Treatment Of Knee Osteoarthritis Research Articles

A review of exercise training for the treatment of knee osteoarthritis

A review of exercise training for the treatment of knee osteoarthritis

Progress of treating knee osteoarthritis with traditional Chinese medicine

Knee osteoarthritis is a degenerative diseases-based ailment, the primary cause is lower limb dysfunction in the elderly population, the manifestations of joint pain, swelling, stiffness, deformity, joint friction, dysfunction and other symptoms, adversely impact the patients emotional well-being and quality of life. Chinese herbal medicine, with a long history and as a promising therapeutic, has also been gradually applied to the treatment of osteoarthritis of the knee (KOA). It is based on the conventional Chinese medical theory and its clinical application traditional Chinese medicine (TCM) treatment methods such as using TCM externally, acupuncture, massage, traditional health care, etc., is conducive to achieving significant clinical results. This article reviews the different methods of treating KOA with TCM, and probes into the function and the benefits of combining traditional Western medicine with clinical diagnosis and treatment of KOA in TCM. The results show that shadowboxing, eight trigrams boxing, tendon change classic, the Five Mimic-animal boxing and other important rehabilitation methods in traditional health care not only start from the holistic view of TCM, but also can organically combine breathing, consciousness and movement, and then improve the ability of human motor system through multi-functional exercise. In addition, integrative medicine has positive and effective effect on the treatment of KOA. Different patients should choose the appropriate way to intervene individually. In the future, clinical research efforts should be further strengthened to improve the quality of evidence-based evidence, so as to better guide clinical practice.

Malposition is main cause of failure of Oxford mobile-bearing medial unicompartmental knee arthroplasty.

Unicompartmental knee arthroplasty (UKA) is the preferred treatment for anterior medial knee osteoarthritis (OA) owing to the rapid postoperative recovery. However, the risk factors for UKA failure remain controversial. The clinical data of Oxford mobile-bearing UKAs performed between 2011 and 2017 with a minimum follow-up of five years were retrospectively analyzed. Demographic, surgical, and follow-up data were collected. The Cox proportional hazards model was used to identify the risk factors that contribute to UKA failure. Kaplan-Meier survival was used to compare the effect of the prosthesis position on UKA survival. A total of 407 patients who underwent UKA were included in the study. The mean age of patients was 61.8 years, and the mean follow-up period of the patients was 91.7 months. The mean Knee Society Score (KSS) preoperatively and at the last follow-up were 64.2 and 89.7, respectively (p = 0.001). Overall, 28 patients (6.9%) with UKA underwent revision due to prosthesis loosening (16 patients), dislocation (eight patients), and persistent pain (four patients). Cox proportional hazards model analysis identified malposition of the prostheses as a high-risk factor for UKA failure (p = 0.007). Kaplan-Meier analysis revealed that the five-year survival rate of the group with malposition was 85.1%, which was significantly lower than that of the group with normal position (96.2%; p < 0.001). UKA constitutes an effective method for treating anteromedial knee OA, with an excellent five-year survival rate. Aseptic loosening caused by prosthesis malposition was identified as the main cause of UKA failure. Surgeons should pay close attention to prevent the potential occurrence of this problem.

Comparative study between knee genicular nerve ablation by thermal radiofrequency vs thermal radiofrequency plus alcohol neurolysis for treatment of symptomatic knee osteoarthritis

Comparative study between knee genicular nerve ablation by thermal radiofrequency vs thermal radiofrequency plus alcohol neurolysis for treatment of symptomatic knee osteoarthritis

Research on the efficiency of treatment of knee osteoarthritis by eclectro-acupunture and san-bi-tang remedy combined with herbal steam

