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Babaei-Ghazani A, Eftekharsadat B, Soleymanzadeh H, ZoghAli M. Ultrasound-Guided Pes Anserine Bursitis Injection Choices: Prolotherapy or Oxygen-Ozone or Corticosteroid: A Randomized Multicenter Clinical Trial. Am J Phys Med Rehabil 2024; 103:310-317. [PMID: 37752656 DOI: 10.1097/phm.0000000000002343] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
OBJECTIVE Pes anserine bursitis is the most common cause of periarticular knee pain. The aim of the study was to evaluate the efficacy of local injection-based therapies with different materials. DESIGN The enrolled patients were randomly allocated to three groups to receive different interventions. Outcome measures included pain severity using the visual analog scale and the Western Ontario and McMaster Universities osteoarthritis index that was evaluated before the intervention, 1 and 8 wks after that. RESULTS This trial was performed on 72 participants, with male-to-female ratio of 0.14 and with a mean age of 61.49 ± 9.35 yrs. Corticosteroids in the first group, oxygen-ozone in the second group, and dextrose 20% in the third group, were injected into the pes anserine bursa under ultrasound guidance. Interaction between time and group showed a statistically significant improvement in visual analog scale and Western Ontario and McMaster Universities Arthritis Index ( P ≤ 0.05) in favor of corticosteroids and oxygen-ozone groups after 1 wk and in favor of oxygen-ozone and prolotherapy groups after 8 wks. CONCLUSIONS All three treatment options are effective for patients with pes anserine bursitis. This study showed that the effects of oxygen-ozone injection and prolotherapy last longer than those of corticosteroid injection.
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Affiliation(s)
- Arash Babaei-Ghazani
- From the Neuromusculoskeletal Research Center, Department of Physical Medicine and Rehabilitation, School of Medicine, Iran University of Medical Sciences, Tehran, Iran (AB-G); Department of Physical Medicine and Rehabilitation, University of Montreal Health Center, Montreal, Canada (AB-G); Physical Medicine and Rehabilitation Research Center, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran (BE); Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran (HS); and Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran (MZ)
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Gouda W, Abbas AS, Abdel-Aziz TM, Shoaeir MZ, Ahmed W, Moshrif A, Mosallam A, Kamal M. Comparing the Efficacy of Local Corticosteroid Injection, Platelet-Rich Plasma, and Extracorporeal Shockwave Therapy in the Treatment of Pes Anserine Bursitis: A Prospective, Randomized, Comparative Study. Adv Orthop 2023; 2023:5545520. [PMID: 37810418 PMCID: PMC10560108 DOI: 10.1155/2023/5545520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 10/10/2023] Open
Abstract
Background Pes anserine bursitis (PAB) is one of the most common causes of painful knee syndromes. This study aimed at examining the efficacy of local corticosteroid injection, platelet-rich plasma (PRP) injection, and extracorporeal shock wave therapy (ESWT) as different modalities to alleviate pain and enhance function in patients with pes anserine bursitis (PAB). Methods A prospective, randomized, comparative study was conducted on 180 patients diagnosed with chronic PAB. They were equally divided into three groups as follows: Group I received a local corticosteroid injection of 40 mg of methylprednisolone acetate/1 ml; Group II received a PRP injection; and in Group III, ESWT was used. Outcome measures included the visual analog scale (VAS), Western Ontario and McMaster Universities (WOMAC) pain score, WOMAC physical function score, and Ritchie articular index (RAI) for tenderness, which were recorded at the baseline, after 1 week, and after 8 weeks. Results Before the application of procedures, there was a statistically significant increase in the WOMAC pain score in the local corticosteroid group compared to the PRP group and the ESWT group (P < 0.001). After the application of procedures, there was a statistically significant improvement in the 1-week and 8-week WOMAC pain score, WOMAC physical function score, and VAS in the local corticosteroid group in comparison to the PRP group and the ESWT group. (P < 0.001). Moreover, RAI for tenderness shows statistically significant improvement at 8 weeks in the local corticosteroid groups compared to the PRP groups (P < 0.001) and ESWT groups (P < 0.001). Similarly, a statistically significant difference was found between the PRP and ESWT groups (P=0.023). Conclusion Our data suggest that in patients with PAB, local corticosteroid injection is more efficient than PRP injection and ESWT for reducing pain and enhancing function.
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Affiliation(s)
- Wesam Gouda
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Al Azhar University, Assiut, Egypt
| | - Awad S. Abbas
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Al Azhar University, Assiut, Egypt
| | - Tarek M. Abdel-Aziz
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Al Azhar University, Assiut, Egypt
| | - Mohamed Z. Shoaeir
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Al Azhar University, Assiut, Egypt
| | - Walid Ahmed
- Medicine Department, London North West University Healthcare NHS Trust, Harrow, UK
| | - Abdelhfeez Moshrif
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Al Azhar University, Assiut, Egypt
| | - Ahmed Mosallam
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Al Azhar University, Assiut, Egypt
| | - Mohamed Kamal
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Al Azhar University, Cairo, Egypt
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Majidi L, Saeb F, Alaei B, Khateri S, Ezzati Amini E, Nikoo MR. Comparison of the Effectiveness of Local Corticosteroid Injection and Extracorporeal Shockwave Therapy in Patients With Pes Anserine Bursitis: An Open-Label Randomized Clinical Trial. Med J Islam Repub Iran 2023; 37:10. [PMID: 37123337 PMCID: PMC10134082 DOI: 10.47176/mjiri.37.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Indexed: 05/02/2023] Open
Abstract
Background: The success rate of extracorporeal shock wave therapy (ESWT) in treating epicondylitis, plantar fasciitis, rotator cuff tendonitis, Achilles tendonitis, and Jumper knee has been reported to be 60% to 80%. Most published studies have compared focused ESWT at different intensities with local corticosteroid injection (LCI). We only identified a few studies that specifically compared ESWT with LCI in patients with pes anserine bursitis (PAB). This study aimed to compare the effectiveness of ESWT and LCI in patients with PAB. Methods: The present study was a randomized clinical trial. Patients diagnosed with PAB who were referred to the physical medicine and rehabilitation clinic underwent a complete physical examination. They (n = 60 patients) were randomly assigned to the ESWT and LCI groups if they met the study criteria. In the ESWT group, 1 ESWT session was performed weekly for 3 consecutive weeks. In the LCI group, 1 injection was performed under an ultrasonography guide. Pes anserine thickness, pain intensity, and treatment satisfaction were measured with visual analog scale (VAS) and quality of life (Short Form-12). A paired-samples t test was used to compare the results obtained in the pre-and posttests. Analysis of variance for repeated measures was used to detect differences over time. The null hypothesis would not be confirmed if the P value was less than the 0.05 level of significance. Results: Pes anserine thickness and pain intensity decreased significantly during the study in both groups (P < 0.001). However, the mean difference of pes anserine thickness was more in the LCI group the ESWT group [(-0.6; 95% CI, -1.0 to -0.3) than (-0.1; 95% CI, -0.5, -0.2); P = 0.008]. Also, the mean difference of pain intensity was lower in the ESWT group] than the LCI group [(-2.9; 95% CI, -3.7 to -2.1) (1.0; 95% CI, 0.1to 1.8); P < 0.001]. Patients' quality of life in both groups increased significantly during the study period (P < 0.001), but the increase in quality of life in patients in the ESWT group (mean difference, 15.3 [95% CI, 10.6-19.9]) was considerably more than in the LCI group (mean difference, -5.3 (95% CI, -10.0 to -0.6). Conclusion: Overall, the results of this study showed that both local corticosteroid injections and extracorporeal shock wave therapy are safe and effective in PAB patients.
