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Vilchez-Cavazos F, Gamboa Alonso AA, Simental-Mendía M, Peña-Martínez VM, Acosta-Olivo CA, Villarreal-Villarreal GA. Genicular Nerve Block for Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Clinical Trials. Clin J Pain 2024; 40:618-624. [PMID: 39143682 DOI: 10.1097/ajp.0000000000001240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 07/10/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVES Genicular nerve block (GNB) has emerged as a novel nonsurgical therapy for symptomatic knee osteoarthritis (KOA). The objective was to evaluate GNB versus placebo and other intra-articular (IA) therapies. METHODS The Medline, Embase, and Scopus databases were searched from their inception to January 2021. Only randomized controlled trials (RCTs) were included. A random-effects model and the generic inverse variance method were used for quantitative data synthesis. Heterogeneity was tested with the I2 index. RESULTS Regarding pain statistically significant scores were demonstrated at 1 and 3 months overall total effect of 1.43 (95% CI, 0.86, 1.99; P= 0.00001; I2 =85%). Similarly, for knee function a total effect of 0.71 (95% CI, 0.35, 1.06; P= 0.00001; I2 =69%) at 1 and 3 months, statistically significant. The minimal clinically important difference regarding pain was achieved at 1 and 3 months. DISCUSSION Although, GNB achieved the MCID for KOA pain and statistically significant results for knee functions. We cannot recommend its routine use besides being a safe procedure so far, evidence is fair on GNB for primary KOA due to study heterogeneity and limited follow-up.
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Affiliation(s)
- Félix Vilchez-Cavazos
- School of Medicine and University Hospital "Dr Jose Eleuterio Gonzalez", Department of Orthopedics and Traumatology, Universidad Autonoma de Nuevo Leon
| | - Augusto A Gamboa Alonso
- School of Medicine and University Hopsital "Dr Jose Eleuterio Gonzalez", Invest-KER Unit, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Mario Simental-Mendía
- School of Medicine and University Hospital "Dr Jose Eleuterio Gonzalez", Department of Orthopedics and Traumatology, Universidad Autonoma de Nuevo Leon
| | - Víctor M Peña-Martínez
- School of Medicine and University Hospital "Dr Jose Eleuterio Gonzalez", Department of Orthopedics and Traumatology, Universidad Autonoma de Nuevo Leon
| | - Carlos A Acosta-Olivo
- School of Medicine and University Hospital "Dr Jose Eleuterio Gonzalez", Department of Orthopedics and Traumatology, Universidad Autonoma de Nuevo Leon
| | - Gregorio A Villarreal-Villarreal
- School of Medicine and University Hospital "Dr Jose Eleuterio Gonzalez", Department of Orthopedics and Traumatology, Universidad Autonoma de Nuevo Leon
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Feda J, Miller T, Young JL, Neilson B, Rhon DI. Measures of sleep are not routinely captured in trials assessing treatment outcomes in knee osteoarthritis - A scoping systematic review and call to action. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100400. [PMID: 37636007 PMCID: PMC10458296 DOI: 10.1016/j.ocarto.2023.100400] [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: 02/22/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023] Open
Abstract
Objective To identify and map the extent to which trials for pain interventions in individuals with knee osteoarthritis (OA) track measures of sleep, characterize the type of sleep measure assessed, and assess their influence on pain-related effect sizes. Design A scoping review was conducted, searching seven bibliometric databases from 2000 to 2022. We included all randomized controlled trials with a primary purpose of assessing non-surgical pain management interventions for adults with knee OA. All non-surgical interventions and any comparator or control were included. Demographic data were pooled from all trials. Results 926 trials conducted in 61 countries met eligibility. Nineteen trials (2.1%) recorded some form of sleep assessment. Eleven trials (1.2%) assessed a formal index of sleep disturbance collected at multiple time points. No trials formally assessed the influence of sleep on the primary pain outcome (e.g., as a potential mediator), nor met the most recent guidelines for core data element recommendations regarding sleep assessment. Conclusion This review highlights the paucity of sleep data captured and reported in randomized controlled trials for knee OA. The vast majority of trials addressing symptomatic knee OA do not capture sleep measures, significantly limiting the ability to accurately determine an intervention's effect on pain. Future research should include formal sleep-centric assessments measured at multiple time points to analyze sleep dysfunction and its relationship on treatment effects.
