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Elphingstone JW, Alston ET, Colorado BS. Platelet-rich plasma for nonoperative management of degenerative meniscal tears: A systematic review. J Orthop 2024; 54:67-75. [PMID: 39036807 PMCID: PMC11259654 DOI: 10.1016/j.jor.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 07/23/2024] Open
Abstract
Background Meniscus tears are a common cause of knee pain encountered in orthopedics and sports medicine. There are numerous management strategies, from physical therapy and oral medications to surgery. Recent evidence is more favorable for conservative management, as operative treatment has limited clinical benefits and is associated with an accelerated progression toward osteoarthritis. Injections with orthobiologic therapies, such as platelet-rich plasma (PRP), are emerging as an alternative therapeutic tool for degenerative tears. This study aims to evaluate the latest evidence regarding the efficacy of PRP injections for the nonoperative management of degenerative meniscal pathology. Data sources Articles were obtained from Embase, PubMed, World of Science, Cochrane, and Galileo databases after searching "Platelet-rich plasma" AND "Meniscus." Inclusion criteria consisted of original, human studies evaluating the use of platelet-rich plasma for nonoperative management of meniscus tears. Main results A total of 384 articles were screened, with ten studies selected for final inclusion. The pooled study population comprised 686 patients, with an average age ranging from 33 to 53 years, and a 38% female population. Three different injection approaches were utilized, categorized as intra-articular alone (IA), intra-meniscal alone (IM), or a combination of both. Most studies demonstrated improved pain and functionality by 3 months that persisted for at least one year. Within the IA and IM groups, the majority of patients were either radiographically stable (30-70%) or demonstrated interval healing (40-60%). Several studies within IM and combined treatment groups evaluated rates and time to arthroscopy, and found lower failure rates and greater arthroscopy-free survival time than control comparison groups. Conclusion PRP appears to be a safe and efficacious treatment strategy for degenerative meniscal pathology. However, due to diverse periprocedural techniques, PRP injectate characteristics, and a lack of high-quality studies, additional trials are needed to provide greater a degree of confidence in PRP's clinical impact on patients with meniscus tears. Level of evidence Systematic Review.
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Affiliation(s)
| | | | - Berdale S. Colorado
- University of Alabama at Birmingham, Department of Physical Medicine and Rehabilitation, Birmingham, AL, USA
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2
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De la Corte-Rodriguez H, Rodriguez-Merchan EC, Alvarez-Roman MT, Gomez-Cardero P, Jimenez-Yuste V. Ultrasound-guided joint procedures in hemophilia: technique, indications and tips. Expert Rev Hematol 2024:1-12. [PMID: 39008070 DOI: 10.1080/17474086.2024.2380477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/11/2024] [Indexed: 07/16/2024]
Abstract
INTRODUCTION The therapeutic approach to pain in hemophilia should be multimodal. Intra-articular injections are a good option when joint lesions do not respond to hematological treatment or rehabilitation and orthopedic surgery is not yet indicated. Performing these procedures under ultrasound guidance has been shown to improve their accuracy and efficacy. AREAS COVERED This article provides a practical overview of the most frequently employed ultrasound-guided intra-articular procedures on the joints of people with hemophilia. The article describes the key elements for performing the technique on the elbow, knee and ankle as the most affected joints. The particularities of the most frequent indications, arthrocentesis, synoviorthesis and analgesic injections with various products are detailed. EXPERT OPINION Current hematological treatments have made it possible to incorporate new therapeutic tools for pain relief for people with hemophilia, including ultrasound-guided joint procedures, which offer excellent results.
