Use Of Intra-articular Injections Research Articles

Comprehensive Review of Non-Operative Management of Hallux Rigidus.

This article aims to provide an evidence-based literature review for the non-operative management of hallux rigidus. Currently, there is very little article on the evidence for the non-operative management of hallux rigidus. A comprehensive evidence-based literature review of the PubMed database conducted in November 2016, identified 11 relevant articles out of 560 articles assessing the efficacy of non-operative modalities for hallux rigidus. The 11 studies were then assigned to a level of evidence (I-IV). Individual studies were reviewed to provide a grade of recommendation (A-C, I) according to the Wright classification in support of or against the non-operative modality. Based on the results of this evidence-based review, there is poor evidence (grade C) to support use of intra-articular injections for pain relief for a period of three months and fair evidence (grade B) against the use of intra-articular injections for long term efficacy. There is poor evidence (grade C) to support manipulation and physical therapy and poor evidence (grade C) to support modifications in footwear, insoles and orthotics. There were no good evidence (grade A) recommending any interventions. In general, most of the interventions showed improvement. However, the evidence is poor in recommending orthosis, manipulation and intra-articular injections. There is a need for high-quality Level I randomized controlled trials with validated outcome measures to allow for stronger recommendations to be made. There is no study that looked solely at the use of pharmaceutical oral agents for the treatment of hallux rigidus. Non-operative management should still be offered, prior to surgical management.

Therapeutic Efficacy of Ozone Injection into the Knee for the Osteoarthritis Patient along with Oral Celecoxib and Glucosamine.

Suffering from osteoarthritis is prevalent among elderly patients so the use of intra-articular injection of medical ozone may well be the effective way to relieve their pain. To evaluate the effect of intra-articular injection of medical ozone given into the knee of the osteoarthritis patients, and to compare it with taking celecoxib and glucosamine orally. In the present study, 76 patients suffering from osteoarthritis were randomly assigned into two groups. In the ozone group, 20 ml ozone-oxygen mixture gas concentration of 20 μg/ml was injected into knee articular cavity and each patient took oral celecoxib and glucosamine hydrochloride. Patients in control group only took the celecoxib and glucosamine hydrochloride orally.Pain score and Lysholm knee score were measured prior to the injection (pretreatment) and at one, three, six weeks after the beginning of the treatment (posttreatment). After the treatment, the pain intensity and function significantly improved in the two groups compared with the pretreatment (p<0.05). In the ozone group, three weeks after intervention, the pain score improved significantly when compared with the control group (p<0.05).After the treatment, the lysholm scores increased significantly (p<0.05), but in the ozone group, it improved faster. Intra-articular injection of ozone plus oral celecoxib and glucosamine could significantly decrease pain intensity in patients with mild to moderate Knee Osteoarthritis (KOA), and improve their functional status early than oral celecoxib and glucosamine only.

Uso de plasma rico em plaquetas intra-articulares como tratamento pós-cirúrgico da ruptura do ligamento cruzado cranial num cão

Relata-se o caso de um cão que recebeu injeções intra-articulares de plasma rico em plaquetas (PRP) durante o pós-operatório do tratamento cirúrgico de ruptura do ligamento cruzado cranial (RLCCr). Os resultados clínicos e da avaliação da marcha mediante plataforma de força neste paciente sugerem a utilização de injeções intra-articulares de PRP como terapia pós-cirúrgica no tratamento da RLCCr.

Injectable Medications for Osteoarthritis

AbstractOsteoarthritis is one of the most frequent and chronic conditions that affect the U.S. population. Use of intra-articular injections is one of the established treatment options available in the nonoperative care for the management of symptomatic osteoarthritis. Common injectable medications include corticosteroids, hyaluronic acid, and other less traditional compounds (for example, botulinum toxin). Corticosteroids work by anti-inflammatory and antinociceptive actions. Corticosteroids have been shown to decrease pain and symptoms associated with osteoarthritis for up to 3 weeks. Hyaluronic acid has an unclear mechanism of action, but it is thought to promote the restoration of hyaluronic acid within an osteoarthritic joint. The efficacy of hyaluronic acid is modest and is most beneficial between 5 and 13 weeks after treatment. Other injectable compounds have been studied and include botulinum toxin type A, which has been theorized to work as an antinociceptive agent. One must be aware of the potential adverse effects associated with these medications. For all of these injectable treatments, the placebo effect must not be overlooked, because it has be demonstrated in multiple studies that these medications provide similar relief of pain when compared with placebo. Image guidance with ultrasound or fluoroscopy may be considered when performing intra-articular injections to improve accurate placement of medication.

