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Natural Compounds Affecting Inflammatory Pathways of Osteoarthritis. Antioxidants (Basel) 2022; 11:antiox11091722. [PMID: 36139796 PMCID: PMC9495743 DOI: 10.3390/antiox11091722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
Osteoarthritis (OA) is the most common type of arthritis and chronic joint disease, affecting more than 240 million people worldwide. Although there are numerous advances in using drugs in treating OA, the use of natural compounds has aroused much interest among researchers due to their safety margin. Recent discovery shows that natural compounds play an extensive role in the oxidative stress signaling pathway in treating OA. Thus, this review summarizes the commonly used natural compounds for treating OA focusing on the oxidative stress signaling pathway and its downstream mediators. Selected databases—such as Scopus, Web of Science, Nature, and PubMed—were used to search for potentially relevant articles. The search is limited to the last 15 years and the search was completed using the Boolean operator’s guideline using the keywords of natural product AND oxidative stress AND osteoarthritis OR natural extract AND ROS AND degenerative arthritis OR natural plant AND free radicals AND degenerative joint disease. In total, 37 articles were selected for further review. Different downstream mechanisms of oxidative stress involved in the usage of natural compounds for OA treatment and anabolic and catabolic effects of natural compounds that exhibit chondroprotective effects have been discussed with the evidence of in vitro and in vivo trials in this review.
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Mansur H, Maranho DA, de Castro Junior IM, Gomes FF. May the Symptomatic Subtalar Joint Be Conservatively Treated With Intra-Articular Hyaluronic Acid Injections After a Calcaneus Fracture? Foot Ankle Spec 2022:19386400211068256. [PMID: 35125018 DOI: 10.1177/19386400211068256] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Subtalar pain following intra-articular calcaneus fractures may be associated with disability, pain, and a negative impact on the quality of life. Salvage procedures as subtalar fusion are associated with further consequences as stiffness, altered ankle biomechanics, and adjacent articular overloading with degenerative changes. The objective of the present study is to evaluate the short-term effects of viscosupplementation with intra-articular hyaluronic acid (HA) on function and pain, in patients with painful subtalar joint after calcaneus fracture. METHODS We searched for patients who underwent osteosynthesis of intra-articular calcaneus fracture between January 2011 and July 2015 and were diagnosed during the follow-up with pain and subtalar osteoarthritis. Between January and December of 2018, 13 patients (50 ± 10 years) accepted to participate in this study and received intra-articular HA injections. Three consecutive doses of 20 mg of HA were administered within a week interval, through anterolateral injections into the subtalar joint. We prospectively evaluated the function using the ankle/hindfoot American Orthopaedic Foot & Ankle Society score (AOFAS) and level of pain using the visual analog scale (VAS) before the intervention and 4, 12, and 24 weeks after the first injection. RESULTS Hindfoot function improved with an increase of AOFAS from 55 ± 19 before the intervention to 88 ± 20 at the 24th week (P = .001). Similarly, we observed relief of pain during the 24 weeks following intra-articular hyaluronic acid injection, with a decrease in VAS from 8.3 ± 1.3 before treatment to 2.2 ± 3.0 at the 24th week (P = .001). CONCLUSION For patients experiencing pain and dysfunction with subtalar osteoarthritis after intra-articular calcaneus fracture, viscosupplementation with intra-articular HA may be associated with improvement in function and pain in the short term. Furthermore, patients with higher grades of osteoarthritis may have limited benefit in pain relief and function improvement. LEVEL OF EVIDENCE IV, Case series.
