Comparison of Single and Combined Treatment with Exercise Therapy and Collagen Supplementation on Early Knee Arthritis among Athletes-A Quasi-Randomized Trial.

Athletic injuries are commonly implicated in the development of early osteoarthritic (EOA) changes in the knee. These changes have a significant impact on athletic performance, and therefore the early detection of EOA is paramount. The objective of the study is to assess the impact of different interventions on individuals with EOA, particularly focusing on recreational athletes. The study aims to evaluate the effectiveness of three treatment groups in improving various aspects related to knee EOA, including pain, range of motion, strength, and function. A study was undertaken with 48 recreational athletes with EOA who were assigned to one of three groups by the referring orthopedic surgeon: collagen (Col), exercise (Ex), or collagen and exercise (ColEx) groups. All the participants received their respective group-based intervention for 12 weeks. Visual analog scale (VAS), knee flexion range of motion (ROM) knee flexors and extensors strength, and KOOS were assessed at baseline, and after 4 weeks, 8 weeks, and 12 weeks of intervention. VAS for activity improved in all treatment groups, with no difference between groups. The between-group analysis for knee ROM revealed a significant difference (p = 0.022) in the Col vs. Ex group at 12 weeks. The knee flexor and extensor strength and the KOOS scores improved considerably in the Ex and the ColEx group (p < 0.05) at 12 weeks. Exercise therapy improved pain, strength and function in subjects with EOA, whereas the association of collagen seems to have accentuated the effects of exercise in bringing about clinical improvements.

A Retrospective Observational Study Evaluating the Synergistic Effect of a Novel Combination of Alfapin + Native Type 2 Collagen + Mobilee (Hyaluronic Acid) + CurQlife (Curcumin) Nutraceuticals in the Symptomatic Improvement of Knee Osteoarthritis.

Background Treatment of pain and inflammation form the mainstay of osteoarthritis (OA) management. Non-steroidal anti-inflammatory drugs (NSAIDs), due to their inflammation-blocking mechanism, are a highly effective class of drugs for chronic pain and inflammation in OA. However, this comes at a cost of increased risk for multiple adverse effects, including gastrointestinal bleeding, cardiovascular side effects, and NSAID-induced nephrotoxicity. To minimize the potential risk of an adverse event, numerous regulatory bodies and medical societies recommend using the lowest effective NSAID dose for the shortest time necessary. One potential strategy to achieve this is the use of disease-modifying osteoarthritis drugs (DMOADs) containing anti-inflammatory and analgesic properties instead of NSAIDs for the management of OA. This study focuses on the efficacy of Clagen™ [Aflapin (Boswellia serrata extract) + native type 2 collagen + Mobilee (hyaluronic acid (60-70%), polysaccharides (>10%), and collagen (>5%)) + CurQlife (Curcumin)] for the symptomatic improvement in OA patients as well as if this combination is effective in the long-term management of OA instead of NSAIDs. Methodology In this retrospective observational study, a total of 300 patients were screened, of whom 100 OA patients who fulfilled the criteria and agreed to be part of the study were enrolled. The data were analyzed to evaluate the efficacy of the nutraceutical formulation Clagen™ in patients with OA of the knee. From the baseline to two months, primary outcomes of improvement in the Visual Analog Scale (VAS) score, range of motion, and Knee Injury and Osteoarthritis Outcome Score (KOOS) were measured at monthly follow-up. Statistical analyses were performed according to the results obtained from the parameters. The tests were performed at a 5% significance level (p <0.05). The qualitative characteristics were described using absolute and relative frequencies, and the quantitative measures were described as summary measures (mean, standard deviation). Results Of the 100 patients enrolled in the study, 99 (64 males and 35 females) completed the study. The mean age of the patients was 50.6 ± 13.9 years, and the mean body mass index was 24.5 ± 3.5 kg/m2. The statistical analysis of the outcomes from the baseline to the two-month follow-up was analyzed using paired t-test. The difference in the mean of VAS pain score at baseline and two months was 3.3 ± 1.8 [t (97) = 18.2; p < 0.05], which showed a significant reduction in pain at two months. Moreover, the difference in the mean of the goniometer value of 7.3 ± 7.3 [t (98) = -10.0, p < 0.05] indicated statistically significant improvements in the range of motion. It was also observed that Clagen™ significantly improved the composite KOOS score by 10.8% at the end of two months. Similarly, KOOS scores for Symptoms, Function, and Quality of Life showed improvements of 9.6%, 9.8%, and 7.8%, respectively, and were statistically significant (p < 0.05). Conclusions Clagen™ exerted positive adjuvant effects in the management of OA. The combination not only improved the symptoms and quality of life but, in the light of future perspective, NSAIDs can be withdrawn in OA patients, considering their long-term negative effects. To validate these findings further long-term studies with a comparison arm of NSAIDs are needed.

Patellofemoral joint degeneration: A review of current management.

The patellofemoral component of the knee joint is affected by a wide range of degenerative causes without involving the other parts of the knee. It is often the presenting pathology in early knee osteoarthritis and missed due to a variable presentation. Accurate examination and focused investigation can help with early diagnosis and guide treatment. Various aspects to treatment need to be addressed after thorough evaluation. Guidelines to approach the multifactorial pathology of the patello-femoral joint are provided with focus on the degenerative component of disease.

