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Mazy D, Wang J, Dodin P, Lu D, Moldovan F, Nault ML. Emerging biologic augmentation strategies for meniscal repair: a systematic review. BMC Musculoskelet Disord 2024; 25:541. [PMID: 39003467 PMCID: PMC11245777 DOI: 10.1186/s12891-024-07644-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 07/01/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND Meniscal repair should be the gold standard. However, the meniscus is poorly vascularized and even an excellent meniscus repair may not heal. Therefore, numerous studies and systematic reviews have been carried out on platelet-rich plasma (PRP), mesenchymal stem cells (MSCs) and fibrin clots for meniscal augmentation, but the results remain controversial. This systematic review aimed to identify other emerging strategies for meniscal repair augmentation and to assess whether there are different avenues to explore in this field. METHODS A systematic literature review was conducted in August 2022. PubMed, Ovid MEDLINE(R) all, Ovid All EBM Reviews, Ovid Embase and ISI Web of Science databases were searched. In Vivo animal and human studies concerning the biological augmentation of meniscal lesions by factors other than PRP, MSCs or fibrin clots were included. Cartilage-only studies, previous systematic reviews and expert opinions were excluded. All data were analyzed by two independent reviewers. RESULTS Of 8965 studies only nineteen studies covering 12 different factors met the inclusion criteria. Eight studies investigated the use of growth factors for meniscal biologic augmentation, such as vascular endothelial growth factor or bone morphogenic protein 7. Five studies reported on cell therapy and six studies focused on other factors such as hyaluronic acid, simvastatin or atelocollagen. Most studies (n = 18) were performed on animal models with gross observation and histological evaluation as outcomes. Polymerase chain reaction and immunohistochemistry were also common. Biomechanical testing was the object of only two studies. CONCLUSIONS Although several augmentation strategies have been attempted, none has yielded conclusive results, testifying to a lack of understanding with regard to meniscal healing. More research is needed to better understand the pathways that regulate meniscus repair and how to act positively on them. LEVEL OF EVIDENCE Systematic review of case-control and animal laboratory studies.
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Affiliation(s)
- David Mazy
- CHU Sainte-Justine, Montréal, 7905-3175, Côte Ste-Catherine, QC, H3T 1C5, Canada
| | - Jessica Wang
- Faculty of Medicine, Université de Montréal, 2900 Boul. Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Philippe Dodin
- CHU Sainte-Justine, Montréal, 7905-3175, Côte Ste-Catherine, QC, H3T 1C5, Canada
| | - Daisy Lu
- Faculty of Medicine, Université de Montréal, 2900 Boul. Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Florina Moldovan
- CHU Sainte-Justine, Montréal, 7905-3175, Côte Ste-Catherine, QC, H3T 1C5, Canada
| | - Marie-Lyne Nault
- CHU Sainte-Justine, Montréal, 7905-3175, Côte Ste-Catherine, QC, H3T 1C5, Canada.
- Faculty of Medicine, Université de Montréal, 2900 Boul. Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.
- CHU Sainte-Justine Azrieli Research Center, Montréal, 7905-3175 Côte Ste-Catherine, H3T 1J4, QC, Canada.
- Department of Orthopedic Surgery, CIUSSS Hôpital du Sacré-Cœur de Montréal (HSCM), 5400, Boul. Gouin Ouest, Montreal, QC, H4J 1C5, Canada.
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Oluwole SA, Weldu WD, Jayaraman K, Barnard KA, Agatemor C. Design Principles for Immunomodulatory Biomaterials. ACS APPLIED BIO MATERIALS 2024. [PMID: 38922334 DOI: 10.1021/acsabm.4c00537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
The immune system is imperative to the survival of all biological organisms. A functional immune system protects the organism by detecting and eliminating foreign and host aberrant molecules. Conversely, a dysfunctional immune system characterized by an overactive or weakened immune system causes life-threatening autoimmune or immunodeficiency diseases. Therefore, a critical need exists to develop technologies that regulate the immune system to ensure homeostasis or treat several diseases. Accumulating evidence shows that biomaterials─artificial materials (polymers, metals, ceramics, or engineered cells and tissues) that interact with biological systems─can trigger immune responses, offering a materials science-based strategy to modulate the immune system. This Review discusses the expanding frontiers of biomaterial-based immunomodulation, focusing on principles for designing these materials. This Review also presents examples of immunomodulatory biomaterials, which include polymers and metal- and carbon-based nanomaterials, capable of regulating the innate and adaptive immune systems.
