Anterior Knee Pain: A Paradigm of Aversion Towards a Pathology / Dolor anterior de rodilla: un ejemplo de aversión hacia una patología

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Radiofrequency stimulation for potential healing of meniscal injuries in the avascular zone.

We conducted this study to evaluate the effect of radiofrequency (RF) stimulation with suture repair on the healing of tears in the meniscal white-white zone. Fifty-four New Zealand white rabbits underwent surgically induced meniscal injuries within the white-white region. RF was applied using a 0.8-mm TOPAZ MicroDebrider RF wand (ArthroCare) at level 4 for 500 milliseconds. Rabbits were sacrificed at 28 and 84 days for gross and histologic analysis by 3 blinded observers and at 9, 28, and 84 days for biochemical examination. Biochemical analyses included evaluation of cell proliferation (3H-thymidine), as well as mitogenic (IGF-1, bFGF) and angiogenic (VEGF, αV) factors. Of specimens repaired with RF combined with suture, 19 (58%) showed a degree of gross morphologic and histologic healing. No significant healing was seen in specimens with either no repair or repair with suture alone. We observed a 40% increase in cellular proliferation when RF supplementation was used (P<.05). With regards to mitogenic and angiogenic markers (IGF-1, bFGF, VEGF, and αV), there was a significant increase in groups treated with RF at 9 and 28 days (P>0.05). RF supplementation of avascular zone meniscal repairs may lead to an increased healing response.

Low-level laser therapy in meniscal pathology: a double-blinded placebo-controlled trial.

We performed a randomized, double-blinded, placebo-controlled study (ISRCTN24203769) to assess the effectiveness of low-level laser therapy (LLLT) in patients with meniscal pathology, including only symptomatic patients with tiny focus of grade 3 attenuation (seen only on 0.7 thickness sequences) or intrasubstance tears with spot of grade 3 signal intensity approaching the articular surface. None of the patients in the study group underwent arthroscopy or new magnetic resonance imaging investigation. Paired-samples t test was used to detect significant changes in subjective knee pain over the experimental period within groups, and ANOVA was used to detect any significant differences between the two groups. Pain was significantly improved for the LLLT group than for the placebo group (F = 154, p < 0.0001). Pain scores were significantly better after LLLT. Four (12.5 %) patients did not respond to LLLT. At baseline, the average Lysholm score was 77 ± 4.6 for the LLLT group and 77.2 ± 2.6 for the placebo group (p > 0.05). Four weeks after LLLT or placebo therapy, the laser group reported an average Lysholm score of 82.5 ± 4.6, and the placebo group scored 79.0 ± 1.9. At 6 months, the laser group had an average Lysholm score of 82.2 ± 5.7, and after 1 year, they scored 81.6 ± 6.6 (F = 14.82923, p = 0.002). Treatment with LLLT was associated with a significant decrease of symptoms compared to the placebo group: it should be considered in patients with meniscal tears who do not wish to undergo surgery.

Electroestimulación y feedback neuromuscular en la fase inicial de rehabilitación de la artroplastia total de la rodilla / Feedback and neuromuscular electrical stimulation during an early phase of a rehabilitation programe after total knee arthroplasty

Objetivo: Estudiar el efecto de la electroestimulación con feedback del cuádriceps (EENM-feedback) en un programa estándar de rehabilitación de artroplastia total de rodilla. Material y métodos: ensayo clínico en 83 pacientes intervenidos de artroplastia de rodilla por gonartrosis primaria. El protocolo postoperatorio se aleatorizó en un grupo de rehabilitación estándar con EENM-feedback y otro grupo control de rehabilitación estándar. Se valoró el balance articular (BA), el test «timed up and go» (TUG) y el cuestionario funcional WOMAC, antes de la artroplastia, al alta del hospital, al mes y a los 3 meses. Resultados: El BA y el WOMAC evolucionaron igual en ambos grupos. Al tercer mes, el TUG mejoró siginificativamente en el grupo de EENM-feedback (p<0,001), mientras que en el grupo estándar fue similar al previo (p = 0,1). Conclusión: La aplicación de EENM-feedback en el postoperatorio de la artroplastia total de rodilla puede ayudar a mejorar la capacidad de deambulación a corto-medio plazo (AU)

