Osteoarthritis is a common but often difficult problem to manage. Nonsurgical management, consisting of lifestyle modification, physical therapy and pharmacologic therapy (e.g., analgesics, anti-inflammatory medications), is often ineffective or leaves residual symptoms. Viscosupplementation is a newly available option for patients with symptomatic knee osteoarthritis that involves a series of intra-articular injections of hyaluronic acid. The exact mechanism of action is unclear, although increasing the viscoelasticity of the synovial fluid appears to play a role. The exact indications for viscosupplementation are still evolving, but it currently can be considered for use in patients who have significant residual symptoms despite traditional nonpharmacologic and pharmacologic treatments. In addition, patients who are intolerant of traditional treatments (e.g., gastrointestinal problems related to anti-inflammatory medications) can be considered for these injections.
Anti-Inflammatory Agents, Non-Steroidal ; Humans ; Hyaluronic Acid* ; Injections, Intra-Articular ; Life Style ; Osteoarthritis ; Osteoarthritis, Knee ; Synovial Fluid ; Viscosupplementation ; Viscosupplements

PURPOSE: Controversies remain surrounding the choice of hyaluronic acid products and patient selection. A study was conducted to report the long-term survivorship of intra-articular injection effect of high molecular weight hyaluronic preparation hylan GF-20 (Synvisc-One) for patients with symptomatic knee osteoarthritis. MATERIALS AND METHODS: A retrospective observational analysis of a single therapeutic series was carried out. The analysis was conducted to determine therapeutic effect survivorship taking arthroplasty and any other surgical interventions as endpoint results. RESULTS: Seventy-seven consecutive patients (82 knees) were followed up for five years. At one-year follow-up, 71 knees (87%) responded to treatment and only 8 knees (10%) were offered arthroplasty due to persistence of symptoms. At five-year follow-up, 41 (50%) were still considered responders. During the study period, repeat injection was given in 9 knees (11%). Arthroplasty (either total or unicompartmental) was required in 26 (31%). Kaplan-Meier survivorship analysis of therapeutic effect demonstrated 67% survival at 5 years with arthroplasty as endpoint and 58% survival at 5 years with all secondary interventions as endpoint. CONCLUSIONS: This study demonstrates a significantly longer duration of clinical benefit of hylan GF-20 injection. Present results may suggest a notion of an ideal delay therapeutic strategy for patients not ready to receive an arthroplasty. Further studies will be required to help characterise these subsets of patients.
Arthroplasty ; Follow-Up Studies ; Humans ; Hyaluronic Acid ; Injections, Intra-Articular ; Knee ; Molecular Weight ; Osteoarthritis ; Osteoarthritis, Knee ; Patient Selection ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Viscosupplementation ; Viscosupplements

The purpose of this study was to investigate the arthro-sonographic appearance of the chronic anterior talofibular ligament (ATFL) injury. Twenty-nine patient, who were identified to have partial or complete ATFL tears by conventional ultrasonography were included. Intraarticular injection of 5 mL of fluid (2.5 cc lidocaine+2.5 saline) was performed under ultrasound-guidance, which was followed by arthrosonography. Among 23 patients with partial tear which was detected by the conventional ultrasonography, 11 patients were identified to have complete tear by the arthrosonography. Among 6 patients with complete tear was detected by conventional ultrasonography, all of them identified to have complete tear by the arthrosonography. Arthrosonography is helpful in evaluation the configuration of ATFL complete tear and detecting complete tear by making them appear larger and apparent after instillation of fluid.
Humans ; Injections, Intra-Articular ; Ligaments

No abstract available.
Hyaluronic Acid* ; Injections, Intra-Articular*

No abstract available.
Arthroscopy* ; Bupivacaine* ; Injections, Intra-Articular* ; Knee*

No abstract available.
Hyaluronic Acid* ; Injections, Intra-Articular* ; Knee*

No abstract available.
Hyaluronic Acid* ; Injections, Intra-Articular* ; Knee*

PURPOSE: To assess the feasibility of ultrasound-guided shoulder joint injections by the anterior and posterior approaches for performing a MR arthrography. MATERIALS AND METHODS: Between April 2007 and June 2008, 28 patients underwent ultrasound-guided intra-articular contrast injections for a MR arthrography. This study was approached using the antegrade method. As well, all injections were performed by one radiologist. The patient selection criteria for the anterior and posterior approaches were randomly for the anterior approach and alternatively for the posterior approach. Each approach included 13 cases and each were injected by the anterior or posterior approaches exclusively . The patients were classified into three groups as follows: 1) the successful intra-articular injection group, 2) the small leakage group, and 3) the injection failure group. RESULTS: Of the 15 patients that underwent the anterior approach, two were unsuccessful for the MR arthrography. Whereas, two other cases experienced small leakage. The two failed MR arthography cases using the anterior approach were later injected using the posterior approach. The 15 patients subjected to the posterior approach to perform a MR arthrogram were successful in all cases, without any leakage. CONCLUSION: The ultrasound-guided intra-articular injections were feasible with a high success rate by both the anterior and posterior approaches. However, better results were achieved from the posterior approach than the anterior approach in this study.
Arthrography ; Humans ; Injections, Intra-Articular ; Patient Selection ; Shoulder ; Shoulder Joint

PURPOSE: To evaluate the treatment results of intraarticular injection according to the frequency of hyaluronic acid with mesenchymal stem cells on the osteochondral defect of rabbits' medial femoral condyles. MATERIALS AND METHODS: A 5 mm diameter and 4 mm depth osteochondral defect was made on the medial femoral condyles of 18 rabbits, divided into six groups. One week after osteochondral defect, group B was injected intraarticularly with hyaluronic acid (HA), group C with mesenchymal stem cells (MSCs), and group D, E and F with both HA and MSCs. Group E and F received second HA injection a week after. Further, group F received third HA injection in the third week. RESULTS: In a macroscopic evaluation, groups B (6; range, 5-8), C (6; range, 6-7), D (7; range, 6-7), E (6.5; range, 6-8) and F (7.5; range, 6-8) showed statistically significant improvements in osteochondral defect healing, compared with that of group A (4; range, 3-5) (p=0.002). In histological evaluation, groups B (11.5; range, 11-13), C (13; range, 12-18), D (16; range, 13-18), E (17.5; range, 13-20), and F (19.5; range, 12-22) showed statistically significant differences in osteochondral defect healing, compared with group A (8; range, 6-9) (p=0.006). CONCLUSIONS: The intraarticular injections of MSCs or HA can play an effective role during the healing osteochondral defects in rabbits.
Hyaluronic Acid ; Injections, Intra-Articular ; Knee ; Mesenchymal Stromal Cells ; Rabbits

Many authors have studies to relieve the pain after arthniscopic knee surgery. We undertook a randomized, double-blind trial to compare the efficacy of intraarticular morphme and bupivacaine between arthroscopic meniscus surgery group and cruciate ligament reconstruction group. As an results, intraarticular injection of morphine-bupivacaine combination is effective to control pain after minor athroscopic surgery such as menisectomy and meniscal repair ancf intraarticu]ar injection of mor- phine-bupivacaine combination is not effective to relieve pain after major arthroscopic surgery including cru- ciate ligament reconstruction. So, more potent analgesics should be adminishated.
Analgesia ; Analgesics ; Arthroscopy ; Bupivacaine* ; Injections, Intra-Articular ; Knee* ; Ligaments ; Morphine*