The pharmacological effects of glucosamine chondroitin, chitosan, and phytoestrogen on knee osteoarthritis

Osteoarthritis (OA) of the knee significantly disrupts daily activities and reduces quality of life due to pain. The primary treatment involves anti-inflammatories, which can cause stomach issues. Alternative therapies, including glucosamine, chondroitin, chitosan, and phytoestrogens, are being explored, but their effects need further study. While some benefits may be due to the placebo effect, researchers conducted a literature review to determine their actual benefits. A review of seven meta-analyses found that glucosamine and chondroitin can alleviate pain, reduce stiffness, improve function, and reduce joint space narrowing (JSN) in OA patients. Chitosan's use in intra-articular injections for OA has been studied in four observational studies and clinical trials on animals, but the effects of oral chitosan supplements remain unknown. A literature review on phytoestrogens in OA, particularly in post-menopausal women, identified four relevant studies. The review suggests that glucosamine, chondroitin, chitosan, and phytoestrogens have significant therapeutic benefits for OA, such as reducing pain (measured by VAS score), relieving stiffness, and improving functionality due to their anti-inflammatory and chondroprotective effects. Therefore, additional randomized controlled trials are needed to confirm their effectiveness in managing knee OA.

Influence of yoga on pain, lower extremity kinetics, kinematics and function in patients with knee osteoarthritis

Background: Knee osteoarthritis (OA), is one of the leading cause of disability that causes significant reduction in function and strength with an increase in pain. The present study evaluates effects of Yoga with Physiotherapy exercises on pain, kinetics, kinematics and function in patients with knee osteoarthritis. Methods: A randomized controlled trial was conducted for evaluating the effect of Yoga on pain, lower limb kinetics, kinematics and function in patients with knee osteoarthritis over a period of 6 weeks. A total of 50 participants volunteered for the study. The participants were randomly allocated into Control group (n=25) and Intervention group (n=25). The participants of control group performed conventional exercises. The participants of intervention group performed conventional exercises along with Yoga. Results: Findings from present study reported significant improvement in muscle flexibility of Rectus Femoris (p<0.05) and Tensor Fascia Lata (p<0.05) in the interventional group as compared to the control group. There was a significant improvement in knee flexion range of motion(p<0.05) in the interventional group compared to the control group. Lower extremity muscle strength evaluation demonstrated a significant improvement(p<0.05) in muscle strength of hip and knee musculature in the interventional group as compared to the control group. There was a significant reduction in pain scores(p<0.05) for stair climbing in the interventional group as compared to the control group. There was no significant improvement in function pre and post intervention. Conclusions: Findings from present study report yoga practice improves knee flexion range of muscle, muscle strength and flexibility in patients with knee osteoarthritis.

Comparison of blood loss in total knee replacement surgery with and without tranexamic acid: a prospective, time framed and observational analytical study

Background: Total knee replacement is one of the common orthopaedic procedures performed worldwide. Blood transfusion is one of the major requirements in TKR procedure due to the amount of blood loss during and after the procedure. We carried out a prospective study to determine the efficacy of tranexamic acid in controlling blood loss during TKR procedure. Methods: Study was conducted at a tertiary care centre, involving cases operated by a single surgeon. Study included 140 patients undergoing primary TKR for advance degenerative disease of knee and were divided into two groups of 70 each, one group that received tranexamic acid before surgery and another group that did not receive tranexamic acid before surgery. Patient with allergy to the drug, hepato/renal dysfunction, DVT, abnormal PT and INR were not included. Tranexamic acid was given intravenously as well as intra-articular. Results: Pre-operative haemoglobin ranged from 10.2 gm% to 14.4 gm% in the group getting tranexamic acid and from 10% to 14 % in the group not getting tranexamic acid. Post operatively haemoglobin varied from 8.4 gm% to 12.8 gm% in Group 1 and from 7.8 gm% to 12 gm% in Group 2. Difference of mean post-operative Hb (p=0.0045) and PCV (p=0.0024) in two groups was statistically significant. Conclusions: We concluded that administration of tranexamic acid reduces the blood loss as well as need of blood transfusion in a patient undergoing total knee replacement.

Effects of Magnesium in Physiotherapy Treatment for Patients with Knee Osteoarthritis

Background: Osteoarthritis (OA) is a complex joint degenerative disorder. Pain is a dominant characteristic, becoming persistent and more limiting as the disease progresses, resulting in reduced physical function, quality-of-life. Magnesium deficiency is considered to be a major risk factor for osteoarthritis development and progression. Oral magnesium presents unique challenges for many individuals to effectively restore intracellular magnesium levels. Transdermal magnesium absorption could be more effective than oral absorption due to its greater absorption rate and presents fewer negative effects due to its gastrointestinal tract-bypassing nature. Method: Total 40 subjects with knee osteoarthritis were selected as per the inclusion and exclusion criteria and randomly assigned to either Group A (intervention) or Group B (conventional), each having 20 patients. Assessment of the outcome measures was done pre and post 8 sessions. Outcome measures used were Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Arthritis Index (WOMAC), Timed up and go test (TUG), 9 Step stair climb test, Knee ROM, Quadriceps strength using pressure biofeedback. Group A was given conventional therapy along with Epsom salt foot soak and Magnesium oil application. Group B was given conventional therapy alone. Result: There was statistically significant improvement seen in all the outcome measures in intragroup analysis with p<0.05. Intergroup analysis showed statistically significant difference in VAS on activity, WOMAC, Knee ROM, Quadriceps strength with p <0.05 indicating Group A performed better than Group B.Conclusion: The study found that Magnesium when used as an adjunct to conventional therapy shows significant difference in pain levels, knee mobility, quadriceps strength and better functionality in activities of daily living.

