution for postoperative pain control in arthroscopic ACL reconstruction.

The analgesic efficacy and safety of peri-articular injection versus intra-articular injection in one-stage bilateral total knee arthroplasty: a randomized controlled trial

BackgroundAs an essential component of multimodal analgesia approaches after total knee arthroplasty (TKA), local infiltration analgesia (LIA) can be classified into peri-articular injection (PAI) and intra-articular injection (IAI) according to administration techniques. Currently, there is no definite answer to the optimal choice between the two techniques. Our study aims to investigate analgesic efficacy and safety of PAI versus IAI in patients receiving simultaneous bilateral TKA.MethodsThis randomized controlled trial was conducted from February 2017 and finished in July 2018. Sixty patients eligible for simultaneous bilateral total knee arthroplasty were randomly assigned to receive PAI on one side and IAI on another. Primary outcomes included numerical rating scale (NRS) pain score at rest or during activity at 3 h, 6 h, 12 h, 24 h, 48 h, and 72 h following surgery. Secondary outcomes contained active or passive range of motion (ROM) at 1, 2, and 3 days after surgery, time to perform straight leg raise, wound drainage, operation time, and wound complications.ResultsPatients experienced lower NRS pain scores of the knee receiving PAI compared with that with PAI during the first 48 h after surgery. The largest difference of NRS pain score at rest occurred at 48 h (PAI: 0.68, 95%CI[0.37, 0.98]; IAI: 2.63, 95%CI [2.16, 3.09]; P < 0.001); and the largest difference of NRS pain score during activity also took place at 48 h (PAI: 2.46, 95%CI [2.07, 2.85]; IAI: 3.90, 95%CI [3.27, 4.52]; P = 0.001). PAI group had better results of range of motion and time to perform straight leg raise when compared with IAI group. There were no differences in operation time, wound drainage, and wound complication.ConclusionPAI had the superior performance of pain relief and improvement of range of motion to IAI. Therefore, the administration technique of peri-articular injection is recommended when performing local infiltration analgesia after total knee arthroplasty.Trial registrationThe trial was retrospectively registered in the Chinese Clinical Trial Registry as ChiCTR1800020420 on 29th December, 2018.Level of evidenceTherapeutic Level I.

Comparison of intra-articular steroid injection and hyaluronic acid in mono-articular synovitis knee

Introduction: Mono articular presentation of rheumatoid arthritis is infrequent and has been previously reported to involve the hip and knee joints. Rheumatoid arthritis is a common symmetrical chronic inflammatory arthritis with the prevalence of 1% worldwide. Mono- articular rheumatoid arthritis is a rare entity reported to initially affect large joints such as hips and knees, progressing to a poly articular presentation within 3 to 5 years. Synovitis is an important component of rheumatoid arthritis, so we conducted a study to include all the recurrent effusion of knee cases, and we have compared the functional outcome of intra-articular steroid injection and hyaluronic acid in the treatment of such cases. Material and Methods: 40 cases of recurrent effusion of knee joint attending the OPD or emergency services at Government Medical College and Rajindra hospital, Patiala between July 2016 to July 2019 were evaluated with the clinical examination, haematological investigations and radiological investigations. In all the cases, the joint was aspirated with a 16 G Needle and aspirated fluid was sent for pus cultural sensitivity in a microbiology Department of our hospital and was sent for CBNAAT to chest and TB hospital of our hospital. In Group 1, following the aspiration, injection of local corticosteroid (methylprednisolone acetate 80 mg) was given and in group 2, injection of hyaluronic acid was given, followed by a short course of antibiotics for 5 days and short course of non-steroidal anti-inflammatory drugs was given for 10 days and a crêpe bandage was applied for 2 days. The results were assessed by VAS for pain and KOOS (Knee Injury and Osteoarthritis Outcome Score) scores. Results: In all 40 patients, the pus cultural sensitivity was negative for any microorganism and CBNAAT was negative in all the 40 patients. By comparing the results obtained in KOOS scale it was seen that symptoms improved after six months in both steroid (P = 0.017) and HA groups (P = 0.004). Besides, daily activity improved in both steroid (P = 0.027) and HA groups (P = 0.047). On the contrary, pain did not decrease 6 months after intervention in both steroid (P = 0.096) and HA groups (P = 0.17) Conclusion: Mono articular synovitis in an otherwise seronegative patient is due to recurrent inflammatory response due to recurrent stress or any other intra articular pathology. Patients are advised rest, and a short course of steroidal anti-inflammatory drugs, which also helped to relieve the inflammation. This was markedly improved by intra-articular HA injection as shown by the recovery in intra-articular HA injection group as compared to the steroid group.