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Affiliation(s)
- Jessica Feda
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA
- Doctor of Physical Therapy Program, Baylor University, Waco, TX, USA
| | - Tyler Miller
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA
- School of Physical Therapy, Belmont University, Nashville, TN, USA
| | - Jodi L. Young
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA
| | - Brett Neilson
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA
- Doctor of Physical Therapy Program, Hawai'i Pacific University, Honolulu, HI, USA
| | - Daniel I. Rhon
- Doctor of Science in Physical Therapy Program, Bellin College, Green Bay, WI, USA
- Department of Rehabilitation Medicine, School of Medicine, Uniformed Services University of Health Sciences, Bethesda, MD, USA
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Singh S, Singh S, Nachimuthu M, Kassim AF, Bhullar AK, Veerakumaran R, Kol GN, Roslan NAM. Effectiveness of Ultrasound-guided versus Anatomical Landmark-guided Genicular Nerve Block to Treat Chronic Knee Osteoarthritis: A Retrospective Cohort Study. Oman Med J 2023; 38:e550. [PMID: 38225997 PMCID: PMC10788927 DOI: 10.5001/omj.2023.103] [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: 01/08/2023] [Accepted: 03/26/2023] [Indexed: 01/17/2024] Open
Abstract
Objectives There is limited data on the relative effectiveness of different techniques used for administering genicular nerve block (GNB) for pain management of chronic knee osteoarthritis (OA) in the Malaysian population. This study aims to determine and compare the effectiveness of GNB administered using two pain management techniques?"anatomical landmark-guided (ALG) and ultrasound-guided (USG)?"for chronic knee OA in this population. Methods This retrospective cohort study included 40 patients with chronic knee OA who received GNB, 20 of whom underwent treatment with the USG technique and the other 20 with the ALG technique. Pain, stiffness, and functional limitation scores were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index Questionnaire (WOMAC) and Numeric Rating Scale (NRS-11) at baseline and post-treatment day one, three weeks, and six weeks. Results Both groups reported a significant reduction in WOMAC and NRS-11 scores as per their feedback on day one, three weeks, and six weeks post-treatment. Greater reductions in WOMAC and NRS-11 scores were reported by patients who received GNB via USG than by ALG technique, the difference achieving statistical significance at six weeks after treatment (p =0.026). Conclusions GNB administration using USG and ALG techniques are both effective in significantly reducing pain, stiffness, and functional limitation in patients suffering from chronic knee OA. Among the two techniques, USG appears to be more effective. Nevertheless, GNB guided by ALG continues to be a viable treatment modality, especially in healthcare settings with limited to no USG facilities.
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Affiliation(s)
- Sarbhjit Singh
- Department of Orthopedics, Hospital Sultanah Bahiyah, Kedah, Malaysia
| | - Sarbhan Singh
- Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Setia Alam, Malaysia
| | | | | | | | | | - Goh Ni Kol
- Department of Orthopedics, Hospital Raja Permaisuri Bainun, Perak, Malaysia
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Cho J, Yi J, Song Y, Kim YU. Assessment of patellar cartilage cross-sectional area in patients with lower grade chondromalacia patella. Medicine (Baltimore) 2023; 102:e34307. [PMID: 37603532 PMCID: PMC10443766 DOI: 10.1097/md.0000000000034307] [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: 05/23/2023] [Accepted: 06/20/2023] [Indexed: 08/23/2023] Open
Abstract
Chondromalacia patella (CMP) is abnormal softening of the cartilage of the underside the patella. It is a cause of anterior knee pain. Previous study has demonstrated that the patellar cartilage hypertrophy is correlated with early signs of CMP (Grade 1 or 2). However, no studies have investigated the clinical cutoff value of patella cartilage hypertrophy. Thus, we devised the patellar cartilage cross-sectional area (PCCSA) as a new predictive parameter for diagnosing the CMP. The purpose of this research was to compare MR measured PCCSA between CMP patients and gender matched healthy controls. The PCCSA samples were collected from 50 patients with CMP, and from 50 healthy controls who underwent knee MRI with no evidence of CMP. The T2-weighted turbo spin echo transverse MRI images were acquired. We measured the PCCSA on MRI using a PACS system. The PCCSA was measured on the axial angled sections through the whole images by drawing outlines. The average PCCSA was 104.28 ± 23.28 mm2 in the healthy controls and 134.09 ± 26.55 mm2 in the CMP group. CMP patients had significantly higher PCCSA (P < .001). Regarding the validity of PCCSA as predictors of CMP, Receiver Operating Characteristic curve analysis showed that the best cutoff point for the PCCSA was 116.24 mm2, with 72.0% sensitivity, 72.0% specificity, and the area under curve (AUC) of 0.79 (0.71-0.88). The PCCSA is a sensitive measurement parameter to predict low grade CMP. Thus, to evaluate CMP patients, the treating physician carefully inspect the PCCSA.
