Efficacy of stromal vascular fraction for knee osteoarthritis:A prospective,single-centre,non-randomized study with 2 years follow-up

BACKGROUND Current osteoarthritis(OA)treatments focus on symptom relief without addressing the underlying disease process.In regenerative medicine,current treatments have limitations.In regenerative medicine,more research is needed for intra-articular stromal vascular fraction(SVF)injections in OA,including dosage optimization,long-term efficacy,safety,comparisons with other treatments,and mechanism exploration.AIM To compare the efficacy of intra-articular SVF with corticosteroid(ICS)injections in patients with primary knee OA.METHODS The study included 50 patients with Kellgren-Lawrence grades II and III OA.Patients were randomly assigned(1:1)to receive either a single intra-articular SVF injection(group A)or a single intra-articular ICS(triamcinolone)(group B)injection.Patients were followed up at 1,3,6,12,and 24 months.Visual analog score(VAS)and International Knee Documentation Committee(IKDC)scores were administered before the procedure and at all followups.The safety of SVF in terms of adverse and severe adverse events was recorded.Statistical analysis was performed with SPSS Version 26.0,IBM Corp,Chicago,IL,United States.RESULTS Both groups had similar demographics and baseline clinical characteristics.Follow-up showed minor patient loss,resulting in 23 and 24 in groups A and B respectively.Group A experienced a notable reduction in pain,with VAS scores decreasing from 7.7 to 2.4 over 24 months,compared to a minor reduction from 7.8 to 6.2 in Group B.This difference in pain reduction in group A was statistically significant from the third month onwards.Additionally,Group A showed significant improvements in knee functionality,with IKDC scores rising from 33.4 to 83.10,whereas Group B saw a modest increase from 36.7 to 45.16.The improvement in Group A was statistically significant from 6 months and maintained through 24 months.CONCLUSION Our study demonstrated that intra-articular administration of SVF can lead to reduced pain and improved knee function in patients with primary knee OA.More adequately powered,multi-center,double-blinded,randomised clinical trials with longer follow-ups are needed to further establish safety and justify its clinical use.

Knee osteoarthritis:A review of animal models and intervention of traditional Chinese medicine

Background:Knee osteoarthritis(KOA)characterized by degeneration of knee cartilage and subsequent bone hyperplasia is a prevalent joint condition primarily affecting aging adults.The pathophysiology of KOA remains poorly understood,as it involves complex mechanisms that result in the same outcome.Consequently,researchers are interested in studying KOA and require appropriate animal models for basic research.Chinese herbal compounds,which consist of multiple herbs with diverse pharmacological properties,possess characteristics such as multicomponent,multipathway,and multitarget effects.The potential benefits in the treatment of KOA continue to attract attention.Purpose:This study aims to provide a comprehensive overview of the advantages,limitations,and specific considerations in selecting different species and methods for KOA animal models.This will help researchers make informed decisions when choosing an animal model.Methods:Online academic databases(e.g.,PubMed,Google Scholar,Web of Science,and CNKI)were searched using the search terms“knee osteoarthritis,”“animal models,”“traditional Chinese medicine,”and their combinations,primarily including KOA studies published from 2010 to 2023.Results:Based on literature retrieval,this review provides a comprehensive overview of the methods of establishing KOA animal models;introduces the current status of advantages and disadvantages of various animal models,including mice,rats,rabbits,dogs,and sheep/goats;and presents the current status of methods used to establish KOA animal models.Conclusion:This study provides a review of the animal models used in recent KOA research,discusses the common modeling methods,and emphasizes the role of traditional Chinese medicine compounds in the treatment of KOA.

