Clinical effect of sodium hyaluronate joint cavity filling combined with exercise therapy on patients with post-traumatic knee arthritis

Objective:To research the sodium hyaluronate joint cavity filling combined with exercise therapy on the indicator of pain,motor function,and levels of inflammatory factors in joint fluid in patients with post-traumatic knee arthritis.Method Totally 100 patients(Department of Orthopaedics,The second Affiliated Hospital to Liaoning University of Chinese Medicine,2013.10-2018.8)with post-traumatic knee arthritis were selected,then they were divided into observation group(n=50)and control group(n=50).The control group was given glucosamine sulfate and sodium hyaluronate joint cavity filling,the observation group was given leg press with visual feedback,they were treated 4 weeks.Assessing the pain degree through visual analog scale(VAS),hospital for special surgery knee score(HSS)as the indicator of motor function,inflammatory factor(TNF-α,IL-6,and IL-8)in the joint fluid.Results The score of VAS were lower than pretherapy(P<0.05),the degree of VAS of observation group were lower than control group(P<0.05).The score of HSS were higher than pretherapy(P<0.05),the degree of VAS of observation group were higher than control group(P<0.05).The inflammatory factor(TNF-α,IL-6,and CRP)in the joint fluid were lower than pretherapy(P<0.05),and the observation group were lower than control group(P<0.05).Conclusions Giving sodium hyaluronate joint cavity filling combined with exercise therapy can improve the function of joint.

Effects of Activating Blood Circulation to Resolve Blood Stasis and Glucosamine Capsules Therapy on the Expression of Matrix Metalloproteinase in Post-traumatic Knee Osteoarthritis

[Objectives] To observe the clinical effects of activating blood circulation to resolve blood stasis and glucosamine hydrochloride capsules therapy on post-traumatic knee osteoarthritis treatment,to measure the expression of matrix metalloproteinase in post-traumatic knee osteoarthritis patients before and after treatment,and to explore its relevant molecular mechanisms. [Methods]A total of 60 patients with posttraumatic knee osteoarthritis in early stage in Affiliated Hospital of Shannxi University of Chinese Medicine from January 2015 to December2017 were selected and randomly divided into the control group( n = 30) and the observation group( n = 30). The control group was given oral administration of glucosamine hydrochloride capsules for 6 courses of the treatment. The observation group was using the activating blood circulation to resolve blood stasis therapy for 6 courses of treatment. The recovery of traumatic knee osteoarthritis and the symptom of traditional Chinese medicine( TCM) in 2 groups was compared before and after treatment. The symptoms and the quantitative assessment rating scale of knee osteoarthritis,the pain index of knee and the TCM symptom scores were recorded in both groups. And the synovial fluid and serum of patients were collected to detect the expression of matrix metalloproteinase. [Results]The symptoms and the quantitative assessment rating scale of knee osteoarthritis,the pain index of knee and TCM symptom scores of the 2 groups in the 1 st week,the 12 th week and the 24 th week after the treatment were significantly lower than those before the treatment,and the difference was statistically significant( P < 0. 05). Two therapeutic methods had certain therapeutic effects on the recovery from traumatic knee osteoarthritis,and could significantly improve the TCM syndrome. There were better therapeutic effects on oral decoction of traditional Chinese medicine than oral glycosaminoglycans hydrochloride capsules on treating traumatic knee osteogenesis( P < 0. 05). The expression level of MMP3 was decreased significantly in both groups( P <0. 001),while the expression level of MMP13 had no significant change in both groups( P >0. 05). The expression level of MMP1 was decreased significantly in the observation group( P < 0. 001),but there was no significant change in the control group after treatment( P >0. 05). [Conclusions]Two treatment methods have been effective in this clinical study. We found that the expression level of MMP3 was decreased significantly after treatment in 2 therapies,which can be clinically applied.

