knee

Zizyphus jujuba is a thorny Rhamnaceous plant found throughout Europe and Southeast Asia. It possesses medicinal properties and is utilized in traditional medicine. Frankincense is recognized for its analgesic properties. The purpose of this study was to determine the anti-nociceptive efficacy of Z. jujuba and Frankincense in assessing their effect on pain associated with knee osteoarthritis. This research included 46 people ranging in age from 50 to 70 years. They were placed into two groups: test and control. Z. jujuba and Frankincense pills were made, and participants were given a Persian-validated Western Ontario and McMaster Universities (WOMAC), and visual analogue score (VAS) questionnaire. The variables were evaluated before and after the intervention. In the test group, there was a considerable decrease in pain VAS score following the administration of dosages of Z. jujuba/Frankincense pills. The analgesic efficacy of the aforementioned herbal medicines under study was significant after taking mixed jujube/frankincense/aloe vera tablets at doses of 250 mg/100 mg/25 mg, respectively. The combined standardized mean difference for the WOMAC, were 14.56 ± 3.2, 13.9 ± 3.50, and 13.33 ± 4.09, for the before, one-week, and one-month follow-ups, respectively. WOMAC and VAS scores were different between “before intervention” as well as both “one week”, and “one-month” follow-ups. In summary, pain reduced in study group compared to their respective baseline (VAS and WOMAC outcome measures). These findings confirmed that Z. jujube, and frankincense supplementation effectively reduce pain and improve functional outcomes in OA patients, supporting their use as a complementary treatment alongside standard therapies.

Gonarthrosis (GA) is a chronic degenerative disease. This study aimed to determine the frailty level of patients with GA aged 65 and over and to investigate the effect of pain on frailty.

The population of this cross-sectional study consisted of patients and their relatives who applied to the orthopedics and traumatology outpatient clinic of a university hospital for examination, follow-up and treatment from October 1, 2021, to January 31, 2022. The study was completed with 160 elderly people aged 65 years and over. Data were collected using Personal Information Form, Tilburg Frailty Indicator (TFI), Get Up and Go Test (GGT), and Geriatric Pain Scale (GPS). Simple descriptive statistics, as well as correlation and multiple linear regression analysis, were used to analyze the data using SSPS 20. The significance level was set at p <0.05.

In this study, 45.6% of the participants were found to have moderate pain (52.42±12.40), 70% were frail (7.58±2.13), and 36.9% had a fall risk (17.15±7.57). The mean TFI (7.48±2.38), GGT (12.01±6.16), and GPS (71.37±14.20) scores of the participants with GA were significantly higher than those without GA. The frailty scores of the participants with severe pain and a high risk of falling were significantly higher (p <0.05). Moreover, the pain severity of the participants accounted for 47.7% of the frailty level. According to our regression model, the variable affecting the severity of major pain was GA stage IV (p=0.000), which increased pain by 3.260 (2.456-3.944) times.

The study provides ample evidence supporting the potential importance of pain severity assessment and pain management to prevent frailty in patients with GA aged 65 and over.

Total joint arthroplasty (TJA) of the lower extremities is a successful surgical procedure for end-stage degeneration and is gaining increasing popularity worldwide. Preexisting neurological conditions have been a significant challenge for arthroplasty surgeons for a long time, and they have avoided performing TJA in these patients. Parkinson’s disease (PD), an age-related neurodegenerative disorder, is prevalent and associated with a higher likelihood of gait imbalance, falling, and osteoarthritis (OA). The number of patients with PD who experience hip and knee OA is increasing. As a result, some of these individuals may need to undergo total hip or knee arthroplasty (THA/TKA) to alleviate symptoms and improve their function. Patients with PD present a remarkable set of challenges for surgeons owing to increased muscle tone, higher fracture risk, and ligament instability. Currently, limited information is available regarding the outcomes and effectiveness of these procedures in PD patients. The lack of data is a concern because it prevents surgeons from making informed decisions regarding the use of TJA in this patient population. This study aims to summarize the recent literature regarding total hip arthroplasty (THA) and total knee arthroplasty (TKA) procedures in patients with PD to help surgeons in this challenging setting and improve their knowledge of potential complications and outcomes in this complex background.

