scholarly journals Use of Hyaluronic Acid Injection after Arthroscopic Release in Lateral Patellar Compression Syndrome with Degenerative Cartilage Changes: Randomized Control Trial

2020 ◽  
Author(s):  
Sherwan Hamawandi

Abstract BackgroundDegenerative cartilage changes can be seen, in cases of lateral patellar compression syndrome, involving the patellofemoral joint. Hyaluronic acid is a natural component of the synovial fluid and responsible for its elastic features and function of articular surfaces. The aim of this study is to show the effect of intra-articular injection of Hyaluronic acid, after arthroscopic lateral release in lateral patellar compression syndrome, on the functional outcome and knee pain in those patients with degenerative cartilage changes. MethodNinety patients age (30-50) years with lateral patellar compression syndrome and degenerative cartilage changes were divided randomly into 2 groups. Group A was treated by arthroscopic lateral release and received intrarticular injection of Hyaluronic acid 2 weeks after surgery. Group B was treated by arthroscopic lateral release only. Both groups were assessed by Kujala score and visual analogue scale for knee pain preoperatively and re-assessed postoperatively at 3 months, 6 months, 12 months and 24 months.ResultsThere was significant improvement in Kujala score and Visual analogue scale post-operatively in both groups (P-value<0.001) with better improvement in Kujala score in group A after intra-articular injection of Hyaluronic acid up to 2 year of follow up (P-value=0.006) as well as better improvement in visual analogue score at 6 months post-operatively (P-value=0.035)ConclusionIntra-articular injection of Hyaluronic acid after arthroscopic release, in patients with lateral patellar compression syndrome and degenerative cartilage changes, can result in better improvement of knee pain and functional outcome up to 2 years of follow up.Trial registration: NCT, NCT04134611. Registered 18 October 2019 -Retrospectively registered, https://www.clinicaltrials.gov/NCT04134611

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sherwan A. Hamawandi

Abstract Background Degenerative cartilage changes can be seen, in cases of lateral patellar compression syndrome, involving the patellofemoral joint. Hyaluronic acid is a natural component of the synovial fluid and responsible for its elastic features and function of articular surfaces. The aim of this study is to show the effect of intra-articular injection of Hyaluronic acid, after arthroscopic lateral release in lateral patellar compression syndrome, on the functional outcome and knee pain in those patients with degenerative cartilage changes. Method Ninety patients age (30–50) years with lateral patellar compression syndrome and degenerative cartilage changes were divided randomly into 2 groups. Group A was treated by arthroscopic lateral release and received intraarticular injection of Hyaluronic acid 2 weeks after surgery. Group B was treated by arthroscopic lateral release only. Both groups were assessed by Kujala score and visual analogue scale for knee pain preoperatively and re-assessed postoperatively at 3 months, 6 months, 12 months and 24 months. Results There was significant improvement in Kujala score and Visual analogue scale post-operatively in both groups (P-value< 0.001) with better improvement in Kujala score in group A after intra-articular injection of Hyaluronic acid up to 2 year of follow up (P-value = 0.006) as well as better improvement in visual analogue score at 6 months post-operatively (P-value = 0.035). Conclusion Intra-articular injection of Hyaluronic acid after arthroscopic release, in patients with lateral patellar compression syndrome and degenerative cartilage changes, can result in better improvement of knee pain and functional outcome up to 2 years of follow up. Trial registration NCT, NCT04134611. Registered 18 October 2019 -Retrospectively registered.