Reply to: Letter regarding manuscript: KSST-D-11-00615R3: ‘A randomised controlled trial for the effectiveness of intra-articular Ropivacaine and Bupivacaine on pain after knee arthroscopy: the DUPRA (DUtch Pain Relief after Arthroscopy)-trial’

Dear Sirs, Thank you for your interest in our manuscript. With pleasure, we took time to read your comments. In general, we would like to state that it is obvious that high level of evidence research costs time for design of a study, time for the study to be executed and results to be analysed and subsequently for the results to be published. In this time period, the evidence- and eminence-based opinion based on latest literature can change. This, however, does not implicate that results from randomised clinical trials with negative outcome should not be shared with the research community. Allow us to comment that you quote the study performed by Farkas et al. [3]. This study is methodologically very solid. However, it remains an in vitro study with partly monolayer cultures tested, and partly with osteochondral samples, where both had long times of exposure to the agents, and in the osteochondral sample group, only the superficial layer was affected. There are also in vivo studies to quote when commenting that intra-articular use of Bupivacaine seems not safe. The DUPRA trial was primarily designed to come up with level 1 evidence regarding the effectiveness of single dose intra-articular Ropivacaine and Bupivacaine after arthroscopy. During the design of the DUPRA trial, the first in vivo studies on the safety aspects of intra-articular injection of Bupivacaine were not yet published, and therefore the DUPRA trial was without concern regarding safety approved by the medical ethical committee of the University of Utrecht. During inclusion, publications on the safety of intra-articular Bupivacaine and Ropivacaine came out; the first being an in vitro study by Chu et al. [2]. Other in vitro studies followed and raised general concern. The first well-designed in vivo studies were published in 2010 [1]. At this time, inclusion of our study was completed and data analysis was started. Study results were then presented at congress meetings as well as a manuscript was written and prepared for publication in the KSSTA journal. Although the aforementioned information gives a clear picture on how it works in the field of research and publication, we felt that the information from the DUPRA trial was still very much worth sharing with other researchers in the field considering that our outcomes provide an extra definitive argument to stop with the daily use of intra-articular injection of Bupivacaine or Ropivacaine after arthroscopy. Allow us to explain. In daily practice, the discussion on safety aspects remained viable for the use of single-shot, low doses of an intra-articular injection with Bupivacaine or Ropivacaine, simply because of the fact that numerous colleagues were not convinced of the chondrotoxic effect of low-dose single-shot intra-articular injections—Bupivacaine and Ropivacaine have time- and dose-dependent chondrotoxicity [3–5]—and were convinced advocates of the beneficial effect on pain reduction of these aforementioned low doses. The DUPRA trial failed to demonstrate clinically relevant beneficial effects of both Bupivacaine and Ropivacaine and therefore ends the discussion. Hence, there is no need to argue on the details of the safety aspects of low-dose single-shot intra-articular injections at all anymore, since there is no clinically relevant beneficial aspect to be expected.

Homing and reparative effect of intra-articular injection of autologus mesenchymal stem cells in osteoarthritic animal model.

BackgroundThis work aimed to study the homing evidence and the reparative effect of mesenchymal stem cells (MSCs) in the healing process of induced osteoarthritis in experimental animal model (donkeys).MethodsTwenty-seven donkeys were equally divided into 3 groups based on the observation period after induction of arthritis (3, 6 and 9 weeks) to achieve different degrees of osteoarthritis. Each group was subdivided into three subgroups of three animals each based on the follow-up period (1, 2 and 6 months) after treatment. The induction was done through intra-articular (IA) injection of 2 ml of Amphotericin-B in both carpal joints. MSCs were harvested in a separate procedure, labeled with green fluorescent protein (GFP) using monster GFP vector and suspended in hyaluronic acid for IA injection. Treatment approaches consisted of cell-treatment using MSCs suspended in 3 ml of hyaluronic acid (HA) for the right carpal joint; and using the same amount of (HA) but without MSCs for the left contralateral carpal joint to serve as a control. Animals were assessed clinically and radiologically before and after treatment. Synovial fluid was also evaluated. Histopathologically; articular cartilage structural changes, reduction of articular cartilage matrix staining, osteophyte formation, and subchondral bone plate thickening were graded. Data was summarized using median and percentile for scores of histopathologic grading. Comparison between groups was done using non-parametric Mann Whitney test.ResultsThe reparative effect of MSCs was significant both clinically and radiologically in all treated groups (P < 0.05) compared to the control groups. Fluorescence microscopy of sections of the cell-treated joints of all animals indicated that the GFP-transduced injected cells have participated effectively in the reparative process of the damaged articular surface and have integrated within the existing articular cartilage. The cells were associated with the surface of the cartilage and, were also detected in the interior.ConclusionsHoming was confirmed by the incorporation of injected GFP-labeled MSCs within the repaired newly formed cartilage. Significant recovery proves that the use of IA injection of autologous MSCs is a viable and a practical option for treating different degrees of osteoarthritis.

