Knee Injection Research Articles

The Booster Effect of a Single Quarterly Dose of Hyaluronic Acid in Knee Osteoarthritis: Five-Year Results of a Registry-Based Study.

Objective Viscosupplementation by hyaluronic acid (HA) is well established non-surgical treatment of knee osteoarthritis (KOA). This registry-basedstudy investigated the booster effect of a quarterly intra-articular single knee injection (30mg/2ml) for five years. Methods Sixty patients, including 29 males and 31 females, with a mean ± SD age 61.07 ± 9.15 with Kellgren-Lawrence grade I-III KOA, have been selected from a registry of interventional treatments for musculoskeletal pain conditions. To be eligible, patients had to be treated with a single quarterly intraarticular injection of HA with a follow-up of at least five yearsand assessed with Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Numeric Rating Scale (NRS) at baseline and after each HA injection in the first 24 months and at 36, 48, and 60 months. Results Sixty of 63 patients enrolled in this study completed the 60 months of follow-up.Patients had a marked improvement in knee function and pain, expressed by the significant reduction in WOMAC (T0 48.62±8.95 vs. T11 10.75±4.36; p<0.0001) and NRS scores (6.38±1.06 vs. T11 0.95±0.89 p<0.0001) from the baseline to the end of the follow-up period. Conclusion A quarterly injection of HA provides a rapid, safe, and stable long-term reduction of pain and improvement of function in elderly people with mild to moderate knee osteoarthritis along a five-yearperiod of treatment and follow-up. Further investigations are necessary to confirm these findings.

Analgesic and Anti-Inflammatory Properties of Ethanolic Extract of Piper vicosanum Leaves.

Nonclinical trials are important to validate the efficacy and safety of medicinal plants. Scientific toxicological studies with Piper vicosanum Yuncker have showed its safety; however, no studies have indicated the analgesic or antiarthritic potential of the ethanolic extract of P. vicosanum leaves (EEPV). The objective of the present work was to evaluate the antiarthritic and antinociceptive effects of EEPV in experimental mouse models. The oral administration of EEPV (100, 300, and 700 mg/kg) and dexamethasone (1 mg/kg) were performed in carrageenan-induced pleurisy, in formalin and acetic-acid-induced nociception, and in zymosan-induced articular inflammation models in Swiss mice. The EEPV (300 mg/kg) was tested in zymosan-articular inflammation, the complete Freund's adjuvant (CFA) inflammatory model, and in in situ intravitreal microscopy analysis of rolling and adhesion events of leukocytes in the mesenteric microcirculation in mice. EEPV significantly inhibited: (i) nociceptive response at phase 1 and 2, and also in the cold response in the formalin model; (ii) abdominal contortion induced by acetic acid; (iii) mechanical hyperalgesia after 4 and 6 h, knee edema after 6 h, and leukocyte migration in articular inflammation induced by zymosan. All doses of EEPV reduced the leukocyte migration to the inflamed pleural cavity and knee edema 4 h after the zymosan knee injection. The treatment with the EEPV significantly inhibited the CFA-induced edema, mechanical and cold hyperalgesia, and NAG and MPO. The EEPV also significantly inhibited carrageenan-induced leukocyte rolling and adhesion. The present study revealed, for the first time, the antiarthritic and antinociceptive effects of the EEPV.

A comprehensive review of intraarticular knee injection therapy, geniculate injections, and peripheral nerve stimulation for knee pain in clinical practice.

The knee is the most common joint in adults associated with morbidity. Many pathologies are associated with knee damage, such as gout or rheumathoid arthritis, but the primary condition is osteoarthritis (OA). Not only can osteoarthritis cause significant pain, but it also can result in signficant disability as well. Treatment for this condition varies, starting off with oral analgesics and physical therapy to surgical total knee replacmenet. In the gamut of this various treatments, a conservative approach has included intra articular steroid injections. With time, researchers and clinicians determined that other components injected to the knee may additionally provide relief of this condition. In this investigation, we describe different types of knee injections such as platelet-rich plasma (PRP), hyaluronic acid, stem cells, and prolotherapy. Additionally, we describe the role of geniculate knee injections, radiofrequency, and periopheral nerve stimulation. These treatments should be considered for patients with knee pain refractory to conservative therapies.

Superolateral knee injection with a patellar tilt for osteoarthritis pain.