Exploring cerebral structural and functional abnormalities in a mouse model of post-traumatic headache induced by mild traumatic brain injury

Mild traumatic brain injury(mTBI)-induced post-traumatic headache(PTH)is a pressing public health concern and leading cause of disability worldwide.Although PTH is often accompanied by neurological disorders,the exact underlying mechanism remains largely unknown.Identifying potential biomarkers may prompt the diagnosis and development of effective treatments for mTBI-induced PTH.In this study,a mouse model of mTBI-induced PTH was established to investigate its effects on cerebral structure and function during short-term recovery.Results indicated that mice with mTBI-induced PTH exhibited balance deficits during the early post-injury stage.Metabolic kinetics revealed that variations in neurotransmitters were most prominent in the cerebellum,temporal lobe/cortex,and hippocampal regions during the early stages of PTH.Additionally,variations in brain functional activities and connectivity were further detected in the early stage of PTH,particularly in the cerebellum and temporal cortex,suggesting that these regions play central roles in the mechanism underlying PTH.Moreover,our results suggested that GABA and glutamate may serve as potential diagnostic or prognostic biomarkers for PTH.Future studies should explore the specific neural circuits involved in the regulation of PTH by the cerebellum and temporal cortex,with these two regions potentially utilized as targets for non-invasive stimulation in future clinical treatment.

Promoting Post-Traumatic Growth in Colorectal Cancer Patients:Exploring the Role of Social Support through a Chain Mediation Model

Colorectal cancer(CRC)poses significant physical and psychological challenges that necessitate an exploration of factors influencing post-traumatic growth(PTG)for patient well-being.This study aims to investigate the effects of positive psychological capital(PsyCap)and perceived stress on mediating the social support-PTG relation among 673 CRC patients.Social support,positive PsyCap,perceived stress,and PTG were assessed through questionnaires.The results indicated a direct prediction effect of social support on PTG(LICI=0.481,ULCI=0.644),with the direct effect being 59.5%.Both positive PsyCap and perceived stress exerted a mediating role in the correlation between social support and PTG,with the mediating effects occupying 29.4%(LICI=0.217,ULCI=0.343)and 5.7%(LICI=0.030,ULCI=0.082),respectively.Positive PsyCap further had a chain mediating effect on perceived stress(LICI=0.031,ULCI=0.074),with the chain effect accounting for 5.4%.The total impact of social support on PTG was 100%(LICI=0.882,ULCI=1.008).This model underscores the pivotal role of social support in promoting PTG in CRC patients.Positive PsyCap serves as a crucial mediator in the social support-PTG link,with perceived stress playing a sequential mediating role.Thesefindings suggest that strengthening social support networks and cultivating positive PsyCap may reduce perceived stress and promote the development of PTG in CRC patients.Consequently,intervention programs are recommended to improve the psychosocial well-being of CRC patients.

Ginger oil-loaded transdermal adhesive patch treats post-traumatic stress disorder

Objective:To find a viable alternative to reduce the number of doses required for the patients with post-traumatic stress disorder(PTSD),and to improve efficacy and patient compliance.Methods: In this study,we used ginger oil,a phytochemical with potential therapeutic properties,to prepare ginger oil patches.High-performance liquid chromatography(HPLC)was used to quantify the main active component of ginger oil,6-gingerol.Transdermal absorption experiments were conducted to optimize the various pressure-sensitive adhesives and permeation enhancers,including their type and concentration.Subsequently,the ginger oil patches were optimized and subjected to content determination and property evaluations.A PTSD mouse model was established using the foot-shock method.The therapeutic effect of ginger oil patches on PTSD was assessed through pathological sections,behavioral tests,and the evaluation of biomarkers such as tumor necrosis factor-α(TNF-α),interleukin-6(IL-6),brain-derived neurotrophic factor(BDNF),and melatonin(MT).Results: The results demonstrated that ginger oil patches exerted therapeutic effects against PTSD by inhibiting inflammatory responses and modulating MT and BDNF levels.Pharmacokinetic experiments revealed that ginger oil patches maintained a stable blood drug concentration for at least one day,addressing the rapid metabolism drawback of 6-gingerol and enhancing its therapeutic efficacy.Conclusions: Ginger oil can be prepared as a transdermal drug patch that meets these requirements,and the bioavailability of the prepared patch is better than that of oral administration.It can improve PTSD with good patient compliance and ease of administration.Therefore,it is a promising therapeutic formulation for the treatment of PTSD.

