Intra-articular injection of photo-activated platelet-rich plasma in patients with knee osteoarthritis: a double-blind, randomized controlled pilot study

Improvements in knee osteoarthritis (OA) symptoms with platelet-rich plasma (PRP) have been attributed to its ability to modify intra-articular inflammatory processes. Photo-activation of peripheral blood also improves inflammatory mediators associated with OA, however combined photo-activated PRP (PA-PRP) has not been investigated. This pilot study assessed the feasibility, safety and symptomatic and functional change following injections of PA-PRP compared to hyaluronic acid (HA) in people with knee osteoarthritis (OA)

Management of osteoarthritis of the knee

Osteoarthritis is a chronic disease; management should be patient centred and coordinated, with attention to modifiable risk factors and comorbidities Focus on conservative non-drug treatment, particularly exercise; for overweight or obese patients weight loss is recommended Management should be evidence based; do not use interventions with high cost and risk that outweigh their benefits Use paracetamol or non-steroidal anti-inflammatory drugs for pain relief, with due attention to precautions and contraindications Refer patients to a physiotherapist for exercise, manual therapy, and gait aids; orthotist for bracing; psychologist for cognitive behavioural therapy; and dietitian for nutritional advice Do not use arthroscopy for pain management; refer patients for joint replacement only when symptoms are severe and other treatments have faile

Laterally wedged insoles in knee osteoarthritis: do biomechanical effects decline after one month of wear?

<p>Abstract</p> <p>Objective</p> <p>This study aimed to determine whether the effect of laterally wedged insoles on the adduction moment in knee osteoarthritis (OA) declined after one month of wear, and whether higher reported use of insoles was associated with a reduced effect on the adduction moment at one month.</p> <p>Methods</p> <p>Twenty people with medial compartment OA underwent gait analysis in their own shoes wearing i) no insoles and; ii) insoles wedged laterally 5° in random order. Testing occurred at baseline and after one month of use of the insoles. Participants recorded daily use of insoles in a log-book. Outcomes were the first and second peak external knee adduction moment and the adduction angular impulse, compared across conditions and time with repeated measures general linear models. Correlations were obtained between total insole use and change in gait parameters with used insoles at one month, and change scores were compared between high and low users of insoles using general linear models.</p> <p>Results</p> <p>There was a significant main effect for condition, whereby insoles significantly reduced the adduction moment (all p < 0.001). However there was no significant main effect for time, nor was an interaction effect evident. No significant associations were observed between total insole use and change in gait parameters with used insoles at one month, nor was there a difference in effectiveness of insoles between high and low users of the insoles at this time.</p> <p>Conclusion</p> <p>Effects of laterally wedged insoles on the adduction moment do not appear to decline after one month of continuous use, suggesting that significant wedge degradation does not occur over the short-term.</p

Single leg stance control in individuals with symptomatic gluteal tendinopathy

Background Lateral hip pain during single leg loading, and hip abductor muscle weakness, are associated with gluteal tendinopathy, but it has not been shown how or whether kinematics in single leg stance differ in those with gluteal tendinopathy. Purpose To compare kinematics in preparation for, and during, single leg stance between individuals with and without gluteal tendinopathy, and the effect of hip abductor muscle strength on kinematics. Methods Twenty individuals with gluteal tendinopathy and 20 age-matched pain-free controls underwent three-dimensional kinematic analysis of single leg stance and maximum isometric hip abductor strength testing. Maximum values of hip adduction, pelvic obliquity (contralateral pelvis rise/drop), lateral pelvic translation (ipsilateral/contralateral shift) and ipsilateral trunk lean during preparation for leg lift and average values in steady single leg stance, were compared between groups using an analysis of covariance, with and without anthropometric characteristics and strength as covariates. Results Individuals with gluteal tendinopathy demonstrated greater hip adduction (standardized mean difference (SMD)\ua0=\ua00.70, P\ua0=\ua00.04) and ipsilateral pelvic shift (SMD\ua0=\ua01.1, P\ua0=\ua00.002) in preparation for leg lift, and greater hip adduction (SMD\ua0=\ua01.2, P\ua0=\ua00.002) and less contralateral pelvic rise (SMD\ua0=\ua00.86, P\ua0=\ua00.02) in steady single leg stance than controls. When including strength as a covariate, only between-group differences in lateral pelvic shift persisted (SMD\ua0=\ua01.7, P\ua0=\ua00.01). Conclusion Individuals with gluteal tendinopathy use different frontal plane kinematics of the hip and pelvis during single leg stance than pain-free controls. This finding is not influenced by pelvic dimension or the potentially modifiable factor of body mass index, but is by hip abductor muscle weakness

Kinematics and kinetics during stair ascent in individuals with gluteal tendinopathy

Individuals with gluteal tendinopathy commonly report lateral hip pain and disability during stair ascent. This study aimed to compare kinematics and kinetics between individuals with and without gluteal tendinopathy during a step up task

A Randomized Trial of Patellofemoral Bracing for Treatment of Patellofemoral Osteoarthritis

Purpose The number of effective knee osteoarthritis (OA) interventions, especially those tailored to specific compartmental involvement, are small. The objective of this study was to determine the efficacy of a realigning patellofemoral (PF) brace in improving pain and function among persons with symptomatic lateral PF OA. Method We conducted a double blind, randomized crossover trial of a realigning PF brace for persons with lateral PF OA. Participants had lateral PF OA with anterior knee symptoms on most days of the month, lateral PF joint space narrowing, and radiographic evidence of a definite osteophyte in the PF joint. We compared two treatments: (1) Control treatment consisting of a BioSkin Q Brace with patellar realigning strap removed; and (2) Active treatment consisting of a realigning BioSkin Q Brace with the strap applied. For each participant, the trial lasted 18 weeks, including 6 weeks each of active and control treatment period separated by a 6-week washout period. The order of treatments was randomized. The primary outcome was change in knee pain on the visual analog scale (VAS). Secondary outcomes included WOMAC pain, function, and stiffness. An unstructured correlation matrix for observations within participants was used in generalized estimating equation fitting to derive a linear regression model that expressed the relation between the intervention and change in VAS pain. Results 80 participants (63 F) with a mean age and body mass index of 61 years and 28 kg/m2, respectively, were randomized by order of treatment. A model examining the main effects for change in VAS knee pain (0–100) demonstrated no significant treatment effect (−0.68 VAS units, 95% CI: −6.2, 4.8 units, P = 0.81) and no differential carryover effect. There was also no significant difference between active and control treatments for WOMAC pain, function, or stiffness outcomes. Conclusion The effects of a specific realigning PF brace are not of clinical or statistical significance

Self-Report Measures of Physical Activity.

'No abstract