Viscosupplementation in haemophilic arthropathy: a long‐term follow‐up study

Haemophilic arthropathy is the most common clinical manifestation of haemophilia, secondary to recurrent haemarthroses and chronic synovitis. Modern bleeding-preventing drugs have limited significantly the incidence of severe arthropathy, and primary approach is usually conservative. Use of intra-articular injections of hyaluronan acid is considered one of the most efficient treatments for early stages of articular degenerative diseases. Assessment of long-term effectiveness of intra-articular administration of hyaluronic acid (HA) in knees, ankles and elbows of patients affected by haemophilic arthropathy was done for 46 patients (10 elbows, 24 knees and 25 ankles) affected by haemophilic arthropathy. They received injections of HA and were evaluated with Visual Analogue Scale, Short Form-36, World Federation of Haemophilia score and Petterson score with a 6-year mean follow-up. Most of the patients showed improvement in pain relief and functional recovery without any complications: only a limited number of patients (8.6%) found poor results, undergoing surgery or other further treatments in the follow-up period for persistent pain or limitation. Viscosupplementation is an effective therapeutic strategy in early stages of haemophilic arthropathy, with no complications and long-term good clinical results.

Matrix metalloproteinase-3 inhibitor retards treadmill running-induced cartilage degradation in rats

IntroductionThe effect of intra-articular injection of matrix metalloproteinase (MMP)-3 inhibitor was investigated in a rat model to understand the role of MMP-3 in cartilage degradation induced by excessive loading from running.MethodsA total of 24 male Wistar rats were randomly assigned into groups of sedentary control (SED), high-intensity running (HIR), HIR + low dosage of MMP-3 Inhibitor I (HIRI1), and HIR + high dosage of MMP-3 Inhibitor I (HIRI2). Rats in the HIR, HIRI1 and HIRI2 groups were intensively trained for six weeks on the treadmill. Those in HIRI1 and HIRI2 groups were provided bilateral intra-articular injections of 80 μL of 0.2 mM and 2 mM MMP-3 Inhibitor I in knee joints once a week, respectively. Blood samples were collected to measure serum MMP-3 level using ELISA. Femoral condyles were collected to observe cartilage characteristics by histochemistry, and MMP-3 as well as collagen II was measured by immunohistochemistry. In addition, cartilage samples were obtained to assess MMP-3 mRNA expression by RT-PCR.ResultsHistological examination showed osteoarthritic changes in rats after six weeks of high intensity running. In comparison to the SED group, significant decreases in glycosaminoglycans (GAG) and collagen content were found in the HIR group, which corresponded to significant increase in serum MMP-3 level, cartilage MMP-3 activity and gene expression. However, such a degradative process was considerably retarded by intra-articular injection of MMP-3 inhibitor at higher dosage. Statistical differences were found between the HIR and HIRI2 groups with regard to GAG and collagen II content, serum MMP-3 level, cartilage MMP-3 activity and gene expression.ConclusionsHigh-intensity running for six weeks may lead to cartilage degradation in a rat model. It was shown that the chrondroprotective effect was offered by the use of intra-articular injection of MMP-3 inhibitor. MMP-3 acts as the key mediator of this catabolic change under such mechanical condition. The results also showed that MMP-3 selective inhibitor may be an effective option for retarding such osteoarthritic changes.