Addressing trauma,post-traumatic stress disorder,and posttraumatic growth in breast cancer patients

BACKGROUND Breast cancer(BC)is a common cancer among females in Africa.Being infected with BC in Africa seems like a life sentence and brings devastating experiences to patients and households.As a result,BC is comorbid with trauma,post-traumatic stress disorder(PTSD),and post-traumatic growth(PTG).AIM To identify empirical evidence from peer-reviewed articles on the comorbidity trajectories between BC and trauma,BC and PTSD,and BC and PTG.METHODS This review adhered to the PRISMA guidelines of conducting a systematic review.Literature searches of the National Library of Medicine,Scopus,PubMed,Google Scholar,and Scopus databases were conducted using search terms developed for the study.The search hint yielded 769 results,which were screened based on inclusion and exclusion criteria.At the end of the screening,24 articles were included in the systematic review.RESULTS BC patients suffered trauma and PTSD during the diagnosis and treatment stages.These traumatic events include painful experiences during and after diagnosis,psychological distress,depression,and cultural stigma against BC patients.PTSD occurrence among BC patients varies across African countries,as this review disclosed:90%was reported in Kenya,80%was reported in Zimbabwe,and 46%was reported in Nigeria.The severity of PTSD among BC patients in Africa was based on the test results communicated to the patients.Furthermore,this review revealed that BC patients experience PTG,which involves losing,regaining,and surrendering final control over the body,rebuilding a personified identity,and newfound appreciation for the body.CONCLUSION Patients with BC undergo numerous traumatic experiences during their diagnosis and treatment.Psychological interventions are needed in SSA to mitigate trauma and PTSD,as well as promote PTG.

MicroRNAs as potential biomarkers for diagnosis of post-traumatic stress disorder

Post-traumatic stress disorder is a mental disorder caused by exposure to severe traumatic life events.Currently,there are no validated biomarkers or laboratory tests that can distinguish between trauma survivors with and without post-traumatic stress disorder.In addition,the heterogeneity of clinical presentations of post-traumatic stress disorder and the overlap of symptoms with other conditions can lead to misdiagnosis and inappropriate treatment.Evidence suggests that this condition is a multisystem disorder that affects many biological systems,raising the possibility that peripheral markers of disease may be used to diagnose post-traumatic stress disorder.We performed a PubMed search for microRNAs(miRNAs)in post-traumatic stress disorder(PTSD)that could serve as diagnostic biomarkers and found 18 original research articles on studies performed with human patients and published January 2012 to December 2023.These included four studies with whole blood,seven with peripheral blood mononuclear cells,four with plasma extracellular vesicles/exosomes,and one with serum exosomes.One of these studies had also used whole plasma.Two studies were excluded as they did not involve microRNA biomarkers.Most of the studies had collected samples from adult male Veterans who had returned from deployment and been exposed to combat,and only two were from recently traumatized adult subjects.In measuring miRNA expression levels,many of the studies had used microarray miRNA analysis,miRNA Seq analysis,or NanoString panels.Only six studies had used real time polymerase chain reaction assay to determine/validate miRNA expression in PTSD subjects compared to controls.The miRNAs that were found/validated in these studies may be considered as potential candidate biomarkers for PTSD and include miR-3130-5p in whole blood;miR-193a-5p,-7113-5p,-125a,-181c,and-671-5p in peripheral blood mononuclear cells;miR-10b-5p,-203a-3p,-4488,-502-3p,-874-3p,-5100,and-7641 in plasma extracellular vesicles/exosomes;and miR-18a-3p and-7-1-5p in blood plasma.Several important limitations identified in the studies need to be taken into account in future studies.Further studies are warranted with war veterans and recently traumatized children,adolescents,and adults having PTSD and use of animal models subjected to various stressors and the effects of suppressing or overexpressing specific microRNAs.