In this Watch & Learn video, Daniel Stulberg, MD, FAAFP, demonstrates a superolateral knee injection with a patellar tilt. This injection, with a sodium hyaluronate product, is intended for patients who have osteoarthritis pain and no current effusion. The technique would be the same for an intra-articular knee steroid injection.

Association Between Bio-Fermentation Derived Hyaluronic Acid and Healthcare Costs Following Knee Arthroplasty.

BackgroundLimiting access to intra-articular knee injections, including hyaluronic acid (HA), has been advocated as a cost-containment measure in the treatment of knee osteoarthritis. The association between presurgical injections and post-surgical complications such as early periprosthetic joint infection and revision remained to be investigated. This study evaluated pre- and post-surgical costs and rates of post-surgical complications in knee arthroplasty (KA) patients with or without prior HA use.MethodsCommercial and Medicare Supplemental Claims Data (IBM MarketScan Research Databases) from January 1, 2012 to December 31, 2018 were used to identify unilateral KA patients. Those who completed a course of bio-fermentation derived HA (Bio-HA) as the first-line HA therapy comprised of the test group (n = 4091), while the control group did not use HA prior to KA (n = 118,659). Using multivariable regression with propensity score (PS) weighting, overall healthcare costs, readmission rates, and revision rates were assessed at six months following KA.ResultsHealthcare costs following KA were significantly lower for the Bio-HA group ($10,021 ± $22,796) than No HA group ($12,724 ± $32,966; PS p < 0.001). Bio-HA patients had lower readmission rates (8.9% vs 14.0%; PS p < 0.001) and inpatient costs per readmitted patient ($43,846 ± $50,648 vs $50,533 ± $66,150; PS p = 0.005). There were no differences in revision rate for any reason (Bio-HA: 0.78% vs No HA: 0.67%; PS p = 0.361) and with PJI (Bio-HA: 0.42% vs No HA: 0.33%; PS p = 0.192). Costs in the six months up to and including the KA were similar for both groups (Bio-HA: $49,759 ± $40,363 vs No HA: $50,532 ± $43,183; PS p = 0.293).ConclusionBio-HA use prior to knee arthroplasty did not appear to increase overall healthcare costs in the six months before and after surgery. Allowing access to HA injections provides a non-surgical therapeutic option without increasing cost or risk of post-surgical complications.

Protocol for a multi-center randomized controlled trial to evaluate the benefits of exercise incentives and corticosteroid injections in osteoarthritis of the knee (MOVE-OK)

BackgroundKnee osteoarthritis (KOA) is a high-priority problem among the aging population. While exercise has been shown to be beneficial in management of the disease, scalable and low-cost interventions to improve exercise in this population are lacking. Recent controversy over the value of corticosteroid injections for palliation has also arisen. Therefore, we designed a randomized, double-blind, placebo-controlled clinical trial with a 2-period crossover design to study (1) behavioral incentives to promote exercise and (2) corticosteroid injections to reduce pain and improve function in patients with KOA when compared to lidocaine only.MethodsThe study design is a pragmatic factorial and crossover randomized clinical trial. Patients with KOA who are deemed eligible by their provider to receive knee injections and are able to walk without assistive devices will be recruited from clinical practices at four sites within the Veterans Affairs (VA) Health System in the USA. In total, 220 participants will be randomized to receive social incentives with gamification (i.e., incorporation of game elements) to promote exercise and compared to controls that receive a Fitbit but no incentive. Each patient will also be assigned to receive a blinded corticosteroid injection and a lidocaine-only injection in random order. The primary outcomes are the change in average daily step counts from baseline and the change in Knee Osteoarthritis Outcome Score (KOOS) from baseline. The study team will continuously collect step count, heart rate, and sleep data using activity monitors and patient-reported outcomes using the Way to Health (WTH) platform at two four-week intervals over eight months of follow-up. Mixed effects regression incorporating all available data points will be used for analysis.DiscussionThe “Marching on for Veterans with Osteoarthritis of the Knee” (MOVE-OK) trial will take a pragmatic approach to evaluate (1) whether incentives based on behaviorally enhanced gamification can improve physical activity in this patient population and (2) whether corticosteroids injections reduce pain and disability in patients with KOA. Results of this trial will help to direct clinical practice and inform management guidelines.Trial registrationClinicalTrials.gov NCT05035810. Registered on 5 September 2021.