Comparative study between intra-articular injections of hyaluronic acid with platelet-rich plasma versus genicular nerve thermal radiation in management of pain in knee osteoarthritis

ABSTRACT Background There are many factors affecting knee osteoarthritis (OA) as genetic and metabolic factors, obesity, mechanical trauma, osteoporosis, inflammatory joint disorders, previous joint infection, and laxity of ligaments. Objectives The aim of this study was to detect the influence of intra-articular injection (IAI) of both hyaluronic acid (HA) with platelet-rich plasma (PRP) and radiofrequency (RF) of genicular nerve and to compare their effects in the treatment of knee OA pain. Subjects and methods After approval of local research committee of anesthesia, Tanta University (committee protocol code 32049/01/18) and written informed consent, this prospective randomized study was done at Tanta University Hospital on 100 patients complaining of knees OA with mild-to-moderate degrees. IAI was performed in a pain clinic and RF was performed in an operating room during the period from April 2018 to January 2019. Results In intra-articular knee injection group, results show decreased visual analog scale (VAS) score from (3–10) at 1-week follow-up session to (0–8) in 6-month follow-up session. It also shows reduction of analgesia requirements (etoricoxib 60 and 90 mg) from (60–270) to (0–180) mg/day. In RF group patients, results show decreased VAS score from (0–9) at 1-week follow-up session to (0–5) in 6-month follow-up session. It also shows reduction of analgesia requirements (etoricoxib 60 and 90 mg) from (0–270) to (0–90) mg/day. Conclusion Both IAI of PRP with HA and RF of genicular nerves reduced pain of knee OA and reduced analgesic requirements with rapid onset in RF group.

Intra articular steroid injection versus shoulder arthroscopy in the patients with adhesive capsulitis

Introduction: Shoulder stiffness has been variously described as frozen shoulder, adhesive capsulitis and scapulohumeral periarthritis. It is commonly found disorder especially in patients with diabetes mellitus. Our aim is to compare the symptomatic and functional outcome of intra articular steroid injection as an out-patient procedure with shoulder arthroscopy for adhesive capsulitis of shoulder. Materials and Methods: The study was conducted by a single surgeon at a tertiary care hospital between October 2017 and May 2019. Total of twenty patients diagnosed with adhesive capsulitis were taken into the study. These patients were divided equally into two groups namely Intra articular injection group (IA) and Shoulder arthroscopy group (SA). The patients were followed by after two, six, twelve and sixteen weeks. They were assessed according to visual analogue scale (VAS) and Quick DASH (Disability of Arm, Shoulder and Hip). The results were analysed using SPSS software (Illinois, Chicago). P value ≤ 0.01 was considered to be statistically significant.Results: The VAS, and Quick DASH were found to be better and statistically significant in SA group as compared to IA group.Discussion: Arthroscopic capsular release when combined with biceps tenotomy, sub acromial decompression, manipulation under anaesthesia and peri articular steroid injection improves the functional outcomes of patients as compared with intra articular injection alone.Conclusion: Shoulder arthroscopy along with steroid injection provides better functional and clinical outcomes as compared with intra articular steroid injection alone.