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Oo WM, Linklater J, Siddiq MAB, Fu K, Hunter DJ. Comparison of ultrasound guidance with landmark guidance for symptomatic benefits in knee, hip and hand osteoarthritis: Systematic review and meta-analysis of randomised controlled trials. Australas J Ultrasound Med 2024; 27:97-105. [PMID: 38784696 PMCID: PMC11109994 DOI: 10.1002/ajum.12386] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Introduction More than half of the patients with moderate and severe osteoarthritis (OA) report unsatisfactory pain relief, requiring consideration of intra-articular (IA) injections as the second-line management. Ultrasound-guided IA injection has proven evidence of higher accuracy in administering IA injectates into the joints than landmark-guided or blind IA injections. However, questions remain about translating higher accuracy rates of ultrasound-guided injection into better clinical improvements. Therefore, we examined the symptomatic benefits (pain, function and patient satisfaction) of ultrasound-guided injection in knee, hip and hand OA compared with blind injections by synthesising a systematic review and meta-analysis of randomised controlled trials (RCT). Methods PubMed, Medline and Embase databases were searched for eligible studies from their inception to August 28, 2023. Results Out of 295 records, our meta-analysis included four RCTs (338 patients with knee OA), demonstrating significant improvement in procedural pain [-0.89 (95% CI -1.25, -0.53)], pain at follow-up [-0.51 (95% CI -0.98, -0.04)] and function [1.30 (95% CI 0.86, 1.73)], favouring ultrasound guidance. One single study showed higher patient satisfaction with ultrasound guidance. Conclusion Ultrasound-guided IA injection provided superior clinical outcomes compared with landmark-guided IA injection.
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Affiliation(s)
- Win Min Oo
- Department of Physical Medicine and Rehabilitation, Mandalay General HospitalUniversity of MedicineMandalayMyanmar
- Rheumatology Department, Royal North Shore Hospital, and Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | | | - Md Abu Bakar Siddiq
- Rheumatology Department, Royal North Shore Hospital, and Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | - Kai Fu
- Rheumatology Department, Royal North Shore Hospital, and Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
- Department of Orthopedic SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - David J. Hunter
- Rheumatology Department, Royal North Shore Hospital, and Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
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Ye Z, Chen H, Qiao Y, Wu C, Cho E, Wu X, Li Z, Wu J, Lu S, Xie G, Dong S, Xu J, Zhao J. Intra-Articular Platelet-Rich Plasma Injection After Anterior Cruciate Ligament Reconstruction: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2410134. [PMID: 38728032 PMCID: PMC11087838 DOI: 10.1001/jamanetworkopen.2024.10134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/07/2024] [Indexed: 05/12/2024] Open
Abstract
Importance Platelet-rich plasma (PRP) has been considered a promising treatment for musculoskeletal disorders. The effects of PRP on clinical outcomes of anterior cruciate ligament reconstruction (ACLR) are controversial. Objective To compare subjective outcomes and graft maturity in patients undergoing ACLR with and without postoperative intra-articular PRP injection. Design, Setting, and Participants This surgeon- and investigator-masked randomized clinical trial included patients treated at a national medical center in China who were aged 16 to 45 years and scheduled to undergo ACLR. Participants were enrolled between March 21, 2021, and August 18, 2022, and followed up for 12 months, with the last participant completing follow-up on August 28, 2023. Interventions Participants were randomized 1:1 to the PRP group (n = 60), which received 3 doses of postoperative intra-articular PRP injection at monthly intervals, or to the control group (n = 60), which did not receive postoperative PRP injection. Both groups had the same follow-up schedule. Main Outcomes and Measures The primary outcome was the mean score for 4 subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS4) (range, 0-100, with higher scores indicating better knee function and fewer symptoms) at 12 months postoperatively. Secondary outcomes were patient-reported outcomes, graft maturity (on magnetic resonance imaging), and physical examinations at 3, 6, and 12 months. Results Among the 120 randomized participants (mean [SD] age, 29.0 [8.0] years; 84 males [70%]), 114 (95%) were available for the primary outcome analysis. The mean KOOS4 scores at 12 months were 78.3 (SD, 12.0; 95% CI, 75.2-81.4) in the PRP group and 76.8 (SD, 11.9; 95% CI, 73.7-79.9) in the control group (adjusted mean between-group difference, 2.0; 95% CI, -2.3 to 6.3; P = .36). Secondary outcomes were not statistically significantly different between the 2 groups except for sports and recreation level and graft maturity at 6 months. Intervention-related adverse events included pain at the injection site and knee swelling after injection. Conclusions and Relevance In this randomized clinical trial among patients undergoing ACLR, the addition of postoperative intra-articular PRP injection did not result in superior improvement of knee symptoms and function at 12 months compared with no postoperative injection. Further studies are required to determine appropriate indications for PRP in musculoskeletal disorders. Trial Registration Chinese Clinical Trial Registry Identifier: ChiCTR2000040262.