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Affiliation(s)
- Jaeho Cho
- Department of Anesthesiology and Pain Medicine, Comprehensive Pain Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jungmin Yi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| | - Yumin Song
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
| | - Young Uk Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary`s Hospital, Incheon, Republic of Korea
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Kolakkanni C, Gonnade NM, Gaur R, Nayyar AK, Ghuleliya R, Tk A. Can ultrasound-guided radiofrequency ablation of genicular nerves of the knee, be performed without locating corresponding arterial pulsations-a cadaveric study. BMC Musculoskelet Disord 2023; 24:654. [PMID: 37587439 PMCID: PMC10429091 DOI: 10.1186/s12891-023-06761-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/28/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Given the rising prevalence of knee osteoarthritis, radiofrequency ablation of genicular nerves (RFA) has emerged as a promising treatment option for knee pain. The knee has an extremely complex and variable innervation with nearly 13 genicular nerves described. The frequently ablated genicular nerves are the superomedial (SMGN), the superolateral (SLGN), and the inferomedial (IMGN) genicular nerves. Conventionally, under ultrasound guidance, these nerves are ablated near the corresponding arterial pulsations, but due to the rich vascular anastomosis around the knee joint, identifying the arteries corresponding to these constant genicular nerves can be tedious unless guided by some bony landmarks. In this study, we have evaluated whether it is possible to accurately target these three genicular nerves by just locating bony landmarks under ultrasound in human cadaveric knee specimens. METHODS Fifteen formalin-fixed cadaveric knee specimens were studied. SMGN was targeted 1 cm anterior to the adductor tubercle in the axial view. For SLGN, in the coronal view, the junction of the lateral femoral condyle and shaft was identified, and at the same level in the axial view, the crest between the lateral and posterior femoral cortex was targeted. For IMGN in the coronal view, the midpoint between the most prominent part of the medial tibial condyle and the insertion of the deep fibers of the medial collateral ligament was marked. The medial end of the medial tibial cortex was then targeted at the same level in the axial view. The needle was inserted from anterior to posterior, with an in-plane approach for all nerves. Eosin, 2% W/V, in 0.1 ml was injected. Microdissection was done while keeping the needle in situ. Staining of the nerve was considered a positive outcome, and the percentage was calculated. The nerve-to-needle distance was measured, and the mean with an interquartile range was calculated. RESULT The accuracies of ultrasound-guided bony landmarks of SMGN, SLGN, and IMGN were 100% in terms of staining, with average nerve-to-needle distances of 1.67, 3.2, and 1.8 mm respectively. CONCLUSION It is with 100% accuracy, that we can perform RFA of SMGN, SLGN, and IMGN under ultrasound guidance, by locating the aforementioned bony landmarks.
