Monthly Archives: April 2015

Injection of your own serum gives better relief than steroids.

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OC38 EFFICACY STUDY OF THE TREATMENT OF OSTEOARTHRITIS-INDUCED KNEE PAIN WITH AUTOLOGOUS CONDITIONED SERUM: A COMPARATIVE, PROSPECTIVE AND RANDOMIZEDSTUDY D. W. Hang1 1Shin Kong Orthopedic Sports Medicine Institute, Taipei, Taiwan, Province of China Objective: To compare the efficacy of the standardized injection therapies of (1) autologous conditioned serum (ACS) against (2) corticosteroid in patients with bilateral knee pain secondary to osteoarthritis. Material and Methods:34patients(N=68knees)withbilateral knee pain secondary to osteoarthritis were followed prospectively after intra-articular knee injection of either corticosteroid (group 1) or ACS (group 2). Every patient received a series of six intra-articular injections with ACS into one of the randomly selected knee over a three week period. The other contra-lateral knee received a one-time only standard regime of corticosteroid injections (dexamethasone). Results: In group 1, 23.5 % of the 34 knees experienced 50100 % pain reduction at 12 months after injection. Average VAS pain relief was 41.0 %. The WOMAC score showed significant (p Conclusion: Therapy with both steroid and ACS effectively reduces pain in osteoarthritic knees. Both treatments have beneficial effects on pain, function, and mobility in osteoarthritic knees. In addition, the risk profile is minimal for both treatment regimens.

A Comparative, Prospective and Randimised Study with Autologous Conditioned Serum (Interleukin-1 Receptor Antagonist Containing Serum) and Corticosteroid for Treatment of Osteoarthritic Knee. Abstract OC38

MILAN, Italy — April1, 2015 — Intra-articular injections of autologous conditioned serum (ACS) are effective and safe compared with a corticosteroid for the treatment of mild to moderate knee osteoarthritis, according to prospective trial results presented at the World Congress on Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (WCO).

Interleukin-1 (IL-1) is the main cytokine responsible for the pathophysiological processes underlying cartilage destruction. Conversely, an IL-1 receptor antagonist is a naturally occurring 25-kDa glycoprotein cytokine that can decrease cartilage destruction through antagonism of IL-1 effects. Based on this knowledge, “a new technique was developed to produce a serum containing high concentrations of autologous IL-1 receptor antagonist,” stated lead investigator David W. Hang, MD, Shin Kong Orthopaedic Sports Medicine Institute, Taipei, Taiwan, China, speaking here on March 29.

The production of this IL-1 antagonist-containing serum, or ACS, is based on the concept of cell adherence, in which direct contact between monocytes in the blood and specially etched glass beads stimulates production of the autologous cytokine by monocytes.

Dr. Hang and colleagues produced ACS by the glass-bead treatment of 60 mL of blood from 34 patients with bilateral knee pain secondary to osteoarthritis (mean age, 61.3 years), providing 68 knees for evaluation. Production of ACS resulted in increased mean IL-1 receptor antagonist levels in this serum from 270 pg/mL at baseline to 4,051.3 pg/mL after 24 hours (mean ratio: 15.9).

For each patient, the researchers randomised 1 knee to 2 ml ACS as 6 biweekly intra-articular injections. The contralateral knee, as a comparator, received a single injection of 5 mg 5% dexamethasone (1 mL) and 2% xylocaine (1 mL).

Efficacy (defined at 12 months as >50% reduction in visual analogue scale [VAS] pain score) was achieved in 67.6% of ACS-injected knees, compared with 23.5% of corticosteroid-injected knees. Similarly, the mean percentage reduction in VAS pain scores at 12 months demonstrated greater benefit for ACS-injected knees (56.2% vs 41.0%).

For the VAS and Western Ontario McMaster (WOMAC) scores assessed over 3, 6, and 12 months, at all times there were significant improvements over baseline for ACS (P < .0001 for all) and corticosteroid (P < .001 for all). ACS generally provided significant benefits over corticosteroid across these assessments for VAS pain score and WOMAC function and pain scores (P < .05).

In the safety analysis, Dr Hang noted that, “The average side effects were 26% for the steroid group and 7% for the ACS group, but [side effects] were all transient, and were resolved in a few hours.”

Dr Hang also noted possible synergistic effects on the contralateral knee that he feels require further study. “The long-term effectiveness and the histological effects of ACS on cartilage remain to be determined,” he stated.

WCO is sponsored by the International Osteoporosis Foundation (IOF) and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO).

Knee Injections No benefit to Exercise

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This paper shows that the use of knee injections

JAMA Intern Med. Published online March 30, 2015. doi:10.1001/jamainternmed.2015.0461
Go To The Abstract on Line

to treat Osteoarthritis has no effect on exercise tolerance

Evaluation of the Benefit of Corticosteroid Injection Before Exercise Therapy in Patients With Osteoarthritis of the KneeA Randomized Clinical Trial ONLINE FIRST

Marius Henriksen, PT, MSc, PhD1; Robin Christensen, PhD1; Louise Klokker, MSc1; Cecilie Bartholdy, MSc1; Elisabeth Bandak, MSc1; Karen Ellegaard, PhD1; Mikael P. Boesen, PhD1,2; Robert G. Coumine Riis, MD1,2; Else M. Bartels, PhD1; Henning Bliddal, DMSc1

Importance to Kneejoint pain

Osteoarthritis (OA) of the knee is the most frequent form of arthritis and a cause of pain and disability. Combined nonpharmacologic and pharmacologic treatments are recommended as the optimal treatment approach, but no evidence supports the recommendation.