Adipose-derived regenerative therapies for the treatment of knee osteoarthritis

Knee osteoarthritis is a degenerative condition with a significant disease burden and no disease-modifying therapy.Definitive treatment ultimately requires joint replacement.Therapies capable of regenerating cartilage could significantly reduce financial and clinical costs.The regenerative potential of mesenchymal stromal cells(MSCs)has been extensively studied in the context of knee osteoarthritis.This has yielded promising results in human studies,and is likely a product of immunomodulatory and chondroprotective biomolecules produced by MSCs in response to inflammation.Adipose-derived MSCs(ASCs)are becoming increasingly popular owing to their relative ease of isolation and high proliferative capacity.Stromal vascular fraction(SVF)and micro-fragmented adipose tissue(MFAT)are produced by the enzymatic and mechanical disruption of adipose tissue,respectively.This avoids expansion of isolated ASCs ex vivo and their composition of heterogeneous cell populations,including immune cells,may potentiate the reparative function of ASCs.In this editorial,we comment on a multicenter randomized trial regarding the efficacy of MFAT in treating knee osteoarthritis.We discuss the study’s findings in the context of emerging evidence regarding adipose-derived regenerative therapies.An underlying mechanism of action of ASCs is proposed while drawing important distinctions between the properties of isolated ASCs,SVF,and MFAT.

Therapeutic effect of San Bi Tang combined with glucosamine sulfate capsules in cold-dampness-type knee osteoarthritis

BACKGROUND Cold-dampness-type knee osteoarthritis is a common middle-aged and elderly disease,but its pathogenesis is not fully understood,and its clinical treatment has limitations.Glucosamine sulfate capsules are commonly used for treating arthritis,and San Bi Tang is a classic formula of traditional Chinese medicine(TCM)that has the effects of warming yang,dispelling dampness,relaxing muscles,and activating collaterals.This research hypothesized that the combination of modified San Bi Tang and glucosamine sulfate capsules could enhance the clinical efficacy of treating cold-dampness-type knee osteoarthritis through complementary effects.AIM To analyze the clinical efficacy of San Bi Tang combined with glucosamine sulfate capsules when treating cold-dampness-type knee osteoarthritis.METHODS A total of 110 patients with cold-dampness-type knee osteoarthritis were selected as research subjects and randomly divided into a control group and an experimental group of 55 cases each.The control group received only treatment with glucosamine sulfate capsules,while the experimental group received additional treatment with modified San Bi Tang for a duration of 5 wk.The patients’knee joint functions,liver and kidney function indicators,adverse reactions,and vital signs were evaluated and analyzed using SPSS 26.0 software.RESULTS Before treatment,the two groups’genders,ages,and scores were not significantly different,indicating comparability.Both groups’scores improved after treatment,which could indicate pain and knee joint function improvement,but the test group had better scores.The TCM-specific symptoms and the clinical efficacy of the treatment in the test group were higher.Before and after treatment,there were no abnormalities in the patients’liver and kidney function indicators.CONCLUSION The combination of modified San Bi Tang and glucosamine sulfate capsules is superior to treatment with sulfated glucosamine alone and has high safety.

Autologous peripheral blood-derived orthobiologics:Different types and their effectiveness in managing knee osteoarthritis

Knees are the most commonly impacted weight-bearing joints in osteoarthritis(OA),affecting millions of people worldwide.With increasing life spans and obesity rates,the incidence of knee OA will further increase,leading to a significant increase in the economic burden.Conventional treatment modalities utilized to manage knee OA have limitations.Over the last decade,the role of various autologous peripheral blood-derived orthobiologics(APBOs)for the treatment of knee OA has been extensively investigated.This editorial provided an overview and focused on defining and shedding light on the current state of evidence based on the most recent published clinical studies concerning the use of APBO for the management of knee OA.While numerous studies have demonstrated promising results for these preparations,a notable gap exists in the comparative analysis of these diverse formulations.This absence of head-to-head studies poses a considerable challenge for physicians/surgeons in determining the optimal preparation for managing knee OA and achieving sustained longterm results.Thus,more adequately powered,multicenter,prospective,doubleblind,randomized controlled trials with longer follow-ups are needed to establish the long-term efficacy and to aid physicians/surgeons in determining the optimal APBO for the management of knee OA.