Background: Knee Osteoarthritis (OA) is a chronic disease, the second leading cause of disability for the elderly after cardiovascular disease. Treatment with traditional medicine is highly effective, has safety in the long run and has few side effects. Beside, herbal steaming is a simple, easy-to-implement treatment method that works quickly and can be widely applied in the community. Objectves: To evaluate treatment effects of electro-acupuncture and San-bi-tang remedy combined with herbal steam in patients of primary knee osteoarthritis. Subjects and Methods: Clinical trial with comparison before and after treatment, from August 2019 to May 2020, on 58 patients diagnosed with primary knee OA according to the standards of the American Society of Rheumatology (ACR), X -ray phase I, II according to Kellgren &amp; Lawrence, Wind Cold Damp clinical forms or Wind Cold Damp together with Liver and kidney damage clinical forms according to traditional medicine. Patients were assessed clinically, subclinical, and VAS scale, Lequesne index, WOMAC index, heel-buttock index, Rank of Motion (ROM) at baseline and after 9 days (D9), 18 days (D18). Results: Mean VAS score decreased to 1.60 ± 1.32 points (compared with 6.26 ± 1.00 points at D0; 3.98 ± 1.36 points at D9), the difference was statistically significant (p &lt; 0.05). Lequesne index decreased significantly at the time D18, D9 compared with the time D0, at the time of D18 Lequesne average point was 5.01 ± 2.10 (p &lt; 0.05). WOMAC index: After 18 days of treatment, there was no patient with severe or moderate dysfunction. Patients distributed at non-dysfunctional levels 53.45% and mild dysfunction 46.55% (p &lt; 0.05). The range of movement of the knee joint after treatment increased significantly, the average range of movement of the joint at the time of D18 was 129.410 ± 6.470 (p &lt; 0.05). The heel-buttock index decreased significantly: before treatment, the average heel-buttock index was 18.24 ± 6.07 (cm), and after treatment was 8.95 ± 5.33 (cm). There was an improvement in the color, tongue shape, thinness of tongue moss, nocturia symptoms, back pain after treatment (p &lt; 0.05). Overall results: 53.45% good; 44.83% fair; 1.72% average and no poor level (p &lt; 0.05). Conclusion: The electro-acupuncture and San-bi-tang remedy combined with herbal steam in patients of primary knee osteoarthritis is a safe treatment, effectively reducing pain and improving motor function significantly. Key words: Knee Osteoarthritis, electro-acupuncture, San-bi-tang remedy, herbal steam.

Efficacy and safety of corticosteroids, hyaluronic acid, and PRP and combination therapy for knee osteoarthritis: a systematic review and network meta-analysis

ObjectiveThere are many injectable treatments for knee osteoarthritis with different characteristics and effects, the aim is to understand which one can lead to better and safer results.MethodsThe PRISMA principles were followed when doing the literature search. Web of Science databases, Embase, the Cochrane Library, PubMed, and the Wanfang database were searched to identified randomized controlled trials that assessed the efficacy of corticosteroids (CSC), platelet-rich plasma (PRP), hyaluronic acid (HA), and combination therapy in treating KOA. Risk of bias was assessed using the relevant Cochrane tools (version 1.0). The outcome measure included the visual analog scale (VAS) score, the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) score, and treatment-related adverse events. The network meta-analysis was performed using STATA17 software and a Bayesian stratified random effects model.ResultsNetwork meta-analysis using the Bayesian random-effects model revealed 35 studies with 3104 participants. PRP showed the best WOMAC score at a 3-month follow-up, followed by PRP + HA, HA, placebo, and CSC; PRP + HA scored the highest VAS, followed by PRP, CSC, HA, and placebo. PRP, CSC, HA, and placebo had the highest WOMAC scores six months following treatment; PRP + HA showed the best VAS scores. PRP showed the best WOMAC score at 12 months, followed by PRP + HA, HA, placebo, and CSC; The best VAS score was obtained with PRP, followed by PRP + HA, HA, and CSC. No therapy demonstrated a rise in adverse events linked to the treatment in terms of safety.ConclusionsThe current study found that PRP and PRP + HA were the most successful in improving function and alleviating pain after 3, 6, and 12 months of follow-up. CSC, HA, PRP, and combination therapy did not result in an increase in the incidence of treatment-related side events as compared to placebo.

