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Актуальність. Дегенеративно-дистрофічні захворювання суглобів нижньої кінцівки досить поширені. Серед оперативних методів лікування, відповідно до стадії гонартрозу, корегуючі остеотомії проксимального відділу великогомілкової кістки (ПВВГК) займають важливе місце завдяки можливості перерозподілу навантаження в суглобі та подовженню терміну його функціонування. Мета: оцінка віддалених результатів лікування деформацій проксимального відділу великогомілкової кістки із застосуванням модифікованої нами методики Г.А. Ілізарова. Матеріали та методи. Спостерігали за 14 пацієнтами із деформацією ПВВГК, яким виконана корегуюча кортикотомія великогомілкової кістки з фіксацією в апараті Ілізарова за пропонованою нами методикою. Результати. Через 2 роки 10 із 14 прооперованих пацієнтів відзначали покращення стану суглоба: майже повністю зник біль, збільшилась амплітуда рухів, був відсутній синовіт. Через 10 років оглянуто 9 пацієнтів, які ще відносно активно користувалися прооперованою кінцівкою. Висновки. Запропонована нами методика кортикотомії великогомілкової кістки з подальшою фіксацією в апараті Ілізарова є досить ефективною при лікуванні деформацій ПВВГК завдяки малоінвазивності втручання, без необхідності застосування металевих фіксаторів та можливості корекції осі кінцівки в післяопераційному періоді. Крім того, немає потреби в кістковій пластиці та подальшому видаленні ­фіксатора., Актуальность. Дегенеративно-дистрофические заболевания суставов нижней конечности достаточно распространены. Среди оперативных методов лечения, в соответствии со степенью гонартроза, корригирующие остеотомии проксимального отдела большеберцовой кости (ПОББК) занимают важное место за счет возможности перераспределения нагрузки в суставе и увеличения срока его функционирования. Цель: оценка отдаленных результатов лечения деформаций проксимального отдела большеберцовой кости с использованием модифицированной нами методики Г.А. Илизарова. Материалы и методы. Наблюдали 14 пациентов с деформацией ПОББК, которым выполнена корригирующая кортикотомия большеберцовой кости с фиксацией в аппарате Илизарова по предложенной нами методике. Результаты. Через 2 года 10 из 14 прооперированных пациентов отмечали улучшение состояния сустава: почти полностью исчезла боль, увеличилась амплитуда движений, отсутствовал синовит. Через 10 лет осмотрено 9 пациентов, которые еще достаточно активно пользовались оперированной конечностью. Выводы. Предложенная нами методика кортикотомии большеберцовой кости с дальнейшей фиксацией в аппарате Илизарова достаточно эффективна при лечении деформаций ПОББК за счет малоинвазивности, без необходимости применения металлических фиксаторов и возможности коррекции оси в послеоперационном периоде. Кроме того, нет необходимости в костной пластике и дальнейшем удалении фиксатора., Background. Degenerative-dystrophic diseases of the joints of the lower extremities are quite spread. Among the intervention methods of treatment, according to the stage of knee osteoarthritis, correcting osteotomies hold an important place due to the opportunity of load redistribution in the joint and prolong of the term of its functioning. Purpose: to evaluate the long-term results of treatment of the proximal tibia deformity ­using the modified method of Ilizarov Materials and methods. We observed 14 patients with deformities of the proximal tibia deformity, who underwent corrective corticotomy of the tibia with fixation in Ilizarov frame using our technique. Results. After 2 years, 10 out of 14 operated patients showed improvement in the knee joint functioning: the pain had almost relieved, the range of movements increased, there were no synovitis. After 10 years, 9 patients were examined who were still quite active in using the operated limb. Conclusions. The tibia corticotomy technique proposed by us with further fixation with Ilizarov frame is quite effective in preventing proximal tibia deformity due to intervention, without the need to use small invasive metal clamps, and the possibility of postoperative correcting the limb axis. In addition, there is no need for bone grafting and further removal of the clamp.

Nine participants undergoing primary TKA submitted to spinal anesthesia, sedation, ultrasound-guided obturator and Femoral nerve Block analgesia, and photobiomodulation Therapy (FBMT) were evaluated regarding postoperative pain and morphine consumption. FBMT sessions were performed in the Immediate Postoperative period (IPO) and after 24 hours. Participants received 16.7±15 mg of morphine up to the third postoperative day. At IPO, mean pain score was 4.8 ± 3.2 and 5.6 ± 3.5, at rest and on movement, respectively. Photo biomodulation therapy can be considered an option for mitigating pain for patients undergoing TKA.

Objectives: To evaluate the feasibility and efficacy of treatment for the recovery of knee joint function after total knee arthroplasty (TKA) using a robotic suit. Patients and Methods: Knee joint extension exercise sessions were started with a robotic suit (single-joint hybrid assistive limb [HAL-SJ, Cyberdyne, Inc., Tsukuba, Japan]) in one group of patients after TKA. Patients who underwent standard rehabilitation were enrolled in the control group. To evaluate feasibility and safety, we assessed the adverse events, the number of training sessions, and training time. We compared the changes in knee joint pain and extension lag (°) between the groups. Results: The average age was 71.3 ± 6.2 years in the HAL-SJ group and 74.9 ± 8.7 years in the control group. There were no severe adverse events. In the HAL-SJ group, training was performed 2.9 times, on average, and lasted 18.8 min. In the HAL-SJ group, there was a reduction in the visual analog scale (VAS) for pain after training, which was not significant. In the control group, the VAS score worsened after the sessions. The extension lag significantly improved in the HAL-SJ group after the 2nd and 3rd sessions, and this was more due to improvements in their active extension range of motion than their passive extension range of motion. Conclusions: HAL-SJ-based training is safe and effective, and leads to instantaneous improvement of extension lag, without worsening knee joint pain. HAL-SJ-based knee extension training could represent a viable novel post-TKA rehabilitation modality.