Injerto osteocondral congelado para tratamiento de lesiones de cartílago de rodilla: resultados a 7 años de seguimiento / Use of frozen osteochondral allograft for the treatment of cartilage defects of the knee. Results at seven-year follow-up

Resumen Introducción : Las lesiones osteocondrales de rodilla son una afección frecuente en jóvenes. Los trasplantes alogénicos usando injerto congelado se presentan como una opción de tratamiento en pacientes con lesiones grandes o sin zona dadora. Este trabajo buscó analizar retrospectivamente los resultados funcionales y la tasa de falla de los trasplantes osteocondrales con injerto cadavérico congelado. Métodos : Se incluyeron pacientes sometidos a tras plantes osteocondrales de rodilla con injerto cadavérico congelado en nuestra institución, entre 2014 y 2019, con dos años de seguimiento mínimo. Variables evaluadas: edad al momento de la intervención, escalas funciona les International Knee Documentation Committee (IKDC) y Lysholm pre y post operatorios, complicaciones y tasa de falla. Resultados : Incluimos 25 pacientes. La edad media fue de 43.5 años (RIQ 29-50), 45% fueron mujeres y el seguimiento promedio fue de 83 meses (DS 54.6). El ta maño promedio del defecto osteocondral fue de 4 cm2. La escala de Lysholm promedio pre y postoperatorio fue de 39 (DS 19.3) y 82 (DS 15.4) respectivamente (p < 0.01). El IKDC promedio pre y postoperatorio fue de 42 (DS 13.8) y 60 (DS 13.5) respectivamente (p < 0.01). La tasa de falla fue del 20% (n=5). Discusión : Los pacientes presentaron una mejoría postoperatoria evidenciada en los resultados funcio nales, y una tasa de falla del 20%. El uso de trasplante osteocondral congelado se presenta como un recurso útil para el tratamiento de lesiones condrales graves.

Abstract Introduction : Knee osteochondral lesions represent a frequent pathology within young active patients. One possible indication for severe lesions or in case of im possibility of harvesting an autograft is the use of fresh frozen allograft. The objective of this study was to ret rospectively analyze functional results and failure rate after osteochondral transplants using fresh frozen al lografts. Methods : We analyzed data from patients who under went knee osteochondral transplant using mosaicplasty technique with fresh frozen allografts at our institution between 2014 and 2019. We included those patients with at least two-year follow-up. Demographic characteristics such as age at the moment of intervention and size of the defect were included. Functional results were assessed using pre and postoperative Lysholm and IKDC scores. Patients who underwent a knee replacement were considered failures. Results : Twenty-five patients were included. The me dian age was 43.5 years (IQR 29-50), 45% were female and the mean follow-up was 83 months (SD 54.6). Mean osteochondral defect size was 4 cm2. Mean pre and post operative Lysholm scores were 39 (SD 19.3) and 82 (SD 15.4) respectively (p < 0.01). Mean pre and postoperative IKDC scores were 42 (SD 13.8) and 60 (SD 13.5) respec tively (p < 0.01). Five patients (20%) underwent a knee replacement afterwards and were considered failures. Discussion : Our results after a mean seven-year follow-up evidenced an overall improvement in func tional scores and a failure rate of 20%. Osteochondral transplant using fresh frozen allografts is a reliable and feasible treatment for patients with large osteochondral defects.

Effect of kinesio tape application on the lymphatic system during knee arthroscopy surgery

Introduction: To control edema, physical therapy employs several techniques, such as elastic bandages application - Kinesio tape (KT) - to block or drain subcutaneous body fluids, due to the secondary effects of its elastic properties. Objective: To evaluate the effect kinesio tape application on the lymphatic system during knee arthroscopy surgery. Methods: Controlled clinical trial, with 28 patients, alternately divided into two groups (intervention and control) referred to arthroscopic surgical treatment of anterior cruciate ligament and meniscus injuries. Patients were evaluated in the preoperative and, on the 1st postoperative day, while the intervention group received KT application for the lymphatic system in the intraoperative period. Results: The intervention group showed statistically significant results in the non-formation of edema, according to perimetric (Point 2: p=0.010, Point 3: p≤0.001 and Point 4: p≤0.001) and ultrasound (p=0.007) analyses when compared to the control group. On the other hand, pain (p=0.056) did not present a significant difference, but in the intragroup comparison pre and postoperative, a considerable reduction (p=0.002) was observed. Conclusion: KT application for the lymphatic system in the intraoperative period of knee arthroscopy effectively minimized edema formation and reduced pain.

Outcomes of Anterior Cruciate Ligament Reconstruction in Patients with Associated Anterolateral Ligament Injury / Resultados da reconstrução do ligamento cruzado anterior em pacientes com lesão associada do ligamento anterolateral

Abstract Objective To evaluate if there is a significant difference in the outcomes of isolated anterior cruciate ligament (ACL) reconstruction in patients with or without associated anterolateral ligament (ALL) injury. Methods We conducted a retrospective cross-sectional study through the analysis of medical records and the application of the questionnaires of the Lysholm Knee Scoring Scale and the International Knee Documentation Committee (IKDC) Subjective Knee Form to patients undergoing isolated ACL reconstruction. Results The 52 participants included were divided into two groups: 19 with associated ALL injury and 33 with no associated ALL injury. None of the patients with associated ALL injury suffered an ACL rerupture, and 21.1% presented injuries to other knee structures after surgery. Among the patients with no associated injury, 6.1% suffered ACL rerupture, and 18.2% presented injuries to other structures after surgery (p = 0.544). Return to activities at the same level as that of the preoperative period occurred in 60% of the patients with associated ALL injury and in 72% of those with no associated injury (p = 0.309). The mean score on the Lysholm Knee Scoring Scale was of 81.6 points in patients with associated ALL injury, and of 90.1 in those with no associated injury (p = 0.032). The mean score on the IKDC Subjective Knee Form was of 70.3 points in patients with associated ALL injury and of 76.7 in those with no associated injury (p = 0.112). Conclusion There was no statistically significant difference regarding graft injuries or new injuries to other structures, satisfaction with the operated knee, or the score on the IKDC Subjective Knee Form. Return to activity was similar in the groups with and without associated ALL injuries. The scores on the Lysholm Knee Scoring Scale were better, with a statistically significant difference in the group with no associated ALL injuries.

