The use of radon baths in the rehabilitation of patients with osteochondrosis.

OBJECTIVE: One of the most common methods of rehabilitation for this disease is balneotherapy. Radon therapy is one of the types of balneotherapy based on radon radiation (Rn) for therapeutic, prophylactic, and rehabilitation purposes. A significant number of authors report a positive effect of radon baths on the condition of patients with osteochondrosis. Some authors report the absence of a real therapeutic effect when using radon therapy. The work aimed at investigating the therapeutic efficacy of radon baths in patients suffering from osteochondrosis. PATIENTS AND METHODS: We examined 40 patients with osteochondrosis of various parts of the spine with radicular syndrome. The patients were randomly divided into two groups of 20 people with an equal number of men and women. The study group received a course of balneotherapy using radon water (general baths at a temperature of 34-36°C, duration 10-15 minutes, every other day, No. 10). The control group received balneotherapy using ordinary tap water in the same regimen to decrease placebo effects. RESULTS: Decreased pain and movement difficulties were observed only in the study group. These changes refer only to the spine but not to the joints of the extremities. CONCLUSIONS: Our studies have shown that using radon baths helps to reduce pain and increase the mobility of the spine in patients with osteochondrosis. These data substantiate the prospects for further research of this technique in the complex rehabilitation of osteochondrosis.

Hyperosmolar dextrose injection for Osgood-Schlatter disease: a double-blind, randomized controlled trial.

OBJECTIVE: Osgood-Schlatter disease (OSD) is one of the common causes of long-term knee pain, leading to functional limitations, long-term deformity of the tubercle interfering with kneeling, and impaired peer-important sport participation. Nonetheless, patient management continues to rely on the usual conservative methods. This study examined the use of hyperosmolar dextrose injection in patients with OSD. METHODS: We conducted a randomized, double-blind clinical trial involving 70 patients with OSD. One group received a hyperosmolar dextrose injection (12.5%), while the other received a saline injection. The injections were conducted under ultrasound guidance. The Victorian Institute of Sport Assessment (VISA) score was used to assess each patient's pain and sport level. RESULTS: The dextrose group outperformed the saline group in improvement in the VISA-Patella (VISA-P) score from baseline to 3 months (27.1 ± 6.5 vs. 1.4 ± 2.6; mean difference 25.4 (22.4 to 28.3); p < .0001), 6 months (31.7 ± 7.9 vs. 25.2 ± 7.8; mean difference 6.2 (3.2 to 9.4); p < .0001), and 12 months (34 ± 9.0 vs. 28.2 ± 7.5; mean difference 5.5 (1.9 to 9.1); p = .0026). The changes in both groups were clinically important, suggesting that both therapies were active treatments. The dextrose group improved too rapidly for spontaneous improvement to explain much of this change. CONCLUSION: After three injections, at the 6-month and 12-month follow-up visits, the VISA-P scores of the two groups were significantly improved; the dextrose group score was better than the saline group score, and there were significant differences between the two groups.

No superiority of dextrose injections over placebo injections for Osgood-Schlatter disease: a prospective randomized double-blind study.

PURPOSE: Osgood-Schlatter disease (OSD) is a traction apophysitis of the tibial tuberosity. Patellar tendinopathy and deep infrapatellar bursitis have recently been shown to contribute to pain in patients with OSD. We compared the effects of dextrose injection and saline injection. METHODS: We performed a clinical trial from April 2012 to January 2016 and included 49 knees from 37 boys and 1 girl (mean age, 12.3 ± 1.1 years) for whom conventional conservative therapy for > 1 month was ineffective. They were randomly assigned to receive double-blind injections of 1% lidocaine (1 mL) with 20% dextrose (1 mL; dextrose group) or 1% lidocaine (1 mL) with saline (1 mL; saline group). Injections were administered monthly for 3 months by a single investigator. The Victorian Institute of Sport Assessment (VISA) score was used to evaluate anterior knee pain. RESULTS: Overall, 43 knees were included; 6 knees were lost to follow-up. The mean pre-injection VISA scores in the dextrose and saline groups were 58.7 ± 18.3 and 63.4 ± 16.4, respectively. No significant differences were found between the two groups at any time point. The mean VISA score before injections significantly increased at the 1-month follow-up in both groups (P < .01). The injection had no adverse effects. CONCLUSIONS: We were not able to show the efficacy of dextrose injections compared to that of saline. LEVEL OF EVIDENCE: Randomized controlled trial. Level I.

Bisphosphonate use in the horse: what is good and what is not?