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Affiliation(s)
- Samuel Abidemi Oluwole
- Department of Chemistry, University of Miami, Coral Gables, Florida 33124, United States
| | - Welday Desta Weldu
- Department of Chemistry, University of Miami, Coral Gables, Florida 33124, United States
| | - Keerthana Jayaraman
- Department of Chemistry, University of Miami, Coral Gables, Florida 33124, United States
| | - Kelsie Amanda Barnard
- Department of Chemistry, University of Miami, Coral Gables, Florida 33124, United States
| | - Christian Agatemor
- Department of Chemistry, University of Miami, Coral Gables, Florida 33124, United States
- Department of Biology, University of Miami, Coral Gables, Florida 33124, United States
- Sylvester Comprehensive Cancer Center, University of Miami Health System, Miami, Florida 33136, United States
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Yuan Z, Jiang D, Yang M, Tao J, Hu X, Yang X, Zeng Y. Emerging Roles of Macrophage Polarization in Osteoarthritis: Mechanisms and Therapeutic Strategies. Orthop Surg 2024; 16:532-550. [PMID: 38296798 PMCID: PMC10925521 DOI: 10.1111/os.13993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024] Open
Abstract
Osteoarthritis (OA) is the most common chronic degenerative joint disease in middle-aged and elderly people, characterized by joint pain and dysfunction. Macrophages are key players in OA pathology, and their activation state has been studied extensively. Various studies have suggested that macrophages might respond to stimuli in their microenvironment by changing their phenotypes to pro-inflammatory or anti-inflammatory phenotypes, which is called macrophage polarization. Macrophages accumulate and become polarized (M1 or M2) in many tissues, such as synovium, adipose tissue, bone marrow, and bone mesenchymal tissues in joints, while resident macrophages as well as other stromal cells, including fibroblasts, chondrocytes, and osteoblasts, form the joint and function as an integrated unit. In this study, we focus exclusively on synovial macrophages, adipose tissue macrophages, and osteoclasts, to investigate their roles in the development of OA. We review recent key findings related to macrophage polarization and OA, including pathogenesis, molecular pathways, and therapeutics. We summarize several signaling pathways in macrophage reprogramming related to OA, including NF-κB, MAPK, TGF-β, JAK/STAT, PI3K/Akt/mTOR, and NLRP3. Of note, despite the increasing availability of treatments for osteoarthritis, like intra-articular injections, surgery, and cellular therapy, the demand for more effective clinical therapies has remained steady. Therefore, we also describe the current prospective therapeutic methods that deem macrophage polarization to be a therapeutic target, including physical stimulus, chemical compounds, and biological molecules, to enhance cartilage repair and alleviate the progression of OA.