Prolotherapy Improves Anatomical and Clinical Outcomes in Monosodium Iodoacetate Induced Model of Osteoarthritis

Objective: To assess the ameliorative effects of Prolotherapy on the pain score of the gait cycle in Monosodium Iodoacetate (MIA) induced osteoarthritis in the rat knee joint.&#x0D; Study Design: Laboratory-based experimental study.&#x0D; Place and Duration of Study: Department of Anatomy, Army Medical College, Rawalpindi in collaboration with the National Institute of Health (NIH), Islamabad and Pathology Lab Pak Emirates Rawalpindi, Pakistan, from Aug to Nov 2021.&#x0D; Methodology: Thirty male Sprague Dawley rats were randomly divided into three groups (n=10 in each group). The control group was Group-A. To induce osteoarthritic changes in Group-B, a single dose of 1mg Monosodium Iodoacetate was injected intra-articularly into the right knee. Group-C received a single dose of 1mg Monosodium Iodoacetate injection in the right knee intra articularly to induce osteoarthritic changes, and was followed by 0.1ml Prolotherapy (3ml of 25% dextrose, 2ml of 2% Xylocaine, 1ml of injection thiamine, and 1ml of injection Methylcobalamin) at 2, 6 and 10 weeks intra articularly into the right knee joint. Before euthanasia, Pain scoring schemes for gait in rats of all groups were done at 0, 2 and 14 weeks.&#x0D; Results: The present study concluded that prolotherapy improved the gait cycle pain score in experimental group C (p-value 0.001 on the intergroup comparison at two weeks and 14 weeks while p-value 0.001 when compared pain score within the Group C at 0, 2 and 14 weeks).&#x0D; Conclusion: Prolotherapy had ameliorative effects on the pain score of the gait cycle in experimental Group C on Monosodium Iodoacetate......

Short-term results of intra-articular injections of stromal vascular fraction for early knee osteoarthritis

BackgroundIn knee osteoarthritis, progressive degeneration of the articular cartilage surface produces disability and chronic pain. Intra-articular injections of stromal vascular fraction (SVF) could be an innovative approach to manage patients with early knee osteoarthritis.MethodsBetween June 2019 and November 2020, 123 patients were recruited to receive intra-articular injection of SVF. Radiographic evidence of degenerative joint disease was classified according to Kellgren and Lawrence grades. Knee injury and osteoarthritis outcome score (KOOS) and visual analog scale (VAS) were collected preoperatively, at 1 month, and after 6 months from injection.ResultsThere was a statistically significant improvement of KOOS and VAS of all patients to 6 months (p < 0.05). The mean KOOS before injection was 51.4 ± 16.5, after 1 month it was 75.5 ± 15.8, and at 6 months it was 87.6 ± 7.7. Stratifying the mean KOOS according to Kellgren–Lawrence Grades, the difference remained statistically significant (p < 0.05). The patients’ mean VAS before injection was 6.5, after 1 month it was 3.5, and after 6 months it was 2.4. No complications were observed.ConclusionsIntra-articular knee injection of SVF is safe and effective to ameliorate the clinical and functional scores in patients with early knee osteoarthritis for 6 months.

Extended-release triamcinolone provides prolonged relief for patients who failed standard corticosteroid injection for knee osteoarthritis; a pragmatic retrospective study

ObjectiveIdentify if extended-release triamcinolone has a longer duration of action in a cohort of patients who have had limited duration of relief from prior corticosteroid injection. DesignRetrospective analysis of patients with knee osteoarthritis. SettingAcademic outpatient musculoskeletal practice. SubjectsOne hundred and fifty patients (age 67.5 ​± ​13.7, 68.2% female) with knee osteoarthritis who had subjectively insufficient relief from a standard corticosteroid injection. MethodsUltrasound-guided knee injections of extended-release triamcinolone were administered to all patients by experienced practitioners. The primary outcome measure was comparative duration of subjective relief from extended-release triamcinolone, compared to the patients’ duration from their prior standard corticosteroid injection. The secondary outcome was the duration of relief from extended-release triamcinolone. ResultsPatients reported 7.1 ​± ​8.7 additional weeks of relief from extended-release triamcinolone (t ​= ​6.50, p ​< ​0.001), with lower Kellgren-Lawrence score being the only factor associated with increased comparative duration of relief (B ​= ​−2.39, p ​= ​0.042). No factors were associated with duration of pain relief from extended-release triamcinolone. ConclusionsThis retrospective study suggests that injection of extended-release triamcinolone is associated with prolonged pain relief in patients who have had insufficient duration of pain relief from a standard corticosteroid injection. Those with lower Kellgren-Lawrence grades were more likely to have an increased comparative duration of relief.

