BACKGROUND Non-steroid anti-inflammatory drugs(NSAIDs)have played a crucial role in the treatment of osteoarthritis,especially in the early stages.However,the cardiovascular risk and adverse gastrointestinal reactions...BACKGROUND Non-steroid anti-inflammatory drugs(NSAIDs)have played a crucial role in the treatment of osteoarthritis,especially in the early stages.However,the cardiovascular risk and adverse gastrointestinal reactions of oral NSAIDs in elderly people cannot be underestimated.Intra-articular injection of NSAIDs may be a new attempt for early knee osteoarthritis treatment.Parecoxib may be a suitable drug for intra-articular injection.AIM To observe the clinical efficacy of the intra-articular injection of parecoxib for early knee osteoarthritis.METHODS Early knee osteoarthritis patients(n=110)were retrospectively analyzed.These patients were divided into three groups:Basic treatment+oral glucosamine(group A,n=37),oral celecoxib+basic treatment+oral glucosamine(group B,n=37),and intra-articular injection of parecoxib+basic treatment+oral glucosamine(group C,n=36).Intra-articular injection of parecoxib was performed once every 2 wk at a dose of 40 mg each time,for three times total.The three groups were compared in terms of visual analogue scale(VAS)scores,Hospital for Special Surgery(HSS)scores and patient satisfaction before and after treatment.The levels of inflammatory cytokines in the synovial fluid were detected in the three groups before and after treatment.RESULTS All patients were followed up for an average of 15.5±2.7 mo.The clinical efficacy was estimated by VAS and HSS scores at 12 mo after treatment.Inflammatory cytokine levels in the synovial fluid were evaluated at 3 mo after treatment.VAS and HSS scores were significantly improved in each group compared with before(P<0.001).There were significant differences among the three groups in VAS and HSS scores(P<0.001).The clinical efficacy of group C was superior to that of groups A and B(P<0.001),while group B outperformed group A in this respect(P<0.001).The patient satisfaction was the highest in group C(P<0.001).After treatment,the levels of tumor necrosis factorα(TNF-α)and interleukin(IL)-6 in the synovial fluid decreased in each group compared with before(P<0.001),while the levels of IL-10 increased(P<0.001).The three groups differed significantly in the levels of TNF-a,IL-6 and IL-10 in the synovial fluid after treatment(P<0.001).CONCLUSION For patients with early knee osteoarthritis,intra-articular injection of parecoxib could effectively improve clinical symptoms.This method may be a reliable alternative for early knee osteoarthritis.展开更多
Tetramethylpyrazine(TMP) is a traditional Chinese herbal medicine with strong antiinflammatory and cartilage protection activities, and thus a promising candidate for treating osteoarthritis. However, TMP is rapidly c...Tetramethylpyrazine(TMP) is a traditional Chinese herbal medicine with strong antiinflammatory and cartilage protection activities, and thus a promising candidate for treating osteoarthritis. However, TMP is rapidly cleared from the joint cavity after intra-articular injection and requires multiple injections to maintain efficacy. The aim of this study was to encapsulate TMP into poly(lactic-co-glycolic acid)(PLGA) microspheres to enhance the TMP retention in the joint, reducing injection frequencies and decreasing dosage. TMP microspheres were prepared by emulsion/solvent evaporation method. The intra-articular retention of the drug was assessed by detecting the drug concentration distributed in the joint tissue at different time points. The therapeutic effect of TMP microspheres was evaluated by the swelling of knee joints and histologic analysis in papain-induced OA rat model. The prepared freezedried microspheres with a particle size of about 10 μm can effectively prolong the retention time of the drug in the articular cavity to 30 d, which is 4.7 times that of the TMP solution.Intra-articular injection of TMP microspheres efficiently relieved inflammatory symptoms,improved joint lesions and decreased the depletion of proteoglycan. In conclusion, intraarticular injection of TMP loaded microspheres was a promising therapeutic method in the treatment of OA.展开更多