Resumo Objetivo Avaliar se há diferença significativa nos resultados da reconstrução isolada do ligamento cruzado anterior (LCA) em pacientes com e sem lesão associada do ligamento anterolateral (LAL). Métodos Foi realizado um estudo transversal retrospectivo com análise de prontuários e aplicação dos questionários da Escala de Pontuação do Joelho de Lysholm e do Formulário Subjetivo de Joelho do International Knee Documentation Committee (IKDC) a pacientes com reconstrução isolada do LCA. Resultados Os 52 participantes incluídos foram separados em 2 grupos: 19 com lesão associada do LAL e 33 sem lesão associada. Nenhum paciente com lesão associada do LAL sofreu rerruptura do LCA, e 21,1% tiveram lesões em outras estruturas do joelho após a cirurgia. Entre os pacientes sem lesão associada, 6,1% sofreram rerruptura do LCA, e 18,2% tiveram lesões em outras estruturas após a cirurgia (p = 0,544). O retorno às atividades no mesmonível do quenopré-operatóriofoi observadoem60% dos pacientes com lesão associada do LAL e em 72% daqueles sem lesão associada (p = 0,309). Na Escala de Pontuação do Joelho de Lysholm, os pacientes com lesão associada do LAL obtiveram média de 81,6 pontos, e os sem lesão associada, média de 90,1 pontos (p = 0,032). No Formulário Subjetivo de Joelho do IKDC, os pacientes com lesão associada do LAL obtiveram média de 70,3 pontos, e os sem lesão associada, média de 76,7 pontos (p = 0,112). Conclusão Não foi observada diferença estatística significativa quanto a lesões do enxerto ou novas lesões de outras estruturas, satisfação com o joelho operado ou pontuação no Formulário Subjetivo de Joelho do IKDC. Oretorno às atividades foi semelhante nos grupos com e sem lesão associada do LAL, e os resultados na Escala de Pontuação do Joelho de Lysholm foram melhores, com diferença estatística significativa no gruposem lesãoassociada do LAL.

Updates in the Treatment of Knee Osteoarthritis / Atualizações no tratamento da osteoartrite de joelho

Abstract Knee osteoarthritis (OA) is an inflammatory and degenerative condition resulting in articular cartilage destruction and functional loss. Its prevalence has grown considerably due to increased life expectancy and obesity, and its diagnosis relies on evaluation, medical examination, and confirmation by supplementary radiographic images. Knee OA is multifactorial and influenced by several local, systemic, and external aspects. In addition, its progress and therapeutic responses highly depend on the characteristics of each subject. The initial recommendation is drug treatment and alternative therapies to improve quality of life. However, if these treatments are unsuccessful, one must consider surgical treatment. Surgical options include arthroscopies, osteotomies, and partial and total arthroplasties, while non-surgical treatments include medications and alternative therapies such as infiltrations, acupuncture, and physical exercise. It is worth highlighting that biomarkers can be a significant strategy for early disease detection, assessment of disease activity, prediction of prognosis, and monitoring a better response to therapy. Nevertheless, this topic must be the focus of further research to confirm its findings.

Resumo A osteoartrite (OA) do joelho é uma doença inflamatória e degenerativa que ocasiona a destruição da cartilagem articular e leva à perda de funções. Sua prevalência vem crescendo consideravelmente devido ao aumento da expectativa de vida e da obesidade, e o diagnóstico pode ser feito por meio de avaliação e exames médicos, e é confirmado em imagens radiográficas complementares. Uma condição multifatorial, a OA do joelho pode ser influenciada por diversos aspectos locais, sistêmicos e externos; além disso, a sua evolução e as respostas aos tratamentos dependem muito das características de cada indivíduo. Inicialmente, recomenda-se proceder a um tratamento medicamentoso e a terapias alternativas que melhorem a qualidade de vida do paciente; mas, a partir do momento em que se verifica que tais terapias não estão proporcionando resultados satisfatórios, um tratamento cirúrgico deve ser considerado. Entre os tratamentos cirúrgicos, as artroscopias, as osteotomias e as artroplastias parciais e totais são destacadas; os métodos não cirúrgicos incluem o uso de medicamentos e de terapias alternativas, como infiltrações, acupuntura e prática de exercícios físicos. Vale ressaltar ainda que a utilização de biomarcadores pode ser uma importante estratégia para detectar precocemente a doença, avaliar sua atividade, prever um prognóstico e monitorar uma melhor resposta à terapia; porém, esse tema ainda deve ser foco de mais estudos para que os seus resultados sejam comprovados.