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Affiliation(s)
- Henrique Mansur
- Department of Orthopedic Surgery, Hospital DF Star and Santa Helena, Brasília, Brazil
- Department of Foot and Ankle Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
| | | | | | - Fernanda Ferreira Gomes
- Department of Foot and Ankle Surgery, National Institute of Traumatology and Orthopedics, Rio de Janeiro, Brazil
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Ong KL, Runa M, Xiao Z, Ngai W, Lau E, Altman RD. Severe Acute Localized Reactions Following Intra-Articular Hyaluronic Acid Injections in Knee Osteoarthritis. Cartilage 2021; 13:1474S-1486S. [PMID: 32063023 PMCID: PMC8808807 DOI: 10.1177/1947603520905113] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Concerns have been raised about severe acute localized reactions (SALR) following intra-articular (IA) hyaluronic acid (HA) injections for knee osteoarthritis (OA). We compared surrogate SALR measures between hylan G-F 20 and non-hylan G-F 20 HA patients and evaluated corresponding SALR risk factors for hylan G-F 20 patients. DESIGN Knee OA patients were identified from the Optum Clinformatics dataset (January 2006 to June 2016), stratified into hylan G-F 20 and non-hylan G-F 20 HA users. Occurrences of surrogate SALR measures including inflammation/infection, intra-articular corticosteroid (CS) injections, arthrocentesis/aspiration, and office visits were evaluated within 3 days of HA use. Risk factors were evaluated using logistic regression. RESULTS The cohort involved 748,428 HA patients (23.2% in the hylan G-F 20 group). Inflammation/infection rate was 0.001% for hylan G-F 20 and 0.002% for non-hylan G-F 20 HA groups. Risk of CS injection (any diagnosis) was greater for hylan G-F 20 patients by 28% (P < 0.001). Combined rates of CS injection and arthrocentesis/aspiration (any diagnosis) were comparable for both groups (hylan G-F 20, 2.2%; non-hylan G-F 20 HA, 2.6%). The risk of any visit or studied responses was lower for the hylan G-F 20 cohort by 12% (P < 0.001). Clinical characteristics, such as CS injections within 1 week before HA and fluoroscopic imaging, were associated with the outcomes. CONCLUSIONS The diagnosis of inflammations or infections within 3 days of the HA injection was extremely rare. The overall risk of surrogate SALR measures was similar for hylan G-F 20 and non-hylan G-F 20 HA patients.
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Affiliation(s)
- Kevin L. Ong
- Exponent, Inc., Philadelphia, PA,
USA,Kevin L. Ong, Exponent, Inc., 3440 Market
Street, Suite 600, Philadelphia, PA 19104, USA.
| | | | | | | | | | - Roy D. Altman
- School of Medicine, University of
California, Los Angeles, CA, USA
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Peck J, Slovek A, Miro P, Vij N, Traube B, Lee C, Berger AA, Kassem H, Kaye AD, Sherman WF, Abd-Elsayed A. A Comprehensive Review of Viscosupplementation in Osteoarthritis of the Knee. Orthop Rev (Pavia) 2021; 13:25549. [PMID: 34745480 DOI: 10.52965/001c.25549] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/03/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose of Review The purpose of this systematic review is to discuss emerging evidence in the field of viscosupplementation for chronic knee pain secondary to Osteoarthritis (OA). This review focuses on types of viscosupplementation that are clinically available currently, evidence to support their use, contraindications, and adverse events. Recent Findings OA, also known as degenerative joint disease, is the most common form of arthritis in the United States, affecting 54.4 million, or 22.7% of the adult population. The knee is the most common joint affected in OA, with up to 41% involvement, 30% in the hands, and 19% in the hips. The pathophysiology of OA is complex, with contributing factors including mechanical stress to the joint, as well as many person-specific factors such as genetic susceptibility, ethnicity, nutrition, and sex. Treatment modalities include weight control, exercise, non-steroidal and steroidal anti-inflammatory drugs, opioids, intra-articular platelet-rich plasma, placebo, corticosteroid injection, intra-articular viscosupplementation, and surgery. Viscosupplementation consists of injection of hyaluronic acid (HA) into affected joints, intending to restore the physiologic viscoelasticity in the synovial fluid (SF) in the absence of inflammation. HA has also been shown to downregulate pro-inflammatory factors, such as PGE2 and NFkB, and proteases and proteinases known to break down the joint matrix.The contraindications for HA injection are similar to any other injection therapy, and adverse events are usually mild, local, and transient. Viscosupplementation (VS) is effective over placebo and more effective than NSAIDs and corticosteroids in pain reduction and improved functionality; however, guidelines recommend neither for nor against its use, demonstrating variability in the existing evidence base.Current VS options divide primarily into native vs. cross-linked and low-molecular-weight vs. high-molecular-weight. Current treatment options include Hylan g-f-20, Sodium Hyaluronate preparations (Suparts Fx, Euflexxa, Gelsyn-3, Durolane, Hyalgen), single-use agents (Gel-One, Synvisc-One, Monovisc), and Hyaluronan (Orthovisc, Monovisc, Hymovic). They share a common safety profile, and all have evidence supporting their efficacy. Their specific details are reviewed here. Summary OA is the most common form of arthritis. It is a chronic, debilitating illness with a high impact on the functionality and quality of life of a significant part of the population in the western world. Treatments include medical management, physical therapy, activity modification, injection, and surgery. VS effectively reduces pain, increases functionality, and delays surgery in the knee to treat osteoarthritis. While previous studies have demonstrated variable results, more evidence is becoming available generally supportive of the benefit of VS in the treatment of knee OA.
