KOOS Scale Research Articles

Efficacy and pharmacodynamics of herbal medicine in patients with metabolic phenotype of osteoarthritis

High prevalence of the metabolic phenotype of osteoarthritis (MPOA) and unsatisfactory methods of its treatment necessitate the development of novel therapeutic approaches for this phenotype of OA. Turmeric preparations have a wide range of biological activity; their use in patients with MPOA can be effective and reduce the drug burden. In the present paper, we review our own published research findings on the effectiveness and pharmacodynamics of turmeric preparations in patients with MPOA. In the two studies, we evaluated the effects of two curcumin-containing parapharmaceuticals: Epigenorm Antivir (EA) and Curcumin. Forty-one women with MFOA were included in both studies. Twenty-three patients received EA at a daily dose of 1000 mg for 12 weeks, and 18 patients received curcumin from Evalar at a dose of 1000 mg for 8 weeks. The endpoints for both studies were VAS pain, dysfunction and other symptoms of OA measured using the KOOS scale. After 12 weeks of EA treatment, there was a 2.5-fold decrease pain levels. The decrease in pain was associated with an improvement in the patient’s daily and sports activities and quality of life. These effect sizes were classified as moderate to large according to Cohen. No adverse events were observed during the period of taking EA. Clinical improvement was associated with a decrease in the content of MS individual components: low-density lipoprotein cholesterol and triglycerides. The treatment caused a decrease in the level of systemic inflammation, as evidenced by a decrease in the concentration of TNFα, histamine, IL-18, C-reactive protein, and neopterin. The concentrations of IL-10 and adiponectin increased after treatment. In another study, treatment with curcumin for 4 weeks had an analgesic effect, improved measures of function and quality of life. Clinical improvement was associated with the reductions in serum levels of a number of proinflammatory cytokines, C-reactive protein, and lipids. Thus, the results of the pilot studies evaluating efficacy, safety, and pharmacodynamics of parapharmaceuticals EA and Curcumin in patients with MFOA indicate pleiotropic effects of the interventions. The findings provide a rationale for conducting larger, controlled, blind, randomized clinical trials.

The Effectiveness of Treating Osgood-Schlatter Disease (OSD) with Leukocyte-Rich Platelet-Rich Plasma (LR-PRP) Depending on the Duration of the Disease.

Background: Osgood-Schlatter disease (OSD) occurs mainly in physically active adolescents, causing significant physical activity restrictions. The aim of this study is to compare the effectiveness of treating OSD with leukocyte-rich platelet-rich plasma (LR-PRP) depending on the duration of the disease and to attempt to develop an alternative treatment method to the currently used conservative therapy. Methods: Treatment efficacy was evaluated using the VAS, Tegner, Lysholm, and KOOS scales. Subject satisfaction, return to sports activity, potential adverse effects, and X-ray evaluation were likewise used to assess the success of the procedure. Results: Analysis across all scales showed statistically significant treatment effectiveness with LR-PRP in both groups of patients. When comparing the two groups, significantly better treatment outcomes were achieved in the acute phase of OSD. Treatment satisfaction in the acute OSD group was 95%, compared to 64% in the chronic group. The MCID value after LR-PRP injection in acute OSD compared to chronic OSD reached 100% vs. 81% on the VAS scale, 95.5% vs. 55% on the Tegner scale, 95% vs. 47% on the Lysholm scale and 91% vs. 27% on the KOOS scale. No adverse effects were recorded in either group. Conclusions: The high efficacy of LR-PRP treatment in patients with acute OSD, in correlation with high safety, as well as rapid and lasting results, can be an effective and beneficial alternative to conservative treatment. This single procedure seems particularly justified in a group of young professional athletes, where absence from training can lead to serious consequences.

Mid-term clinical radiological results of the constrained condylar knee prosthesis in total knee revision.

