Acupuncture in patients with osteoarthritis of the knee: a randomised trial.

BACKGROUND: Acupuncture is widely used by patients with chronic pain although there is little evidence of its effectiveness. We investigated the efficacy of acupuncture compared with minimal acupuncture and with no acupuncture in patients with osteoarthritis of the knee. METHODS: Patients with chronic osteoarthritis of the knee (Kellgren grade < or =2) were randomly assigned to acupuncture (n=150), minimal acupuncture (superficial needling at non-acupuncture points; n=76), or a waiting list control (n=74). Specialised physicians, in 28 outpatient centres, administered acupuncture and minimal acupuncture in 12 sessions over 8 weeks. Patients completed standard questionnaires at baseline and after 8 weeks, 26 weeks, and 52 weeks. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index at the end of week 8 (adjusted for baseline score). All main analyses were by intention to treat. RESULTS: 294 patients were enrolled from March 6, 2002, to January 17, 2003; eight patients were lost to follow-up after randomisation, but were included in the final analysis. The mean baseline-adjusted WOMAC index at week 8 was 26.9 (SE 1.4) in the acupuncture group, 35.8 (1.9) in the minimal acupuncture group, and 49.6 (2.0) in the waiting list group (treatment difference acupuncture vs minimal acupuncture -8.8, [95% CI -13.5 to -4.2], p=0.0002; acupuncture vs waiting list -22.7 [-27.5 to -17.9], p<0.0001). After 52 weeks the difference between the acupuncture and minimal acupuncture groups was no longer significant (p=0.08). INTERPRETATION: After 8 weeks of treatment, pain and joint function are improved more with acupuncture than with minimal acupuncture or no acupuncture in patients with osteoarthritis of the knee. However, this benefit decreases over time.

[Early arthroscopy of the knee joint of the athlete also without hemarthrosis?]. / Früharthroskopie des Sportlerkniegelenkes auch ohne Hämarthros?

Differentiating from the indications to an acute or early arthroscopic procedure in cases of injuries of athlete's knee joints the consequence of an early arthroscopy in this patient group is demonstrated in cases without haemarthrosis. If conservative treatment is unsuccessful an early arthroscopy is particularly indicated in these cases due to the shortening of the required time of treatment.

[Synovial volume of healthy and arthrotic human knee joints]. / Das Synovia-Volumen gesunder und arthrotischer menschlicher Kniegelenke.

The volume of synovial fluid in human knee joints was determined by the dilution method through the intra-articular injection of 35 ml 0.5% hydroxyethyl starch in saline. In 15 control knees the mean synovial volume was 6.7 +/- 2.3 ml (mean +/- SD). In patients with latent gonarthrosis we found a mean intra-articular volume of 13.6 +/- 7.4 ml (n = 21) and in activated gonarthrosis 24.2 +/- 16.3 ml (n = 34). All 3 groups differ significantly. After entire aspiration of the effusion, we found yet 13.4 +/- 4.4 ml (n = 32) synovial fluid in the knee joint. Using the dilution method, we obtained a punctate from each knee joint. The punctates can be used for biochemical investigations. Since the dilution factors of the punctates are known, the concentrations of HWM parameters in the original synovial fluid can be calculated.

[Risk of hemorrhage in the knee joint following intraarticular injections]. / Das Blutungsrisiko in das Kniegelenk nach intraartikulären Injektionen.

The relative and absolute blood contents in the knee joint after intraarticular injections were determined using a biochemical joint function test. Normally, only minimal amounts of blood leak into the joint cavity, but in a few cases greater quantities were found, unnoticed at the time of injection. Intraarticular injections should be done only by a specialist.

Elimination of tritium-labelled hyaluronic acid from normal and osteoarthritic rabbit knee joints.

The half-life of [3H]hyaluronic acid in rabbit knee joints was estimated using two methods: (i) by following the [3H]hyaluronan content of the synovial fluid after intra-articular injection and (ii) by following the 3H2O radioactivity of plasma after intra-articular injection of [3H]hyaluronan. For normal rabbits we obtained a half-life of 15.8 hours (method I) and 17.5 +/- 1.0 hours (mean +/- SEM, method II), respectively. The second method was used to estimate the kinetics of the hyaluronan elimination from normal, sham-operated, as well as from osteoarthritic rabbit knee joints (Colombo model of osteoarthritis). Four weeks after injury, during the developing phase of osteoarthritis, the half-life of hyaluronan rose significantly to 23.5 +/- 2.1 hours and returned to normal levels (17.4 +/- 2.7 hours) 12 weeks after the operation (osteoarthritis developed). At the stage of developed osteoarthritis, the clearance rates were considerably higher than in normal rabbits.