Intraarticular Steroid Injection in Hip and Knee with Fluoroscopic Guidance: Reassessing Safety.

Background Intraarticular corticosteroid (IACS) injections are frequently performed for hip and knee osteoarthritis (OA); however, there are conflicting data about the benefits and complications of IACS injections and a lack of large studies with follow-up. Purpose To determine the number of patients with complications after hip and knee IACS injections in a large study sample with long-term follow-up. Materials and Methods This retrospective single-center case series included patients who received a corticosteroid injection in the hip (n = 500) or knee (n = 500) and who underwent clinical and radiologic follow-up (conventional radiography, fluoroscopy, CT, or MRI) between 1 and 12 months after injection (January 2016 to May 2020). General descriptive statistics and the χ2 test were applied. P < .05 was indicative of a significant difference. Results Of the 1000 patients (mean age, 57 years ± 16 [SD]; 545 women), 10 patients (1%) developed severe complications. Four patients developed osteonecrosis; three, insufficiency fractures; and three, rapid progressive OA. All 10 complications occurred between 2 and 9 months after injection: six (60%) in the hip and four (40%) in the knee. Of the included 1000 patients, 545 (54%) were women, but they had nine of the 10 (90%) complications (P = .02). Conclusion Intraarticular steroid injection had a substantially lower complication rate than that reported in previous smaller studies. The rate of severe complications was disproportionally higher in women than in men. © RSNA, 2022 See also the editorial by Jennings in this issue.

P088 Utilising virtual reality for remote joint injection training for the post-pandemic rheumatologist

Abstract Background/Aims The impact of dealing with COVID-19 for rheumatology higher specialist trainees has been profound. Sacrifices were made to their training to support the UK's pandemic response. Virtual Reality (VR) has long been used as a solution for specific surgical skills; providing a hands-on experience to enable specific delivery of outcomes. We utilised existing technology alongside a specialist VR and haptics team to review ways at delivering a valid and reliable training tool to administer joint injections, beginning with the review of this procedure specific to the knee. We aimed to describe this process. Methods A qualitative study using focus groups was undertaken, one medical student, four higher specialty trainees and two consultants were convened in a focus group to review existing mannequin-based training with the purpose of identifying a skill to develop in virtual reality. A story board was developed through collaboration with a graphic designer. The scenario was imbedded into a virtual reality environment in collaboration with a virtual reality partner. Results The focus group identified intra-articular knee injection as the most appropriate rheumatology skill to develop. Storyboarding built a series of scenarios around clinical situations which would require injection or aspiration. Working with the engineering team we successfully mapped knee joint anatomy and rendered an authentic clinical environment for the storyboards to run inside. Conclusion Virtual reality training scenarios are complex to develop but have enormous potential to create immersive training and assessment experiences which are not boundaried by the challenges of social distancing and COVID-19 risks. Disclosure B.D. Clarke: Honoraria; Abbvie. Grants/research support; Innovate UK. S. Balachandran: None. D. Nagra: None. M.D. Russell: Honoraria; Lilly, Pfizer, Janssen, UCB, Menarini. K. Bechman: None. M. Adas: None. A. Hope-Smith: None. M. Yates: Honoraria; Abbvie, UCB. A. Barrow: Grants/research support; Innovate UK. T. Smith: Grants/research support; Innovate UK. J. Galloway: Honoraria; Abbvie, Biovitrum, BMS, Celgene, Chugai, Gilead, Janssen, Lilly, Novartis, Pfizer, Roche, Sanofi, Sobi and UCB.

Clinical Response After Treatment of Knee Osteoarthritis With a Standardized, Closed-System, Low-Cost Platelet-Rich Plasma Product: 1-Year Outcomes.