The aim of the present study is to analyze the clinical-radiological outcomes of patients undergoing knee prosthesis revision surgery using constrained condylar prosthesis (LCCK; Zimmer-Biomet). Retrospective study of 89 patients operated on between the years 2008 and 2020 with a minimum of 2years of follow-up. Clinical outcomes were evaluated using the WOMAC Index score and KOOS scales. Radiological results (radiolucent lines, osteolysis, and cortical hypertrophy) were evaluated by two independent observers. Implant survival was analyzed using the Kaplan-Meier method. At the end of follow-up, a mean WOMAC Index score of 78.67 and KOOS score of 68.8 were obtained. Radiolucent lines (both non-progressive and progressive) were detected in 83.3% of the patients in the sample. Areas of osteolysis > 5mm around the components were present in 6.75%. Cortical hypertrophy was seen around the femoral stem in 20.3% of cases, around the tibial stem in 20.3% and around both components in 6.76%. No statistically significant relationship was found between the presence of radiolucent lines, osteolysis or cortical hypertrophy with functional results. Implant survival was 88.1% at 13years. The present study shows high survival of LCCK prosthesis in revision surgery. The progressive radiolucencies, were associated with worst clinical outcome.

Mid-term Results of a Single-Stage Revision Anterior Cruciate Ligament Reconstruction: A Retrospective Analysis of 36 Cases

Background. Revision anterior cruciate ligament reconstruction is becoming more and more common in the knee surgery due to the annual increase in the number of primary anterior cruciate ligament reconstructions. Choosing the most suitable graft and determining the staging of the surgical treatment by preoperative assessment of the possibility of performing the most anatomical revision canals and their interposition with the primary canals are the main factors that influence treatment results.
 Aim of the study — comparative assessment of the results of using hamstring tendon and peroneus longus tendon autografts in a one-stage revision reconstruction of the anterior cruciate ligament.
 Methods. A retrospective analysis of the medical records of 36 patients who underwent revision anterior cruciate ligament reconstruction was performed. The patients were divided into two groups: in the patients of the study group (n = 19) a peroneus longus tendon (PLT) autograft was used, in the comparison group (n = 17) a hamstring tendon autograft (HT) was applied. Subjective and objective evaluation using the KOOS, IKDC, and Lysholm scales was performed, and position of the central entry points of the primary and revision canals was determined.
 There were no statistically significant differences in the objective assessment of the knee joint stability. Significantly better results of subjective assessment of the knee function according to the Lysholm and KOOS scales were obtained in the PLT group (p = 0.042 and p0.001, respectively). Position of revision canals corresponded to the standard values, but position of the femoral canal had a slight cranial and anterior displacement. It was also found that the PLT graft diameter was statistically significantly larger than the HT graft diameter (p0.001).
 Results. There were no statistically significant differences in the objective assessment of the knee joint stability. Significantly better results of subjective assessment of the knee function according to the Lysholm and KOOS scales were obtained in the PLT group (p = 0.042 and p0.001, respectively). Position of revision canals corresponded to the standard values, but position of the femoral canal had a slight cranial and anterior displacement. It was also found that the PLT graft diameter was statistically significantly larger than the HT graft diameter (p0.001).
 Conclusion. One-stage revision anterior cruciate ligament reconstruction is a safe and effective surgical procedure providing satisfactory objective and subjective clinical results. Use of peroneus longus tendon autograft allows to obtain better results in comparison with the hamstring tendon autograft.

Comparative Study on Russian Current Stimulation Versus Faradic Current in Pain and Functional Outcome in Osteoarthritis Knee

Background: This study was designed to inspect the effectiveness of a comparative study on Russian CurrentStimulation versus Faradic Current in pain and functional outcome in osteoarthritis knee. Russian current is themost commonly used electrical stimulation to improve muscle strength. Faradic current is effective in treatingmuscle spasms caused by inflammation and in lowering painPurpose: To compare the effectiveness of Russian current stimulation versus Faradic current using the KOOSscale.Materials and Methods: This experimental study has been conducted from November 2022 to April 2023.A totalof 196 adults were collected from APR physiotherapy center with OA knee have been selected using the inclusionand exclusion criteria. They have been split into 2 groups Group A (n=98) and Group B (n=98) were assigned.Group A got Russian current stimulation, whereas Group B received Faradic current and the KOOS scale was usedto evaluate the subjects. The treatments were given for 5 sessions per week and continued for 4 weeks.Results: The mean value of Russian current at the post-test was found to be higher than the mean value of Faradiccurrent with a p-value of <0.0001.Conclusion: The result suggests that Russian current stimulation shows a significant effect in reducing pain in theOA knee when compared to Faradic current.