AIM: To test whether intra-articular injection of porcine adipose-derived stem cells(ADSCs) can treat canine osteoarthritis(OA).METHODS: To enroll in this study dogs must have stifle joint OA that had lasted ≥ 3 mo a...AIM: To test whether intra-articular injection of porcine adipose-derived stem cells(ADSCs) can treat canine osteoarthritis(OA).METHODS: To enroll in this study dogs must have stifle joint OA that had lasted ≥ 3 mo and been treated with OA medication without significant improvement. Three dogs fulfilled these criteria and were thus subjects for ADSCs treatment. ADSCs were isolated from abdominal adipose tissue of a 2-mo-old female Yorkshire pig. Their stem cell marker expression was examined by immunofluorescence staining. For treatment, 5 million ADSCs were injected into the diseased joint of each dog. In the next 48 h, the patient was observed for signs of inflammatory and allergic reactions. Thepatient was then discharged to the owner and, at 2, 6, and 12 wk, followed up with orthopedic assessment, owner questionnaire, X-ray imaging, and force-plate gait analysis.RESULTS: Porcine ADSCs expressed mesenchymal stem cell markers CD90 and CD105. Injection of porcine ADSCs into canine stifle joints did not cause any inflammatory or allergic reactions. Orthopedic evaluation found improvements in two dogs, particularly at the longest time point. Owners' evaluation found increased capacity and decreased pain in all three dogs' activities such as walking and running. Radiographic evaluation did not find statistically significant differences before and after treatment. Force-plate analysis found significant improvements in all three dogs after treatment.CONCLUSION: Xenotransplantation of ADSCs for the treatment of OA is feasible. Further studies are needed to validate this novel treatment modality, which can then be implemented for the routine treatment of OA in veterinary medicine.展开更多
Objectives: To evaluate the postoperative analgesic yield of continuous intra-articular (IA) ropivacaine/tramadol infusion as against infusion of ropivacaine alone after total knee arthroplasty. Patients and Methods: ...Objectives: To evaluate the postoperative analgesic yield of continuous intra-articular (IA) ropivacaine/tramadol infusion as against infusion of ropivacaine alone after total knee arthroplasty. Patients and Methods: Sixty patients accompanied by arthrosis were randomly divided into three equal groups: The ropivacaine group, which obtained a continuous intraarticular (IA) infusion of ropivacaine alone;the combination group, which obtained a continuous (IA) infusion of a combination of ropivacaine and tramadol at a rate of 6 ml/h for 72 h postoperatively;and the control group, which did not receive IA medications. After release of the ischemic tourniquet and assurance of haemostasis, a vacuum drainage tube was applied. The (IA) infusion was delivered through a multipored catheter for 72 h. Postoperative pain was assessed using visual analogue pain scale (VAS), and intravenous meperidine was administered as rescue analgesia if the (VAS) pain score was greater than or equal to (4) or on patient’s request. The total rescue analgesia consumption, angle of flexion of the knee and hospital stay were recorded. Results: The ability to achieve better angle of flexion was significantly higher in the combination group compared with the other groups, with a significant difference in favour of the ropivacaine group compared with the control group. At 2 h postoperatively, the mean pain (VAS) scores were significantly lower in patients who received (IA) analgesia compared with the control group and in the ropivacaine/tramadol group versus the ropivacaine group. The number of requests and total dose of rescue analgesia consumed were significantly lower with (IA) analgesia, with a significant difference in favour of the combination group. There was significant correlation between pain (VAS) scores and angle of flexion of the knee joint. Conclusion: Continuous (IA) ropivacaine/tramadol infusion safely reduced postoperative pain and spared administration of rescue analgesics with a significantly improved range of joint movement.展开更多
PRIMARY synovial chondromatosis is a rarecondition in which foci of cartilage develop in thesynovial membrane of joints, bursae and tendonsheaths. It typically involves a single large jointin a young adult male.1 The ...PRIMARY synovial chondromatosis is a rarecondition in which foci of cartilage develop in thesynovial membrane of joints, bursae and tendonsheaths. It typically involves a single large jointin a young adult male.1 The ectopic foci of cartilage canresult in painful joint effusion, and the generation of loosebodies can cause mechanical symptoms.2,3 The etiology ofprimary synovial chondromatosis remains unknown, butmetaplastic theory is the most popular hypothesis. Thecommonly involved joints are knee, elbow, and hip.^4 Theshoulder is a rare site of synovial chondromatosis2,3,5 andthe extra-articular involvement even rarer, with only fewcases presented in literature. This report presents a rarecase of primary combined intra-articular andextra-articular synovial chondromatosis of shoulder jointtreated with arthroscopy.展开更多
