To summarize the clinical efficacy and experience of Salter pelvic osteotomy combined with proximal femoral osteotomy in the treatment of children with developmental dysplasia of the hip (DDH), and to analyze the effects of the differences in age, acetabular index, and the degree of subluxation on the clinical efficacy.
Methods
Children diagnosed with DDH who underwent Salter pelvic osteotomy combined with proximal femoral osteotomy in the Department of Joint Surgery of the 940th Hospital of PLA Joint Logistics Support Force from January 2010 to December 2020 were enrolled, and the patients with cerebral palsy, joint disorders or spinal cord diseases and incomplete data were excluded. A retrospective study of the clinical data was carried out to analyze acetabular index (AI) and center-edge angle (CE angle) in the orthopantomograms of the pelvis taken at before operation, one day, three and six months, as well as one, two, and three years of follow-up. The treatment effect was evaluated according to the Severin radiological criteria and the Mckay hip functionality score at the final follow-up after the operation, and the surgery-related complications were counted. The patients were then divided into groups according to different ages, degrees of dislocation (IHDI typing), and acetabular indices (AI), and differences in clinical efficacy were comparatively analyzed using the Spearman correlation coefficient test.
Results
A total of 70 children (88 hips) with DDH were enrolled, including 23 males and 47 females, with average age of (36±15) months at the time of Salter osteotomy. At the final follow-up, 79 hips were excellent and nine hips were good according to Severin criteria; while in Mckay score, 51 hips were excellent, 21 hips were good, 13 hips were moderate, and three hips were poor. Postoperative complications occurred in six cases and six hips, including three cases and three hips of femoral stem fracture, one case and one hip of femoral head necrosis, and two cases and two hips of joint stiffness with limitation of movement after internal fixation removal. Severin standard evaluation of children≤three years old group was excellent in 55 hips, Mckay score was excellent in 43 hips, good in 12 hips. Severin standard evaluation of children>three years old was excellent in 24 hips, good in nine hips; Mckay scores were excellent in eight hips, good in nine hips, moderate in 13 hips, poor in three hips. The patient age was negatively corelated to Severin grades and Mckay scores at the last follow-up (R=-0.469, -0.681, both P<0.01). According to the IHDI subgroups, children with IHDI type Ⅲ had 59 excellent hips for Severin’s criteria, while 44 excellent hips and 15 good hips according to Mckay score. Children with IHDI type Ⅳ had 20 excellent hips and nine good hips by Severin’s criteria, while seven excellent hips, six good hips, 13 moderate hips and three poor hips according to Mckay’s score. IHDI stages were negatively correlated to Severin grades and Mckay scores at the last follow-up (R=-0.481, -0.591, both P<0.01). In the children with AI≤35°, Severin’s criteria was excellent in 47 hips, Mckay’s score was excellent in 37 hips, good in 10 hips. Severin’s criteria in the children with AI>35° were evaluated as excellent in 32 hips, good in nine hips, while according to Mckay’s scores 14 hips were excellent, 11 hips were good, 13 hips were moderate and three hips were poor ( R=-0.361, -0.515, both P<0.01).
Conclusions
Salter pelvic osteotomy combined with proximal femoral osteotomy for the treatment of DDH can significantly improve the morphology and function of the hip joint, improve the quality of life of the children, and have fewer related complications. Among them, children≤3Years old, IHDI type Ⅲ, and AI≤35°obtained better hip joint morphology and function.
To investigate the risk predictors of early femoral head necrosis (FHN) after femoral neck system (FNS) treatment for femoral neck fractures of Pauwels type I to type III.