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Affiliation(s)
- Chinchu Kolakkanni
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Phase 2 Basni, Jodhpur, Rajasthan, India, 342005
| | - Nitesh Manohar Gonnade
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Phase 2 Basni, Jodhpur, Rajasthan, India, 342005.
| | - Ravi Gaur
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Phase 2 Basni, Jodhpur, Rajasthan, India, 342005
| | - Ashish Kumar Nayyar
- Department of Anatomy, All India Institute of Medical Sciences, Phase 2 Basni, Jodhpur, Rajasthan, India
| | - Rambeer Ghuleliya
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Phase 2 Basni, Jodhpur, Rajasthan, India, 342005
- Department of Physical Medicine and Rehabilitation, Himalayan Institute of Medical Sciences, Swami Ram Nagar, Doiwala, Jolly Grant, Dehradun, Uttarakhand, India, 248140
| | - Abins Tk
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Phase 2 Basni, Jodhpur, Rajasthan, India, 342005
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Liu B, Xu HY, Zhang R, Han L, Li Y, Sun XF. An Update on Clinical Utility of Musculoskeletal Ultrasonography in Knee Osteoarthritis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1413-1422. [PMID: 36715025 DOI: 10.1002/jum.16176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/27/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
In knee osteoarthritis (KOA), timely and accurate assessment of the severity is essential to help orthopedic surgeons determine the most appropriate therapeutic strategies and evaluate disease outcomes and responses for corresponding treatments. In KOA, musculoskeletal ultrasonography (MSUS) could effectively help detect various abnormalities, including synovitis, osteophytes, and cartilage damage. Further, MSUS could be used to monitor the response to different therapies in KOA, to guide local diagnostic and therapeutic procedures. In the future, applications based on continuously evolving US tools could enhance the clinical utility of MSUS in KOA.
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Affiliation(s)
- Bo Liu
- Department of Cadre's Wards Ultrasound Diagnostics,Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Hui-Ying Xu
- Department of Cadre's Wards Ultrasound Diagnostics,Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Rui Zhang
- Department of Cadre's Wards Ultrasound Diagnostics,Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Lu Han
- Department of Cadre's Wards Ultrasound Diagnostics,Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yang Li
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xiao-Feng Sun
- Department of Cadre's Wards Ultrasound Diagnostics,Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, Jilin, China
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Shanahan EM, Robinson L, Lyne S, Woodman R, Cai F, Dissanayake K, Paddick K, Cheung G, Voyvodic F. Genicular Nerve Block for Pain Management in Patients With Knee Osteoarthritis: A Randomized Placebo-Controlled Trial. Arthritis Rheumatol 2023; 75:201-209. [PMID: 36369781 DOI: 10.1002/art.42384] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/05/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study was undertaken to determine the efficacy of ultrasound-guided genicular nerve block (GNB) for the management of knee pain in patients with knee osteoarthritis. METHODS We performed a 12-week parallel-group, placebo-controlled randomized trial of GNB. Within 2 weeks of randomization, patients with knee osteoarthritis in the active arm received 3 injections of 5.7 mg celestone chronodose (1 ml) and 0.5% bupivacaine (3 ml) to the inferomedial, superomedial, and superolateral genicular nerves; patients with knee osteoarthritis in the placebo arm received injections of normal saline. At baseline and at weeks 2, 4, 8, and 12, patients recorded their pain and disability on a 100-mm visual analog scale (VAS) (the primary outcome measure), the Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC), and the Intermittent and Constant Osteoarthritis Pain scale. Statistical significance was set at a 2-sided Type I error of α = 0.0125 for comparisons at each of the 4 time points. We used a global perceived effect scale to measure patient satisfaction. RESULTS The 59 patients (36 female, 23 male) who completed the trial had a mean ± SD age of 68.2 ± 8.6 years. Patients in the active group reported improvements in pain scores at 2, 4, 8, and 12 weeks with a diminution of the effect over time. VAS scores at baseline and at weeks 2, 4, 8, and 12 in the active group (n = 31) versus placebo group (n = 28) were 6.2 versus 5.3 (P = 0.294), 2.7 versus 4.7 (P < 0.001), 3.2 versus 5.1 (P < 0.001), 3.9 versus 4.9 (P < 0.001), and 4.6 versus 5.1 (P = 0.055), respectively. Total WOMAC scores at baseline and at weeks 2, 4, 6, 8, and 12 in the active group versus the placebo group were 54.5 versus 48.1 (P = 0.177), 32.9 versus 44.4 (P < 0.001), 33.7 versus 45.8 (P < 0.001), 39.2 versus 44.8 (P = 0.001), and 42.65 versus 45.1 (P = 0.012), respectively. CONCLUSION GNB offers short-term pain relief for knee osteoarthritis.