MACROSCOPIC ANALYSES OF THE EFFECTS OF HYALURONATES AND CORTICOSTEROIDS ON INDUCED OSTEOARTHRITIS IN RABBITS’ KNEES

Objective: To evaluate the effects of intra-articular injections of corticosteroids, native hyaluronic acid and branched-chain hyaluronic acid in experimentally-induced osteoarthrosis. Methods: 44 rabbits underwent anterior cruciate ligament resection and were then divided into four groups of eleven. Group 1: one intra-articular injection of saline solution per week, for three weeks; Group 2: three injections (one per week) of native hyaluronic acid; Group 3: three injections (one per week) of branched-chain hyaluronic acid; Group 4: two injections of betamethasone with an interval of three weeks. The cartilage of the tibial plateaus was evaluated macroscopically twelve weeks after surgery. Changes to the joint surface were graded as follows: Grade 0: smooth joint surface without relief changes; Grade 1: rough surface without any depressions; Grade 2: similar to grade 1, but with depressions on the joint surface; and Grade 3: subchondral bone exposure. The statistical analysis consisted of the use of Student's t test, chi-square test and analysis of variance (ANOVA). The significance level used was 5%. Results: A statistical difference was found between the control group and the three study groups 2, 3, 4 in relation to the development and severity of arthrosis. However, there was no difference between the groups regarding the drugs studied. Conclusion: A similar degree of attenuation of the osteoarthrosis process in the rabbits’ knees was found with the use of intra-articular injections of low-molecular-weight and high-molecular-weight glycosaminoglycans, and the corticosteroid betamethasone, compared with placebo.

The Role of Viscosupplementation in the Ankle Using Hylan G-F 20

The use of intra-articular injections of high molecular weight elastoviscous solutions of hyaluronan or hylans (cross-linked derivatives of hyaluronan) to treat arthritis is termed viscosupplementation. The function of viscosupplementation is to restore the rheologic properties of synovial fluid. Although anecdotal data exist, no long-term studies regarding the use of viscosupplementation in the ankle have been published to date. The goal of this clinical trial was to compare pain reduction following ankle arthroscopy versus that following ankle arthroscopy combined with weekly intra-articular instillation of hylan G-F 20 during the first 3 postoperative weeks. In the series of patients described in this report, we found that both treatment groups experienced statistically significantly decreased pain following the intervention (P = .002 and P = .0009 for the arthroscopy alone and arthroscopy plus hylan groups, respectively), and that those who received 3 intra-articular injections of hylan G-F 20 following ankle arthroscopy improved statistically significantly (P = .0014) more than did those who underwent arthroscopy as a sole therapy. These preliminary results suggest that viscosupplementation combined with arthroscopy may be more beneficial than arthroscopy alone, and provide further insight into the role of viscosupplementation in the treatment of ankle osteoarthritis. 4.

Injectable Mesenchymal Stem Cell Therapy for Large Cartilage Defects—A Porcine Model

Current techniques in biological resurfacing of cartilage defects require an open arthrotomy or arthroscopy and involve the direct transplantation of isolated cells and/or scaffolds or whole tissue grafts with chondrogenic potential onto the cartilage defect. Our study investigates the possibility of direct intra-articular injection of mesenchymal stem cells suspended in hyaluronic acid (HA) as an alternative to the much more invasive methods currently available. A partial-thickness (without penetration of the subchondral bone) cartilage defect was created in the medial femoral condyle of an adult minipig. Mesenchymal stem cells from the iliac crest marrow of the same pig harvested in a separate procedure and suspended in 2 milliliters of hylan G-F 20 (Synvisc) were injected intra-articularly after the creation of the defect. This was followed by two more injections of hylan G-F 20 (HA) at weekly intervals. Either saline or HA was injected into the knees of the controls. The pigs were sacrificed at 6 and 12 weeks for morphological and histological analysis. The cell-treated groups showed improved cartilage healing both histologically and morphologically at 6 and 12 weeks compared with both controls. The use of intra-articular injections of mesenchymal stem cells suspended in HA is a viable option for treating large cartilage defects. This would be further explored in clinical trials.