Effect of a Sensorimotor Training on Pain, Proprioception, and Functional Activities in Participants with Chronic Knee Osteoarthritis: A Randomized Controlled Clinical Trial

Background: Knee osteoarthritis (OA) is a chronic, debilitating condition that significantly impairs functional health status among affected individuals. Key challenges associated with chronic knee OA include persistent pain, diminished functional capabilities, and compromised balance. These factors highlight the critical need for effective intervention strategies. Recent research suggests that sensorimotor training may play a pivotal role in addressing these issues. However, there remains a gap in the literature regarding the specific effects of sensorimotor training on pain perception, proprioception, and overall functional levels in this population. Therefore, the aim of this study was to systematically investigate the impact of sensorimotor training on pain, proprioceptive abilities, and functional performance in individuals with chronic knee OA. Methods: Total 66 patients with chronic knee OA were divided into two equal groups. The control group received a traditional exercise programme and the experimental group received sensorimotor training in addition to traditional exercises. Blind assessment was conducted at the beginning of the study and after 4 weeks of training to measure pain by NPRS, proprioception acuity by passive – active joint position reproduction method, and functional disability by TUG & KOOS scale. Statistical analysis was performed using SPSS 23. Data were presented as mean, standard deviation (SD) and mean difference. Within groups compare we used Paired t test and between groups compare we used Independent t test with post data comparison in SPSS. The significance level was set at (p<0.05). Result: For experimental group and control group statistical significant (p<0.05) improvements were recorded in all measured parameters. Mean difference of KOOS in control group is 5.97% and experimental group is 17.63% and in mean difference of pain in control group is 2.33 and experimental group is 3.88 which shows that SMT is very effective than traditional exercise only. According to MCID of all outcomes, pain, KOSS and TUG test is clinically significant. The sensorimotor group produced significantly better improvement than the traditional group. Conclusion: Sensorimotor training along with traditional exercises is more effective then only traditional exercises for patients with chronic knee OA. The addition of sensorimotor training to traditional strengthening and stretching exercises could provide more motor control and help neuromuscular restoration of balance and subsequently improve the functional level of chronic knee OA subjects.

Physiotherapy rehabilitation in severe damaged osteoarthritis knee following surgically treated bilateral total knee replacement – A case study

This 62-year-old female patient case study describes physiotherapy rehabilitation exercises of stage 4 osteoarthritis in the post-operative phase. The patient has pain, symptoms, decreased adl activities and decreased quality of life (study measures completely done by Koos scale). Following surgical managed total knee replacement patient gets better with her symptomatically level and this study tells the importance of replacing knee joint in time as suggested by an orthopaedic surgeon, else there would be a marked functional outcome limitation of the patient. It also emphasis on the importance of physiotherapy and maintaining the operative knee joint in long term care.

High tibial osteotomy with computer navigation for medial gonarthritis

To study significance of computer navigation for improving clinical and radiological results of medial gonarthritis treatment compared to non-invasive methods of lower limb axis correction control. The study included 73 patients who were divided into 2 groups. The main group included 40 patients, the control group - 33 patients. In the main group, high tibial osteotomy was performed using computer navigation, in the control group - using non-invasive techniques. Clinical assessment was carried out according to the KSS, KOOS and VAS scales. We assessed the main reference angles of the lower limb considering X-ray data. Both groups were characterized by postoperative improvement of clinical results according to various scales. Computer navigation provided higher accuracy in most cases. We focused on target correction of 3° valgus. High tibial osteotomy with computer navigation or non-invasive techniques is an effective treatment method for medial gonarthritis. There are no significant differences in clinical results according to the KSS and KOOS scales, as well as X-ray data after correction. We found significant differences in VAS scores.