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Affiliation(s)
- Lobat Majidi
- Department of Physical Medicine and Rehabilitation, School of Medicine
Sina (Farshchian) Educational and Medical Center, Hamadan University of Medical
Sciences, Hamedan, Iran
| | - Farzaneh Saeb
- Department of Physical Medicine and Rehabilitation, School of Medicine
Sina (Farshchian) Educational and Medical Center, Hamadan University of Medical
Sciences, Hamedan, Iran
| | - Behnaz Alaei
- Department of Physical Medicine and Rehabilitation, School of Medicine
Sina (Farshchian) Educational and Medical Center, Hamadan University of Medical
Sciences, Hamedan, Iran
| | - Sorour Khateri
- Department of Physical Medicine and Rehabilitation, School of Medicine
Sina (Farshchian) Educational and Medical Center, Hamadan University of Medical
Sciences, Hamedan, Iran
| | - Elnaz Ezzati Amini
- Social Determinant of the Health Research Center, Research Institute for
Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Mohammad Reza Nikoo
- Department of Physical Medicine and Rehabilitation, School of Medicine
Sina (Farshchian) Educational and Medical Center, Hamadan University of Medical
Sciences, Hamedan, Iran
- Corresponding author:Mohammad
Reza Nikoo,
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Marcolina A, Vu K, Chang Chien G. Peripheral Joint Injections. Phys Med Rehabil Clin N Am 2022; 33:267-306. [DOI: 10.1016/j.pmr.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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A Review of Randomized Controlled Trials of Pes Anserinus Tendinitis/Bursitis Syndrome in the China National Knowledge Infrastructure Database. JOURNAL OF ACUPUNCTURE RESEARCH 2021. [DOI: 10.13045/jar.2021.00192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The purpose of this study was to review randomized controlled trials (RCTs) of pes anserinus tendinitis or bursitis (PATB) syndrome in the China National Knowledge Infrastructure database to investigate the efficacy of traditional Chinese medicine treatment for PATB syndrome. There were 20 RCTs published from 2001 to 2021 which were selected for analysis by publication year, number of samples, evaluation criteria, treatment duration, and treatment method. Out of the 142 retrieved RCTs, 20 were relevant to this review, and had performed Chinese medicine treatments including acupuncture (the most common treatment typically using acupoints SP10, ST35, SP9, and LR8), manipulation (typically using acupoints ST35, SP10, and SP9), and external application therapy (typically herbal medicine) in the treatment of PATB syndrome. Chinese medicine treatments were used widely in the treatment of PATB syndrome. We hope in the future, this review may initiate the development of treatments for PATB syndrome using Korean medicine.
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The comparison of different medical treatment modalities in pes anserinus tendino-bursitis: a prospective clinical study. CURRENT ORTHOPAEDIC PRACTICE 2021. [DOI: 10.1097/bco.0000000000001048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Karabaş Ç, Talay Çaliş H, Topaloğlu US, Karakükçü Ç. Effects of ultrasound guided leukocyte-rich platelet-rich plasma (LR-PRP) injection in patients with pes anserinus tendinobursitis. Transfus Apher Sci 2021; 60:103048. [PMID: 33574009 DOI: 10.1016/j.transci.2020.103048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 12/21/2020] [Accepted: 12/30/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To demonstrate the efficacy and safety of ultrasound guided leukocyte-rich platelet-rich plasma (LR-PRP) injection in patients with pes anserinus tendinobursitis (PATB). METHODS A prospective, randomized and single-blinded study of 60 patients with PATB were randomly assigned into 2 groups. Whereas 2 mL LR-PRP injection was applied to one grup, once accompanied by ultrasonography (USG), 2 mL LR-PRP injection was applied to the other group accompanied by USG twice with a one-week interval. Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), 6-minute walking test (6MWT), Likert Scale were evaluated pre-treatment, at the 4th and 12th weeks after treatment. RESULTS There was no statistical difference between the two groups in terms of age, gender, body mass index, duration of symptoms, affected side. When both groups are compared within themselves before and after treatment, there was a significant improvement in all VAS, in all WOMAC subgroups, 6MWT, at the 4th and 12th weeks after treatment. When the two groups are compared with each other, there was no statistical difference. In addition, when all patients were evaluated with Likert scale in the 12th week after treatment, complete healing in 22(36.7 %) patients, significant relief in 25(41.7 %) patients, mild relief in 4(6.7 %) patients, 5(8.3 %) same as before treatment patients, and worsened pain in 4(6.7 %) patients were seen. CONCLUSION Both single-dose and double-dose local LR-PRP is a safe and effective treatment option for patients with PATB syndrome. We believe that once LR-PRP injection may be sufficient for the treatment efficacy in PATB.