Background: The aim of this study was to study the effect of feedback and neuromuscular electrical stimulation (feedback-NMS) on an standard rehabilitation protocol after total knee arthroplasty (TKA). Methods: Clinical trial in 83 patients undergoing TKA for primary knee osteoarthritis. After surgery, patients were randomized in feedback-NMS rehabilitation program or standard rehabilitation. Range of movement (ROM), timed up and go test (TUG) and the Western Ontario and MacMaster Universities (WOMAC osteoarthritis index) were tested previous surgery, at hospital discharge, one month and three moths after. Results: Changes in ROM and WOMAC values were similar in both groups. At three months TUG values were better than previous in feedback-NMS group (p<0,001) but not in control group (p = 0,1). Conclusion: Feedback and NMS as a immediate therapy after TKA can help to improve walking capacity in short-mid term (AU)

Effect of He-Ne laser radiation on healing of osteochondral defect in rabbit: a histological study.

This study examined the influence of low-level laser therapy (LLLT) on the healing of a large osteochondral defect in rabbits.An osteochondral defect with 5 mm diameter was surgically induced in the right femoral patellar groove of 48 adult male rabbits. They were divided into a control and an experimental group. The rabbits were treated at 2, 4, 8, and 16 weeks after surgery, with six rabbits in each study period being tested at each biweekly period. The experimental group received LLLT with a helium-neon (He-Ne) laser (632.8 nm, 10 mW) of 148.4 J/cm(2) three times a week, and the control group received placebo LLLT with equipment switched off. The defects were examined macroscopically and microscopically. The results of the histological examination 2 weeks after surgery showed that the osteochondral healing of the control group was significantly accelerated compared with that of the experimental group. However, the osteochondral healing of the experimental group 4 weeks and 16 weeks after surgery showed that healing accelerated significantly compared with that of the control group. The conclusion was that LLLT with an He-Ne laser could not significantly accelerate healing of a large osteochondral defect in rabbits of the experimental group compared with that of the control group throughout the duration of the present study.

Sutureless avascular meniscal repair with a photoactive naphthalimide compound: a preliminary animal study.

PURPOSE: The purpose of this study was to evaluate the ability of 2 new photoactive naphthalimide compounds to repair a lesion in the avascular zone of the meniscus. TYPE OF STUDY: In vivo animal study. METHODS: Ten Barbados sheep were used as the animal model. Under anesthesia, the left knee joint was opened and 2 identical lesions were produced in the avascular zone of the medial meniscus. The posterior horn lesion was left alone and used as the control and the lesion in the anterior horn was repaired using the photoactive laser technique. The photoactive laser technique involved placing small amounts of a naphthalimide compound into the lesion and then irradiating the site with a laser (457 nm and 1.8 W/cm2) for 6 minutes. Two different versions of the naphthalimide compound were produced and divided between the 10 animals. The joint was then flushed with normal saline and closed in layers with resorbable sutures. Four animals were euthanized at the end of 1 month and 6 animals were euthanized at the end of 3 months. After death, the medial meniscus was exposed, dissected free, and then placed in 10% buffered formalin for histologic preparation and staining. RESULTS: At 1 month, the control lesions grossly showed no repair and the photochemically repaired lesions appeared to be bonded. The photochemically repaired lesions showed some bridging by an eosinophilic amorphous-appearing substance. The previous cleft within the fibrocartilaginous structure had disappeared, and early formation of connective tissue fibers was identified. However, some reduction in cellularity was seen in these tissue sections. At 3 months, again the control lesions did not show any repair response, while the photochemically repaired lesions showed results similar to the animals at 1 month, but with a less consistent pattern of tissue bonding and remodeling. The reduced tissue cellularity was still noted. There was no discernible difference between the naphthalimide compounds. CONCLUSIONS: These preliminary results demonstrate the potential usefulness of this photochemical bonding for the treatment of avascular meniscal lesions. Additional research will be necessary to fully understand the mechanism of this repair and optimize its use before any human trials. CLINICAL RELEVANCE: This is a preliminary animal study investigating the short-term in vivo effects of a novel photochemical compound for the repair of meniscal lesions. This repair may someday be valuable in the repair of avascular meniscal lesions.