Лечение остеоартроза коленных суставов на основе применения клеточных технологий

Osteoarthritis (OA) is the most common chronic disease of joint and a major cause of joint pain and disability. Traditional therapies for knee osteoarthritis show little clinical benefit, and the terminal treatment option is joint replacement. Currently, cell therapy is prospective for the treatment of knee osteoarthritis and has shown significant results in animal studies and human clinical trials. The aim: to investigate the treatment results in patients with knee osteoarthritis using adipose tissue stromal-vascular fraction and synovial mesenchymal stem cells.Methods. 60 patients with knee osteoarthritis were included in the study. The stage of knee osteoarthritis was assessed using the Kellgren-Lawrence classification, and patients with stage II-III of osteoarthritis were included in this study. After arthroscopic debridement, patients were divided into 2 groups. The first group was injected with the stromal-vascular fraction (SVF) of synovial membrane, and the second group was injected with adipose tissue mesenchymal stem cells (SVF). The minimum clinical and radiologic follow-up period was 12 months. Results. The assessment of the joints condition after 12 months using different scales showed that in both experimental groups there was a significant improvement of the functional status of the knee of the patients after treatment with MSC and SVF. Functional indicators of knee joints on the WOMAC scale improved by 14.7 and 13.4, on the KOOS scale by 23.6 and 26.4 in the SVF and MSC groups, respectively. Pain syndrome regressed by 1.8 and 2.1 on the VAS scale in the SVF and MSC groups, respectively.Conclusion. The results of both study groups showed that there is a significant difference between WOMAC, VAS and KOOS values before and after surgery (8, 12 weeks and 12 months) in the compared groups towards improvement

The effectiveness of Kinesio Taping in improving pain and edema during early rehabilitation after Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized, Control Study.

Background and aim:The Kinesio Taping (KT) is being increasingly applied in physical therapy and rehabilitation. The aim of this study was to evaluate the effect of KT on an early rehabilitation program, in combination with the standard protocol after ACL reconstruction (ACLR).Methods:This study enrolled 52 male patients, aged 18 to 45 years, who underwent ACLR with doubled gracilis and semitendinosus tendon (DGST) autograft. The patients were randomized into 2 groups: Group A (the control group) which received a standard rehabilitation protocol, and Group B (the experimental group), which had the same rehabilitation protocol plus the KT application. Pain intensity, range of motion, edema, thigh circumference, Tegner-Lysholm Scale and KOOS scale were measured at the second and fourth week follow-ups.Results:Patients in the experimental group showed significant results during the second week for both pain and edema reduction compared to the control group (p< 0.05). After 4 weeks of rehabilitation, pain intensity in the two groups was similar (n.s.), while edema reduction in the experimental group showed a significant result compared to the control group (p< 0.05). Nevertheless, the other outcomes did not show significant differences.Conclusions:The application of KT after ACLR contributed to relieve pain and reduce edema in the early postoperative rehabilitation period. Other potential benefits of KT on muscle activation and strength should be investigated through a longer follow-up and a targeted test. (www.actabiomedica.it)

A Study to Assess the Effectiveness of Moringa Oleifera Powder on Level of Pain and the Level of Activity among Clients with Osteoarthritis in Selected Community Area at Vellore District

India is facing a grave public health; with the prevalence of Osteoarthritis is being greater than 40%. An experimental study was conducted to assess the effectiveness of Moringa Oleifera powder on level of pain and the level of activity among Osteoarthritis clients. Quantitative evaluative approach was used for this study and the researcher adopted a Quasi- experimental research design. The sample size of the study was 60 Osteoarthritis clients in selected community area at Vellore, in which 30 were in experimental group and 30 were in control group. According to samples convenient and availability, convenient sampling technique was used to select the samples. The researcher adopted Imogene king’s goal attainment theory as a conceptual framework. Eight different hypothesis were tested in this study. The Structured interview schedule was used to collect the demographic and clinical variables. KOOS scale was used to assess the level of pain and the level of activity. Experimental group received intervention of Moringa Oleifera powder for 21 days and control group advised to follow daily routine and no intervention was given. For both the groups, on 22nd day the researcher was conducted posttest by using same tool. The data were analyzed using both descriptive and inferential statistics in terms of frequency distribution, chi-square test. The study revealed that the mean posttest pain and activity score in experimental group was 20&amp;17.37 respectively whereas in the control group, the mean posttest pain and activity score was 26.87&amp;27.17. The mean difference was 6.07 &amp;9.73. The obtained independent “t” value was 6.97 &amp; 8.57 respectively, which is more than the table value (P&lt;0.001) was highly significance. There is significant Association between levels of pain among Osteoarthritis clients Selected Demographic variable marital status in control group. No other demographic variables were shown any association with level of pain. The Frequency and percentage distribution