INCIDENCE OF KNEE SURGERIES OVER 5 YEARS AMONG PATIENTS WITH KNEE OSTEOARTHRITIS TREATED WITH A NON-INVASIVE, HOME-BASED, BIOMECHANICAL INTERVENTION

Background: The annual demand for total knee arthroplasty (TKA) will increase by 182%, from more than 700,000 in 2014 to 1.2M in the year 2030, placing an immense financial and social burden on healthcare systems to control medical costs and quality of care. This study aimed to examine the long-term effect of a home-based, non-surgical biomechanical intervention on surgery incidence amongst patients with moderate-severe knee osteoarthritis (OA). Methods: This is a retrospective registry review done at the Department of Rehabilitation Medicine of Albert Einstein College of Medicine, Montefiore Medical Center. Between September 2015 and December 2018, 95 patients (81% females, mean age 62.6± 8.3 years) diagnosed with primary knee OA were referred to receive a new non-invasive biomechanical foot-worn device after exhausting other non-surgical care. Patients were personally fitted with a non-invasive, biomechanical device, that alters the foot’s pressure points to reduce loads, minimize symptoms, and promote neuromuscular control training using adjustable, convex pods under the sole. Patients used the device for short periods during regular home/work activities. The primary outcome was the occurrence of knee surgery during an average follow-up time of 5.6 years. TKA incidence was compared to that of a reference group of patients with knee OA who were referred to receive traditional physical therapy (PT). Results: Of the patients who were treated with the biomechanical intervention, 12/95 patients (12.6%) had a TKA, compared to 23/67 patients (34.3%) who received traditional PT and had a TKA. Conclusion: The use of the biomechanical intervention was associated with avoiding TKA in more than 87% of patients at five years. Increased use of biomechanical intervention to treat knee OA may help reduce some of the burden on healthcare and society associated with end-stage knee OA by delaying or avoiding surgery.

Efficacy and safety of curcumin therapy for knee osteoarthritis: A Bayesian network meta-analysis

Ethnopharmacological relevanceCurcumin, a polyphenolic compound extracted from turmeric (Curcuma longa L.), is widely used in traditional Chinese medicine to treat osteoarthritis and rheumatoid arthritis. Clinical and experimental studies show that curcuminoid formulations have considerable clinical application value in the treatment of knee osteoarthritis (KOA). Aim of the studyTo evaluate the efficacy and safety of curcumin, both alone and in combination with other drugs, in KOA treatment through a Bayesian network meta-analysis (NMA). MethodsWe searched PubMed, Embase and Cochrane Library for randomized controlled trials of curcumin for KOA treatment. The time range of the search was from the establishment of each database to April 26, 2023. The NMAs of outcome indicators were all performed using a random-effects model. NMAs were calculated and graphed in R using MetaInsight and Stata 140 software. Measurement data were represented by the mean difference (MD), while count data were represented by the odds ratio (OR); the 95% confidence interval (CI) of each effect size was also calculated. ResultsThis study included 23 studies from 7 countries, including 2175 KOA patients and 6 interventions. The NMA results showed that compared with placebo, curcumin significantly reduced the visual analogue scale pain score (MD = −1.63, 95% CI: −2.91 to −0.45) and total WOMAC score (MD = −18.85, 95% CI: −29.53 to −8.76). Compared with placebo, curcumin (OR = 0.17, 95% CI: 0.08 to 0.36), curcumin + NSAIDs (OR = 0.01, 95% CI: 0.00 to 0.13) and NSAIDs (OR = 0.11, 95% CI: 0.02 to 0.47) reduced the use of rescue medication. Compared with NSAIDs, curcumin (OR = 0.51, 95% CI: 0.25 to 0.94) and curcumin + NSAIDs (OR = 0.23, 95% CI: 0.06 to 0.9) had a reduced incidence of adverse reactions. The surface under the cumulative ranking curve results indicated that curcumin monotherapy, curcumin + chondroprotective agents, and curcumin + NSAIDs have good clinical value in KOA treatment. ConclusionsCurcumin, either alone or in combination with other treatments, is considered to have good clinical efficacy and safety in KOA treatment. Drug combinations containing curcumin may have the dual effect of enhancing efficacy and reducing adverse reactions, but this possibility still needs to be confirmed by further clinical and basic research.