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Affiliation(s)
- Çağlar Karabaş
- Department of Physical Medicine and Rehabilitation, Kastamonu Rehabilitation Center, Kastamonu, Turkey.
| | - Havva Talay Çaliş
- Department of Physical Medicine and Rehabilitation, Kayseri City Hospital, Kayseri, Turkey
| | | | - Çiğdem Karakükçü
- Department of Biochemistry, Kayseri City Hospital, Kayseri, Turkey
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Algarni AD. Pes anserinus pain syndrome following total knee arthroplasty for degenerative varus: incidence and predictors. INTERNATIONAL ORTHOPAEDICS 2020; 44:1083-1089. [PMID: 32047961 DOI: 10.1007/s00264-020-04498-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 01/31/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Pes anserinus pain syndrome (PAPS) is a well-described condition in the native knee; however, its incidence after total knee arthroplasty (TKA) is unknown. This study aimed to determine the incidence of PAPS after primary TKA, identify potential risk factors, and assess its response to treatment. Few case reports have been published until now; to our knowledge, ours is the first study assessing the incidence and predictors of post-TKA PAPS. METHODS A total of 389 primary TKAs performed for degenerative varus knee at a single institution by the same surgeon were analyzed. We recorded demographic variables, medical comorbidities, and clinical, radiographic, and surgical data. Specific predictors of interest were compared between post-TKA PAPS and controls. RESULTS The incidence was 5.6% (22/389). On univariate analysis, female sex (p = 0.03), body mass index (BMI) (41.3% ± 7.9; p < 0.001), and absence of pes anserinus release (p = 0.04) were significant predictors. On multivariable regression analysis, only BMI was a significant independent risk factor (p = 0.01). All patients were treated non-operatively; 81.8% responded to nonsteroidal anti-inflammatory drug-physical therapy program and 18.2% required an additional local steroid injection. CONCLUSION PAPS occurs after TKA; the incidence was found to be 5.6%. BMI seems to be an independent risk factor. It is a benign condition and can be effectively treated conservatively in most cases.
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Lee JH, Lee JU, Yoo SW. Accuracy and efficacy of ultrasound-guided pes anserinus bursa injection. JOURNAL OF CLINICAL ULTRASOUND : JCU 2019; 47:77-82. [PMID: 30378129 DOI: 10.1002/jcu.22661] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 09/03/2018] [Accepted: 09/27/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE To compare the accuracy and efficacy of ultrasound (US)-guided versus blind pes anserinus bursa (PAB) injection in patients with pes anserinus tendinobursitis (PATB). METHODS Forty-seven patients with clinically diagnosed PATB were randomly assigned to a US-guided group or a blind group of steroid injection. In the US-guided group, the injectate was delivered under sonographic visualization. In the blind group, the conventional technique was used without any visual guidance. After the PAB injection, the injectate location was identified using US in both groups. Treatment effects were assessed using the visual analogue scale (VAS) of knee tenderness. Outcomes were measured before, 1 week and 4 weeks after the injection. RESULTS Both groups showed pain relieving at 1 week and 4 weeks after the injection. The injectate in the US guided group were found to be accurately at the PAB in all subjects, whereas blind group were found to be just in 4 of 22 subjects. The US-guided group showed significant improvement of both of VAS scores compared to the blind group at 1 week and 4 weeks after the injection (P < .05). CONCLUSION Our results suggest that US-guided PAB injection is more accurate and effective than blind injection in patients with PATB.
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Affiliation(s)
- Jong H Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Jae U Lee
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Republic of Korea
| | - Seung W Yoo
- Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan, Republic of Korea
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Injecting autologous platelet rich plasma solely into the knee joint is not adequate in treating geriatric patients with moderate to severe knee osteoarthritis. Exp Gerontol 2019; 119:1-6. [PMID: 30664923 DOI: 10.1016/j.exger.2019.01.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/25/2018] [Accepted: 01/15/2019] [Indexed: 01/23/2023]
Abstract
Knee pain caused by osteoarthritis (OA) is commonly seen in geriatric patients. Patients with knee OA are often complicated with joint pain, soreness, and weakness. The injection of autologous platelet rich plasma (aPRP) has been proven to be effective in treating mild knee OA. The effect of injecting aPRP in treating moderate to severe degrees of knee OA remains controversial. This study aimed to evaluate the effectiveness of aPRP in treating patients with at least grade 2 on the Kellgren and Lawrence system for the classification of knee OA using a proteomic approach and clinical evaluation tool of Lequesne index. Musculoskeletal ultrasound was used for accurate needle placement into the knee joint, and to the perimeniscal soft tissue for the injection of aPRP. Three monthly aPRP injections were performed. Group 1 patients received intra-articular (IA) injection only, while group 2 received simultaneous IA and pes anserinus aPRP injections. After two monthly aPRP injections, both groups revealed significant drops in average SF total protein concentrations, and increases in the protein concentrations associated with chelation and anti-aging (eg/transthyretin, matrilin, and complement). However, it is group 2 that revealed significant decreases in the protein concentrations associated with inflammation (eg/immunoglobulin and apolipoprotein), and improved knee functional status. SF appeared to become less susceptible to degeneration after aPRP injections in group 2. As a result, at least 2 monthly injection of IA aPRP in conjunction with accurate injection of aPRP to the perimeniscal soft tissue structure such as the pes anserinus may be a viable option in treating patients with moderate to severe degrees of knee OA.