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Affiliation(s)
- Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiang Chen
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Qiao
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenliang Wu
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Eunshinae Cho
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiulin Wu
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyun Li
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinlong Wu
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Simin Lu
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoming Xie
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shikui Dong
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Walter WR, Burke CJ, Adler RS. Tips and tricks in ultrasound-guided musculoskeletal interventional procedures. J Ultrason 2023; 23:e347-e357. [PMID: 38020507 PMCID: PMC10668939 DOI: 10.15557/jou.2023.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/09/2023] [Indexed: 12/01/2023] Open
Abstract
Ultrasound visualization affords proceduralists versatile and accurate guidance for a variety of percutaneous, minimally invasive procedures in the musculoskeletal system including joint (intra-articular) injections or aspirations, intra-bursal injections, peritendinous, and perineural injections. A variety of percutaneous procedures are traditionally performed blindly, but may be more easily or more accurately performed with the real-time assistance of ultrasound guidance. Other procedures are only possible utilizing image-guidance, due to the required precision of the injection because of delicate local anatomy or depth of the injection; ultrasound is a safe, portable, and widespread modality that can be used to assist the proceduralist in localizing the needle tip in such cases, to ensure safe and accurate delivery of the medication, most frequently a solution of steroid and anesthetic. This review aims to provide a foundational approach to ultrasound-guided procedures in the musculoskeletal system, offering tips and tricks that can be employed in many different procedures including intra-articular, juxta-articular, and perineural injections for a multitude of clinical scenarios. Technical considerations regarding ultrasound transducer selection, sonographic technique, as well as common indications, contraindications, and complications of these procedures, are presented. Additionally, a variety of pharmacologic considerations for proceduralists contemplating ultrasound-guided injections are discussed.
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Wang CC, Hu TM, Chen CL, Hong CC, Chang YH, Kao CL. Concurrent Imaging and Clinical Study of the Efficacy of Hyaluronic Acid Injection for Knee Osteoarthritis: A Synovial Membrane Investigation with Ultrasound Imaging. Pharmaceuticals (Basel) 2023; 16:1186. [PMID: 37631101 PMCID: PMC10459875 DOI: 10.3390/ph16081186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/12/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
We investigated whether hyaluronic acid (HA) injections can ameliorate ultrasound-detected synovitis in knee osteoarthritis (OA). We recruited 103 patients with symptomatic knee OA and ultrasound-detected synovitis and performed two ultrasound-guided fluid drainage procedures, followed by the administration of a low-molecular-weight HA injection (2.5 mL) in the subpatellar bursa, at a 2-week interval. Knee ultrasound imaging evaluations were performed before injection (baseline) and at 1 and 6 months after the second injection and included the measurements of synovial vascularity by using color Doppler ultrasound, synovial fluid depth over the suprapatellar bursa (SF), and synovial hypertrophy (SH). Initial clinical assessments included a visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). VAS scores decreased significantly at both 1-month and 6-month evaluations (p < 0.001). WOMAC scores also significantly decreased at 1 month (p < 0.001), but not at 6 months (p = 0.23). The ultrasound parameters did not significantly change, except color Doppler grading, which tended to decrease at the 6-month evaluation (p = 0.059). Our findings revealed that two ultrasound-guided HA injections following fluid drainage improved pain and knee function but did not considerably influence imaging-detected synovitis in patients with knee OA.
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Affiliation(s)
- Chien-Chih Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital Yuli Branch, Hualien 981002, Taiwan;
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Tsung-Ming Hu
- Department of Psychiatry, Taipei Veterans General Hospital Yuli Branch, Hualien 981002, Taiwan;
- Department of Future Studies and LOHAS Industry, Fo Guang University, Yilan 262307, Taiwan
| | - Chien-Lung Chen
- Taipei Hospital, Ministry of Health and Welfare, New Taipei City 24213, Taiwan;
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Chung-Chih Hong
- Tri-Service General Hospital Songshan Branch, Taipei 10508, Taiwan;
| | - Yu-Hui Chang
- Department of Nursing, Taipei Veterans General Hospital, Taipei 11220, Taiwan;
| | - Chung-Lan Kao
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Section 2, Shi-Pai Road, Taipei 11220, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Chiao Tung University, Hsinchu 30010, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
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7
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Patel A, Chadwick N, von Beck K, Goswami P, Soliman SB, Patel A, McGill KC. Ultrasound-guided joint interventions of the lower extremity. Skeletal Radiol 2023; 52:911-921. [PMID: 36042035 DOI: 10.1007/s00256-022-04168-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 02/02/2023]
Abstract
The purpose of this article is to better understand the role ultrasound plays in lower extremity joint interventions. Ultrasound is an important and reliable tool diagnostically and therapeutically. Real-time feedback, lack of ionizing radiation, and dynamic maneuverability make ultrasound an important tool in the proceduralist's armament. This article will touch upon the important anatomic considerations, clinical indications, and technical step-by-step details for lower extremity ultrasound interventions. Specifically, we will look at interventions involving the hip, knee, ankle, and foot. In addition, this article will discuss the roles corticosteroid and platelet-rich plasma may play in certain interventions.