Bone Healing and Clinical Outcome Following Medial Opening-wedge High Tibial Osteotomy Using Wedge-Shaped Cancellous Allograft.

Medial opening-wedge high tibial osteotomy (MOWHTO) is considered to be an effective treatment for symptomatic knee osteoarthritis (KOA) of isolated the medial compartment with varus alignment of the lower extremity. However, the choice of material to fill the void remains controversial. This study aims to evaluate the bone union of the osteotomy gap using a novel wedge-shaped cancellous allograft after MOWHTO and its effect on clinical outcomes. All patients who underwent MOWHTO using a novel wedge-shaped cancellous allograft combined with TomoFix locking compression plate (LCP) fixation between January 2016 and July 2020 were enrolled. The radiographic parameters including hip-knee-ankle angle (HKAA), medial proximal tibial angle (MPTA), femorotibial angle (FTA) and posterior tibial slope angle (PTSA) were measured between pre-operative and post-operative radiographs. Knee Society score (KSS) and range of motion (ROM) were assessed preoperatively and at last follow-up. Patients included in this study were divided into two groups according to the correction angle: small correction group (< 10°; SC group) and large correction group (≥ 10°; LC group). The modified Radiographic Union score for tibial fractures (mRUST) was used to assess the difference in bone healing between the two groups at 1, 3, 6, and 12 months postoperatively and at the final follow-up. A paired student's t test was conducted for comparison of differences of the relevant data pre-operatively and post-operatively. A total of 82 patients (88 knees) were included in this study. The HKAA, MPTA, FTA and PTSA increased from -6.4° ± 3.0°, 85.1° ± 2.6°, 180.1° ± 3.2° and 7.7° ± 4.4° preoperatively to 1.2° ± 4.3° (p < 0.001), 94.4° ± 3.3° (p < 0.001), 171.0° ± 2.8° and 11.8° ± 5.8° (p < 0.001) immediately postoperatively, respectively. However, no significant statistic difference was found in above-mentioned parameters at last follow-up compared to immediate postoperative data (p > 0.05). All patients in this study achieved good bone healing at the final follow-up and no significant differences in mRUST scores were seen between the SC group and LC group. The KSS-Knee score and KSS-Function score improved significantly from 55.4 ± 3.7 and 63.3 ± 4.6 preoperatively to 86.4 ± 2.8 (p < 0.001) and 89.6 ± 2.9 (p < 0.001) at last follow-up, respectively. Nevertheless, there was no significant difference in ROM between pre-operation and last follow-up (p > 0.05). For MOWHTO, the wedge-shaped cancellous allograft was a reliable choice for providing good bone healing and clinical outcomes.

Short-term and long-term effectiveness of acupuncture and Tuina on knee osteoarthritis: study protocol for a randomized controlled trial.

The effectiveness of acupuncture and tuina in treating knee osteoarthritis (KOA) is still controversial, which limits their clinical application in practice. This study aims to evaluate the short-term and long-term effectiveness of acupuncture and tuina on KOA. This parallel-group, multicenter randomized clinical trial (RCT) will be conducted at the outpatient clinic of five traditional Chinese medicine hospitals in China. Three hundred and thirty participants with KOA will be randomly assigned to acupuncture, tuina, or home-based exercise group with a ratio of 1:1:1. The primary outcome is the proportion of participants achieving a minimal clinically important improvement defined as a ≥ 12% reduction on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain dimension on short term (week 8) and long term (week 26) compared with baseline. Secondary outcomes are knee joint conditions (pain, function, and stiffness), self-efficacy of arthritis, quality of life, and psychological conditions, which will be evaluated by the WOMAC score and the Patient Global Assessment (PGA), and in addition, the respondents index of OMERACT-OARSI, Short Form 12 Health Survey (SF-12), arthritis self-efficacy scale, and European five-dimensional health scale (EQ-5D). Adverse events will be collected by self-reported questionnaires predefined. https://www.chictr.org.cn.