BACKGROUND: Bisphosphonates (BPs) are a family of molecules characterized by two key properties: their ability to bind strongly to bone mineral and their inhibitory effects on mature osteoclasts and thus bone resorption. Chemically two groups of BPs are recognized, non-nitrogen-containing and nitrogen-containing BPs. Non-nitrogen-containing BPs incorporate into the energy pathways of the osteoclast, resulting in disrupted cellular energy metabolism leading to cytotoxic effects and osteoclast apoptosis. Nitrogen-containing BPs primarily inhibit cholesterol biosynthesis resulting in the disruption of intracellular signaling, and other cellular processes in the osteoclast. BODY: BPs also exert a wide range of physiologic activities beyond merely the inhibition of bone resorption. Indeed, the breadth of reported activities include inhibition of cancer cell metastases, proliferation and apoptosis in vitro. In addition, the inhibition of angiogenesis, matrix metalloproteinase activity, altered cytokine and growth factor expression, and reductions in pain have been reported. In humans, clinical BP use has transformed the treatment of both post-menopausal osteoporosis and metastatic breast and prostate cancer. However, BP use has also resulted in significant adverse events including acute-phase reactions, esophagitis, gastritis, and an association with very infrequent atypical femoral fractures (AFF) and osteonecrosis of the jaw (ONJ). CONCLUSION: Despite the well-characterized health benefits of BP use in humans, little is known regarding the effects of BPs in the horse. In the equine setting, only non-nitrogen-containing BPs are FDA-approved primarily for the treatment of navicular syndrome. The focus here is to discuss the current understanding of the strengths and weaknesses of BPs in equine veterinary medicine and highlight the future utility of these potentially highly beneficial drugs.

Biologic Adjuvants for the Management of Osteochondral Lesions of the Talus.

Surgical techniques for the management of recalcitrant osteochondral lesions of the talus have improved; however, the poor healing potential of cartilage may impede long-term outcomes. Repair (microfracture) or replacement (osteochondral transplants) is the standard of care. Reparative strategies lead to production of fibrocartilage, which, compared with the native type II articular cartilage, has decreased mechanical and wear properties. The success of osteochondral transplants may be hindered by poor integration between grafts and host that results in peripheral cell death and cyst formation. These challenges have led to the investigation of biologic adjuvants to augment treatment. In vitro and in vivo models have demonstrated promise for cartilage regeneration by decreasing inflammatory damage and increasing the amount of type II articular cartilage. Further research is needed to investigate optimal formulations and time points of administration. In addition, clinical trials are needed to investigate the long-term effects of augmentation.

[Evaluation of bio-inverse communication and Cytoflavin effects on the dynamics of the clinical and psychophysiological condition of elderly patients with osteochondrosis].

We conducted a study of 150 patients on the basis of polyclinic № 91 in St. Petersburg. The effect of Cytoflavin and bio-inverse communication therapy on the dynamics of the condition of elderly patients with osteochondrosis was evaluated. A number of positive effects from such an addition to existing therapy, potentiating the nominal effect, were revealed.

Effects of osteochondral defect size on cartilage regeneration using a double-network hydrogel.

BACKGROUND: There has been increased interest in one-step cell-free procedures to avoid the problems related to cell manipulation and its inherent disadvantages. We have studied the chondrogenic induction ability of a PAMPS/PDMAAm double-network (DN) gel and found it to induce chondrogenesis in animal osteochondral defect models. The purpose of this study was to investigate whether the healing process and the degree of cartilage regeneration induced by the cell-free method using DN gel are influenced by the size of osteochondral defects. METHODS: A total of 63 mature female Japanese white rabbits were used in this study, randomly divided into 3 groups of 21 rabbits each. A 2.5-mm diameter osteochondral defect was created in the femoral trochlea of the patellofemoral joint of bilateral knees in Group I, a 4.3-mm osteochondral defect in Group II, and a 5.8-mm osteochondral defect in Group III. In the right knee of each animal, a DN gel plug was implanted so that a vacant space of 2-mm depth was left above the plug. In the left knee, we did not conduct any treatment to obtain control data. Animals were sacrificed at 2, 4, and 12 weeks after surgery, and gross and histological evaluations were made. RESULTS: The present study demonstrated that all sizes of the DN gel implanted defects as well as the 2.5mm untreated defects showed cartilage regeneration at 4 and 12 weeks. The 4.3-mm and 5.8-mm untreated defects did not show cartilage regeneration during the 12-week period. The quantitative score reported by O'Driscoll et al. was significantly higher in the 4.3-mm and 5.8-mm DN gel-implanted defects than the untreated defects at 4 and 12 weeks (p < 0.05). The 2.5-mm and 4.3-mm DN gel implanted defects maintained relatively high macroscopic and histological scores for the 12-week implantation period, while the histological score of the 5.8-mm DN gel implanted defect had decreased somewhat but statistically significantly at 12 weeks (p = 0.0057). CONCLUSIONS: The DN gel induced cartilage regeneration in defects between 2.5 and 5.8 mm, offering a promising device to establish a cell-free cartilage regeneration therapy and applicable to various sizes of osteochondral defects.