Study on compound Duzhong Jiangu granule in the treatment of knee osteoarthritis based on transcriptome analysis strategy

Duzhong Jiangu Granule in the treatment of primary osteoarthritis(POA)model of postmenopausal kidney deficiency type in Hartley female guinea pigs after ovariectomy,and the correlation between gene expression of bone marrow tissue,cartilage tissue,and knee osteoarthritis.Methods:383-months-old Hartley female guinea pigs after one week of adaptive feeding were weighed about 400 g±20 g,numbered,and sorted by ear tag.Six of them were selected as normal groups by looking up random number tables.The remainder were removed from the bilateral ovaries to construct the postmenopausal kidney deficiency model,and castrated guinea pigs were used to construct the postmenopausal kidney deficiency POA model.After the modeling cycle,a guinea pig from the blank group and a guinea pig from the model group were sacrificed and the right knee was observed.The model was established and the experiments continued.There were five guinea pigs in the blank group,and the remaining model guinea pigs were randomly divided into model control group,high-dose group of compound Duzhong Jiangu granules,middle-dose group of compound Duzhong Jiangu granules,low-dose group of compound Duzhong Jiangu granules and design group,with 5 guinea pigs in each group.Blanks and model groups were given a cellulose sodium solution by gavage.The guinea pigs were sacrificed after 30 days of intragastric administration.The left knee cartilage and bone marrow of the blank group,model group,middle dose group,and high dose group of compound Duzhong Jiangu granule were collected and applied to transcriptome sequencing,and the sequencing data were analyzed,including differential gene expression analysis,functional enrichment analysis of database established by Gene Ontology federation(GO)and Kyoto Encyclopedia of Gene and Genome(KEGG)pathway enrichment analysis.The complete specimens of the right knee joint were collected,and the morphological changes of the cartilage of the right knee joint in each group were observed by saffron rapid green staining,and the subchondral bone was quantitatively analyzed by Micro CT so that the expression of TRAF6,MIP-1βand IL-1βprotein in NF-kappa B signaling pathway was detected by Western Blot technique(WB).Results:The results of Safranin Fast Green staining showed that Compound Duzhong Jiangu Granules could effectively reduce the degree of morphological damage of articular cartilage in guinea pigs with the POA model.According to the analysis results of the subchondral bone structure under Micro CT,Compound Duzhong Jiangu Granules can improve the bone condition of the POA model,thus delaying the process of degenerative changes of the knee joint.From the results of transcriptome analysis,Compound Duzhong Jiangu Granules can inhibit the expression of related genes in POA model guinea pigs.According to the results of Wester Bolt verification,Compound Duzhong Jiangu Granules can effectively improve knee osteoarthritis.Conclusions:The effect of Compound Duzhong Jiangu Granules on OA is obvious,and its mechanism may be related to the expression of genes GZMK,Jchain,igkc,IGHV3-74,IGHV3-11,IGHV4-1,CCL5,and IGKV1–39.

Research Progress in Traditional Chinese Medicine Treatment of Knee Osteoarthritis

Knee osteoarthritis(KOA)is a degenerative disease characterized by pathological changes in the cartilage and subchondral bone of the knee joint.Initially,knee joint pain is the main symptom,and in the later stages,deformities and mobility disorders may occur.Modern medicine lacks effective treatment methods for early and mid stage KOA,and has drawbacks such as significant side effects and high costs.A large number of stud‐ies have confirmed that traditional Chinese medicine has unique advantages in treating KOA,and has obvious advantages such as small trauma,low cost,and definite therapeu‐tic effect,which are gradually being accepted by a large number of KOA patients.The commonly used methods for preventing and treating KOA with traditional Chinese medicine in clinical practice include:oral administration of traditional Chinese medi‐cine,external application of traditional Chinese medicine,fumigation,acupuncture therapy,massage therapy for regulating tendons,and targeted penetration therapy of tra‐ditional Chinese medicine.According to relevant literature,traditional Chinese medicine can significantly alleviate knee joint symptoms and improve knee joint function in patients with knee osteoarthritis,which is of great significance for the prevention and treatment of knee osteoarthritis.This article provides a review of the research progress in the prevention and treatment of KOA using traditional Chinese medicine in recent years.