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Affiliation(s)
| | - Annabel Slovek
- Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix
| | - Paulo Miro
- University of Arizona College of Medicine-Phoenix, AZ
| | - Neeraj Vij
- University of Arizona College of Medicine-Phoenix, AZ
| | - Blake Traube
- University of Arizona College of Medicine-Phoenix, AZ
| | - Christopher Lee
- Creighton University School of Medicine-Phoenix Regional Campus, Phoenix, AZ
| | - Amnon A Berger
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | | | | | - Alaa Abd-Elsayed
- University of Wisconsin School of Medicine and Public Health, Madison, WI
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Datti IP. Letter to the Editor - Viscosupplementation - Rezende MU, Campos GC. Rev Bras Ortop 2012;47(2):160-164. Rev Bras Ortop 2021; 56:271. [PMID: 33935327 PMCID: PMC8075640 DOI: 10.1055/s-0041-1728704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Iberê Pereira Datti
- Grupo de Cirurgia de Joelho, Clínica de Ortopedia e Traumatologia, Hospital do Servidor Público Municipal, São Paulo, SP, Brasil
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Iturriaga V, Vásquez B, Bornhardt T, Del Sol M. Effects of low and high molecular weight hyaluronic acid on the osteoarthritic temporomandibular joint in rabbit. Clin Oral Investig 2021; 25:4507-4518. [PMID: 33392807 DOI: 10.1007/s00784-020-03763-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 12/21/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To compare the effect between intra-articular infiltration of low molecular weight (LMW-HA) and high molecular weight hyaluronic acid (HMW-HA) on the histopathological characteristics of the cartilage and disc of the temporomandibular joint (TMJ) osteoarthritis (OA) induced in rabbits. MATERIAL AND METHODS An experimental study was conducted on 38 rabbit TMJs. The effect of different hyaluronic acids was compared at 30 and 135 days. Histopathological analysis was performed. Cartilage damage was assessed with the OARSI scale. RESULTS The severity of the induced OA according to OARSI was 3.4 degrees in the mandibular condyle (MC) and 3.2 in the mandibular fossa (MF); the articular disc (AD) presented disorganization of the collagen fibers, with randomly arranged hypertrophic chondrocytes. At 30 days, untreated TMJs worsened. TMJ treated with LMW-HA reduced its severity to 1.5 degrees in MC and 1.6 in MF, the AD presented histological aspects within normal limits. TMJ treated with HMW-HA presented 2.4 degrees in MC and 2.2 in MF, the AD maintained characteristics similar to the group with OA. At 135 days, all groups worsened. CONCLUSION Exogenous HA is effective in the management of TMJ-OA induced in rabbits, showing cartilage and articular disc repair at 30 days. The LMW-HA group had better effects on joint tissue than HMW-HA 30 days after treatment. However, at 135 days, both groups presented regression of joint tissue repair. CLINICAL RELEVANCE HA is effective in the anti-arthritic treatment of TMJ-OA induced in rabbits; LMW-HA shows better results in cartilage and articular disc repair than HMW-HA.
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Affiliation(s)
- Veronica Iturriaga
- Department of Integral Adult Care Dentistry, Temporomandibular Disorder and Orofacial Pain Program, Sleep & Pain Research Group, Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
| | - Bélgica Vásquez
- Faculty of Health Sciences, Universidad de Tarapacá, Avenida 18 de Septiembre #2222, Arica, Chile.
