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2016 ; 44
(2
): 101-8
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Intra-articular treatment of knee osteoarthritis: from anti-inflammatories to
products of regenerative medicine
#MMPMID26985986
Richards MM
; Maxwell JS
; Weng L
; Angelos MG
; Golzarian J
Phys Sportsmed
2016[]; 44
(2
): 101-8
PMID26985986
show ga
OBJECTIVES: Knee osteoarthritis (OA) is a debilitating condition that may
ultimately require total knee arthroplasty (TKA). Non-operative treatments are
bracing, oral analgesics, physical therapy, and intra-articular knee injection
(IAKI). The objective of this paper is to provide a systematic literature review
regarding intra-articular treatment of knee OA and insight into promising new
products of regenerative medicine that may eventually have a substantial effect
on treatment. METHODS: A literature search was executed using Medline, Cochrane,
and Embase with keywords "knee osteoarthritis" and "injection." Specifically, 45
articles that discussed intra-articular knee injection using corticosteroids,
hyaluronic acid, analgesics, local anesthetics, and newer products of
regenerative medicine, such as platelet-rich plasma (PRP) and mesenchymal stem
cells (MSC), were analyzed. Of these, eleven were level 1, three were level 2,
twelve were level 3, two were level 4, and seventeen were level 5 evidence.
Papers included animal models. RESULTS: Local anesthetics have potential side
effects and may only be effective for a few hours. Morphine and ketorolac may
provide significant pain relief for 24 hours. Corticosteroids may give patients
weeks to months of effective analgesia, but complications may occur, such as
systemic hyperglycemia, septic arthritis, and joint degradation . Hyaluronic acid
is a natural component of synovial fluid, but efficacy with respect to analgesia
is controversial. Platelet-rich plasma formulations, autologous conditioned
serum, autologous protein solution, and mesenchymal stem cell injections contain
anti-inflammatory molecules and have been proposed to attenuate joint destruction
or potentially remodel the joint. CONCLUSIONS: Currently, knee OA treatment does
not address the progressively inflammatory environment of the joint. More
investigation is needed regarding products of regenerative medicine, but they may
ultimately have profound implications in the way knee OA is managed.
|Adrenal Cortex Hormones/adverse effects/therapeutic use
[MESH]