AIM： To investigate clinical efficacy of displaced intra-articular calcaneal fracture （DIACF） following operation and nonoperation. METHODS： Literature search was performed of PubMed and Cochrane Library by two in...AIM： To investigate clinical efficacy of displaced intra-articular calcaneal fracture （DIACF） following operation and nonoperation. METHODS： Literature search was performed of PubMed and Cochrane Library by two independent authors to identify randomized controlled trials （RCTs） comparing operative vs nonoperative treatment of DIACF from inception to December 31st, 2013. RCT quality was evaluated by the modified Jadad scale. Dichotomous variables were pooled using risk ratios by review manager 5.3 software. Fixed-effects or random-effects models were adopted with P 〉 0.05 or P ≤ 0.05 for heterogeneity tests, respectively.RESULTS： Eight RCTs comprising 767 cases met inclusion criteria. Results revealed that more surgically treated patients could resume pre-injury job （P = 0.006）. No statistical differences were found between the two groups in residual pain （P = 0.33）, shoe fitting problems （P = 0.07）, limited walking distance （P = 0.56） or secondary late arthrodesis （P = 0.38）. However, operative treatment was associated with a higher complication rate （P = 0.003）. Subgroup analyses of specific complications revealed that except for a higher risk of superficial wound problems （P 〈 0.0001） in operative group, the two groups had similar complication rate in deep wound infection （ P = 0.34）,CONCLUSION： Current evidence demonstrates that compared with operative treatment, conservative treatment of DIACF lead to similar clinical outcomes regarding residual pain, shoe fitting, walking distance and secondary subtalar arthrodesis but a significantly lower complication rate.展开更多
The comparison of biochemical composition and biophysical properties of synovial fluid and blood serum leads to a conclusion about the pathogenetic expediency of using serum as a corrector of synovial medium of osteoa...The comparison of biochemical composition and biophysical properties of synovial fluid and blood serum leads to a conclusion about the pathogenetic expediency of using serum as a corrector of synovial medium of osteoarthritic joints. Serum modification was realized by preliminary prescription of a single-dose drug to the patient. Then, the patient’s blood was sampled in the period of its maximal saturation with the drug. Autoserum from such blood samples was injected thrice into the knee joints affected by osteoarthritis of the 2nd or 3rd stages. The value of treatment results after 4 - 6 months of described therapeutics shows a significantly better therapeutic effect in the experimental of patient’s group as compared with the control group. The effect is connected with pain diminishing, normalization of the tissue joint nutrition, suppression of the local inflammation, and improvement of cartilage lubrication.展开更多
<strong>Background: </strong>Nodular fasciitis (NF) is currently considered a self-limited clonal neoplastic process. It shares the rearrangement of USP6-gene with aneurysmal bone cysts and myositis ossifi...<strong>Background: </strong>Nodular fasciitis (NF) is currently considered a self-limited clonal neoplastic process. It shares the rearrangement of USP6-gene with aneurysmal bone cysts and myositis ossificans. The presented case is of interest as this is a rare site of presentation of NF;so far only few single cases of intraarticular NF have been reported with documented USP6-gene rearrangement. Intraarticular neoplasias of the knee joint are rare;the most frequent being tenosynovial giant cell tumor (TSGCT). Given a nationwide annual incidence rate of 14 for the lower extremity and about 75% affecting the knee joint about 10 new cases involving the knee joint can be expected per 1 million persons/year. All other types of benign neoplasms are comparably rare while malignant intraarticular processes are extremely rare with most of them reported as single case studies. <strong>Aim: </strong>We report our case to emphasize the importance of preoperative diagnostics including the option of biopsy. Intraarticular malignant processes are extremely rare and frequently are operated on accidently with negative consequences for the patient. Tactics and techniques to treat benign processes depend on the correct pathologic diagnosis. <strong>Case presentation: </strong>The 38 year old man noticed slowly increasing swelling of his left knee joint after wakeboarding. Because of continuing discomfort 2 months later MRI diagnostic revealed, apart from retropatellar cartilage lesions, a popliteal mass compatible with a Baker cyst. The lesion of interest (later diagnosed as NF) was neither recognized by the radiologist nor the treating clinician. During the following 8 months the patient felt increasing swelling of the knee joint. The repeat MRI documented the crescent intraarticular solid synovial mass in the medial patellofemoral recess without signs of hemosiderin impregnation. A percutaneous sonographically guided 16G needle biopsy was performed. Histologically, bland myofibroblastic proliferation suggestive of nodular fasciitis (NF) was found. The next generation sequencing (NGS) demonstrated the presence of <em>MYH9-USP6</em> gene fusion, confirming the diagnosis of NF. The lesion was excised under arthroscopic control. At 1 year follow-up the patient is asymptomatic. <strong>Conclusion: </strong>The case is of interest because of its rare pathology. The decision how to treat was based on pathologic biopsy diagnostics including the USP6-gene rearrangement. In view of similar presentation of the rare malignancies we also want to stress the importance of definitive diagnostics which generally are possible only through biopsy.展开更多