Comparative effectiveness of adipose-derived mesenchymal stromal cells in the management of knee osteoarthritis:A meta-analysis

BACKGROUND Osteoarthritis(OA)is the most common joint disorder,is associated with an increasing socioeconomic impact owing to the ageing population.AIM To analyze and compare the efficacy and safety of bone-marrow-derived mesenchymal stromal cells(BM-MSCs)and adipose tissue-derived MSCs(AD-MSCs)in knee OA management from published randomized controlled trials(RCTs).METHODS Independent and duplicate electronic database searches were performed,including PubMed,EMBASE,Web of Science,and Cochrane Library,until August 2021 for RCTs that analyzed the efficacy and safety of AD-MSCs and BM-MSCs in the management of knee OA.The visual analog scale(VAS)score for pain,Western Ontario McMaster Universities Osteoarthritis Index(WOMAC),Lysholm score,Tegner score,magnetic resonance observation of cartilage repair tissue score,knee osteoarthritis outcome score(KOOS),and adverse events were analyzed.Analysis was performed on the R-platform using OpenMeta(Analyst)software.Twenty-one studies,involving 936 patients,were included.Only one study compared the two MSC sources without patient randomization;hence,the results of all included studies from both sources were pooled,and a comparative critical analysis was performed.RESULTS At six months,both AD-MSCs and BM-MSCs showed significant VAS improvement(P=0.015,P=0.012);this was inconsistent at 1 year for BM-MSCs(P<0.001,P=0.539),and AD-MSCs outperformed BM-MSCs compared to controls in measures such as WOMAC(P<0.001,P=0.541),Lysholm scores(P=0.006;P=0.933),and KOOS(P=0.002;P=0.012).BM-MSC-related procedures caused significant adverse events(P=0.003)compared to AD-MSCs(P=0.673).CONCLUSION Adipose tissue is superior to bone marrow because of its safety and consistent efficacy in improving pain and functional outcomes.Future trials are urgently warranted to validate our findings and reach a consensus on the ideal source of MSCs for managing knee OA.

Clinical value of ankle flexion and extension exercises combined with a psychological intervention in knee osteoarthritis

BACKGROUND Considering the limited effectiveness of clinical interventions for knee osteoarthritis(KOA),it is necessary to continue to explore appropriate and effective treatment strategies to improve the condition of KOA patients.AIM To clarify the influence of ankle flexion and extension exercises combined with a psychological intervention on the psychological status and activities of daily living(ADLs)of patients with KOA.METHODS The research participants were 116 KOA patients admitted to The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine between May 2019 and May 2022,including 54 patients receiving routine treatment,care and psychological intervention(control group)and 62 patients additionally treated with ankle flexion and extension exercises(research group).The two groups were comparatively analyzed in terms of psychological status(Self-rating Anxiety/Depression Scale,SDS/SAS),ADLs,knee joint function(Lysholm Knee Scoring Scale),pain(Visual Analog Scale,VAS),fatigue(Multidimensional Fatigue Inventory,MFI),and quality of life(QoL;Short-Form 36 Item Health Survey,SF-36).RESULTS After evaluation,it was found that the postinterventional SDS,SAS,VAS,and MFI scores in the research group were significantly reduced compared with the baseline(before the intervention)values and those of the control group,while the postinterventional Lysholm,ADL and SF-36 scores were markedly elevated.CONCLUSION Therefore,ankle flexion and extension exercises are highly effective in easing negative psychological status,enhancing ADLs,daily living ability,knee joint function and QoL,and relieving pain and fatigue in KOA patients,thus warranting clinical promotion.

Effects of acupotomy on the activity of osteoclasts and osteoblasts in the subchondral bone of rabbits with early and mid-stage knee osteoarthritis models

Objective:To investigate whether acupotomy could inhibit subchondral bone remodeling in knee osteoarthritis(KOA)rabbits by regulating the activity of osteoblasts and osteoclasts.Methods:KOA rabbits were prepared by immobilization for 6 and 9 weeks by Videman method.Nine groups of rabbits(control,6 weeks and 9 weeks model,6 weeks and 9 weeks acupotomy,6 weeks and 9 weeks electroacupuncture,and 6 weeks and 9 weeks drug groups)received acupotomy,electroacupuncture and risedronate sodium intervention,respectively,for 3 weeks.Results:Acupotomy can inhibit the activity of osteoclasts and osteoblasts in subchondral bone by reducing the proteins expression of cathepsin K(CK)and tartrate-resistant acid phosphatase(TRAP)and decreasing the proteins expression of osteocalcin(OCN)and alkaline phosphatase(ALP),to intercept the abnormal bone resorption and bone formation of subchondral bone in 6-week and 9-week immobilization-induced KOA rabbits.Conclusion:These findings indicated that acupotomy may be more advantageous than risedronate sodium intervention in modulating subchondral bone remodeling in KOA rabbits,especially in 9-week immobilization-induced KOA rabbits.