Author(s):  
Sherwan A. Hamawandi ◽  
Hazhar I. Amin ◽  
Ameer Kadhim Al-Humairi

Abstract Introduction Lateral patellar compression syndrome is one of the causes of anterior knee pain in young adults and resulted from tight lateral patellar retinaculum. The aim of our study is to compare between open and arthroscopic release of lateral patellar compression syndrome in relation of functional outcome, time of surgical procedure, length of hospital stays, intraoperative and postoperative complications as bleeding, infection, recurrence, and patellar instability with 2 years of follow-up. Materials and methods 80 patients, age (21–49 years), were divided randomly into 2 groups (A and B). Group A (40 patients) were treated with open release. Group B (40 patients) were treated by arthroscopic release. All these patients are diagnosed as lateral patellar compression syndrome depending on clinical features and MRI. All patients were assessed by Lysholm knee scoring scale before surgery and at periods of 2, 6 weeks, 6, 12, and 24 months after surgery. Results There is significant difference in functional outcome, measured by Lysholm knee scoring scale, between preoperative and postoperative assessment periods in both groups (P < 0.001). There is significantly better functional outcome at 2 years of follow-up with arthroscopic release (P = 0.018). There is no recurrence in both groups, but there were 4 patients develop medial patellar instability in the group of open release. Conclusion Both open and arthroscopic lateral release for patients with isolated lateral patellar compression syndrome can be effective surgical procedures, but arthroscopic release can achieve better functional outcome. Trial registration: NCT, NCT04130412. Retrospectively registered on 3rd of June, 2020 at ClinicalTrials.gov.


2020 ◽  
Author(s):  
Ji-Bin Chen ◽  
Dong Chen ◽  
Ya-Ping Xiao ◽  
Jian-Zhong Chang ◽  
Te Li

Abstract Objective: To investigate the method and effect of arthroscopic lateral patella retinaculum releasing (LPRR) either through or outside synovial membrane for the treatment of lateral patellar compression syndrome (LPCS).Methods: From September 2014 to December 2017, 125 patients with LPCS underwent arthroscopic LPRR either through or outside synovial membrane combined with joint debridement. In the outside synovial membrane (OSM) group, synovial membrane was retained. In the through synovial membrane (TSM) group,The synovial membrane was cut open. Active rehabilitation training was conducted after surgery. Before and after surgery, Lysholm score, patella medial shift, Kujala score, VAS score and surgical complications were evaluated and compared.Results: All patients in this study were followed up for 1.5-5 years. All patients had significant reduction in knee pain and improved function after 1 month and 1 year. The Lysholm score, the distance of patella medial shift, the Kujala score, and the VAS score in the OSM group and the TSM group were significantly improved in the final follow-up compared with before surgery ( P <0.001), but these observed targets before surgery and at the last follow-up between the two groups were compared with no statistical differences. However, the number of occurrences of joint hematoma and adhesion was significantly higher in the TSM group than the OSM group ( P =0.024).Conclusion: Arthroscopic closing LPRR for the treatment of LPCS can effectively improve the function and symptoms of the patellofemoral joint with the advantages of small trauma, rapid recovery and less complications. But, the number of occurrences of hemarthrosis and joint adhesion in the TSM group were significantly higher than those in the OSM group.


2019 ◽  
Author(s):  
Ji-Bin Chen ◽  
Dong Chen ◽  
Ya-Ping Xiao ◽  
Jian-Zhong Chang ◽  
Te Li

Abstract Objective: To investigate the method and effect of arthroscopic lateral patella retinaculum releasing (LPRR) through/outside synovial membrane for the treatment of lateral patellar compression syndrome (LPCS). Methods: From September 2014 to December 2017, 125 patients with LPCS underwent arthroscopic LPRR through/outside synovial membrane combined with joint debridement. In the outside synovial membrane (OSM) group, the joint was cleaned first. The surface of lateral patella retinaculum (LPR) was created the chamber for arthroscopic operation. The LPR was released under the arthroscopy, and the synovial membrane was retained. In the through synovial membrane (TSM) group, the joint was cleaned first, and the synovial membrane, joint capsule and LPR, and superficial fascia were gradually incised from the joint cavity to the subcutaneous tissue. The synovial membrane was cut open. Active rehabilitation training was conducted after surgery. Before and after surgery, Lysholm score, patella medial shift, Kujala score, VAS score and surgical complications were evaluated and compared. Results: All patients in this study were followed up for 1.5-5 years. All patients had significant reduction in knee pain and improved function after 1 month and 1 year. The final follow-up of the Lysholm score, the distance of patella medial shift, the Kujala score, and the VAS score in the OSM group and the TSM group were significantly improved compared with those before surgery (P<0.001), but these observed targets at the last follow-up and before surgery between the two groups were compared with no statistical differences. In the TSM group, 5 patients had hemarthrosis and 3 cases joint adhesion. There were no postoperative complications in the OSM group. Conclusion: Arthroscopic closing LPRR for the treatment of LPCS can effectively improve the function and symptoms of the patellofemoral joint. It has the advantages of small trauma, good effect and rapid recovery. Among them, the hemarthrosis and joint adhesion in the TSM group were significantly higher than those in the OSM group, and arthroscopic closing LPRR outside synovial membrane was more advantageous.