Background:Intra-articular infiltration of platelet-rich plasma (PRP) is an alternative therapeutic option to classic hyaluronic acid for the treatment of symptomatic knee osteoarthritis (KOA). However, variation in preparation methods and quality assessment of PRP makes the study of its real clinical efficacy difficult.Purpose:To (1) evaluate the clinical efficacy of a characterized PRP product prepared in a standardized manner and in a closed-system for the treatment of KOA and to (2) evaluate the association of the clinical response to PRP-related variables.Study Design:Case series; Level of evidence, 4.Methods:We recruited 130 patients with nonoperative KOA and evaluated them for 1 year. PRP was prepared from a donation of autologous blood, obtaining 3 aliquots of approximately 10mL of product, which were frozen, allowing platelet disruption, platelet factor release, and long-term storage, until administration. Patients were treated 3 consecutive times every 4 weeks with an intra-articular PRP knee injection under sterile conditions. Complete blood count was performed on the whole-blood sample and the processed PRP before freezing it, for product quality assessment. Patients were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and basic satisfaction scale at 3 months, 6 months, and 1 year after intervention.Results:Quality assessment confirmed a leukocyte-poor PRP product (white blood cell count, 0.09 ± 0.09 × 109/L) with a high platelet purity (platelet count, 630.86 ± 191.75 × 109/L). WOMAC scores improved, and basic satisfaction was achieved in 70% of patients. No adverse events were reported. No correlations were observed between PRP quality parameters and clinical results. PRP complete treatment production costs were €108/US$125 (€36/US$41.6 per injection).Conclusion:This standardized PRP production method resulted in improved WOMAC scores at 1 year postoperatively in 70% of patients with KOA. This technique was safe and affordable and ensured consecutive infiltrations with the same product to each patient.

Experimental study of silkworm larvae plasma colorimetry based on immune cascade reaction in accurate diagnosis of periprosthetic joint infection

To investigate the diagnostic efficacy of silkworm larvae plasma (SLP) colorimetry in the accurate diagnosis of periprosthetic joint infection (PJI). Ninety healthy male New Zealand white rabbits were used for knee arthroplasty with Swanson prosthesis. Then they were randomly divided into 3 groups according to different pathogenic bacteria: group A ( Staphylococcus aureus group), group B ( Staphylococcus epidermidis group) and group C ( Escherichia coli group), with 30 rats in each group. The PJI model was prepared by knee injection with 1 mL of pathogenic bacteria of different concentrations. Samples were taken before inoculation and at 7, 14, and 21 days after inoculation, and based on the 2018 PJI Philadelphia International Consensus diagnostic criteria, the success rate of modeling among 3 groups of experimental animals was determined. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic efficiency of SLP colorimetry were calculated. At 21 days after inoculation, 26, 18, and 23 rabbits in groups A, B, and C were diagnosed as infection, respectively. The success rates of modeling were 86.7%, 60.0%, and 76.7%, respectively, showing no significant difference among the 3 groups ( χ 2=5.724, P=0.073). The results of PJI colorimetry showed that 1 false-positive animal (specificity 75.0%) appeared in group A at 7 days, and the specificity of SLP increased to 100.0% over time (on 14 and 21 days); on 14 and 21 days, another animal appeared false-negative results (sensitivity decreased from 100.0% to 96.2%). One false-positive animal appeared in group B at 7 days (specificity 91.7%), the specificity returned to 100.0% over time; 1 and 4 false-negative animals appeared at 14 and 21 days, respectively (sensitivity 94.4% and 83.3%, respectively). In group C, two false-positive animals (specificity 71.4%) were found at 7 days, and then returned to 100.0%. The diagnostic efficiency of groups A and C was very high at 21 days (96.7% and 100.0%), even for the low virulence Staphylococcus epidermidis in group B, the diagnostic efficiency could be maintained at 90.0% (21 days), and the overall diagnostic efficiency was very good (95.6%). SLP colorimetry has high sensitivity, specificity, and diagnostic efficiency in the diagnosis of PJI, which is a potential diagnostic method.