Effectiveness of balance training on pain and functional outcomes in knee osteoarthritis: A systematic review and meta-analysis.

Background: Knee osteoarthritis (OA) is a musculoskeletal disorder that causes pain and increasing loss of function, resulting in reduced proprioceptive accuracy and balance. Therefore, the goal of this systematic review and meta-analysis is to evaluate the effectiveness of balance training on pain and functional outcomes in knee OA. Methods: "PubMed", "Scopus", "Web of Science", "Cochrane", and "Physiotherapy Evidence Database" were searched for studies conducted between January 2000 and December 2021. Randomized controlled trials (RCTs) that investigated the effectiveness of balance training in knee OA, as well as its effects on pain and functional outcome measures, were included. Conference abstracts, case reports, observational studies, and clinical commentaries were not included. Meta-analysis was conducted for the common outcomes, i.e., Visual Analog Scale (VAS), The Timed Up and Go (TUG), Western Ontario and McMaster Universities Arthritis Index (WOMAC). The PEDro scale was used to determine the quality of the included studies. Results: This review includes 22 RCTs of which 17 articles were included for meta-analysis. The included articles had 1456 participants. The meta-analysis showed improvement in the VAS scores in the experimental group compared to the control group [ I 2= 92%; mean difference= -0.79; 95% CI= -1.59 to 0.01; p<0.05] and for the WOMAC scores the heterogeneity ( I 2) was 81% with a mean difference of -0.02 [95% CI= -0.44 to 0.40; p<0.0001]. The TUG score was analyzed, the I 2 was 95% with a mean difference of -1.71 [95% CI= -3.09 to -0.33; p<0.0001] for the intervention against the control group. Conclusions: Balance training significantly reduced knee pain and improved functional outcomes measured with TUG. However, there was no difference observed in WOMAC. Although due to the heterogeneity of the included articles the treatment impact may be overestimated. Registration: The current systematic review was registered in PROSPERO on 7th October 2021 (registration number CRD42021276674).

Effectiveness of proprioceptive training versus conventional exercises on postural sway in patients with early knee osteoarthritis - A randomized controlled trial protocol.

INTRODUCTION: In recent times, 'early osteoarthritis' (EOA) has achieved recognition as a disease entity. The importance of defining EOA is in the fact that a variety of joint preservation treatments are available. Development of the sense of proprioception is a known vital element of most exercise rehabilitation programmes. Postural sways have been found to be prevalent in arthritic patients. It follows therefore that correction of early postural aberrations should help patients with EOA. The current study aims to determine the effectiveness of such proprioceptive training versus conventional exercises in patients with EOA. METHOD: This study is a randomized controlled trial. A total of 100 participants between the age of 20-45 years will be recruited. Participants will be randomly assigned to conventional or interventional group. Participants in both the groups will receive 12 session of treatment over a period of four weeks. Outcome measure considered are center of pressure excursion, joint position sense, hand held dynamometer, visual analog scale and knee injury and osteoarthritis Outcome Score for functional outcome. RESULTS: Data collected will be analyzed by mean, SD and 2 factor ANOVA for repeated measure, followed by Bonferroni post hoc analysis. Data will be analyzed using SPSS package version 17.0, p < 0.05 will be considered as significant. CONCLUSION: The authors hope to determine whether proprioceptive training improves outcome better than conventional exercise therapy and hope to contribute to an improved targeted treatment for patients with Early osteoarthritis.

Patient handling in India-Evidence from a pilot study.

BACKGROUND: Manual handling forms an important part of a health care worker's daily routine. Faulty techniques may result in musculoskeletal injuries in health workers and further injury to patients. OBJECTIVES: In our study, we assessed the techniques of patient moving and handling by health care workers in our hospital. Our aim was to educate them on standard moving and handling techniques and assess the impact of the same. METHODS: We carried out a time-bound prospective clinical audit wherein we observed workers in the emergency department for a period of 2 weeks to evaluate their moving and handling techniques. This was followed by a training session where the workers were trained in "best-practices," and a 2-week period of reevaluation to assess compliance with standard practices. RESULTS: During bed-to-bed transfers, we found improvements in the following seven parameters after the training session: (a) the use of good posture, (b) the use of wheel stoppers, (c) adjustment of bed height, (d) positioning the receiving bed parallel to patient's bed, (e) general risk assessment before transferring a patient, (f) involvement of at least three carers, and (g) the use of a standard command like "GO" before the transfer. CONCLUSION: Apart from serving the purpose of an audit, our study has revealed that the training of health care providers in safe moving and handling of patients is a neglected subject in India.

Avoid post operative bracing to reduce ACL rerupture rates.