2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
N Ayoub ◽  
Y Tryliskyy ◽  
M K Baig

Abstract Introduction Several studies have shown benefit from use of preoperative antibiotics in reducing postoperative infection after appendectomy as well as efficacy of postoperative antibiotics in complicated appendicitis (defined as perforated appendix or presence of pus in peritoneum). While for uncomplicated appendicitis, several studies showed no benefit from antibiotics postoperatively but there are no clear NICE guidelines till now and so surgeons have different practice based on their preferences. Method This study included patients who had appendectomy for uncomplicated appendicitis in Worthing hospital from 1st July 2019 till 30th June 2020. The end point was 30-day follow up postoperatively for wound infection or collection. Results 90 patients were admitted with uncomplicated appendicitis with age 6-80 years (mean of 31.3). 46 patients (51%) did not receive postoperative antibiotics (group A) and 44 (49%) received postoperative antibiotics (group B) with a variable practice from one dose to 8-day course. postoperatively, only 1 patient (2.1%) in group A developed wound infection requiring drainage while none in group B developed complications (p-value=1). Conclusions Administration of postoperative antibiotics in uncomplicated appendicitis showed no superiority over non-administration. in addition, they add extra cost on NHS. So, their routine use postoperatively is not recommended, however, larger studies are required to confirm this.


2013 ◽  
Vol 21 (2) ◽  
pp. 74-79
Author(s):  
Md Abdul Wahab ◽  
Mohammad Jamal Uddin ◽  
Biswas Shahen Hassan ◽  
Md Zafrul Islam ◽  
Ishrat Bhuiyan ◽  
...  

Background: Tinea pedis (athlet’s foot) is the most common fungal infection. Relapse is common in tinea pedis and may be result of recurrence following inadequate treatment or reinfection. Objective: To evaluate the comparable efficacy of terbinafine and itraconazole in the treatment of tinea pedis. Methods: 120 patients of tinea pedis confirmed by KOH microscopy were included in the study. The study was carried out in three different Hospitals and Private Chambers for a period of 3 years from July 2006 to June 2009. Mean age of the patients was 40.28±10.23. The patients were devided into 2 equal group:A & B. Group- A was given terbinafine 250 mg/day and group-B was given intraconazole 200 mg/day for 2 weeks. Results: Follow up 2 weeks after cessation of therapy revealed clinical and mycological cure of 93.3% in terbinafine group and 86.6% in itraconazole group. Conclusion: Efficacy analysis revealed that terbinafine is superior than itraconazole in the treatment of tinea pedis (P value 0.224). DOI: http://dx.doi.org/10.3329/bjmed.v21i2.13615 Bangladesh J Medicine 2010; 21: 74-79


2020 ◽  
Author(s):  
Jinlong Zhao ◽  
Hetao Huang ◽  
Guihong Liang ◽  
Ling-feng Zeng ◽  
Weiyi Yang ◽  
...  

Abstract Background Studies have shown that the combined application of hyaluronic acid (HA) and platelet-rich plasma (PRP) can repair degenerated cartilage and delay the progression of knee osteoarthritis (KOA). The purpose of this study was to explore the efficacy and safety of PRP combined with HA in the treatment of KOA compared with intra-articular injection of PRP or HA alone. Methods The PubMed, Cochrane Library, EMBASE and China National Knowledge Infrastructure (CNKI) databases were searched from inception to December 2019. Two orthopaedic surgeons conducted the literature retrieval and extracted the data. Outcome indicators include the Western Ontario and McMaster Universities Arthritis Index (WOMAC), the Lequesne Index, the visual analogue scale (VAS) for pain, and adverse events (AEs). Results Seven studies (5 randomized controlled trials, 2 cohort studies) with a total of 941 patients were included. In the VAS comparison after 6 months of follow-up, PRP combined with HA was more likely to reduce knee pain than PRP alone (standardized mean difference (SMD): -0.31; 95% confidence interval (CI): -0.55 to -0.06; P=0.01 <0.05). PRP combined with HA for KOA achieved better improvement in WOMAC Function Score (SMD: -0.32; 95% CI: -0.54 to -0.10) and WOMAC Total Score (SMD: -0.42; 95% CI: -0.67 to -0.17) at the 12-month follow-up than the application of PRP alone. In a comparison of Lequesne Index scores at a 6-month follow-up, PRP combined with HA improved knee pain scores more than PRP alone (SMD: -0.42; 95% CI: -0.67 to -0.17). In terms of AEs, PRP combined with HA was not significantly different from PRP or HA alone (P>0.05). Conclusions Compared with intra-articular injection of PRP alone, PRP combined with HA can improve WOMAC Function Scores, WOMAC Total Score, 6-month follow-up VAS ratings, and Lequesne Index scores. However, in terms of the incidence of AEs, PRP combined with HA was not significantly different from PRP or HA alone.


