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Sports Health Jul 2015Popliteal synovial cysts, also known as Baker's cysts, are commonly found in association with intra-articular knee disorders, such as osteoarthritis and meniscus tears....
CONTEXT
Popliteal synovial cysts, also known as Baker's cysts, are commonly found in association with intra-articular knee disorders, such as osteoarthritis and meniscus tears. Histologically, the cyst walls resemble synovial tissue with fibrosis evident, and there may be chronic nonspecific inflammation present. Osteocartilaginous loose bodies may also be found within the cyst, even if they are not seen in the knee joint. Baker's cysts can be a source of posterior knee pain that persists despite surgical treatment of the intra-articular lesion, and they are routinely discovered on magnetic resonance imaging scans of the symptomatic knee. Symptoms related to a popliteal cyst origin are infrequent and may be related to size.
EVIDENCE ACQUISITION
A PubMed search was conducted with keywords related to the history, diagnosis, and treatment of Baker's cysts-namely, Baker's cyst, popliteal cyst, diagnosis, treatment, formation of popliteal cyst, surgical indications, and complications. Bibliographies from these references were also reviewed to identify related and pertinent literature.
STUDY DESIGN
Clinical review.
LEVEL OF EVIDENCE
Level 4.
RESULTS
Baker's cysts are commonly found associated with intra-articular knee disorders. Proper diagnosis, examination, and treatment are paramount in alleviating the pain and discomfort associated with Baker's cysts.
CONCLUSION
A capsular opening to the semimembranosus-medial head gastrocnemius bursa is a commonly found normal anatomic variant. It is thought that this can lead to the formation of a popliteal cyst in the presence of chronic knee effusions as a result of intra-articular pathology. Management of symptomatic popliteal cysts is conservative. The intra-articular pathology should be first addressed by arthroscopy. If surgical excision later becomes necessary, a limited posteromedial approach is often employed. Other treatments, such as arthroscopic debridement and closure of the valvular mechanism, are not well studied and cannot yet be recommended.
PubMed: 26137182
DOI: 10.1177/1941738113520130 -
Singapore Medical Journal Jan 2014Lipoma arborescens is a chronic, slowly progressive intra-articular lesion characterised by villous lipomatous proliferation of the synovium, usually involving the... (Review)
Review
Lipoma arborescens is a chronic, slowly progressive intra-articular lesion characterised by villous lipomatous proliferation of the synovium, usually involving the suprapatellar pouch of the knee joint. It is an uncommon cause of intra-articular masses that presents as slowly progressive painless swelling of the joint, which persists for many years and is accompanied by intermittent effusions. We highlight this condition to raise awareness of its clinical spectrum and imaging features, so that early diagnosis and appropriate treatment can be given, and misinterpretation of this condition as other more complex intra-articular masses is avoided. This pictorial essay aims to provide a brief yet comprehensive review of the clinical features, distribution, morphological types and imaging characteristics of lipoma arborescens, including its common differential diagnoses and management.
Topics: Adolescent; Adult; Aged; Cell Proliferation; Child; Diagnosis, Differential; Female; Humans; Inflammation; Knee Joint; Lipoma; Lipomatosis; Magnetic Resonance Imaging; Male; Middle Aged; Prognosis; Synovial Membrane; Young Adult
PubMed: 24452971
DOI: 10.11622/smedj.2014003 -
International Journal of Surgery... Mar 2017A meta analysis to compare efficacy and safety of intraarticular hyaluronic acid (HA) and intraarticular corticosteroids (CS) in patients with knee osteoarthritis. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
A meta analysis to compare efficacy and safety of intraarticular hyaluronic acid (HA) and intraarticular corticosteroids (CS) in patients with knee osteoarthritis.
METHOD
Potential studies were searched from the electronic databases included PubMed, Embase, web of science and the Cochrane Library up to August 2016. High quality randomized controlled trials (RCTs) were selected based on inclusion criteria. RevMan 5.3 were used for the meta-analysis.
