Current Trends in Intra-articular Knee Injections Among Family Physicians.

Introduction: Family physicians use a variety of medications and techniques to perform intra-articular knee injections in the treatment of knee osteoarthritis. Currently, there is no consensus in the literature among the various specialties that perform joint injections for osteoarthritis of the knee regarding frequency of injections and injectate. The purpose of this study is to examine (1) the types of intra-articular knee injections used by family physicians for arthritis, (2) the most commonly used injectate, (3) the procedural approach, and (4) the maximum number of times the majority of family physicians would inject a single knee. Our study provides a descriptive epidemiology of current knee injection practices in the United States among family physicians. Methods: Surveys were emailed to family physicians. We evaluated and analyzed responses. Results: We received 360 responses, of which 317 family physicians indicated using intra-articular knee injections for pain. The majority (99%) used intra-articular injection steroid therapy in the treatment of knee osteoarthritis. About half (57.4%) of the family physicians would inject the same knee between one to five times. Conclusion: This study provides an overview of current practices in intra-articular injections among family physicians in the United States and provides important information regarding injection practices. Given the lack of consensus and that current practice contradicts evidence in the literature, consideration should be given among all specialties who perform joint injections to create evidence-based clinical practice guidelines to optimize patient care.

Use of Ultrasonically Interdigitated Anchors in Haglund's Deformity Correction Surgery.

Haglund's deformity is a common cause of foot pain, with high success rates of surgical intervention. Because early weightbearing rehabilitation correlates with better surgical results, the integrity of anchors employed in these surgeries needs to be evaluated for proper fixation strength, leading to improved postoperative outcomes. The ultrasonically interdigitated anchor is a biodegradable suture anchor that is melted into bony trabeculae using ultrasound, leaving a small biological footprint and less interference on computed tomography and magnetic resonance imaging scans, without loss of fixation strength. We performed a review of 44 patients aged 26 to 84 years treated with either ultrasonically interdigitated anchors or fully threaded titanium anchors during Haglund's deformity excision. Overall, 7 of 14 patients who received an ultrasonically interdigitated anchor reported raw PROMIS (Patient-Reported Outcomes Measurement Information System) scores averaging 14.3, with an average return to ambulation time of 4.2 weeks. Fifteen of 30 patients receiving a fully threaded titanium anchor reported raw PROMIS scores averaging 9.7, with an average return to ambulation time of 3.5 weeks. We found little difference between the outcomes between the 2 anchors and no massive failures or infections in either group, implying that ultrasonically interdigitated anchors are a viable option for Achilles tendon reattachment during Haglund's deformity repair surgery.Levels of Evidence: Level III: Case control study.

Arthroscopic Treatment of Synovial Chondromatosis in the Ankle Joint.

Synovial chondromatosis of the ankle is rare and sparsely documented. Traditional surgical intervention is open loose body excision and synovectomy. Upon literature review, only two other cases were found to be managed arthroscopically. We report a case of synovial chondromatosis in a 54-year-old man leading to pain and limited range of motion of his ankle. This unique case of extensive nodule formation was treated via a three-port arthroscopic approach. Removal of loose bodies and synovectomy were successfully performed arthroscopically. A total of 76 loose bodies were removed and synovectomy performed using a 3.5 mm diameter full radius shaver. This case demonstrates that a three-port arthroscopic approach can provide adequate treatment while maintaining the superior risk profile inherent to arthroscopic intervention.