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Ariff MAM, Ros MIAC, Yahaya NHM. Painful Pes Anserine Bursitis Following Total Knee Replacement Surgery: Two cases. Sultan Qaboos Univ Med J 2018; 18:e97-e99. [PMID: 29666689 DOI: 10.18295/squmj.2018.18.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/12/2017] [Accepted: 12/07/2017] [Indexed: 11/16/2022] Open
Abstract
Pes anserine bursitis (PAB) is an inflammation of the bursa located between the medial aspect of the tibia and the hamstring muscles. It is common in patients with degenerative or inflammatory knee arthritis, usually has a self-limiting course and tends to respond well to conservative treatment. However, painful PAB directly following total knee replacement surgery is rare. We report two such cases who were diagnosed via ultrasonography at the Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia, in 2015. Both patients were treated locally with triamcinolone acetonide under ultrasound guidance and responded well to treatment.
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Affiliation(s)
- Mohamed A M Ariff
- Department of Orthopaedics & Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Mohd I A C Ros
- Department of Orthopaedics & Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Nor H M Yahaya
- Department of Orthopaedics & Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Affiliation(s)
- Glenn H Sapp
- University of Florida, Orthopaedics and Sports Medicine Institute, Gainesville, FL
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Mun JU, Cho HR, Bae SM, Park SK, Choi S., Seo MS, Lim YS, RN SHW, Kim YU. Effect of polydeoxyribonucleotide injection on pes anserine bursitis: A case report. Medicine (Baltimore) 2017; 96:e8330. [PMID: 29069005 PMCID: PMC5671838 DOI: 10.1097/md.0000000000008330] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
RATIONALE Pes anserine (PA) bursitis is an inflammatory condition of the medial knee. The PA bursa becomes more painful when infected, damaged, or irritated. Although various treatment options have been attempted to treat PA bursitis, optimal treatments are still debated. This study aims to investigate the effect of polydeoxyribonucleotide (PDRN) injection on reducing pain and inflammation in a patient presenting with PA bursitis. PATIENT CONCERNS A 50-year-old female patient was admitted to our pain clinic with symptoms of tenderness and pain over the medial knee. Physical examination revealed the pain to be located over the proximal medial tibia at the insertion of the conjoined tendons of the PA. The knee had lost its range of movement and strength, and resisted knee flexion. DIAGNOSES She was diagnosed as having PA bursitis. INTERVENTIONS Ultrasound guided PA bursa injection was carried out. OUTCOMES Follow-up for the patient was more than eight months. She showed good improvement in PA bursitis without any complications. LESSONS This is the first successful report of successful PDRN injection for PA bursa.
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Affiliation(s)
- Jong-Uk Mun
- Department of Orthopedic Surgery, Changwon Gyeongsang National University Hospital, Incheon
| | - Hyung R. Cho
- Department of Anesthesiology and Pain Medicine, Myongji Hospital, College of Medicine, Seonam University, Goyang
| | - Sae M. Bae
- Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Incheon
| | - Soo K. Park
- Department of Anesthesiology and Pain Medicine, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Incheon
| | - Soo .l Choi
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary‘s Hospital, Incheon
| | - Mi S. Seo
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary‘s Hospital, Incheon
| | - Young S. Lim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary‘s Hospital, Incheon
| | - Soo H. Woo RN
- Department of Nursing, Kyung-In Women‘s University, Incheon, Republic of Korea
| | - Young U. Kim
- Department of Anesthesiology and Pain Medicine, Catholic Kwandong University of Korea College of Medicine, International ST. Mary‘s Hospital, Incheon
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Sakamoto A, Matsuda S. Pes Anserinus Syndrome Caused by Osteochondroma in Paediatrics: A Case Series Study. Open Orthop J 2017; 11:397-403. [PMID: 28603571 PMCID: PMC5447900 DOI: 10.2174/1874325001711010397] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/23/2017] [Accepted: 04/16/2017] [Indexed: 11/30/2022] Open
Abstract
Introduction: Osteochondroma is a common benign bone tumor, protruding from the underlying normal bone. Osteochondromas can cause pain depending on their location and size. The pes anserinus is located at the proximal medial side of the tibia, where the tendinous insertions of the sartorius, gracilis and semitendinosus muscles collectively attach. Pes anserinus syndrome, or anserine bursitis, is a painful condition of the pes anserinus, and is more common in adults typically with overweight females. The occurrence of pes anserinus syndrome is rare in the paediatric population. Results: In the current case series, five patients with pes anserinus syndrome due to proximal tibial osteochondroma are reported. Pain was present in all cases, with snapping in one case. The average age of the patients was 13 ± 1.2 years, ranging from 12 to 15 years. Three patients had a single osteochondroma, and two patients had hereditary multiple exostoses. The sizes of the osteochondromas on plain radiographs varied from 0.5 to 2.5 cm, with an average of 1.46 ± 0.83 cm. All lesions characteristically were located at the medial-posterior edge of the proximal tibia. The symptoms resolved in four cases with surgical resection, and persisted in one non-resected patient. Conclusion: The characteristic location of the osteochondroma causes pes anserinus syndrome, even though the lesion is small. The diagnosis of osteochondroma or pes anserinus syndrome may be overlooked when it occurs in a paediatric population. The symptoms seem to be consistent, and resection of the osteochondroma is necessary for treatment.
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Affiliation(s)
- Akio Sakamoto
- The Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- The Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Khosrawi S, Taheri P, Ketabi M. Investigating the Effect of Extracorporeal Shock Wave Therapy on Reducing Chronic Pain in Patients with Pes Anserine Bursitis: A Randomized, Clinical- Controlled Trial. Adv Biomed Res 2017. [PMID: 28626745 PMCID: PMC5468784 DOI: 10.4103/2277-9175.190999] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Knee pain, is one of the most common causes of patients’ referring to physiatric clinics, and several factors, are involved in its creation. One of these factors is pes anserine bursitis (PAB) for which various treatment methods are used. This study aims to investigate the effect of this method on reducing chronic pain in these patients. Materials and Methods: This clinical trial was conducted in 2013- 2014 on patients with PAB referring to academic, physical medicine clinics. The patients with chronic PAB (pain duration more than 3 months), who were refractory to conservative treatments, were randomly divided into two 20-member experimental groups (extracorporeal shock wave therapy [ESWT] and sham ESWT). Pain scores of all patients were measured using the Visual Analog Scale (VAS) and McGill Pain Questionnaire (MPQ) (total and present pain indexes [TPIs and PPIs]) before intervention, immediately after intervention (3rd week), and after 8 weeks. The pain scores were then compared and statistically analyzed. Results: In the ESWT group, the mean patient pain score of the VAS and TPI in MPQ were significantly lower than in the sham ESWT group immediately after intervention (3rd week): P =0.02, P = 0.04 respectively; and 8 weeks after the end of treatment: P =0.01, P = 0.000. Moreover, the PPI in both groups had significantly decreased over time, although in ESWT group this decrement was significantly more than sham ESWT group (P < 0.001). Conclusion: The results showed that ESWT could be effective in reducing the pain and treating PAB.
