Alternative and complementary therapies in osteoarthritis and cartilage repair

Osteoarthritis (OA) is the most common joint condition and, with a burgeoning ageing population, is due to increase in prevalence. Beyond conventional medical and surgical interventions, there are an increasing number of ‘alternative’ therapies. These alternative therapies may have a limited evidence base and, for this reason, are often only afforded brief reference (or completely excluded) from current OA guidelines. Thus, the aim of this review was to synthesize the current evidence regarding autologous chondrocyte implantation (ACI), mesenchymal stem cell (MSC) therapy, platelet-rich plasma (PRP), vitamin D and other alternative therapies. The majority of studies were in knee OA or chondral defects. Matrix-assisted ACI has demonstrated exceedingly limited, symptomatic improvements in the treatment of cartilage defects of the knee and is not supported for the treatment of knee OA. There is some evidence to suggest symptomatic improvement with MSC injection in knee OA, with the suggestion of minimal structural improvement demonstrated on MRI and there are positive signals that PRP may also lead to symptomatic improvement, though variation in preparation makes inter-study comparison difficult. There is variability in findings with vitamin D supplementation in OA, and the only recommendation which can be made, at this time, is for replacement when vitamin D is deplete. Other alternative therapies reviewed have some evidence (though from small, poor-quality studies) to support improvement in symptoms and again there is often a wide variation in dosage and regimens. For all these therapeutic modalities, although controlled studies have been undertaken to evaluate effectiveness in OA, these have often been of small size, limited statistical power, uncertain blindness and using various methodologies. These deficiencies must leave the question as to whether they have been validated as effective therapies in OA (or chondral defects). The conclusions of this review are that all alternative interventions definitely require clinical trials with robust methodology, to assess their efficacy and safety in the treatment of OA beyond contextual and placebo effects

Tendinopathies and platelet-rich plasma (PRP): from pre-clinical experiments to therapeutic use

Objectives: The restorative properties of platelets, through the local release of growth factors, are used in various medical areas. This article reviews fundamental and clinical research relating to platelet-rich plasma applied to tendinous lesions. Materials and method: Articles in French and English, published between 1 January 2012 and 31 December 2014. dealing with PRP and tendons were searched for using the Medline and Scopus data bases. Results: Forty-seven articles were identified which addressed pre-clinical and clinical studies: 27 relating to in vitro and in vivo animal studies and 20 relating to human studies. Of these, five addressed lateral epicondylitis, two addressed rotator cuff tendinopathies, ten dealt with patellar tendinopathies and three looked at Achilles tendinopathies. Conclusions: The majority of pre-clinical studies show that PRP stimulates the tendon's healing process. However, clinical series remain more controversial and level 1, controlled, randomised studies are still needed

Barriers to development and expansion of adaptive physical activity and sports for individuals with a physical disability in sports clubs and centres

Physical activity has shown to be a useful tool in rehabilitating motor deficiencies among individuals with a physical disability. However, when patients are discharged from in-patient rehabilitation, their physical activity levels tend to drop. This is partly due to a lack of opportunity to be physically active through adaptive physical activity and sports (APAS) programmes within communities. This study aimed to identify reasons which limit the development or expansions of the APAS offer, in order to emit guiding points as how these could be overcome. An online survey was completed by 330 different sports clubs and centres in Belgium. Several barriers were identified, including lack of demand from potential candidates and lack of funding for these activities. However, despite these barriers, 44% of the sports clubs and centres reported accommodating individuals with a physical disability nonetheless, and 17% reported offering APAS programmes. There is therefore potential to develop APAS sessions in inclusion with individuals without a disability. Communication between different stakeholders within the sports community, and with health professionals, is urgently needed to improve collaborations. Similarly, partnerships with rehabilitation centres and hospitals should be formed in order to enhance visibility of APAS and boost recruitment of participants. Finally, health professionals should recognise the vital role they play in relaying information to their patients concerning leisure-time physical activity’s benefits, safety and opportunity in their community

Validity of algometry and video assessment to diagnose pain in sheep with knee synovitis

Reasons to perform study. To assess lameness in animals, semi-objective scales are used. Video is sometimes used to enable blinding of the clinician. In addition, the assessment of pain is particularly difficult in animals since they cannot report their feelings. The interpretation of the reactions of the animals can be different between observers. A method to quantify pain is the measure of mechanical nociceptive thresholds (MNT), a method called algometry. Since synovitis is often linked to swelling of periarticular tissues and to synovial fluid effusion, palpation of the joint is also a useful test. The objectives of the current study were to assess in sheep whether (1) video assessment of lameness is in agreement with real observation; (2) algometry of the knee is correlated with lameness evaluation; (3) algometry is correlated with identification of swelling by palpation. Material and methods. The population of sheep enrolled in a controlled trial at the Ovine Research Center of UNamur was used for the current study. Results. There was a moderate inter-rater agreement (value of kappa was 0,41) between the experimenter who evaluated the ewes on site and the one who watched the videos. No significant correlation was identified between lameness scores and algometry. A negative correlation (algometry reactive threshold is lower when palpation score is higher) was identified between palpation scores and MNT (P<0.05). Discussion. Video assessment can be used in research to assess lameness. The experience of the observer must be taken into account. Algometry is not entirely valid since an adaptation or learning process seems to develop in sheep