New concept of orthosis treatment for knee osteoarthritis: Clinical and radiological outcomes.

Given the increasing numbers of young patients with knee osteoarthritis there is a need for treatments that can postpone a joint prosthesis (total knee replacement). As an alternative to the effective yet invasive knee joint distraction procedure, a knee orthosis was developed aiming to unload the affected knee and improving synovial fluid flow. The aim of this study was to examine the effectiveness of using a load-reducing orthosis for two months on functioning, pain, and disease progression (e.g. amount of damaged cartilage) in patients with symptomatic osteoarthritis of the knee for at least one year. This is an interventional single-center pilot study. Ten patients with symptomatic osteoarthritis of one knee (5males/5 females; median age 57; age range 42-59) used a custom-made orthosis for 60 days during daily life activities that involved knee loading (e.g. standing, walking, but not during stair climbing). Cycling was not allowed. Clinical outcomes were assessed up to 24 months after intervention at 6 timepoints using patient reported-outcome measures Western Ontario and McMaster Universities Osteoarthritis (WOMAC) range 0-100; Visual Analogue Scale (VAS), range 0-100 for pain. Minimum joint space width (mJSW) was assessed using knee images digital analysis (KIDA) and articular cartilage volume with magnetic resonance imaging (MRI) using custom software at baseline and at 12 and 24 months follow-up. Clinically beneficial effects were found for functioning (WOMAC improvement compared to baseline ranged between 18 points at 3 months follow-up and 31 points at 12 months follow-up, with only the 24-months follow-up (improvement of 27 points) not reaching statistical significance (p< 0.05)) and for pain (VAS improvement compared to baseline at follow-up time points ranged between 41-56 points; all p< 0.05). No improvements in mJSW- or MRI-derived parameters were found. This study demonstrates that use of a custom-made knee-unloading orthosis for 60 days can result in improved functional ability and decrease in pain in relatively young patients with knee osteoarthritis. No effect on disease progression could be evidenced.

Effect of adding hip exercises to general rehabilitation treatment of knee osteoarthritis on patients’ physical functions: a randomized clinical trial

BackgroundHip adductor and abductor strength were both reduced in KOA patients. But to date, most of the researches have only focused on quadriceps combined with hip abductor strengthening versus quadriceps strengthening.ObjectiveThe aim of the study is to evaluate the effect of adding hip abductor and adductor strengthening to quadriceps strengthening on lower limb strength, knee pain and physical function in patients with medial compartmental knee osteoarthritis.MethodsIn this study, 42 participants, were randomly divided into two groups: the general treatment group (GT group) and the added-hip-exercise group (AH group). All participants were given a general rehabilitation treatment. The AH group performed hip abductor and adductor strengthening in addition to the general rehabilitation treatment. Knee and hip muscle strength, Five Times Sit-to-Stand Test (FTSST), the Timed Up and Go Test (TUGT), Numerical Rating Scale (NRS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were assessed at baseline and 6 weeks. A two-sided 2-sample unpaired t test was performed to compare the difference in mean change scores between AH and GT groups.ResultsFinally, 36 participants completed the study: both groups consist of 18 participants. In the per-protocol analysis, the AH group had a greater improvement in knee extension strength (mean changes, 7.84 versus 36.48; P < 0.001) and hip abduction strength (mean changes, 5.05 versus 26.62; P = 0.001) than the control group. Similarly, the AH group had a greater improvement in the FTSST time (mean changes, 0.40 s versus 3.57 s; P < 0.001) and the TUFT time (mean changes, 0.18 s versus 1.67 s; P = 0.002) than the GH group. No statistical difference was found in the change of WOMAC pain scores and NRS between the 2 groups.ConclusionsOlder adults with knee OA in the AH group had superior muscle strength, symptoms and daily activity performance at the 6th week than those in the GT group. And adding hip exercises could expedite improvement of pain at the 2th week, but not at the 6th week.Trial registrationClinical trial registration numbers and date of registration: ChiCTR-IOR-16009124, Registered 30 August 2016.