Dynamics of Quality of Life Indicators in Patients with Chronic Synovitis of the Knee Joint after Arthroscopic Laser Double-mode Synovectomy

Background: The treatment of patients with chronic synovitis of the knee joint is a challenge faced by many doctors all around the world. Treatment of this pathology is often a difficult task.&#x0D; Aim. The aim of the study was improving the results of treatment of patients with chronic synovitis of the knee joint by applying two wavelengths of radiation.&#x0D; Material and methods. The treatment results of 50 patients with chronic synovitis of the knee joint aged 23 to 67 years with stage II-IV osteoarthritis according to the Kellgren-Lawrence classification were analyzed. All patients underwent arthroscopic sanation, partial laser synovectomy using LSP-IRE-Polus apparatus, wavelength 0,97 microns in pulse-periodic mode (pulse 100 ms, pause 50 ms) with power 5 W and wavelength 1,56 microns in continuous mode with power 5 W. Morphological examination of the synovial membrane and capsule was performed. Preoperative, 3, 6 and 12 month postoperative questionnaires were administered using the following scales and questionnaires: VAS, Leken index, WOMAC and KOOS.&#x0D; Results. Mean age (M) was 45.32±131, BMI 28.63±4.72kg/m2, duration of synovitis 2.26±1.91 years. A statistically significant improvement on the VAS, WOMAC, Leken, KOOS scales was noted by the 3rd month of postoperative follow-up. By the 6th month postoperatively, the results had further improved. The achieved results were preserved up to 12 months after surgery (P &lt;0.05).&#x0D; Conclusion. The results suggest that the proposed technique may be introduced into clinical practice.

Therapeutic Effects of Intra-articular Botulinum Neurotoxin Versus Physical Therapy in Knee Osteoarthritis.

BackgroundKnee osteoarthritis (KOA) is the most common cause of chronic knee pain, and disability and different modalities have been used to improve pain and function. Botulinum toxin intra-articular injection is proposed to manage resistant joint pains.ObjectivesThis study was carried out to compare therapeutic effects of intra-articular botulinum neurotoxin (BTX) versus physical therapy (PT) in KOA.MethodsIn this single-blind randomized clinical trial, patients with KOA attending to Imam-Reza Hospital, Tehran, Iran, from June 2018 to March 2019 were enrolled. Patients who met the inclusion criteria were randomly divided into BTX receiving a single intra-articular dose of 100 units (250 units from disport brand) and PT groups. The study was described for patients, and informed consent forms were received. For assessment of the pain and related severity, the VAS score and KOOS scales were used. Post-intervention assessment was done 1, 3, and 6 months after the intervention. The level of significance was set at α = 0.05. All data analyses were performed with SPSS version 26 for windows.ResultsIn this study, 50 patients were randomly divided into BTX and PT groups. All patients completed the study, and there was no loss to follow-up. There was no significant difference between demographic data of the two groups, including age and BMI. The VAS score was similar in the two groups at the beginning. KOOS subscales were not significantly different, but the quality of life was better in the BTX than the PT group (86.2 ± 15 vs. 72.1 ± 11.5, P < 0.001). One month after the intervention, all KOOS subscales were improved in the BTX group in comparison to the PT group (P < 0.001). This difference was statistically significant in the 3rd (P < 0.001 in all comparisons except Sport/Rec subscale in which P = 0.02) and 6th months (P < 0.001) after the intervention, and the improvement in all KOOS subscales and VAS score were higher in the BTX group than the PT group. The trend of KOOS subscales and VAS score was improved over time in the BTX (P < 0.001 in all tests), but the PT group showed no improvement (P > 0.05) except for Sport/Rec and VAS score (P < 0.001).ConclusionsTotally, it is concluded that the use of BTX can reduce pain and improve the function and quality of life in patients with KOA.