AIM To compare the results of arthroscopic capsular release with intra-articular steroid injections in patients of frozen shoulder.METHODS Fifty-six patients with frozen shoulder were randomised to one of two treatmen...AIM To compare the results of arthroscopic capsular release with intra-articular steroid injections in patients of frozen shoulder.METHODS Fifty-six patients with frozen shoulder were randomised to one of two treatment groups: Group 1, complete 360 degree arthroscopic capsular release and group 2, intra-articular corticosteroid injection(40 mg methyl prednisolone acetate). Both groups were put on active and passive range of motion exercises following the intervention. The outcome parameters were visual analogue scale(VAS) score for pain, range of motion and Constant score which were measured at baseline, 4, 8, 12, 16 and 20 wk after intervention.RESULTS All the parameters improved in both the groups. The mean VAS score improved significantly more in the group 1 as compared to group 2 at 8 wk. This greater improvement was maintained at 20 wk with P value of 0.007 at 8 wk, 0.006 at 12 wk, 0.006 at 16 wk and 0.019 at 20 wk. The Constant score showed a more significant improvement in group 1 compared to group 2 at 4 wk, which was again maintained at 20 wk with P value of 0.01 at 4, 8, 12 and 16 wk. The gain in abduction movement was statistically significantly more in arthroscopy group with P value of 0.001 at 4, 8, 12, 16 wk and 0.005 at 20 wk. The gain in external rotation was statistically significantly more in arthroscopy group with P value of 0.007 at 4 wk, 0.001 at 8, 12, and 16 wk and 0.003 at 20 wk. There was no statistically significant difference in extension and internal rotation between the two groups at any time. CONCLUSION Arthroscopic capsular release provides subjective and objective improvement earlier than intra-articular steroid injection.展开更多
基金National Natural Science Foundation of China,NO.81774274Project of Jiangsu Provincial Hospital of Traditional Chinese Medicine,NO.Y19058
文摘BACKGROUND Non-steroid anti-inflammatory drugs(NSAIDs)have played a crucial role in the treatment of osteoarthritis,especially in the early stages.However,the cardiovascular risk and adverse gastrointestinal reactions of oral NSAIDs in elderly people cannot be underestimated.Intra-articular injection of NSAIDs may be a new attempt for early knee osteoarthritis treatment.Parecoxib may be a suitable drug for intra-articular injection.AIM To observe the clinical efficacy of the intra-articular injection of parecoxib for early knee osteoarthritis.METHODS Early knee osteoarthritis patients(n=110)were retrospectively analyzed.These patients were divided into three groups:Basic treatment+oral glucosamine(group A,n=37),oral celecoxib+basic treatment+oral glucosamine(group B,n=37),and intra-articular injection of parecoxib+basic treatment+oral glucosamine(group C,n=36).Intra-articular injection of parecoxib was performed once every 2 wk at a dose of 40 mg each time,for three times total.The three groups were compared in terms of visual analogue scale(VAS)scores,Hospital for Special Surgery(HSS)scores and patient satisfaction before and after treatment.The levels of inflammatory cytokines in the synovial fluid were detected in the three groups before and after treatment.RESULTS All patients were followed up for an average of 15.5±2.7 mo.The clinical efficacy was estimated by VAS and HSS scores at 12 mo after treatment.Inflammatory cytokine levels in the synovial fluid were evaluated at 3 mo after treatment.VAS and HSS scores were significantly improved in each group compared with before(P<0.001).There were significant differences among the three groups in VAS and HSS scores(P<0.001).The clinical efficacy of group C was superior to that of groups A and B(P<0.001),while group B outperformed group A in this respect(P<0.001).The patient satisfaction was the highest in group C(P<0.001).After treatment,the levels of tumor necrosis factorα(TNF-α)and interleukin(IL)-6 in the synovial fluid decreased in each group compared with before(P<0.001),while the levels of IL-10 increased(P<0.001).The three groups differed significantly in the levels of TNF-a,IL-6 and IL-10 in the synovial fluid after treatment(P<0.001).CONCLUSION For patients with early knee osteoarthritis,intra-articular injection of parecoxib could effectively improve clinical symptoms.This method may be a reliable alternative for early knee osteoarthritis.