Background. Current evidence based research data lead to reassessment of traditional approaches for treatment of patients with bone and joint disorders especially knee osteoarthritis (OA). The purpose of the study was to review randomized clinical trials (RCT) and meta-analyses of RCT as well as recent guidelines of professional societies for application of arthroscopic lavage, debridement and meniscectomy in knee OA. Materials and Methods. Databases PubMed, e-LIBRARY, EMBASE (Ovid), Cochrane Central Register of Controlled Trials (CENTRAL) were searched for the period from 2000 till 2019. From 138 heats irrelevant and poor quality studies were excluded. In total there were 1614 patients aged 48,9–62,8 in RCT and 20 770 patients aged 42–62,4 in meta-analyses of RCT. Results. Both arthroscopic lavage and debridement do not lead to significant pain relief as well as functional improvement in long term therefore are not recommended. Nonsurgical treatment should be the first line strategy in patients with early and moderate knee OA even with degenerative meniscal tears irrespective of mechanical symptoms like painful locking, catching or sudden giving way. Arthroscopy might be performed only if complex non-surgical treatment including non-steroidal anti-inflammatory drugs, structured exercises program and intra-articular injections failed after 3 months in patients without ‘bone on bone’ cartilage erosions and frontal malalignment or if the knee is mechanically locked due to bucked handle type meniscus tear or loose body. Conclusion. Evidence based medicine approach let us to conclude that arthroscopy in knee OA is non-efficient and rarely indicated therefore if proper non-surgical treatment is failed around the knee osteotomies and partial or total arthroplasty should be considered.

The aim of this non-inferiority study was to evaluate and compare the effects of Tiszasüly and Kolop mud pack therapy on pain, function and quality of life in patients with knee osteoarthritis. In this double-blind, randomised, follow-up study, 60 patients with knee osteoarthritis were treated with either Tiszasüly hot mud pack (group 1) or with Kolop hot mud pack (group 2) on 10 occasions for 2 weeks (10 working days). One hundred millimetre visual analogue scale (VAS) for knee pain, the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Lequesne Index for physical function and EuroQoL-5D for quality-of-life measurements were recorded at baseline, at the end of treatment (week 2) and 3 months later (week 12). In both groups, all measured parameters improved significantly from the baseline until the end of treatment and during the follow-up period (p

In the knee joint, articular cartilage injury can often lead to osteoarthritis of the knee (OAK). Currently, no point-of-care treatment can completely address OAK symptoms and regenerate articular cartilage to restore original functions. While various cell-based therapies are being developed to address OAK, exosomes containing various components derived from their cells of origin have attracted attention as a cell-free alternative. The potential for exosomes as a novel point-of-care treatment for OAK has been studied extensively, especially in the context of intra-articular treatments. Specific exosomal microRNAs have been identified as possibly effective in treating cartilage defects. Additionally, exosomes have been studied as biomarkers through their differences in body fluid composition between joint disease patients and healthy subjects. Exosomes themselves can be utilized as a drug delivery system through their manipulation and encapsulation of specific contents to be delivered to specific cells. Through the combination of exosomes with tissue engineering, novel sustained release drug delivery systems are being developed. On the other hand, many of the functions and activities of exosomes are unknown and challenges remain for clinical applications. In this review, the possibilities of intra-articular treatments utilizing exosomes and the challenges in using exosomes in therapy are discussed.

Purpose To evaluate the postoperative change in patellar position after medial closed distal femoral osteotomy (DFO) performed for valgus osteoarthritic knees. Methods The study included 21 consecutive knees in 20 patients undergoing DFO. A minimum of 2-year follow-up data was obtained for all subjects with a mean follow-up period of 42 months (range 31–59 months). The patellar position was evaluated on plain radiographs preoperatively, 1-year postoperatively, and 2-year postoperatively. For patellar height, the modified Insall–Salvati Index (mISI), modified Caton–Deschamps Index (mCDI) and modified Blackburne–Peel Index (mBPI) were measured on the standing lateral radiographs. Patellofemoral alignment on the axial plane was assessed on skyline views with 30° flexion based on the measurements for lateral patellar tilt (LPT) and lateral patellar shift (LPS). Measured values at pre- and postoperative phases were statistically compared using a two-way analysis of variance. Results All indices including mISI, mCDI, mBPI, LPT and LPS showed no statistically significant postoperative changes. Conclusion Medial closed-wedge DFO performed for valgus osteoarthritic knees did not significantly influence patellofemoral alignment either on the sagittal or axial plane. Therefore, to highlight the clinical relevance of our findings, medial closed-wedge DFO for the valgus knee does not adversely affect the patellofemoral joint. Level of evidence Level IV, case series.

Background: Periprosthetic bone mineral density (BMD) may influence implant fixation and subsequent loosening. Unicompartmental knee arthroplasty (UKA) restores normal knee kinematics and load distribution to the surrounding bone. We studied the influence of systemic and periprosthetic BMD of the proximal tibia on migration of the tibial component of cemented medial UKA. Methods: The cohort was dichotomized into a normal BMD group (T-score ≥ −1; n = 37) and a low BMD group (T-score < −1; n = 28) according to World Health Organization criteria. BMD of the proximal tibia and migration of the tibial component were measured with dual X-ray absorptiometry scans and stereoradiographs with 2-year follow-up. Results: Patients with normal systemic BMD had an 11% to15% higher BMD in all regions of interest (ROIs) compared to patients with low systemic BMD throughout follow-up. Over time, a decrease in periprosthetic BMD in ROI 1-3 was seen for both groups. The operated knees and contralateral knees showed a similar reduction in BMD in all ROIs between preoperative and 24 months. Between 12 and 24 months, the normal BMD group migrated (maximal total point motion) 0.03 mm (95% confidence interval, −0.01, 0.08) and the low BMD group migrated 0.02 mm (95% confidence interval, −0.03, 0.07). Migration over time was not influenced by change in periprosthetic BMD. Conclusion: Migration of cemented medial tibial UKA was low until 24 months and was neither affected by preoperative systemic BMD nor affected by postoperative change in periprosthetic BMD. This suggests good long-term fixation despite an index difference in proximal tibial BMD.

