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AUTOLOGOUS BLOOD VERSUS CORTICOSTEROID LOCAL INJECTION IN THE SHORT-TERM TREATMENT OF LATERAL ELBOW TENDINOPATHY: A RANDOMIZED CLINICAL TRIAL OF EFFICACY. Kazemi M, Azma K, et al. American Journal of Physical Medicine and Rehabilitation. 2010;89(8):660-667
A single blind, randomised clinical trial was performed in an outpatient clinic at a university hospital. Sixty patients aged 27–64 yrs with a new episode of tennis elbow were recruited. Thirty patients were randomised to methylprednisolone and 30 to autologous blood group over 1 year. Severity of pain within last 24 hours; limb function; pain and strength in maximum grip; disabilities of the arm, shoulder, and hand quick questionnaire (Quick DASH) scores; modified
AUTOLOGOUS BONE MARROW–DERIVED MESENCHYMAL STEM CELLS VERSUS AUTOLOGOUS CHONDROCYTE IMPLANTATION. AN OBSERVATIONAL COHORT STUDY. Nejadnik H, Hui JH, et. American Journal of Sports Medicine 2010;38:1110-1116 (published online before print April 14)
Seventy-two matched (lesion site and age) patients underwent cartilage repair using chondrocytes (n = 36) or bone marrow–derived mesenchymal stem cells (BMSCs) (n = 36). Clinical outcomes were measured before operation and 3, 6, 9, 12, 18, and 24 months after operation using the International Cartilage Repair Society (ICRS) Cartilage Injury Evaluation Package, which included questions from the Short- Form Health Survey, International Knee Documentation Committee (IKDC) subjective knee evaluation form, Lysholm knee scale,
and Tegner activity level scale. There was significant improvement in the patients’ quality of life (physical and mental components of the Short Form-36 questionnaire included in the ICRS package) after cartilage repair in both groups (autologous chondrocyte implantation and BMSCs). However, there was no difference between the BMSC and the autologous chondrocyte implantation group in terms of clinical outcomes except for Physical Role Functioning, with a greater improvement over time in the BMSC group. The IKDC subjective knee evaluation, Lysholm, and Tegner scores
A convincing study and a natural remedy and presumably without the longer term detrimental effects that continuous use of steroids can have.
At 4 weeks, between-group analyses showed superiority of autologous blood for severity of pain, pain in grip, pressure pain threshold , and
did not show any significant difference between groups over time. But, in general, men showed significantly better improvements than women. Patients younger than 45 years of age scored significantly better than patients older than 45 years in the autologous chondrocyte implantation group, but age did not make a difference in outcomes in the BMSC group.
sportEX coment Using BMSCs in cartilage repair is
as effective as chondrocytes for articular cartilage repair, and it required one less knee surgery, reduced costs, and minimised donor-site morbidity so it has the edge.
Nirschl scores; and pressure pain threshold were evaluated before injection and at 4 and 8 weeks after injection. Within- group analyses showed better results for autologous blood. In the corticosteroid group, differences in severity of pain and grip strength were significant.
Quick DASH questionnaire score. There were no significant differences in modified Nirschl score, grip strength, and limb function. At 8 weeks, autologous blood was more effective in all the outcomes.
sportEX comment
DETECTION OF KNEE EFFUSION BY ULTRASONOGRAPHY. HONG BY, LIM SH ET AL American Journal of Physical Medicine and Rehabilitation. 2010;89(9):715-721
The question posed in this piece of research was which ultrasonography scan view was sensitive in detecting knee effusion. An intra-articular injection of normal saline with contrast dye was done in increments (5, 10, 15, and 20ml) into the knee joint of eight fresh cadavers. After infusion of each amount, sonographic images were obtained with five different scans: medial, midline, and lateral on longitudinal scans and medial and lateral on transverse scans. When 20ml had been injected, the knee was flexed to 30o and serial images were taken. After infusion of 10ml, effusion of more than 2mm depth with ultrasonography was most frequently seen in lateral transverse scans, and the next most frequent view was a lateral longitudinal scan. After knee flexion, the amount of effusion was increased on medial and middle longitudinal scans and was decreased on transverse scans.
sportEX comment Scanning devices are becoming more and more portable and more importantly for the therapist, significantly cheaper. They take much of the (educated) guess work out of diagnosis so should be a welcome addition to the medical tool box.
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