Migliore et al (2011) evaluated the effectiveness of viscosupplementation treatment of ankle OA in the current literature. The following databases were searched: Medline (period 2006 to 2008), Database of Abstract on Reviews and Effectiveness and Cochrane Database of Systematic Reviews. Reference lists of relevant articles were controlled for additional references. The search terms Review, Viscosupplementation (VS), Osteoarthritis (OA), Hyaluronic acid (HA), Hyaluronan, Sodium hyaluronate, Ankle OA, Ankle joint were used to identify all studies relating to the use of VS therapy for the ankle OA. Methodological quality of included studies was assessed by assigning level of evidence as previously defined by the Centre for Evidence Based Medicine (CEBM). A total of 7 articles concerning the efficacy of a total of 275 patients undergoing VS treatment for ankle OA were included. One European study, 1 Taiwanese study, 1 Italian study, 1 Turkish study and 3 American studies with level of evidence ranging from I to IV evaluated the following products: Hyalgan, Synvisc, Supartz, Adant. The authors concluded that viscosupplementation is used widely in knee OA and is included in the professional guidelines for treatment of the disease in this joint. The potential for treating OA of the ankle joint by viscosupplementation has been suggested in the literature, however, no dosing studies have been published to date, and dosing in the ankle joint remains an area for discussion. They stated that viscosupplementation could potentially provide an useful alternative in treating such patients with painful ankle OA.
Treating Joint Pain: A Patient's Guide to Platelet-Rich Plasma free 11
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Intra-articular pharmacologic therapy includes injection of a corticosteroid or sodium hyaluronate (ie, hyaluronic acid [HA] or hyaluronan) or biologic agent (ie, platelet-rich plasma [PRP]), which may provide pain relief and have an anti-inflammatory effect on the affected joint. [86, 87] Ultrasound guidance can facilitate arthrocentesis and injection and is increasingly being adopted by physicians such as rheumatologists and physiatrists for this purpose.
Approximately 20% of people with chronic high (proximal) hamstring tendinopathy who undergo non-invasive (conservative) treatment, such as rest and physical therapy, have residual hamstring pain. 1 Lempainen L, Sarimo J, Mattila K, Vaittinen S, Orava S. Proximal hamstring tendinopathy: results of surgical management and histopathologic findings. Am J Sports Med 2009;37:727-34., 2 Puranen J, Orava S. The hamstring syndrome--a new gluteal sciatica. Ann Chir Gynaecol 1991;80:212-4., 3 Fredericson M, Moore W, Guillet M, Beaulieu C. High Hamstring Tendinopathy in Runners: Meeting the Challenges of Diagnosis, Treatment, and Rehabiliation. Phys Sports Med 2005;33:32-43., 4 Zissen M, Wallace G, Stevens K, Fredericson M, Beaulieu C. High hamstring tendinopathy: MRI and ultrasound imaging and therapeutic efficacy of percutaneous corticosteroid injection. AJR Am J Roentgenol 2010;195:993-8., 5 Sarimo J, Lempainen L, Mattila K, Orava S. Complete proximal hamstring avulsions: a series of 41 patients with operative treatment. Am J Sports Med 2008;36:1110-5. For those that find no relief from non-invasive (conservative) management, minimally invasive treatments such as ultrasound-guided corticosteroid injections, ultrasound-guided needle tenotomy, ultrasound-guided platelet-rich plasma (PRP) injections, or ultrasound-guided percutaneous (through the skin) ultrasonic tenotomy may be pursued.
This in-office procedure is done using ultrasound guidance and may be an option for patients with refractory symptoms. The physician will first numb (anesthetize) the area and the needle track and tendon using local numbing medicine. Following this, the physician, using ultrasound guidance, introduces a slightly larger needle into the tendon and manipulates it in a back-and-forth motion to create bleeding and tissue damage, bringing blood and platelets to the area, with a goal of promoting new growth factors and healing. 7 Finnoff J, Fowler S, Lai J, et al. Treatment of chronic tendinopathy with ultrasound-guided needle tenotomy and platelet-rich plasma injection. PM R 2011;3:900-11., 8 Chiavaras M, Jacobson J. Ultrasound-guided tendon fenestration. Semin Musculoskelt Radiol 2013;17:85-90., 9 Housner J, Jacobson J, Misko R. Sonographically guided percutaneous needle tenotomy for the treatment of chronic tendinosis. J Ultrasound Med 2009;28:1187-92., 10 McShane J, Nazarian L, Harwood M. Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow. J Ultrasound Med 2006;25:1281-9., 11 McShane J, Shah V, Nazarian L. Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow: is a corticosteroid necessary? J Ultrasound Med 2008;27:1137-44., 12 Testa V, Capasso G, Benazzo F, Maffulli N. Management of Achilles tendinopathy by ultrasound-guided percutaneous tenotomy. Med Sci Sports Exerc 2002;34:573-80. The use of ultrasound-guided needle tenotomy for chronic tendinopathies has been reported with good success and represents another possible treatment option for patients with recalcitrant tendinopathies. 4 Zissen M, Wallace G, Stevens K, Fredericson M, Beaulieu C. High hamstring tendinopathy: MRI and ultrasound imaging and therapeutic efficacy of percutaneous corticosteroid injection. AJR Am J Roentgenol 2010;195:993-8., 7 Finnoff J, Fowler S, Lai J, et al. Treatment of chronic tendinopathy with ultrasound-guided needle tenotomy and platelet-rich plasma injection. PM R 2011;3:900-11., 8 Chiavaras M, Jacobson J. Ultrasound-guided tendon fenestration. Semin Musculoskelt Radiol 2013;17:85-90., 9 Housner J, Jacobson J, Misko R. Sonographically guided percutaneous needle tenotomy for the treatment of chronic tendinosis. J Ultrasound Med 2009;28:1187-92., 10 McShane J, Nazarian L, Harwood M. Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow. J Ultrasound Med 2006;25:1281-9., 11 McShane J, Shah V, Nazarian L. Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow: is a corticosteroid necessary? J Ultrasound Med 2008;27:1137-44., 12 Testa V, Capasso G, Benazzo F, Maffulli N. Management of Achilles tendinopathy by ultrasound-guided percutaneous tenotomy. Med Sci Sports Exerc 2002;34:573-80.
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