Goals Periarticular fat pads of the human knee are relatively well studied structures, but the majority of the reviewed articles focus on fat pads of the anterior part of the knee. Therefore, the goal of this scoping systematic review is to summarize and disseminate current knowledge about the only fat pad in the posterior part of the knee – the pericruciate fat pad (PCFP). Methods In November 2020 two independent researchers, in order to gather the maximally broad set of articles pertaining to the studied topic, searched the following databases: PubMed, Embase, Karger, Scopus, using terms: pericruciate fat pad, PCL fat pad, posterior cruciate ligament fat pad. The article inclusion criteria was that it contained any scientific or clinical data about the PCFP, regardless of the type of article (original study, case report, review), and the year of its publication. Article exclusion criteria were that the study was not related to the PCFP and the article was written in any other language than English. In order to write each section of this review the included studies were then sorted into subtopics related to the PCFP. Main findings During the initial search of medical databases only eight articles mentioning the PCFP were identified, and only four directly focused on the PCFP. PCFP is located in the intercondylar fossa, filling the space between cruciates near their femoral attachment sites, surrounding the posterior cruciate ligament (PCL) and directly contacting the posterior capsule of the knee joint. The PCFP is composed of fatty tissue, covered by a thin synovial layer. It can be visualized on a magnetic resonance imaging (MRI) and during arthroscopy. Injuries of the PCFP may occur, resulting in nonspecific posterior knee pain. It has been proposed that alterations of the PCFP signal in MRI were a secondary sign of acute anterior cruciate ligament (ACL) injury, and an early indicator of osteoarthritis of the knee joint. While functions of the PCFP are not yet well studied, the PCFP is hypothesized to be a container of reparative stem cells. In agreement with this hypothesis, „the PCL fat pad transfer technique” was described as a promising treatment to enhance synovialization and revascularization of the ACL, after its repair or reconstruction. Conclusions Anatomy and imaging of PCFP is relatively well studied, however, we still need additional studies concerning its histology, functions, injuries, and a role in osteoarthritis. While there are theoretical promising benefits of using PCFP in ACL repair or reconstruction, high level-of-evidence research is needed to formulate any stronger opinions on the topic.

Purpose Tibial condylar valgus osteotomy (TCVO) is a type of opening-wedge high tibial osteotomy for advanced medial knee osteoarthritis (OA) with subluxated lateral joint. We report the concept, the current surgical technique with a locking plate, and the short-term clinical and radiological results of this procedure. Methods 11 knees with medial OA and a widened lateral joint were treated by TCVO (KL stage III: 6, IV: 5). In this procedure, by the L-shaped osteotomy from the medial side of the proximal tibia to the intercondylar eminence and the valgus correction, lateralization of the mechanical axis and reduction of the subluxated lateral joint are obtained with early postoperative weight-bearing. Before, 6 months, 1, and 5 years after the operation, a visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), alignment of the lower extremity, and congruency and stability of the femorotibial joint were investigated. Results The VAS improved from an average of 73 mm to 13 mm, and the total WOMAC score from 52 to 14 before to 5 years after the operation, respectively. The mechanical axis changed from 1 to 60%, and the FTA changed from 186° to 171°. The joint line convergence angle (JLCA) changed from 6° to 1°, and the angle difference of JLCA between varus and valgus stress improved from 8° to 4° after the procedure. Conclusion Improvements in pain and activities of daily living were observed by TCVO along with valgus correction of the lower extremity and stabilization of the femorotibial joint.

Background In the progression of osteoarthritis (OA) of the knee, a correlation between meniscal posterior segment injuries and medial meniscal extrusion has been reported, but there have been few reports on the relationship with the meniscal shape. The purpose of this study was to clarify the features of the meniscal shape involved in the progression of knee OA. Methods Data were obtained from the Osteoarthritis Initiative (OAI) database. We defined two sets of subjects. One set included 455 knees of subjects whose OA grade on the Kellgren Lawrence (KL) scale progressed in 24 months from baseline and the other set consisted of 455 knees with no progression. The OA progressed subjects were divided to three groups: the “OA change group”, KL0 and KL1 knees that progressed to KL2 and KL3; the “mild change group”, KL2 knees that progressed to KL3; and the “severe change group”, KL2 and KL3 knees that progressed to KL4. The no progression set was divided into three groups whose OA grade remained unchanged. We used magnetic resonance imaging data and manually measured seven items (longitudinal diameter [LD], anterior wedge thickness, anterior wedge width, posterior wedge width, posterior wedge thickness, anterior wedge angle, posterior wedge angle) from the sagittal slice and the extrusion from the coronal slice. These measurements were compared between knees with and without OA progression. Results In the “OA change group” and “mild change group”, the anterior and posterior wedge widths and the extrusion were significantly larger, but the anterior and the posterior wedge angles were significantly smaller. In the “severe change group,” the LD and the extrusion were significantly larger. In each group, there was no uniform tendency for the correlation coefficient of the parameters evaluated. Conclusions Our findings suggested (1) a larger meniscal LD at the baseline predicted progression of knee OA after 24 months and (2) a larger meniscal width and smaller meniscal angle predicted progression of knee OA after 24 months.

Introduction:. NEO6860 is a TRPV1 antagonist when activated by capsaicin but not by heat or pH, developed to relieve pain without the adverse events reported with non–modality-selective TRPV1 antagonists. Objective:. The primary Objective of this study was to evaluate the analgesic efficacy and safety of NEO6860 after 1 day oral dosing in patients with Kellgren-Lawrence stage I, II or III osteoarthritis of the knee. Method:. This randomized, double-blinded, 3-period crossover, phase II study compared 1 day (2 doses) of NEO6860 (500 mg twice a day), placebo, and naproxen in 54 patients with osteoarthritis knee pain. Primary endpoint was reduction in pain intensity (PI) on Numerical Rating Scale after exercise, using the staircase test, 8 hours after dose. Results:. Level of PI, compared with baseline, was numerically lower during NEO6860 and naproxen periods vs placebo at 3 and 24 hours, but not at 8 hours after first dose. A statistically significant effect for naproxen and a trend for NEO6860 were observed at 3 and 24 hours. Least square means' (95% confidence interval) change in PI at 24 hours was −0.67 (−1.09 to −0.26), −0.97 (−1.39 to −0.55), −0.29 (−0.71 to 0.13) for NEO6860, naproxen, and placebo, respectively. NEO6860 exposure was ∼1.6 times higher compared with previous phase I. In this study, NEO6860 safety profile was less favorable than naproxen or placebo. Possibly NEO6860-related adverse events included: feel hot, headache, nausea, dizziness, fatigue, hypoaesthesia, and increased blood pressure. Conclusion:. In this exploratory study, NEO6860 did not statistically significantly outperform placebo but showed an analgesic trend, without impacting body temperature and heat pain perception. Further studies are warranted to explore the potential of NEO6860 in other pain indications. We intent to optimize the dose and evaluate analgesic synergism with other mechanism.