The Influence of Different Hamstrings Assemblies on the Final Graft Diameter in Anterior Cruciate Ligament Reconstruction / A influência de diferentes montagens dos tendões flexores no diâmetro final do enxerto na reconstrução do ligamento cruzado anterior

Abstract Objective This study aimed to compare gracilis and semitendinosus tendon graft diameters in anterior cruciate ligament (ACL) reconstruction using quadruple, quintuple, and sextuple assemblies. Another objective was to evaluate the percentage of patients in which each assembly type is possible, depending on the length of each free tendon. Methods Seventy-one patients underwent ACL reconstruction using hamstring tendons. We measured the diameters of the quadruple, quintuple, and sextuple assemblies in all patients. We recorded tendon length and graft diameter from three assembly types. Results Assembly comparison showed a statistically significant difference (p < 0.001). In each assembly, graft diameter increased by 1 mm, a statistically significant value (p < 0.001). In 2.8% of patients, the only potential assembly was the quadruple assembly because the free lengths of the 2 tendons removed were lower than 24 cm. The quintuple assembly was possible in 23.9% of subjects, as only the semitendinosus had a minimum length of 24 cm. The sextuple assembly was possible in 73.2% of patients because both tendons were at least 24 cm in length. Conclusion A quintuple or sextuple assembly is possible in 97.2% of cases since the final graft length of at least 8 cm is statistically significant between comparisons.

Resumo Objetivo Buscamos comparar o diâmetro dos enxertos com utilização dos tendões grácil e semitendíneo na reconstrução do ligamento cruzado anterior (LCA) utilizando as montagens quádrupla, quíntupla e sêxtupla. Outro objetivo é avaliar em qual porcentagem de pacientes é possível cada tipo de montagem, em função do comprimento de cada tendão livre. Métodos Setenta e um pacientes foram submetidos à reconstrução do LCA utilizando tendões isquitibiais. Foram medidos os diâmetros das montagens quádrupla, quíntupla e sêxtupla em todos pacientes. Registramos os comprimento dos tendões e o diâmetro do enxerto com os três tipos de montagens. Resultados As comparações entre as montagens mostraram diferença estatisticamente significativa (p < 0,001). A cada montagem, aumentou 1 mm o diâmetro do enxerto e isso foi estatisticamente significativo (p < 0,001). Em 2,8% dos pacientes, somente a montagem quádrupla foi possível, pois os comprimentos livres dos 2 tendões retirados foram menores que 24 cm. Em 23,9% desses, foi possível a montagem quíntupla; pois somente o semitendíneo tinha comprimento mínimo de 24 cm e, em 73,2%, foi possível a montagem sêxtupla com o comprimento dos 2 tendões igual ou superior a 24 cm. Conclusão Em 97,2% dos casos foi possível realizar a montagem quíntupla ou sêxtupla, já que o comprimento final do enxerto de no mínimo 8 cm apresenta diferença estatisticamente significante entre as comparações.

Benefits of core strengthening exercise in osteoarthritis knee patients: a narrative review

Osteoarthritis is a degenerative joint disease results from breakdown of cartilage that covers the ends of bones in joint. Breakdown causes bones to rub each other leading to pain, stiffness, swelling, loss of function in joint and can be accompanied by synovitis with or without joint fluid effusion. Muscle atrophy may develop if patient was inactive and did not perform exercises, which will affect functionality and stability of joint including activities of daily life. The aim of the study was to evaluate current literature and provide comprehensive overview of benefits of core muscle strengthening exercise in managing OA. The objective of this study was to discuss effectiveness of core muscle strengthening exercise in reducing pain, improving physical function, and enhancing quality of life in individuals with osteoarthritis knee. A systematic search was conducted to identify all relevant studies related to core muscle strengthening, database such as Pubmed, Cochrane library, Scopus had been used. Studies demonstrating clinical importance of core strengthening in treatment of osteoarthritis knee are limited. By performing randomized controlled trials with a big sample size, new researchers should produce more unique findings.

EFFECTS OF PLATELET-RICH PLASMA INJECTIONS ON OSTEOARTHRITIC PATIENTS

Objective: Various treatment options are available for knee osteoarthritis such as medical treatment with NSAID, conservative management with platelet-rich plasma (PRP) and corticosteroids. We have done this prospective study to know the use and safety of platelet- rich plasma (PRP) injections in knee osteoarthritis (KOA) patients. We know platelet rich plasma (PRP) clinical and functional outcome in knee osteoarthritis (KOA) by doing this study and using the available literature.Methods: This prospective study consisted of a total number of 96 patients suffering from knee osteoarthritis. Both males and females are included. Intra-articular injection of platelet rich plasma (PRP) was given in sterile conditions and clinical and functional outcomes were analyzed with Western Ontario and McMaster University Arthritis Index (WOMAC), Visual Analogic Scale (VAS), and Knee Society score (KSS). This study is done in a tertiary care institute during the study period. Results: Most patients were females aged>40 years with knee osteoarthritis. The injections of platelet rich plasma (PRP) showed results at three, six and twelve months follow-up showed significantly reduced WOMAC scores, Visual Analogic Scale (VAS) and Knee Society score (KSS). No complications were observed during the follow-up period.Conclusion: The results confirm the efficacy of the PRP injections on Knee osteoarthritis, suggesting that decreasing pain was obtained one month after injection, with the best results observed after 12 months—however, a more extensive study group. Follow-up is required for a prolonged period to assess the efficacy of PRP injection.

Tendencias en la cirugía de artroplastía total de rodilla en Chile. ¿Cómo las estamos operando? / Trends in total knee replacement surgery in Chile. How are we operating them?