Management of Hepple Stage V Osteochondral Lesion of the Talus with a Platelet-Rich Plasma Scaffold.

There has been no consensus on the treatment or prognosis of Hepple stage V osteochondral lesions of the talus (OLTs), especially for lesions greater than 1.5 cm2 in size. The objective of this study was to investigate the clinical outcomes achieved upon application of a platelet-rich plasma (PRP) scaffold with a cancellous bone autograft for Hepple stage V OLTs. Fourteen patients (mean age, 39 years) were treated with a cancellous bone graft and a PRP scaffold between 2013 and 2015. The mean time to surgical treatment was 23.5 months. Ankle X-ray and magnetic resonance imaging were performed at the final follow-up. Functional outcomes were evaluated according to the Visual Analog Scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Short Form 36 (SF-36) score. The range of motion (ROM) of the ankle joint and complications also were recorded. Thirteen patients completed the full follow-up, with a mean follow-up duration of 18 months. MRI demonstrated the complete regeneration of subchondral bone and cartilage in all patients. The postoperative VAS, AOFAS ankle and hindfoot, and SF-36 scores were improved significantly (all P < 0.001) without obvious complications. We suggest that, for the Hepple stage V OLTs, management with cancellous bone graft and PRP scaffold may be a safe and effective treatment.

Unilateral striae distensae of the knee after a steroid injection for the treatment of Osgood-Schlatter disease.

We report a 12-year-old girl with new diagnosisof right knee Osgood-Schlatter who developedhorizontal purple striae below the right tibial tubercletwo months after a right knee intra-articular steroidinjection. She is the second reported case of unilaterallocalized striae after an intra-articular steroid injectionand the first with triamcinalone as the corticosteroid.

Are chondrocytes damaged when rheumatologic inflammation is suppressed?

AIM: The use of biological agents (BAs) for treating diseases such as rheumatoid arthritis (RA), spondyloarthropathy, and systemic lupus erythematosus to reduce inflammation has been fruitful. Especially as part of the increasing number of studies on the intra-articular application of BAs, the effects of BAs on cartilage have been widely investigated. In the present study, the effects of rituximab, abatacept, and adalimumab, all approved antirheumatic agents, on human primary chondrocytes were investigated comparatively and on the molecular level through viability, proliferation, and toxicity analyses. MATERIALS AND METHODS: Osteochondral tissues from the distal femur and proximal tibia were resected during total knee arthroplasty from patients (n = 3) with confirmed gonarthrosis in whom all medical or conservative treatments had failed. Standard human primary chondrocyte cell culturing was carried out. Immunophenotyping was performed on the cells that adhered to the flask, and their chondrotoxicity was observed using a flow cytometry device. Images of the cells showing chondrotoxicity were analyzed using invert and environmental scanning microscopes, and microimages were obtained. The MTT-enzyme linked immunosorbent assay was performed to observe the toxic effects of BAs on the proliferation of chondrocytes at 24 and 48 h. The results were analyzed using the number of cells and proliferation; statistical comparisons among the groups were carried out using one-way ANOVA. The alpha significance level was set at <0.01. RESULTS: These pharmaceutical agents were chondrotoxic, especially on viability and proliferation (p = 0.0000). CONCLUSION: BAs are generally used during active inflammation, and following the management of inflammation, their dosage should be determined taking into consideration their cellular-level toxic effects on chondrocytes.

Osteochondrosis prevalence and severity at 12 and 24 weeks of age in commercial pigs with and without organic-complexed trace mineral supplementation.