Methods
From January 2020 to July 2024 120 patients with femoral neck fractures in the Affiliated Hospital of Chengdu University were retrospectively selected. Inclusion criteria: unilateral traumatic femoral neck fracture, aged from 18 to 65 years, clear surgical indications, complete data; exclusion criteria: pathological fracture, immune disease, history of hormone use, malignant tumor. and treated with FNS after admission. According to the presence or absence of occurrence of early FHN, the enrolled patients were divided into femoral head necrosis group (FHN group, n=39) and non-femoral head necrosis group (non-FHN group, n=81). The general data, laboratory indicators and perioperative indicators in the two groups were collected. The differences in related factors of FHN between groups were compared by univariate analysis. The independent influencing factors of FHN were screened by multivariate logistic model, and the predictive efficiency of each factor on the risk of early FHN was analyzed by receiver operating characteristic curve.
Results
There was a statistical difference in Pauwels type composition between the FHN group and the non-FHN group (χ2=2.629, P=0.009). The waiting time from fracture to surgery, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), interleukin (IL)-6 and IL-33 in the FHN group were longer or higher than those in the non-FHN group while the β-C-terminal telopeptide of type I collagen (β-CTX) and pro-collagen I N-terminal pro-peptide (P1NP) were lower, with statistical difference (all P<0.05). After logistic regression analysis, it was found that the waiting time from fracture to surgery, NLR, IL-6, β-CTX and P1NP were the influencing factors for early FHN. As for predicting early FHN alone and in combination with waiting time from fracture to surgery, NLR, IL-6, β-CTX and P1NP, the sensitivities were 0.513, 0.821, 0.718, 0.872, 0.667 and 0.974 respectively; the specificities were 0.765, 0.889, 0.889, 0.556, 0.864 and 0.951; the Yoden indices were 0.278, 0.709, 0.607, 0.427, 0.531 and 0.925; the areas under the curves were 0.683, 0.924, 0.829, 0.748, 0.801 and 0.993 respectively.
Conclusions
The risk factors for postoperative early FHN in patients with femoral neck fractures treated with FNS for different fracture types include the waiting time from fracture to surgery, NLR, IL-6, β-CTX and P1NP. The combination of various factors has extremely high efficiency on predicting the occurrence of FHN and has great clinical promotion value.
To evaluate the effect of intraoperative tranexamic acid (TXA) use on postoperative coagulation and fibrinolysis function following lower extremity joint arthroplasty.
Methods
This retrospective cohort study included the patients who underwent lower limb joint replacement surgery at the Affiliated Kunshan Hospital of Jiangsu University between April 2018 and February 2021. Inclusion criteria: patients indicated for lower-limb arthroplasty (total knee, unicompartmental knee, hemiarthroplasty, or total hip) with no contraindications to tranexamic acid or the study anticoagulants. Exclusion criteria: allergy or contraindication to tranexamic acid or any study anticoagulant; past or current coagulopathy or bleeding tendency; concomitant use of drugs that affect anticoagulation or increase bleeding risk; severe renal impairment (creatinine clearance <30 ml/min); active or prior peptic ulcer/gastrointestinal bleeding within six months; or venous thromboembolism (e.g., deep vein thrombosis, pulmonary embolism) within the past year. Data on preoperative and postoperative 48-hour blood routine, biochemical markers, and coagulation indicators were collected. Patients were divided into different groups based on the use of TXA. The outcomes measured included postoperative hemoglobin, hematocrit, transfusion rate, and coagulation indicators. Data between groups were compared using t-tests or Mann-Whitney U rank-sum tests for continuous variables, and chi square tests for categorical variables.The independent effect of intraoperative tranexamic acid (TXA) use on postoperative hemoglobin levels, transfusion rates, and coagulation indicators after sequential administration of different anticoagulants, controlling for confounding factors using logistic and multiple linear regression.
Results
A total of 403 patients were enrolled. Among them, 190 patients received tranexamic acid (TXA) intraoperatively, while 213 patients did not. Postoperative anticoagulation was achieved with low-molecular-weight heparin in 294 patients and with oral anticoagulants in 109 patients. The TXA group had significantly higher postoperative hemoglobin (111.25 ± 18.35) g/L and hematocrit (34.38%) compared to the control group [(106.25 ± 18.42) g/L, 32.91%] (t=-2.65, P=0.009; t=-2.26, P=0.024). The transfusion rate in the TXA group was 8.84%, significantly lower than the 19.19% observed in the control group (χ2=8.294, P<0.05). Logistic regression analysis showed that TXA use reduced the risk of moderate postoperative anemia [odds ratio (OR)=0.34, 95%CI (0.17, 0.69), P=0.003] and decreased transfusion requirements [OR=0.34, 95%CI (0.17, 0.68), P=0.002]. Multiple linear regression analysis showed that intraoperative TXA and postoperative sequential anticoagulation with different types of anticoagulants had no significant effect on postoperative coagulation parameters.