INTRODUCCION La artroplastía total de rodilla (ATR), que ha tenido un aumento importante en la población en las últimas décadas, presenta una gran variación en su estudio y técnica entre los distintos países. En la actualidad no hay datos nacionales registrados que evalúen la forma de su implementación. Objetivo Registrar las tendencias respecto de la ATR en distintos aspectos en Chile y compararlas con los registros de otros países. MATERIALES y METODOS Se realizó una encuesta vía email a cirujanos de rodilla en Chile considerando cuatro aspectos: generalidades, estudio preoperatorio, técnica quirúrgica y técnica de cementación. Se excluyeron las encuestas que no rellenadas por completo. Se analizaron los datos generales y separados según años de experiencia (ADE). Se compararon los datos con los obtenidos en estudios internacionales. RESULTADOS Se obtuvieron 87 encuestas completas. La mayoría de los encuestados realizaba entre 25 y 50 ATR en 1 año (44%), y el 16%, más de 75. Sólo un 20% utilizaba la modalidad ambulatoria, y un 43% creía que siempre deben ser hospitalizadas (mayor frecuencia en los cirujanos con más de 10 ADE). Un 18% utilizaba algún sistema robótico, con mayor frecuencia en cirujanos con más de 10 ADE; los sistemas más usados fueron ROSA y CORI. El 90% creía que la ATR debería ser parte del programa de Garantías Explícitas de Salud (GES), sin diferencias según ADE. El 81% usaba sistema estabilizado posterior (posterior-estabilized, PS, en inglés), 96% realizaba un abordaje parapatelar medial, 82% usaba guía extramedular tibial, 41% tendía a recambiar la patela, y un 35% no usaba torniquete (ninguna de las variables mostró diferencias según ADE). Sólo un 31% utilizaba cementación al vacío (mayor frecuencia en el grupo con menos de 10 ADE), 95% colocaba el cemento en componentes y en hueso, 75% colocaba en la quilla, y 56% utilizaba el dedo para colocarlo (sólo 22% con pistola). La secuencia más frecuente de cementación fue tibia-fémur-patela. En la mayoría de los aspectos evaluados, se observaron diferencias importantes con estudios de otros países. CONCLUSION Existe una gran variabilidad en la realización de ATR en Chile, con tendencias distintas a las de otros países. En general, en relación con los distintos ADE, no hay grandes diferencias en la técnica quirúrgica, sí habiendo diferencias en la técnica de cementación y en el uso de sistemas robóticos

INTRODUCTION Total knee replacement (TKR) significantly increased among the population in recent decades, and it shows great variation in its study and technique in different countries. There is no registered Chilean data to assess TKR implementation. Objective To record the trends in TKR in different aspects within Chile and compare them with records from other countries. MATERIALS AND METHODS We conducted an email survey among knee surgeons in Chile considering four aspects: general features, preoperative study, surgical technique, and cementation technique. We excluded surveys not completed in full. The analyses included overall data and data per years of experience (YOEs), and we compared the results with those of international studies. RESULTS We obtained 87 complete surveys. Most respondents performed 25 to 50 TKRs each year (44%), with only 16% performing over 75 TKRs. Only 20% used the ambulatory modality, while 43% believed patients always require hospitalization (especially surgeons with more than 10 YOEs). Robotic systems were used by 18% of the surgeons, especially those with more than 10 YOEs; the most used systems were ROSA and CORI. In total 90% of the respondents believed TKR should be part of the Explicit Health Guarantees (Garantías Explícitas de Salud, GES, in Spanish) program, with no differences in terms of YOEs. A total of 81% used the posterior-stabilized (PS) system, 96% performed a medial parapatellar approach, 82% used an extramedullary tibial guide, 41% tended to replace the patella, and 35% did not use a tourniquet (none of the variables showed differences according to YOEs). Only 31% used vacuum cementation (with a higher frequency in the group with fewer than 10 YOEs), 95% placed cement on components and bone, 75% placed it in the keel, and 56% used finger packing (only 22% with a gun). The most common cementation sequence was tibia femur-patella. In most aspects evaluated, we observed important differences compared with studies from other countries. CONCLUSION There is a high variability in the performance of TKR in Chile, with different trends compared with those of other countries. Overall, there are no major differences in the surgical technique concerning YOEs, although there is variation in the cementation technique and the use of robotic systems

Tratamiento de la contractura en flexión de rodilla en parálisis cerebral / Treatment for knee flexion contracture in cerebral palsy

La extensión completa de la rodilla es esencial para la marcha. Los pacientes con parálisis cerebral infantil con frecuencia pueden tener déficit de extensión de distinta magnitud, lo que compromete la marcha e incluso la bipedestación. El tratamiento de la contractura en flexión de rodilla parte por tratar la espasticidad de los músculos comprometidos y con fisioterapia. Cuando el flexo es estructurado, el tratamiento es quirúrgico mediante distintas técnicas, dependiendo de la magnitud de la contractura y de la edad del paciente. Las técnicas sobre partes blandas incluyen alargamientos funcionales de isquiotibiales y transferencias musculares. Cuando la contractura es capsular, es preferible realizar cirugía ósea, la cual extiende el fémur proximal, ya sea en forma progresiva, mediante fisiodesis anterior en pacientes pediátricos, o en forma aguda, mediante osteotomía extensora del fémur distal. Con frecuencia existe una patela alta, la cual hay que corregir en el mismo acto quirúrgico para mantener la eficiencia del aparato extensor

Full knee extension is essential for gait. Patients with cerebral palsy frequently have extension deficits of different magnitudes, which compromise walking and even standing up. The treatment of knee flexion contracture begins by addressing the spasticity of the involved muscles and includes physical therapy. For structured extension deficits, the treatment is surgical, using different techniques depending on the magnitude of the contracture and the patient's age. Soft tissue techniques include functional hamstring lengthening and muscle transfers. For capsular contracture, bone surgery is preferable and extends the proximal femur either progressively, through anterior physiodesis in pediatric patients, or acutely, by extensor distal femoral osteotomy. A high patella is common and requires correction during the same surgical procedure to maintain the efficiency of the extensor apparatus

