Arthrodiatasis for Management of Knee Osteoarthritis

Aly, Tarek; Hafez, Kamal; Amin, Osama

doi:10.3928/01477447-20110627-17

Cited by 21 publications

(21 citation statements)

References 28 publications

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“…Two studies were excluded as they reported the results of arthroscopic microfracture in combination with KJD and it was the authors opinion that, as microfracture is already an established treatment for cartilaginous loss, it would not be possible to delineate any treatment effect seen. 16,17 The first of these studies by Deie et al reported the outcomes of six knees managed with KJD and microfracture and found at a mean 3-year follow-up significant improvements in Japanese Orthopaedic Association Score, VAS pain score, and radiographic joint space width. 16 The second, by Aly et al, reported the outcomes of 61 knees, 19 managed with KJD, joint debridement and microfracture and 42 managed with joint debridement and microfracture and found that at a mean follow-up of 3 to 5 years the group managed with KJD, joint debridement, and microfracture had significantly improved pain, walking capacity, stair climbing, and radio-graphic joint space width compared with baseline, whereas those treated with joint debridement and microfracture without KJD did not.…”

Section: Resultsmentioning

confidence: 99%

“…16 The second, by Aly et al, reported the outcomes of 61 knees, 19 managed with KJD, joint debridement and microfracture and 42 managed with joint debridement and microfracture and found that at a mean follow-up of 3 to 5 years the group managed with KJD, joint debridement, and microfracture had significantly improved pain, walking capacity, stair climbing, and radio-graphic joint space width compared with baseline, whereas those treated with joint debridement and microfracture without KJD did not. 17 Outcomes of KJD Improvement from Baseline to One Year Post Intervention…”

Section: Resultsmentioning

confidence: 99%

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Is Knee Joint Distraction a Viable Treatment Option for Knee OA?—A Literature Review and Meta-Analysis

et al. 2018

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Knee joint distraction (KJD) is a new application of an established technique to regenerate native cartilage using an external fixator. The purpose of this study is to perform a systematic review and meta-analysis of the literature to determine whether KJD is beneficial for knee osteoarthritis and how results compare with established treatments. Studies assessing the outcomes of KJD were retrieved, with three studies (one cohort and two randomized controlled trials), 62 knees, meeting the inclusion criteria. The primary outcome was functional outcome, assessed using a validated outcome score, at 1 year. Secondary outcomes included pain scores, structural assessment of the joint, and adverse events. KJD is associated with improvements in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) from baseline to 1 year as well as reductions in pain scores and improvements in structural parameters assessed radiographically and by magnetic resonance imaging. KJD is not associated with decreased knee flexion, but is associated with a high risk of pin site infection. In patients aged 65 years or under at 1 year, no differences in WOMAC or pain scores was detected between patients managed with KJD compared with high tibial osteotomy or total knee arthroplasty. KJD may represent a potential treatment for knee arthritis, though further trials with longer term follow-up are required to establish its efficacy compared with contemporary treatments. This is a Level I (systematic review and meta-analysis) study.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Is Knee Joint Distraction a Viable Treatment Option for Knee OA?—A Literature Review and Meta-Analysis

et al. 2018

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“…12,13 Studies have demonstrated a progressive decrease in pain, normalization of function, and a sustained increase in cartilage thickness as seen on weightbearing radiographs. [14][15][16][17] Arthroscopy [14][15][16] and magnetic resonance imaging (MRI) 14,18 evaluation showed cartilage repair after KJD. As a surrogate marker for cartilage quality, biochemical markers for collagen type-II turnover demonstrated an increase of synthesis over release.…”