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Affiliation(s)
- Ernst M Shanahan
- College of Medicine and Public Health, Flinders University, Bedford Park, and Department of Rheumatology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Lucinda Robinson
- Department of Rheumatology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Suellen Lyne
- Department of Rheumatology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Richard Woodman
- College of Medicine and Public Health, Flinders University, Bedford Park, Adelaide, South Australia, Australia
| | - Fin Cai
- Department of Rheumatology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Kokum Dissanayake
- Department of Rheumatology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Kate Paddick
- Department of Radiology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Giovanna Cheung
- Department of Radiology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Frank Voyvodic
- Department of Radiology, Flinders Medical Centre, and Bensons Radiology, Wayville, Adelaide, South Australia, Australia
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Güler T, Yurdakul FG, Önder ME, Erdoğan F, Yavuz K, Becenen E, Uçkun A, Bodur H. Ultrasound-guided genicular nerve block versus physical therapy for chronic knee osteoarthritis: a prospective randomised study. Rheumatol Int 2022; 42:591-600. [PMID: 35165769 PMCID: PMC8852952 DOI: 10.1007/s00296-022-05101-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/01/2022] [Indexed: 12/28/2022]
Abstract
To compare the effectiveness of ultrasound-guided genicular nerve block (GNB) and physical therapy (PT) in patients with chronic knee osteoarthritis. A prospective randomised study with 102 patients (45–70 years) was performed wherein the patients received ultrasound-guided GNB (n = 51) and PT (n = 51) along with a standard home exercise programme. Scores for pain on a Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and 6-min walking test (6MWT) were assessed pre-treatment and at 2- and 12-weeks post-treatment. Both groups were comparable for sociodemographic characteristics. VAS scores (in mm) in the ultrasound-guided GNB group at 0, 2 and 12 weeks were 7.01 ± 1.36; 3.71 ± 2.18; 5.08 ± 2.22 (p < 0.001) and 6.64 ± 1.99; 4.35 ± 1.09; 5.25 ± 1.33, (p < 0.001) in the PT group. While the increase in the 6MWT test in the 2nd week was similar for both groups (p = 0.073), the increase in walking distance was greater in the ultrasound-guided GNB group at 12 weeks (p = 0.046). As compared to PT, ultrasound-guided GNB is beneficial in reducing pain and increasing functional and physical capacity, with greater retention of effects on the physical capacity seen at 12 weeks. Trial registration number: ClinicalTrials.gov (NCT04782401).
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Affiliation(s)
- Tuba Güler
- Physical Medicine and Rehabilitation Hospital, Ankara City Hospital, Ankara, Turkey
| | - Fatma Gül Yurdakul
- Physical Medicine and Rehabilitation Hospital, Ankara City Hospital, Ankara, Turkey
| | - Mustafa Erkut Önder
- Division of Rheumatology, Training and Research Hospital, Aksaray University, Aksaray, Turkey
| | - Faruk Erdoğan
- Physical Medicine and Rehabilitation Hospital, Ankara City Hospital, Ankara, Turkey
| | - Kaan Yavuz
- Physical Medicine and Rehabilitation Hospital, Ankara City Hospital, Ankara, Turkey
| | - Elif Becenen
- Physical Medicine and Rehabilitation Hospital, Ankara City Hospital, Ankara, Turkey
| | - Aslı Uçkun
- Department of Physical Medicine and Rehabilitation, İzmir Medicana Hospital, İzmir, Turkey
| | - Hatice Bodur
- Physical Medicine and Rehabilitation Hospital, Ankara City Hospital, Ankara, Turkey
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Intra-articular corticosteroid injection and genicular nerve block under ultrasound guidance in pain control of knee osteoarthritis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00577-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Chronic knee osteoarthritis (OA) is a frequent disease among the elderly. Intra-articular corticosteroid injection (IACSI) was commonly adopted to alleviate knee OA-related pains. Recently, Genicular nerve block (GNB) has emerged as a new alternative technique. The current study aimed to investigate the efficacy of those two approaches when guided with ultrasound and to determine which one offers better results. This study included 40 patients with painful chronic knee OA (Nine males and 31 females, age ranged from 44 to 65 years) and were randomly assigned to two equal groups. Groups 1 was managed with ultrasound-guided IACSI and group 2 with ultrasound-guided GNB using a mixture of lidocaine and Triamcinolone Acetonide. The baseline mean visual analogue scale (VAS) and Oxford knee score (OKS) for the group 1 were 87.10 and 51.3, while for group 2 were 87.75 and 53.25 respectively. Follow up values were obtained at 2, 4 and 8 weeks using VAS and OKS.