2021 ◽  
Vol 71 (Suppl-3) ◽  
pp. S612-16
Author(s):  
Maryam Khan ◽  
Kamran Ashfaq Ahmed Butt ◽  
Naeem Riaz ◽  
Zaheer Ul Hassan ◽  
Attique Ahmed ◽  
...  

Objective: To compare the efficacy of steroid antibiotic wick with Ichthammol Glycerol wick in the management of Acute Otitis Externa in terms of tenderness and clearance of discharge/debris. Study Design: Quasi-experimental study. Place and Duration of Study: ENT Out Patient department of Combined Military Hospital Peshawar and Hayatabad Medical Complex Peshawar, from May to Nov 2018. Methodology: A total of 250 patients were included and divided into two groups of 125 each. After necessary suction clearance topical Ciprofloxacin/Dexamethasone (Cipotec-D) wick was placed in auditory canal of group A patients and topical Glycerol/Ichthammol wick was placed in group B. Follow up visits were done on 3rd and 7th day of starting the treatment. Results: Group A patients responded better in terms of tenderness (88%) however both groups had similar response in terms of discharge reduction (7.2% vs 6.4%). In terms of efficacy neither of the treatment proved more efficacious compared to the other (p-value 0.058). Conclusion: While steroid antibiotic wick is significantly more efficient in terms reducing tenderness, in terms of overall efficacy and discharge reduction Ichthammol/glycerol is equally effective.


2020 ◽  
pp. 1-7
Author(s):  
Aliya Ishaq ◽  
Muhammad Shadab Khan ◽  
Mariya Ishaq ◽  
Ayesha Saba ◽  
Turab Pishori