| | - Thomas Bornhardt
- Department of Integral Adult Care Dentistry, Temporomandibular Disorder and Orofacial Pain Program, Sleep & Pain Research Group, Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
| | - Mariano Del Sol
- Center of Excellence in Morphological and Surgical Studies (CEMyQ), Doctoral Program in Morphological Sciences, Universidad de La Frontera, Temuco, Chile
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Peal BT, Gagliardi R, Su J, Fortier LA, Delco ML, Nixon AJ, Reesink HL. Synovial fluid lubricin and hyaluronan are altered in equine osteochondral fragmentation, cartilage impact injury, and full-thickness cartilage defect models. J Orthop Res 2020; 38:1826-1835. [PMID: 31965593 PMCID: PMC7354223 DOI: 10.1002/jor.24597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 11/21/2019] [Accepted: 01/13/2020] [Indexed: 02/04/2023]
Abstract
The objectives of this study were to evaluate temporal changes in lubricin, hyaluronan (HA), and HA molecular weight (MW) distributions in three distinct models of equine joint injury affecting the carpal (wrist), tarsal (ankle), and femoropatellar (knee) joints. To establish ranges for lubricin, HA, and HA MW distributions across multiple joints, we first evaluated clinically healthy, high-motion equine joints. Synovial fluid was collected from high-motion joints in horses without clinical signs of joint disease (n = 11 horses, 102 joints) and from research horses undergoing carpal osteochondral fragmentation (n = 8), talar cartilage impact injury (n = 7), and femoral trochlear ridge full-thickness cartilage injury (n = 22) prior to and following arthroscopically induced joint injury. Lubricin and HA concentrations were measured via enzyme-linked immunosorbent assays, and gel electrophoresis was performed to evaluate HA MW distributions. Synovial fluid parameters were analyzed via linear regression models, revealing that lubricin and HA concentrations were conserved across healthy, high-motion joints. Lubricin concentrations increased post-injury in all osteoarthritis models (carpal fragmentation P = .001; talar impact P < .001; femoral trochlear ridge cartilage defect P = .03). Sustained loss of HA was noted post-arthroscopy following carpal osteochondral fragmentation (P < .0001) and talar impact injury (P < .001). Lubricin may be elevated to compensate for the loss of HA and to protect cartilage post-injury. Further investigation into the mechanisms regulating lubricin and HA following joint injury and their effects on joint homeostasis is warranted, including whether lubricin has value as a biomarker for post-traumatic osteoarthritis.
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Affiliation(s)
- Bridgette T. Peal
- Department of Clinical Sciences, College of Veterinary
Medicine, Cornell University, 930 Campus Road, Ithaca, NY 14853 USA
| | - Rachel Gagliardi
- Department of Clinical Sciences, College of Veterinary
Medicine, Cornell University, 930 Campus Road, Ithaca, NY 14853 USA
| | - Jin Su
- Department of Clinical Sciences, College of Veterinary
Medicine, Cornell University, 930 Campus Road, Ithaca, NY 14853 USA
| | - Lisa A. Fortier
- Department of Clinical Sciences, College of Veterinary
Medicine, Cornell University, 930 Campus Road, Ithaca, NY 14853 USA
| | - Michelle L. Delco
- Department of Clinical Sciences, College of Veterinary
Medicine, Cornell University, 930 Campus Road, Ithaca, NY 14853 USA
| | - Alan J. Nixon
- Department of Clinical Sciences, College of Veterinary
Medicine, Cornell University, 930 Campus Road, Ithaca, NY 14853 USA
| | - Heidi L. Reesink
- Department of Clinical Sciences, College of Veterinary
Medicine, Cornell University, 930 Campus Road, Ithaca, NY 14853 USA
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Silva Júnior JIS, Rahal SC, Santos IFC, Martins DJC, Michelon F, Mamprim MJ, Tomacheuski RM, Correia LECS. Use of Reticulated Hyaluronic Acid Alone or Associated With Ozone Gas in the Treatment of Osteoarthritis Due to Hip Dysplasia in Dogs. Front Vet Sci 2020; 7:265. [PMID: 32478113 PMCID: PMC7237717 DOI: 10.3389/fvets.2020.00265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/20/2020] [Indexed: 01/27/2023] Open
Abstract
This study aimed to evaluate reticulated hyaluronic acid alone or associated with ozone gas in the treatment of osteoarthritis due to hip dysplasia in dogs. Fourteen client-owned dogs were randomly assigned into two groups: Group 1-single intra-articular injection of hyaluronic acid; Group 2-single intra-articular infiltration injection of hyaluronic acid associated with ozone gas. Each hip joint received an average of 0.75 mL of reticulated hyaluronic acid ultrasound-guided. Ozone gas at a dose of 45 μg/mL was incorporated into hyaluronic acid by insufflation. Dogs were evaluated for body condition scoring, orthopedic examination and radiographic scores of the hip joints, goniometric measurements of the hip joints, visual gait score, and kinetic analysis. The evaluations were conducted immediately before treatments (M0), and at days 30 (M1), 60 (M2), and 90 (M3) after treatments. There were no significant differences in body mass and body condition scoring (5-point scale) in each group in all evaluation moments. The scores of orthopedic examination of the hip joints showed statistical differences in each group between moments (M0 > M3), but differences were not observed between groups. No statistical differences were found for radiographic scores in each group between moments, but differences were observed between groups immediately prior to treatments (G1 > G2) and 90 (G1 > G2) after treatments. Goniometric measurements of hip flexion and extension showed no significant differences in each group between moments or between groups. No statistical differences between groups were found concerning the lameness score. There were significant differences for lameness score among moments in Group 1, being M0 > M2 and M0 > M3, and Group 2 in which M0 > M1, M0 > M2, and M0 > M3. The mean percentage of change of PVF and VI between M3 and M0 in Group 1 was almost null and in Group 2 was positive, being 31.1 ± 29.4 and 10.6 ± 25.4, respectively. In conclusion, the intra-articular viscosupplementation alone or associated with ozone gas allowed improvement of lameness scores and orthopedic examination score. In Group 2 the association of ozone gas had better results on kinetic analysis.