文摘Tetramethylpyrazine(TMP) is a traditional Chinese herbal medicine with strong antiinflammatory and cartilage protection activities, and thus a promising candidate for treating osteoarthritis. However, TMP is rapidly cleared from the joint cavity after intra-articular injection and requires multiple injections to maintain efficacy. The aim of this study was to encapsulate TMP into poly(lactic-co-glycolic acid)(PLGA) microspheres to enhance the TMP retention in the joint, reducing injection frequencies and decreasing dosage. TMP microspheres were prepared by emulsion/solvent evaporation method. The intra-articular retention of the drug was assessed by detecting the drug concentration distributed in the joint tissue at different time points. The therapeutic effect of TMP microspheres was evaluated by the swelling of knee joints and histologic analysis in papain-induced OA rat model. The prepared freezedried microspheres with a particle size of about 10 μm can effectively prolong the retention time of the drug in the articular cavity to 30 d, which is 4.7 times that of the TMP solution.Intra-articular injection of TMP microspheres efficiently relieved inflammatory symptoms,improved joint lesions and decreased the depletion of proteoglycan. In conclusion, intraarticular injection of TMP loaded microspheres was a promising therapeutic method in the treatment of OA.
文摘AIM: To test whether intra-articular injection of porcine adipose-derived stem cells(ADSCs) can treat canine osteoarthritis(OA).METHODS: To enroll in this study dogs must have stifle joint OA that had lasted ≥ 3 mo and been treated with OA medication without significant improvement. Three dogs fulfilled these criteria and were thus subjects for ADSCs treatment. ADSCs were isolated from abdominal adipose tissue of a 2-mo-old female Yorkshire pig. Their stem cell marker expression was examined by immunofluorescence staining. For treatment, 5 million ADSCs were injected into the diseased joint of each dog. In the next 48 h, the patient was observed for signs of inflammatory and allergic reactions. Thepatient was then discharged to the owner and, at 2, 6, and 12 wk, followed up with orthopedic assessment, owner questionnaire, X-ray imaging, and force-plate gait analysis.RESULTS: Porcine ADSCs expressed mesenchymal stem cell markers CD90 and CD105. Injection of porcine ADSCs into canine stifle joints did not cause any inflammatory or allergic reactions. Orthopedic evaluation found improvements in two dogs, particularly at the longest time point. Owners' evaluation found increased capacity and decreased pain in all three dogs' activities such as walking and running. Radiographic evaluation did not find statistically significant differences before and after treatment. Force-plate analysis found significant improvements in all three dogs after treatment.CONCLUSION: Xenotransplantation of ADSCs for the treatment of OA is feasible. Further studies are needed to validate this novel treatment modality, which can then be implemented for the routine treatment of OA in veterinary medicine.