Conclusions
TXA administration improves postoperative hemoglobin levels, reduces transfusion requirements, and lowers the risk of moderate anemia in patients undergoing lower limb joint replacement surgery. In the context of sequential anticoagulants following surgery, TXA use did not increase the risk of postoperative coagulation abnormalities, indicating its effectiveness in reducing bleeding while maintaining a favorable safety profile.
To investigate the correlation between the degree of knee cartilage damage observed by knee arthroscopy and bone metabolism markers, in order to provide a clinical theoretical basis for early identification of high-risk groups for knee osteoarthritis (KOA) and the formulation of individualized KOA prevention and treatment strategies.
Methods
A total of 156 patients who needed arthroscopic knee surgery at the department of spinal joint surgery, Shengjing Hospital Affiliated with China Medical University were analyzed retrospectively from January 2021 to December 2023, exclusion criteria comprised inflammatory arthropathies, history of knee surgery and significant knee trauma. According to the Outerbridge classification of the degree of knee cartilage injury observed in knee arthroscopy, the subjects were divided into four groups according to the grade of injuries. Various factors, including bone metabolism markers such as 25-hydroxyvitamin D (25-OH-VD), parathyroid hormone (PTH), β-collagen degradation products (β-CTX), N-terminal osteocalcin (N-MID), total type I collagen amino-terminal extension peptide (TP1NP), as well as gender, age, body mass index (BMI), bone mineral density, meniscus injury, and cruciate ligament injury were analyzed. The general data difference analysis was carried out and the statistically significant variables were included in the univariate multivariate ordered logistic regression model one by one. The indicators with statistically significant differences were further selected and included in the multivariable ordinal logistic regression model for analysis, so as to explore the correlation between each factor and the degree of knee cartilage injury.
Results
The results of the analysis of the differences in general data showed that there were statistical differences in age, BMI, T value of bone density, 25-OH-VD, β-CTX, N-MID, TP1NP and whether there was meniscus injury or not in the four groups (all P<0.05). The results of multifactorial orderly and multiclassified logistic regression analysis showed that age increase [odds ratio (OR)=1.067, P<0.01], BMI increase (OR=1.198, P<0.05) and meniscus injury (OR=3.697, P<0.05) are Independent risk factors for the degree of knee cartilage injury (P< 0.05), while large bone density T value (OR=0.252, P<0.001) 、higher levels of 25-OH-VD (OR=0.937, P<0.05) and N-MID (OR=0.881, P<0.001) are independent protective factors for the degree of knee cartilage injury.
Conclusions
Higher levels of 25-OH-VD and N-MID, as well as better bone density have a certain protective effect on knee articular cartilage, thus maintaining normal bone mass and normal levels of 25-OH-VD and N-MID can help protecting the articular cartilage of knee and postpone the occurrence and development of KOA. Knee cartilage injury tends to gradually worsen with the increase of age and BMI, and meniscus injury is an independent risk factor for knee cartilage injury.
To evaluate the efficacy and safety of tranexamic acid (TXA) in reducing perioperative blood loss in patients with intertrochanteric fractures (ITF) undergoing proximal femoral nail antirotation (PFNA) treatment.
