Common Practices in Intra-Articular Corticosteroid Injection for the Treatment of Knee Osteoarthritis: A Survey of the American Association of Hip and Knee Surgeons Membership

Blankstein, Michael; Lentine, Brandon; Nelms, Nathaniel J.

doi:10.1016/j.arth.2020.09.022

Cited by 23 publications

(20 citation statements)

References 24 publications

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“…Despite the controversy regarding possible chondrotoxic effects of immediate-release intra-articular corticosteroids, the functional improvement detected with TA-ER in the current study and decreased pain following treatment with TA-ER in prior work [ 2 , 16 ] support the need for considering for which patients and where in the knee OA treatment paradigm TA-ER may be indicated to balance potential risks and benefits. This need also is supported by the high level of use in clinical practice (100% of hip and knee surgeon respondents report corticosteroid use and 88.4% indicated always or often using this therapy for treatment of knee OA) [ 17 ], and the vast majority of clinical practice guidelines recommend use of intra-articular corticosteroids for knee OA [ 18 ], including current guidelines that TA-ER “be used over immediate release to improve patient outcomes” [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

The effect of intra-articular extended-release triamcinolone acetonide on OARSI-recommended physical performance measures in adults with bilateral symptomatic knee osteoarthritis

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Alm

2022

Osteoarthritis and Cartilage Open

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Section: Discussionmentioning

confidence: 99%

The effect of intra-articular extended-release triamcinolone acetonide on OARSI-recommended physical performance measures in adults with bilateral symptomatic knee osteoarthritis

Segal

Alm

2022

Osteoarthritis and Cartilage Open

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“…In addition to that, the compliance of patients also differed greatly, making the collection of postoperative MRI nearly impossible. After thorough consideration, only the latest MRI results (at least 1 year postoperative) was included in the study, if it was done in the following sequences 1 : coronal spin echoes T1 weighted image, 2 sagittal fat‐saturated protein density‐weighted imaging, 3 sagittal fat‐suppressed 3‐dimensional fast spoiled gradient echo. The MOCART (Magnetic Resonance Observation of Cartilage Repair Tissue) 2.0 Knee Score was utilized to evaluate the quality of the repaired cartilage.…”

Section: Methodsmentioning

confidence: 99%

“…1 As a result, cartilage defect without proper treatment could eventually develop into degenerative osteoarthritis (OA), which ultimately could lead to joint pain, joint dysfunction, and even the irreversible loss of total joint function. 2 Conservative methods for cartilage damage, such as injections of steroid, 3 hyaluronic acid, 4 platelet-rich plasma (PRP) 5 or stem cells 6 help relieve symptoms, but no evidence indicates restoration of the damaged cartilage. When conservative treatments fail, patients often seek surgical intervention.…”

Section: Introductionmentioning

confidence: 99%

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Mid‐ toLong‐TermClinical Outcomes of Cartilage Restoration of Knee Joint with AllogenicNext‐Generation Matrix‐InducedAutologous Chondrocyte Implantation (MACI)

Liu

Zhao

et al. 2023

Orthopaedic Surgery

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Objective Cartilage defect is a common pathology still lacking a unified treating option. The purpose of this retrospective study is to evaluate the safety, efficacy, and clinical and radiological outcome of cartilage restoration of knee joint with allogenic next‐generation Matrix‐Induced Autologous Chondrocyte Implantation (MACI) for the first time, as well as the correlation between postoperative clinical and radiological outcomes and preoperative patient history and demographics. Methods From July 2014 to August 2020, 15 patients who went through cartilage restoration with allogenic next‐generation MACI were included in this study. Patient demographics and PROM including the International Knee Documentation Committee (IKDC) subjective knee score, Lysholm score, Tegner Activity Scale (TAS), and Knee Injury and Osteoarthritis Outcome Score (KOOS) were obtained preoperatively, at 3, 6, 12 months postoperatively and the last follow‐up using an online questionnaire platform. MOCART 2.0 score was calculated at the last follow‐up. Analysis of variance (ANOVA) was used to compare PROM pre‐ and post‐operation, with two‐tailed p < 0.05 defined as statistical significant. Pearson correlation coefficient was used to evaluate correlation between the PROM and MOCART 2.0 score at the last follow‐up with patients demorgraphics. Results All patients were followed for an average of 66.47 ± 24.15 months (range, 21–93). All patients were satisfied with the outcome of the surgery and no complication was reported at the end of the study. No significant improvement was observed until 1 year after the implantation, except for IKDC score at 6 months. All PROM showed significant improvement 1 year post‐op except for Lysholm score and TAS, which also increased significantly at the time of the last follow‐up. Pearson correlation coefficient showed that the size of the defect, before or after debridement, was significantly negatively correlated with final KOOS‐Pain (before debridement: r = −0.57, p < 0.05; after debridement: r = −0.54, p < 0.05) and KOOS‐Symptoms score (before debridement: r = −0.66, p < 0.05; after debridement: r = −0.67, p < 0.05). The MOCART 2.0 score was found significantly and negatively correlated with BMI (r = −0.60, p < 0.05), and significantly and positively correlated with Lysholm score (r = 0.70, p < 0.05). Conclusion The next generation MACI with autologous chondrocyte and allogenic chondrocyte ECM scaffold could be used to treat focal articular cartilage defect in the knee joint safely and efficiently with lasting promising outcomes for more than 5 years. The size of the defects should be considered the most negatively correlated parameters influencing the postoperative clinical outcomes.