Research progress of necroptosis and ferroptosis in knee osteoarthritis

Knee osteoarthritis,as a chronic disabling disease,not only brings trouble to the patients,but also brings great psychological and economic burden to their families.Although there are various treatment methods,the curative effect is not good,mainly relieving symptoms,and cannot intervene the disease progression.Necroptosis and ferroptosis are two new pathways of programmed cell death discovered in recent years,they play a key role in the occurrence and development of knee osteoarthritis and also provide a new opportunity for the prevention and treatment of knee osteoarthritis.This article reviews necroptosis and ferroptosis and their related studies in knee osteoarthritis.

Research progress in mechanism of traditional Chinese medicine in the treatment of Knee Osteoarthritis

Knee osteoarthritis(KOA)is a chronic degenerative Osteoarthritis disease.The majority of patients with knee osteoarthritis were elderly patients.The disease not only greatly affects the work and life of patients but also brings serious burden to families and society.The traditional Chinese medicine has a long history in China,which has shown a multi-pathway and multitarget mechanism for the prevention and treatment of knee osteoarthritis.According to the properties of Chinese medicine,it was divided into four categories:drugs to promote blood circulation and remove blood stasis,drugs to clear heat,drugs to dispel wind dampness and drugs to tonify deficiency.In addition,the relevant literatures at home and abroad in recent five years were reviewed to summarize and generalize the mechanism of traditionalChinese medicine in the treatment of knee osteoarthritis,in order to provide reference for the treatment of knee osteoarthritis with traditional Chinese medicine.

Evaluation of the Therapeutic Effect of Contrast-Enhanced Ultrasound on Different Types of Knee Osteoarthritis in the Elderly

Objective: To evaluate the curative effect of the Traditional Chinese Medicine (TCM) external therapy on knee osteoarthritis patients with different TCM constitutions using musculoskeletal ultrasonography and contrast-enhanced ultrasonography, and to explore the application value of contrast-enhanced ultrasonography in knee joint diseases. Methods: A total of 57 patients diagnosed with knee osteoarthritis in Shaanxi University of Traditional Chinese Medicine from December 2019 to May 2021 were collected, and they were divided into qi stagnation and blood stasis type group (23 cases) and cold-dampness obstruction type group (34 cases) according to the traditional Chinese medicine method. All patients were given acupuncture combined with TCM fumigation and washing. All patients underwent musculoskeletal ultrasonography and contrast-enhanced ultrasonography before and after treatment, observed and recorded relevant data, and compared the treatment effects between the two groups. Results: 85.96% (49/57) of knee osteoarthritis (KOA) patients had suprapatellar bursa effusion, 42.1% (24/57) had iliotibial band bursae effusion, some of which had poor sound transmission, and thickened synovium was seen in most effusions, 33.33% (19/57) had osteophyte formation. Compared with before treatment, the depth of suprapatellar sac effusion in the Qi stagnation and blood stasis type group decreased after treatment (P Conclusion: Musculoskeletal contrast-enhanced ultrasonography was used to quantitatively evaluate the efficacy of TCM external therapy on KOA for different TCM constitutions. Dynamic observation of synovial lesions of knee osteoarthritis provides a valuable imaging method for evaluating the efficacy of traditional Chinese medicine.