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Affiliation(s)
- Zimu Yuan
- West China Medical SchoolSichuan UniversityChengduChina
- West China HospitalSichuan UniversityChengduChina
| | - Decheng Jiang
- West China Medical SchoolSichuan UniversityChengduChina
- West China HospitalSichuan UniversityChengduChina
| | - Mengzhu Yang
- West China Medical SchoolSichuan UniversityChengduChina
- West China HospitalSichuan UniversityChengduChina
| | - Jie Tao
- West China Medical SchoolSichuan UniversityChengduChina
- West China HospitalSichuan UniversityChengduChina
| | - Xin Hu
- Orthopedic Research Institute, Department of OrthopedicsWest China Hospital, Sichuan UniversityChengduChina
| | - Xiao Yang
- National Engineering Research Center for BiomaterialsSichuan UniversityChengduChina
| | - Yi Zeng
- Orthopedic Research Institute, Department of OrthopedicsWest China Hospital, Sichuan UniversityChengduChina
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Khalid S, Ali A, Deepak FNU, Zulfiqar MS, Malik LU, Fouzan Z, Nasr RA, Qamar M, Bhattarai P. Comparative effectiveness of intra-articular therapies in knee osteoarthritis: a meta-analysis comparing platelet-rich plasma (PRP) with other treatment modalities. Ann Med Surg (Lond) 2024; 86:361-372. [PMID: 38222750 PMCID: PMC10783230 DOI: 10.1097/ms9.0000000000001615] [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] [Received: 09/27/2023] [Accepted: 12/03/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Knee osteoarthritis (KOA) is a progressive joint disease commonly treated with intra-articular injections, including platelet-rich plasma (PRP), hyaluronic acid (HA), or corticosteroids (CS). This updated meta-analysis aims to enhance the statistical power of the results and provide comprehensive clinical evidence that reflects the most current research. By doing so, the authors aim to suggest a reliable estimate for the development of guidelines, addressing the pressing need for effective and minimally invasive treatment options. Methods PubMed, Scopus, clinicaltrials.gov, Cochrane Central were searched until March 2023, for randomized controlled trials (RCTs) comparing the effectiveness of intra-articular injectable therapies, including PRP, HA, CS, and placebo, in KOA. Data extraction involved baseline characteristics and outcome measures [Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores, Visual Analog Scale (VAS) pain scores, KOOS, and IKDC scores] at 1, 3, 6 and 12 months. Statistical analysis, including subgroup analysis, assessment of heterogeneity, and publication bias, was conducted using Review Manager. Results Our meta-analysis of 42 studies involving 3696 patients demonstrated that PRP treatment resulted in significant pain relief compared to HA injections, as evidenced by improved WOMAC pain (MD: -0.74; 95% CI: -1.02 to -0.46; P≤0.00001; I 2=94%) and VAS pain (MD: -0.65; 95% CI: -1.24 to -0.06; P=0.03; I2=97%) outcomes. Similarly, PRP showed greater efficacy in reducing WOMAC pain (MD: -8.06; 95% CI: -13.62 to -2.51: P=0.004; I 2=96%) and VAS pain (MD: -1.11; 95% CI: -1.64 to -0.59; P≤0.0001; I 2=68%) compared to CS injections, with the most significant improvement observed at 6 months. Conclusions PRP is an effective treatment for KOA. It provides symptomatic relief, has the potential to reduce disease progression, and has sustained effects up to 12 months. PRP offers superior pain relief and functional enhancement compared to CS and HA injections.
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Affiliation(s)
- Saad Khalid
- Department of Medicine, Dow University of Health Sciences
| | - Abraish Ali
- Department of Medicine, Dow University of Health Sciences
| | - FNU Deepak
- Shaheed Mohtarma Benazir Bhutto Medical College Lyari
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Tanha A, Rabiee M, Rostami A, Ahmadi S. A green-based approach for noninvasive skin rejuvenation: Potential application of hyaluronic acid. ENVIRONMENTAL RESEARCH 2023; 234:116467. [PMID: 37343757 DOI: 10.1016/j.envres.2023.116467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 06/23/2023]
Abstract
Gradually, loss of skin elasticity and elastic properties occurs after 30 years of age and will be associated with several changes, including creating wrinkles, skin laxity (sagging skin), and skin blemishes. In general, people all over the world are looking for ways to keep their facial skin young over time. There are several strategies to skin rejuvenate, including invasive and non-invasive methods. However, invasive methods have less popularity than non-invasive methods due to their need for specialist physicians (medical expertise), localized neuropathic pains for patients, the prevalence and incidence of skin infections, and high-cost clinical services. In the meantime, skin hydration is one of the simplest non-invasive methods for skin rejuvenation, and HA, with anti-aging and skin collagen-stimulating properties, has been introduced as a natural skin moisturizing agent. Therefore, since this composition maintains facial skin moisture and radiance, and improves its elasticity, it has always been considered by experts and specialist physicians. On the other hand, due to its lipophilic properties, hydrophilic macromolecules containing HA cannot pass through the stratum corneum. However, they have temporary and superficial softening effects on the skin. Hence, some nanocarriers have been suggested to overcome this problem and develop the properties and positive influences of HA on skin rejuvenation. Therefore, the present study aimed to introduce some new non-invasive approaches in facial skin rejuvenation, including applying liposomes, niosomes, ethosomes, and ionic liquids, to transport HA into the inner and deeper layers of the skin, including Dermis. In this review article, we examine non-invasive methods using nanoparticles to deliver HA to the epidermis and dermis of the skin for skin rejuvenation.