Post-Traumatic Stress Disorder among Defence and Security Forces in Northern Benin (2023)

Introduction: Post-traumatic stress disorder (PTSD) is defined as “actual exposure to death or the threat of death, serious injury or sexual violence”, either directly or indirectly, resulting in a symptomatic procession of repetition, avoidance, neurovegetative hyperactivity and individualized symptoms, with or without negative cognitive and mood changes. It therefore goes without saying that the defence and security forces constitute a high-risk population in need of attention. Objective: To study post-traumatic stress disorder in defence and security forces in the city of Parakou in 2023. Methods: Descriptive cross-sectional study conducted from December 2022 to July 2023. The study population consisted of active military, republican police and firefighters in the city of Parakou in 2023. Non-proportional stratified sampling was used, given the inaccessibility of the source population size for national security reasons. Post-traumatic stress disorder was assessed using the “post-traumatic stress disorder checklist-5 (PCLS-5) scale. Results: A total of 305 subjects participated in the survey. Males dominated 90.2%. The most represented corps was the Republican Police (41.6%), most of whom were non-commissioned officers (46.6%). The majority count between 11 and 20 years of service (48.9%), with 2 to 5 missions completed (67.5%). The calculated prevalence of post-traumatic stress disorder was 11.8%, based on the post-traumatic stress disorder checklist-5 (PCL-5). Of the 36 respondents with post-traumatic stress disorder, 20 (55.6%) had experienced an armed attack, 25 (69.4%) had witnessed a violent death, 18 (50.0%) had witnessed the agony of a colleague, 15 (41.7%) had been exposed to a fire or explosion, while 26 (72.2%) had been traumatized by physical and/or verbal aggression. 5 (13.9%) had consulted a specialist psychiatrist, while 6 (16.7%) were on medication and 26 (72.2%) used sport as a means of maintaining physical and mental health. Respectively 22 (61.1%) and 21 (58.3%) had definite symptoms of anxiety and depression. Multivariate analysis revealed a significant association between post-traumatic stress disorder and the following variables: total number of children ≤ 2 (p = 0.015), comorbidities such as arterial hypertension (p = 0.007), history of hepatitis (p = 0.017), work accidents (p = 0.016), alcohol dependence (p = 0.004), domestic violence (p = 0.004), psychological violence (p = 0.017) and anxiety disorders (p Conclusion: Defence and security personnel can also be prey to post-traumatic stress disorder (PTSD), which needs to be systematically taken into account when they are subjected to trauma in the course of their duties. Mental health should be an integral part of the periodic medical check-up objectives for defence and security forces throughout the country.

Effects of Pearl Yangxin Anshen Decoction on HAMD and PTSD-SS Scores, Cytokines and Related Metabolites in Patients with Post-Traumatic Stress Disorder

Objective: This paper aims to observe the Pearl Yangxin Anshen Decoction to influence the score of HAMD and PTSD-SS, the changes of the cytokines and the related metabolic product in patients with PTSD. Methods: From June 2015 to May 2016, in the traditional Chinese medicine clinics of Hainan Province People’s Hospital, there were 50 patients with PTSD, the age were from 30 to 60, they were randomly divided into treatment group (25 cases) and control group (25 cases), then compared the scores of HAMD and PTSD-SS between the two groups, searched the changes of cytokines and the related metabolic product. Results: In the treatment group: before and after treatment the scores of PTSD-SS were 65.64 ± 7.02, 28.32 ± 4.18, and the scores of HAMD were 29.28 ± 1.97, 11.72 ± 2.13;In the control group: before and after treatment the scores of PTSD-SS were 63.24 ± 6.16, 31.40 ± 4.29, the scores of HAMD were 30.24 ± 2.05, 13.08 ± 2.30. After 3 months patients in treatment group the scores of PTSD-SS and HAMD were lower than the control group (t = 2.570, P = 0.013, t = -2.1640, P = 0.035). In the control group: before and after 3 months treatment the IL-2 levels respectively were 79.84 ± 26.46 pg/ml, 56.18 ± 22.67 pg/ml, the IL-6 levels respectively were 110.83 ± 47.65 pg/ml, 59.67 ± 44.68 pg/ml, the IL-8 levels respectively were 73.11 ± 78.51 pg/ml, 55.83 ± 81.94 pg/ml, the NE levels respectively were 420.04 ± 674.75 pg/ml, 185.31 ± 417.91 pg/ml, the MDA levels respectively were 112.35 ± 62.87 ng/ml, 60.42.33 ± 53.64 ng/ml, the NO levels were 126.6 ± 47.4 μmol/L, 78.6 ± 45.7 μmol/L, the VIP levels were 396.6 ± 144.4 pg/ml, 122.4 ± 111.5 pg/ml. In the treatment group: before and after 3 months treatment the IL-2 levels respectively were 86.00 ± 32.29 pg/ml, 53.84 ± 27.01 pg/ml, the IL-6 levels respectively were 108.21 ± 44.60 pg/ml, 42.46 ± 42.16 pg/ml, the IL-8 levels respectively were 81.48 ± 94.19 pg/ml, 54.07 ± 84.15 pg/ml, the NE levels respectively were 392.93 ± 592.84 pg/ml, 243.85 ± 588.45 pg/ml, the MDA levels respectively were 117.58 ± 63.37 ng/ml, 45.91 ± 38.94 ng/ml, the NO levels respectively were 135.9 ± 46.4 μmol/L, 72.6 ± 46.6 μmol/L, the VIP levels respectively were 414.0 ± 140.1 pg/ml, 185.8 ± 105.3 pg/ml. In the two groups as the extension of treatment time, the content of IL-2, IL-8, IL-6, NE, MDA, NO, and VIP were gradually reduced, and the level of reduction of the treatment group patients was higher than the control group, the change of ACTH and SOD levels just the opposite. Conclusion: The Pearl Yangxin Anshen Decoction could improve the symptoms of psychological anxiety, depression and other psychological problems in patients with PTSD, and influence the change of cytokines and related metabolites product.