Racial and Ethnic Disparities in the Imaging Workup and Treatment of Knee and Hip Osteoarthritis

BackgroundThere is limited evidence on sociodemographic differences in osteoarthritis management, particularly in non-African American (AA) minorities. We sought to identify differences in imaging modalities, administration of intra-articular injections, and total joint arthroplasty (TJA) between racial/ethnic groups. MethodsWe retrospectively reviewed patients presenting to outpatient clinics with a diagnosis of hip or knee osteoarthritis from January 2013 to March 2020 at a tertiary center. Univariate analyses compared differences between groups. Multivariate logistic regression analyses determined sociodemographic predictors of imaging workup and treatment. ResultsIn total, 105,873 patients were included. There were 74,769 (70.6%) Caucasian, 27,117 (25.6%) AA, 1,878 (1.8%) Hispanic, 1,479 (1.4%) Asian, and 630 (0.6%) Native American patients. Multivariate analyses demonstrated that AAs had decreased odds of undergoing a knee magnetic resonance imaging (odds ratio [OR] 0.77, P < .001) or injection (OR 0.94, P = .006). Asian patients had lower odds of receiving any hip X-ray (OR 0.72, P = .047) or knee injection (OR 0.83, P = .017). AA (total knee arthroplasty [TKA]: OR 0.51, P < .001; total hip arthroplasty [THA]: OR 0.57, P < .001), Hispanic (TKA: OR 0.69, P = .003; THA: OR 0.60, P = .006), and Asian (TKA: OR 0.73, P = .010; THA: OR 0.56, P = .010) patients had lower odds of undergoing TJA compared to Caucasians. We found that higher income quartiles had greater odds of receiving a magnetic resonance imaging and TJA, males had lower odds of receiving injections and greater odds of undergoing TJA, and Medicaid and self-pay patients had lower odds of undergoing TJA (P < .05). ConclusionAfter adjusting for sociodemographic factors, we found disparities in the imaging, administration of injections, and/or arthroplasty for AA, Asian, and Hispanic patients. Insurance status, income, and gender were also associated with imaging and treatments performed in managing hip and knee osteoarthritis.

Analysis of the Cost and Efficacy of Intra-Articular Knee Injections.

Intra-articular joint injections have been used with the goal of providing patients with symptomatic relief. Recently, however, the efficacy of corticosteroid (CS) and hyaluronic acid (HA) injections in the management of knee osteoarthritis (OA) is questionable. In this analysis, we investigated the costs associated with injections by assessing overall use, conversion and average time to total knee arthroplasty (TKA), and reimbursement. Patients aged 50 to 70 years with a knee-related diagnosis of pain, effusion, or OA were identified in the Humana insurance national data set. Patients who received intra-articular injections were stratified by the type and number of injection(s) received. The subsequent rates of TKA were compared with Kaplan-Meier curves for patients who underwent CS injections, HA injections, and a benchmarking cohort of patients with OA and no history of knee injections in the medical record. Average time to TKA was determined from index diagnosis, and total cost was compared using Wilcoxon rank sum analyses. A total of 778,686 patients were identified. Of these, 637,112 had no knee injection history, while 124,129 received CS and 17,445 received HA injections. The 10-year conversion to TKA was highest in HA cohort (31.6%), followed by the CS cohort (24.0%) and the noninjection cohort (7.3%) (P < 0.001). Time to TKA increased with number of injections for both injection types. For patients who underwent TKA, median cost was greater in HA ($16,687) and CS ($15,563) cohorts relative to noninjection cohort ($14,733) (P < 0.001). Compared with the noninjection cohort, both HA and CS cohorts experienced increased costs and increased time to TKA. However, while the cost incurred in HA cohort was greater than that in CS cohort, no appreciable benefit was demonstrated for conversion or time to TKA. Therefore, if intra-articular knee injections are indicated for the nonsurgical management of knee OA, the results of this study support CS over HA.

A Guide to Performing Seated, Foot-On-Floor Position Ultrasound Guided Knee Injections Targeting the Medial &amp; Lateral Parapatellar Bursae &amp; Their Channels

Ultrasound guided (USG) supra patellarbursa (SPB)knee aspirations-injections are a current standard practice, typically performed with the patient supine on a plinth, and with the knee flexedto around 30 degrees. This follows research that 30 degrees of knee flexion offers optimal SPB bursal resolution. However,in circumstances of pain-mobility issues affecting plinth transfer, an alternative seated, foot on floor or wheelchair pedal, knee-flexed 90 degrees procedure (SKIF)is proposed. This foot on floor position may facilitate a push-off counter resistance, facilitatingisometric quadriceps contraction enhanced suprapatellar bursa (SPB) viewing, along with improved resolution of thelesser describedmedial-lateral parapatellarbursae(MPPB-LPPB) and their communicating SPB recess channels. As the MPPB-LPPB interconnect to the medial-lateral SPB recesses but are located more superficially and centrifugal to the femoral condyles in areas devoid of underlying articular cartilage, their preferential SKIFinjection-aspiration,mayalso prevent cartilage needle stick injuries.alsoknown as the paracondylar gutters, the relatively superficial MPPB-LPPB position may likewise offer better image resolution, lessenneedle travel distances and needle trajectory re-directs, which may in turn enhance procedure safety, comfort, and speed. Though the medial-lateral SPB recesses have some mention in the literature, it would appear thatinter tri-bursal connecting channels linking the MPPB-LBBP to the SPB recesses have not previously been described.This report explores tri-bursal and inter-bursal channel anatomy, relevant to performing USG SKIF injections and also elucidates the method, potential advantages, and pitfalls of this novel technique.