Low back pain (LBP) is a significant issue in both clinical and public health settings, resulting in high healthcare and social costs. While knee joint pain is more prevalent than hip joint pain, standing posture is influenced not only by spinal alignment but also by hip and knee joint alignment. The knee and spine are interconnected anatomically, and degenerative changes in one area could often cause discomfort in the entire axis, leading to what is known as "knee-spine syndrome". LBP is a common condition associated with knee pain and can significantly affect the results of total knee arthroplasty (TKA). Surgeons need to consider knee-spine syndrome before any surgical intervention in patients with knee or back pain and explain it to the patients before the surgery.

The use of metal screws for the fixation of knee osteochondral lesions requires a second surgery for screw removal. However, bioabsorbable screws are expensive and not widely available in many orthopedic centers. 

This study aims to determine the outcomes of Kirschner wire (K-wire) fixation in such lesions, which are easily removable and widely available in most orthopedic centers.

The medical profiles of 15 patients with knee osteochondral lesions managed with K-wire fixation were retrospectively reviewed. The etiology of the lesion was osteochondritis dissecans in seven patients, femoral condyle fracture in four, and osteochondral lesion of the patella in four. Functional outcomes were evaluated using the knee injury and osteoarthritis outcome score (KOOS), International Knee Documentation Committee (IKDC) score, and Lysholm knee scoring scale. Postoperative complications were derived from patient profiles.

The study population included nine males and six females, averaging 16.2±3.2 years. The patients had a mean follow-up of 27.9±21.9 months. The patients’ mean KOOS was 95.7±5.5. The mean IKDC score was 95.9±8.3. The mean Lysholm knee score was 96.7±4.9. Accordingly, knee function was excellent in 11 patients and good in four. Nonunion was observed in one patient (6.7%) who required reoperation. One patient underwent manipulation under anesthesia. 

K-wire fixation provides acceptable results for managing knee osteochondral lesions and can be considered an adequate substitute for conventional methods.

There have not been any clear studies on the use of mesenchymal stem cells (MSCs) to treat osteoarthritis (OA) in the knee.

This study investigates the effects of different MSC dosages on pain alleviation in individuals with OA in the knee by conducting a meta?analysis of existing randomized controlled trials. Electronic resources such as Google Scholar,PubMed, Cochrane Library, and Web of Science were searched up until June 2023. Treatment effect sizes were computed using the knee osteoarthritis outcome score (KOOS), the Western Ontario and McMaster Universities Osteoarthritis Index  WOMAC), and the Knee Society Score (KSS). Random or fixed effect models were applied to aggregate the data. We performed a subgroup analysis according to dosage level. The heterogeneity of the research was investigated using the Chi?square test and the I2 index.

The meta?analysis included 26 studies with a total sample size of 739 patients. A significant reduction in pain was observed 1 year and 2 years following the injection of MSCs into the injured joint, as indicated by the Visual Analogue Scale, WOMAC, KOOS, and KSS indexes (P < 0.05). Patients on MSCs reported much reduced pain after 1 and 2 years compared to the control group (P < 0.05). Subgroup and meta?regression analyses revealed no statistically significant variations in the effectiveness of MSC dosage (P < 0.05). The studies did not report any adverse effects.

Different dosages of MSCs had the same pain?relieving effectson patients with OA in the knee. MSC injections were safe and beneficial in such cases.

Knee arthroplasty procedures improve pain, function, stability, and appearance of the limb. Total knee arthroplasty (TKA) in severe, long-standing osteoarthritis (OA) with large medial tibial defects could be a challenge. This paper looks at TKA outcomes when large tibial defects are managed without metal wedges or stems.

TKA cases done for OA with tibial defects of 15-25 mm, without any metal wedge or stem from 2004 to 2017 by a single surgeon in Shiraz, Iran, were clinically and radiographically evaluated. The preoperative questionnaires of SF36, WOMAC, KSS, and radiographs were compared with the follow-up assessments of the same parameters. Data were analyzed by R programming language using student t test, ANOVA, and Kruskal-Wallis. P<0.05 was considered significant. 