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“…Between March 1, 2018, and February 11, 2020, 267 patients were assessed for eligibility; of these, 145 were randomized (94 [65%] women; 51 [35%] men; mean [SD] age, 67 [10] years) (Figure 1;…”

Section: Patientsmentioning

confidence: 99%

Effect of Intramuscular vs Intra-articular Glucocorticoid Injection on Pain Among Adults With Knee Osteoarthritis

et al. 2022

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IMPORTANCE Intra-articular (IA) glucocorticoid injection is widely used in patients with knee osteoarthritis (OA), but the safety of this technique is in question among physicians. Intramuscular (IM) glucocorticoid injection could be an alternative approach. OBJECTIVE To investigate whether an IM glucocorticoid injection is noninferior to an IA glucocorticoid injection in reducing knee pain for patients with knee OA in primary care. DESIGN, SETTING, AND PARTICIPANTSThe KIS trial, a multicenter, open-label, randomized clinical noninferiority trial including patients with symptomatic knee OA, was conducted in 80 primary care general practices in the southwest of the Netherlands. The study was conducted from March 1, 2018, to July 28, 2020. INTERVENTIONS Patients were randomly allocated to receive an injection of triamcinolone acetonide, 40 mg, either IM in the ipsilateral ventrogluteal region or IA in the knee joint. All patients were followed up for 24 weeks. MAIN OUTCOMES AND MEASURESThe pain score at 4 weeks measured with Knee Injury and Osteoarthritis Outcome Score (range, 0-100; 0 indicates extreme pain), with a noninferiority margin of −7 (IM minus IA). A per-protocol analysis was prespecified as the primary analysis.RESULTS A total of 145 patients (94 women [65%]; mean [SD] age, 67 [10] years) were included; of these, 138 patients (IM, 72; IA, 66) were included in the per-protocol analysis. Clinically relevant improvements in knee pain were reached up to 12 weeks after the injection in both groups. At 4 weeks, the estimated mean difference in the Knee Injury and Osteoarthritis Outcome Score between the 2 groups was −3.4 (95% CI, −10.1 to 3.3). Noninferiority could not be declared because the lower limit exceeded the noninferiority margin. Intramuscular injection was noninferior to IA injection at 8

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Common Practices in Intra-Articular Corticosteroid Injection for the Treatment of Knee Osteoarthritis: A Survey of the American Association of Hip and Knee Surgeons Membership

Cited by 23 publications

References 24 publications

The effect of intra-articular extended-release triamcinolone acetonide on OARSI-recommended physical performance measures in adults with bilateral symptomatic knee osteoarthritis

The effect of intra-articular extended-release triamcinolone acetonide on OARSI-recommended physical performance measures in adults with bilateral symptomatic knee osteoarthritis

Mid‐ toLong‐TermClinical Outcomes of Cartilage Restoration of Knee Joint with AllogenicNext‐Generation Matrix‐InducedAutologous Chondrocyte Implantation (MACI)

Effect of Intramuscular vs Intra-articular Glucocorticoid Injection on Pain Among Adults With Knee Osteoarthritis

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