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Affiliation(s)
- Saeid Khosrawi
- Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parisa Taheri
- Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marziyeh Ketabi
- Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
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Lee DH, Lee MY, Kwack KS, Yoon SH. Effect of adductor canal block on medial compartment knee pain in patients with knee osteoarthritis: Retrospective comparative study. Medicine (Baltimore) 2017; 96:e6374. [PMID: 28328826 PMCID: PMC5371463 DOI: 10.1097/md.0000000000006374] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Knee osteoarthritis (KOA) is a common disease in middle-aged and elderly people. Pain is the chief complaint of symptomatic KOA and a leading cause of chronic disability, which is most often found in medial knees. The aim of this study is to evaluate the efficacy of pain relief and functional improvement in KOA patients treated with ultrasound-guided adductor canal block (ACB).This is a 3-month retrospective case-controlled comparative study. Two hundred patients with anteromedial knee pain owing to KOA that was unresponsive to 3-month long conservative treatments. Ninety-two patients received ACB with 9 mL of 1% of lidocaine and 1 mL of 10 mg triamcinolone acetonide (ACB group), and 108 continued conservative treatments (control group). The main outcome measure was visual analog scale (VAS) of the average knee pain level for the past one week. Secondary outcomes were the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the timed up and go test, numbers of analgesic ingestion per day, and opioid consumption per day.During the 3-month follow-up, 86 patients in ACB group and 92 in control group were analyzed. There was no significant difference, with the exception of the duration of symptoms, between the 2 groups in age, sex, body mass index, and Kellgren-Lawrence grade. Repeated-measures analysis of variance and post hoc tests showed improvement of VAS (at month 1), WOMAC (at month 1), and opioid consumption per day (at month 1 and 2) in ACB group. No adverse events were reported.To our knowledge, this is the first study to assess the efficacy of ACB for patients with KOA. ACB is an effective and safe treatment and can be an option for patients who are either unresponsive or unable to take analgesics.
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Affiliation(s)
- Doo-Hyung Lee
- Department of Orthopedic Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Michael Y. Lee
- Department of Physical Medicine and Rehabilitation (M.Y. Lee), University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC
| | | | - Seung-Hyun Yoon
- Department of Physical Medicine and rehabilitation, Ajou University School of Medicine, Suwon, Republic of Korea
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Ertürk C, Altay MA, Altay N, Kalender AM, Öztürk İA. Will a single periarticular lidocaine-corticosteroid injection improve the clinical efficacy of intraarticular hyaluronic acid treatment of symptomatic knee osteoarthritis? Knee Surg Sports Traumatol Arthrosc 2016; 24:3653-3660. [PMID: 25362247 DOI: 10.1007/s00167-014-3398-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 10/20/2014] [Indexed: 01/02/2023]
Abstract
PURPOSE A local injection of corticosteroid-lidocaine into the periarticular soft tissue structures is used commonly for rapid pain relief. It is hypothesized that knee pain associated with knee osteoarthritis would be relieved quickly and effectively in patients receiving intraarticular hyaluronic acid combined with a periarticular lidocaine-corticosteroid injection. To test this hypothesis, the clinical effect of the combined treatment with hyaluronic acid injection alone in patients with symptomatic knee osteoarthritis as compared in this prospective single-blinded randomized trial. METHODS This study included 70 patients. Group 1 (n = 35) received intraarticular hyaluronic acid injections only, whereas group 2 (n = 35) received intraarticular hyaluronic acid injections combined with a single local injection of corticosteroid-lidocaine. Injections were administered to the most painful areas of the anterior or posterior medial condyle of the femur or tibia. The outcome was measured by independent assessors (blinded to treatment) using a linear VAS pain scale and WOMAC and HSS knee scores. Assessments were performed at baseline and at 1, 3, 6, 12, 26, and 52 weeks. RESULTS During the first 3 weeks, group 2 patients showed significantly better all scores than did group 1 patients (p < 0.01). However, no significant differences were detected at 6, 12, 26 or 52 weeks (n.s.). CONCLUSION The combined treatment may lead to earlier pain relief compared with intraarticular hyaluronic acid alone in patients with knee osteoarthritis and can be considered a useful adjunctive treatment modality. This combined method may provide early return to patient's daily activity. LEVEL OF EVIDENCE Therapeutic study, Level I.
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Affiliation(s)
- Cemil Ertürk
- Department of Orthopedic Surgery, Harran University Faculty of Medicine, 63100, Yenisehir, Sanliurfa, Turkey.