Methods
Randomized controlled trials (RCTs) evaluating the effect of TXA on perioperative blood loss in ITF patients treated with PFNA were searched in medical electronic databases, including China National Knowledge Infrastructure, China Biology Medicine Database, VIP Journal Integration Platform, Wanfang Data Knowledge Service Platform, Web of Science, PubMed, Excerpta Medica Database (Embase), and Cochrane Library, from the establishment of each database up to October 31, 2024. The quality and risk of bias of the included studies were assessed using the modified Jadad scale and the Cochrane Risk of Bias Tool 2.0 for randomized controlled trials. Meta-analysis, heterogeneity analysis, sensitivity analysis, subgroup analysis, publication bias analysis, trim-and-fill analysis, and trial sequential analysis were performed using StataSE 15, with trial sequential analysis conducted using TSA 0.9.5.
Results
This study included 21 RCTs with a total of 1 938 patients. Meta-analysis indicated that compared to equivalent normal saline or placebo controls, TXA significantly reduced total blood loss [mean difference (MD)=-225.42, 95% confidence interval (CI) (-281.49, -169.36), P<0.001], hidden blood loss [MD=-215.43, 95% CI (-267.48, -163.38), P<0.001], and transfusion rate [relative risk (RR)= 0.54, 95% CI (0.48, 0.62), P<0.001]. It also reduced visible blood loss, intraoperative bleeding, postoperative 24h drainage volume, transfusion volume, and maintained hemoglobin concentration on the third postoperative day without significantly increasing the incidence of serious adverse events. Subgroup analysis demonstrated that the reduction in perioperative blood loss for patients with ITF treated with PFNA using TXA was not influenced by the type of intervention, average patient age, average body mass index (BMI), preoperative hemoglobin concentration, or total TXA dosage, all showing significant superiority over the control group. The publication bias analysis did not reveal significant publication bias for primary outcomes such as total blood loss, hidden blood loss, and transfusion rate. Trial sequential analysis further confirmed the robustness of the conclusions regarding the primary outcome measures.
Conclusions
TXA is effective and safe in reducing perioperative blood loss in ITF patients undergoing PFNA. However, due to methodological and design limitations in existing studies, these conclusions should be interpreted with caution. More rigorously designed and high-quality RCTs are needed in the future to further validate these findings.
This review systematically summarized the core pathological mechanisms of synovial cell senescence in the onset and progression of osteoarthritis (OA) and focused on recent advances in targeted therapies for senescent synovial cells, aiming to provide a theoretical basis for precise OA interventions. Relevant literature from PubMed, Web of Science, and China National Knowledge Infrastructure (CNKI) databases in recent years was reviewed to analyze the molecular mechanisms of synovial cell senescence and its pathological effects mediated by the senescence-associated secretory phenotype (SASP). The findings indicate that senescent synovial cells release pro-inflammatory cytokines and matrix-degrading enzymes (e.g., MMP-13), which drive chronic synovial inflammation, cartilage degeneration, and loss of joint function. In recent years, emerging approaches such as senolytic drugs (e.g., dasatinib plus quercetin combination therapy), CRISPR-based gene editing, and mesenchymal stem cell transplantation have shown significant efficacy in eliminating senescent synovial cells or reversing their pathological phenotype, thereby ameliorating joint damage in OA animal models. Targeting synovial cell senescence offers a novel direction for OA treatment, and future studies are urgently needed to further elucidate the spatiotemporal dynamics of the senescent microenvironment and facilitate the clinical translation of these findings.
Osteoarthritis (OA) is one of the most common chronic degenerative diseases, which mainly damages articular cartilage and involves the entire joint tissue. In recent years, the incidence rate of the disease has gradually increased among middle-aged and elderly people. The specific etiology and pathogenesis are still unclear, and its occurrence is related to the patient’s age, hormone level, weight, inflammation, trauma, heredity and other factors. Chondroitin sulfate (CS) is a type of sulfated glycosaminoglycan that is widely presented in the extracellular matrix and cartilage of animal tissues. It plays a role in maintaining homeostasis in various intracellular environments, such as inflammation regulation, reactive oxygen species regulation, immune regulation, and tissue adhesion regulation. In recent years, the research on how CS inhibits OA has become more and more in-depth, and biomaterials derived from CS have also become the focus of research in recent years, such as chondroitin sulfate based hydrogels, biological scaffolds and drug delivery systems are being widely used. Therefore, this article systematically reviewed the latest progress of chondroitin sulfate and its derived biomaterials in the treatment of osteoarthritis, focusing on OA development inhibition induced by regulation of CS in the immune microenvironment of cartilage, synovium, and subchondral bone, cartilage matrix metabolism, as well as the application of its derived biomaterials in OA.