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Affiliation(s)
- José I. S. Silva Júnior
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, Brazil
| | - Sheila C. Rahal
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, Brazil
| | - Ivan F. C. Santos
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, Brazil
| | - David J. C. Martins
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, Brazil
| | - Fernanda Michelon
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, Brazil
| | - Maria J. Mamprim
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, Brazil
| | - Rubia M. Tomacheuski
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal Science, São Paulo State University (UNESP), Botucatu, Brazil
| | - Luiz E. C. S. Correia
- Department of Animal Science, School of Agricultural and Veterinary Studies, UNESP, Jaboticabal, Brazil
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Urits I, Hasegawa M, Orhurhu V, Peck J, Kelly AC, Kaye RJ, Orhurhu MS, Brinkman J, Giacomazzi S, Foster L, Manchikanti L, Kaye AD, Viswanath O. Minimally Invasive Treatment of Chronic Ankle Instability: a Comprehensive Review. Curr Pain Headache Rep 2020; 24:8. [PMID: 32020393 DOI: 10.1007/s11916-020-0840-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Chronic ankle pain is a prevalent and significant cause of chronic pain. While the definition of chronic ankle pain is heterogeneous and poorly defined in the literature, systematic reviews and meta-analyses have estimated this condition to be a prevalent and debilitating source of chronic pain. The most identifiable and prominent cause of chronic ankle pain is chronic ankle instability (CAI), a condition defined by instability of the ankle-joint complex. It is a common consequence of lateral ankle sprains or ligamentous injuries and can be described as a failure of the lateral ankle joint complex after an acute, or recurring, ankle injury. The objective of this manuscript is to provide a comprehensive review of CAI diagnosis and our current understanding of minimally invasive treatment options. RECENT FINDINGS First-line treatment is conservative management, some of which includes neuromuscular rehabilitation, balance training, nonsteroidal anti-inflammatory drugs (NSAIDs), manual mobilization, ice therapy, and compression. While conservative management is effective, additional treatments for those who fail conservative management, or who seek alternative options also have been explored. Recent advances and modern techniques have expanded available treatment options, many of which are becoming less invasive, and have shown improving functionality, recovery, and patient satisfaction. Minimally invasive treatments highlighted in this review include: arthroscopic surgery, steroid injections, plasma-rich plasma injections, hyaluronic acid (HA) injections, medicinal signaling cell injections, radiofrequency therapies, and shockwave therapies. This review will discuss some of these current treatments for minimally invasive treatment of CAI, as well as suggest novel treatments for clinical trials and further investigation.