Background Evaluation of knee and lower limb function alone is not sufficient to assess gait. For accurate assessment of gait abnormality, gait oscillation should also be measured. The goal of this analysis was to assess the influence of the knee joint on gait oscillation during gait and stair-stepping in patients with osteoarthritis of the knee. Methods In 33 patients diagnosed with knee osteoarthritis and 33 healthy adults as the control group, we examined acceleration (anterior and lateral directions) and gait barycentric factors (single-support phase and ratio of center of gravity maximum values) during gait and stair-stepping. Results Acceleration in the anterior direction in the sacral region was greater in healthy adults than in osteoarthritis (OA) patients during gait and stair-down. Acceleration in the anterior direction in the dorsal vertebral region was greater in OA patients than in healthy adults during (up and down) stair-stepping. Acceleration in the lateral direction in the sacral region was greater in healthy adults than in OA patients during stair-up. Acceleration in the lateral direction in the dorsal vertebral region was greater in OA patients than in healthy adults during stair-stepping. The single-support phase was close to 1 for gait and stair-stepping in healthy adults and OA patients. The single-support time was largely the same for gait and stair-stepping in healthy adults. On the other hand, the single-support time was longer for stair-stepping than for gait in OA patients. The ratio of the center of gravity maximum values was greater for the sacral region than for the dorsal vertebral region. There was a significant difference in the stair-stepping ratio of the center of gravity maximum values between healthy adults and OA patients for the sacral region. Conclusion We considered that knee OA influenced acceleration in the anterior and lateral direction in the dorsal vertebral and the ratio of the center of gravity maximum values on gait oscillation.

We show for the first time that imaging of osteoarthritic subchondral bone with 99mTc-sestamibi (MIBI) may be a valuable diagnostic tool to assess the severity of subchondral sclerosis. This is a report on a patient who had osteoarthritis of both knees and where MIBI was accumulated in the lesion sites. Due to the accumulation of MIBI in the bone, we believe that excessive stress had been applied to the bone and microfractures had activated bone remodeling. Typically, MIBI accumulation is not observed in the bone, but MIBI is believed to exhibit high accumulation where there is an increased presence of osteoblasts and osteoclasts. Osteoclasts absorb calcium, consequently causing a depolarization of the mitochondrial membrane potential, which may decrease the ability to retain MIBI and enhance washout. Pathological examination of the tissues of this case confirmed an abundance of osteoclasts. This suggests that using MIBI may be useful for determining the increased presence of osteoblasts and osteoclasts.

Background Knee pain is common and related to knee osteoarthritis. However, there is a discrepancy between knee pain and radiographic osteoarthritis. In the general population, knee pain is associated with psychological and cognitive factors, which would be one explanation for the discrepancy. Limited evidence demonstrates that somatization is associated with knee pain. This study examined the association between disability due to knee pain and a high somatising tendency. Methods Japanese adults (aged 20–64 years) who had experienced knee pain in the past four weeks were included in this study (n = 14,695, 50% women). Data were extracted from a large internet survey. Somatising tendency was assessed using the Somatic Symptom Scale-8 (SSS-8). Disability due to knee pain was categorized into three levels: 1) knee pain without difficulty with activities of daily living (ADL), 2) knee pain with ADL difficulty but without requiring sick leave, and 3) knee pain requiring sick leave. The association between ≥ high somatising tendency (SSS-8 score ≥ 12) as well as very high somatising tendency (SSS-8 score ≥ 16) and disability due to knee pain was examined using logistic regression models adjusted for age, sex, body mass index, depressive symptoms, education level, regular exercise, chronicity of knee pain (≥3 months), osteoarthritis, rheumatoid arthritis, and fibromyalgia. Results Greater disability due to knee pain was associated with a higher odds ratio for ≥ high somatising tendency (adjusted odds ratio (aOR) = 2.36 [2.10–2.66] in group 2 vs. group 1, aOR = 3.23 [2.66–3.92] in group 3 vs. group 1). Stronger associations were found for a very high somatising tendency (aOR = 2.80 [2.42–3.23] in group 2 vs. group 1, aOR = 4.51 [3.64–5.58] in group 3 vs. group 1). Conclusions Somatization may play a role in disability due to knee pain in the general adult population with knee pain, similar to the role of somatization in low back pain.

peer-reviewed Background: Platelet-rich plasma (PRP) is a concentrate of autologous blood growth factors which has been shown to provide some symptomatic relief in early osteoarthritis (OA) of the knee. The objective of this study was to test the feasibility and efficacy potential of platelet rich plasma (PRP) in primary care. Methods: Feasibility study to assess safety of the intervention procedures and assess primary and secondary outcome measures. Consecutive patients presenting with symptomatic knee OA were recruited in a primary care setting in Ireland. All participants received three injections of PRP 4 weeks apart. The following self-reported clinical outcomes were evaluated before and after therapy (4 months): Pain and disability (ICOAP questionnaire); health utility (EUROQol); adverse events; patient satisfaction and goal-orientated outcomes. Results: Seventeen potential patients were identified of whom 14 were eligible to participate. Twelve consented and completed the intervention and all outcome measures. There were no losses to follow-up. One patient reported pain and stiffness for 2 days after the first injection but did complete the study. No growth was detected from nine consecutive samples sent for microbiology analysis. Changes in constant, intermittent and total pain scores were reported; pain fully resolved in two patients. In addition, health utility, patient satisfaction and goal-orientated outcomes also demonstrated improvement. Conclusions: Platelet-rich plasma therapy is a simple and minimally invasive intervention which is feasible to deliver in primary care to treat osteoarthritis of the knee joint. Well-designed randomised controlled trials are needed to measure outcomes, durability of effect and cost effectiveness.