Steroids induced avascular necrosis of femoral head (SANFH) is a metabolic disease in which ischaemia and necrosis of the femoral head occur as a result of obstruction of local blood circulation due to continuous administration of high doses of glucocorticoids (GCs). SANFH has a high disability rate, which seriously affects the quality of patients’ survival, but its specific pathogenesis has not been fully elucidated, among which the imbalance of osteogenic and lipogenic differentiation of bone marrow mesenchymal stem cells (BMSCs) is considered to be one of the main mechanisms for the development of SANFH. The research progresses of BMSCs in the pathogenesis of SANFH were reviewed to provide a reference basis for further prevention and treatment of SANFH.
Osteonecrosis of the femoral head (ONFH) is a necrosis of bone tissue caused by interrupted blood supply, often leading to femoral head collapse and loss of hip joint function. For young patients, hip preservation surgery has become an important option as it reduces the risk of hip replacement surgery and functional limitations. In recent years, bone morphogenetic protein 2 (BMP2) has gradually become an innovative strategy for treating femoral head necrosis due to its key role in bone formation. BMP2 can promote osteogenesis and angiogenesis, significantly enhancing the effectiveness of hip preservation treatment for femoral head necrosis when combined with bone repair materials through local delivery systems. When used in conjunction with quadratus femoris muscle-bone flap transplantation, BMP2 has demonstrated unique advantages in accelerating bone regeneration and improving surgical efficacy, providing strong support for emerging treatment methods.
Tibial plateau fracture is treated with percutaneous minimally invasive techniques to protect the local soft tissue and promote bone healing due to the thin skin of the proximal tibia. Detailed CT 3D reconstruction is required to accurately determine the type of fracture prior to treatment. The main goal of treatment is to restore the alignment of the lower limb, followed by precise repositioning of the articular surfaces and restoration of joint stability. Surgical navigation and arthroscopic techniques are essential to verify the effectiveness of the reduction. Fracture stabilisation can be achieved with bone cement, cannulated screws or minimally invasive percutaneous plates. The key to percutaneous surgery is to protect metaphyseal blood supply, not the size of the incision, to ensure quality of healing and long-term stability. Compared to open reduction, percutaneous surgery not only performs better in Schatzker type I, II, and III fractures, but also in complex fractures, where it has the advantage of being less invasive and reducing complications.
Medial meniscus posterior root tear (MMPRT) is a radial tear or avulsion within one centimetre of the medial meniscus root point. When this type of injury occurs in the medial meniscus, there may be a meniscus extrusion and increased cartilage pressure, while the meniscus will lose its ability to convert axial pressure to circumferential pressure, resulting in rapid degeneration of the knee joint. However, accurately diagnosing injuries to the root of the medial meniscus presents certain challenges. To maximize the preservation of knee joint function, meniscus repair surgery should be preferred over traditional meniscectomy. There are primarily two repair approaches for suturing tears in the posterior root of the medial meniscus: transtibial pullout repair and anchor repair. Numerous reports have been published in domestic and international literature on the treatment of medial meniscus root injuries. However, there is still controversy over whether these methods can prevent or delay the onset of knee osteoarthritis. The article reviewed the progress in the diagnosis and treatment of MMPRT.
To investigate the clinical effect and value of combined application of low-dose propofol intravenous anesthesia and local anesthesia in manual reduction of shoulder dislocation in emergency practice.
