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The knee joint
Published in David Silver, Silver's Joint and Soft Tissue Injection, 2018
In recent years, there has been an increasing interest in viscosupplementation in the treatment of osteoarthritis of the knees.1 This treatment has been largely used in Canada and Europe, and presents an alternative treatment for this condition.
Osteoarthritis
Published in Kohlstadt Ingrid, Cintron Kenneth, Metabolic Therapies in Orthopedics, Second Edition, 2018
David Musnick, Richard D. Batson
Intra-articular hyaluronans (viscosupplementation) have been used extensively to treat pain and mechanical dysfunction associated with osteoarthritis of the knee. Many controlled clinical studies have demonstrated their efficacy and a low side-effect profile for this indication and application (Kelly et al., 2004; Aggarwal and Sempowski, 2004).
Arthritis and Common Musculoskeletal Conditions
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
Jennifer H. Paul, Katarzyna Iwan, Claudia Ramirez
Intra-articular hyaluronic acid (HA) is a US Food and Drug Administration-approved treatment (since 1997) for knee OA; however, its efficacy remains controversial. Viscosupplementation is also used for other joints. In arthritic joints, synovial fluid has a diminished HA concentration and lower viscosity and decreased elasticity. These injections are believed to restore the elasticity and improve pain and function in patients with arthritis. Viscosupplementation can be an alternative to treatment such as medications and corticosteroid injections when they are contraindicated, not tolerated, or ineffective. Typically, one injection per week for 3–5 weeks is a common approach.
Pain management in people with hemophilia in childhood and young adulthood
Published in Expert Review of Hematology, 2021
E. Carlos Rodriguez-Merchan, Hortensia De la Corte-Rodriguez
There are 3 main methods for relieving chronic musculoskeletal pain due to cartilage joint degeneration: pharmacologic treatment, PRM, and intra-articular injections. Regarding pharmacological treatment, there is evidence that COX-2 inhibitors are better than paracetamol/acetaminophen, and it is recommended that they be used together. The advantages of using opioids in general are few. With respect to PRM, there is no definitive evidence that adding an orthesis to drug treatment helps to relieve pain. Land-based curative exercise and aquatic exercise produce little short-term pain relief. Curative ultrasound might be helpful (although there is a low degree of evidence). The effectiveness of transcutaneous electrostimulation for pain relief has not been demonstrated. Electrostimulation can provide significant relief. Regarding intra-articular injections, viscosupplementation appears to relieve pain in the short term (over months). The short-term (for weeks) efficacy of intra-articular corticosteroid injections in the management of chronic musculoskeletal pain has also been demonstrated.
Coll2-1 and Coll2-1NO2 as exemplars of collagen extracellular matrix turnover – biomarkers to facilitate the treatment of osteoarthritis?
Published in Expert Review of Molecular Diagnostics, 2019
Ali Mobasheri, Cecile Lambert, Yves Henrotin
Viscosupplementation is an important and expanding area of innovation and therapeutic development in OA [40]. A study published in 2013 evaluated the utility of Coll2-1 and Coll2-1NO2 in knee OA patients after viscosupplementation [40]. Fifty-one patients with unilateral symptomatic knee OA were recruited for this prospective open-label study. They received three intra-articular injections of 2 ml of hyaluronic acid (Hylan GF-20) and were followed for 3 months. In addition to functional tests, the levels of Coll2-1 and Coll2-1 NO2 were measured in the serum using immunoassays. The serum concentrations of Coll2-1 and Coll2-1 NO2 were significantly higher in KL III/IV patients compared to KL I/II patients at baseline. These biomarkers decreased systematically over time after viscosupplementation and the observed effects were found to be more pronounced in patients with KL III/IV. The serum levels of Coll2-1 were significantly lower at baseline in responders than in non-responders. This study demonstrated that the serum level of Coll2-1 is a predictive factor for response to viscosupplementation treatment [40].
Joint lavage followed by intra-articular injection of hyaluronic acid and/or corticosteroids in patients with severe hemophilic arthropathy of the knee: Is this intervention really effective?
Published in Expert Review of Hematology, 2018
E. Carlos Rodriguez-Merchan, Leonard A. Valentino
Rodriguez-Merchan [8] performed a review of available literature on the efficacy of hyluronic acid as a single intra-articular agent. Although the literature supported the use of hyaluronic acid in the treatment of knee osteoarthritis, because of its ability to decrrease pain and improve functional ability, generally within 1 week of injection and for durations of up to 3–12 months, in patients with hemophilic arthropathy the evidence was weak and any short-lived improvements afforded by viscosupplementation did not warrant its use in hemophilia patients due to the associated risks (hemarthrosis) and the cost involved (factor coverage) for the procedure. Despite these limitations, viscosupplementation may be a way of delaying the need of operative interventions when noninvasive medical therapy (relative rest, oral anti-inflammatory drugs, oral analgesics, and physical therapy) has failed.