Results
The VAS score and OKS score were significantly lower in the GNB group and IACSI group at 2, and 4 weeks after the procedure (p < 0.001 for all), then returned near baseline values at 8 weeks. When the two groups were compared according to changes in VAS and OKS from baseline at 2, 4, and 8 weeks, GNB group showed significant alleviation of pain (mean reduction of 58.5, 53.3, and 9.25 points at 2, 4, and 8 weeks versus 44.9, 39.4, and 5.6 points at the IACSI groups, p < 0.001 at 2 and 4 weeks, p < 0.006 at 8 weeks). Similarly at the OKS, the GNB group showed significantly better results (33.50, 28.60, and 8.5 at GNB and 26.45, 20.10, 5.25 at IACSI. p < 0.001 at all periods).
Conclusions
Both GNB and IACSI are effective methods to relieve chronic knee osteoarthritis-related pains. When compared to each other, GNB showed more significant pain relief and functional improvement than IACSI.
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Bosch P, Carubbi F, Scirè CA, Baraliakos X, Falzon L, Dejaco C, Machado PM. Value of imaging to guide interventional procedures in rheumatic and musculoskeletal diseases: a systematic literature review informing EULAR points to consider. RMD Open 2021; 7:rmdopen-2021-001864. [PMID: 34810228 PMCID: PMC8609947 DOI: 10.1136/rmdopen-2021-001864] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To summarise current data on the value of imaging to guide interventional procedures in patients with rheumatic and musculoskeletal disease (RMDs) informing an European Alliance of Associations for Rheumatology taskforce. METHODS A systematic literature review was conducted to retrieve prospective and retrospective studies published in English and comparing different (imaging) techniques, different settings and procedural protocols to guide interventions in patients with RMDs. MEDLINE, EMBASE, the Cochrane Library and Epistemonikos databases were searched through October 2021. Risk of bias (RoB) was assessed using the Cochrane RoB tool for randomised trials V.2 (ROB2), the RoB tool for Non-Randomised Studies of Interventions and the appraisal tool for cross-sectional studies. RESULTS Sixty-six studies were included (most with moderate/high RoB); 49 were randomised controlled trials, three prospective cohort studies and 14 retrospective studies. Fifty-one studies compared either one imaging technique with another imaging technique, or with palpation-guided interventions. Ultrasound (US) was most frequently studied (49/51), followed by fluoroscopy (10/51). Higher accuracy was found for US or fluoroscopy compared with palpation-guided interventions. Studies comparing different imaging techniques (12/51) did not endorse one specific method. Different settings/equipment for imaging-guided procedures (eg, automatic vs manual syringes) were investigated in three studies, reporting heterogeneous results. Fifteen studies compared different imaging-guided procedures (eg, intra-articular vs periarticular injections). CONCLUSION Higher accuracy of needle positioning at joints and periarticular structures was seen in most studies when using imaging (especially US) guidance as compared with palpation-guided interventions with the limitation of heterogeneity of data and considerable RoB.