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Affiliation(s)
- Ashish Patel
- Division of Musculoskeletal Imaging, Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Nicholson Chadwick
- Division of Musculoskeletal Imaging, Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kelly von Beck
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Pulak Goswami
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Steven B Soliman
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Arjun Patel
- Division of Musculoskeletal Imaging, Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kevin C McGill
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
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Smith M, Innes S, Wildman S, Baker D. A proposed framework for point of care musculoskeletal ultrasound and ultrasound image-guided interventions by physiotherapists: scope of practice, education and governance. Ultrasound J 2023; 15:15. [PMID: 36939971 PMCID: PMC10027973 DOI: 10.1186/s13089-023-00311-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/12/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND The use of point of care ultrasound (PoCUS) in the management of musculoskeletal (MSK) disorders is a diverse area of PoCUS practice. Its use by clinicians, such as physiotherapists, can occur across a wide range of roles and care pathway configurations; however, professional, educational and regulatory uncertainties can leave clinicians, managers and patients at risk. MAIN BODY A PoCUS framework approach (previously applied to support PoCUS consolidation and expansion) is used to frame these proposals. Central to this is the defining of (clinical and sonographic) scope of practice (ScoP). A number of indicative ScoPs are described to both (i) illustrate application of the principles and (ii) provide templates for ScoP derivations for individual services or clinicians. Image-guided MSK interventions are increasingly an aspect of MSK physiotherapy PoCUS. Given the utility of physiotherapists drawing upon their imaging to fully inform the selection (and performance) of such techniques, we present a rationale for competency in undertaking sonographic differentials as a pre-cursor to performing ultrasound image-guided MSK interventions. Alignment of ScoP with the relevant education and formal competency assessments are a cornerstone of the PoCUS framework approach; as such, key aspects of MSK PoCUS education and competency assessment are outlined. Strategies for addressing such requirements in healthcare settings where formal provision is not accessible, are also presented. Governance considerations are aligned with the regulatory environment, including those pertaining to professional guidance and insurance considerations. In addition, generic quality assurance elements are emphasised, as core aspects of high-quality service provision. Whilst the paper clarifies the situation for MSK physiotherapists using PoCUS in the UK, prompts are provided to support other professional groups working in MSK services in the United Kingdom (UK) and MSK physiotherapists/physical therapists in other countries-to facilitate their application of the principles. CONCLUSION Acknowledging the breadth of MSK physiotherapy PoCUS practice, this paper draws upon a framework approach to provide integrated ScoP, education/competency and governance solutions, along with mechanisms for other professions working with MSK PoCUS-and physiotherapists/physical therapists outside of the UK-to consolidate and expand their practice.
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Affiliation(s)
- Mike Smith
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK.