Maternal and progeny diets supplemented with 2 sources of trace mineral (TM) were evaluated for effects on the size and severity of osteochondrosis (OC) lesions in progeny produced by 64 Landrace × Large White sows. At breeding, sows were randomly assigned to maternal diets (gestation and lactation) consisting 1 of 2 TM treatments. One treatment consisted of inorganic TM (ITM) with ZnO, MnSO, and CuSO at concentrations to provide 150, 50, and 16.5 mg/kg diet of Zn, Mn, and Cu, respectively. The other treatment consisted of the same ITM concentrations plus an additional 50, 20, and 10 mg/kg diet of Zn, Mn, and Cu, respectively, supplied by a blend of AA-complexed TM (CTM) using Availa Sow. Within maternal dietary treatment groups, selected progeny ( = 280) were fed either ITM- or CTM-supplemented diets. The humerus and femur (1 each) from progeny euthanized at 12 ( = 80) or 24 wk ( = 200) were collected for microscopic (12 wk) or gross (24 wk) assessment of OC lesions. Microscopic OC lesions were present in all pigs at 12 wk. Dietary treatments had limited effects on OC prevalence or severity. A maternal × progeny diet interaction ( = 0.044) revealed femoral OC latens lesions that were approximately twice the size in progeny fed CTM that were produced by sows fed CTM compared with those found in pigs in the other 3 dietary treatment groups. At 24 wk, the sum of gross OC scores at predilection sites of the thoracic (elbow joint) and pelvic (stifle and hock joints) limbs remained similar among treatments, despite greater ( = 0.004) gross OC scores of the medial femoral condyle in progeny from sows fed CTM diets than in progeny from sows fed ITM diets, regardless of progeny diet. Progeny produced by sows fed CTM vs. ITM had increased ADG (0.71 vs. 0.68 ± 0.01 kg/d), regardless of the diet fed to progeny during the growth phases. Covariant analysis using ADG did not alter inferences about maternal or progeny diet effects on OC responses. Although 100% of progeny at 12 wk had histologically apparent OC lesions, only 3 of the 200 pigs examined at 24 wk had gross lesions of sufficient severity to potentially result in clinically apparent disease. Therefore, although some results imply that maternal and progeny CTM diets increased the size (12 wk) and severity (24 wk) of OC in 1 site (the femur), on the whole animal level, no evidence of lameness was noted.

Clinical effects of image-guided hyaluronate injections for the osteochondral lesions of ankle in sport active population.

BACKGROUND: Hyaluronic acid injections are effective as intra-articular treatment, but their use in the ankle has been hindered for the difficulty of execution in this area. Use of a guidance of musculo-skeleletal ultrasound could improve the success rate and the subsequent clinical outcome, for the ameliorating placement of the needle tip. The aim of this pilot study was to assess the short-term efficacy in terms of functional outcomes and pain of a image-guided intra-articular hyaluronic acid injections of post-traumatic osteochondral lesions (OLs) of the ankle. METHODS: Thirty sport active patients (21 males; mean age 27.6±7.46) with a clinical and radiological diagnosis of post-traumatic ankle OLs at initial stage, received a course of three injections within a month. Patients were evaluated for pain (with Numerical Rating Scale, NRS) e function (Ankle-Hindfoot Scale, AHS, and range of motion, ROM) before every injection and ninety days after the last injection (T0-T3). RESULTS: Pain showed a significant and clinically relevant improvement during the period of treatment (P<0.001), even if pain was still presented at last follow-up assessment. Also for AHS e ROM, it was recorded a similar positive trend during time (P<0.001 for both measurements). Before intervention, pain and function resulted correlated (P<0.001), while at follow-up assessment these correlations were reduced, remaining only between pain at rest and plantar-flexion range. CONCLUSIONS: These results showed positive effects of the intra-articular hyaluronic acid for the osteochondral lesions, with a full recovery of the functional activity and a significant reduction of pain.

Effects of a synovial flap and gelatin/ß-tricalcium phosphate sponges loaded with mesenchymal stem cells, bone morphogenetic protein-2, and platelet rich plasma on equine osteochondral defects.

This study aimed to evaluate the efficacy of a synovial flap and gelatin/ß-tricalcium phosphate (GT) sponge loaded with mesenchymal stem cells (MSCs), bone morphogenetic protein-2 (BMP-2), and platelet rich plasma (PRP) for repairing of osteochondral defects in horses. Osteochondral defects were created on the medial condyle of both femurs (n=5). In the test group, a GT sponge loaded with MSCs, BMP-2, and PRP (GT/MSCs/BMP-2/PRP) was inserted into the defect and then covered with a synovial flap. In the control group, the defect was treated only with the GT/MSCs/BMP-2/PRP. The test group showed significantly higher macroscopic scores than the control group. In addition, hyaline cartilaginous tissue was detected in the test group in areas larger than those in the control group. This study demonstrated that the combination of a synovial flap and GT sponge loaded with MSCs, BMP-2, and PRP promoted osteochondral regeneration in an equine model.