Systematic Review and Meta-Analysis of Health State Utility Values for Osteoarthritis-Related Conditions.

Health state utility values (HSUVs) are a key input in health economic modeling, but HSUVs of people with osteoarthritis (OA)-related conditions have not been systematically reviewed and meta-analyzed. Our objective was to systematically review and meta-analyze the HSUVs for people with OA. Searches within health economic/biomedical databases were performed to identify eligible studies reporting OA-related HSUVs. Data on study design, participant characteristics, affected OA joint sites, treatment type, HSUV elicitation method, considered health states, and the reported HSUVs were extracted. HSUVs for people with knee, hip, and mixed OA in pre- and posttreatment populations were meta-analyzed using random effects models. A total of 151 studies were included in the systematic review, and 88 in meta-analyses. Of 151 studies, 56% were conducted in Europe, 75% were in people with knee and/or hip OA, and 79% were based on the EuroQoL 5-dimension instrument. The pooled mean baseline HSUVs for knee OA core interventions, medication, injection, and primary surgery treatments were 0.64 (95% confidence interval [95% CI] 0.61-0.66), 0.56 (95% CI 0.45-0.68), 0.58 (95% CI 0.50-0.66), and 0.52 (95% CI 0.49-0.55), respectively. These were 0.71 (95% CI 0.59-0.84) for hip OA core interventions and 0.52 (95% CI 0.49-0.56) for hip OA primary surgery. For all knee OA treatments and hip OA primary surgery, pooled HSUVs were significantly higher in the post- than the pretreatment populations. This study provides a comprehensive summary of OA-related HSUVs and generates an HSUV database for people with different affected OA joint sites undergoing different treatments to guide HSUV choices in future health economic modeling of OA interventions.

Application Effect of Different Concentrations of Platelet-Rich Plasma Combined with Quadriceps Training on Cartilage Repair of Knee Osteoarthritis.

We investigated the application effect of different concentrations of platelet-rich plasma (PRP) combined with quadriceps training on cartilage repair of knee osteoarthritis. Data of 37 patients with knee osteoarthritis (KOA) treated in our hospital (November 2019–February 2021) were retrospectively analyzed and the patients were divided into low concentration group (LCG) (n = 12), medium concentration group (MCG) (n = 12), and high concentration group (HCG) (n = 13) according to the order of admission. All patients received quadriceps training. Three groups above received knee injection of PRP, and the platelet concentrations were 1000–1400 × 109/L, 1400–1800 × 109/L, and 1800–2100 × 109/L, respectively. Articular cartilage thickness of the medial and lateral femur, knee joint function scores, inflammatory factor levels, and matrix metalloproteinases (MMPs) levels were compared. After treatment, compared with the MCG and HCG, articular cartilage thickness of the medial and lateral femur of the diseased side in the LCG was obviously lower (P < 0.05). At 2 months after treatment (T3), compared with the HCG, articular cartilage thickness of the medial and lateral femur of the diseased side in the MCG was obviously higher (P < 0.05), without remarkable difference in articular cartilage thickness of the medial and lateral femur of the healthy side among three groups (P > 0.05). After treatment, compared with the LCG, knee joint function scores of the MCG and HCG were obviously better (P < 0.001). Compared with the HCG, the knee function score at T3 in the MCG was obviously better (P < 0.001). After treatment, compared with the LCG, inflammatory factor levels and levels of MMPs in the MCG and HCG were obviously lower (P < 0.05). Compared with the HCG, inflammatory factor levels and levels of MMPs at T3 in the MCG were obviously lower (P < 0.05). PRP combined with quadriceps training can accelerate cartilage repair of patients with KOA and reduce inflammatory factor levels and levels of MMPs, but the treatment effect of PRP depends on platelet concentration, with the best range of 1400–1800 × 109/L. Too high or too low platelet concentrations will affect recovery of knee function.