An Investigator-Initiated, Prospective, Single-Center, Open-Label Clinical Study to Evaluate Safety and Performance of Intra-Articular Hyaluronic Acid (IA-HA) (Biovisc Ortho) in Patients with Osteoarthritis (OA) of the Knee.

ObjectiveIA-HA is injected into the osteoarthritis knee as a viscosupplementation for therapeutic purposes. This clinical trial was carried out for evaluating the efficacy and safety of Biovisc Ortho IA-HA (20 mg/2 mL) in a 2 mL prefilled syringe.DesignThe study was conducted as an open-label, single-center, single-arm clinical trial in India. Patients of knee OA with moderate to severe symptoms for a minimum duration of 3 months were included in the study. Five visits were conducted at weekly intervals and the investigational product was administered at each visit. Two follow-up visits were conducted at 3 and 6 months after the completion of the last injection cycle. The primary outcome variable was change in KOOS pain score from baseline. The secondary outcome variables were analyzed for other KOOS scales and safety of the device.ResultsChange in KOOS pain score at 6 months from baseline was 29.71±15.74 and the change in mean KOOS score for pain was statistically significant (p<0.0001) for all post-baseline visits. Statistically significant improvement was observed for mean values of efficacy assessments (KOOS) during the study period (6 months) for all the domains evaluated, including pain, joint function and quality of life.ConclusionDespite being an open, noncomparative study, the safety and efficacy results of IA-HA establish the therapeutic effect of the treatment throughout the study period of 6 months and are safe.

Baker’s Cyst with Knee Osteoarthritis: Clinical and Therapeutic Implications

Objective: Several symptoms are common to knee osteoarthritis and Baker’s cyst. To what extent each condition contributes to the patient’s discomfort is still a matter of debate. The aim of the present study was twofold: first, to compare the burden of symptoms in patients with isolated knee osteoarthritis and patients with knee osteoarthritis associated with Baker’s cyst; second, to assess the outcomes after conservative treatments. Subject and Methods: Patients suffering from monolateral idiopathic knee osteoarthritis were enrolled. Demographic, anthropometric and clinical data (KOOS scale) were collected. Ultrasound evaluation was performed according to standard protocols. On the basis of the clinical presentation different therapeutic options were used (fluid withdrawal, hyaluronic acid and/or steroids injections). Results: One-hundred and thirty patients were included in the study (97 with isolated knee osteoarthritis, 33 with knee osteoarthritis and Baker’s cyst). In basal conditions, lower scores in KOOS sub-scales were observed in patients with knee osteoarthritis associated with Baker’s cyst and in patients with effusion compared with patients without effusion. At 3 months after therapy significant higher scores were observed in both groups. At 6 months the scores were unchanged in the patients without Baker’s cyst, but worsened in those with Baker’s cyst. Conclusions: The study shows that Baker’s cysts associated with knee osteoarthritis contribute to the burden of symptoms. The conservative treatment of both conditions allows significant improvements, but in the medium term (6 months) the efficacy of the therapy declines in patients with knee osteoarthritis associated with Baker’s cyst.