Debridement and Continuous Irrigation for the Treatment of Pyogenic Arthritis Caused by the Use of Intra-Articular Injection in the Osteoarthritic Knee: Indications and Outcomes

To discuss the indications and therapeutic outcomes of synovectomy, debridement, and continuous irrigation for the treatment of pyogenic arthritis caused by intra-articular injection used in the treatment of osteoarthritis of the knee. Records of 41 patients with infectious arthritis of the knee who presented to our hospital from 1981 were reviewed. 11 of them had a history of intra-articular injection. They underwent synovectomy, debridement, and continuous irrigation using a Salem double-lumen tube after confirmation that one side of the femorotibial joint cartilage was basically healthy. The infection was successfully treated in 9 of the 11 patients. Of these 9 patients, one died after 3 years and 2 underwent total knee arthroplasty after 3 and 8 years. The remaining 6 patients were followed up for 5 to 15 years. Five of them had deteriorating arthropathy, and the condition was unchanged in the others. Two of these 6 patients had pain while walking, and their Japanese Orthopaedic Association scores were 70. The remaining 4 had good knee function and reduction of pain, with a mean Japanese Orthopaedic Association score of 91 and a mean range of motion of 131 degrees. Arthrodesis is frequently considered the treatment for osteoarthritis if the joint destruction has affected the weight-bearing surface. However, in our experience, even when inflammatory granulation develops in the cartilage surface of one side of the femorotibial joint, good results can still be obtained by synovectomy, debridement, and continuous irrigation. After the pyogenic arthritis has subsided, if osteoarthritis has advanced and bowleg has exacerbated, further treatment options are available, such as tibial resection and even joint replacement. Continuous irrigation should be considered a feasible treatment option for pyogenic arthritis.

Patient characteristics and clinical management of patients with shoulder pain in U.S. primary care settings: Secondary data analysis of the National Ambulatory Medical Care Survey

BackgroundAlthough shoulder pain is a commonly encountered problem in primary care, there are few studies examining its presenting characteristics and clinical management in this setting.MethodsWe performed secondary data analysis of 692 office visits for shoulder pain collected through the National Ambulatory Medical Care Survey (Survey years 1993–2000). Information on demographic characteristics, history and place of injury, and clinical management (physician order of imaging, physiotherapy, and steroid intraarticular injection) were examined.ResultsShoulder pain was associated with an injury in one third (33.2% (230/692)) of office visits in this population of US primary care physicians. Males, and younger adults (age ≤ 52) more often associated their shoulder pain with previous injury, but there were no racial differences in injury status. Injury-related shoulder pain was related to work in over one-fifth (21.3% (43/202)) of visits.An x-ray was performed in 29.0% (164/566) of office visits, a finding that did not differ by gender, race, or by age status. Other imaging (CT scan, MRI, or ultrasound) was infrequently performed (6.5%, 37/566).Physiotherapy was ordered in 23.9% (135/566) of visits for shoulder pain. Younger adults and patients with a history of injury more often had physiotherapy ordered, but there was no significant difference in the ordering of physiotherapy by gender or race. Examination of the use of intraarticular injection was not possible with this data set.ConclusionThese data from the largest sample of patients with shoulder pain presenting to primary care settings offer insights into the presenting characteristics and clinical management of shoulder pain at the primary care level. The National Ambulatory Medical Care Survey is a useful resource for examining the clinical management of specific symptoms in U.S. primary care offices.

Use of a three-drill-tract technique for arthrodesis of the distal tarsal joints in horses with distal tarsal osteoarthritis: 54 cases (1990-1999).

To assess the long-term clinical outcome of horses with distal tarsal osteoarthritis (OA) in which a 3-drill-tract technique was used to induce arthrodesis of the affected joints, identify any preoperative or operative factors associated with outcome, and describe any complications associated with the technique. Retrospective study. 54 horses. Medical records were reviewed for information on signalment, use, history, physical and lameness examination findings, surgical technique, and postoperative care. Radiographs were examined, and severity of OA was graded. Follow-up information was obtained through telephone interviews with owners at least 13 months after the procedure. 32 (59%) horses had a successful outcome, 6 (11%) improved but were not sound after surgery, and 16 (30%) did not improve following surgery. Outcome was negatively associated with the previous use of intra-articular injections. Few postoperative complications were evident. Results suggest that distal tarsal OA in horses can be successfully treated by means of distal tarsal arthrodesis with a 3-drill-tract technique. Horses with advanced distal tarsal OA are likely to have poorer outcomes, and the procedure will likely be of minimal benefit in horses with concomitant causes of hind limb lameness prior to surgery and in horses with preexisting proximal intertarsal joint disease.