Effect of mesenchymal stromal cells transplantation on the outcomes of patients with knee osteoarthritis: A systematic review and meta-analysis.

Cell therapy has been explored as a new regenerative treatment for osteoarthritis in the field of regenerative medicine. However, the efficacy of stem cell transplantation from different sources for the treatment of knee osteoarthritis (KOA) remains controversial. This study integrates and evaluates the previously published data of stem cell transplantation for KOA to explore the curative effect of different stem cells. We conducted a meta-analysis of randomized controlled trials on stem cell therapy for KOA. Measures of efficacy included Visual Analog Scale (VAS), Lequesne index, Lysholm Knee Scoring Scale (LKSS), and Western Ontario and McMaster University Osteoarthritis Index (WOMAC). Joint injury was evaluated through the Whole-Organ Magnetic Resonance Imaging Score (WORMS) system. We analyzed 16 studies involving 875 KOA patients. The stem cell treatment showed significant VAS reduction from the third month onwards. Subgroup analysis suggested the most significant pain relief at different postoperative months came from adipose-derived and umbilical cord-derived stem cells. Autologous adipose tissue resulted in better pain alleviation compared with allogenic. However, autologous bone marrow stem cells did not show increased pain relief over allogeneic ones. Combination therapy (HA and/or PRP) showed no effect. Autologous adipose-derived stem cells demonstrate the most effective recovery of knee joint function. In WORMS assessment, there was no significant difference between the stem cell group and control. Stem cell transplantation proved safe and effective for KOA treatment. Different sources stem cells have a good effect on alleviating knee joint pain, restoring knee joint function, and minimizing patient trauma.

An Analysis of the Treatment of Knee Osteoarthritis with Three-Dimensional Model

Knee osteoarthritis (KOA) is a common degenerative bone and joint disease. Its pathogenesis is based on the deficiency of liver, spleen and kidney, and marked by exogenous wind-cold dampness. According to the pathogenesis and overall concept, Professor Li Zhibin has created a three-dimensional model for the treatment of knee osteoarthritis, that is, the organic combination of internal Chinese medicine, external hot compress and exercise therapy. This article will explore Professor Li Zhibin's treatment of knee osteoarthritis with "three-dimensional model" theory, in order to provide a new direction for the treatment of knee osteoarthritis in the future.

Efficacy and safety of platelet-rich plasma combined with Tai Chi for knee osteoarthritis: study protocol for a placebo-controlled randomized trial

