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Minerva Dental and Oral Science Apr 2023The aim of this paper was to report our experience and to review the literature of arthrocentesis focusing on protocols and results. (Review)
Review
BACKGROUND
The aim of this paper was to report our experience and to review the literature of arthrocentesis focusing on protocols and results.
METHODS
Arthrocentesis with supplemental hyaluronic acid was performed in patients with TMDs between January 2017 and December 2020 at the Division of Maxillofacial Surgery. The maximum interincisal opening (MIO) and pain score were recorded preoperatively (T0), 2 months postoperatively (T1), and 6 months postoperatively (T2). A literature search was performed to analyze the same parameters in patients with TMDs. Patient demographic, characteristics and treatment protocols used were also recorded.
RESULTS
This retrospective analysis enrolled 45 patients. Twenty-two patients (20 females, 2 males) with mean age of 37.13 years with internal derangement were included in study group A. Study group B included 23 patients with degenerative joint disease (19 females and 4 males) with mean age of 55.73 years. The outcomes trend of MIO and pain during the follow-up period showed a gradual improvement. Fifty articles meeting the proposed scientific criteria were selected for the literature revision. A range of clinical and procedural variables were analyzed by grouping the studies into two broad categories based on the diagnosis of TMD.
CONCLUSIONS
Based on our experience and on the basis of the most accredited scientific studies in the literature, intra-articular injections of HA are beneficial for the improvement of the pain and/or functional symptoms of TMDs.
Topics: Male; Female; Humans; Adult; Middle Aged; Temporomandibular Joint; Temporomandibular Joint Disorders; Arthrocentesis; Retrospective Studies; Treatment Outcome; Range of Motion, Articular; Pain
PubMed: 37052194
DOI: 10.23736/S2724-6329.22.04653-8 -
Blood Coagulation & Fibrinolysis : An... Sep 2019: The role of the orthopedic surgeon is to use invasive and/or surgical methods to treat the musculoskeletal disorders suffered by persons with hemophilia, always within...
: The role of the orthopedic surgeon is to use invasive and/or surgical methods to treat the musculoskeletal disorders suffered by persons with hemophilia, always within the context of a multidisciplinary team. Muscle hematomas must be diagnosed as early as possible and be subjected to continuous treatment until full resolution, as they are associated with the risk of severe complications (compartment syndromes and pseudotumors). Arthrocentesis (extraction of intra-articular blood) is recommended in cases of acute and profuse hemarthrosis. Synovectomy is mandatory in the case of synovitis. Radiosynovectomy plays a key role as it has been shown to reduce bleeding by 65%. Our department uses Yttrium-90 in knees and Rhenium-186 in elbows and ankles. Radiosynovectomy is our treatment of choice for synovitis whereas arthroscopic synovectomy is resorted to as second-line treatment. Total knee replacement (TKR) has shown itself to be effective for treating severe hemophilic arthropathy, although the infection risk in patients with hemophilia is higher than in patients with osteoarthritis (1-2 vs. 7%).
Topics: Arthroplasty, Replacement, Knee; Hemarthrosis; Hemophilia A; Humans; Joint Diseases; Radioisotopes; Rhenium; Synovectomy; Synovitis; Yttrium Radioisotopes
PubMed: 31517710
DOI: 10.1097/MBC.0000000000000824 -
Cureus Mar 2024Temporomandibular disorder (TMD) is a multifaceted disorder impacting the temporomandibular joint (TMJ), causing substantial discomfort and functional limitations. This... (Review)
Review
Temporomandibular disorder (TMD) is a multifaceted disorder impacting the temporomandibular joint (TMJ), causing substantial discomfort and functional limitations. This systematic review aims to comprehensively assess the effectiveness of non-invasive treatment modalities for TMJ dysfunction, prioritizing a definitive protocol to ensure patient safety and enhance quality of life. Employing the PRISMA guidelines, we meticulously analyzed 20 studies from a pool of 1,417 articles sourced from databases such as PubMed, Google Scholar, ScienceDirect, and Medline. These studies underscore the multifarious nature of TMD and the varied responses to treatments such as physical therapy, laser therapy, ultrasound and electrical stimulation, splint therapy, injections, and arthrocentesis. Notably, the review highlights the paramount importance of precise diagnosis, often through surface electromyography, followed by a tailored treatment approach integrating manual therapy, counseling, and splint therapy. The systematic analysis revealed that while certain treatments such as transcutaneous electrical nerve stimulation and low-level laser therapy showed limited efficacy, combination therapies, especially those involving manual therapy, counseling, and splint therapy, demonstrated substantial improvement in reducing pain, depression, and anxiety. The findings advocate for a non-invasive, patient-centric approach, emphasizing education and symptom management before considering more invasive procedures such as injections and arthrocentesis. The review identifies the need for more comprehensive, longitudinal studies to establish a standardized, evidence-based treatment protocol for TMJ dysfunction, aiming to improve patient outcomes holistically.