Ejercicio terapéutico en la disminución del dolor en pacientes con artrosis de rodilla grado 1: revisión sistemática / Therapeutic exercise to reduce pain in patients with grade 1 knee arthrosis: systematic review / Exercício terapêutico para reduzir a dor em pacientes com artrose grau 1 do joelho: revisão sistemática

La artrosis de rodilla grado 1 es un problema frecuente a escala mundial. La fisioterapia se presenta como una alternativa prometedora para el tratamiento conservador de esta patología, ya que reduce eficazmente la artralgia. Objetivo. Describir la eficacia de los ejercicios terapéuticos para aliviar el dolor en la artrosis de rodilla grado I. Metodología. Se trata de una revisión sistemática, que abarcó una búsqueda exhaustiva en varias bases de datos como Pubmed, Scielo y Elsevier. Los criterios de búsqueda incluyeron ensayos de control aleatorios, experimentales y cuasiexperimentales realizados entre los años 2017 y 2023. Resultados. De un total de 82 documentos se excluyeron 40 al ser estudios secundarios. Posteriormente, se excluyeron 21 estudios adicionales debido a la escasa relación entre las variables del estudio y a su falta de disponibilidad. Finalmente, se seleccionaron 21 artículos que cumplieron con los criterios de evaluación de calidad metodológica mediante la escala CRF-QS. Para evaluar el dolor, la rigidez, la funcionalidad y la calidad de vida, se utilizaron escalas como EVA, NPRS, WOMAC y OXFORD. Los ejercicios isocinéticos resultaron ser los más efectivos, ya que demostraron un aumento de la fuerza y el grosor del cartílago articular, lo que resultó en una disminución de las puntuaciones de EVA de 8,05 a 3,75. Conclusión. El ejercicio terapéutico supervisado centrado en el fortalecimiento de las extremidades inferiores ha demostrado ser una alternativa efectiva para el tratamiento conservador de la artrosis de rodilla grado I. Este enfoque alivia eficazmente el dolor, mejora la calidad de vida e incluso puede detener la progresión de la enfermedad.

Grade 1 knee osteoarthritis is a common problem worldwide. Physiotherapy is presented as a promising alternative for the conservative treatment of this pathology, since it effectively reduces arthralgia. Aim. To describe the effectiveness of therapeutic exercises to relieve pain in grade I knee osteoarthritis. Methodology. This is a systematic review, which included an exhaustive search in several databases such as Pubmed, Scielo and Elsevier. Search criteria included randomized, experimental and quasi-experimental control trials conducted between the years 2017 and 2023. Results. Of a total of 82 documents, 40 were excluded as they were secondary studies. Subsequently, 21 additional studies were excluded due to poor relationships between study variables and lack of availability. Finally, 21 articles were selected that met the methodological quality evaluation criteria using the CRF-QS scale. To evaluate pain, stiffness, functionality and quality of life, scales such as VAS, NPRS, WOMAC and OXFORD were used. Isokinetic exercises were found to be the most effective, demonstrating an increase in articular cartilage strength and thickness, resulting in a decrease in VAS scores from 8.05 to 3.75. Conclusion. Supervised therapeutic exercise focused on strengthening the lower extremities has been shown to be an effective alternative to the conservative treatment of grade I knee osteoarthritis. This approach effectively relieves pain, improves quality of life, and may even stop the progression of osteoarthritis. disease.

A osteoartrite do joelho grau 1 é um problema comum em todo o mundo. A fisioterapia apresenta-se como uma alternativa promissora para o tratamento conservador desta patologia, uma vez que reduz eficazmente a artralgia. Mirar. Descrever a eficácia dos exercícios terapêuticos no alívio da dor na osteoartrite de joelho grau I. Metodologia. Trata-se de uma revisão sistemática, que incluiu uma busca exaustiva em diversas bases de dados como Pubmed, Scielo e Elsevier. Os critérios de pesquisa incluíram ensaios de controle randomizados, experimentais e quase-experimentais realizados entre os anos de 2017 e 2023. Resultados. De um total de 82 documentos, 40 foram excluídos por se tratarem de estudos secundários. Posteriormente, 21 estudos adicionais foram excluídos devido às más relações entre as variáveis do estudo e à falta de disponibilidade. Por fim, foram selecionados 21 artigos que atenderam aos critérios de avaliação da qualidade metodológica pela escala CRF-QS. Para avaliar dor, rigidez, funcionalidade e qualidade de vida foram utilizadas escalas como VAS, NPRS, WOMAC e OXFORD. Os exercícios isocinéticos foram considerados os mais eficazes, demonstrando um aumento na força e espessura da cartilagem articular, resultando em uma diminuição nos escores VAS de 8,05 para 3,75. Conclusão. O exercício terapêutico supervisionado focado no fortalecimento das extremidades inferiores tem se mostrado uma alternativa eficaz ao tratamento conservador da osteoartrite do joelho grau I. Esta abordagem alivia eficazmente a dor, melhora a qualidade de vida e pode até interromper a progressão da osteoartrite.

