Acceptability of a nurse-led non-pharmacological complex intervention for knee pain: Nurse and patient views and experiences.

OBJECTIVES: The overall purpose of this research programme is to develop and test the feasibility of a complex intervention for knee pain delivered by a nurse, and comprising both non-pharmacological and pharmacological interventions. In this first phase, we examined the acceptability of the non-pharmacological component of the intervention; issues faced in delivery, and resolved possible challenges to delivery. METHODS: Eighteen adults with chronic knee pain were recruited from the community. The intervention comprised holistic assessment, education, exercise, weight-loss advice (where appropriate) and advice on adjunctive treatments such as hot/cold treatments, footwear modification and walking aids. After nurse training, the intervention was delivered in four sessions spread over five weeks. Participants had one to one semi-structured interview at the end of the intervention. The nurse was interviewed after the last visit of the last participant. These were audio recorded and transcribed verbatim. Themes were identified by one author through framework analysis of the transcripts, and cross-checked by another. RESULTS: Most participants found the advice from the nurse easy to follow and were satisfied with the package, though some felt that too much information was provided too soon. The intervention changed their perception of managing knee pain, learning that it can be improved with self-management. However, participants thought that the most challenging part of the intervention was fitting the exercise regime into their daily routine. The nurse found discussion of goal setting to be challenging. CONCLUSION: The nurse-led package of care is acceptable within a research setting. The results are promising and will be applied in a feasibility randomised-controlled trial.

Analgesic and anti-inflammatory articular effects of essential oil and camphor isolated from Ocimum kilimandscharicum Gürke leaves.

ETHNOPHARMACOLOGICAL RELEVANCE: Leaves from Ocimum kilimandscharicum Gürke (Lamiaceae) are popularly used against articular pain. AIM OF STUDY: The aim of this study was to test the anti-inflammatory and anti-hyperalgesic (analgesic) properties of the essential oil and camphor isolated from O. Kilimandscharicum leaves (EOOK) in 4 models including zymosan induced-articular inflammation model in mice. MATERIAL AND METHODS: For in vivo models, EOOK was tested in carrageenan-induced paw edema model with oral doses of 30, 100, and 300 mg/kg (oral administration = p.o.) and in zymosan-induced articular inflammation (including knee edema, leukocyte infiltration, mechanical hyperalgesia and nitric oxide), EOOK (100 mg/kg, p. o.) and camphor (30 mg/kg, p. o.) were tested. EOOK (100 mg/kg, p. o.) was tested in the rolling and also in the adhesion of leukocytes to the mesenteric microcirculation in situ model of carrageenan induced inflammation and EOOK (1, 3, 10, 30, and 60 µg/mL) was tested in vitro against neutrophils chemotaxis induced by N-formyl methionyl leucyl phenylalanine (fMLP). RESULTS: The treatment with EOOK significantly inhibited the carrageenan-induced edema, mechanical and cold hyperalgesia. Both, EOOK and camphor inhibited all articular parameters induced by zymosan. In situ intravitral microscopy analysis, EOOK significantly inhibited carrageenan-induced leukocyte rolling and adhesion. In vitro neutrophils chemotaxis, EOOK inhibited the leukocyte chemotaxis induced by fMLP. CONCLUSIONS: The present study showed that EOOK inhibited pain and inflammatory parameters contributing, at least in part, to explain the popular use of this plant as analgesic natural agent. This study also demonstrates that camphor and some known anti-inflammatory compounds present in EOOK could contribute for analgesic and anti-inflammatory articular properties.

Vague Posterior Knee Discomfort in a Soccer Player: A Clinical Vignette.

A 24-yr-old male soccer player presented with a 7-yr history of left posterior knee "looseness." Evaluation 7 yrs ago, at the time of initial injury, revealed atraumatic anterior and posterior cruciate ligament sprains. On representation, the patient described the pain as a constant, dull ache, 3/10, but his biggest complaint was this feeling of "instability" and looseness where his knee would "buckle" 3-4 times a week. Physical examination was positive for grade 1 posterior drawer and grade 1 posterior sag signs. Reverse KT-1000 testing showed a 3-mm side-to-side difference. Sonographic evaluation confirmed magnetic resonance imaging findings of posterior cruciate ligament laxity and buckling and a small cystic lesion abutting the posteromedial margin of the distal 1/3 of the posterior cruciate ligament. After a trial of physical therapy, the patient elected to undergo experimental injection of dextrose hyperosmolar solution. This resulted in resolution of the cyst and reverse KT-1000 measurements improved to a side-to-side difference of 1 mm. The patient's subjective feeling of looseness and instability resolved by 7 wks.

[Case-control study on Chinese medicine fumigation and massage therapy for the treatment of knee stability and func tional recovery after anterior cruciate ligament reconstruction operation].