Single intra-articular injection with or without intra-osseous injections of platelet-rich plasma in the treatment of osteoarthritis knee: A single-blind, randomized clinical trial

BackgroundSubchondral bony structure damage plays an essential role in the pathogenesis of osteoarthritis (OA) knee. An intra-articular injection cannot reach the damaged subchondral bony structure and treat its pathologies effectively. The objective of the study was to compare the clinical effects of single intra-articular injection with or without intra-osseous injections of PRP in the treatment of osteoarthritis (OA) knee. MethodsThis was a single-blind, parallel-group, randomized clinical trial. Fifty patients, with OA knee (K&L grade III), with ages between 50 and 65 years, were randomly allocated into ‘intra-osseous, intra-articular PRP’ (‘IO+IA-PRP’) (n = 25) or ‘intra-articular PRP’ group (‘IA-PRP’) (n = 25). Patients in the ‘IO+IA-PRP’ group received 18 ml PRP injection, and the ‘IA-PRP’ group received 8 ml PRP injection. Intra-osseous injections were given at the tibial plateau (5 ml) and femoral condyle (5 ml), along with intra-articular knee injection (8 ml), under fluoroscopic guidance. Outcomes were measured using VAS-pain, the knee injury and osteoarthritis outcome score (KOOS), and the treatment satisfaction scale. All patients (n = 50) were followed up till six months. ResultsThe mean age was 57.12(4.27) years and 57.00(4.96) years in the ‘IO+IA-PRP’ and ‘IA-PRP’ groups. Both groups showed significant improvement in pain relief (VAS pain) and KOOS parameters: pain, symptoms, ADL function, sport and recreation function, and quality of life. Compared to the ‘IA-PRP’ group, the ‘IO+IA-PRP’ group showed a greater reduction of VAS pain at six months. However, no significant difference was obtained in VAS pain-relief between these two groups (p = 0.422) at six months. Similarly, at 6 months, in inter-group comparison, except ‘sport and recreation function’ (p < 0.05), no significant differences were obtained in mean-scores of KOOS parameters: pain (p = 0.514); symptom (p = 0.148), ADL-function (p = 0.991), QoL-(p = 0.376). Patients in the ‘IO+IA-PRP’ group complained of significant ‘injection-associated’ adverse events and consumed a greater number of Acetaphenomen. ConclusionsBoth groups showed significant improvement following the intervention. Intra-osseous PRP injections did not provide any additional benefit over intra-articular PRP injection until six months regarding pain relief and functional improvement.

Adductor Canal Block Combined with Interspace between the Popliteal Artery and Capsule of the Knee (iPACK) versus Periarticular Injection for Total Knee Arthroplasty.

The combination of the adductor canal block (ACB) and the infiltration of anesthetic solution into the interspace between the popliteal artery and capsule of the knee (iPACK) has become increasingly used to augment rapid recovery protocols in total knee arthroplasty (TKA). However, its efficacy in comparison with periarticular anesthetic injection (PAI) alone has yet to be evaluated. Hence, we conducted a retrospective study to compare PAI and ACB + iPACK for controlling pain after TKA. Propensity scores, incorporating American Society of Anesthesiologists scores, body mass index, age, and sex, were used to match the ACB + iPACK group with the PAI group. All patients received the identical surgical technique and postoperative care. Outcome measures were visual analog scale (VAS) for pain, morphine consumption, knee flexion angle, straight leg raising (SLR), postoperative nausea vomiting (PONV), and length of stay (LOS) after the surgery. After matching by propensity score, there were 49 patients with comparable demographic data in each group. The VAS and morphine requirements of the PAI and ACB + iPACK groups were not different during the first 48 hours after TKA. At 72 hours postoperatively, the VAS of the ACB + iPACK was 0.97 higher than that of the PAI group (p = 0.020). Knee flexion angle, SLR, PONV, and LOS were not significantly different between groups. No procedure-related complications were identified in either group. The anesthesiologist-administered ACB + iPACK was as effective as surgeon-administered PAI in controlling pain in the first 48 hours after TKA. However, the ACB + iPACK group had higher intensity of pain than did the PAI group at 72 hours after TKA.