文摘Objectives: To evaluate the postoperative analgesic yield of continuous intra-articular (IA) ropivacaine/tramadol infusion as against infusion of ropivacaine alone after total knee arthroplasty. Patients and Methods: Sixty patients accompanied by arthrosis were randomly divided into three equal groups: The ropivacaine group, which obtained a continuous intraarticular (IA) infusion of ropivacaine alone;the combination group, which obtained a continuous (IA) infusion of a combination of ropivacaine and tramadol at a rate of 6 ml/h for 72 h postoperatively;and the control group, which did not receive IA medications. After release of the ischemic tourniquet and assurance of haemostasis, a vacuum drainage tube was applied. The (IA) infusion was delivered through a multipored catheter for 72 h. Postoperative pain was assessed using visual analogue pain scale (VAS), and intravenous meperidine was administered as rescue analgesia if the (VAS) pain score was greater than or equal to (4) or on patient’s request. The total rescue analgesia consumption, angle of flexion of the knee and hospital stay were recorded. Results: The ability to achieve better angle of flexion was significantly higher in the combination group compared with the other groups, with a significant difference in favour of the ropivacaine group compared with the control group. At 2 h postoperatively, the mean pain (VAS) scores were significantly lower in patients who received (IA) analgesia compared with the control group and in the ropivacaine/tramadol group versus the ropivacaine group. The number of requests and total dose of rescue analgesia consumed were significantly lower with (IA) analgesia, with a significant difference in favour of the combination group. There was significant correlation between pain (VAS) scores and angle of flexion of the knee joint. Conclusion: Continuous (IA) ropivacaine/tramadol infusion safely reduced postoperative pain and spared administration of rescue analgesics with a significantly improved range of joint movement.
文摘PRIMARY synovial chondromatosis is a rarecondition in which foci of cartilage develop in thesynovial membrane of joints, bursae and tendonsheaths. It typically involves a single large jointin a young adult male.1 The ectopic foci of cartilage canresult in painful joint effusion, and the generation of loosebodies can cause mechanical symptoms.2,3 The etiology ofprimary synovial chondromatosis remains unknown, butmetaplastic theory is the most popular hypothesis. Thecommonly involved joints are knee, elbow, and hip.^4 Theshoulder is a rare site of synovial chondromatosis2,3,5 andthe extra-articular involvement even rarer, with only fewcases presented in literature. This report presents a rarecase of primary combined intra-articular andextra-articular synovial chondromatosis of shoulder jointtreated with arthroscopy.
文摘AIM： To investigate clinical efficacy of displaced intra-articular calcaneal fracture （DIACF） following operation and nonoperation. METHODS： Literature search was performed of PubMed and Cochrane Library by two independent authors to identify randomized controlled trials （RCTs） comparing operative vs nonoperative treatment of DIACF from inception to December 31st, 2013. RCT quality was evaluated by the modified Jadad scale. Dichotomous variables were pooled using risk ratios by review manager 5.3 software. Fixed-effects or random-effects models were adopted with P 〉 0.05 or P ≤ 0.05 for heterogeneity tests, respectively.RESULTS： Eight RCTs comprising 767 cases met inclusion criteria. Results revealed that more surgically treated patients could resume pre-injury job （P = 0.006）. No statistical differences were found between the two groups in residual pain （P = 0.33）, shoe fitting problems （P = 0.07）, limited walking distance （P = 0.56） or secondary late arthrodesis （P = 0.38）. However, operative treatment was associated with a higher complication rate （P = 0.003）. Subgroup analyses of specific complications revealed that except for a higher risk of superficial wound problems （P 〈 0.0001） in operative group, the two groups had similar complication rate in deep wound infection （ P = 0.34）,CONCLUSION： Current evidence demonstrates that compared with operative treatment, conservative treatment of DIACF lead to similar clinical outcomes regarding residual pain, shoe fitting, walking distance and secondary subtalar arthrodesis but a significantly lower complication rate.
文摘The comparison of biochemical composition and biophysical properties of synovial fluid and blood serum leads to a conclusion about the pathogenetic expediency of using serum as a corrector of synovial medium of osteoarthritic joints. Serum modification was realized by preliminary prescription of a single-dose drug to the patient. Then, the patient’s blood was sampled in the period of its maximal saturation with the drug. Autoserum from such blood samples was injected thrice into the knee joints affected by osteoarthritis of the 2nd or 3rd stages. The value of treatment results after 4 - 6 months of described therapeutics shows a significantly better therapeutic effect in the experimental of patient’s group as compared with the control group. The effect is connected with pain diminishing, normalization of the tissue joint nutrition, suppression of the local inflammation, and improvement of cartilage lubrication.