Objective of Investigation

To assess the clinical benefits of an intra-articular corticosteroid injection given before exercise therapy in patients with OA of the knee.

Design, Setting, and Participants

We performed a randomized, blinded, placebo-controlled clinical trial evaluating the benefit of intra-articular corticosteroid injection vs placebo injection given before exercise therapy at an OA outpatient clinic from October 1, 2012, through April 2, 2014. The participants had radiographic confirmation of clinical OA of the knee, clinical signs of localized inflammation in the knee, and knee pain during walking (score >4 on a scale of 0 to 10).

Interventions Participants were randomly allocated (1:1) to an intra-articular 1-mL injection of the knee with methylprednisolone acetate (Depo-Medrol), 40 mg/mL, dissolved in 4 mL of lidocaine hydrochloride (10 mg/mL) (corticosteroid group) or a 1-mL isotonic saline injection mixed with 4 mL of lidocaine hydrochloride (10 mg/mL) (placebo group). Two weeks after the injections, all participants started a 12-week supervised exercise program.

Main Outcomes and Measures The primary outcome was change in the Pain subscale of the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire (range, 0-100; higher scores indicate greater improvement) at week 14. Secondary outcomes included the remaining KOOS subscales and objective measures of physical function and inflammation. Outcomes were measured at baseline, week 2 (exercise start), week 14 (exercise stop), and week 26 (follow-up).

Results One hundred patients were randomized to the corticosteroid group (n = 50) or the placebo group (n = 50); 45 and 44 patients, respectively, completed the trial. The mean (SE) changes in the KOOS Pain subscale score at week 14 were 13.6 (1.8) and 14.8 (1.8) points in the corticosteroid and placebo groups, respectively, corresponding to a statistically insignificant mean difference of 1.2 points (95% CI, −3.8 to 6.2; P = .64). We found no statistically significant group differences in any of the secondary outcomes at any time point.

Conclusions and Relevance No additional benefit results from adding an intra-articular injection of 40 mg of corticosteroid before exercise in patients with painful OA of the knee. Further research is needed to establish optimal and potentially synergistic combinations of conservative treatments.

Trial Registration clinicaltrialsregister.eu Identifier: 2012-002607-18; clinicaltrials.gov Identifier:

Exercise helps reduce ACL injury

ACL rehabilitation Injury Prevention, , ,

Exercise helps reduce ACL injury

Exercise helps reduce ACL injury when done before an injury when the training targeting at prevention of injury to the ACL. All research paper were analysed and the results pooled together and analysed. The results showed that it was especially effective in preventing injury in female athletes. This Meta analysis of a recent paper in the medical literature ads to this evidence.

Exercise helps reduce ACL injury See at the BJSM Site
Exercise helps reduce ACL injury See at the BJSM Site

Specific Exercise Effects of Preventive Neuromuscular Training Intervention on Anterior Cruciate Ligament Injury Risk Reduction in Young Females

Meta-analysis and Subgroup Analysis

Dai Sugimoto, Gregory D Myer, Kim D Barber Foss, Timothy E Hewett,   Br J Sports Med. 2015;49(5):282-289.

Context

Clinical trials have demonstrated that preventive neuromuscular training (PNMT) can be effective to reduce ACL injuries in young females. However, the magnitude of the overall effect of PNMT for ACL injury reduction has not reached consensus. In addition, the effects of individual exercises in PNMT that optimise ACL injury reduction are unknown.

Objective

The purpose of this project was to systematically review previously published clinical trials and evaluate types of exercises that best support ACL injury reduction in young females.

Data sources

The key words ‘knee’, ‘anterior cruciate ligament’, ‘ACL’, ‘prospective’, ‘neuromuscular’, ‘training’, ‘female’, and ‘prevention’ were used for studies published from 1995 to May 2012 in PubMed and EBSCO host.

Study selection

Inclusion criteria for the current analysis were: (1) documented number of ACL injuries, (2) employed a PNMT intervention that aimed to reduce ACL injuries, (3) had a comparison group, (4) used a prospective controlled study design, (5) recruited female athletes and (6) recorded exercises implemented in the PNMT.

Data extraction

The number of ACL injuries and female athletes in each group (control and intervention) were extracted. In addition, exercises were categorised into four types and analysed for each investigation.

Data synthesis

A total of 14 clinical trials met the inclusion criteria. The subgroup analyses identified fewer ACL injuries in PNMT that focused on strengthening (OR 0.32, 95% CI 0.23 to 0.46, p=0.001), proximal control exercises (OR 0.33, 95% CI 0.23 to 0.47, p=0.001) and multiple exercise interventions (OR 0.32, CI 0.22 to 0.46, p=0.001).

Conclusions

The current subgroup analyses indicate strengthening, proximal control exercises and multi exercise genres increased efficacy in PNMT intervention designed to reduce ACL injury in young female athletes.