| | - Mehmet Akif Altay
- Department of Orthopedic Surgery, Harran University Faculty of Medicine, 63100, Yenisehir, Sanliurfa, Turkey
| | - Nuray Altay
- Department of Anesthesiology and Reanimation, Harran University Faculty of Medicine, Sanliurfa, Turkey
| | - Ali Murat Kalender
- Department of Orthopaedic Surgery, Kahramanmaras Sutcu Imam University Faculty of Medicine, Kahramanmaras, Turkey
| | - İbrahim Avşin Öztürk
- Department of Orthopedic Surgery, Harran University Faculty of Medicine, 63100, Yenisehir, Sanliurfa, Turkey
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Homayouni K, Foruzi S, Kalhori F. Effects of kinesiotaping versus non-steroidal anti-inflammatory drugs and physical therapy for treatment of pes anserinus tendino-bursitis: A randomized comparative clinical trial. PHYSICIAN SPORTSMED 2016; 44:252-6. [PMID: 27276165 DOI: 10.1080/00913847.2016.1199251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Pes anserinus tendino-bursitis is a condition caused by repetitive friction over the bursa or direct trauma to knee joint and it presents with proximal medial tibial pain and swelling. The aim of this study is to determine the effects of kinesiotaping in comparison with naproxen and physical therapy in treatment of pes anserinus tendino-bursitis. METHODS In a randomized comparative clinical trial 56 patients with clinical diagnosis of pes anserinus tendino-bursitis were randomly assigned to kinesiotaping and naproxen/physical therapy (28 patients in each group). Kinesiotaping on the tender area in the form of space-correction (lifting) technique was used and repeated for three times with a one-week interval. Another group received naproxen (250mg TID for 10 days) and ten sessions of daily physical therapy. The visual analog scale (VAS) was used for evaluation of pain. The depth of swelling of the area was measured with sonography before and after treatment. Wilcoxon signed ranks test has been used for determining the influence of interventions on pain (VAS) and swelling scores in each group. The ANCOVA (Analysis of covariance) test was applied for comparing the influence of interventions on VAS and swelling scores after adjustment for co-variables. RESULTS At end of the study, 27 patients remained in the kinesiotaping group and 19 patients in naproxen/physical therapy group. Treatment with kinesiotaping significantly decreased the pain (P=0.0001) and swelling scores (P=0.0001) in comparison with naproxen/physical therapy after adjustment for baseline characteristics. Kinesiotaping was safe without any complications except for a mild local skin irritation in one patient. CONCLUSION Kinesiotaping is more effective than naproxen plus physical therapy in reduction of pain and swelling in patients with pes anserinus tendino-bursitis. CLINICAL TRIAL REGISTRATION www.ClinicalTrials.gov identifier is NCT01680263.
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Affiliation(s)
- Kaynoosh Homayouni
- a Department of Physical Medicine and Rehabilitation , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Shima Foruzi
- a Department of Physical Medicine and Rehabilitation , Shiraz University of Medical Sciences , Shiraz , Iran
| | - Fereshte Kalhori
- a Department of Physical Medicine and Rehabilitation , Shiraz University of Medical Sciences , Shiraz , Iran
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Sarifakioglu B, Afsar SI, Yalbuzdag SA, Ustaömer K, Bayramoğlu M. Comparison of the efficacy of physical therapy and corticosteroid injection in the treatment of pes anserine tendino-bursitis. J Phys Ther Sci 2016; 28:1993-7. [PMID: 27512249 PMCID: PMC4968491 DOI: 10.1589/jpts.28.1993] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/07/2016] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The aims of this study were twofold. The first was to compare the functional capacity and pain of patients with knee osteoarthritis (KOA), with or without pes anserine tendino-bursitis (PATB). The second is to compare the efficacy of two treatment methods (physical therapy and corticosteroid injection) for patients with PATB. [Subjects and Methods] Sixty patient with KOA and PATB (Group 1) and 57 patients with KOA but without PATB (Group 2) were enrolled in the study. The patients' visual analog scale (VAS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC) scores and three-meter timed-up and go scores were measured. The PATB group was randomly divided into two groups (Group A and B). Physical therapy (PT) modalities were applied to the first group (Group A), and the second group (Group B) received corticosteroid injections to the pes anserine area. Eight weeks later, patients' parameters were measured again. [Results] Initial WOMAC scores and timed up-and-go times were significantly higher in Group 1 than in Group 2. Both treatments resulted in significant improvements in all measured parameters, but no significant difference was detected between Group A and B. [Conclusion] Patients with PATB tend to have more severe pain, more altered functionality, and greater disability than those with KOA but without PATB. Both corticosteroid injection and PT are effective methods of treatment for PATB. Injection therapy can be considered an effective, inexpensive and fast therapeutic method.
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Affiliation(s)
- Banu Sarifakioglu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Namık Kemal University: Tekirdağ, Turkey
| | - Sevgi Ikbali Afsar
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Baskent University, Turkey
| | - Seniz Akcay Yalbuzdag
- Department of Physical Medicine and Rehabilitation, Izmir Bozyaka Education and Research Hospital, Turkey
| | - Kubra Ustaömer
- Department of Physical Medicine and Rehabilitation, Optimed Medical Center, Turkey
| | - Meral Bayramoğlu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Acıbadem University, Turkey
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Toktas H, Dundar U, Adar S, Solak O, Ulasli AM. Ultrasonographic assessment of pes anserinus tendon and pes anserinus tendinitis bursitis syndrome in patients with knee osteoarthritis. Mod Rheumatol 2014; 25:128-33. [PMID: 25036227 DOI: 10.3109/14397595.2014.931909] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to assess the ultrasonographic (US) findings of pes anserinus tendon and bursa in patients with knee osteoarthritis (OA) with or without clinical pes anserinus tendinitis bursitis syndrome (PATBS). METHODS A total of 157 female patients with the diagnosis of knee OA on both knees (314 knees), and 30 age, and body mass index- matched healthy female controls without knee pain (60 knees), were included in the study. PATBS was clinically diagnosed. US evaluation parameters were the measurement of the thickness of pes anserinus tendon insertion region (PA) and examination of the morphologic intratendinous PA tissue characteristics and pes anserinus bursitis (PAB). Radiographic knee osteoarthritis graded I-IV according to Kellgren and Lawrence (KL) for each knee was recorded. Pain and functional status were assessed by the Visual Analog Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). RESULTS There were 183 PATBS (58.3%) clinical diagnoses among the 314 knees with OA. The mean thickness of PA in the patients with knee OA graded 1,2,3,4 with/without PATBS was significantly greater than the controls (p = 0.001). The mean thickness of PA in knees with OA KL graded 3 and 4 with/without PATBS, was greater than knees with OA KL graded 1 and 2 with/without PATBS (p < 0,05) (except knee OA KL graded 2 with PATBS versus knee OA KL graded 4 without PATBS).The knee OA KL graded 1,2,3,4 with PATBS had significantly more PAB and less loss of normal fibrillar echotexture of PA compared to controls and knees with OA KL graded 1,2,3,4 without PATBS (p < 0.05). The VAS scores of knees with OA KL graded 3, 4 with PATBS were significantly greater than those of knees with OA KL graded 3,4 without PATBS (p < 0.05). PA thickness was significantly associated with the KL grade (r: 0.336, p:0.001) and PATBS (r: 0.371, p < 0.001). CONCLUSION It is concluded that the mean thickness of PA in knees with OA with/without PATBS was significantly greater than the controls. The mean thickness of PA in knees with OA, KL graded 3 and 4 with/without PATBS, was greater than in knees with OA KL graded 1 and 2 with/without PATBS. The knee OA with PATBS had significantly more PAB, less loss of normal fibrillar echotexture of PA, and higher VAS scores compared to the knees with OA without PATBS. US can serve as a useful diagnostic tool for detection of PATBS in knee OA.