RESULTS
12 RCTs containing 1794 patients meet the inclusion criteria. Visual analog scale (VAS) score in CS group decrease more than HA group up to 1 month (p = 0.03) and it shows equal efficacy at 3 months (p = 0.29); HA is more effective than CS at 6 months (p = 0.006). To Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, there is no significant difference for two groups at 3 months (p = 0.29); HA shows greater relative effect than CS at 6 months (p = 0.005). No significant difference is found on proportion of rescue medication use after initiation of treatment (p = 0.58) and proportion of withdrawal for knee pain (p = 0.54). HA and CS exhibit equal efficacy on improvement of active range of knee flexion at 3 months (p = 0.73) and 6 months (p = 0.43). More topical adverse effects occurred in intraarticular HA group when compared with intraarticular CS group.
CONCLUSION
Intraarticular CS is more effective on pain relief than intraarticular HA in short term (up to 1 month), while HA is more effective in long term (up to 6 months). Two therapies benefit similarly for knee function improvement. Both two methods are relatively safe, but intraarticular HA causes more topical adverse effects compared with intraarticular CS.
Topics: Adrenal Cortex Hormones; Female; Humans; Hyaluronic Acid; Injections, Intra-Articular; Knee Joint; Musculoskeletal Pain; Osteoarthritis, Knee; Pain Measurement; Randomized Controlled Trials as Topic; Treatment Outcome; Viscosupplements
PubMed: 28137554
DOI: 10.1016/j.ijsu.2017.01.087 -
Cartilage Dec 2021Hip osteoarthritis is a prevalent condition responsible for important pain and disability. Most available guidelines for nonsurgical management of hip osteoarthritis... (Review)
Review
INTRODUCTION
Hip osteoarthritis is a prevalent condition responsible for important pain and disability. Most available guidelines for nonsurgical management of hip osteoarthritis recommend a combination of nonpharmacological and pharmacological treatment modalities. Intraarticular corticosteroid injections have been used for decades, although evidence is quite scarce, and many controversies remain.
METHODS
This article reviews the available literature from Medline and Embase and discusses the evidence for intraarticular corticosteroid injections in hip osteoarthritis, where only 5 randomized controlled trials were found in the literature. These are analyzed in this article, which also aims to explain the main characteristics and features of glucocorticoids, along with their contraindications and potential adverse effects.
RESULTS
Available randomized controlled trials show that intraarticular corticosteroid injections provide pain relief and functional improvement in hip osteoarthritis. This efficacy has not been shown with intraarticular hyaluronic acid injections.
CONCLUSION
This review shows that intraarticular corticosteroid injections are efficacious in hip osteoarthritis and that this benefit can last up to 12 weeks.
Topics: Adrenal Cortex Hormones; Humans; Injections, Intra-Articular; Osteoarthritis, Hip; Pain; Pain Management; Range of Motion, Articular; Treatment Outcome
PubMed: 32815375
DOI: 10.1177/1947603520951634 -
Nature Reviews. Rheumatology Jan 2014Diarthrodial joints are well suited to intra-articular injection, and the local delivery of therapeutics in this fashion brings several potential advantages to the... (Review)
Review
Diarthrodial joints are well suited to intra-articular injection, and the local delivery of therapeutics in this fashion brings several potential advantages to the treatment of a wide range of arthropathies. Possible benefits over systemic delivery include increased bioavailability, reduced systemic exposure, fewer adverse events, and lower total drug costs. Nevertheless, intra-articular therapy is challenging because of the rapid egress of injected materials from the joint space; this elimination is true of both small molecules, which exit via synovial capillaries, and of macromolecules, which are cleared by the lymphatic system. In general, soluble materials have an intra-articular dwell time measured only in hours. Corticosteroids and hyaluronate preparations constitute the mainstay of FDA-approved intra-articular therapeutics. Recombinant proteins, autologous blood products and analgesics have also found clinical use via intra-articular delivery. Several alternative approaches, such as local delivery of cell and gene therapy, as well as the use of microparticles, liposomes, and modified drugs, are in various stages of preclinical development.