Arthroscopic laser surgery combined with intraosseous infiltration of autologous platelet-rich plasma in the treatment of knee osteoarthritis

Purpose. To improve the cure of knee osteoarthirtis using a combination of arthroscopic laser surgery and intraosseous infiltration of autologous platelet-rich plasma (PRP). Material and methods. 32 patients (18 men and 14 women) with osteoarthrosis (OA) of the knee joint, degree II–III (by Kellgren–Lawrence classification), participated in the study. By MRI findings, all patients had meniscus and cartilage damage. The arthroscopic intervention was done with laser device «LSP IRE Polyus», wavelength 0.97 mkm. In addition to the arthroscopy, patients were made extra-articular intraosseous infiltration of autologous platelet-rich plasma topically into the altered subchondral bone under the control of an electronic optical transducer (OEC Fluorostar 7900 COMPACT 2). The evaluation of treatment efficacy was made using WOMAC and KOOS knee function assessment scales, as well as VAS scale (pain intensity) before surgery and 1 and 3 months after the treatment beginning. Results. In 3 months, WOMAC scale showed the improved knee joint function by 25.38 points, KOOS scale – by 37.4 points and VAS scale – by 35 points (p &lt; 0.01). Thus, the performed curative technique increased the support capacity, range of motion in the knee joint, less pain – all these contributed to the achievement of prolonged effect.

Effectiveness of intraosseous infiltration of autologous platelet-rich plasma in the area of the bone marrow edema in osteoarthritis of the knee joint

Osteoarthritis (OA) affects both elderly people, for whom it is one of the main causes of disability, and people of active working age and is an urgent clinical and social problem of resistance of pain syndrome to therapy. The disease is characterized by both destruction of intra-articular and paraarticular structures, such as subchondral bone. While OA is an important sign of pathological changes believe the bone marrow edema (BME). This work examines the effect of BME on development osteoarthritis, and therapeutic approaches to the management of patients with OA. The aim of the study was to develop a method of treatment of BME in OA of the knee joint by locally intraosseous injection of autologous thrombotic-rich plasma (PRP) into the edema zone. In this study 17 patients with the diagnosis: Osteoarthritis II-IV Grade. according to the classification of Kellgren–Lawrence, in which areas of local inflammation in the form of BME were detected on MRI in the subchondral zone in accordance with the international classification of WORMS (Whole Organ Magnetic Resonance Imaging Score). The mean age of patients was 41,7 ± 14,3 years, 10 of them were women and 7 men. Patients were treated with autological platelet-rich plasma under x-ray control injected from extra-articular intraosseous access in the area of BME. Evaluation of effectiveness of treatment performed by VAS, WOMAC and KOOS scales, before the introduction of autoplasma, after 1 and 3 months after the start of treatment. Three months after the manipulation, there was a statistically significant decrease in the intensity of inflammatory syndrome: for WOMAC by 17.5%, for KOOS by 19.4% and for VAS by 33,1% (p &lt; 0,01). Thus, the efficiency of intraosseous Infiltration of autologous platelet-rich plasma in the treatment of patients with OA, accompanied by edema of the bone marrow in the subchondral zone, was proved.

Comparative analysis of the results of the posterior cruciate ligament restoration with «inlay» methods and transtibial canal conduction

Damage of the posterior cruciate ligament is one of the most challeging in the knee joint. The question of the optimal method of its restoration remains open.Objective: on the basis of comparative analysis of results and complications, to evaluate the effectiveness of posterior cruciate ligament restoration with the graft taken from tibia flexors tendons by the transtibial method method «Іnlay» using a graft from the tendon quadriceps femoris with retrograde drill of the tibia.Methods: the results of treatment of two groups of patients were analyzed: I (56 patients) were operated with «Inlay» method with retrograde drill of the tibia using graft from the quadriceps muscle tendon (QT, one sheath of the tendon), ІІ (47) — the usual techniques of drilling canals and graft from the semitendinosus and gracilis (single-bundle) were used. The indicators of the VAS, IKDS, Tegner, Lysholm and KOOS scales were evaluated, and we evaluated the progression of arthrosis changings according to Kellgren and Lawrence classification.Results: in group I, a subjective assessment of satisfaction was obtained from 27 (48.21 %) patients. Very satisfied with the result of 12 (21.43 %) patients, satisfied — 9 (16.07 %), conditionally satisfied — 5 (8.93 %), dissatisfied — 1 (1.79 %). The indicator for VAS was (2.46 ± 1.65). In the II group, 27 (57.45 %) patients were evaluated: 12 (25.53 %) — very satisfied, 11 (23.40 %) — satisfied, 2 (4.46 %) — conditionally satisfied, 2 (4.46 %) — not satisfied. The indicator for VAS was (2.75 ± 1.27).Conclusions: arthroscopic posterior cruciate ligament restoration with «Inlay» QT method with the usage of RetroDrill® technology can be recommended as an alternative method. However, attention should be paid to the progression of arthrosis and the possibility of iatrogenic damage a. poplitea that needs to be thoroughly protected during surgery.