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Affiliation(s)
- Hasan Toktas
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Afyon Kocatepe University , Turkey
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Lee JH, Kim KJ, Jeong YG, Lee NS, Han SY, Lee CG, Kim KY, Han SH. Pes anserinus and anserine bursa: anatomical study. Anat Cell Biol 2014; 47:127-31. [PMID: 24987549 PMCID: PMC4076419 DOI: 10.5115/acb.2014.47.2.127] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 06/02/2014] [Accepted: 06/13/2014] [Indexed: 11/27/2022] Open
Abstract
This study investigated the boundary of anserine bursa with the recommended injection site and shape on the insertion area of pes anserinus (PA), with the aim of improving clinical practice. Eighty six legs from 45 Korean cadavers were investigated. The mixed gelatin solution was injected to identify the shape of anserine bursa, and then the insertion site of the PA tendons was exposed completely and carefully dissected to identify the shape of the PA. The sartorius was inserted into the superficial layer and gracilis, and the semitendinosus was inserted into the deep layer on the medial surface of the tibia. The number of the semitendinosus tendons at the insertion site varied: 1 in 66% of specimens, 2 in 31%, and 3 in 3%. The gracilis and semitendinosus tendons were connected to the deep fascia of leg. Overall, the shape of the anserine bursa was irregularly circular. Most of the anserine bursa specimens reached the proximal line of the tibia, and some of the specimens reached above the proximal line of the tibia. In the medial view of the tibia, the anserine bursa was located posteriorly and superiorly from the tibia's midline, and it followed the lines of the sartorius muscle. The injection site for anserine bursa should be carried out at 20° from the vertical line medially and inferiorly, 15 or 20 mm deeply, and at the point of about 20 mm medial and 12 mm superior from inferomedial point of tibial tuberosity.
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Affiliation(s)
- Je-Hun Lee
- Department of Anatomy, Konyang University College of Medicine, Daejeon, Korea
| | - Kyung-Jin Kim
- Department of Anatomy, Catholic Institute for Applied Anatomy, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Young-Gil Jeong
- Department of Anatomy, Konyang University College of Medicine, Daejeon, Korea
| | - Nam Seob Lee
- Department of Anatomy, Konyang University College of Medicine, Daejeon, Korea
| | - Seung Yun Han
- Department of Anatomy, Konyang University College of Medicine, Daejeon, Korea
| | - Chang Gug Lee
- College of Natural Sciences, Soonchunhyang University, Cheonan, Korea
| | - Kyung-Yong Kim
- Department of Anatomy, Chung-Ang University College of Medicine, Seoul, Korea
| | - Seung-Ho Han
- Department of Anatomy, Chung-Ang University College of Medicine, Seoul, Korea
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Prevalence of pes anserine bursitis in symptomatic osteoarthritis patients: an ultrasonographic prospective study. Clin Rheumatol 2014; 34:529-33. [DOI: 10.1007/s10067-014-2653-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 04/24/2014] [Accepted: 04/26/2014] [Indexed: 11/26/2022]
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Jacobs JWG, Michels-van Amelsfort JMR. How to perform local soft-tissue glucocorticoid injections? Best Pract Res Clin Rheumatol 2013; 27:171-94. [PMID: 23731930 DOI: 10.1016/j.berh.2013.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Inflammation of periarticular soft-tissue structures such as tendons, tendon sheaths, entheses, bursae, ligaments and fasciae is the hallmark of many inflammatory rheumatic diseases, but inflammation or rather irritation of these structures also occurs in the absence of an underlying rheumatic disease. In both these primary and secondary soft-tissue lesions, local glucocorticoid injection often is beneficial, although evidence in the literature is limited. This chapter reviews local injection therapy for these lesions and for nerve compression syndromes.
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Affiliation(s)
- J W G Jacobs
- Department of Rheumatology & Clinical Immunology, F02.127, University Medical Center Utrecht, Box 85500, 3508 GA Utrecht, The Netherlands.
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Chalmers PN, Ellman MB, Chahal J, Verma NN. Injection Therapy in the Management of Musculoskeletal Injuries of the Knee. OPER TECHN SPORT MED 2012. [DOI: 10.1053/j.otsm.2012.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Vega-Morales D, Esquivel-Valerio JA, Negrete-López R, Galarza-Delgado DÁ, Garza-Elizondo MA. Safety and efficacy of methylprednisolone infiltration in anserine syndrome treatment. ACTA ACUST UNITED AC 2012; 8:63-7. [PMID: 22317851 DOI: 10.1016/j.reuma.2011.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/11/2011] [Accepted: 10/29/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The anserine syndrome is a common cause of knee pain. Infiltration with glucocorticoids has been evaluated in studies with low level of evidence and there are no published clinical trials to determine its usefulness. The objective of this study was to determine the efficacy and safety of the infiltration of methylprednisolone in the treatment of Anserin Syndrome. METHODS We conducted a clinical trial in 58 adult patients with anserin syndrome, which presented intra-articular pathology ruled that reflected pain in the medial aspect of the knee. The WOMAC scale was assessed at baseline and patients were randomized to receive an infiltration of lidocaine plus 40 mg methylprednisolone acetate (group 1) versus xylocaine plus distilled water (group 2). Both groups received 100mg of diclofenac sodium for 10 days. The WOMAC scale was applied at 4 weeks and adverse events were recorded. RESULTS Equivalence was demonstrated in both groups for demographic variables and initial clinical evaluation. There was no statistical difference in the three domains of assessment of the baseline WOMAC score. The median baseline WOMAC in group 1 was 32 and in group 2 was 25.5 points. At 4 weeks it was 8 and 6.5 points, which corresponded to an improvement of 61.6 and 62.8% respectively. CONCLUSION The infiltration with methylprednisolone in anserin syndrome is not superior to placebo in patients taking diclofenac measured by the WOMAC scale at 4 weeks. The incidence of adverse events did not show any differences either.