PURPOSE: It has been quoted that the graft is more prone to injury in the early stages of ligamentization between 3 and 6 months when the muscles are weak and compliance with post-op protocol is waning. Purpose of this study was to evaluate the functional outcome of avoiding postoperative bracing following ACL reconstruction and early enhanced recovery protocol on the reinjuries of graft. METHODS: Thirty-two consecutive patients who underwent arthroscopic ACL reconstruction by a single surgeon in the same specialist center between October 2015 and May 2017 were included in the study. All the patients were educated regarding rehabilitation before the index surgery and preoperative quadriceps exercises had been initiated. Rehabilitation was undertaken as per a standard protocol with emphasis on early mobilization. No brace was used. Patients were followed up between 3 months and 1 year. Lysholm knee scores were evaluated at 6 and 12 months postoperatively. RESULTS: No failures were noted (failure defined as instability, stiffness or persistent pain). The average Lysholm knee score at 6 months was 88 and at 12 months period was 91. No statistical significance (P > 0.00001) was noted in the scores between braced and unbraced at 1 year. CONCLUSION: ACL rehabilitation without a knee brace can indirectly prevent rerupture and is a cheaper as well as a safer method with better outcomes.

Total knee replacement in the obese patient: comparing computer assisted and conventional technique.

PURPOSE: Obesity is being considered a "global epidemic." Surgical procedures are rendered more difficult in obese patients. We aimed to see whether any benefits were evident with use of computer navigation during total knee replacement in these cases. METHODS: A retrospective analysis of 287 TKR performed by a single surgeon was undertaken, including 133 TKR undertaken with computer navigation and 154 using standard instrumentation. Each group was further divided into subgroups depending on whether the patients were obese or nonobese. RESULTS: We found that TKR in obese patients took longer with standard instruments, but not with computer navigation. A chronological analysis revealed that the surgeon progressively got quicker using computer navigation to the point that there was no difference in time with either of the operative techniques in obese patients. The mid-term clinical outcomes at five years were similar. Computer navigated TKR were more consistently accurately aligned. CONCLUSIONS: In obese patients, a dual advantage is provided by computer navigation: better alignment and no time penalty.

Computer navigation of soft tissues in total knee replacement.

Following the success of computer navigation in producing consistently accurate alignment, the focus has shifted to use of these techniques for soft tissue assessment during total knee replacement (TKR). We undertook a prospectively randomized clinical study to compare two methods of tissue balancing in TKR. One method, called bone referencing (BR) employed independent cutting of the femur and tibia followed by subjective assessment with trial prostheses and soft tissue release as deemed necessary. The other method, termed ligament balancing (LB), involved cutting the tibia first and titration of tissue balance and alignment parameters to guide femoral cuts. Our total sample comprised 77 subjects with 80% statistical power. To assess tissue balance we used (a) coronal laxity testing and (b) computer navigation generated passive knee range of movement graphs. The graphical assessment was validated with coronal laxity testing. There was no difference between the resultant tissue balances achieved. However, correlation with preoperative status revealed the LB technique to show better results in a smaller subgroup of knees with greater preoperative tissue imbalance. We advocate variation of tissue balancing technique to suit the individual knee, based on preoperative assessment, to achieve an optimal result in all TKR.

Functional outcome after computer-assisted total knee arthroplasty using measured resection versus gap balancing techniques: a randomised controlled study.

PURPOSE: To compare the 2-year outcome of total knee arthroplasty (TKA) using the measured resection versus the gap balancing techniques. METHODS: 21 men and 31 women aged 41 to 89 (mean, 73) years who underwent primary TKA by a single surgeon for osteoarthritis and had an American Society of Anesthesiologists I or II physical status were prospectively studied. Patients were randomised to undergo computer-assisted TKA using the measured resection technique (n=26) or the gap balancing technique (n=26). At the 2-year follow-up, patients were assessed by a single orthopaedic registrar blinded to the type of surgery using the Knee Society score (KSS), functional Knee Society score (FKSS), and revised Oxford Knee score (ROKS). RESULTS: In the measured resection group, the mean KSS, FKSS, and ROKS increased from 34.3, 48, and 21 to 85.9, 89.6, and 36.5, respectively. In the gap balancing group, the respective scores increased from 35.4, 50, and 22.5 to 89.1, 92.4, and 40.6. Postoperative increases in the respective scores were slightly better with the gap balancing technique; the respective p values were 0.46, 0.44, and 0.12. CONCLUSION: Improvements in the knee scores were comparable with the 2 techniques.

Does computer navigation in total knee arthroplasty improve patient outcome at midterm follow-up?

Computer navigation assistance in total knee arthroplasty (TKA) results in consistently accurate alignment of prostheses. We aimed to compare the outcome of computer-navigated and conventional TKA and to analyse the radiologically malaligned knees. We analysed 637 primary TKA, carried out by a single surgeon, over five consecutive years and divided them into two cohorts: group 1 = STA (standard instrumentation) and group 2 = CAS (computer-assisted surgery). There was no significant difference between the average Oxford Knee Scores (OKS) of the two groups at any time from one to five years. However, the malaligned TKA at three years had a worse OKS. At medium term there is no difference in clinical outcome measures that can be attributed to the surgeon having used computer-assisted navigation for TKA. But group 1, having a higher proportion of malaligned TKA, might show worsening of OKS at long term.