| | - Sue Innes
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
| | - Stuart Wildman
- Homerton University Hospital NHS Foundation Trust, London, UK
- Royal Surrey NHS Foundation Trust, Guilford, UK
- Brunel University, London, UK
| | - David Baker
- Brunel University, London, UK
- Complete Physio Limited, London, UK
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9
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Martin J, Malanga G. Orthobiologic Standardization and Clinical Outcome Measurement. Phys Med Rehabil Clin N Am 2023; 34:285-290. [DOI: 10.1016/j.pmr.2022.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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10
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Protocols and Techniques for Orthobiologic Procedures. Phys Med Rehabil Clin N Am 2023; 34:105-115. [DOI: 10.1016/j.pmr.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Lam KHS, Wu YT, Reeves KD, Hadzic A, Perez MF, Fu SN. A novel infrapatellar approach of ultrasound-guided intra-articular injection of the knee from both lateral and medial side: a case series. Ther Adv Musculoskelet Dis 2023; 15:1759720X221149954. [PMID: 36793993 PMCID: PMC9923012 DOI: 10.1177/1759720x221149954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 12/21/2022] [Indexed: 02/01/2023] Open
Abstract
Knee osteoarthritis (OA) is common. Ultrasound-guided intra-articular injection (UGIAI) using the superolateral approach is currently the gold standard for treating knee OA, but it is not 100% accurate, especially in patients with no knee effusion. Herein, we present a case series of chronic knee OA treated with a novel infrapatellar approach to UGIAI. Five patients with chronic grade 2-3 knee OA, who had failed on conservative treatments and had no effusion but presented with osteochondral lesions over the femoral condyle, were treated with UGIAI with different injectates using the novel infrapatellar approach. The first patient was initially treated using the traditional superolateral approach, but the injectate was not delivered intra-articularly and became trapped in the pre-femoral fat pad. The trapped injectate was aspirated in the same session due to interference with knee extension, and the injection was repeated using the novel infrapatellar approach. All patients who received the UGIAI using the infrapatellar approach had the injectates successfully delivered intra-articularly, as confirmed with dynamic ultrasound scanning. Their Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, stiffness, and function scores significantly improved 1 and 4 weeks post-injection. UGIAI of the knee using a novel infrapatellar approach is readily learned and may improve accuracy of UGIAI, even for patients with no effusion.
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Affiliation(s)
| | - Yung-Tsan Wu
- Department of Physical Medicine and
Rehabilitation, Tri-Service General Hospital, School of Medicine, National
Defense Medical Center, Taipei, Taiwan,Integrated Pain Management Center, Tri-Service
General Hospital, School of Medicine, National Defense Medical Center,
Taipei, Taiwan,Department of Research and Development, School
of Medicine, National Defense Medical Center, Taipei, Taiwan
| | | | | | - Mario Fajardo Perez
- Ultradissection Group, Madrid, Spain,MOMARC, Madrid, Spain,Vithas Hospital, Madrid, Spain
| | - Sau Nga Fu
- Department of Family Medicine, The Chinese
University of Hong Kong, Shatin, Hong Kong,Department of Family Medicine, The University
of Hong Kong, Pokfulam, Hong Kong
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Khokhar NS, DePalma MJ. Joints. Regen Med 2023. [DOI: 10.1007/978-3-030-75517-1_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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13
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Raja AE, Emam M, Shustorovich A, Tatini AL, Coslick A, Dreher GM, Singh AD, Friedlander T, Morice K, Kim SY. A Hybrid Musculoskeletal Ultrasound Curriculum for Physical Medicine and Rehabilitation Residents-a Multi-center Pilot Program. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023; 11:51-61. [PMID: 36785739 PMCID: PMC9909640 DOI: 10.1007/s40141-023-00380-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 02/11/2023]
Abstract
Purpose of Review The increased use of musculoskeletal ultrasound (MSKUS) in clinical practice warrants achieving competency earlier in physiatrists' careers. Physical Medicine and Rehabilitation (PM&R) residency programs have started incorporating formal MSKUS training in their curricula; however, significant heterogeneity remains in MSKUS education. Recent Findings Numerous barriers contribute to the lack of consensus for MSKUS training during residency, but the COVID-19 pandemic severely disrupted in-person learning. As an adjunct or alternative to in-person learning, teleguided technology is being utilized. Summary This curriculum demonstrates the role of a hybrid MSKUS training with interinstitutional collaboration. Twenty PM&R learners, from two institutions, were divided into a fundamental or advanced track. Virtual didactic sessions alternated weekly with hands-on ultrasonographic scanning sessions. Following a 12-month longitudinal curriculum, an end-of-year practical examination was used for competency assessment, in addition to a survey assessing resident perceptions and feedback. To our knowledge, this is the first collaborative and hybrid MSKUS curriculum for PM&R learners that can be easily reproduced at most training institutions and circumvent some of the barriers amplified by the COVID-19 pandemic. Supplementary Information The online version contains supplementary material available at 10.1007/s40141-023-00380-z.
