INTRODUCTIONKnee osteoarthritis (OA) is the most common articular disease. Different methods are used to alleviate the symptoms of patients with knee OA, including analgesics, physical therapy, exercise prescription, and intra-articular injections (glucocorticoids, hyaluronic acid [HA], etc). New studies have focused on modern therapeutic methods that stimulate cartilage healing process and improve the damage, including the use of platelet-rich plasma (PRP) as a complex of growth factors. Due to the high incidence of OA and its consequences, we decided to study the long-term effect of intraarticular injection of PRP and HA on clinical outcome and quality of life of patients with knee OA.METHODThis non-placebo-controlled randomized clinical trial involved 160 patients affected by knee OA, grade 1–4 of Kellgren–Lawrence scale. In the PRP group (n = 87), two intra-articular injections at 4-week interval were applied, and in the HA group (n = 73), three doses of intra-articular injection at 1-week interval were applied. All patients were prospectively evaluated before and at 12 months after the treatment by Western Ontario and McMaster Universities Arthritis Index (WOMAC) and SF-36 questionnaires. The results were analyzed using SPSS 16.1 software (RCT code: IRCT2014012113442N5).RESULTSAt the 12-month follow-up, WOMAC pain score and bodily pain significantly improved in both groups; however, better results were determined in the PRP group compared to the HA group (P < 0.001). Other WOMAC and SF-36 parameters improved only in the PRP group. More improvement (but not statistically significant) was achieved in patients with grade 2 OA in both the groups.CONCLUSIONThis study suggests that PRP injection is more efficacious than HA injection in reducing symptoms and improving quality of life and is a therapeutic option in select patients with knee OA who have not responded to conventional treatment.

BackgroundLateral humeral epicondylitis, or ‘tennis elbow’, is a common condition with a variety of treatment options. Platelet-rich plasma (PRP) and Autologous Whole Blood (AWB) represent new therapeutic options for chronic tendinopathies including tennis elbow. The aim of the present study was to compare the long term effects of PRP versus autologous whole blood local injection in patients with chronic tennis elbow.MethodsSeventy six patients with chronic lateral humeral epicondylitis with duration of symptoms more than 3 months were included in this study and randomized into 2 groups. Group 1 was treated with a single injection of 2 mL of autologous leukocyte rich PRP (4.8 times of plasma) and group 2 with 2 mL of AWB. Tennis elbow strap, stretching and strengthening exercises were administered for both groups. Pain and functional improvements were assessed using visual analogue scale (VAS), Mayo score (modified Mayo Clinic performance index for the elbow) and pressure pain threshold (PPT) at 0, 4, 8 weeks and 6 and 12 months.ResultsAll pain variables including VAS, PPT and Mayo scores improved significantly in both groups at each follow up intervals compared to baseline. No statistically significant difference was noted between groups regarding pain, functional scores and treatment success rates in all follow up examinations (P >0/05).ConclusionPRP and autologous whole blood injections are both effective methods to treat chronic lateral epicondylitis and their efficacy persisted during long term follow up. PRP was not superior to AWB in long term follow up.

Patients in the neurofeedback and EMG-biofeedback groups showed hand improvement similar to conventional OT. Further studies are suggested to assign the best protocol for neurofeedback and EMG-biofeedback therapy.

Background and objectives:Knee osteoarthritis is the most common joint disease. We aimed to compare the efficacy and safety of intra-articular injection of a newly developed plasma rich in growth factor (PRGF) versus hyaluronic acid (HA) on pain and function of patients with knee osteoarthritis.Methods:In this single-blinded randomized clinical trial, patients with symptomatic osteoarthritis of knee were assigned to receive 2 intra-articular injections of our newly developed PRGF in 3 weeks or 3 weekly injections of HA. Our primary outcome was the mean change from baseline until 2 and 6 months post intervention in scores of visual analog scale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Lequesne index. We used analysis of variance for repeated-measures statistical test.Results:A total of 69 patients entered final analysis. The mean age of patients was 58.2 ± 7.41 years and 81.2% were women. In particular, total WOMAC index decreased from 42.9 ± 13.51 to 26.8 ± 13.45 and 24.4 ± 16.54 at 2 and 6 months in the newly developed PRGF group (within subjects P = .001), and from 38.8 ± 12.62 to 27.8 ± 11.01 and 27.4 ± 11.38 at 2 and 6 months in the HA group (within subjects P = .001), respectively (between subjects P = .631). There was no significant difference between PRGF and HA groups in patients’ satisfaction and minor complications of injection, whereas patients in HA group reported significantly lower injection-induced pain.Conclusions:In 6 months follow up, our newly developed PRGF and HA, both are effective options to decrease pain and improvement of function in patients with symptomatic mild to moderate knee osteoarthritis.

Please cite this article as follows: Rayegani SM, Raeissadat SA, Heidari S, Moradi-Joo M. Safety and effectiveness of low-level laser therapy in patients with knee osteoarthritis: a systematic review and meta-analysis. J Lasers Med Sci. 2017;8(Suppl 1):S12-S19. doi:10.15171/ jlms.2017.s3. IntroductionOsteoarthritis is one of the most common diseases which has affected many people; this disease increases with age. In general, it may be said that approximately 14% of adults in United States and 40% of the population under 65 years old in Britain and Australia suffer from this disease; this disease prevalence is growing.1 Osteoarthritis is an example of physical and motor disability and one of the most important causes of functional disabilities in individuals, and imposes significant costs to individuals and consequently, to society. 2Knee osteoarthritis (KOA) is one of the most common osteoarthritis types and is associated with symptoms such as knee stiffness, pain, and limited movement range of knee joint. These conditions lead to physical function impairment, limited independence in doing daily life activities, decreased quality of life, and other disabilities. 3,4 KOA is also known as arthritis or knee joint stiffness; it mainly affects the articular cartilage. The articular cartilage is a soft tissue which is inside the joint and between bones; in the case of its damage, the bones will rub on each other and extended bone will be created around the joint. Ultimately, the ligaments and muscles around the joint will be narrowed and weakened. [1][2][3][4] There are several different treatments to control this disease (pharmacotherapy, surgery, physiotherapy, exercise therapy). It seems that the use of these methods depends on disease stage and patient's specific condition. In general, however, the logic and philosophy of these methods is relieving patient from pain, make him/her independent in doing daily life activities, and improving his/her life. 5Due to numerous complications which are associated with using non-steroidal drugs, using them to control this disease is limited. 5 Recently, other therapies which are based on rehabilitation methods (such as exercise therapy, tensile muscle movement, electrical stimulation, acupuncture, and heat therapy) are more considered by physicians than using non-steroidal drugs.6 Low-level laser therapy (LLLT) is one of the safe and non-invasive methods which has recently attracted the attention of Iran Health Insurance Organization, Tehran, Iran Abstract Introduction: Low-level laser therapy (LLLT) was introduced as an alternative non-invasive treatment for osteoarthritis, but its effectiveness is still controversial. The main objective of this article was to determine the safety and efficacy of LLLT in patients with knee osteoarthritis (KOA). Methods:In order to gather evidence, main medical databases as well as relevant websites were browsed without time limit. We searched with appropriate keywords and strategies. After quality assessment of studies, study data were extrac...