Correlation Study of Neurotransmitter and Immune Levels in Pre-Hospital Emergency Nurses with Post-Traumatic Stress Disorder

Objective: To investigate the occurrence of PTSD in pre-hospital emergency nurses and its related factors, and to compare the differences of neurotransmitter and immune-related factors between pre-hospital emergency nurses who experienced traumatic events and those who did not develop PTSD and healthy people. How: Post-traumatic Stress Disorder Self-Rating Scale (PCL-C) tests were performed on pre-hospital emergency nurses in PTSD group, non-PTSD group and healthy control group, and the plasma monoamine neurotransmitters and serum cytokines were determined by double-antibody sandwich ABC-ELISA assay using enzyme-linked adsorption kit provided by Shanghai Xitang Biotechnology Co., Ltd. Results: 1) There were statistically significant differences in PCL-C scores between PTSD group, non-PTSD group and healthy group (p α between PTSD group, non-PTSD group and healthy group (p Conclusion: Pre-hospital emergency nurses should have early psychological intervention and guidance to reduce the occurrence of PTSD in emergency and emergency nurses.

Principles and Techniques of Post-Traumatic Rhinoplasty: A Review of the Literature

Post-traumatic rhinoplasty is the surgical treatment of the complex functional and aesthetic sequelae of nasal trauma. Correcting a post-traumatic nose is a challenging task, requiring the surgeon to employ a range of techniques and grafts to adequately address the deformities observed. The results of our research show that restoring pre-traumatic form and function remains complex, although many guidelines have been established to refine and optimize the management of the after-effects of nasal trauma. But it is achievable with the right techniques. The objective of our review is to highlight the various post-traumatic nasal sequelae, describe the fundamental principles in the field of post-traumatic rhinoplasty and provide the surgeon with the various existing surgical techniques and strategies so that he or she can make an appropriate choice for the patient.