Prospektive Studie zur JCR-Oligo I der Arbeitsgemeinschaft Kinder- und Jugendrheumatologie

Intra-articular injection of corticosteroids is a powerful anti-inflammatory treatment with relatively few side effects. To date no prospective RCT exists on its use in children with oligoarthritis type I. Thus, in January 2000 the Arbeitsgemeinschaft started a multicenter RCT to compare in children with this diagnosis the initial treatment recommended in the textbooks, which is NSAID plus physiotherapy, with the early use of intra-articular injection of Triamcinolonhexacetonide. In the synovial fluid the presence of cytokines and the specific reactivity of T cells will be explored, and a highly sensitive screening for infectious agents will be performed.

MR diagnosis of superior labral anterior posterior (SLAP) injuries of the glenoid labrum: value of routine imaging without intraarticular injection of contrast material.

Superior labral anterior posterior (SLAP) lesions are peculiar types of tears that involve the superior and anterior aspects of the glenoid labrum and extend posteriorly. The biceps tendon may also be involved in the injury. There have been conflicting reports in the literature about the value of MR imaging in depicting these injuries. Some authors have advocated imaging in special planes and, more recently, the use of intraarticular injection of contrast material to facilitate the diagnosis of SLAP injuries. Symptoms of SLAP injury of the glenoid labrum are nonspecific, and patients are often imaged according to routine imaging protocols that include images in axial, oblique coronal, and oblique sagittal planes using spin-echo pulse sequences. Intraarticular injection of contrast material is not part of routine MR imaging of the shoulder. We sought to determine the value of routine MR imaging without intraarticular contrast enhancement in the diagnosis of SLAP injuries of the glenoid labrum. The MR images of eight patients with arthroscopically proved SLAP lesions were selected for this study. The MR imaging appearance of the glenoid labrum, biceps tendon attachment, and rotator cuff tendons were retrospectively evaluated in the axial, oblique coronal, and oblique sagittal planes in each case. The findings were correlated with the surgical observations. All eight patients showed an abnormal labrum on the coronal MR images, on 88% of the axial images, and on 50% of the sagittal images. An oblique or horizontal linear focus of increased signal was seen to traverse the labrum in 50% of the cases on sagittal images. Fifty percent of the cases also showed an intraarticular body, presumably representing the displaced fragment of a bucket-handle tear, on all imaging planes (the MR "Cheerio" sign). Routine MR imaging of the shoulder without intraarticular injection of contrast material is useful in the diagnosis of SLAP injuries of the glenoid labrum.

Clinical Evaluation of the Intra-articular Injection of Arteparon for Osteoarthrosis of the Knee Joint: A Multicentric Double-blind Controlled Study

Arteparon contains 50 mg mucopolysaccharide polysulfuric acid esters (MPS-L), i. e. polysulfuric acid esters of chondroitin sulfate extracted from bovine lung. Experimental and clinical studies suggest that the use of intra-articular injections of arteparon is effective in the treatment of osteoarthrosis. However, no doubleblind controlled studies have been performed yet. This report presents the results of a double-blind comparative study of intra-articular injection of arteparon in osteoarthrosis of the knee which was carried out in 26 orthopaedic clinics throughout Japan. A total of 120 patients were divided into groups ; One treated with 1 mg MPS-L (control group) and the other with 50 mg MPS-L (drug group). Five or more injections (average 9.3) were given at about weekly intervals (average 8.2 days). Score derived from knee scoring scale improved significantly in both groups, either after the 5 th and the 10 th injections. Score improved after the 10 th injection in drug group was statistically superior than that in the control (P<0.05), however, the difference in the two after the 5 th injection did not reach a level of any statistical significance. Doctors' assessment of the usefulness of the drug based on the balance of effects and side effects was obtained in 71.2% and 41.1% in drug group and the control, respectively. The difference was significant statistically (P<0.01). In conclusion, this study confirmed that intra-articular injection of 50 mg MPS-L was useful for osteoarthrosis of the knee although the clinical symptoms were improved gradually following the injections.

The value of intra-articular injections in osteoarthritis of the knee.

1 . Criticisms are expressed of previous reports on the use of intra-articular injections in the treatment of osteoarthritis of the knee. 2. A series of 181 patients with primary osteoarthritis of the knee treated by certain intra-articular injections is reported. Three solutions in common use were studied; normal saline and mock injections served as controls. 3. Irrespective of the injection used, including the controls, no significant difference in the effects was demonstrated in the results. 4. The place of intra-articular injection therapy in osteoarthritis is discussed. Attention is drawn to the psychological implications.