Topics: Adrenal Cortex Hormones; Anti-Inflammatory Agents, Non-Steroidal; Antirheumatic Agents; Humans; Injections, Intra-Articular; Rheumatic Diseases; Time Factors
PubMed: 24189839
DOI: 10.1038/nrrheum.2013.159 -
Foot & Ankle Orthopaedics Jul 2020Calcaneal fractures are the most common fracture of the tarsal bones and represent 1% to 2% of all fractures. Roughly 75% of these fractures include intra-articular... (Review)
Review
Calcaneal fractures are the most common fracture of the tarsal bones and represent 1% to 2% of all fractures. Roughly 75% of these fractures include intra-articular involvement of the posterior facet of the calcaneus. Intra-articular calcaneal fractures are challenging injuries to manage for both patients and surgeons given their association with both early and late complications. This article aims to review the management, classification systems, surgical approaches, and care regarding intra-articular calcaneal fractures. A review of the current literature yielded treatment strategies that aim to reduce complications such as soft tissue injury or loss of articular reduction while maintaining satisfactory clinical outcomes. The purpose of this article is to review these current concepts in the management of intra-articular calcaneal fractures. Level V, expert opinion.
PubMed: 35097384
DOI: 10.1177/2473011420927334 -
International Journal of Surgery Case... Aug 2022Distal radius fractures are one the most common upper extremity injuries, accounting for 25 % of pediatric fractures and up to 18 % of elderly fractures....
INTRODUCTION
Distal radius fractures are one the most common upper extremity injuries, accounting for 25 % of pediatric fractures and up to 18 % of elderly fractures. Intraarticular malunion is one major complication of distal radius fractures and was reported in 0 to 33 % of total cases. It usually causes pain, deformity, limited range of motion (ROM), and loss of strength. Therefore, proper surgical management to satisfactorily unite the fragment is necessary. Case Illustrations: This is a case series of three adult male and female patients diagnosed with intraarticular distal radius fracture with malunion. They had been diagnosed based on clinical and radiological examinations. Preoperative and postoperative QuickDASH and ROM were measured. Three-dimensional printing was created for planning the osteotomy. Osteotomy was performed using arthroscopy. All patients showed QuickDASH and ROM improvement in all wrist movements.
DISCUSSION
The primary goal of the procedure was to restore normal anatomic alignment to improve wrist function and reduce pain. Osteotomy guided by arthroscopy planned by 3D printed surgical guide successfully reduced the malunion fracture.
CONCLUSION
Osteotomy assisted by arthroscopy combined with the 3D-printed surgical guide is a promising technique to restore challenging intraarticular distal radius malunion.
PubMed: 35853284
DOI: 10.1016/j.ijscr.2022.107391 -
Biomedical Reports Sep 2023Hemophilia is an inherited X-linked bleeding condition with predominant joint involvement due to intra-articular bleeding, hemosiderin deposition and the synovial... (Review)
Review
Hemophilia is an inherited X-linked bleeding condition with predominant joint involvement due to intra-articular bleeding, hemosiderin deposition and the synovial hypertrophy that is responsible for cartilage destruction, joint deformity and malalignment, pain and functional restriction. Management of chronic arthropathy includes conservative and surgical approaches. Conservative therapies consist of pain modulation, oral drugs, physiotherapy and intra-articular agents. For the present review, the literature was searched for intra-articular agents and 20 papers on the use of corticosteroids (CS), hyaluronic acid (HA) and platelet-rich plasma (PRP), with different regimes of administration, were included. CS had a longer record of injection, with statistically significant pain reduction and functional improvement in the short-term and moderate persistence in the long-term. HA was able to improve the clinical and functional status of joints with moderate or severe hemophilia. PRP was relatively recently introduced to joint management and the results remain controversial. Different associations between the above-mentioned agents were proposed by studies including a small number of patients, producing comparable results. It was concluded that there is a need for extensive research on intra-articular agents, with stratification according to the severity of joint involvement. The lack of a blinded or placebo-controlled arm due to ethical aspects makes the task challenging.
PubMed: 37614987
DOI: 10.3892/br.2023.1641