PubMed: 38646388
DOI: 10.7759/cureus.56713 -
Journal of Personalized Medicine Jul 2023Septic arthritis (SA) in children is an acute inflammatory disease of the joints. If not treated promptly, it could become a surgical emergency. The incidence of the... (Review)
Review
BACKGROUND
Septic arthritis (SA) in children is an acute inflammatory disease of the joints. If not treated promptly, it could become a surgical emergency. The incidence of the disease in children in Europe is approximately 2-7 per 100,000 children. The aim of this systematic review was to investigate which of these treatments-arthrocentesis, arthrotomy, and arthroscopy-provides better results in children and when to use them.
METHODS
Three independent authors conducted a systematic review of PubMed, ScienceDirect, and MEDLINE databases to assess studies with any level of evidence that reported the surgical outcome of SA. Two senior investigators evaluated and approved each stage's findings.
RESULTS
A total of 488 articles were found. After screening, we chose 24 articles that were suitable for full-text reading based on the inclusion and exclusion criteria. The results of our analysis showed that there are no numerically significant differences reported in the literature on clinical and radiographic outcomes by surgical technique.
CONCLUSIONS
We developed an algorithm that could be used if septic arthritis is suspected. Based on our results, the surgical technique to be used will depend on the operator who will perform it.
PubMed: 37511710
DOI: 10.3390/jpm13071097 -
Journal of Oral Rehabilitation Sep 2021To compare intra-operative and postoperative outcomes between the single-puncture and the standard double-puncture techniques of arthrocentesis. (Meta-Analysis)
Meta-Analysis Review
Comparison of outcomes with the single-puncture and double-puncture techniques of arthrocentesis of the temporomandibular joint: An updated systematic review and meta-analysis.
OBJECTIVE
To compare intra-operative and postoperative outcomes between the single-puncture and the standard double-puncture techniques of arthrocentesis.
METHODS
PubMed, Embase, ScienceDirect and CENTRAL databases were searched from inception up to 31 August 2020. Randomised controlled trials (RCTs), prospective and retrospective studies conducted on patients with temporomandibular joint disorders comparing any type of single-puncture arthrocentesis with standard double-puncture arthrocentesis and reporting intra-operative/postoperative outcomes were included. Assessment of the risk of bias was done with the Cochrane Collaboration risk assessment tool.
RESULTS
Thirteen studies were included (12 were RCTs). Analysis of a limited number of studies indicated no difference in pain or maximal mouth opening (MMO) between the single-puncture type-1 or type-2 and the double-puncture technique at various follow-up intervals. Pooled analysis (four studies) demonstrated that the single-puncture type-2 technique requires significantly less operating time as compared to the double-puncture method. No such difference was noted between single-puncture type-1 and double-puncture techniques. Analysis of two studies indicated significantly reduced intra-operative needle relocations with the single-puncture techniques. Studies were not of high quality with concerns of bias in randomisation, allocation concealment and blinding.
CONCLUSIONS
Limited data indicate no difference in pain or MMO with single- or double-puncture techniques of arthrocentesis. Amongst the three techniques, the single-puncture type-2 technique has the advantages of significantly lower operating time and reduced intra-operative needle relocations and it may be the preferred method of TMJ arthrocentesis in clinical practice.