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Affiliation(s)
- Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Morgan Hasegawa
- Creighton University School of Medicine at Regional Campus St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Vwaire Orhurhu
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Jacquelin Peck
- Mount Sinai Medical Center of Florida, Department of Anesthesiology, Miami Beach, FL, USA
| | - Angele C Kelly
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, USA
| | - Rachel J Kaye
- Medical University of South Carolina, Charleston, SC, USA
| | - Mariam Salisu Orhurhu
- Department of Anesthesia, Critical Care, and Pain Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Joseph Brinkman
- Creighton University School of Medicine at Regional Campus St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Stephen Giacomazzi
- Creighton University School of Medicine at Regional Campus St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Lukas Foster
- Creighton University School of Medicine at Regional Campus St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | | | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA.,Department of Anesthesiology, University of Arizona College of Medicine - Phoenix, Phoenix, AZ, USA.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA
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Liao YY, Lin T, Zhu HX, Shi MM, Yan SG. Intra-Articular Viscosupplementation for Patients with Hip Osteoarthritis: A Meta-Analysis and Systematic Review. Med Sci Monit 2019; 25:6436-6445. [PMID: 31454342 PMCID: PMC6724564 DOI: 10.12659/msm.916955] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 07/31/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The aim of this study was to review the efficacy and safety of intra-articular (IA) viscosupplementation (VS) for hip osteoarthritis (OA). MATERIAL AND METHODS We searched Medline, Clinical Trial Register Center, EMBASE, and Cochrane databases for randomized controlled trials (RCTs) comparing VS with placebo injection for hip OA. We included suitable studies, assessed the quality of studies, and extracted data on pain reduction, function improvement at different time points, and safety profiles. The comparisons of pain and function outcome were performed by meta-analysis. RESULTS Five high-quality randomized controlled studies trials (RCTs) with 591 patients with hip OA were identified. Although several trials demonstrated a significant decline in pain in VS groups during follow-up compared to baseline, without severe adverse events, the pooled analysis did not show VS was superior to placebo at any time windows [7-14 days: standardized mean difference (SMD): -0.18; 95% CI, -0.47 to 0.10, p=0.21; 28-30 days: 0.02 (-0.15, 0.19), p=0.82; or at final visit: -0.14 (-0.46, 0.18), p=0.38]. Similar results were also observed in the combined data of functional results. CONCLUSIONS IA VS does not reduce pain or improve function significantly better than placebo in a short-term follow-up. The benefits and safety of VS should be further assessed by sufficiently-sized, methodologically sound studies with validated assessment of more clinically relevant end-points.
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Affiliation(s)
- Ying-Yang Liao
- Department of Musculoskeletal Oncology, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
- Department of Orthopedic Surgery, Hui-Ya Hospital of The First Affiliated Hospital, Sun Yat-sen University, Huizhou, Guangdong, P.R. China
| | - Tiao Lin
- Department of Musculoskeletal Oncology, Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China
| | - Han-Xiao Zhu
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Ming-Min Shi
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
| | - Shi-Gui Yan
- Department of Orthopedic Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, P.R. China
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11
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de Campos GC, de Sousa EB, Hamdan PC, de Almeida CS, Tieppo AM, de Rezende MU, Alchaar AADA, Pinheiro CB, Rocha EDMC, Cunha FG, Pacheco I, Vieira MSR, Antonio SF, Menegassi ZJB. BRAZILIAN CONSENSUS STATEMENT ON VISCOSUPPLEMENTATION OF THE KNEE (COBRAVI). ACTA ORTOPEDICA BRASILEIRA 2019; 27:230-236. [PMID: 31452625 PMCID: PMC6699386 DOI: 10.1590/1413-785220192704218616] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 03/13/2019] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The aim of this consensus statement on viscosupplementation is to serve as a reference document based on relevant literature and clinical experience in the treatment of knee osteoarthritis using an intra-articular injection of hyaluronic acid, covering key aspects such as clinical indications, effectiveness, and tolerability. METHODS A multidisciplinary panel including two sports medicine physicians, six orthopedists, four physiatrists, and two rheumatologists were selected based on their clinical and academic experience of viscosupplementation. Sixteen statements were prepared and discussed, after which a vote was held. Each member of the panel gave a score between 0 and 10 on a Likert scale, specifying their level of agreement with the statement. RESULTS The panel reached a consensus on several issues. Specifically, the panel agreed that the best indication is for mild to moderate knee arthrosis; prior or concomitant use of intraarticular triamcinolone hexacetonide may optimize the effect of hyaluronic acid; viscosupplementation should not be performed as an isolated procedure but in conjunction with other rehabilitative and pharmacological measures; viscosupplementation has analgesic, anti-inflammatory, and chondroprotective effects; and viscosupplementation is cost-effective. CONCLUSION This consensus statement provides clear information and guidance for both individuals and payers. Level of evidence V, Consensus statement.