Empleo de laser terapéutico versus corrientes TENS para manejo de dolor en pacientes posoperados de artroscopia de rodilla en etapa posoperatoria / Use of therapeutic laser vs TENS currents for pain management in postoperative knee arthroscopy patients in the postoperative stage

Resumen Objetivo: Comprar el dolor en pacientes posoperados de artroscopia de rodilla después de ser sometidos a tratamiento con láser terapéutico versus corrientes TENS. Materiales y método: Se realizó un estudio de tipo experimental, longitudinal, prospectivo, y comparativo que incluyó a 14 pacientes que acudieron al área de Medicina Física y Rehabilitación del Hospital Central Militar, identificados con el diagnóstico de posoperados de artroscopia de rodilla, mediante aleatorización simple, por sorteo, para incluir a los pacientes en los grupos de trabajo: tratamiento con láser terapéutico versus tratamiento con corrientes TENS. Se aplicó la escala visual análoga en la evaluación, y se realizó la medición de ambas rodillas por circometria, pre y postratamiento para medir el edema. El análisis se realizó con el programa estadístico SPSS versión 26 y se utilizó la prueba T de student. Nivel de significancia p<0.05. Resultados: Ingresaron al estudio un total de 14 pacientes, a 7 se les dio en tratamiento con láser terapéutico y a 7 con corrientes TENS. El 50% (7 pacientes) fueron mujeres y el 50% (7 pacientes) fueron hombres. La edad promedio fue de 44.85 años. Al analizar la escala visual análoga, en la evaluación pre y postratamiento ambos grupos disminuyeron su intensidad de dolor con diferencias estadísticamente significativas, (con una desviación típica de 1.15 para TENS y una desviación típica de 1.35) al comparar ambos resultados, se observó una diferencia estadisticamente significativa a favor de las corrientes TENS sobre el láser terapeutico p<0.0001. Conclusiones: En ambos tratamientos, se observaron mejorías en el dolor percibido por los pacientes. Teniendo mayor disminución del dolor con las corrientes TENS. Por lo tanto, en este estudio se llega a la conclusión que este tratamiento es más efectivo que el láser terapéutico en el manejo del dolor en pacientes posoperados de artroscopia de rodilla. No se observó mejoría en el edema en ninguno de los tratamientos.

Abstract Objective: To measure pain in postoperative knee arthroscopy patients after undergoing treatment with therapeutic laser vs. TENS currents. Materials and method: An experimental, longitudinal, prospective, and comparative study was carried out that included 14 patients who attended the Physical Medicine and Rehabilitation area of the Hospital Central Militar, identified with the diagnosis of postoperative knee arthroscopy, through randomization. simple, by lottery, to include patients in the work groups: treatment with therapeutic laser vs treatment with TENS currents. The visual analogue scale was applied in the evaluation, and measurement of both knees was carried out by circometry, pre- and post-treatment to measure edema. The analysis was carried out with the statistical program SPSS version 26 and the student's T test was used. Significance level p<0.05. Results: A total of 14 patients entered the study, 7 were treated with therapeutic laser and 7 with TENS currents. 50% (7 patients) were women and 50% (7 patients) were men. The average age was 44.85 years. When analyzing the visual analog scale, in the pre- and post-treatment evaluation, both groups decreased their pain intensity with statistically significant differences (with a standard deviation of 1.15 for TENS and a standard deviation of 1.35). When comparing both results, a difference was observed. statistically significant difference in favor of TENS Currents over therapeutic laser p<0.0001. Conclusions: In both treatments, both the therapeutic laser and the TENS currents, improvements were observed in the pain perceived by the patients. Having a greater reduction in pain with TENS currents. Therefore, in this study we conclude that treatment with TENS currents is more effective than therapeutic laser in pain management in post-knee arthroscopy patients. No improvement in edema was observed in any of the treatments.

Pharmacological Therapy approaches for the treatment of Knee Osteoarthritis

To date, no effective treatment has been able to modify the pathological progression of osteoarthritis (OA).Current therapy can be broadly categorized into pharmacological and non-pharmacological approaches before considering surgical interventions. Non-pharmacological methods address lifestyle modifications, weight reduction and physical therapy, all aiming at alleviating mechanical stress on the affected joint.In this article, we focused on pharmacological treatment options, that primarily target pain reduction by reducing joint inflammation or restoring the altered synovial environment to a normal state.In this literature review , the main focus is on approved conservative therapies and examined emerging conservative strategies. Evaluating their advantages and limitations.

Quality of Life of Patients submitted to Total Knee Arthroplasty / Qualidade de vida de pacientes submetidos à artroplastia total do joelho

Objective: the aim of this study was to evaluate the quality of life between patients who have already undergone the TKA surgery and those who have not. Methodology: 118 patients [60 undergoing TKA (G1) and the remaining 58 awaiting the procedure (G2)] answered questions about QoL using the WOMAC and SF-36 protocols. The comparison was performed using the chi-square test and Student's t-test, with a significance level of 0.05. Results: with regard to clinical aspects, there was a higher level of pain in Group G2, as well as greater frequency in the use of medications, especially for pain relief. In the QoL evaluation, significant difference was observed in all the domains of the generic questionnaire SF-36 and in WOMAC, estando a capacidade functional do G2 reduzida e abaixo do nível observado nos pacientes do G1. Conclusion: patients with advanced knee arthrosis who underwent TKA, compared to those who did not undergo the procedure, had better quality of life in all domains assessed by both the general SF-36 questionnaire and the WOMAC questionnaire.