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Affiliation(s)
- Altamash E Raja
- Department of Rehabilitation Medicine, Neuromusculoskeletal Institute, Rowan University School of Osteopathic Medicine, Sewell, NJ USA
| | - Mohammed Emam
- Department of Physical Medicine & Rehabilitation, The Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 120, Baltimore, MD USA
| | - Alexander Shustorovich
- Center for Sports & Spine Medicine, Department of Physical Medicine & Rehabilitation, JFK Johnson Rehabilitation Institute/Hackensack Meridian, Edison, USA
| | - Anisa L Tatini
- Department of Physical Medicine & Rehabilitation, The Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 120, Baltimore, MD USA
| | - Alexis Coslick
- Department of Physical Medicine & Rehabilitation, Department of Orthopaedics, The Johns Hopkins University School of Medicine, Baltimore, USA
| | - Geoffrey M Dreher
- Department of Family and Community Medicine, Sports Medicine, Penn Medicine Lancaster General Health, Lancaster, USA
| | - Adeepa D Singh
- Brain and Spine Surgeons of New York, Department of Physical Medicine & Rehabilitation and Pain Medicine, White Plains Hospital, White Plains, USA
| | - Tracy Friedlander
- Department of Physical Medicine & Rehabilitation, The Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 120, Baltimore, MD USA
| | - Karen Morice
- Department of Rehabilitation Medicine, Burke Rehabilitation Hospital, White Plains, USA
| | - Soo Yeon Kim
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY USA
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14
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Calder D, Fathi A, Oveissi F, Maleknia S, Abrams T, Wang Y, Maitz J, Tsai KHY, Maitz P, Chrzanowski W, Canoy I, Menon VA, Lee K, Ahern BJ, Lean NE, Silva DM, Young PM, Traini D, Ong HX, Mahmoud RS, Montazerian H, Khademhosseini A, Dehghani F, Dehghani F. Thermoresponsive and Injectable Hydrogel for Tissue Agnostic Regeneration. Adv Healthc Mater 2022; 11:e2201714. [PMID: 36148581 DOI: 10.1002/adhm.202201714] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/16/2022] [Indexed: 01/28/2023]
Abstract
Injectable hydrogels can support the body's innate healing capability by providing a temporary matrix for host cell ingrowth and neovascularization. The clinical adoption of current injectable systems remains low due to their cumbersome preparation requirements, device malfunction, product dislodgment during administration, and uncontrolled biological responses at the treatment site. To address these challenges, a fully synthetic and ready-to-use injectable biomaterial is engineered that forms an adhesive hydrogel that remains at the administration site regardless of defect anatomy. The product elicits a negligible local inflammatory response and fully resorbs into nontoxic components with minimal impact on internal organs. Preclinical animal studies confirm that the engineered hydrogel upregulates the regeneration of both soft and hard tissues by providing a temporary matrix to support host cell ingrowth and neovascularization. In a pilot clinical trial, the engineered hydrogel is successfully administered to a socket site post tooth extraction and forms adhesive hydrogel that stabilizes blood clot and supports soft and hard tissue regeneration. Accordingly, this injectable hydrogel exhibits high therapeutic potential and can be adopted to address multiple unmet needs in different clinical settings.
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Affiliation(s)
- Dax Calder
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, NSW, 2006, Australia.,Faculty of Medicine and Health, Nano Institute, The University of Sydney, Sydney, NSW, 2006, Australia.,Faculty of Health and Medical Sciences, School of Biomedical Sciences, University of Western Australia, Perth, WA, 6009, Australia
| | - Ali Fathi
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, NSW, 2006, Australia.,Tetratherix, Sydney, NSW, 2015, Australia
| | - Farshad Oveissi
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, NSW, 2006, Australia
| | | | | | - Yiwei Wang
- Burns and Reconstructive Surgery Research Group, ANZAC Research Institute, Concord, NSW, 2139, Australia
| | - Joanneke Maitz