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Affiliation(s)
| | | | - Paulo César Hamdan
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | | | | | - Marcia Uchôa de Rezende
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Department of Orthopedics and Traumatology (DOT/FMUSP), São Paulo, Brazil
| | | | | | | | | | - Ivan Pacheco
- Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
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Rodrigues TA, Freire AO, Bonfim BF, Cartágenes MSS, Garcia JBS. Strontium ranelate as a possible disease-modifying osteoarthritis drug: a systematic review. Braz J Med Biol Res 2018; 51:e7440. [PMID: 29924137 PMCID: PMC6040865 DOI: 10.1590/1414-431x20187440] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 05/02/2018] [Indexed: 12/20/2022] Open
Abstract
Considering that osteoarthritis (OA) is the most prevalent joint disease worldwide, multiple pharmacological treatments have been proposed to alter the articular structure with potential benefit in the progression of the disease. The so-called disease-modifying OA drugs have been frequently investigated but conclusive findings are rare. Strontium ranelate (SrRan) is a drug usually prescribed to treat osteoporosis, with proven effects in decreasing the risk of fractures and possible effect in reducing the progression of OA. The objective of this review was to demonstrate the current panorama of knowledge on the use of SrRan in clinical and experimental models, clarifying its mechanisms of action and describing possible anti-nociceptive and anti-inflammatory effects. The systematic review was based on the PRISMA statement and included articles that are indexed in scientific databases. Fifteen studies were included: seven pre-clinical and eight clinical studies. Despite the limited number of studies, the results suggest a positive effect of SrRan in patients with OA, through changes in functional capacity and reduction of progression of morphological parameters and joint degradation, with moderate quality of evidence for those clinical outcomes. Novel studies are necessary to elucidate the molecular targets of SrRan, focusing on anti-inflammatory effects and histological changes promoted by SrRan, which seemed to reduce the progression of OA in the experimental and clinical studies.
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Affiliation(s)
- T A Rodrigues
- Centro de Ciências Biológicas e da Saúde, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - A O Freire
- Centro de Ciências Biológicas e da Saúde, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - B F Bonfim
- Centro de Ciências Biológicas e da Saúde, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - M S S Cartágenes
- Centro de Ciências Biológicas e da Saúde, Universidade Federal do Maranhão, São Luís, MA, Brasil
| | - J B S Garcia
- Centro de Ciências Biológicas e da Saúde, Universidade Federal do Maranhão, São Luís, MA, Brasil
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Oliveira MZ, Albano MB, Stirma GA, Namba MM, Vidigal L, Cunha LAMD. Intra-articular viscosupplementation of hyaluronic acids in an experimental osteoarthritis model. Rev Bras Ortop 2018; 53:293-299. [PMID: 29892579 PMCID: PMC5993877 DOI: 10.1016/j.rboe.2018.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/06/2017] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To analyze, from the immunohistochemical perspective, the effects of hyaluronic acid of different molecular weights in an experimental model of osteoarthritis in rabbits. METHODS Forty-four male California rabbits were randomly assigned to three different groups (PR, S, and P) and submitted to the resection of the anterior cruciate ligament of the right knee. Three weeks after the surgical procedure, three intra-articular weekly injections were carried out with low-molecular-weight native hyaluronic acid (Hyalgan®) to PR group, high molecular weight branched chain hyaluronic acid (Synvisc®) to group S, and saline solution 0.9% to group P. All animals were sacrificed 12 weeks after the surgical procedure, and the tibial plateaus of the infiltrated knees were then dissected. Histological sections of cartilage from the tibial plateau support areas were stained with immunohistochemical markers in order to investigate the amount of metalloproteases (MMPs 3 and 13) and their inhibitors (TIMPs 1 and 3). The staining intensity was quantified on a Zeiss Imager.Z2 Metasystems microscope and analyzed by Metafer4 Msearch software. RESULTS The chondroprotective effect of the hyaluronic acids used in the study was demonstrated when compared to the control group. However, the comparison between them presented no significant statistical difference regarding chondroprotection. CONCLUSION The injection of saline solution demonstrated signs of OA development, while adding native hyaluronic acid of low molecular weight (Hyalgan®) and hyaluronic acid of high molecular weight (Synvisc®) protected the articular cartilage in this model of OA.