Randomized, Double-Blind, Double-Masked, Parallel Group Clinical Study to Compare the Effectiveness of Diclofenac Potassium 150 mg, LP OD, vs Diclofenac Potassium 50 mg, TID, Three Times a Day, in Knee Osteoarthritis

Background: Osteoarthritis is a chronic disease associated with pain, inflammation, stiffness and synovial effusion, with progressive functional limitation, compromising quality of life. It progressively leads to loss or decrease in joint function. Pharmacological and non-pharmacological therapy seeks symptomatic management, complicated by a lack of adherence. After acetaminophen, non-steroidal anti-inflammatory drugs such as diclofenac are the most widely used medications. Objectives: The primary objective compared the analgesic effect of diclofenac 150 mg once daily vs. 50 mg three times daily in patients with knee osteoarthritis. The secondary objective assessed changes in quality of life. Method: One group received diclofenac 150 mg OD with placebo TTD. Another group received placebo OD and 50 mg active diclofenac (reference) TTD, both for 30 days. The evaluation of pain was carried out by a visual analog scale (VAS), at the beginning, 2, 3, 4, 15 and 30 days, quality of life (the WOMAC scale) and adverse effects, at 15 and 30 days. Results: Pain decreased significantly on days 15 and 30, compared to day 0, in both groups, without differences between groups. The total results in the WOMAC scale showed a very marked improvement at 15 and 30 days, without differences between groups. The most frequent adverse effects were constipation 6% in the reference group, and gastric discomfort 30.3% in the reference group vs 28.1%, in the Test group. Conclusions: Prolonged-release diclofenac 150 mg OD is as effective as diclofenac 50 mg TID for the treatment of patients with knee osteoarthritis.

Clinical and Magnetic Resonance Image Changes of Platelet-Rich Plasma Therapy in Combination with Human Mesenchymal Stem Cells from Autologous Adipose Tissue for Knee Osteoarthritis Treatment

Objective: To evaluate the efficacy based on clinical symptom and on magnetic resonance image of platelet-rich plasma therapy in combination with mesenchymal stem cells from autologous adipose tissue for knee osteoarthritis treatment. Patients and Method: 30 patients including 26 females and 4 males;correspondingly, 60 knee joints were diagnosed with osteoarthritis with stages II - III of Kellgren and Lawrence, their mean age was 58.63 ± 11.11. All were injected with autologous platelet-rich plasma that was extracted by PRP set, APC 30 PRP PRCEDURE PRAK and autologously extracted mesenchymal stem cells from abdominal adipose tissue using the ADI-25-01 ADIPOSEPRCEDURE PRAK of USA. Results: After 12 months: the pain level according to VAS score at the right knee joint was decreased from 6.0 ± 1.28 before treatment to 1.9 ± 0.3;VAS score at the left knee joint was decreased from 6.43 ± 1.19 to 2.25 ± 0.43. Total Lequene score at right knee joint was decreased from 16.04 ± 1.57 before treatment to 4.31 ± 1.04, at left knee joint was decreased from 17.52 ± 1.74 before treatment to 5.15 ± 1.48. Total WOMAC score at right knee joint was decreased from 55.93 ± 5.56 to 10.37 ± 1.56;at left knee joint was decreased from 53.97 ± 5.57 to 10.07 ± 1.59. There were 86.77% joints with cartilage thickness change and the patellar cartilage thickness was increased from 1.56 ± 0.09 mm before treatment to 1.65 ± 0.09 mm. Conclusion: The treatment of knee osteoarthritis by platelet-rich plasma therapyin combination with mesenchymal stem cells from autologous adipose tissue is effective in reducing pain, improving patient's mobility and walking function, reforming articular cartilage thickness on magnetic resonance image.

Some Problems of Warm Acupuncture in the Treatment of Knee Osteoarthritis

Knee osteoarthritis(KOA)is a chronic derivative joint issue that mainly damages the artistic cartilage and leads to pain,swelling,and stiffness around the joint,which is commomly worldwide.With the aging of society and the increment in obesity rate,the incidence of KOA increases sharply,which seriously effects the quality of human life.Before,how to take effective treatment methods is very important.Severe ways to treat the disease include non-steroidal drugs,local injections,surgery,and cell and gene therapies.However,each therapy has certain defections,such as gastrotestinal tract irritation,cardiovascular safety,or high medical costs for patients.Traditional Chinese medicine has a long history in treating KOA,reported by acupuncture,massage,internal administration of traditional Chinese medicine,and external use of traditional Chinese medicine.In clinical practice,patients can be treated from the root agreement to different etiology,and patients can be treated agreement to different syndrome types by syndrome difference to achieve effect.Studies have shown that warm acupuncture is effect in treating KOA.It has two kinds of treatment methods:acupuncture and moxibustion at the same time.It has fewer side effects and is more acceptable to patients.However,there are still some problems in the basic research and clinical application of warm acupuncture and moxibustion in treating KOA.This paper discussed the existing problems from the followingfive aspects:lack of unified synthesis difference and treatment system,problems in clinical research,weak basic research,problems in the study of moxibustion,and lack of the best treatment program recognized by the academic community.Meanwhile,the selection of acupoints,the relationship between acupuncture depth and anatomy should be further studied in order to offer research ideas for the healthy development of the treatment of KOA with warming acupuncture and moxibustion in the future.