BackgroundNo definitive treatment methods of curative for knee osteoarthritis (KOA). The combined therapies that into account both the biochemical and biomechanical may provide potential opportunities for treat KOA, and previous studies have demonstrated that the platelet-rich plasma of intra-articular injection (IAI-PRP) and exercise treatments afford more benefits than do their corresponding monotherapies. The absence of a specific exercise plan and detailed explanation renders the aforementioned study results questionable. Furthermore, Tai Chi (TC) with moderate-intensity, whole body movements and good adherence may prove to be more effective for treating KOA. However, few studies examined the effectiveness and safety of combined IAI-PRP and TC for KOA.MethodsThis study protocol will be a placebo-controlled, assessor-blinded randomized trial involving 12-week intervention and 1-year follow-up. The stratified randomization will be used to randomly assign the 212 participants to four groups: group A (placebo IAI); group B (PRP IAI); group C (TC and placebo IAI); group D (TC and PRP IAI). Injection will be performed once a week, three consecutive times as a course, after a week of rest to continue the next course, a total of 3 courses (12 week). Additionally, the TC interventions will be carried out 3 days per week for a total of 12 weeks. The primary outcome measures will include the efficacy (Western Ontario and McMaster Universities Osteoarthritis Index), acceptability and safety of these interventions. The secondary outcome measures will include physical function (Timed Up and Go test), walking function (Gait Analysis), inflammatory factor levels (e.g., Interleukin-1 β, interleukin-6, vascular endothelial growth factor), quality of life (36-Item Short Form Health Survey), volume of patellofemoral cartilage and effusion-synovitis (MRI). Two-way of variance with repeated measures will be applied to examine the main effects of the group and the time factor and group-time interaction effects for all outcome measures.DiscussionThis trial will be first one to propose an integrated scheme combing IAI-PRP and TC for treatment of KOA, based on the consideration of the biochemical and biomechanical pathogenesis of KOA. These results of the study will provide evidence with high quality for integrated IAI-PRP and TC to treatment KOA.Trial Registration Chinese Clinical Trial Registry ChiCTR2300067559. Registered on 11 January 2023.

A bibliometric analysis of intra-articular injection therapy for knee osteoarthritis from 2012 to 2022.

Knee osteoarthritis (KOA) is the most common joint disease worldwide and, with the progression of an aging population, is one of the most important causes of disability worldwide. Its main symptoms include articular cartilage damage, periarticular pain, swelling, and stiffness. Intra-articular (IA) injections offer many advantages over systemic administration and surgical treatment, including direct action on the target joint to improve local bioavailability, reduce systemic toxicity, and lower costs. This study analyzed KOA intra-articular injection treatment and its hot literature and research horizons using bibliometric methodologies and graphical tools to aid future research. We performed a bibliometric analysis of 2360 publications in the Web of Science core collection using CiteSpace software. The United States (28.26% of publications) and China (18%) had the biggest publications. Rush University was the most active institution, but Boston University had the greatest citation/publication rate (65.77), suggesting a high literature standard. The majority of publications were in Osteoarthritis and cartilage. Bannuru RR was the most referenced author, while Filardo, Giuseppe was the most productive author. Studies in platelet-rich plasma (PRP), mesenchymal stem cells (MSCs), and microsphere formulation are likely to be future research hotspots. The current scientometric study provides an overview of KOA intra-articular injection therapy studies from 2012 to 2022. This study outlines the current research hotspots and potential future research hotspots in the field of intra-articular injection treatment for KOA and may serve as a resource for researchers interested in this topic.

From sceptic to believer: Acceptability of cognitive muscular therapyTM , a new intervention for knee osteoarthritis.

Cognitive Muscular TherapyTM (CMT) is an integrated behavioural intervention developed for knee osteoarthritis. CMT teaches patients to reconceptualise the condition, integrates muscle biofeedback and aims to reduce muscle overactivity, both in response to pain and during daily activities. This nested qualitative study explored patient and physiotherapist perspectives and experiences of CMT. Five physiotherapists were trained to follow a well-defined protocol and then delivered CMT to at least two patients with knee osteoarthritis. Each patient received seven individual clinical sessions and was provided with access to online learning materials incorporating animated videos. Semi-structured interviews took place after delivery/completion of the intervention and data were analysed at the patient and physiotherapist level. Five physiotherapists and five patients were interviewed. All described a process of changing beliefs throughout their engagement with CMT. A framework with three phases was developed to organise the data according to how osteoarthritis was conceptualised and how this changed throughout their interactions with CMT. Firstly, was an identification of pain beliefs to be challenged and recognition of how current beliefs can misalign with daily experiences. Secondly was a process of challenging and changing beliefs, validated through new experiences. Finally, there was an embedding of changed beliefs into self-management to continue with activities. This study identified a range of psychological changes which occur during exposure to CMT. These changes enabled patients to reconceptualise their condition, develop a new understanding of their body, understand psychological processes, and make sense of their knee pain.

