Comment on “early efficacy of intra-articular HYADD® 4 (Hymovis®) injections for symptomatic knee osteoarthritis”

We read with great interest the study by Priano titled“Early efficacy of intra-articular HYADD® 4 (Hymovis®) injections for symptomatic knee osteoarthritis.” 1 The author would like to explore the efficacy of intra-articular HYADD 4 (Hymovis) injections for symptomatic knee osteoarthritis. Results from this study are very interesting and promising from a clinical aspect; however, we believe that studying patient’sclinical status with visual analog scale and Western Ontario and McMaster Universities Arthritis Index scale should be supported by biomechanical information. From this point of view, to have more data that could influence the clinical practice, it is important to note the possible action that intraarticular injections of different kinds of hyaluronic acid could have on walking biomechanics using an objective measurement tool as gait analysis. In our opinion, the work by Priano1 is promising because it investigates the efficacy of a new formulation of hyaluronic acid. Nowadays, many hyaluronic acid formulations are approved for clinical use in Europe and the United States. Furthermore, hyaluronic acid injections’ efficacy has been demonstrated also in hip osteoarthritis. 2 However, even if these formulations differ in their chemical– physical properties, joint space half-life, rheological properties, and clinical efficacy, there are few studies that investigate hyaluronic acid’s possible action from a biomechanical point of view. 3,4 From this point of view, we believe that osteoarthritis management and rehabilitation should be prescribed after an objective analysis of functional walking alterations using gait analysis instrumentations. The use of gait analysis should be desirable during diagnosis and follow-up. In fact, it is capable to identify different walking patterns in patient with osteoarthritis of the lower limbs, whereas the radiology can evaluate the status of the joint’s structures

Comment on "Effect of extracorporeal shockwave therapy versus intra-articular injections of hyaluronic acid for the treatment of knee osteoarthritis"

We read with great interest the study by Lee et al. titled “Effect of Extracorporeal Shockwave Therapy Versus Intra-articular Injections of Hyaluronic Acid for the Treatment of Knee Osteoarthritis. The authors were able to evaluate and compare the effects and outcomes of the extracorporeal shock wave therapy and intraarticular injections of hyaluronic acid in patients with knee osteoarthritis. This research is considered relevant and interesting, especially because it is noted that the authors compare an invasive therapy, such the intraarticular injections, with the administration of an extracorporeal show wave therapy, which is notably a kind of therapy that does not involve the interruption of the integrity of the skin. It is noted that the results from the study are promising from a clinical aspec

Shear Wave Elastographic Study of the Myotendinous Junction of the Medial Gastrocnemius Normal Patterns and Dynamic Evaluation

Objectives—The myotendinous junction (MTJ) represents a specialized anatomic region through which the contractile strength is transmitted from the muscle to the tendon. The integrity of this region is essential to permit force transmission and to optimize energy expenditure during walking, running, and globally for human movement. We evaluated the MTJ with shear wave elastography to assess its elasticity variation during a functional test. Methods—Forty professional soccer players were enrolled in the study. Shear wave elastography was performed at the level of the medial gastrocnemius MTJ both in a resting position and during a standing calf rise position to assess functional contraction. Results—All 40 participants were male, aged between 18 and 38 years (mean age, 25 years). The results of the elastographic study showed mean stiffness values SD of 4.19 0.86 m/s for the right medial gastrocnemius and 4.20 0.87 m/s for the left medial gastrocnemius with the muscle relaxed. During contraction, the stiffness values were 8.33 0.5 m/s for the right medial gastrocnemius and 8.30 0.48 m/s for the left medial gastrocnemius. Conclusions—Our study showed an increase of stiffness at the level of the MTJ during muscle contraction. This result is in line with the physiologic stiffening of the MTJ to resist the high level of force applied during muscle contraction. Shear wave elastography could be a useful method to assess the characteristics of the MTJ under both physiologic and pathologic conditions

Hyaluronic acid in the management of osteoarthritis: injection therapies innovations

Subjects with chronic diseases are more likely to be nonpersistent to pharmacological treatment. Lack of persistence is common among subjects using oral anti-osteoporotic drugs, and leads to increased risk of fragility fracture. The aim of our retrospective study is to analyze the rates and reasons for discontinuation of anti-osteoporotic drugs in the Campania Region. Subjects aged over 40 years were included if they had received at least one prescription for any anti-osteoporotic drugs. Data were obtained from an administrative database of regional data on outpatient drug prescriptions reimbursed by the National Health Service. Patients were followed until the discontinuation of anti-osteoporotic therapy or until the end of the observation period. A total of 30,048 were incident users of anti-osteoporotic drugs: 28,317 (94.2%) females. The mean age of the cohort was 69.0±10.0 years. Weekly bisphosphonates (51.1%) were the most commonly prescribed drugs. In the overall population, persistence rates were 34.8% after 6 months and 13.4% at one year. A multivariate Cox proportional hazard analysis showed that daily regimen (HR 1.9) treatments remained at higher risk of early discontinuation compared to weekly regimen therapies. Our data showed that the persistence to osteoporosis therapy is significantly worse than reported in literatur