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Affiliation(s)
- Marcello Zaia Oliveira
- Departamento de Ortopedia e Traumatologia, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
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Trueba Vasavilbaso C, Rosas Bello CD, Medina López E, Coronel Granado MP, Navarrete Álvarez JM, Trueba Davalillo CA, Gil Orbezo FI. Benefits of different postoperative treatments in patients undergoing knee arthroscopic debridement. Open Access Rheumatol 2017; 9:171-179. [PMID: 29026341 PMCID: PMC5626376 DOI: 10.2147/oarrr.s138353] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To assess the effectiveness of viscosupplementation or platelet-rich plasma (PRP), compared to standard care, for pain relief after knee arthroscopic debridement in patients with meniscal pathology and osteoarthritis (OA), under normal clinical practice conditions. PATIENTS AND METHODS We conducted a prospective, randomized, evaluator-blind, pilot study. After arthroscopy, patients were randomized to receive 1) five injections of HA1 (Suprahyal®/Adant®); 2) four injections of HA2 (Orthovisc®); 3) three injections of HA3 (Synvisc®); 4) a single injection of PRP (GPS™ II); or 5) standard care (control). Patients were followed up for 18 months. Clinical outcomes were evaluated using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) at 3, 6, 12, and 18 months. Minimally Clinical Important Improvement (MCII), as relative improvement ≥20 for pain and function, was also calculated. RESULTS Fifty patients were included. At early follow-up (3 months), total WOMAC scores improved in all groups compared to baseline with reductions of 44.79% (HA1), 24.02% (HA2), 40.38% (HA3), 39.77% (PRP), and 27.64% (control) (p=0.002 HA1 compared to HA2). At 18 months, the higher improvement in total WOMAC was in HA1 with a 65.20% reduction, followed by PRP (55.01%), HA3 (49.57%), and HA2 (29.82%), whereas the control group had a 14.55% increase over baseline (p=0.001 control compared to HA1 and HA3). The percentage of patients achieving the MCII for both pain and function at 18 months was 100% (HA1), 80% (HA3), 60% (HA2), and 60% (PRP), whereas, in the control group, all patients returned to pre-arthroscopy levels. There were no adverse events attributable to surgery or to intraarticular administration. CONCLUSION Viscosupplementation following arthroscopy is more effective than PRP in adequately selected patients with meniscal lesions occurring concomitantly with OA. Further controlled studies with a larger sample size and/or alternative regimens would be of interest for the scientific community.
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Dernek B, Kesiktas FN, Duymus TM, Diracoglu D, Aksoy C. Therapeutic efficacy of three hyaluronic acid formulations in young and middle-aged patients with early-stage meniscal injuries. J Phys Ther Sci 2017; 29:1148-1153. [PMID: 28744035 PMCID: PMC5509579 DOI: 10.1589/jpts.29.1148] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 04/12/2017] [Indexed: 12/26/2022] Open
Abstract
[Purpose] To investigate and compare the efficacy of three hyaluronic acid formulations in patients with early-stage meniscal injuries. [Subjects and Methods] Male and female patients who were admitted to our clinic between January 2013 and December 2013, diagnosed with early-stage meniscus lesions of the knee, and given a hyaluronic acid treatment were included in this retrospective study. Patients were categorized into 3 groups according to their treatments: MONOVISC, OSTENIL PLUS, or ORTHOVISC. Scores from a Visual Analog Scale and the Western Ontario and McMaster Universities Arthritis Index were evaluated at baseline and one, three, and six months after baseline. [Results] A total of 55 patients were included in this study. Most of the patients were female (55%), and the mean age of the patients was 42.4 (± 8.1) years. Based on the pre- and post-injection data, there was significant reductions both in the Visual Analog Scale score and the Western Ontario and McMaster Universities Arthritis Index score after the injections for all groups. According to intergroup comparisons, no significant difference was observed in terms of efficacy. [Conclusion] Three hyaluronic acid formulations produced a similar efficacy in patients with meniscal injuries, and further studies are needed to evaluate long-term results.
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Affiliation(s)
- Bahar Dernek
- Istanbul Kanuni Sultan Suleyman Training and Research
Hospital, Physical Medicine and Rehabilitation Clinic, Turkey
| | - Fatma Nur Kesiktas
- Istanbul Kanuni Sultan Suleyman Training and Research
Hospital, Physical Medicine and Rehabilitation Clinic, Turkey
| | - Tahir Mutlu Duymus
- Istanbul Kanuni Sultan Suleyman Training and Research
Hospital, Orthopedics Clinic, Turkey
| | - Demirhan Diracoglu
- Department of Physical Medicine and Rehabilitation,
Istanbul Faculty of Medicine, Istanbul University, Turkey
| | - Cihan Aksoy
- Department of Physical Medicine and Rehabilitation,
Istanbul Faculty of Medicine, Istanbul University, Turkey
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