Effectiveness of Maitland and Mulligan mobilization methods for adults with knee osteoarthritis:A systematic review and metaanalysis

BACKGROUND As a serious global problem,knee osteoarthritis(KOA)often leads to pain and disability.Manual therapy is widely used as a kind of physical treatment for KOA.AIM To explore further the efficacy of Maitland and Mulligan mobilization methods for adults with KOA.METHODS We searched PubMed,the Cochrane Library,EMbase,Web of Science and Google Scholar from inception to September 20,2020 to collect studies comparing Maitland and Mulligan mobilization methods in adults with KOA.The quality of the studies was assessed using the Physiotherapy Evidence Database Scale for randomized controlled trials.Data analyses were performed using Review Manager 5.0 software.RESULTS A total of 341 articles were screened from five electronic databases(PubMed,the Cochrane Library,EMbase,Web of Science and Google Scholar)after excluding duplicates.Ultimately,eight trials involving 471 subjects were included in present systematic review and meta-analysis.The mean PEDro scale score was 6.6.Mulligan mobilization was more effective in alleviating pain[standardized mean difference(SMD)=0.60;95%confidence interval(CI):0.17 to 1.03,P=0.007;I2=60%,P=0.020]and improving Western Ontario and McMaster Universities function score(SMD=7.41;95%CI:2.36 to 12.47,P=0.004;I2=92%,P=0.000).There was no difference in the effect of the two kinds of mobilization on improving the range of motion(SMD=9.63;95%CI:-1.23 to 20.48,P=0.080;I2=97%,P=0.000).CONCLUSION Mulligan mobilization technique is a promising intervention in alleviating pain and improving function score in KOA patients.

A comprehensive health education plus monitoring support program for older adults with knee osteoarthritis coexisting with overweight and type 2 diabetes

Objectives:To examine the patient outcomes of a comprehensive health education plus village health volunteer monitoring support program on older adults with knee osteoarthritis who are overweight and have type 2 diabetes.Methods:Quasi-experimental,two-group,pretest-posttest design was applied.Using random geographic cluster sampling,older adults who met the inclusion criteria were assigned to two groups,62 in the intervention group and 71 in the control group.The intervention group received the comprehensive health education plus village health volunteer monitoring support program.The control group received only the comprehensive health education program.Study outcomes,including blood glucose level,knee pain and range of motion,body weight,physical ability(Timed Up and Go Test),fatigue,depressive symptoms,quality of sleep,and quality of life,were assessed at baseline,3 months,and 6 months after enrollment and analyzed using descriptive statistics and multivariate analysis of variance.Results:One hundred and ten participants completed the study(55 participants in each group).Most patient outcomes in the two groups showed general improvement with statistical significance(P<0.001):pain decreased,physical ability improved,less depressive symptoms and fatigue,quality of life and sleep improved.The interaction effect(the group and time)demonstrated statistically significant differences between the intervention and control groups on pain,knee range of motion,and fatigue according to each time follow-up(P<0.001).Conclusions:The comprehensive health education plus village health volunteer monitoring support program promotes good patient outcomes in this population.The integrated health education resource and support for older adults with knee osteoarthritis and type 2 diabetes is an effective,non-surgical treatment that highlights professional nursing roles and non-professional rolesdvillage health volunteers.Nurses should consider implementing a health education plus monitoring support program to mitigate the effects of chronic diseases and improve patients’quality of life.