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Affiliation(s)
- Amirabas Tanha
- Biomaterials Group, Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Mohammad Rabiee
- Biomaterials Group, Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran.
| | - Azin Rostami
- Biomaterials Group, Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, Iran
| | - Sepideh Ahmadi
- Student Research Committee, Department of Medical Biotechnology, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Cellular and Molecular Biology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Geng R, Li J, Yu C, Zhang C, Chen F, Chen J, Ni H, Wang J, Kang K, Wei Z, Xu Y, Jin T. Knee osteoarthritis: Current status and research progress in treatment (Review). Exp Ther Med 2023; 26:481. [PMID: 37745043 PMCID: PMC10515111 DOI: 10.3892/etm.2023.12180] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 08/11/2023] [Indexed: 09/26/2023] Open
Abstract
Knee osteoarthritis (KOA) is a common chronic articular disease worldwide. It is also the most common form of OA and is characterized by high morbidity and disability rates. With the gradual increase in life expectancy and ageing population, KOA not only affects the quality of life of patients, but also poses a burden on global public health. OA is a disease of unknown etiology and complex pathogenesis. It commonly affects joints subjected to greater loads and higher levels of activity. The knee joint, which is the most complex joint of the human body and bears the greatest load among all joints, is therefore most susceptible to development of OA. KOA lesions may involve articular cartilage, synovium, joint capsule and periarticular muscles, causing irreversible articular damage. Factors such as mechanical overload, inflammation, metabolism, hormonal changes and ageing serve key roles in the acceleration of KOA progression. The clinical diagnosis of KOA is primarily based on combined analysis of symptoms, signs, imaging and laboratory examination results. At present, there is no cure for KOA and the currently available therapies primarily focus on symptomatic treatment and delay of disease progression. Knee replacement surgery is typically performed in patients with advanced disease. The current study presents a review of epidemiological characteristics, risk factors, histopathological manifestations, pathogenesis, diagnosis, treatment modalities and progress in KOA research.