Surgical versus conservative management of osteochondrosis.

The paper reviews current knowledge on conservative versus surgical options for the treatment of osteochondrosis entities in the horse. Clinical and radiographic signs of each significant osteochondrosis entity in the horse are presented, followed by the value of conservative treatment versus arthroscopic surgery options as well as the results for each option with the various entities. The entities presented in detail include, osteochondritis dissecans (OCD) of the femoropatellar, tarsocrural, metacarpophalangeal and metatarsophalangeal, and glenohumural articulations. The various treatment options for subchondral cystic lesions of the medial femoral condyle are detailed with evidence for the value of various treatments and subchondral cystic lesions in other locations are briefly reviewed.

[Epidural pharmacotherapy in the treatment of the pain syndrome in osteochondrosis complicated by intervertebral discs protrusion of lumbar part of the vertebral column].

Experience of application of intralaminar epidural pharmacotherapy for the treatment of the pain syndrome in the patients, suffering osteochondrosis of lumbar portion of vertebral column, complicated by intervertebral discs protrusion, was summarized. The method introduction permits to escape the operative intervention performance for complicated osteochondrosis.

Hyperosmolar dextrose injection for recalcitrant Osgood-Schlatter disease.

OBJECTIVE: To examine the potential of dextrose injection versus lidocaine injection versus supervised usual care to reduce sport alteration and sport-related symptoms in adolescent athletes with Osgood-Schlatter disease. PATIENTS AND METHODS: Girls aged 9 to 15 and boys aged 10 to 17 were randomly assigned to either therapist-supervised usual care or double-blind injection of 1% lidocaine solution with or without 12.5% dextrose. Injections were administered monthly for 3 months. All subjects were then offered dextrose injections monthly as needed. Unaltered sport (Nirschl Pain Phase Scale < 4) and asymptomatic sport (Nirschl Pain Phase Scale = 0) were the threshold goals. RESULTS: Sixty-five knees in 54 athletes were treated. Compared with usual care at 3 months, unaltered sport was more common in both dextrose-treated (21 of 21 vs 13 of 22; P = .001) and lidocaine-treated (20 of 22 vs 13 of 22; P = .034) knees, and asymptomatic sport was more frequent in dextrose-treated knees than either lidocaine-treated (14 of 21 vs 5 of 22; P = .006) or usual-care-treated (14 of 21 vs 3 of 22; P < .001) knees. At 1 year, asymptomatic sport was more common in dextrose-treated knees than knees treated with only lidocaine (32 of 38 vs 6 of 13; P = .024) or only usual care (32 of 38 vs 2 of 14; P < .0001). CONCLUSIONS: Our results suggest superior symptom-reduction efficacy of injection therapy over usual care in the treatment of Osgood-Schlatter disease in adolescents. A significant component of the effect seems to be associated with the dextrose component of a dextrose/lidocaine solution. Dextrose injection over the apophysis and patellar tendon origin was safe and well tolerated and resulted in more rapid and frequent achievement of unaltered sport and asymptomatic sport than usual care.

Effect of the administration of an oral hyaluronan formulation on clinical and biochemical parameters in young horses with osteochondrosis.

The aim of this study was to evaluate the clinical and biochemical effects of the administration of oral hyaluronan (Hyal-Joint [HJ]) on young horses with osteochondrosis (OC). Our hypotheses were that HJ administration is safe, would decrease the degree of synovial effusion and the concentration of nitric oxide (NO) and prostaglandin E2 (PGE2) in synovial fluid, and would increase the concentration of hyaluronic acid (HA) in plasma and synovial fluid. Eleven young horses with tarsocrural OC were included in a randomised, double-blinded, placebo-controlled pilot clinical trial. Six horses received 250 mg/day HJ for 60 days (T60) and five horses received a placebo. The initial values of the degree of synovial effusion, NO, PGE2 and HA concentrations in synovial fluid and HA concentration in plasma were obtained. The horses were evaluated in terms of the same parameters at the end of treatment (T60) and 30 days thereafter (T90). The differences between the groups for each of the parameters evaluated at T0, T60 and T90 were not significant. Nevertheless, the horses treated with HJ tended to show a lower score for synovial effusion as well as higher HA, NO and PGE2 concentrations in synovial fluid, but these differences were non-significant. At a dose of 250 mg/day, HJ did not produce any adverse clinical effects and was well tolerated by the horses.