- Burns and Reconstructive Surgery Research Group, ANZAC Research Institute, Concord, NSW, 2139, Australia
| | - Kevin Hung-Yueh Tsai
- Burns and Reconstructive Surgery Research Group, ANZAC Research Institute, Concord, NSW, 2139, Australia
| | - Peter Maitz
- Burns and Reconstructive Surgery Research Group, ANZAC Research Institute, Concord, NSW, 2139, Australia
| | - Wojtek Chrzanowski
- Faculty of Medicine and Health, Nano Institute, The University of Sydney, Sydney, NSW, 2006, Australia.,Faculty of Health and Medical Sciences, School of Biomedical Sciences, University of Western Australia, Perth, WA, 6009, Australia
| | - Ivan Canoy
- Anatomical Pathology, NSW Health Pathology, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
| | - Vivek Ashoka Menon
- Anatomical Pathology, NSW Health Pathology, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia
| | - Kenneth Lee
- Anatomical Pathology, NSW Health Pathology, Concord Repatriation General Hospital, Concord, NSW, 2139, Australia.,School of Medicine, University of Sydney, Sydney, NSW, 2006, Australia
| | - Benjamin J Ahern
- School of Veterinary Science, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Natasha E Lean
- School of Veterinary Science, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Dina M Silva
- Macquarie Medical School, Faculty of Medicine and Health, Macquarie University & Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, 2037, Australia.,Ab Initio Pharma, Camperdown, NSW, 2050, Australia
| | - Paul M Young
- Macquarie Medical School, Faculty of Medicine and Health, Macquarie University & Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, 2037, Australia.,Ab Initio Pharma, Camperdown, NSW, 2050, Australia
| | - Daniela Traini
- Macquarie Medical School, Faculty of Medicine and Health, Macquarie University & Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, 2037, Australia.,Ab Initio Pharma, Camperdown, NSW, 2050, Australia
| | - Hui Xin Ong
- Macquarie Medical School, Faculty of Medicine and Health, Macquarie University & Woolcock Institute of Medical Research, The University of Sydney, Glebe, NSW, 2037, Australia.,Ab Initio Pharma, Camperdown, NSW, 2050, Australia
| | | | - Hossein Montazerian
- Terasaki Institute for Biomedical Innovation, Los Angeles, CA, 90024, USA.,Department of Bioengineering, University of California, Los Angeles, CA, 90095, USA.,California NanoSystems Institute (CNSI), University of California, Los Angeles, CA, 90095, USA
| | - Ali Khademhosseini
- Terasaki Institute for Biomedical Innovation, Los Angeles, CA, 90024, USA
| | - Fariba Dehghani
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Fariba Dehghani
- School of Chemical and Biomolecular Engineering, The University of Sydney, Sydney, NSW, 2006, Australia
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15
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Raja AE, Meyer R, Tunis BG, Moreland ML, Tunis JG. Prone Lachman with Ultrasound: A Literature Review and Description of the Technique. Curr Sports Med Rep 2022; 21:336-342. [PMID: 36083709 DOI: 10.1249/jsr.0000000000000992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Magnetic resonance imaging is the current gold standard imaging modality for diagnosing anterior cruciate ligament (ACL) tears. However, ultrasound has grown in popularity for detecting ACL injuries because of its low cost, portability, and dynamic assessment capabilities. Recent studies demonstrate high sensitivity and specificity for diagnosing isolated ACL tears via ultrasound, but tremendous heterogeneity remains for optimal technique including patient positioning, transducer placement, and dynamic versus static ultrasound usage. As ultrasound becomes ubiquitous in clinics, training rooms, and on the sidelines, identifying objective and sensitive measurements to appropriately screen athletes for significant knee injuries is imperative. This article aims to review the current role of diagnostic ultrasound in ACL injuries and propose a standardized version of the Prone Lachman with Ultrasound test, which is an objective, reliable, and easily reproducible technique to evaluate ACL competency. Developing a standardized protocol will expand the use of point-of-care ultrasound, which may reduce cost and improve efficiency in care.