Objective: This study aims to determine the effect of preservation /division of ilioinguinal nerve in patients undergoing lichenstein hernioraphy on severity of chronic post operative pain as well well as presence /absence of groin numbness. Method: A randamised control trial was conducted for a period of six months on 60 patient fulfilling inclusion criteria who underwent lichenstein hernioraphy at general surgery department of Liaquat National university hospital Karachi , Pakistan. Result: A total of 60 patients undergoing elective inguinal hernia mesh repair were Included in study and divided in two groups with 30 patients each. Only male patients were included in the study as female gender was one of the exclusion criteria so gender stratification was no considered. Patients between 17 to 77 yrs of age were included in study and randomly divided in two groups. Mean age of population in group A is 42.96 +/- 17.76 an in group B is 54.23 +/- 15.0. The minimum age of the patient in Group A is 17 years and maximum age is 73 years whereas minimum age of the patient in Group B is 20 years and maximum age is 77 years. 45.9% Patients in group A (Nerve preservation group) have right inguinal hernia. 54.0%% Patients in group B (Nerve Division group) have right inguinal hernia. 56.5%% Patients in group A (Nerve Preservation group) have left inguinal hernia. 43.4% Patients in group B (Nerve Division group) have left inguinal hernia. Chronic groin pain while different physical activities and groin numbness in nerve preservation and nerve division group was assessed at three and six months follow ups in all patients of the study population. 3% of the patients from nerve preservation group had mild pain during climbing stairs at three and six months follow up and the P-Value was 0.313 which is statistically not significant. 10% of the patients from nerve division group and 50% patients from nerve preservation group had pain during brisk walking at three months follow up and the P-Value was 0.001 which is statistically significant. 23% of the patients from nerve division group and 60% patients from nerve preservation group had pain during brisk walking at six months follow up and the P-Value was 0.004 which is statistically significant. 13.3% patients from nerve preservation group had moderate pain during brisk walking at three months follow up while none of the patient from nerve division group had pain and P-Value was 0.038 which is statistically significant. 6.6% of the patients from nerve preservation group had moderate pain during brisk walking at six months follow up while none of the patient from nerve division group had pain and p-value was 0.150 which is statistically in significant. 20% of the patients from nerve division group and 30% of the patients from nerve preservation group had mild groin numbness at three months follow up with P-Value of 0.371 which is statistically in significant. 33.3% of the patients from nerve division group and 30% of the patients from nerve preservation group had groin numbness at six months follow up with a p-value of 0.781 which is statistically in significant. Conclusion: Prophylactic ilioinguinal neurectomy during Lichtenstein tension free inguinal hernia repair decreases the incidence of exertional chronic post operative pain as compare to the nerve preservation group. However the cutaneous neurosensory disturbance/groin numbness between the two groups has no difference in term of outcome. In order to prepare ourselves from a expected third wave of Covid-19, we should not repeat mistakes that we made during previos waves. We should refrain ourselves from dismantling our enhanced healthcare facilities, there should not be any sorts of shortage of oxygen , hospital beds, and drug that we have already witnessed. We must have an aggressive containment measure comprising of a really strong and pro-active surveillance system. This can be achieved by increasing the capacity of the existing surveillance system by identifying active cases early. We must ensure that we should follow “social vaccine” of proper masking, avoid indoor gatherings, and proper sanitization. Our vaccination programme needs a boost. We should vaccinate a large section of people before any third wave hits us. The more we vaccinate, the better prepared we are. As medical professionals, it must be ensured that proper scientific protocol must be implemented while handling Covid-19 cases. And last but not the least efforts must be made to fill up vacancies seen in our public health system, especially for frontline healthcare workers. As it is anticipated that the young children are more vulnerable to the forthcoming third wave, efforts are to be sought in order to start vaccination of the younger children in our country. Trials for which has already been started in India and across the world. Till the time vaccine is made available, the resources are to be mobilized to build up healthcare facilities catering the vulnerable age group in this third wave such as building up of more paediatric wards, paediatric ICU’s , training of healthcare personals in handling the emergencies for expected third wave .In addition to these efforts , more and more paediatric covid care centers must be set up at various parts of the country. Equally important is making arrangements for rehabilitation centers for the orphans. Countries like US, Singapore and UAE have already started vaccinating the children in age group between 12 to 15 years with Pfizer-BioNTech Covid vaccine. It’s a high time that the government in India must consider for allowing “expedited approval pathway” to the companies like Pfizer for their Covid-19 vaccine for children. All these combined efforts from everyone may ensure that the country and world may remain well equipped against these subsequent waves of this deadly virus and pave the path of the triumph in the near future.


2017 ◽  
Vol 24 (01) ◽  
pp. 89-94
Author(s):  
Muhammad Umar Javed ◽  
Sidra Aleem ◽  
Sheraz Jamil Asif ◽  
Javed Iqbal

Objectives: To compare the recurrence rate between incision drainage andmultiple needle aspiration for breast abscess treatment. Study Design: Randomized ControlledTrial. Setting: Department of General Surgery, Bahawal Victoria Hospital, Bahawalpur. StudyDuration: 29th September 2015 to 29th June 2016. Materials & Methods: A total of 60 femalepatients with breast abscess of <2 cm in size and of duration <2 weeks between 20 to 40 yearsof age were included. Patients with multiple breast abscesses, recurrent breast abscesses andcomplicated abscesses were excluded. The patients were randomized into Group A (incisionand drainage) & Group B (needle aspiration), by using lottery method. Follow up was done forup to 7 days and recurrence was noted. Results: The mean age of patients in group A was30.83 ± 5.67 years and in group B was 31.53 ± 5.73 years. Mean duration of disease was 7.58± 2.83 days. Mean size of abscess was 0.86 ± 0.43 cm. Recurrence was found in 07 (23.33%)patients in group A (incision drainage) while in 21 (70.0%) patients in group B (multiple needleaspiration) with p-value of 0.000 which is statistically significant. Conclusion: The recurrencerate is less after incision & drainage as compared to multiple needle aspirations for treatingbreast abscess.


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