91 knees in 72 patients at 65.99±8.66 years of age and 8.28±2.58 years follow-up were studied. The tibial defects were managed with extra tibial cuts and adjustment of tibial component position in all, and the addition of structural autograft in 14 knees. 89 (98%) knees survived with a knee society score (KSS) of 79.4±17.6 and were significantly functioning well (P<0.001). Two knees required revision surgery. Significant improvement in outcome measurements was seen in all cases (P<0.001). No radiographic loosening, alignment change, or clinical instability was detected. The tibial plateau reconstruction without bone grafting and the ones that had autologous bone grafting had similar functional results and radiographic outcomes.

TKA with tibial defects of 15-25 mm treated with a semi-constrained posterior-cruciate ligament (PCL) sacrificing condylar prosthesis without any metal wedges or stem extensions with or without additional autogenous bone graft obtained very good functional and radiographic outcome and 97% survival in 6-17 years follow-up.

Surgical fixation is required for displaced posterior cruciate ligament (PCL) tibial bony avulsion fractures or with fractures having grade 2 or more posterior instability. The purpose of this study is to evaluate the results of arthroscopic fixation of PCL tibial bony avulsion fractures using the double suture bridge technique.

A retrospective study was done involving 24 patients having displaced PCL tibial bony avulsion fractures. The arthroscopic double suture bridge technique was used to fix these fractures. Patients were followed up for a period of 3 year and assessed for knee related symptoms, signs, Lysholm knee score and satisfaction.

The study group consisted of 21 males and 3 females. Fracture union was achieved in all cases by 2 months post operative. The mean Lysholm knee score at follow up of 3 months, 6 months, 1 year, 2 years and 3 years was 86.6, 96.5, 98.8, 99.1 and 99.4 respectively.  At latest follow up all the patients were satisfied with their knee function with respect to pain, range of motion, stability and resumption of pre injury activity level.

The arthroscopic double suture bridge technique is an effective method for fixation of PCL tibial bony avulsion fractures with respect to knee stability, range of motion and resumption of pre injury activity level.

This study aims to evaluate the effectiveness and safety of Aspirin and LMWH in an arthroscopic anterior cruciate ligament (ACL) reconstruction of low-risk patients. 

We conduct a single-center, assessor-blind, simple randomized clinical trial from March 2019- May 2020. 18 to 45 years old patients with ACL rupture without concomitant injury, diagnosed by magnetic resonance imaging, enrolled in the study. Selected subjects were allocated between three parallel arms of the study, with 46 participants. Three parallels are 8o mg aspirin bid for 14 days, LMWH subcutaneous injection for 14 days, and no treatment parallel. Effectiveness outcomes were estimated by the DVT rate and PE rate, and safety was checked out by bleeding or hemarthrosis. Orthopedists assessed knee effusion with stroke score and ask patients for any symptoms during weekly clinic visits. The radiologist performed ultrasonography of lower extremities, searching for a sign of DVT. 

Mean age of participants was 31.4 + 5.6, and 93 individuals (67%) were male and 23% were female. No DVT and PE were observed. Three cases in the LMWH and one case in aspirin groups had minor surgical site bleeding. One case of hemarthrosis with normal ultrasonography occurred in the LMWH group. Regarding safety and effectiveness, there was no statistically significant difference between the parallels. 

Use of LMWH or Aspirin after simple arthroscopic ACL reconstruction in low-risk patients have no different effectiveness. Hence routine use of thromboprophylaxis in this setting is questionable, although adverse events are rare.

Knee osteoarthritis (KOA) is the most expected diagnosis for an arthropathy that causes discomfort and disability in older adults. Radiography is frequently used to assess patients with KOA and there have been few prior research evaluating the diagnostic efficacy of ultrasonography (US). The current study sought to assess the diagnostic efficacy of the US in identifying variouscharacteristics of KOA in the scientific literature.

This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement. A  ystematic search in PubMed, Web of Science, Scopus, and Embase databases was completed in March 2023. This study focused on the diagnostic value of US in KOA, including sensitivity, specificity, positive predictive value, and negative predictive value. The quality assessment was conducted using the Joanna Briggs Institute critical appraisal tools.

Out of 552 records of database searches, finally, two studies met this systematic review’s eligibility criteria and were included in the study. Both of the included studies were cross sectional studies. US demonstrated remarkable sensitivity with adequate specificity for the detection of radiographic knee OA; however, it was found not to be an appropriate method for the detection of early KOA.