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Affiliation(s)
- Altamash E Raja
- Primary Care Sports Medicine, Geisinger Wyoming Valley, Wilkes-Barre, PA
| | - Ryan Meyer
- Primary Care Sports Medicine, Geisinger Wyoming Valley, Wilkes-Barre, PA
| | - Brandon G Tunis
- Primary Care Sports Medicine, Geisinger Wyoming Valley, Wilkes-Barre, PA
| | - Michael L Moreland
- Primary Care Sports Medicine, Geisinger Wyoming Valley, Wilkes-Barre, PA
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16
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Sebro R, de la Garza-Ramos C. Statistically based nomograms for the minimal needle length required to achieve intra-articular fluoroscopic-guided injections of the shoulder, hip, and knee. PM R 2022. [PMID: 35706365 DOI: 10.1002/pmrj.12864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/09/2022] [Accepted: 05/31/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Image-guided intra-articular injections are commonly performed to reduce pain in patients with arthritis or other joint-related pathology. Utilizing a needle length that is too short could lead to increased patient discomfort, increased procedural time, and extra-articular injections. OBJECTIVE To predict the minimum needle length required for fluoroscopic-guided intra-articular injections of the hips, knees, and shoulders based on patient age, gender, height and weight, or BMI; and to evaluate whether this varies by gender. STUDY DESIGN Cross-sectional study. SETTING Tertiary care academic center. PARTICIPANTS 600 consecutive patients with available magnetic resonance imaging (MRI) of the hips, knees, and shoulders (100 males and 100 females for each joint). METHODS The distance from the skin to the joint (glenohumeral, hip and knee) and the thickness of the subcutaneous fat pad (distance from the skin to the muscle) along the injection path were measured. Multivariable linear ridge regression with 10-fold cross-validation was used to predict the distance from the skin to the hip, knee, and glenohumeral joints using age, gender, weight, and height; or using age, gender, and BMI. RESULTS The data show that the subcutaneous fat thickness and the distance from the skin to all joints increase with weight (P < 0.001) and BMI (P < 0.001). Subcutaneous fat pads around the anterior shoulder (P < 0.02) and knee (<0.001) are thicker in women than in men. CONCLUSIONS Patient habitus, in particular weight and BMI, are strong predictors of the thickness of the subcutaneous fat pads and consequently strong predictors of the distance from the skin to the joint. Subcutaneous fat pad thickness around the shoulders and knees varies by gender. We present nomograms showing the minimal needle length required to achieve intra-articular injections of the hip, knee and glenohumeral joints. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ronnie Sebro
- Mayo Clinic, 4500 San Pablo S, Jacksonville, Florida, United States.,Center for Augmented Intelligence, Mayo Clinic, 4500 San Pablo S, Jacksonville, Florida, United States
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17
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Delesky EM, Gaughan J, Roberts B, Sodhi S. Comparison of knee arthrocentesis first‐attempt success between Ultrasound‐Guided, Ultrasound‐Localised and Landmark‐Guided techniques in the novice: A crossover study with random order of events. Australas J Ultrasound Med 2022; 25:74-79. [PMID: 35722054 PMCID: PMC9201202 DOI: 10.1002/ajum.12294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction/Purpose To compare knee arthrocentesis first-attempt success using landmark-guided, ultrasound-localised and ultrasound-guided techniques when performed by third-year medical students. Methods In this prospective, crossover study with randomised order of events, medical students performed three different arthrocentesis techniques on knee models: landmark-guided, ultrasound-localised and ultrasound-guided. Each subject attempted the techniques in a randomly assigned permutation at both high- and low-volume simulated knee effusions. The data were analysed with general estimating equations, which produced odds ratios comparing first-attempt success between different techniques at all effusion volumes. Results Ninety four of 111 third-year medical students were enrolled. Proportions of first-attempt success for the landmark-guided, US-localised and US-guided were 72%, 86% and 75%, respectively. For all effusion volumes, US-localised demonstrated a statistically significant increase in first-attempt success over the landmark-guided technique, OR = 2.38 (95% CI: 1.52-3.70). There was a greater increase in first-attempt success at low-volume effusions, OR = 2.86 (95% CI: 1.47-5.56), but no significant increase at high-volume effusions: OR = 1.85 (95% CI: 1.00-3.45). For all effusion volumes, US-guided demonstrated no difference to first-attempt success compared with landmark, OR = 1.15 (95% CI: 0.71-1.85). At low-volume effusions, US-guided demonstrated a statistically significant increase in first-attempt success over landmark-guided, OR = 2.17 (95% CI: 1.10-4.35), with no significant difference at high volumes, OR: 0.55 (95% CI: 0.28-1.06). Discussion The data presented here suggest that in this simulated knee model of arthrocentesis, ultrasound-guided approaches tend to have best efficacy at lower volume effusions, while ultrasound localized tends to do best at higher volume effusions, and both tended to perform better than the landmark technique. This study specifically looked at novices to both arthrocentesis and ultrasound, so extrapolating these results to other groups would require more study, but suggests that ultrasound incorporation into arthrocentesis benefits may offer some benefits for success rates and first attempt success. Conclusion In simulated knee arthrocentesis, ultrasound-guided techniques increased first-attempt success over landmark-guided techniques among medical students. This increase was most evident for arthrocentesis of smaller volume effusions.
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Affiliation(s)
| | - John Gaughan
- Cooper University Hospital Camden New Jersey USA
| | | | - Sarab Sodhi
- Cooper University Hospital Camden New Jersey USA
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