全膝关节置换中BrainlabKnee3导航辅助间隙平衡技术的应用优势

背景:近年来,计算机导航技术辅助关节置换逐渐受到医疗领域的关注。文献报道计算机导航在全膝关节置换中的应用临床效果不一。为了探索新一代Brainlab Knee 3导航系统的临床效果,进行了此项研究。目的:分析计算机导航系统(Brainlab Knee 3)结合间隙平衡技术在全膝关节置换中的应用效果。方法:2020年11月至2021年5月大连市第二人民医院关节外科收治71例行全膝关节置换患者,导航组35例,术中采用计算机导航结合间隙平衡技术行全膝关节置换;传统组36例,术中采用传统手术器械定位截骨。比较两组患者术中内、外侧关节间隙差;膝关节活动度、KSS评分;髋膝踝角;冠状面股骨组件角、冠状面胫骨组件角和矢状面胫骨组件角偏差值。结果与结论:①导航组伸直位内外侧间隙差0,1,2 mm的患者分别为19,14,2例;屈膝90°位内外侧间隙差0,1,2 mm的患者分别为18,15,2例。传统组伸直位内外侧间隙差0,1,2 mm的患者分别为10,20,6例;屈膝90°位内外侧间隙差0,1,2 mm的患者分别为10,15,8例。②导航组手术时间长于传统组(P<0.05),导航组有2例患者术后形成下肢肌间静脉血栓,传统组患者均无并发症。③置换后6,12个月两组患者膝关节活动度均明显增加,导航组膝关节活动度高于传统组(P<0.05)。④置换后12个月两组患者KSS评分均明显增加,导航组KSS评分高于传统组(P<0.05)。⑤置换后6个月髋膝踝角、冠状面股骨组件角、冠状面胫骨组件角、矢状面胫骨组件角偏差值均显著小于传统组(P<0.05)。⑥结果表明,采用计算机导航结合间隙平衡技术辅助全膝关节置换对关节活动度、下肢力线、胫骨假体组件位置的准确性方面具有优势,置换后关节功能恢复良好。

Total knee arthroplasty for treatment of post-traumatic arthritis: Systematic review

AIM To review and report functional outcomes, complications,and survivorship associated with total knee arthroplasty(TKA) in the treatment of post-traumatic arthritis(PTA).METHODS We conducted a systematic review according to the PRISMA guidelines. We searched PubMed, Cochrane Library, and SCOPUS in December 2015 for Englishlanguage clinical research studies, both prospective and retrospective, examining the use of TKA for the treatment of PTA. All relevant articles were accessed in full. The manual search included references of retrieved articles.We extracted data on patients' demographics and clinical outcomes, including preoperative diagnosis and pre- and post-operative functional scores. We summarized the data and reported the results in tables and text.RESULTS Sixteen studies, four prospective and ten retrospective,examined patients who underwent TKA for PTA due to fractures of the proximal tibia, patella, and/or distal femur. Eleven studies utilized the Knee Society Scores criteria to assess functional outcomes. All studies utilizing these criteria reported an improvement in functional and knee scores of patients following TKA. Further, studies reported an increased range of motion(ROM) and reduction of pain following surgery. The most commonly reported complications with TKA included infection, stiffness, wound complications, intraoperative rupture of tendons, and osteolysis/polyethylene wear. The overwhelming majority of these complications occurred within the first two years following surgery. Six studies examined the survivorship of TKA with subsequent revision for any reason as an endpoint. Compared to patients with osteoarthritis, patients with PTA required more revisions, the majority for polyethylene wear.CONCLUSION Although associated with higher complication rates,TKA is an effective treatment for PTA, as it improves ROM, pain and functional outcomes.

Analysis of the causes of primary revision after unicompartmental knee arthroplasty: A case series

BACKGROUND Unicompartmental knee arthroplasty(UKA)has great advantages in the treatment of unicompartmental knee osteoarthritis,but its revision rate is higher than that of total knee arthroplasty.AIM To summarize and analyse the causes of revision after UKA.METHODS This is a retrospective case series study in which the reasons for the first revision after UKA are summarized.We analysed the clinical symptoms,medical histories,laboratory test results,imaging examination results and treatment processes of the patients who underwent revision and summarized the reasons for primary revision after UKA.RESULTS A total of 13 patients,including 3 males and 10 females,underwent revision surgery after UKA.The average age of the included patients was 67.62 years.The prosthesis was used for 3 d to 72 months.The main reasons for revision after UKA were improper suturing of the surgical opening(1 patient),osteophytes(2 patients),intra-articular loose bodies(2 patients),tibial prosthesis loosening(2 patients),rheumatoid arthritis(1 patient),gasket dislocation(3 patients),anterior cruciate ligament injury(1 patient),and medial collateral ligament injury with residual bone cement(1 patient).CONCLUSION The causes of primary revision after UKA were gasket dislocation,osteophytes,intra-articular loose bodies and tibial prosthesis loosening.Avoidance of these factors may greatly reduce the rate of revision after UKA,improve patient satisfaction and reduce medical burden.