Background The meniscus plays an important role in the integrity of the knee joint. Therefore, meniscus tissue preserving techniques for the therapy of meniscus injuries seem to be reasonable. One of the important questions is whether meniscal repair can prevent the knee joint from early onset of osteoarthritis. Methods According to the review of the current literature, the principles of a successful meniscal repair are explained and the functional outcome and its impact on the prevention of osteoarthritis are analyzed in this article. Results Current data show a positive impact of a successful meniscus repair on the functional outcome in long-term. By this a protective effect on the development of osteoarthritis via the repair of meniscus lesions to restore the meniscus integrity can be confirmed. However, higher rates of re-operations in context to meniscus suturing have to be considered. Conclusion Due to the improved functional outcomes as well as preventive effect on the development of osteoarthritis within the knee joint in long-term, it is of importance to preserve as much meniscus tissue as possible in meniscus therapy. Patients previously have to be informed about the higher revision rate in context to meniscus suturing.

ResumenDentro de la osteoartritis (OA) la de rodilla es el tipo más frecuente, siendo la principal causa de dolor y discapacidad músculo-esquelética crónica en los pacientes adultos mayores. Para reducir el dolor y mejorar la función física en estos pacientes con discapacidad leve a moderada, se ha reportado que el fortalecimiento muscular y los ejercicios aeróbicos son efectivos. El objetivo de esta revisión es mostrar la efectividad de distintos diseños de ejercicios terapéuticos para esta enfermedad, basado en una revisión de la literatura y la clínica.SummaryAmong all types of arthrosis or osteoarthritis (OA), osteoarthritis of the knee is the most frequent. It is also the main cause of chronic pain and musculoskeletal disability in elderly patients. It has been reported that muscle strength training and aerobic exercise are effective reducing pain and improving physical function in patients with mild to moderate disability. The aim of this paper is to present the efectiveness of different types of therapeutic exercises in the treatment of knee OA based on a review of the current clincial literature.

Osteoarthritis of joints is a degenerative disease whose main characteristics are damage and loss of articular cartilage, thickening of the bone just beneath the cartilage (subchondral bone) and hypertrophy of bone at the edges of the joint. Clinically, OA of joints knees, depending on the stage of the disease, manifested by pain in degenerative altered joint, stiffness, restricted range of motion, precipitation, joint effusion within deformations, and varying degrees of inflammation. In this research were involved 100 patients and presented the results of the clinical manifestations of the disease, including amnesics and objective parameters, demographics status, radio-logical findings and the presence of co morbid conditions.

Summary Introduction A new concept has been recently developed for use in the treatment of isolated medial tibiofemoral osteoarthritis: the Unispacer™ implant. This mobile interpositional, self-centering implant replicates the meniscal shape. This mini-invasive device does not require bone cuts or component fixation. The implant trajectory is guided by the medial condyle. Hypothesis The Unispacer™ knee implant enhances knee function in the treatment of isolated tibiofemoral osteoarthritis graded 2 and 3 according to Ahlback radiographic evaluation scale. Material and methods This prospective study involved 17 Unispacer™ knee systems implanted in 16 patients between April 2003 and March 2009 within the frame of a clinical research project (CRP). Patients were clinically (IKS score) and radiographically evaluated during a mean follow-up period of 40 months. Results Nine patients (10 implants) had a IKS score > 160. The mean overall knee score at reassessment, including failures, increased from 51 points preoperatively to 78 points postoperatively. The mean overall Knee Society Function score increased from 55 preoperatively to 75/100 postoperatively. The reported complication rate was 35% (pain or implant instability). One-third of the failures were not technique- or implant-related but rather induced by the use of an inappropriate width in the frontal plane. Discussion Good results regarding pain relief and function are reported when using a mobile implant with no peripheral overhang which could be responsible for medial capsuloligamentous impingement. The Unispacer™ has three theoretical advantages: no bone resection, no implant fixation, no polyethylene wear debris. On the basis of its uncertain clinical results and high revision rate (six cases out of 17), we do not recommend this system despite the expected improvements on this range of implants. Level of evidence Level III, prospective study.

Objective : The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis (OA) Index is a tested questionnaire to assess symptoms and physical functional disability in patients with OA of the knee and the hip. We adapted the WOMAC for the Italian language and tested its metric properties in 304 patients with symptomatic OA of the knee. Methods : Three hundred and four consecutive patients, attending 29 rheumatologic outpatient clinic in northern, central, and southern Italy, were asked to answer two disease-specific questionnaires (WOMAC and Lequesne algofunctional index) and one generic instrument (Medical Outcomes Study SF-36 Health Survey—MOS SF-36). A sample of 258 patients was readministered the WOMAC 7–10 days after the first visit and the structured interview, which also assessed demographic and other characteristics. Internal consistency was assessed using Cronbach's alpha, reliability using intraclass correlation coefficients (ICCs), and construct and discriminant validity using Spearman's correlations, Wilcoxon rank sum test, and Kruskal–Wallis test. Results : All WOMAC subscales (pain, stiffness, and physical function) were internally consistent with Cronbach's coefficient alpha of 0.91, 0.81, and 0.84, respectively. Test–retest reliability was satisfactory with ICCs of 0.86, 0.68, and 0.89, respectively. In comparison with the SF-36, the expected correlations were found when comparing items measuring similar constructs, supporting the concepts of convergent construct validity. Very high correlations were also obtained between WOMAC scores and Lequesne OA algofunctional index. WOMAC physical function, but not WOMAC stiffness and pain subscales, was weakly associated with radiological OA severity ( P =0.03). Also, WOMAC pain score was inversely correlated ( P =0.01) with years of formal education. Examination of discriminant validity showed that the scores on the WOMAC and SF-36 followed hypothesized patterns: the WOMAC discriminated better among subjects with varying severity of knee problems, whereas the SF-36 discriminated better among subjects with varying levels of self-reported health status and comorbidity. Conclusion : The Italian version of WOMAC is a reliable and valid instrument for evaluating the severity of OA of the knee, with metric properties in agreement with the original, widely used version.

