Glucosamine, chondroitin, and manganese ascorbate for degenerative joint disease of the knee or low back: a randomized, double-blind, placebo-controlled pilot study.

OBJECTIVE: A 16-week randomized, double-blind, placebo-controlled crossover trial of a combination of glucosamine HCl (1,500 mg/day), chondroitin sulfate (1,200 mg/day), and manganese ascorbate (228 mg/day) in degenerative joint disease (DJD) of the knee or low back was conducted. METHODS: Thirty-four males from the U.S. Navy diving and special warfare community with chronic pain and radiographic DJD of the knee or low back were randomized. A summary disease score incorporated results of pain and functional questionnaires, physical examination scores, and running times. Changes were presented as a percentage of the patient's average score. RESULTS: Knee osteoarthritis symptoms were relieved as demonstrated by the summary disease score (-16.3%; p = 0.05), patient assessment of treatment effect (p = 0.02), visual analog scale for pain recorded at clinic visits (-26.6%; p = 0.05) and in a diary (-28.6%; p = 0.02), and physical examination score (-43.3%; p = 0.01). Running times did not change. The study neither demonstrated, nor excluded, a benefit for spinal DJD. Side effect frequency was similar to that at baseline. There were no hematologic effects. CONCLUSIONS: The combination therapy relieves symptoms of knee osteoarthritis. A larger data set is needed to determine the value of this therapy for spinal DJD. Short-term combination therapy appears safe in this setting.

The impact of magnetic resonance imaging of the knee on surgical decision making.

Although magnetic resonance imaging (MRI) of the knee is known to be an accurate technique for diagnosing soft tissue disorders of the knee, the value of MRI in improving patient outcome is controversial. The purpose of this project was to study the value of MRI in a subgroup of patients with knee pain and disability whose diagnosis was uncertain after standard orthopaedic evaluation. An extensive database was recorded prospectively for each of 208 patients providing clinical data as well as diagnoses from clinical, MRI, and surgical observations. These data were analyzed to determine the effect of MRI on diagnosis and patient outcome regarding surgical decision making. The overall diagnostic accuracy of MRI was determined to be 97% in patients undergoing arthroscopy. MRI differed from the clinical diagnosis in 33% of cases, the most common variance being diagnosis of meniscal tear. After combining the MRI and clinical information, surgical decision making was altered in 27% of cases. In a group of patients with acute knee symptoms, the decision not to proceed with surgery was made in 64% of cases. The study shows that MRI of the knee is a valuable tool for augmenting the diagnostic process. The data further show that MRI is a cost-effective technique for avoiding unnecessary surgery and affects patient outcome by improving surgical decision making.

Core decompression for avascular necrosis of the femoral head: correlation between long-term results and preoperative MR staging.

A long-term radiographic follow-up study was conducted on 24 patients (34 hips) who underwent core decompression of the femoral head for avascular necrosis (AVN). The purpose of the study was to assess the potential correlation between the extent of AVN, as determined with preoperative magnetic resonance (MR) imaging, and development of collapse. The preoperative MR results were classified into four categories: group A, no AVN; group B, less than 25% involvement of the weight-bearing portion of the femoral head; group C, 25%-50% involvement; and group D, more than 50% involvement. Histologic evidence of AVN was found in all 34 hips. Collapse occurred in none of the hips in groups A and B (n = 12), in three of seven hips (43%) in group C, and in 13 of 15 hips (87%) in group D. It is concluded that MR estimation of the extent of femoral head involvement with AVN may help in predicting which femoral heads will collapse shortly after core decompression, so that this invasive procedure can be avoided in patients at risk.

Magnetic resonance imaging of tendons.

MRI provides unprecedented spatial resolution and contrast resolution of the soft tissues of the joints, allowing accurate evaluation of both normal anatomy and pathology of virtually any tendon. However, its exact role for the evaluation of tendon lesions is yet to be determined. In most instances, less expensive techniques like US, CT, or tenography can demonstrate the abnormality and provide enough information for patient management. MRI may be indicated in the following circumstances: to study suspected tendon lesions not demonstrated by other techniques, to evaluate tendons located in areas beyond the reach of US, or to study those cases in which the exact etiology of the symptoms is not clear on clinical grounds and lesions other than tendinous in origin may be present.

Ankle: surface coil MR imaging at 1.5 T.

High-field surface coil magnetic resonance (MR) images were obtained of 12 ankles: two from healthy volunteers, seven from patients, and three from fresh cadavers. The cadaver ankles were sectioned in the coronal, sagittal, and axial planes for direct comparison with the MR images. Plain film confirmation of pathologic conditions was obtained in all patients, and five underwent arthroscopy or surgery, or both. MR imaging provided excellent delineation of ligaments and cartilaginous structures in all cases.

The knee: surface-coil MR imaging at 1.5 T1.

Seven normal knees (in five volunteers) and seven injured knees (in seven patients) were examined by high-resolution magnetic resonance (MR) imaging at 1.5 T with a surface coil. Seven medial meniscal tears, three anterior cruciate ligament tears, one posterior cruciate ligament avulsion, an old osteochondral fracture, femoral condylar chondromalacia, and one case of semimembranous tendon reinsertion were identified. MR images correlated well with recent double-contrast arthrograms or results of surgery. All tears were identified in both the sagittal and coronal planes. Because of its ability to demonstrate small meniscal lesions and ligamentous injuries readily, MR imaging with a surface coil may eventually replace the more invasive arthrography.

Meniscal tears: MR demonstration of experimentally produced injuries.

Magnetic resonance (MR) imaging was performed using a 1.5-T magnet on eight immature swine knees with surgically produced vertical and horizontal meniscal tears. Three radiologists, interpreting the images independently, detected all tears. Tears in the middle portion of the meniscus were best seen on sagittal views, while lesions of the anterior and posterior horns of the meniscus were best seen on coronal views. MR has several advantages over arthrography, the current diagnostic method for knee injuries: it is noninvasive, uses no ionizing radiation, and provides excellent soft-tissue contrast resolution.

Joint effusions: MR imaging.

Magnetic resonance (MR) images of the hips and knees of three healthy volunteers were reviewed and compared with images obtained from the hips of three patients with effusions. Comparison was also made with MR images obtained from two swine knees following the injections of saline in one and blood in the other. The anatomy of the knees and hips was well defined. The hip effusions were all easily recognized. MR images of the swine knees clearly demonstrated the experimentally produced joint effusions. The hip effusions and the experimentally introduced blood and saline all had long T1 and T2 values allowing easy differentiation from articular cartilage. We were unable to distinguish fresh blood from saline in the knee joints.