There is more to the knee joint than just the quadriceps:A systematic review with meta-analysis and evidence gap map of hamstring strength,flexibility,and morphology in individuals with gradual-onset knee disorders

Background:Impairments in hamstring strength,flexibility,and morphology have been associated with altered knee biomechanics,pain,and function.Determining the presence of these impairments in individuals with gradual-onset knee disorders is important and may indicate targets for assessment and rehabilitation.This systematic review aimed to synthesize the literature to determine the presence of impairments in hamstring strength,flexibility,and morphology in individuals with gradual-onset knee disorders.Methods:Five databases(MEDLINE,Embase,CINAHL,SPORTDiscus,and Web of Science)were searched from inception to September 2022.Only studies comparing hamstring outcomes(e.g.,strength,flexibility,and/or morphology)between individuals with gradual-onset knee disorders and their unaffected limbs or pain-free controls were included.Meta-analyses for each knee disorder were performed.Outcome-level certainty was assessed using the Grading of Recommendations Assessment,Development,and Evaluation,and evidence gap maps were created.Results:Seventy-nine studies across 4 different gradual-onset knee disorders(i.e.,knee osteoarthritis(OA),patellofemoral pain(PFP),chondromalacia patellae,and patellar tendinopathy)were included.Individuals with knee OA presented with reduced hamstring strength compared to pain-free controls during isometric(standard mean difference(SMD)=-0.76,95%confidence interval(95%CI):-1.32 to-0.21)and concentric contractions(SMD=-0.97,95%CI:-1.49 to-0.45).Individuals with PFP presented with reduced hamstring strength compared to painfree controls during isometric(SMD=-0.48,95%CI:-0.82 to-0.14),concentric(SMD=-1.07,95%CI:-2.08 to-0.06),and eccentric contractions(SMD=-0.59,95%CI:-0.97 to-0.21).No differences were observed in individuals with patellar tendinopathy.Individuals with PFP presented with reduced hamstring flexibility when compared to pain-free controls(SMD=-0.76,95%CI:-1.15 to-0.36).Evidence gap maps identified insufficient evidence for chondromalacia patellae and hamstring morphology across all gradual-onset knee disorders.Conclusion:Our findings suggest that assessing and targeting impairments in hamstring strength and flexibility during rehabilitation may be recommended for individuals with knee OA or PFP.

Rehabilitation care for pain in elderly knee replacement patients

BACKGROUND Total knee arthroplasty(TKA)is recognized as the most effective surgical intervention for relieving pain and improving joint mobility and deformity in patients with knee osteoarthritis and other synovial diseases.The application of accelerated postoperative rehabilitation(enhanced recovery after surgery)has demonstrated its efficacy in improving patient outcomes,and early postoperative joint function exercise has become a key prognostic factor in knee replacement.The unexpected appearance of limb pain and swelling hindered the patient’s tendency for early mobilization,leading in prolonged hospitalization,delayed functional recovery and negative psychological responses.A retrospective analysis was conducted on a cohort of 116 patients who under-went TKA at our hospital between July 2019 and July 2021.The patients were divided into two groups:A control group(n=58)receiving programmatic nur-sing,and an observed group(n=58)receiving programmed nursing combined with a collaborative nursing model.A pain management team consisting of attending physicians,head nurses,and responsible nurses was established.Outcome measures included visual analogue scale(VAS)scores,activities of daily living(ADL)scale scores,and functional scores.The ADL scores of patients in both groups exhibited a continuous increase.However,there was no statistically significant difference in the ADL scores between the two groups at 48 h and the 7th d post-surgery(P>0.05).Upon reexamination at the 3rd mo,the observation group demonstrated higher ADL scores compared to the control group(67.48±14.69 vs 59.40±16.06,P<0.05).The VAS scores of both groups significantly decreased,with no significant difference observed between the groups at each time point(P>0.05).The functional status of patients in both groups exhibited a gradual increase prior to intervention and at the 1st,2nd,and 3rd month following discharge(P<0.05).There was no statistically significant difference in knee joint function scores between the two groups at the 1st month after discharge(47.52 vs 45.81,P>0.05).However,the knee joint function scores of patients in the observation group were significantly higher than those in the control group at the 2nd(59.38 vs 53.19,P<0.05)and 3rd month(71.92 vs 64.34,P<0.05)following discharge.CONCLUSION The utilization of programmed pain nursing in conjunction with collaborative nursing for out-of-hospital care of TKA patients has demonstrated favorable outcomes,encompassing pain reduction,enhanced prognosis,and improved nursing quality for patients.