Background Osteoarthritis is a chronic disease with a multifactor etiology involving changes in bone alignment, cartilage, and other structures necessary to joint stability. There is a need to investigate therapeutic resources that combine different wavelengths as well as different light sources (low-level laser therapy and light-emitting diode therapy) in the same apparatus for the treatment of osteoarthritis. The aim of the proposed study is to analyze the effect of the incorporation of phototherapy into a therapeutic exercise program for individuals with osteoarthritis of the knee. Methods/Design A double-blind, controlled, randomized clinical trial will be conducted involving patients with osteoarthritis of the knee. Evaluations will be performed using functional questionnaires before and after the treatment protocols, in a reserved room with only the evaluator and participant present, and no time constraints placed on the answers or evaluations. The following functional tests will also be performed: stabilometry (balance assessment), dynamometry (muscle strength of gluteus medius and quadriceps), algometry (pain threshold), fleximeter (range of motion), timed up-and-go test (functional mobility), and the functional reach test. The participants will then be allocated to three groups through a randomization process using opaque envelopes: exercise program, exercise program + phototherapy, or exercise program + placebo phototherapy, all of which will last for eight weeks. Discussion The purpose of this randomized clinical trial is to analyze the effect of the incorporation of phototherapy into a therapeutic exercise program for osteoarthritis of the knee. The study will support the practice based on evidence to the use of phototherapy in individuals with a diagnosis of osteoarthritis of the knee. Data will be published after the study is completed. Trial registration The protocol for this study has been submitted to Clinical Trials, registration number NCT02102347, on 29 March 2014.

Contains fulltext : 136442.pdf (Publisher’s version ) (Open Access) BACKGROUND: Despite policy interest, an ethical imperative, and evidence of the benefits of patient decision support tools, the adoption of shared decision making (SDM) in day-to-day clinical practice remains slow and is inhibited by barriers that include culture and attitudes; resources and time pressures. Patient decision support tools often require high levels of health and computer literacy. Option Grids are one-page evidence-based summaries of the available condition-specific treatment options, listing patients' frequently asked questions. They are designed to be sufficiently brief and accessible enough to support a better dialogue between patients and clinicians during routine consultations. This paper describes a study to assess whether an Option Grid for osteoarthritis of the knee (OA of the knee) facilitates SDM, and explores the use of Option Grids by patients disadvantaged by language or poor health literacy. METHODS/DESIGN: This will be a stepped wedge exploratory trial involving 72 patients with OA of the knee referred from primary medical care to a specialist musculoskeletal service in Oldham. Six physiotherapists will sequentially join the trial and consult with six patients using usual care procedures. After a period of brief training in using the Option Grid, the same six physiotherapists will consult with six further patients using an Option Grid in the consultation. The primary outcome will be efficacy of the Option Grid in facilitating SDM as measured by observational scores using the OPTION scale. Comparisons will be made between patients who have received the Option Grid and those who received usual care. A Decision Quality Measure (DQM) will assess quality of decision making. The health literacy of patients will be measured using the REALM-R instrument. Consultations will be observed and audio-recorded. Interviews will be conducted with the physiotherapists, patients and any interpreters present to explore their views of using the Option Grid. DISCUSSION: Option Grids offer a potential solution to the barriers to implementing traditional decision aids into routine clinical practice. The study will assess whether Option Grids can facilitate SDM in day-to-day clinical practice and explore their use with patients disadvantaged by language or poor health literacy. TRIAL REGISTRATION: Current Controlled Trials ISRCTN94871417.

The recommendations for the management of osteoarthritis (OA) of the knee firstly proposed by the EULAR in 2000, have been updated in 2003. One of the most important objectives of the expert charged to provide these recommendations was their dissemination. Thus, the information generated may be used by each individual country to produce their own set of management guidelines and algorithms for treatment in primary care. The Italian Society of Rheumatology (SIR) and the Italian League against Rheumatism (LIMAR) have organised a Consensus on the EULAR recommendations 2003 with the aim to analyse their acceptability and the applicability according to our own experience and local situations in the Italy. The results of this Consensus have demonstrated that a large majority of the EULAR recommendations are endorsed by the Italian experts. Furthermore, the final document of the Italian Consensus clearly indicated the need that the specialists involved in the management of knee OA strongly encourage the dissemination of the EULAR 2003 recommendations also in Italy.

A osteoartrite é a forma mais prevalente de doença articular. Os agentes físicos como o gelo e o calor podem combater o processo álgico quando corretamente indicados e utilizados. O objetivo deste trabalho foi a comparação de protocolos de tratamento fisioterapêutico, que envolveram o uso de cinesioterapia, crioterapia e ondas curtas, em indivíduos com osteoartrite de joelho. Em um estudo randomizado prospectivo cego foram tratados 25 indivíduos (25 joelhos), de 58 a 78 anos. GRUPO A: cinesioterapia e ondas curtas (n=9). GRUPO B: cinesioterapia e gelo (n=6). GRUPO C: cinesioterapia (grupo controle) (n=9). As variáveis analisadas foram: percepção subjetiva de dor (Borg), qualidade funcional (Lequesne), amplitude de movimento, flexibilidade e força muscular. A dor melhorou significativamente somente no grupo B, com qualidade funcional e flexibilidade positiva em todos grupos. O ganho de amplitude foi semelhante nos grupos B e C. Houve manutenção da força flexora nos grupos A e B e ganho nos indivíduos do grupo C. Na musculatura extensora observou-se ganho de força no grupo B e C e perda no grupo A. O melhor protocolo foi aquele que envolveu a aplicação de gelo e cinesioterapia para analgesia; não houve relação de ganho de amplitude, flexibilidade e força associado a termoterapia. Osteoarthritis is the most prevalent form of joint disease. Physical agents such as ice and heat can fight the pain process, when correctly indicated and used. The objective of this study was to compare physiotherapy protocols involving the use of exercise, cryotherapy and short waves in individuals with knee osteoarthritis. In a prospective randomized study, 25 individuals were treated (25 knees), with ages ranging from 58 to 78 years. GROUP A: exercise and short-waves (n=9). GROUP B: exercise and ice (n=6). GROUP C: exercise alone (control) (n=9). Analyzed variables were: subjective perception of pain (Borg), functional quality (Lequesne), range of motion, flexibility and muscular strength. Pain significantly improved only for group B, with positive functional quality and flexibility in all groups. The improvement in range of motion was similar for groups B and C. Flexion strength was maintained for groups A and B, and strength gain for individuals in group C. In the extensors muscles, strength gain was seen in groups B and C, while strength loss was reported for group A. The best protocol was that one involving cryotherapy and exercises for pain relief. All groups showed improved functional quality; no correlation was found for range of motion gain, flexibility and strength gain associated with thermotherapy.