Methods
A total of 120 patients with anterior shoulder dislocation admitted to the Emergency Surgery Department of Jinjiang Municipal Hospital from January 2021 to June 2024 were studied. They were divided into local anesthesia group and propofol combined local anesthesia group (combined group) (60 cases each) by random number table method, and the latter group was given a total dose <1.5 mg/kg propofol injection. For measurement data comparison, t test was employed; for count data comparison, chi square test was used to compare reduction time, reduction frequency, subjective satisfaction, pain level, shoulder joint function and complications one month after reduction.
Results
Compared with the local anesthesia group, the combined group demonstrated significantly shorter reduction time (Z=-4.433), lower visual analogue scale (VAS) scores (t=3.684), and higher customer satisfaction questionnaire-8 (CSQ-8) scores (Z=-5.619) after reduction, with statistically significant differences ( all P<0.01). One month after reduction, the Constant-Murley score (excluding muscle strength) were higher in the combined group than in the local anesthesia group (all P<0.01): pain level (t=-3.759), activities of daily life (t=-6.529), and range of motion (t=-4.064).
Conclusion
Low dose propofol intravenous anesthesia combined with local anesthesia can significantly shorten the reduction time, reduce the pain, improve the patient satisfaction and promote the recovery of shoulder joint function in the manual reduction of shoulder dislocation in emergency department, which is worthy of clinical promotion in basic hospitals.
To compare clinical effects between wrist arthroscopy and intraoperative fluoroscopy assisted open reduction and volar plate internal fixation in the treatment of intra-articular distal radius fractures.
Methods
A retrospective analysis was conducted on the clinical data of 151 patients with intra-articular distal radius fractures who received surgical treatment in Ankang Central Hospital from April 2020 to April 2023. According to different adjuvant treatment methods, the patients were divided into the traditional group (traditional intraoperative fluoroscopy assisted surgery, 78 cases) and the arthroscope group (wrist arthroscope assisted surgery, 73 cases). Intraoperative blood loss, length of hospital stay, fracture healing time, duration of surgery, the disabilities of the arm, shoulder and hand (DASH) scores, patient-rated wrist examination (PRWE) scores, wrist range of motion, whole blood low shear viscosity, whole blood high shear viscosity and plasma viscosity of the two groups were recorded. The complication incidence was also recorded. The independent-sample t test and chi square test were used for statistical analysis.
Results
Intraoperative blood loss, length of hospital stay and fracture healing time of the arthroscope group were significantly less and shorter than those of the traditional group, but the duration of surgery was significantly longer than that in the traditional group (t=2.954, 3.231, 5.432, 3.383, all P<0.05). Six months after surgery, DASH and PREW scores of the arthroscope group were significantly lower than those of the traditional group. The ranges of flexion, pronation and supination, ulnar and radial ranges of motion, and range of dorsiflexion were significantly larger than those in the traditional group (t=2.903, 2.261, 2.265, 2.283, 2.190, 3.976, 6.105, 3.289, all P<0.05). Twelve months after surgery, there were decreases in DASH and PREW scores, and increases in the ranges of flexion, pronation and supination, ulnar and radial ranges of motion, and the range of dorsiflexion in both groups. However, there was no statistically significant difference between the groups (t=1.919, 0.527, 0.807, 0.438, 1.003, 1.202, 1.009, 1.049, all P>0.05). Three months after surgery, whole blood low shear viscosity, whole blood high shear viscosity and plasma viscosity in both groups decreased, and these indicators in the arthroscope group were significantly lower than those in the traditional group (t=3.123, 2.082, both P<0.05). The incidence of adverse reactions showed no statistically significant difference between groups (P=0.444).
Conclusions
For intra-articular distal radius fracture, wrist arthroscopy assisted surgery causes less intraoperative blood loss, and is more conducive to fracture healing. It can improve short-term wrist function, and reduce the impact on microcirculation in the body.
To investigate the effect of artificial joint replacement with large trochanter on hip joint function in elderly patients with unstable intertrochanteric fractures during treatment.
