Intra-articular Injection of Bone Marrow Concentrate for Treatment of Patellofemoral Osteoarthritis: Preliminary Results Utilizing an Ultrasound-Guided Marrow Harvesting Technique.

OBJECTIVE: To assess the effectiveness of intra-articular injection of bone marrow concentrate (BMC) under ultrasound (US) guidance in the treatment of patellofemoral osteoarthritis (OA), with clinical and volumetric magnetic resonance (MR) imaging follow-up. METHODS: This retrospective study included 96 consecutive patients referred for US-guided intra-articular injection of BMC for symptomatic patellofemoral OA for which conservative treatment had failed. A control group of 21 patients with symptomatic patellofemoral OA was included for comparison. Data on International Knee Documentation Committee (IKDC), Visual Analog Scale (VAS), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores as well as volumetric MR imaging (using T2 mapping sequence) were collected before and 12 months after injection, and the results were compared. RESULTS: No technical adverse events were noted during bone marrow aspiration, BMC preparation, or intra-articular injection of BMC. No clinical adverse events were reported during long-term follow-up. All mean scores improved between baseline and 12 months after intra-articular injection of BMC (VAS 5.5 to 3.6, P < .0001; WOMAC 36.8 to 22.2, P < .0001; and IKDC 41.8 to 58.2, P < .0001). MR imaging at 1 year of follow-up after BMC treatment showed no statistically significant difference in hyaline cartilage volume compared with that at the baseline (P = .690), suggesting stabilization of the cartilage degradation process. In contrast, the group of untreated patients showed a significant decrease in the cartilage volume (P = .001), corresponding to a cartilage loss of 6.9%. CONCLUSIONS: The results suggest that intra-articular injection of BMC under US guidance could be a promising option for the treatment of symptomatic patellofemoral OA and could promote the preservation of healthy residual cartilage volume.

High risk of adrenal insufficiency after a single articular steroid injection in athletes.

PURPOSE: To determine whether a single intra- or periarticular injection of corticosteroid for posttraumatic or microtraumatic articular injuries in young healthy subjects can induce a biological suppression of hypothalamo-pituitary-adrenal axis activity and reactivity. METHODS: Ten healthy young male athletes (aged 28.8 +/- 2.5 yr) received a single intra- or periarticular injection of either cortivazol (available in Europe but not in the United States) or betamethasone. Morning cortisol levels were measured on four occasions: the day of steroid injection (D0) and 2 d (D2), 7 d (D7), and 14 d (D14) later. During the second visit (D2), a short ACTH test (1 microg) was performed. RESULTS: Two days after corticosteroid administration, adrenal insufficiency (cortisol levels below 100 nM and/or blunted peak cortisol after stimulation with 1 microg of ACTH) occurred in 9 of the 10 subjects. Seven days after steroid injection, cortisol levels were still lower than basal values in all subjects (48.2 +/- 7.3% of D0 levels), and five subjects had abnormal cortisol levels (< 260 nM). Fourteen days after steroid injection, cortisol levels remained significantly lower than preinjection levels (P = 0.02), averaging only 77.3 +/- 8.3% of D0 levels, and three participants remained with abnormal cortisol levels. The extent of biological adrenal suppression was directly related to the steroid dose injected. CONCLUSION: As some athletes are exposed to a high risk of trauma, which can lead to an acute adrenal crisis, they should be informed about the risk of adrenal insufficiency after an intra- or periarticular corticosteroid injection, and they should report any symptoms to their physician.

Athlete's heart patterns in elite rugby players: effects of training specificities.

BACKGROUND: Athlete's heart patterns have been widely described. However, to our knowledge, few studies have focused on professional rugby players, who train differently according to their field position. AIM: To describe electrocardiographic and echocardiographic patterns observed in elite rugby players according to their field position. METHODS: One hundred and thirty-five professional rugby players at the end of the competitive season were included. RESULTS: According to a modified Pelliccia's classification, 68.1% of electrocardiograms were normal or had minor abnormalities, 27.2% were mildly abnormal and 3.7% were distinctly abnormal. Heart rate was higher in scrum first-row players (P<0.05). Absolute and indexed left ventricular end-diastolic internal diameters (LVIDd; absolute value 59.3±4.7 mm) exceeded 65 mm and 32 mm/m2 in 13% and 1.5% of players, respectively. Indexed LVIDd values were higher in back players (P<0.001). Left ventricular interventricular septum and posterior wall thicknesses (absolute values 9.4±1.7 mm and 9.2±1.6 mm, respectively) exceeded 13 mm in 3.7% of players. Concentric cardiac hypertrophy was noted in 3.7% of players. Except for one Wolff-Parkinson-White pattern, players with significant ECG or echocardiographic abnormalities showed no cardiovascular event or disease during follow-up. CONCLUSION: Thus, elite rugby players present similar heart patterns to elite athletes in other sports. Major electrocardiographic and echocardiographic abnormalities are quite rare. Eccentric cardiac remodelling is more frequent in back players.