Topics: Arthrocentesis; Humans; Punctures; Range of Motion, Articular; Temporomandibular Joint; Temporomandibular Joint Disorders; Treatment Outcome
PubMed: 34273184
DOI: 10.1111/joor.13228 -
BMJ Case Reports Mar 2022A male in his 60s with a history of previously treated locally advanced head and neck cancer presented to the emergency department with atraumatic left knee pain and...
A male in his 60s with a history of previously treated locally advanced head and neck cancer presented to the emergency department with atraumatic left knee pain and upper and lower extremity ecchymoses that had been present for 3 weeks. His initial laboratory results showed a normocytic anaemia, normal platelet count, slightly abnormal coagulation studies and normal inflammatory markers. Arthrocentesis of the left knee revealed haemarthrosis, and additional laboratory workup found an undetectable serum vitamin C (ascorbic acid) level consistent with scurvy. It was determined that scurvy had predisposed the patient to injury, leading to haemarthrosis. Following vitamin C supplementation, dietary and activity modifications, and acetaminophen as needed, the patient's serum vitamin C level normalised and his left knee pain and swelling improved. Scurvy is a rare cause of haemarthrosis, but it should be recognised in at-risk patients since treatment is effective.
Topics: Ascorbic Acid; Diet; Hemarthrosis; Humans; Lower Extremity; Male; Scurvy
PubMed: 35256359
DOI: 10.1136/bcr-2021-244594 -
Current Opinion in Pediatrics Feb 2020We present the reader with insight on the most common disorders of the knee in newborns and infants. Knee issues in this population may confuse the first contact... (Review)
Review
PURPOSE OF REVIEW
We present the reader with insight on the most common disorders of the knee in newborns and infants. Knee issues in this population may confuse the first contact physicians due to certain peculiarities of the immature immune system, small size and underdevelopment of joint anatomy. Data presented here are recent and significant, and something to bear in mind when caring for children of this age.
RECENT FINDINGS
With the advent of new diagnostic methods, a shift in the causative agent of pediatric knee infections has been noted. Minimally invasive methods such as arthrocentesis and arthroscopy are successfully employed in treatment of knee problems in newborns and infants. A trial of conservative therapy in congenital patellar instability can give good results, and obviate the need for surgery in some cases. Various syndromes that affect the knee have specific characteristics that need to be recognized early to avoid problems in the future.
SUMMARY
Although rare, knee problems in infants can and do occur. Their cause varies significantly and good outcomes require a multidisciplinary approach. Early diagnosis, referral and initiation of treatment protocols can significantly influence the fate of the joint and with it the patients' functional status for life.
Topics: Bone Diseases; Child; Humans; Infant; Infant, Newborn; Joint Diseases; Knee; Knee Joint; Meniscus; Musculoskeletal Abnormalities
PubMed: 31789974
DOI: 10.1097/MOP.0000000000000859 -
International Journal of Oral and... Jun 2024The aim of this systematic review was to assess the efficacy of arthroscopy compared to arthrocentesis and to conservative treatments for temporomandibular joint... (Meta-Analysis)
Meta-Analysis Review
Arthroscopy versus arthrocentesis and versus conservative treatments for temporomandibular joint disorders: a systematic review with meta-analysis and trial sequential analysis.
The aim of this systematic review was to assess the efficacy of arthroscopy compared to arthrocentesis and to conservative treatments for temporomandibular joint disorders. Thirteen controlled studies on various patient outcomes were included after a systematic search in seven electronic databases. Meta-analyses were conducted separately for arthroscopic surgery (AS) and arthroscopic lysis and lavage (ALL), and short-term (<6 months), intermediate-term (6 months to 5 years), and long-term (≥5 years) follow-up periods were considered. No significant differences in pain reduction and complication rates were found between AS or ALL and arthrocentesis. Regarding improvement in maximum mouth opening (MMO), both AS at intermediate-term and ALL at short-term follow-up were equally efficient when compared to arthrocentesis. However, at intermediate-term follow-up, ALL was superior to arthrocentesis for MMO improvement (mean difference 4.9 mm, 95% confidence interval 2.7-7.1 mm). Trial sequential analysis supported the conclusion of the meta-analysis for MMO improvement for ALL versus arthrocentesis studies at intermediate-term follow-up, but not for the other meta-analyses. Insufficient evidence exists to draw conclusions regarding other patient outcomes or about comparisons between arthroscopy and conservative treatments. Due to the low quality of the primary studies, further research is warranted before final conclusions can be drawn regarding the management of temporomandibular joint disorders.