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Affiliation(s)
- David Vega-Morales
- Departamento de Medicina Interna, Servicio de Reumatología, Hospital Universitario Dr. José Eleuterio González, Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
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Abstract
Ultrasound is one of the standard imaging modalities of the knee. In the recent decades many new ultrasound techniques have been introduced, including power Doppler, dynamic examination, and ultrasound-guided techniques. Some of them have clear advantages over magnetic resonance imaging-today's knee imaging gold standard-whereas others have failed to meet expectations. This pictorial article reviews and demonstrates the use of sonography in different knee joint pathologies underlining recent findings and their practical approach.
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Affiliation(s)
- Łukasz Paczesny
- Department of Orthopaedics for Adults and Children, Provincial Children's Hospital, Toruń, Poland.
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Osman MK, Irwin GJ, Huntley JS. Swelling around a child's knee. Clin Anat 2011; 24:914-7. [PMID: 21538566 DOI: 10.1002/ca.21184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Revised: 09/06/2010] [Accepted: 03/02/2011] [Indexed: 11/08/2022]
Abstract
Swellings around the paediatric knee have a large differential diagnosis, although the majority can be diagnosed clinically. Some swellings merit further investigation by Magnetic Resonance Imaging (MRI).
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Affiliation(s)
- Mohamed K Osman
- Department of Orthopaedics, Royal Hospital for Sick Children, Glasgow, United Kingdom
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Finnoff JT, Nutz DJ, Henning PT, Hollman JH, Smith J. Accuracy of Ultrasound-Guided versus Unguided Pes Anserinus Bursa Injections. PM R 2010; 2:732-9. [DOI: 10.1016/j.pmrj.2010.03.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Revised: 03/01/2010] [Accepted: 03/08/2010] [Indexed: 11/25/2022]
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Kim HA, Kim SH, Seo YI. Ultrasonographic findings of painful shoulders and correlation between physical examination and ultrasonographic rotator cuff tear. Mod Rheumatol 2007; 17:213-9. [PMID: 17564776 DOI: 10.1007/s10165-007-0577-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Accepted: 02/05/2007] [Indexed: 11/25/2022]
Abstract
The objectives of this study were to identify ultrasonographic (US) abnormalities and to compare physical examination with US findings, especially of rotator cuff abnormalities in patients with shoulder pain. A total of 120 patients with shoulder pain were prospectively studied. The physical examination of shoulders was performed as follows: (1) the area of tenderness; (2) the range of passive and active motion for abduction, forward flexion, external rotation, and internal rotation; (3) Neer and Hawkins's tests for shoulder impingement; and (4) maneuvers for determining the location of the tendon lesions. Transverse and longitudinal planes from the long head of the biceps, supraspinatus, infraspinatus, and subscapularis tendons, the subacromial-subdeltoid bursa, and the glenohumeral and acromioclavicular joints were included for US examination. The range of motion most affected by shoulder pain was abduction, followed by external rotation and forward flexion. The most frequent US finding was effusion in the long head of the biceps tendon. Among the rotator cuff tendons, supraspinatus was the most frequently involved. Physical examination had low sensitivity and specificity for the detection of tendon tear. US examination leads to an anatomical diagnosis of shoulder pain in many patients. Whether the US examination of the painful shoulder improves its treatment should be investigated.
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Affiliation(s)
- Hyun Ah Kim
- Division of Rheumatology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, 896, Pyongchondong, Dongan-gu, Anyang, Kyunggi-do 431-070, South Korea.
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Abstract
BACKGROUND Pes anserinus tendinitis/bursitis (PATB) is a frequent cause of knee pain. Its predisposing factors are still controversial. OBJECTIVES Assess the effect of a set of demographic, clinical, somatometric, and biomechanical factors on the risk for PATB. METHODS A case control design was used to evaluate the association between clinically diagnosed PATB and the presence of diabetes; knee osteoarthritis (and its radiographic severity); obesity; knee collateral, and anteroposterior instability; and knee or hindfoot malalignment. RESULTS Twenty-two consecutive, incident PATB patients were included; all were females 62.1 +/- 11.5-year-old (limits 45-82). Thirty-eight sex- and age-matched (59.8 +/- 9.4-year-old; P = 0.41) subjects were used as controls; these had asymptomatic osteoporosis (20) and a series of rheumatic syndromes (18). There was no difference in prevalence of diabetes, knee osteoarthritis, obesity, knee instability, varus knee deformity, and hindfoot malalignment between cases and controls. Furthermore, no difference in overall, lateral, medial, and patellofemoral knee osteoarthritis radiographic severity mean score was found between study groups. The presence of valgus knee deformity alone (OR: 5.2; 95% CI: 1.1-25.5), or in combination with collateral instability (OR: 6.0; 95% CI: 1.4-26.0), was identified as associated with PATB. CONCLUSIONS Valgus knee deformity, alone or in association with collateral instability, seems to be a risk factor for PATB. No association was found between PATB and some conditions previously reported as predisposing factors such as diabetes, knee osteoarthritis, and obesity. PATB should be kept in mind as a highly probable diagnosis in mature women with medial knee pain and valgus knee deformity.
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Affiliation(s)
- José Alvarez-Nemegyei
- Unidad de Investigación Médica, Unidad Médica de Alta Especialidad Yucatán, Instituto Mexicano del Seguro Social, Mérida, Yucatan, Mexico.
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