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Affiliation(s)
- Ruizhi Geng
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- Institute of Traumatology and Orthopedics, 920th Hospital of Joint Logistics Support Force of The People's Liberation Army, Kunming, Yunnan 650051, P.R. China
| | - Jiayi Li
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- Department of Anatomy and Histology, and Embryology, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Chen Yu
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- Department of Orthopedics, The First People's Hospital of Yunnan Province, Kunming, Yunnan 650034, P.R. China
| | - Chaoqun Zhang
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- Institute of Traumatology and Orthopedics, 920th Hospital of Joint Logistics Support Force of The People's Liberation Army, Kunming, Yunnan 650051, P.R. China
| | - Fei Chen
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- Institute of Traumatology and Orthopedics, 920th Hospital of Joint Logistics Support Force of The People's Liberation Army, Kunming, Yunnan 650051, P.R. China
| | - Jie Chen
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- School of Public Health, Kunming Medical University, Kunming, Yunnan 650032, P.R. China
| | - Haonan Ni
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Jiaxu Wang
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- Institute of Traumatology and Orthopedics, 920th Hospital of Joint Logistics Support Force of The People's Liberation Army, Kunming, Yunnan 650051, P.R. China
| | - Kaiqiang Kang
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- Institute of Traumatology and Orthopedics, 920th Hospital of Joint Logistics Support Force of The People's Liberation Army, Kunming, Yunnan 650051, P.R. China
| | - Ziqi Wei
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- Department of Anatomy and Histology, and Embryology, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
| | - Yongqing Xu
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- Institute of Traumatology and Orthopedics, 920th Hospital of Joint Logistics Support Force of The People's Liberation Army, Kunming, Yunnan 650051, P.R. China
| | - Tao Jin
- Graduate School, Kunming Medical University, Kunming, Yunnan 650500, P.R. China
- Institute of Traumatology and Orthopedics, 920th Hospital of Joint Logistics Support Force of The People's Liberation Army, Kunming, Yunnan 650051, P.R. China
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Sprott H, Fleck C. Hyaluronic Acid in Rheumatology. Pharmaceutics 2023; 15:2247. [PMID: 37765216 PMCID: PMC10537104 DOI: 10.3390/pharmaceutics15092247] [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: 07/15/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/29/2023] Open
Abstract
Hyaluronic acid (HA), also known as hyaluronan, is an anionic glycosaminoglycan widely distributed throughout various tissues of the human body. It stands out from other glycosaminoglycans as it lacks sulfation and can attain considerable size: the average human synovial HA molecule weighs about 7 million Dalton (Da), equivalent to roughly 20,000 disaccharide monomers; although some sources report a lower range of 3-4 million Da. In recent years, HA has garnered significant attention in the field of rheumatology due to its involvement in joint lubrication, cartilage maintenance, and modulation of inflammatory and/or immune responses. This review aims to provide a comprehensive overview of HA's involvement in rheumatology, covering its physiology, pharmacology, therapeutic applications, and potential future directions for enhancing patient outcomes. Nevertheless, the use of HA therapy in rheumatology remains controversial with conflicting evidence regarding its efficacy and safety. In conclusion, HA represents a promising therapeutic option to improve joint function and alleviate inflammation and pain.
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Affiliation(s)
- Haiko Sprott
- Medical Faculty, University of Zurich (UZH), CH-8006 Zurich, Switzerland
- Arztpraxis Hottingen, CH-8032 Zurich, Switzerland
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Murphy EJ, Fehrenbach GW, Abidin IZ, Buckley C, Montgomery T, Pogue R, Murray P, Major I, Rezoagli E. Polysaccharides-Naturally Occurring Immune Modulators. Polymers (Basel) 2023; 15:polym15102373. [PMID: 37242947 DOI: 10.3390/polym15102373] [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: 03/04/2023] [Revised: 05/06/2023] [Accepted: 05/07/2023] [Indexed: 05/28/2023] Open
Abstract
The prevention of disease and infection requires immune systems that operate effectively. This is accomplished by the elimination of infections and abnormal cells. Immune or biological therapy treats disease by either stimulating or inhibiting the immune system, dependent upon the circumstances. In plants, animals, and microbes, polysaccharides are abundant biomacromolecules. Due to the intricacy of their structure, polysaccharides may interact with and impact the immune response; hence, they play a crucial role in the treatment of several human illnesses. There is an urgent need for the identification of natural biomolecules that may prevent infection and treat chronic disease. This article addresses some of the naturally occurring polysaccharides of known therapeutic potential that have already been identified. This article also discusses extraction methods and immunological modulatory capabilities.