Topics: Humans; Arthroscopy; Temporomandibular Joint Disorders; Arthrocentesis; Conservative Treatment
PubMed: 38286713
DOI: 10.1016/j.ijom.2024.01.006 -
Journal of Clinical Medicine Jun 2023Temporomandibular joint disorders are a heterogenic group of clinical conditions, which impair physiological functioning of the masticatory system. Arthrocentesis of the... (Review)
Review
Temporomandibular joint disorders are a heterogenic group of clinical conditions, which impair physiological functioning of the masticatory system. Arthrocentesis of the temporomandibular joint has become a widely approved method for non-invasive treatment, bridging the gap between conservative and surgical approaches. Regardless of technique, treatment is based upon joint lavage and lysis of the inflammatory fibrous tissue adhesions, which, in turn, improves joint mobility and reduces pain and closed lock. Recently, approaches for intra-articular injections have been proposed as adjuvant or replacement therapy. The aim of this study was to assess the most efficient technique of arthrocentesis. A systematic search based on PRISMA guidelines, including a computer search with specific keywords, a reference list search and a manual search, was performed. Relevant articles were selected after three search rounds for final review. The studies pulled for the analysis presented information about the relevant predictors, including the technique of arthrocentesis (single- or two-needle method), fluid used for lavage (Ringer lactate or saline), volume of the fluid, application of the injectable, number of interventions, pain (VAS) and mouth opening scores (MMO) and follow-up. All cohorts showed improvement in mouth opening, but significant pain reduction was observed only in cohorts treated either by arthrocentesis alone or arthrocentesis followed by intra-articular injectables. Intra-articular injectables used alone failed to reduce pain post-operatively when compared to other cohorts. We concluded that both double-needle and single-puncture arthrocentesis techniques are equally efficient. Application of the adjuvant injectable did not improve the outcomes of arthrocentesis performed alone. The volume of the fluid used for joint lavage and its chemical composition were not significant in clinical outcomes. However, due to the lack of homogeneity in the study settings, a meta-analysis could not be applied and a systematic review was conducted. We still, however, state that there is a knowledge gap in the current literature regarding the use of injectables alone, as well as a longitudinal follow-up, which provides information about treatment efficiency. More high-quality and randomized controlled trials are required to shed light on this subject.
PubMed: 37445474
DOI: 10.3390/jcm12134439 -
Cranio : the Journal of... May 2023This systematic review and meta-analysis aimed to compare outcomes between ultrasound (US)-guided arthrocentesis and conventional arthrocentesis for the management of... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
This systematic review and meta-analysis aimed to compare outcomes between ultrasound (US)-guided arthrocentesis and conventional arthrocentesis for the management of temporomandibular joint disorders (TMDs).
METHODS
PubMed, Embase, Scopus, BioMed Central, CENTRAL, and Google scholar databases were searched up to April 1 2020 for randomized control trials (RCTs) comparing US-guided and conventional arthrocentesis.
RESULTS
Four RCTs were included. Pooled analysis did not demonstrate any statistically significant difference in pain or maximal mouth opening (MMO) scores after 1 week and 1 month of follow-up between US-guided and conventional arthrocentesis. Studies also reported data on intra-operative needle relocations and operating time but with conflicting results.
CONCLUSION
This study indicates that the use of US during arthrocentesis may not improve postoperative pain and MMO in the short term. Data on intra-operative outcomes are scarce and conflicting for any definitive conclusions. Further high-quality adequately powered RCTs are required to strengthen current evidence.
Topics: Humans; Arthrocentesis; Temporomandibular Joint; Treatment Outcome; Temporomandibular Joint Disorders; Ultrasonography, Interventional; Range of Motion, Articular
PubMed: 33044909
DOI: 10.1080/08869634.2020.1829870