The recommendations for the management of osteoarthritis (OA) of the hip were proposed by EULAR in 2005. Among the most important objectives of the expert charged to provide these recommendations were their wide dissemination and implementation. Thus, the information generated can be used by each individual country to produce their own set of management guidelines and algorithms for treatment in primary care. According with that previously executed for the EU-LAR recommendation 2003 for the knee, the Italian Society of Rheumatology (SIR) has organised a Consensus on the EULAR recommendations 2005 for the management of hip OA. To obtain an acceptability as large as possible, the group of experts was composed by many physicians interested in the management of hip OA, including Orthopaedics, Rheumatologists, Physiatrists, and General Practitioners. Main aim of the Consensus was to analyse the acceptability and applicability of the recommendations according to own experience and local situations in the Italy. The results of this Consensus have demonstrated that a large majority of the EULAR recommendations are endorsed by the Italian experts. Furthermore, the final document of the Italian Consensus clearly indicated the need that the specialists involved in the management of hip OA strongly encourage the dissemination of the EULAR 2005 recommendations also in Italy.

Objective. IA steroid injections (IASIs) have been shown to relieve pain in knee OA and are widely used in clinical practice. There is, however, evidence of some variation in response. Knowledge of predictors of response could aid in the selection of patients for this therapy. The aim of this systematic review was to determine factors associated with response to IASI in knee OA. Methods. Medline, Embase, AMED, CINAHL, Web of Science and Cochrane Central Registers for Controlled Trials up to January 2012 were searched with additional hand searches of relevant articles. Studies included were those that involved adults diagnosed with knee OA in whom IASIs were administered and factors that predicted treatment response were investigated. Results. Eleven publications meeting these criteria were reviewed and relevant information extracted. It was not possible to pool the results because of the different predictors studied, variable outcome measures, different criteria for symptom change and missing data. Given the relative paucity of data and small heterogeneously designed studies, it was difficult to identify predictors of response. Data from individual publications, although not consistent across studies, suggest that the presence of effusion, withdrawal of fluid from the knee, severity of disease, absence of synovitis, injection delivery under US guidance and greater symptoms at baseline may all improve the likelihood of response to IASI. Conclusion. Further larger-scale studies using standardized methods are required to characterize predictors of response and should focus on synovitis, effusion, pain and structural severity of disease. Such data would help in better targeting therapy to those most likely to benefit.

Objectives The knee can be injected at different anatomic sites with or without image-guidance. We undertook a systematic review to determine the accuracy of intra-articular knee injection (IAKI) and whether this varied by site, use of image-guidance, and experience of injectors, and whether accuracy of injection, site, or use of image-guidance influenced outcomes following IAKIs. Methods Medline, Embase, AMED, CINAHL, Web of Knowledge, Cochrane Central Registers for Controlled Trials up to Dec 2012 were searched for studies that evaluated either accuracy of IAKIs or outcomes related to accuracy, knee injection sites, or use of image-guidance. Within-study and between-study analyses were performed. Results Data from 23 publications were included. Within-study analyses suggested IAKIs at the superomedial patellar, medial midpatellar (MMP), superolateral patellar (SLP) and lateral suprapatellar bursae sites were more accurate when using image-guidance than when blinded (ranges of pooled risk difference 0.09–0.19). Pooling data across studies suggested blinded IAKIs at the SLP site were most accurate (87%) while MMP (64%) and anterolateral joint line (ALJL) sites were (70%) least accurate. Overall about one in five blinded IAKIs were inaccurate. There was some evidence that experience of the injector was linked with improved accuracy for blinded though not image-guided injections. Based on a small number of studies, short but not longer-term outcomes for ultrasound-guided were found to be superior to blinded IAKIs. Conclusions Image-guided IAKIs are modestly more accurate than blinded IAKIs especially at the MMP and ALJL sites. Blinded injections at SLP site had good accuracy especially if performed by experienced injectors. Further studies are required to address the question whether accurate localization is linked with an improved response.

The present review is devoted to the problem of progression of the knee osteoarthritis. It has been shown that the most important predictors of the disease progression are female gender, strong knee pain, synovitis, deformation of joints, high body mass index, previous traumas, high bone mineral density of the axial skeleton and subchondral parts of femur and tibia, bone marrow edema. Despite numerous studies conducted in order to reveal risk factors of knee osteoarthritis, results remain controversial and require further investigation.

Background Traditional Indian Ayurvedic medicine uses complex treatment approaches, including manual therapies, lifestyle and nutritional advice, dietary supplements, medication, yoga, and purification techniques. Ayurvedic strategies are often used to treat osteoarthritis (OA) of the knee; however, no systematic data are available on their effectiveness in comparison with standard care. The aim of this study is to evaluate the effectiveness of complex Ayurvedic treatment in comparison with conventional methods of treating OA symptoms in patients with knee osteoarthritis. Methods and design In a prospective, multicenter, randomized controlled trial, 150 patients between 40 and 70 years, diagnosed with osteoarthritis of the knee, following American College of Rheumatology criteria and an average pain intensity of ≥40 mm on a 100 mm visual analog scale in the affected knee at baseline will be randomized into two groups. In the Ayurveda group, treatment will include tailored combinations of manual treatments, massages, dietary and lifestyle advice, consideration of selected foods, nutritional supplements, yoga posture advice, and knee massage. Patients in the conventional group will receive self-care advice, pain medication, weight-loss advice (if overweight), and physiotherapy following current international guidelines. Both groups will receive 15 treatment sessions over 12 weeks. Outcomes will be evaluated after 6 and 12 weeks and 6 and 12 months. The primary endpoint is a change in the score on the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) after 12 weeks. Secondary outcome measurements will use WOMAC subscales, a pain disability index, a visual analog scale for pain and sleep quality, a pain experience scale, a quality-of-life index, a profile of mood states, and Likert scales for patient satisfaction, patient diaries, and safety. Using an adapted PRECIS scale, the trial was identified as lying mainly in the middle of the efficacy-effectiveness continuum. Discussion This trial is the first to compare the effectiveness of a complex Ayurvedic intervention with a complex conventional intervention in a Western medical setting in patients with knee osteoarthritis. During the trial design, aspects of efficacy and effectiveness were discussed. The resulting design is a compromise between rigor and pragmatism. Trial registration NCT01225133

