Knee Injections No benefit to Exercise

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:

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Exercise helps reduce ACL injury

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.