Meta-analysis of factors influencing anterior knee pain after total knee arthroplasty

BACKGROUND Total knee arthroplasty(TKA)is a mature procedure recommended for correcting knee osteoarthritis deformity,relieving pain,and restoring normal biomechanics.Although TKA is a successful and cost-effective procedure,patient dissatisfaction is as high as 50%.Knee pain after TKA is a significant cause of patient dissatisfaction;the most common location for residual pain is the anterior region.Between 4%and 40%of patients have anterior knee pain(AKP).AIM To investigate the effect of various TKA procedures on postoperative AKP.METHODS We searched PubMed,EMBASE,and Cochrane from January 2000 to September 2022.Randomized controlled trials with one intervention in the experimental group and no corresponding intervention(or other interventions)in the control group were collected.Two researchers independently read the title and abstract of the studies,preliminarily screened the articles,and read the full text in detail according to the selection criteria.Conflicts were resolved by consultation with a third researcher.And relevant data from the included studies were extracted and analyzed using Review Manager 5.4 software.RESULTS There were 25 randomized controlled trials;13 were comparative studies with or without patellar resurfacing.The meta-analysis showed no significant difference between the experimental and control groups(P=0.61).Six studies were comparative studies of circumpatellar denervation vs non-denervation,divided into three subgroups for meta-analysis.The two-subgroup meta-analysis showed no significant difference between the experimental and the control groups(P=0.31,P=0.50).One subgroup meta-analysis showed a significant difference between the experimental and control groups(P=0.001).Two studies compared fixed-bearing TKA and mobile-bearing TKA;the results meta-analysis showed no significant difference between the experimental and control groups(P=0.630).Two studies compared lateral retinacular release vs non-release;the meta-analysis showed a significant difference between the experimental and control groups(P=0.002);two other studies compared other factors.CONCLUSION Patellar resurfacing,mobile-bearing TKA,and fixed-bearing TKA do not reduce the incidence of AKP.Lateral retinacular release can reduce AKP;however,whether circumpatellar denervation can reduce AKP is controversial.

Clinical observation on acupoint pressure therapy plus electroacupuncture for post-traumatic knee osteoarthritis

Objective： To investigate the clinical efficacy of Zhang＇s acupoint pressure therapy plus electroacupuncture（EA） in treating post-traumatic knee osteoarthritis.Methods： A total of 98 eligible patients with post-traumatic knee osteoarthritis were divided into group A and B by the random number table, 49 cases in each group. Group A was intervened by Zhang＇s acupoint pressure therapy plus EA; group B was given medicinal fumigation. The clinical efficacies of the two groups were compared. Results： The markedly effective rate of group A was significantly higher than that of group B. Conclusion： Zhang＇s acupoint pressure therapy plus EA can produce a satisfactory clinical efficacy in treating post-traumatic knee osteoarthritis, and is worth promotion.

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.

Post-traumatic heterotopic ossification in front of the ankle joint for 23 years:A case report and review of literature

BACKGROUND Heterotopic ossification(HO)refers to the formation of new bone in non-skeletal tissues such as muscles,tendons or other soft tissues.Severe muscle and soft tissue injury often lead to the formation of HO.However,anterior HO of the ankle is rarely reported.CASE SUMMARY We report a patient with massive HO in front of the ankle joint for 23 years.In 1998,the patient was injured by a falling object on the right lower extremity,which gradually formed a massive heterotopic bone change in the right calf and dorsum of the foot.The patient did not develop gradual ankle function limitations until nearly 36 mo ago,and underwent resection of HO.Even after 23 years and resection of HO,the ankle joint was still able to move.CONCLUSION It is recommended that the orthopedist should be aware of HO and distinguish it from bone tumor.