OBJECTIVE: To study clinical outcomes of Chinese medidine fumigation and massage therapy for the treatment of knee stability and functional recovery after anterior cruciate ligament reconstruction operation,and to explore the effect on tendon-bone healing. METHODS: Total 50 patients were divided into two groups: the control group (normal rehabilitation therapy group),the treatment group (Chinese medicine fumigation and manipulation group). There were 25 patients in the control group, including 16 males and 9 females, who were treated with isometric muscle training, with the gradually enlarging amplitude of flexion and progressive loading of bearing training for knee recovery. There were 25 patients in the treatment group, including 15 males and 10 females,who were treated with the conventional rehabilitation therapy combined with Chinese medicine fumigation and massage therapy. The Chinese herbs named as Haitongpi decoction was steamed by a special equipment to fumigate the knee after operation; Based on the biomechanical parameters of the ligament reconstruction, the massage therapy was designed to control the degree of the knee flexion and release the adhesion for early recovery of knee functions. The Lysholm knee function evaluation system was used, and MRI examination was performed to measure the change in width of ligament tunnel in femur and tibia to evaluate the safety and stability of the treatment. RESULTS: Lysholm system showed that two groups both had improving results from the 1st month after operation to the 3rd month (treatment group, F=36.54, P<0.05; the control group, F=28.12, P<0.05), and the results of the treatment group was better than that of the control group at the observation point (the 1st month, t=0.105, P<0.05; the 3rd month, t=5.361, P<0.01). There was no difference between the two groups when evaluating the bone and tendon healing 3 and 12 months after operation (P>0.05), indicating that Chinese rehabilitation therapy was a safety treatment without the influence on the loosing of tendon. CONCLUSION: Chinese medicine fumigation and massage therapy can early improve the knee function after the anterior cruciate ligament reconstruction operation without the disturbance of the knee stability.

Comparación analgésica postquirúrgica de la infiltración corticoanestésica y la anestésica pura tras meniscectomía artroscópica de rodilla / Postoperative pain comparison between steroids anesthetic infiltration, and pure anesthetic infiltration after arthoscopic knee menisectomy

Objetivo: Evaluar la efectividad de las infiltraciones postquirúrgicas de anestésico local solo y combinado con corticoide, para el tratamiento del dolor e inflamación en el postoperatorio temprano en pacientes intervenidos de menisco artroscópicamente. Material y método: Estudio clínico prospectivo randomizado de 60 pacientes a los que se les practicó menisectomía artroscópica. Finalizada la intervención, los pacientes fueron asignados aleatoriamente a uno de los dos grupos de estudio y se infiltró en un grupo 10 ml de clorhidrato de bupivacaína al 0,5% y en el otro el mismo anestésico, asociado a triamcinolona acetónido (solución de 40 mg). La percepción del dolor fue medida objetivamente por la Escala Visual Análoga (EVA), registrándose el dolor postquirúrgico a las 2, 4 y 24 horas y a los 15 días y al mes, después de la intervención. Resultados: No se encontraron diferencias significativas entre los diferentes grupos de estudio. Conclusión: La infiltración anestésica postquirúrgica en dosis única es un procedimiento muy útil para el manejo del dolor postoperatorio en pacientes que requieren la realización de una menisectomía artroscópica (AU)

Objective: To evaluate the effectiveness of postoperative local anesthetic infiltration alone and combined with corticosteroid for the treatment of pain and inflammation in the early postoperative period in patients undergoing arthroscopic meniscal pathology. Material and method: A prospective randomized clinical study, 60 patients who underwent arthroscopic meniscectomy. After surgery, patients were randomly assigned to one of two study groups and infiltrated a group 10 ml of bupivacaine hydrochloride 0.5% and on the other the same anesthetic, associated with triamcinolone acetonide (solution of 40 mg). Pain perception was objectively measured by the Visual Analog Scale (VAS), postoperative pain recorded at 2, 4 and 24 hours and 15 days and a month after the intervention. Results: No significant differences were found between the different groups. Conclusion: Postoperative anesthetic infiltration single dose is a very useful procedure for the management of postoperative pain in patients requiring arthroscopic meniscectomy performing (AU)

[Healing of osteochondral defects in canine knee with avocado/soybean unsaponifiables: a morphometric comparative analysis]. / Avokado/soya fasülyesinin sabunlasmayan ekstresi verilen köpeklerin dizlerinde osteokondral defekt iyilesmesi: Bir karsilastirmali morfometrik analiz.