Section: Introductionmentioning

confidence: 99%

Cartilage Quality (dGEMRIC Index) Following Knee Joint Distraction or High Tibial Osteotomy

et al. 2018

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Objective High tibial osteotomy (HTO) and knee joint distraction (KJD) are treatments to unload the osteoarthritic (OA) joint with proven success in postponing a total knee arthroplasty (TKA). While both treatments demonstrate joint repair, there is limited information about the quality of the regenerated tissue. Therefore, the change in quality of the repaired cartilaginous tissue after KJD and HTO was studied using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC). Design Forty patients (20 KJD and 20 HTO), treated for medial tibiofemoral OA, were included in this study. Radiographic outcomes, clinical characteristics, and cartilage quality were evaluated at baseline, and at 1- and 2-year follow-up. Results Two years after KJD treatment, clear clinical improvement was observed. Moreover, a statistically significant increased medial (Δ 0.99 mm), minimal (Δ 1.04 mm), and mean (Δ 0.68 mm) radiographic joint space width (JSW) was demonstrated. Likewise, medial (Δ 1.03 mm), minimal (Δ 0.72 mm), and mean (Δ 0.46 mm) JSW were statistically significantly increased on radiographs after HTO. There was on average no statistically significant change in dGEMRIC indices over two years and no difference between treatments. Yet there seemed to be a clinically relevant, positive relation between increase in cartilage quality and patients' experienced clinical benefit. Conclusions Treatment of knee OA by either HTO or KJD leads to clinical benefit, and an increase in cartilage thickness on weightbearing radiographs for over 2 years posttreatment. This cartilaginous tissue was on average not different from baseline, as determined by dGEMRIC, whereas changes in quality at the individual level correlated with clinical benefit.

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“…A few treatment options that preserve the joint are available for severe end‐stage knee OA. Knee joint distraction is considered a novel, still experimental, treatment option that has shown long‐term (at least 5 years [Wiegant K, et al: unpublished observations]) clinical benefit, accompanied by tissue structure repair, as evaluated by imaging techniques (radiography and magnetic resonance imaging [MRI]) and analysis of biochemical (collagen turnover) markers ().…”

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confidence: 99%

Evidence of Cartilage Repair by Joint Distraction in a Canine Model of Osteoarthritis

Wiegant

Intema

Roermund

et al. 2015

Arthritis & Rheumatology

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Objective. Knee osteoarthritis (OA) is a degenerative joint disorder characterized by cartilage, bone, and synovial tissue changes that lead to pain and functional impairment. Joint distraction is a treatment that provides long-term improvement in pain and function accompanied by cartilage repair, as evaluated indirectly by imaging studies and measurement of biochemical markers. The purpose of this study was to evaluate cartilage tissue repair directly by histologic and biochemical assessments after joint distraction treatment.Methods. In 27 dogs, OA was induced in the right knee joint (groove model; surgical damage to the femoral cartilage). After 10 weeks of OA development, the animals were randomized to 1 of 3 groups. Two groups were fitted with an external fixator, which they wore for a subsequent 10 weeks (one group with and one without joint distraction), and the third group had no external fixation (OA control group). Pain/function was studied by force plate analysis. Cartilage integrity and chondrocyte activity of the surgically untouched tibial plateaus were analyzed 25 weeks after removal of the fixator.Results. Changes in force plate analysis values between the different treatment groups were not conclusive. Features of OA were present in the OA control group, in contrast to the generally less severe damage after joint distraction. Those treated with joint distraction had lower macroscopic and histologic damage scores, higher proteoglycan content, better retention of newly formed proteoglycans, and less collagen damage. In the fixator group without distraction, similarly diminished joint damage was found, although it was less pronounced.Conclusion. Joint distraction as a treatment of experimentally induced OA results in cartilage repair activity, which corroborates the structural observations of cartilage repair indicated by surrogate markers in humans.

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Arthrodiatasis for Management of Knee Osteoarthritis

Cited by 21 publications

References 28 publications

Is Knee Joint Distraction a Viable Treatment Option for Knee OA?—A Literature Review and Meta-Analysis

Is Knee Joint Distraction a Viable Treatment Option for Knee OA?—A Literature Review and Meta-Analysis

Cartilage Quality (dGEMRIC Index) Following Knee Joint Distraction or High Tibial Osteotomy

Evidence of Cartilage Repair by Joint Distraction in a Canine Model of Osteoarthritis

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