ANALYSIS OF GAIT AND KNEE FUNCTION PRIOR TO AND AFTER MENISCUS RESECTION

Background. Injuries of meniscus are the frequent lesions in the knee joint (KJ). A big number of false-positive and false-negative outcomes may mislead not only a patient but also a specialist in traumatology and orthopedics. Functional and biomechanical studies of the knee joint might provide additional data for clinical decision making and diagnostics.Materials and Methods. The authors studied 47 patients with traumatic and degenerative tears of the KJ meniscus. All patients were divided into 3 groups. Group I included 10 patients analyzed before and after the arthroscopic treatment, Group II included 22 patients analyzed before treatment only and Group III included 15 patients analyzed after the surgical treatment only. The authors studied the gait biomechanics as well as hip and knee function. In Group I the time from disease onset to the surgical treatment was 9.7 months. The grade on the KOOS scale was 29.4 points before the treatment and 80.2 points after the treatment. In Group II, the grade was 34.2 points. In Group III, the grade was 85.6 point.Results. The temporal characteristics of the gait cycle did not exhibit any differences from the normal state in all the groups. In Group I a statistically significant increase of the hip extension amplitude was observed, both for the operated and the intact leg. In Groups II and III the authors did not observe this pattern. The abduction-adduction and rotation motions in the hip did not exhibit any significant changes in all the three groups. In Group I knee joint kinematics at the affected side did not differ from intact leg prior to the treatment. After the surgery the value of magnitude phase during the basic knee flexion at the operated side significantly decreased. The amplitude itself increased, but the difference did not reach a statistical significance due to high data dispersion. Patients of Group II and III also demonstrated significant difference in the phase of basic flexion with the same value on the intact side. The abduction-adduction motions were decreased at the intact side after the surgery in the first group.Conclusion. Thus, the meniscus injury results in slight disorder in the walking and biomechanics of the knee which are successfully compensated during one year after arthroscopic treatment.

PRELIMINARY CLINICAL RESULTS WITH LIPOASPIRATE STROMAL VASCULAR CELL FRACTION IN TREATMENT OF PATIENTS WITH KNEE OSTEOARTHRITIS

The paper presents results of clinical application of autologous stromal-vascular fraction (SVF) cells in patients with degenerative osteoarthritis (OA) of the knee, grade II and III (Kellgren–Lawrence scale). We recruited six patients with knee OA (3 men and 3 women; median age 64 years) with mean disease duration of 7 years. All the patients were administered a single intra-articular injection of autologous nucleated SVF cells at an average dose of 16.8±0.9 × 106 per joint (a total of 11 joints). The patients did not experience any serious side effects (allergic, toxic or inflammatory) related to the knee injection. Patient surveys at 1 month after SVF administration revealed a decrease in the severity of pain, as measured by a visual analog scale (VAS) and a specialized 100-point scale KOOS (subscale "pain") (p &lt; 0.05 on both scales). Moreover, the patients reported improvement in the joint functions and quality of life related to affected joints on a KOOS scale (p &lt; 0.05). These positive clinical changes persisted during 6 month follow up. Significant improvements were noted in ultrasound findings, with increased thickness of the cartilage layer at 3 months (in 73% of cases) and at 6 months (in 82%). Our pilot study demonstrated the safety and tolerability of intra-articular injection of autologous SVF cells in patients with moderate to severe OA. The results obtained also indicate a significant antiinflammatory effect of autologous adipose tissue SVF cells, which is manifested at the early stages of cell therapy. Our further investigations will be focused on exploring the SVF stimulatory effects on regeneration of damaged joints.