文摘<strong>Background: </strong>Nodular fasciitis (NF) is currently considered a self-limited clonal neoplastic process. It shares the rearrangement of USP6-gene with aneurysmal bone cysts and myositis ossificans. The presented case is of interest as this is a rare site of presentation of NF;so far only few single cases of intraarticular NF have been reported with documented USP6-gene rearrangement. Intraarticular neoplasias of the knee joint are rare;the most frequent being tenosynovial giant cell tumor (TSGCT). Given a nationwide annual incidence rate of 14 for the lower extremity and about 75% affecting the knee joint about 10 new cases involving the knee joint can be expected per 1 million persons/year. All other types of benign neoplasms are comparably rare while malignant intraarticular processes are extremely rare with most of them reported as single case studies. <strong>Aim: </strong>We report our case to emphasize the importance of preoperative diagnostics including the option of biopsy. Intraarticular malignant processes are extremely rare and frequently are operated on accidently with negative consequences for the patient. Tactics and techniques to treat benign processes depend on the correct pathologic diagnosis. <strong>Case presentation: </strong>The 38 year old man noticed slowly increasing swelling of his left knee joint after wakeboarding. Because of continuing discomfort 2 months later MRI diagnostic revealed, apart from retropatellar cartilage lesions, a popliteal mass compatible with a Baker cyst. The lesion of interest (later diagnosed as NF) was neither recognized by the radiologist nor the treating clinician. During the following 8 months the patient felt increasing swelling of the knee joint. The repeat MRI documented the crescent intraarticular solid synovial mass in the medial patellofemoral recess without signs of hemosiderin impregnation. A percutaneous sonographically guided 16G needle biopsy was performed. Histologically, bland myofibroblastic proliferation suggestive of nodular fasciitis (NF) was found. The next generation sequencing (NGS) demonstrated the presence of <em>MYH9-USP6</em> gene fusion, confirming the diagnosis of NF. The lesion was excised under arthroscopic control. At 1 year follow-up the patient is asymptomatic. <strong>Conclusion: </strong>The case is of interest because of its rare pathology. The decision how to treat was based on pathologic biopsy diagnostics including the USP6-gene rearrangement. In view of similar presentation of the rare malignancies we also want to stress the importance of definitive diagnostics which generally are possible only through biopsy.
文摘AIM To compare the results of arthroscopic capsular release with intra-articular steroid injections in patients of frozen shoulder.METHODS Fifty-six patients with frozen shoulder were randomised to one of two treatment groups: Group 1, complete 360 degree arthroscopic capsular release and group 2, intra-articular corticosteroid injection(40 mg methyl prednisolone acetate). Both groups were put on active and passive range of motion exercises following the intervention. The outcome parameters were visual analogue scale(VAS) score for pain, range of motion and Constant score which were measured at baseline, 4, 8, 12, 16 and 20 wk after intervention.RESULTS All the parameters improved in both the groups. The mean VAS score improved significantly more in the group 1 as compared to group 2 at 8 wk. This greater improvement was maintained at 20 wk with P value of 0.007 at 8 wk, 0.006 at 12 wk, 0.006 at 16 wk and 0.019 at 20 wk. The Constant score showed a more significant improvement in group 1 compared to group 2 at 4 wk, which was again maintained at 20 wk with P value of 0.01 at 4, 8, 12 and 16 wk. The gain in abduction movement was statistically significantly more in arthroscopy group with P value of 0.001 at 4, 8, 12, 16 wk and 0.005 at 20 wk. The gain in external rotation was statistically significantly more in arthroscopy group with P value of 0.007 at 4 wk, 0.001 at 8, 12, and 16 wk and 0.003 at 20 wk. There was no statistically significant difference in extension and internal rotation between the two groups at any time. CONCLUSION Arthroscopic capsular release provides subjective and objective improvement earlier than intra-articular steroid injection.
