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Patellofemoral Osteoarthritis: Intra-articular Injections

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Abstract

Many conservative and operative treatment options have been described for isolated patellofemoral (PF) osteoarthritis (OA) in the literature, but the optimal treatment is currently unclear. Among the conservative measures are physical medicine and rehabilitation (taping or knee braces), muscle enhancement, analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) and intra-articular (IA) infiltrations. In this chapter we will review the current role of IA infiltrations in PF OA. IA injections can be divided in four main groups: corticosteroids, hyaluronic acid (HA), platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs) injections. Evidence found about IA therapies for the management of PF knee OA is controversial. Efforts should be made to identify the characteristics of and selection criteria for the OA population likely to benefit from these therapies.

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References

  1. Bijlsma JW, Berenbaum F, Lafeber FP. Osteoarthritis: an update with relevance for clinical practice. Lancet. 2011;377:2115–26.

    Article  Google Scholar 

  2. Lankhorst NE, Damen J, Oei EH, Verhaar JAN, Kloppenburg M, Bierma-Zeinstra SMA, et al. Incidence, prevalence, natural course and prognosis of patellofemoral osteoarthritis: the cohort hip and cohort knee study. Osteoarthr Cartil. 2017;25:647–53.

    Article  CAS  Google Scholar 

  3. Peat G, Duncan RC, Wood LR, Thomas E, Muller S. Clinical features of symptomatic patellofemoral joint osteoarthritis. Arthritis Res Ther. 2012;14:R63.

    Article  Google Scholar 

  4. Hochberg MC, Altman RD, April KT, Benkhalti M, Guyatt G, McGowan J, et al. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Arthritis Care Res. 2012;64:465–74.

    Article  CAS  Google Scholar 

  5. McAlindon TE, Bannuru RR, Sullivan MC, Arden NK, Berenbaum F, Bierma-Zeinstra SM, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthr Cartil. 2014;22:363–88.

    Article  CAS  Google Scholar 

  6. Juni P, Hari R, Rutjes AW, Fischer R, Silletta MG, Reichenbach S, et al. Intraarticular corticosteroid for knee osteoarthritis. Cochrane Database Syst Rev. 2015;10:CD005328.

    Google Scholar 

  7. Bannuru RR, Schmid CH, Kent DM, Vaysbrot EE, Wong JB, McAlindon TE. Comparative effectiveness of pharmacologic interventions for knee osteoarthritis: a systematic review and network meta-analysis. Ann Intern Med. 2015;162:46–54.

    Article  Google Scholar 

  8. Tian K, Cheng H, Zhang J, Chen K. Intra-articular injection of methylprednisolone for reducing pain in knee osteoarthritis: a systematic review and meta-analysis. Medicine (Baltimore). 2018;97:e0240.

    Article  CAS  Google Scholar 

  9. Vannabouathong C, Bhandari M, Bedi A, Khanna V, Yung P, Shetty V, et al. Nonoperative treatments for knee osteoarthritis: an evaluation of treatment characteristics and the intra-articular placebo effect: a systematic review. JBJS Rev. 2018;6(7):e5.

    Article  Google Scholar 

  10. Conrozier T, Monfort J, Chevalier X, Raman R, Richette P, Diraçoglù D, et al. EUROVISCO recommendations for optimizing the clinical results of viscosupplementation in osteoarthritis. Cartilage. 2018. 1947603518783455.

    Google Scholar 

  11. Dasa V, Lim S, Heeckt P. Real world evidence for safety and effectiveness of repeated courses of hyaluronic acid injections on the time to knee replacement surgery. Am J Orthop (Belle Mead NJ). 2018;47:7. https://doi.org/10.12788/ajo.2018.0058.

    Article  Google Scholar 

  12. Fosco M, Dagher E. Proposal of a therapeutic protocol for selected patients with patellofemoral knee osteoarthritis: arthroscopic lateral retinacular release followed by viscosupplementation. Musculoskelet Surg. 2016;100:171–8.

    Article  CAS  Google Scholar 

  13. Ran J, Yang X, Ren Z, Wang J, Dong H. Comparison of intra articular hyaluronic acid and methylprednisolone for pain management in knee osteoarthritis: a meta-analysis of randomized controlled trials. Int J Surg. 2018;53:103–10.