Methods
A total of 120 elderly patients with unstable intertrochanteric fractures of the femur who were treated in the Department of Joint Surgery at Suzhou High tech Zone People’s Hospital from February 2021 to March 2023 were randomly divided into two groups (envelope method). The control group received proximal femoral anti-rotation intramedullary nail treatment, while the study group received artificial joint replacement treatment. The measurement data were analyzed using independent sample t test, and the count data were analyzed using chi square test. The postoperative indicators, incidence of complications, and Harris hip joint function score excellence rate within one year after surgery were compared between the two groups.
Results
The ambulant time and load bearing walking time of the study group were shorter than the control group (t=18.667, 21.627, both P<0.05). The intraoperative blood loss was more than that of the control group (t=20.904, P<0.05), and the operation time was longer than that of the control group (t=18.307, P<0.05). Compared with the control group, the postoperative complication incidence of the study group was lower (χ2=5.745, P<0.05). The excellent and good rates of Harris score at six and 12 months after surgery in the study group were higher than the rates in the control group (χ2=4.943, 4.574, both P<0.05).
Conclusions
Compared with the treatment of proximal femoral anti rotation intramedullary nail, artificial joint replacement surgery has shorter recovery time which can effectively reduce the occurrence of postoperative complications, so that the recovery of hip joint function is better, but it increases the operation time and intraoperative blood loss. Therefore, this treatment plan might be an option for treating unstable intertrochanteric fractures in elderly patients.
To explorer the clinical efficacy of intra-articular injection of autologous platelet rich plasma (PRP) in the treatment of degenerative meniscus tears.
Method
From May 2021 to August 2023, eighty-one patients were selected with meniscus injury who visited the outpatient department of orthopedics in Yancheng First People’s Hospital. All the patients were confirmed meniscus tear by MRI without trauma history. According to the random number method, patients were divided into PRP group (27 cases), hyaluronic acid (HA) group (27 cases), and control group (27 cases). All the patients refused arthroscopic surgery treatment. Each patient received a intra-articular injection treatment once a week, with PRP 5 ml, HA 2.5 ml, and 5 ml of saline for three weeks consecutively. All the patients were treated with the same rehabilitation plan, and the visual analog pain score (VAS), Lysholm score, and knee injury and osteoarthritis outcome score (KOOS) were recorded before treatment, at one, three, and six months after treatment. The results were analyzed by repeated measurement variance analysis. Any of adverse events were recorded during the follow-up. A knee joint MRI was carried out at six months after treatment and the Stoller grade was evaluated. The situations of meniscus repair were analyzed by chi-square test.
Results
All the patients finished the follow-up successfully in this study. There was no significant difference in age, gender, affected side, body mass index or follow-up duration among the three groups before treatment. There was no statistically significant difference in VAS, Lysholm, or KOOS scores among the three groups before treatment (all P>0.05). After treatment, VAS scores in all three groups were lower than before treatment, while KOOS and Lysholm scores were higher than before treatment. VAS scores in the PRP group (4.2±1.2, 2.6±1.0, 2.0±1.1) were lower than those in the HA group (5.2±1.0, 4.5±1.3, 3.2±1.1) and the control group (5.7±1.4, 4.9±1.2, 4.4±1.2) at one, three, and six months after treatment (F=10.966, 29.388, 30.721, all P<0.01), while Lysholm scores in the PRP group (75.6±4.5, 79.6±4.2, 85.1±5.3) were higher than those in the HA group ( 69.3±4.6, 73.8±4.1, 79.1±4.5) and the control group (64.8±3.6, 68.9±5.3, 70.4±4.3) at one, three, and six months after treatment, with statistically significant differences (F=45.504, 36.868, 67.314, all P<0.001). KOOS scores were higher than those in the control group at three and six months after treatment, with statistically significant differences (all P<0.05).None of the three group experience severe adverse events such as knee joint infection. As for the meniscus repair rate, PRP group (66.7%) was higher than that of the HA group (40.7%) and the control group (19.2%) (χ2=15.738, P=0.015).
Conclusion
PRP intra-articular injection could alleviate pain and improve knee joint function in patients with degenerative meniscus tear, with satisfactory clinical efficacy.