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Affiliation(s)
- Philipp Bosch
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Francesco Carubbi
- Internal Medicine and Nephrology Unit, Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Department of Medicine, ASL 1 Avezzano-Sulmona-L'Aquila, San Salvatore Hospital, L'Aquila, Italy
| | | | | | | | - Christian Dejaco
- Department of Rheumatology and Immunology, Medical University of Graz, Graz, Austria .,Rheumatology Service, Hospital of Bruneck, Bruneck, Italy
| | - Pedro M Machado
- Centre for Rheumatology, University College London, London, UK.,National Institute for Health Research (NIHR) University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.,Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
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11
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Novel Use of 3-Point Genicular Nerve Block for Acute Knee Pain in the Emergency Department. J Emerg Med 2021; 61:416-419. [PMID: 34176690 DOI: 10.1016/j.jemermed.2021.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/01/2021] [Accepted: 04/26/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Ultrasound-guided genicular nerve blocks (GNBs) in the emergency department (ED) have easily identifiable anatomic targets and offer an opportunity to provide safe, effective, motor-sparing analgesia for acute knee pain. Case Report A 68-year-old woman presented with acute, 8/10 right knee pain due to an isolated right lateral tibial plateau fracture. After informed consent and with the ultrasound in the sagittal plane, the superior lateral (SLGN), superior medial (SMGN), and inferior medial (IMGN) genicular nerves were identified at the junction of their respective femoral or tibial epicondyle and femoral or tibial epiphysis. The skin was anesthetized and an echogenic needle was inserted under ultrasound guidance to inject 1.0 mL of 0.5% bupivacaine around the right SLGN, SMGN, and IMGN. Approximately 30 minutes after the GNBs, the patient reported 0/10 pain at rest and 1/10 pain with movement. She did not require opioids during her ED visit or upon discharge. Why Should an Emergency Physician Be Aware of This? GNBs show promise as a useful tool to provide acute and medium-term motor-sparing analgesia in a patient with acute knee pain. GNBs have easy-to-recognize anatomic targets on ultrasound and may be a suitable adjunct or alternative to a multimodal pain regimen in the emergency department.
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Atici A, Bahadir Ulger FE, Akpinar P, Illeez OG, Geler Kulcu D, Unlu Ozkan F, Aktas I. Poor Accuracy of Clinical Diagnosis in Pes Anserine Tendinitis Bursitis Syndrome. Indian J Orthop 2021; 56:116-124. [PMID: 35070151 PMCID: PMC8748597 DOI: 10.1007/s43465-021-00424-3] [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: 12/26/2020] [Accepted: 05/12/2021] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To investigate the characteristics of the patients who are clinically diagnosed with pes anserine tendinitis bursitis syndrome (PATBS), and to determine the sensitivity and specificity of clinical diagnose based on magnetic resonance imaging (MRI). METHODS Included in this cross-sectional clinical study were 156 patients who were evaluated based on the clinical presence or absence of PATBS. All patients underwent Q-angle measurement, knee osteoarthritis (OA) grading according to the Kellgren-Lawrence classification, and medial joint space measurement, and their cartilage thickness, and any periarticular and intraarticular knee pathologies were recorded from an assessment of knee MRIs. RESULTS Of the total, 64 cases (41%) were diagnosed clinically with PATBS and 92 (59%) were not. There was no difference in the Q angles of the two groups (p > 0.05), while the medial joint spaces were significantly lower in the PATBS patients (p < 0.05). There were no significant differences between the two groups in an MRI assessment of meniscus and ligament lesions, chondromalacia patella, cyst, bursitis, effusion and synovial pathologies (p > 0.05). The sensitivity and specificity of the PATBS clinical diagnoses relative to the MRI findings were determined as 41.2% and 59.5%, respectively. CONCLUSION The medial joint space was found to be significantly lower in patients with PATBS, while there was no difference in any other knee pathologies between the two groups. The sensitivity and specificity of a PATBS clinical diagnosis were found to be low, and so it was concluded that clinical PATBS diagnoses may be inaccurate, particularly in the presence of such invasive therapies as injection, and that diagnoses based on imaging methods would be more accurate.
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Affiliation(s)
- Arzu Atici
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Icerenkoy, 34752 Istanbul, Turkey
| | - Fatma Esra Bahadir Ulger
- Department of Radiology, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Istanbul, Turkey
| | - Pinar Akpinar
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Icerenkoy, 34752 Istanbul, Turkey
| | - Ozge Gulsum Illeez
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Icerenkoy, 34752 Istanbul, Turkey
| | - Duygu Geler Kulcu
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Haydarpasa Numune Education and Research Hospital, Istanbul, Turkey
| | - Feyza Unlu Ozkan
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Icerenkoy, 34752 Istanbul, Turkey
| | - Ilknur Aktas
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Fatih Sultan Mehmet Education and Research Hospital, Icerenkoy, 34752 Istanbul, Turkey
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