This study as the first systematic review aims to evaluate the diagnostic performance of US in detecting KOA. These findings shed light on the importance of investigating the different US features in the evaluation of KOA to reach appropriate sensitivity and specificity in the diagnosis

Reducing pain is the most important goal of total knee arthroplasty (TKA). 

The present study aimed to evaluate the effect of systemic corticosteroids on pain control after TKA.

The present study was performed as a randomized controlled clinical trial study on 75 patients. Patients were randomly assigned to three groups (n=25): the dexamethasone (Dex) group received Dex 8 mg/IV at three times (24 mg), the Met group received methylprednisolone  (Met)125 mg/IV, and the control group received isotonic fluid IV (placebo). Primary outcomes included knee nausea, vomiting, and pain 4, 12, and 24 hours after surgery. The pain was assessed using the visual analog scale. Also, patients’ performance indices were evaluated based on the Western Ontario and McMaster universities osteoarthritis (WOMAC) index after surgery.

The mean scores of pain, 4, 12, and 24 h after surgery in the Dex and Met groups were significantly lower than the placebo group (P<0.001). The mean score of WOMAC and subscales in the Dex, Met, and placebo groups was not significantly different. Postoperative nausea was reduced significantly in the Dex group (P=0.002).

This study shows that administering 24 mg Dex or 125 mg Met significantly reduces pain and nausea 6, 12, and 24 hours after TKA. The effect of Met is significantly less than Dex in controlling pain and nausea. In contrast, Dex and Met had no impact on improvement based on the WOMAC index in patients after TKA.

The request for total knee arthroplasties (TKA) is increasingly being raised and imposes an enormous burden on the healthcare system. Most subjects represent symptomatic concomitant low back pain (LBP) at baseline, interfering with functional outcomes with little or no improvement in mental health following TKA. Orthopedics should notify the patients suffering from concomitant LBP about the like hood of unfavorable recovery. The authors describe the functional outcomes and satisfaction following TKA in patients suffering from concomitant LBP.

Patellofemoral pain syndrome (PFPS) is one of the common causes of anterior knee pain in young people. This study investigated the length difference of lower limbs in patients with PFPS syndrome. In this descriptive cross-sectional study, the difference in the length of the lower limbs of patients in the supine position was assessed using five different clinical methods. These five methods included: 1- the measurements of the actual length of the lower limb, 2- the apparent length of the lower limb, 3- the method of Iliac Crest Palpation and Book Correction (ICPBC) under the short leg of the patient, 4- evaluation of the internal ankles, and 5- bilateral anterior superior iliac spine (ASIS). Data were analyzed using the SPSS software. Nearly 60% of the patients with PFPS felt pain in both knees. The average actual length difference of the lower limbs in patients was 7.00±4.04 mm. Moreover, 75% of the patients had a limb length difference of more than 4 mm. There was no significant difference in the actual length of the limbs regarding age, BMI, employment status, and history of underlying diseases. However, these factors were significantly higher among women than men (p=0.047). Moreover, the results showed that the average length of limbs was significantly lower among patients who exercised during the week (p=0.015). Measurement of lower limb length had moderately correlated using two methods of actual limb length and ICPBC (p=0.001, Kappa=0.421) and two methods of apparent limb length and medial ankle (p=0.032, Kappa=0.317). The difference in lower limb length was more than 4 mm in most patients (75%). Furthermore, in most patients with knee pain on the left side (unilateral/bilateral left more severe), their right side was short and vice versa.

Only 3% of all proximal tibial fractures result in an avulsion fracture of the tibial tuberosity. It is often seen in youngsters between the ages of 3 and 6 and is less frequent after puberty.

Case Report:

A 15-year-old boy was presented with severe left knee pain following a high jump. X-ray and computed tomography (CT) scan showed a tibial tuberosity fracture with joint surface involvement. The damaged part was fixed with a 4.5mm cannulated screw and washer, reinforced with 2 SwiveLock anchors. In the sixth week, full weight bearing and full range of motion (ROM) were obtained.

The primary objective in managing tibial tubercle fractures is the restoration of both the extensor mechanism and the integrity of the joint surface in cases where they have been compromised.

We greatly appreciate the comments on our recent technical note. However we continue to support the effectiveness of our hamstrings harvest technique, cause of no differences in terms of premature amputations of the graft were observed and the other technique proposed does not eliminate the risk of damage to the infrapatellar branch of the saphenous nerve.