Hyaluronic acid injections relieve knee pain

OBJECTIVE: To evaluate the efficacy of intra-articular viscosupplementation therapy with hyaluronic acid for pain relief of knee osteoarthritis, we conducted a meta-analysis of randomized, double-blinded, placebo-controlled trials. METHODS: We searched systematically for randomized, double-blinded, placebo-controlled trials of hyaluronic acid (hyaluronan and hylan G-F20) for pain relief of knee osteoarthritis. Studies reporting pain visual analogue scale (VAS) differences were included in the meta-analysis. Changes in pain were measured by VAS for placebo and treatment, and summary estimates of the differences between the 2 arms were calculated at 1 week, 5 to 7 weeks, 8 to 12, and 15 to 22 weeks after the last intra-articular injection. Sources of heterogeneity were assessed using information on quality score, type of viscosupplementation, and VAS change in pain with activity or rest. Heterogeneity across the studies was significant in all analyses (P<.01); therefore a random effect model was used. Pain was measured either on activity or at rest. RESULTS: Eleven trials (9 hyaluronan and 2 hylan G-F 20) allowed calculation of the summary estimate of difference in change of VAS pain at 1 week, 6 of the 11 allowed the estimation between 5 to 7 weeks and 8 to 12 weeks, and only 3 at 15 to 22 weeks. The summary estimates of VAS differences between therapy and placebo injection: at 1 week, 4.4 (95% confidence interval [CI], 1.1-7.2); at 5 to 7 weeks, 17.7 (7.5-28.0); at 8 to 12 weeks, 18.1 (6.3-29.9) and at 15 to 22 weeks, 4.4 (-15.3 to 24.1). CONCLUSION: Intra-articular viscosupplementation was moderately effective in relieving knee pain in patients with osteoarthritis at 5 to 7 and 8 to 10 weeks after the last injection but not at 15 to 22 weeks.     

Purulent pericarditis in a patient with knee pain

A 40-year-old man with pain in his left, swollen knee that persisted for 6 weeks presented with chest pain, dyspnoea and subfebrile temperature. The pain worsened during inspiration and was relieved by sitting up straight. The electrocardiogram showed pericarditis. The patient was treated with high-dose carbasalate calcium. Initially, echocardiography revealed a 2-cm pericardial effusion with no signs of influx inhibition. Blood cultures were positive for Neisseria meningitidis, and treatment was expanded to include antibiotics. Based on a deterioration in patient condition and the tamponade image, pericardiocentesis was performed. Repeated transoesophageal echocardiography showed insufficient drainage of the purulent pericardial effusion. Pericardiectomy was then performed. The patient was doing very well, 3 years after this. If left untreated, the mortality rate for purulent pericarditis approaches 100%. It is therefore important to diagnose at an early stage so that treatment with antibiotics and surgery, which can reduce mortality considerably, can be performed.     

Anterior knee pain associated with sports and work

Anterior knee pain is not a disease, but a syndrome with numerous causes. This paper describes its appearance in the patellofemoral joint in sportsmen and in untrained people. Chondromalacia patellae is a condition of the cartilage, not a disease, that is, it is never diagnosed alone. Relative muscular insufficiency, especially of the knee extensors, may occur in children and adolescents, as they grow rapidly. The consequence is a unbalance of active stabilizers and the disturbance of the slippery trail of patella, particularly in the presence of dysplasia of patellofemoral joint. The impingement syndrome pain occurs in sportsmen and people overloading the patellofemoral joint. Other causes of anterior knee pain should be excluded in clinical examination and slippery trail of patella, its position, and signs of instability should be determined. This paper gives an overview of patellar chondromalacia, lateral pressure syndrome, patellar subluxation, patellar acute and recurrent luxation, and idiopathic anterior knee pain. The treatment is basically conservative. Stretching exercises and the strengthening of certain groups of femoral muscles serves to regain the balance, thus normalising the slippery trail and taking off the burden from the patellofemoral joint. If conservative treatment fails, surgery is the alternative.     

膝关节间隙角的测定及其对诊断膝关节疼痛的意义

目的定量分析膝关节间隙角对膝关节疼痛的影响。方法测量膝关节间隙角并与膝关节疼痛程度作相关性分析。结果膝关节间隙度越大，膝关节疼痛程度越高。结论膝关节间隙角对诊断膝关节疼痛有一定的临床意义。     

Diagnostic image (259). A man with knee pain

In a 23-year-old man with knee pain a symptomatic bipartite patella was diagnosed; the small lateral fragment was surgically removed.     

The hard work of self-management: Living with chronic knee pain

Self-management is a key policy initiative in many western countries, and most approaches are designed for people with long-term conditions based upon giving support and advice in order to manage the impact of the condition(s). Less attention has been paid to what people already do themselves. In this paper we focus on the meaning and enactment of self-management in everyday life and the hard work associated with devising and maintaining routine adaptive strategies. This UK-based qualitative study examined how people live with knee pain. From the interviews (22 at baseline, 15 at 6 months) and monthly diaries, it emerged that self-management could be based on implicit and incremental learning from experience or on explicit evaluation of actions. Either way, embodied and emotional hard work was involved in maintaining a daily life that allowed people to fulfil social roles and relationships. This individual and contextualised work needs to be recognised and drawn upon before specific self-management approaches are promoted.     

单双膝痛老年骨关节炎患者生活质量状况的比较

目的 了解单、双膝痛老年膝关节炎(knee osteoarthritis,KOA)患者之间的生活质量状况是否存在差异.方法 对单膝痛组30例、双膝痛组32例和无膝痛组30例老年人进行36项健康调查量表((short-form 36 health survey scale,SF-36)评估.结果 3组SF-36总分比较,差异有统计学意义(P<0.01),双膝痛组[(62.35±10.77)分]明显低于单膝痛组[(76.21±8.74)分],单膝痛组明显低于无膝痛组[(84.19±7.60)分].结论 当老年KOA患者出现单膝痛时,即应及时治疗以避免其生活质量的下降,并避免或延迟双膝痛的发生,使其生活质量免受更大的影响.     

Chondroblastoma: an unusual cause of knee pain in the adolescent.

Chondroblastoma is a rare, benign bone tumor that may mimic an orthopedic infection. Characteristic clinical features include specific radiographic findings, predilection for the adolescent age group, and long bone epiphyseal involvement. This case of chondroblastoma is unusual because of aggressive findings on radiographic studies which underscore the need to obtain hip radiographs on adolescent patients with knee pain.