    Article  Google Scholar 

  14. He WW, Kuang MJ, Zhao J, Sun L, Lu B, Wang Y, Ma JX. Efficacy and safety of intraarticular hyaluronic acid and corticosteroid for knee osteoarthritis: a meta-analysis. Int J Surg. 2017;39:95–103.

    Article  Google Scholar 

  15. National Institute for Health and Care Excellence. Osteoarthritis: care and management (NICE Guideline 177). 2014. https://www.nice.org.uk/guidance/cg177/chapter/1-Recommendations#pharmacological-management. Accessed 20 Oct 2018.

  16. American Academy of Orthopaedic Surgeons. Evidence based guideline: treatment of osteoarthritis of the knee. 2nd ed. 2013. http://www.aaos.org/Research/guidelines/TreatmentofOsteoarthritisoftheKneeGuideline.pdf. Accessed 20 Oct 2018.

  17. Jordan KM, Arden NK, Doherty M, et al. EULAR recommendations 2003: an evidence based approach to the management of knee osteoarthritis: Report of a Task Force of the Standing Committee for International Clinical Studies Including Therapeutic Trials (ESCISIT). Ann Rheum Dis. 2003;62:1145–55.

    Article  CAS  Google Scholar 

  18. Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med. 2013;41:356–64.

    Article  Google Scholar 

  19. Filardo G, Kon E, Roffi A, et al. Platelet-rich plasma: why intra-articular? A systematic review of preclinical studies and clinical evidence on PRP for joint degeneration. Knee Surg Sports Traumatol Arthrosc. 2015;23:2459. https://doi.org/10.1007/s00167-013-2743-1.

    Article  CAS  PubMed  Google Scholar 

  20. Paterson KL, Hunter DJ, Metcalf BR, et al. Efficacy of intra-articular injections of platelet-rich plasma as a symptom- and disease-modifying treatment for knee osteoarthritis – the RESTORE trial protocol. BMC Musculoskelet Disord. 2018;28(19):272. https://doi.org/10.1186/s12891-018-2205-5.

    Article  CAS  Google Scholar 

  21. Di Y, Han C, Zhao L, Ren Y. Is local platelet-rich plasma injection clinically superior to hyaluronic acid for treatment of knee osteoarthritis? A systematic review of randomized controlled trials. Arthritis Res Ther. 2018;20:128.

    Article  Google Scholar 

  22. Kon E, Mandelbaum B, Buda R, Filardo G, Delcogliano M, Timoncini A, et al. Platelet-rich plasma intraarticular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. Arthroscopy. 2011;27:1490–501.

    Article  Google Scholar 

  23. Jang S-J, Kim J-D, Cha S-S. Platelet-rich plasma (PRP) injections as an effective treatment for early osteoarthritis. Eur J Orthop Surg Traumatol. 2013;23:573–80.

    Article  Google Scholar 

  24. Hurley ET, Yasui Y, Gianakos AL, Seow D, Shimozono Y, Kerkhoffs GMMJ, Kennedy JG. Limited evidence for adipose-derived stem cell therapy on the treatment of osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2018;26(11):3499–507. https://doi.org/10.1007/s00167-018-4955-x.

    Article  PubMed  Google Scholar 

  25. Moatshe G, Morris ER, Cinque ME, Pascual-Garrido C, Chahla J, Engebretsen L, et al. Biological treatment of the knee with platelet-rich plasma or bone marrow aspirate concentrates. Acta Orthop. 2017;88:670–4.

    Article  Google Scholar 

  26. Pas HI, Winters M, Haisma HJ, Koenis MJ, Tol JL, Moen MH. Stem cell injections in knee osteoarthritis: a systematic review of the literature. Br J Sports Med. 2017;51:1125–33.

    Article  Google Scholar 

  27. Rodriguez-Merchan EC. Intra-articular injections of fat-derived mesenchymal stem cells in knee osteoarthritis: are they recommended? Hosp Pract (1995). 2018;11:1–3.

    Article  Google Scholar 

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Ruiz-Pérez, J.S., Rodríguez-Merchán, E.C. (2019). Patellofemoral Osteoarthritis: Intra-articular Injections. In: Rodríguez-Merchán, E., Liddle, A. (eds) Disorders of the Patellofemoral Joint. Springer, Cham. https://doi.org/10.1007/978-3-030-12442-7_13

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  • DOI: https://doi.org/10.1007/978-3-030-12442-7_13

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-12441-0

  • Online ISBN: 978-3-030-12442-7

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