Comment on “efficacy of a single intra-articular injection of ultra-high molecular weight hyaluronic acid for hip osteoarthritis: a randomized controlled study”

We read with great interest the study by Clementi et al. that would like to explore the efcacy of a single intraarticular injection of ultra-high molecular weight hyaluronic acid in patients with hip osteoarthritis. Actually, we believe that investigating just patients’ clinical status using VAS and WOMAC scale should have been supported by further information. In fact, in order to have more data that could infuence the recent clinical practice, it is important to consider also  the efect that the intra-articular injection of ultra-high molecular weight hyaluronic acid could have on walking biomechanics using an objective measurement tool as gait analysis. In our opinion, the work by Clementi and colleagues is very important and useful especially for the long-term follow-up. Osteoarthritis is a theme currently representing a hot topic because the number of people afected by this pathology in the world is growing and this situation is a burden for healthcare system. Hence, modern medicine will meet, more and more, this issue. From this point of view, we believe that osteoarthritis management and rehabilitation should be performed by objectifying functional alterations using movement analysis instrumentations. The use of gait analysis should be desirable during diagnosis and follow-up . Gait analysis is able to assess diferent walking patterns in patient with osteoarthritis of the lower limbs, whereas the radiology can evaluate the status of the joint’s structures. Moreover, gait analysis  allows to identify the precise altered sub-phase of the walking cycle, permitting adequate prescription of a rehabilitation protocol, giving to the clinician information about kinematic and kinetic alterations and also about the muscle activity. Finally, gait analysis is easily applicable to the most of patients, without side efects. Hence, this tool is ideal for repetitive follow-up evaluations and allows assessing any variations of walking biomechanics over time. Furthermore, gait analysis examinations could represent very valid outcome measurements in order  to understand the efcacy of injection therapy to treat hip osteoarthritis. These evaluations should be considered as a completion of clinical assessment, and their use should be always considered in rehabilitation of osteoarthritis

Ultrasound guided injection of a painful knee osteoarthritis with medial meniscus extrusion: a case series study

Background: Meniscal subluxation results in the natural history of knee osteoarthritis (OA). Periarticular infiltration should minimize possible complications related to penetration of corticosteroids into the joint space in the treatment of knee OA.According to pain relief and improvement of function, the aim of this study is to evaluate the effectiveness of perimeniscal corticosteroid ultrasound guided injection in knee OA.Methods: Thirty-two patients received an injection of 0.5 ml of methylprednisolone-acetate around perimeniscal tissues. Outcome measures were pain relief and knee function, assessed by Visual Analogue Scale (VAS) [24, 29, 30] measured at rest (VAS-R) and during stairs climbing (VAS-C) and by Italian-Western Ontario and McMaster Universities (WOMAC) scale. Clinical evaluation was performed at baseline, at 1 and 4 weeks of follow-up.Results: Mean baseline values of VAS-R and VAS-C were 6.79 +/- 1.17 and 7.6 +/- 1.39, respectively. All subjects showed a significant reduction in pain over time (p0.05).Conclusion: Corticosteroid perimeniscal ultrasound guided injection can be considered as an adjunct to core treatment for the relief of moderate to severe pain in people with knee OA

Hormetic Effects of Bioactive Compounds from Foods, Beverages, and Food Dressing: The Potential Role in Spinal Cord Injury

Spinal cord injury (SCI) is a damage or trauma to the spinal cord resulting in a total or partial loss of motor and sensory function. SCI is characterized by a disequilibrium between the production of reactive oxygen species and the levels of antioxidant defences, causing oxidative stress and neuroinflammation. This review is aimed at highlighting the hormetic effects of some compounds from foods, beverages, and food dressing that are able to reduce oxidative stress in patients with SCI. Although curcumin, ginseng, and green tea have been proposed for SCI management, low levels of antioxidant vitamins have been reported in individuals with SCI. Mediterranean diet includes food rich in vitamins and antioxidants. Moreover, food dressing, including spices, herbs, and extra virgin olive oil (EVOO), contains multiple components with hormetic effects. The latter involves the activation of the nuclear factor erythroid-derived 2, consequently increasing the antioxidant enzymes and decreasing inflammation. Furthermore, EVOO improves the bioavailability of carotenoids and could be a delivery system for bioactive compounds. In conclusion, Mediterranean dressing in addition to plant foods can have an important effect on redox balance in individuals with SCI