Summary Objective Non-opioid analgesics (NOAs) are widely used to palliate osteoarthritis (OA) pain, however, their role in health-related quality of life (HRQoL) in OA has not been well studied. Here, we assess the relationship of pain, physical function, and HRQoL to NOA use in symptomatic knee OA. Methods NOA dose, pain, physical function, and HRQoL were evaluated longitudinally over 1 year in medial knee OA. Doses provided by subjects' weekly medication diaries were normalized to equi-analgesic ibuprofen-equivalents (IEs). Descriptive analyses at baseline, 1.5, and 12 months, and non-parametric comparisons of NOA with pain, physical function, and HRQoL at 1.5 months and over 12 months were performed. Results Seventy-one subjects (19 males and 52 females; mean 57±10.5 years) used an overall median of 300mg/week of IE. Twenty-five subjects reported no analgesic use during the study; of the 46 subjects that reported NOA use, the median intake was 1325mg/weekIE. Whereas age, Physical Functioning (PF) and HRQoL were predictive of NOA dose both at 1.5 months and during the entire study, pain level was not. The median NOA dose declined over 12 months ( P =0.02), however, the change was not associated with changes in PF, HRQoL or pain. Conclusion Greater age and worse physical function and HRQoL, but not pain severity, are predictive of NOA use in symptomatic knee OA. Longitudinally, NOA use does not change as a function of pain. These data suggest that pain is not the primary determinant of NOA use over time among OA patients.

Objectives: The knee can be injected at different anatomic sites with or without image-guidance. We undertook a systematic review to determine the accuracy of intra-articular knee injection (IAKI) and whether this varied by site, use of image-guidance, and experience of injectors, and whether accuracy of injection, site, or use of image-guidance influenced outcomes following IAKIs. Methods: Medline, Embase, AMED, CINAHL, Web of Knowledge, Cochrane Central Registers for Controlled Trials up to Dec 2012 were searched for studies that evaluated either accuracy of IAKIs or outcomes related to accuracy, knee injection sites, or use of image-guidance. Within-study and between-study analyses were performed. Results: Data from 23 publications were included. Within-study analyses suggested IAKIs at the superomedial patellar, medial midpatellar (MMP), superolateral patellar (SLP) and lateral suprapatellar bursae sites were more accurate when using image-guidance than when blinded (ranges of pooled risk difference 0.09-0.19). Pooling data across studies suggested blinded IAKIs at the SLP site were most accurate (87%) while MMP (64%) and anterolateral joint line (ALJL) sites were (70%) least accurate. Overall about one in five blinded IAKIs were inaccurate. There was some evidence that experience of the injector was linked with improved accuracy for blinded though not image-guided injections. Based on a small number of studies, short but not longer-term outcomes for ultrasound-guided were found to be superior to blinded IAKIs. Conclusions: Image-guided IAKIs are modestly more accurate than blinded IAKIs especially at the MMP and ALJL sites. Blinded injections at SLP site had good accuracy especially if performed by experienced injectors. Further studies are required to address the question whether accurate localization is linked with an improved response. © 2013 The Authors.

Summary We studied the efficacy and tolerability of glycosaminoglycan polysulfuric acid (GAGPS) in 80 patients with osteoarthritis (OA) of the knee. Patients received two series of five intra-articular injections, at 1-week intervals, of 25 mg (0.5 ml) GAGPS into the knee in a double-blind, parallel, randomized, placebo-controlled trial. There was an immediate decrease in pain after the injections of 43% with GAGPS and 33% with placebo ( P = 0.047) (Jezek pain index). Pain relief of GAGPS vs placebo was not different at other intervals (10, 14, 22, 26 weeks after start of treatment). At 6 weeks the Lequesne index decreased 20% after GAGPS and 9% after placebo ( P = 0.17). At 10 weeks the Lequesne index decreased 24% after GAGPS and 13% after placebo ( P = 0.20). The decrease in Lequesne index at 14 weeks was 31% after GAGPS and 15% after placebo ( P = 0.06). The other measured parameters tended to be more favorably influenced by GAGPS than placebo. GAGPS was well tolerated, with associated mild adverse reactions in 8% of cases. GAGPS may have a role as a symptomatic slow acting drug for OA. Further study appears appropriate.

Background Boiogito (Japanese herbal medicine, Tsumura Co. Tokyo, Japan) contains sinomenin which inhibits inflammatory reactions. Since sinomenine is a principle component of the Boiogito, there is a possibility of it being effective on osteoarthritis (OA) of the knee with joint effusion. However, there is no report concerning the effectiveness of Boiogito on knee OA. The objective of the present study is to investigate the therapeutic effect of Boiogito on OA of the knee associated with joint effusion in a comparative study among randomly assigned groups. Methods Study was performed using 50 patients who were diagnosed with primary osteoarthritis of the knee with joint effusion. The patients were randomly assigned to two groups: one group (25 patients) using both loxoprofen (2-{4-[(2-oxocyclopentyl) methyl]} propanoic acid) and Boiogito and the other group (25 patients) using loxoprofen, and were evaluated during a 12 week observation period. The assessment parameters including knee scores in the Knee Society Rating System including Knee score and Functional scores, amount of joint effusion by joint puncture in clinically detected cases, the 36-items short form of the Medical Outcome Study Questionnaire (SF-36) as a measurement of health related quality of life were used. Results The knee scores based on the Knee Society Rating System were improved in both groups. The staircase climbing up and down ability in the Knee society rating system functional score was significantly improved in the group using Boiogito and loxoprofen compared to the loxoprofen group. In the evaluation using SF-36, significant improvements were found in the scores in both groups in physical functioning after 12 weeks. The amount of joint fluid was significantly decreased at 4, 8 and 12 weeks compared to pre-administration baseline in the group using Boiogito and loxoprofen. A side effect of Boiogito, dry mouth, was found in one case. The symptom was mild and improved immediately after discontinuation of administration. Conclusion The results indicated that Boiogito have a possibility for a treatment modality for joint effusion with osteoarthritis of the knee.