Objetivo: o objetivo deste estudo foi avaliar a qualidade de vida entre pacientes que já se submeteram à cirurgia de ATJ e aqueles que ainda não passaram pelo procedimento. Metodologia: 118 pacientes [60 submetidos à ATJ (G1) e os 58 restantes aguardando o procedimento (G2)] responderam perguntas sobre QV usando os protocolos WOMAC e SF-36. A comparação foi realizada usando o teste qui-quadrado e o teste t de Student, com um nível de significância de 0,05. Resultados: em relação aos aspectos clínicos, houve um maior nível de dor no Grupo G2, bem como maior frequência no uso de medicamentos, especialmente para alívio da dor. Na avaliação da QV, foi observada diferença significativa em todos os domínios do questionário genérico SF-36 e no WOMAC, estando a capacidade funcional do G2 reduzida e abaixo do nível observado nos pacientes do G1. Conclusão: pacientes com artrose avançada de joelho que se submeteram à ATJ, em comparação com aqueles que não passaram pelo procedimento, apresentaram melhor qualidade de vida em todos os domínios avaliados tanto pelo questionário geral SF-36 quanto pelo questionário WOMAC.

Strategies for X-ray utilization in the evaluation of knee injuries

Knee injuries are prevalent among young athletes, and an accurate diagnosis is essential for effective treatment. Knee pain is a widespread issue among adolescent athletes. About 50% of athletes experience knee pain every year, and an estimated 2.5 million sports-related knee injuries occur annually in young athletes. The study discusses common knee injuries, including fractures, cartilage damage, patellar injuries, and meniscus tears. It highlights the Ottawa knee rules (OKRs) as a valuable clinical decision tool for guiding the necessity of knee X-rays, emphasizing their high sensitivity and potential cost savings. Prevention strategies for youth athletes, such as injury prevention programs and neuromuscular training, are also discussed. Additionally, the review underscores the importance of radiation exposure and patient safety when utilizing diagnostic imaging, emphasizing adherence to radiation safety principles and the ALARA principle. In conclusion, this review emphasizes multifaceted role of X-rays in diagnosing knee injuries and importance of evidence-based decision rules, prevention strategies, and radiation safety in adolescent knee healthcare.

Pruebas de salto vertical monopodal / Single-leg vertical jump tests

RESUMEN Las pruebas de salto (PS) son utilizadas con frecuencia como método de evaluación funcional en deportistas con lesiones de miembros inferiores. Actualmente, además de las PS convencionales, se propone incorporar las PS vertical. Estas pueden evaluarse mediante pruebas de laboratorio (plataforma de salto) o pruebas de campo (aplicación en smartphone o evaluación clínica). El objetivo de este paso a paso es describir dos pruebas de campo sencillas, confiables y de bajo costo que se pueden utilizar en la práctica clínica, en conjunto con otras pruebas, para ayudar a los/as kinesiólogos/as a diseñar un programa de rehabilitación o progresión del tratamiento.

ABSTRACT Hop tests are frequently used as a method of functional evaluation in athletes with lower limb injuries. In addition to traditional hop tests, there is a current proposal to include vertical jump tests. They can be evaluated through laboratory tests (force platform) or field tests (smartphone application or clinical evaluation). The objective of this study is to describe two simple, reliable, and low-cost field tests that can be used in clinical practice, along with other tests, to help physiotherapists design a rehabilitation program or treatment progression.

Effect of Danggui Niantongtang on Intestinal Flora of Knee Osteoarthritis Mice Based on 16S rDNA Sequencing / 中国实验方剂学杂志

ObjectiveThis study aims to explore the potential mechanism of Danggui Niantongtang in treating knee osteoarthritis （KOA） by regulating the intestinal flora through 16S rDNA analysis. MethodThirty-six C57BL/6J mice were subjected to anterior cruciate ligament transection （ACLT） to establish a KOA model and were randomly divided into the sham surgery group， model group， low-dose Danggui Niantongtang group （0.819 g·kg-1）， medium-dose Danggui Niantongtang group （1.638 g·kg-1）， high-dose Danggui Niantongtang group （3.276 g·kg-1）， and Meloxicam group （0.975 mg·kg-1）， with 6 mice in each group. Except for the treatment groups， the sham surgery group and model group were given normal saline by gavage. After 4 weeks of continuous intervention， feces and intact knee joints of the mice were collected. Hematoxylin-eosin （HE） staining and Safranin O-Fast Green staining were performed to observe the pathological changes in knee joint tissue morphology. The 16S rDNA sequencing was used to analyze changes in the abundance and diversity of intestinal microorganisms before and after treatment， along with corresponding functional predictions. ResultHigh-dose Danggui Niantongtang and Meloxicam significantly relieved pain symptoms in KOA mice， improved the disorder of joint structure， maintained the integrity of knee articular cartilage， increased the expression of type Ⅱ collagen alpha 1 （Col2a1） in articular cartilage， and decreased the expression of matrix metalloproteinase-13 （MMP-13）. The results of 16S rDNA sequencing showed that high-dose Danggui Niantongtang could adjust the abundance and structure of intestinal microbial species. Compared with the sham surgery group， the abundance of Proteobacteria， Actinobacteria， Ruminococcus， and Bacteroides was significantly increased in the model group （P<0.05）， while in the Danggui Niantongtang group， the abundance of these four flora was significantly reduced compared with the model group. Compared with the sham surgery group， the abundance of Verrucomicrobia， Oscillospira， and Akkermansia was significantly decreased in the model group （P<0.05）， while in the Danggui Niantongtang groups， the abundance of these three flora was significantly increased compared with the model group （P<0.05）. Functional pathway prediction of differential genera revealed that species differences among groups mainly involved metabolic pathways with high abundance associated with biosynthesis and precursors， as well as energy production， including amino acid biosynthesis， nucleotide and nucleoside biosynthesis， cofactors， prosthetic groups， electron carriers， and vitamin biosynthesis. ConclusionDanggui Niantongtang can effectively protect articular cartilage and delay the progression of KOA， possibly by regulating the structure of the intestinal flora， promoting probiotics， and inhibiting the growth of harmful pathogenic bacteria.