OBJECTIVES: This study aims to determine the effects of avocado/soybean unsaponifiables (ASU) on healing in a canine osteochondral defect model. MATERIALS AND METHODS: Fourteen dogs were included in the study and randomly divided into two groups. Two osteochondral defects were produced in the lateral aspect of the trochlear groove of the knee joint. The treatment group (group 1; n=7) was given 300 mg ASU capsules every three days whereas the control group (group 2; n=7) was given a normal diet. Animals were then allowed to ambulate normally until euthanasia at 15 weeks. The knees were dissected and the trochlear grooves with defects were removed for pathological examination. The amount of regenerated tissue was determined quantitatively using image analysis and the tissue content was evaluated semi-quantitatively using Safranin-O and Masson trichrome histochemical stains. Transforming growth factor beta (TGF-beta) increase was evaluated semi-quantitatively with immunohistochemical staining methods. RESULTS: Morphometric analysis revealed a significantly more immature repair tissue in group 1 (p<0.002). Both collagen and chondral tissue content of the regenerated tissue were significantly increased in group 1 (p<0.002). Compared to that in group 2, cartilage tissue in group 1 showed a much more marked immunostaining reaction of TGF-beta. CONCLUSION: Avocado/soybean unsaponifiables treatment stimulates the healing of the osteochondral defects in canine knee possibly by increasing TGF-beta in the tissues.

[Lateral superior genicular flap combined with Tuihuang xiaozhong decoction for the treatment of soft tissue defects around the knee joint].

OBJECTIVE: To evaluate the early combination of Chinese and Western medicine for anti-inflammation and lateral superior genicular flap for the treatment of soft tissue defects around the knee joint. METHODS: From June 2004 to September 2008, 8 patients with soft tissue defects around the knee joint were treated with lateral superior genicular flap. Among the patients, 5 patients were male and 3 patients were female, ranging in age from 32 to 56 years, with an average of 35.2 years. The defected area ranged from 7.6 cm x 4.5 cm to 15.2 cm x 7.5 cm. The disease course ranged from 3 months to 3 years. Three patients had the defects at the posterior of the knee, 2 patients had the defects at the popliteal fossa, and 3 patients had the defects at the lateral side of the knee. At the early stage, all the patients were treated with Tuihuang Xiaozhong decoction and antibiotics for 3 to 5 days. RESULTS: All the flaps survived, and the knee function recovered. One patient had epidermis necrosis at the distal end of the flap of lateral side of the knee. CONCLUSION: The early combination of Chinese and Western medicine for anti-inflammation is a simple, easy to promote, and no special microsurgical instruments are needed.

BMP-7 protects against progression of cartilage degeneration after impact injury.

In vivo studies were used to characterize a model of cartilage injury leading to osteoarthritis progression in the medial femorotibial joint of sheep. In three subsequent studies, bilateral impact injuries were created and one joint received intraarticular injections of 340 microg of rhBMP-7 protein in a collagen particle carrier while the contralateral knee received the vehicle alone. Sheep were allocated to three groups that received intraarticular injections on day 0 (group A), 21 (group B), or 90 (group C) after experimental knee injury. In each group the, joints were evaluated for signs of osteoarthritis progression 90 days after the last treatment using India ink stained area, OARSI histological scoring, cartilage sGAG content, immunostaining for apoptosis (TUNEL), caspase-3, collagen degradation (Col 2 3/4C short collagen epitope), and the endogenous (pro-) form of BMP-7 protein. Knee joints that received rhBMP-7 immediately after injury had small focal lesions at the injury site that did not progress into the surrounding cartilage. Joints that received BMP-7 3 weeks after injury were improved and had limited progression compared to controls, but joints that received the protein 12 weeks after injury had no statistically significant improvement. These studies suggest that BMP-7 may be chondroprotective after traumatic injury in patients if it is administered within 3 to 4 weeks of the index injury. The mechanism of protection after sublethal injury appeared to be an increased survival of chondrocytes that are able to participate in the repair process.

High-resolution ultrasound and magnetic resonance imaging to document tissue repair after prolotherapy: a report of 3 cases.

High-resolution ultrasound imaging of musculoskeletal tissue is increasing in popularity because of patient tolerability, low cost, ability to visualize tissue in real-time motion, and superior resolution of highly organized tissue such as a tendon. Prolotherapy, defined as the injection of growth factors or growth factor production stimulants to grow normal cells or tissue, has been a controversial procedure for decades; it is currently gaining in popularity among physiatrists and other musculoskeletal physicians. This report describes imaging of tendons, ligaments, and medial meniscus disease (from trauma or degeneration). Although these tissues have been poorly responsive to nonsurgical treatment, it is proposed that tissue growth and repair after prolotherapy in these structures can be documented with ultrasound and confirmed with magnetic resonance imaging. Directions for future research application are discussed.

Evaluación ecográfica en la rotura del tendon del cuádriceps / Ultrasound image evaluation in the rupture of the cuádriceps muscle tendon

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