Effects of lower body positive pressure treadmill on functional improvement in knee osteoarthritis:A randomized clinical trial study

BACKGROUND Knee joint pain and stiffness are the two main symptoms of knee osteoarthritis(OA)and thus restrict a patient’s activities,such as walking and walking up and downstairs.The lower body positive pressure(LBPP)treadmill as one of the emerging body weight support system devices brings new hope for exerciserelated rehabilitation for knee OA patients.AIM To investigate the biomechanical effects and the subjective clinical assessment of LBPP treadmill walking exercise when compared with conventional therapy in mild to moderate knee OA patients.METHODS Eighteen patients with mild-to-moderate knee OA were recruited in this randomized controlled trial(RCT)study.The eligible knee OA patients were randomly assigned to two groups:LBPP and control groups.The patients in the LBPP group performed an LBPP walking training program for 30 min/session per day,6 d per week for 2 wk whereas the patients in the control group performed walking on the ground for the same amount.All patients underwent clinical assessments and three-dimensional gait analysis at pre-and 2-wk post-treatment.RESULTS The Western Ontario and McMaster Universities Arthritis Index and visual analog scale scores in both the LBPP group and control group were found to decrease significantly at the post-treatment point than the pre-treatment point(LBPP:70.25±13.93 vs 40.50±11.86;3.88±0.99 vs 1.63±0.52;control:69.20±8.88 vs 48.10±8.67;3.80±0.79 vs 2.60±0.70,P<0.001).Moreover,compared with the control group,the LBPP group showed more improvements in walking speed(P=0.007),stride length(P=0.037),and knee range of motion(P=0.048)during walking,which represented more improvement in walking ability.CONCLUSION The results of our RCT study showed that the LBPP group has a greater effect on improving gait parameters than the conventional group,although there was no significant advantage in clinical assessment.This finding indicates that LBPP treadmill walking training might be an effective approach for alleviating pain symptoms and improving lower extremity locomotion in mild to moderate knee OA patients.

Effect of acupotomy on chondrocyte proliferation and expression of CyclinD1,CDK4 and CDK6 in rabbits with knee osteoarthritis

Objective:The aim of this study was to investigate the mechanism of acupotomology(Apo)in the prevention of articular cartilage destruction via the promotion of chondrocyte proliferation and chondrocyte expression of cell cycle regulators,CyclinD1,CDK4 and CDK6 in a rabbit knee osteoarthritis(KOA)model.Methods:Twenty-eight rabbits were randomly divided into a control group,an OA(osteoarthritis)model group,an Apo(acupotomology)group and EA(electro-acupuncture)group(n Z 7).Improved Videman’s method was used to induce a rabbit model of KOA over 6 weeks.One week later,acupotomy and electro-acupuncture therapy was applied to animals in the respective groups and treatment lasted 4 weeks.Following these treatments,quantitative real-time PCR,immunohistochemical staining and western blotting were performed to assess the mRNA and protein levels of cell cycle regulators CyclinD1(Cell cycle protein D1),CDK4(Cyclin-dependent kinase 4)and CDK6(Cyclin-dependent kinase 6).Ethology measures and knee morphology were also compared among groups.Results:The Lequesne MG index score of morphology was increased(P<.01),and the passive range of motion(PROM)and the mRNA and protein levels of CyclinD1,CDK4,and CDK6 were significantly decreased(P<.01)in the OA model compared with the control group.The Lequesne MG index score and the morphology score were decreased in the Apo and EA group compared with the OA model group(P<.05 or P<.01),while the mRNA levels of CyclinD1,CDK4,and CDK6,and the protein levels of CDK4 were increased in the Apo and EA groups compared with the OA model group(P<.05 or P<.01).The PROM,and the protein levels of CyclinD1 and CDK6 were increased(P<.05)in the Apo group compared with the OA model group,while the PROM and the protein levels of CyclinD1 and CDK6 in the EA group were not significantly different(P>.05).Compared with the EA group,the morphology score was decreased in Apo group(P<.05).Conclusions:The mRNA levels of CyclinD1 and CDK4,and the protein level of CDK4 in chondrocytes are regulate by both Apo and EA.Apo is more effective than EA in regulating the protein levels of CyclinD1 and CDK6.According to the observed changes in morphology and cytokine levels,acupotomy can promote chondrocyte proliferation and can alleviate the destruction of articular cartilage in a model of KOA.