Current advances of photobiomodulation therapy in treating knee osteoarthritis.

Knee osteoarthritis (KOA) is manifested by low-grade joint inflammation, irreversible cartilage degeneration, subchondral bone remodeling and osteophyte formation. It is one of the most prevalent degenerative diseases in the elderly. KOA usually results in chronic joint pain, physical impairment even disability bringing a huge socioeconomic burden. Unfortunately, there is so far no effective interventions to delay the progression and development of KOA. There is a pressing need for explorations and developments of new effective interventions. Photobiomodulation therapy (PBMT), also known as low-level light therapy (LLLT), has attracted widespread attention in treating KOA because it is drug-free, non-invasive, safe and useful with rarely reported side effects. It provides the biological stimulatory effects primarily by enhancing the activity of mitochondrial cytochrome c oxidase. This stimulation, in turn, fosters cell proliferation and tissue regeneration. In addition to this, the paper provides a concise overview of the light parameters and the effectiveness of PBMT when applied in the treatment of KOA patients in clinical settings. It also delves into the experimental evidence supporting the modulatory effects of PBMT and its potential underlying mechanisms in addressing synovitis, cartilage degeneration, and pain resolution.

Resistance to enzymatic degradation and efficacy evaluation of crosslinked hyaluronic acid based commercial viscosupplements for knee osteoarthritis treatment

A significant number of people worldwide suffers from knee osteoarthritis (KOA), a chronic and painful disease that is linked to aging, traumatological events and sports medicine. Clinical research indicates that KOA exhibit an altered synovial fluid (SF) with lower endogenous hyaluronic acid (HA) concentration and viscoelastic properties. Nowadays, viscosupplementation by intra-articular HA injections is the most common treatment to restore endogenous HA performance in osteoarthritic SF. In this work, TrHCROSS®, Durolane®, Regenflex®Bio-plus and Monovisc® commercial crosslinked HA viscosupplements were compared in vitro against enzymatic degradation. As key research point, TrHCROSS® demonstrated a considerably increased enzymatic stability compared to the rest of examined viscosupplements, which highlights TrHCROSS® prolonged residence time in joint space reducing more durably and effectively osteoarthritic knee pain. Subsequently, an in-depth physicochemical characterization was realized to support efficacy and stability results of viscosupplements. All in all, TrHCROSS®, developed by SARE® technology, was found to be more successful in treating more durably and effectively KOA based on the remarkable outcomes of conducted trials, which were appropriate findings for the current research investigation.

Prospective Observational Study of a Non-Arthroscopic Autologous Cartilage Micrografting Technology for Knee Osteoarthritis.

Autologous micrografting technology (AMT®) involves the use of autologous micrografts to stimulate/enhance the repair of damaged tissue. This study assessed the efficacy and safety of the AMT® procedure in patients with early stages of knee osteoarthritis. Briefly, the AMT® procedure involved extraction of auricular cartilage, disaggregation using the Rigeneracons® SRT in 4.0 mL of saline solution, and injection of the disaggregated micrografts into the external femorotibial compartment area of the affected knee. Ten patients (4 men, 6 women; age range: 37-84 years) were included in the study. In all patients, there was a steady improvement in knee instability, pain, swelling, mechanical locking, stair climbing, and squatting at 1- and 6-months post-procedure. Improvement in mobility was observed as early as 3 weeks post-procedure in 2 patients. Significant improvements were seen in mean scores of all five subscales of Knee Injury and Osteoarthritis Outcome Score (KOOS [KOOS symptoms, KOOS pain, KOOS ADL, KOOS sport and recreation, and KOOS quality-of-life]) between pre-procedure and 1- and 6-months post-procedure (all p ≤ 0.05). Autologous auricular cartilage micrografts obtained by AMT® procedure (using Rigenera® technology) is an effective and safe protocol in the treatment of early stage knee osteoarthritis. These encouraging findings need to be validated in a larger patient population and in a randomized clinical trial (RCT).