Effectiveness of aspiration in knee joint effusion management: a prospective randomized controlled study.

PURPOSE: Knee effusion is a common symptom in various knee disorders of both traumatic and non-traumatic aetiology. Although intra-articular aspiration is a widespread treatment approach, its beneficial effect has not been confirmed by a randomized controlled study. The purpose was to evaluate the effectiveness and safety of joint aspiration in acute knee effusion, in relation to traumatic or non-traumatic aetiology. METHODS: One hundred and sixty-seven consecutive patients with acute knee joint effusion were allocated in a randomized controlled fashion into two groups. In the first group, joint aspiration was performed, while in the second group, no aspiration was performed. Range of motion, pain relief, use of analgesics and oedema were evaluated post management. The Knee Society Score and the International Knee Documentation Committee Subjective Evaluation Form were also obtained. In addition, a subgroup analysis of our results in relation to the presence of trauma or not was performed. RESULTS: Aspiration exhibited a temporary improvement in all clinical parameters evaluated, especially in the post-traumatic effusion. However, this improvement lasted only for the first week, due to the early re-accumulation of the effusion. There was no difference between the different groups regarding the clinical outcome in neither trauma or non-trauma patients at the end of the follow-up period. Aspiration aided in earlier establishment of the diagnosis in the non-trauma cases of effusion. CONCLUSIONS: Aspiration resulted in only temporary improvement of the outcome in the treatment of traumatic or not traumatic knee effusion. Aspiration is suggested in effusions of unknown origin in order to establish the diagnosis and for immediate clinical relief. However, aspiration should be performed with consideration in the presence of trauma.

Management of proximal interphalangeal joint hyperextension injuries: a randomized controlled trial.

PURPOSE: To compare the effectiveness of buddy strapping and aluminum orthosis for treatment of proximal interphalangeal (PIP) joint hyperextension injuries. We also evaluated the effect of age on the outcome by comparing our results in adults and children. METHODS: One hundred twenty-one consecutive patients with a PIP joint hyperextension injury of the index, middle, ring, or little finger and without fracture were evaluated. Patients were randomly assigned into 2 groups. In the first group, treatment included buddy strapping of the injured finger to its neighbor noninjured finger for a week. In the second group, immobilization was secured with an aluminum extension blocking orthosis for a week in 15° flexion. Assessment of motion, edema, pain, and strength were performed weekly for the first month and then at 3, 6, and 12 months after injury. RESULTS: The patients treated with buddy strapping exhibited similar outcomes compared with those treated with aluminum orthoses. In patients with full recovery, buddy strapping allowed earlier recovery of motion and resolution of edema and pain compared with aluminum orthosis immobilization. Furthermore, PIP injuries appear to have better outcomes in children than in adults. CONCLUSIONS: Buddy strapping is easy and effective treatment for PIP joint hyperextension injuries. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic I.