Comparison of functional performance outcomes between oral patented crystalline glucosamine sulfate and platelet-rich plasma among knee osteoarthritis patients: a propensity score matching analysis.

BACKGROUND: Among the medications used to treat knee osteoarthritis (OA), oral patented crystalline glucosamine sulfate (pCGS) and platelet-rich plasma (PRP) have become popular alternatives to painkillers or nonsteroidal anti-inflammatory drugs (NSAIDs). Although studies have shown that pCGS and PRP improve clinical outcomes, no study has compared outcomes between these optional treatments. We compared functional performance outcomes from baseline to the 1-year follow-up (FU) between oral pCGS and PRP in patients with knee OA. MATERIALS AND METHODS: Three hundred eighty-two patients receiving oral pCGS and 122 patients receiving PRP injections were enrolled for a review of functional performance outcomes, including a five-time sit-to-stand test (5xSST), time up-and-go test (TUGT), and 3-minute walk distance test (3MWDT). The patients were followed up for one year. The pCGS group received 1500 mg daily, whereas the PRP group received 2 cycles of intra-articular injections at week 0 and week 6. Using propensity score matching based on age, sex, height, weight, BMI, and Kellgren and Lawrence (KL) classification, all three functional performance outcomes were compared between the baseline (pretreatment), 6-week, 12-week, 24-week, and 1-year FUs. RESULTS: With a ratio of 2:1 (pCGS: PRP), 204 patients in the pCGS group were matched with 102 patients in the PRP group. Compared with the baseline levels, the PRP group showed significant improvements in 5xSST and TUGT outcomes from 6 weeks and significant improvements in 3MWDT outcomes from 12 weeks, whereas the pCGS group showed significant improvements in TUGT outcomes from 6 weeks and significant improvements in 5xSST and 3MWDT outcomes from 12 weeks. At the 24-week and 1-year FU, both groups showed significant improvements in all three functional performance tests without adverse events. CONCLUSIONS: Although the PRP group showed faster improvements in 5xSST outcomes at six weeks, from the 12-week to 1-year FU, both the pCGS and PRP groups showed significant improvements in 5xSST, TUGT, and 3MWDT outcomes. As the use of PRP is more complicated and invasive than the use of oral pCGS, the benefits and drawbacks of selecting PRP over pCGS in knee OA treatment should be examined.

Lumbar Sympathetic Chain Tract and Mobility of Oblique Lumbar Interbody Fusion Approach: A Cadaveric Study.

OBJECTIVE: We sought to assess the lumbar sympathetic chain (LSC) relation to the surgical corridor for the oblique lumbar approach and the ability to mobilize the LSC. METHODS: Forty-three cadavers were included. A left-sided anterior retroperitoneal approach was performed in supine position. The distances between the great vessels and psoas muscle (oblique corridor) and distance between great vessels and LSC at the L2/3, L3/4, and L4/5 disk levels were measured. Mobilization of LSC at each disk level was done either close to or away from the psoas muscle, and each mobilization distance was measured. RESULTS: The presence rates of LSC in oblique corridor were 19.5%, 43%, and 75.7% at L2/3, L3/4, and L4/5 levels, respectively. At the L2/3 disk level, the mean distance between the psoas muscle and LSC and its mobility were 0.61 mm ± 1.31 mm and 2.72 mm ± 1.24 mm, respectively. At the L3/4 disk level, the mean distance between the psoas muscle and LSC and its mobility were 1.72 mm ± 2.53 mm and 3.11 mm ± 1.02 mm, respectively. At the L4/5 disk level, the mean distance between the psoas muscle and LSC and its mobility were 2.94 mm ± 3.52 mm and 2.53 mm ± 1.03 mm, respectively. The mean width of corridor of L2/3, L3/4, and L4/5 were 10.73 mm ± 5.82 mm, 12.63 mm ± 5.02 mm, and 15.43 mm ± 6.31 mm, respectively. CONCLUSIONS: The LSC tract usually lies in the oblique corridor in L4/5 but keeps decreasing in prevalence when approaching L3/4 and L2/3 levels. It can be mobilized a few millimeters close to or away from the psoas muscle. Care should be taken to prevent an LSC injury, particularly when the LSC needs to be retracted along with the psoas muscle.

A cadaveric study of the location and morphology of the central patellar ridge for bone-patellar tendon-bone graft.

INTRODUCTION: The central ridge of the patella is the thickest area of patella and varies among patients. This cadaveric study identified the location and thickness of the bone at the central patella ridge for bone-patellar tendon-bone (BPTB) harvesting. MATERIALS AND METHODS: Fifty cadaveric knees were assessed. First, the morphology, length, width, and location of the central patellar ridge were recorded. Then, we transversely cut the patella 25 mm from the lower pole and measured the thickness of the anterior cortex, cancellous bone, and cartilage from both the mid-patella and the central ridge location. Finally, the depth of the remaining cancellous bone at the mid-patella was compared to the bone at the central ridge. RESULTS: The location of the central-patellar ridge deviated medially from the mid-patella in 46 samples with an average distance of 4.36 ± 1 mm. Only 4 samples deviated laterally. The mean patella length was 41.19 ± 4.73 mm, and the width was 42.8 ± 5.25 mm. After a transverse cut, the remaining cancellous bone was significantly thicker at the central ridge compared to the bone at the mid-patella. CONCLUSIONS: Most of the central patellar ridge deviated medially, approximately 4 mm from the mid-patella. Harvesting the graft from the central ridge would have more remaining bone compared to the mid-patella.