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Affiliation(s)
- Emma J Murphy
- Shannon Applied Biotechnology Centre, Midwest Campus, Technological University of the Shannon, V94EC5T Limerick, Ireland
- LIFE-Health and Biosciences Research Institute, Midwest Campus, Technological University of the Shannon, V94EC5T Limerick, Ireland
- PRISM, Research Institute, Midlands Campus, Technological University of the Shannon, N37 HD68 Athlone, Ireland
| | - Gustavo Waltzer Fehrenbach
- PRISM, Research Institute, Midlands Campus, Technological University of the Shannon, N37 HD68 Athlone, Ireland
- Applied Polymer Technologies, Midlands Campus, Technological University of the Shannon, N37 HD68 Athlone, Ireland
| | - Ismin Zainol Abidin
- PRISM, Research Institute, Midlands Campus, Technological University of the Shannon, N37 HD68 Athlone, Ireland
- Applied Polymer Technologies, Midlands Campus, Technological University of the Shannon, N37 HD68 Athlone, Ireland
| | - Ciara Buckley
- PRISM, Research Institute, Midlands Campus, Technological University of the Shannon, N37 HD68 Athlone, Ireland
- Applied Polymer Technologies, Midlands Campus, Technological University of the Shannon, N37 HD68 Athlone, Ireland
| | - Therese Montgomery
- School of Science and Computing, Atlantic Technological University, H91 T8NW Galway, Ireland
| | - Robert Pogue
- Universidade Católica de Brasilia, QS 7 LOTE 1-Taguatinga, Brasília 71680-613, DF, Brazil
| | - Patrick Murray
- Shannon Applied Biotechnology Centre, Midwest Campus, Technological University of the Shannon, V94EC5T Limerick, Ireland
- LIFE-Health and Biosciences Research Institute, Midwest Campus, Technological University of the Shannon, V94EC5T Limerick, Ireland
| | - Ian Major
- PRISM, Research Institute, Midlands Campus, Technological University of the Shannon, N37 HD68 Athlone, Ireland
- Applied Polymer Technologies, Midlands Campus, Technological University of the Shannon, N37 HD68 Athlone, Ireland
| | - Emanuele Rezoagli
- Department of Emergency and Intensive Care, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy
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Godek P, Ptaszkowski K. Safety of Epidural Hyaluronic Acid Injections in Managing the Symptoms of Lumbar Foraminal Stenosis: A Prospective Preliminary Study. J Clin Med 2023; 12:jcm12062359. [PMID: 36983359 PMCID: PMC10052817 DOI: 10.3390/jcm12062359] [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: 02/16/2023] [Revised: 03/08/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
Lumbar foraminal stenosis (LFS) of degenerative origin is a common reason for distorted neurodynamics of nerve roots, causing radicular pain that is difficult to resolve with conservative treatments. A hyaluronic acid (HA), providing a sliding layer in the mechanical interface of a nerve root in a narrowed lateral recess, could potentially improve its neurodynamics and the trophic, leading to radicular pain reduction and improvement of function. This study aimed to assess the usefulness of ultrasound-guided HA epidural injections combined with neuromobilization in the conservative treatment of LFS. A group of 10 consecutively admitted patients with MRI-confirmed LFS and reduced straight leg raise (SLR) test results were qualified for a single HA epidural injection along with self-performed neuromobilization. Three measurement tools were used for primary outcomes: the numeric rating scale (NRS) for pain intensity, the Oswestry disability index (ODI) and the Roland-Morris questionnaire (RMQ) for disability level, and the angle of pain-free elevation in the SLR test as a functional assessment. The treatment was accomplished in all patients (100%). Overall, 60% of the patients completed all follow-up visits. There were no statistically significant differences regarding the results of the NRS, ODI, or RMQ; however, a statistically significant increase in the results of the SLR test was noted (p = 0.015). Three patients reported a flare-up of the symptoms shortly after injection but without neurological deficits. In conclusion, an epidural HA injection combined with a self-administered exercise program is a promising method and might be a beneficial way to enhance the neurodynamics of nerve roots in LFS and offer an option for steroid treatment. However, this method of epidural HA administration in LFS should be verified in further studies to confirm its efficiency and safety.
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Affiliation(s)
- Piotr Godek
- Sutherland Medical Center, 04-036 Warsaw, Poland
| | - Kuba Ptaszkowski
- Department of Physiotherapy, Wroclaw Medical University, 50-368 Wrocław, Poland
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