There has been considerable advancement over the last few years in the treatment of osteoarthritis, common chronic disease and a major cause of disability in older adults. In this pathology, the entire joint is involved and the regeneration of articular cartilage still remains one of the main challenges, particularly in an actively inflammatory environment. The recent strategies for osteoarthritis treatment are based on the use of different therapeutic solutions such as cell and gene therapies and tissue engineering. In this review, we provide an overview of current regenerative strategies highlighting the pros and cons, challenges and opportunities, and we try to identify areas where future work should be focused in order to advance this field.

https://www.mdpi.com/2073-4409/8/11/1305/pdf

Articular Cartilage Regeneration in Osteoarthritis.

Background The use of radiofrequency ablation (RFA) procedures to treat chronic knee pain has surged in the past decade, though many questions remain regarding anatomical targets, selection criteria, and evidence for effectiveness Methods A comprehensive literature review was performed on anatomy, selection criteria, technical parameters, results of clinical studies, and complications Databases searched included MEDLINE and Google Scholar, with all types of clinical and preclinical studies considered Results We identified nine relevant clinical trials, which included 592 patients, evaluating knee RFA for osteoarthritis and persistent postsurgical pain These included one randomized, placebo-controlled trial, one randomized controlled trial evaluating RFA as add-on therapy, four comparative-effectiveness studies, two randomized trials comparing different techniques and treatment paradigms, and one non-randomized, controlled trial The results of these studies demonstrate significant benefit for both reduction and functional improvement lasting between 3 and 12 months, with questionable utility for prognostic blocks There was considerable variation in the described neuroanatomy, neural targets, radiofrequency technique, and selection criteria Conclusion RFA of the knee appears to be a viable and effective treatment option, providing significant benefit to well-selected patients lasting at least 3 months More research is needed to better identify neural targets, refine selection criteria to include the use of prognostic blocks, optimize treatment parameters, and better elucidate relative effectiveness compared to other treatments

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Radiofrequency techniques to treat chronic knee pain: A comprehensive review of anatomy, effectiveness, treatment parameters, and patient selection

Knee osteoarthritis is a common painful degenerative condition affecting the aging Canadian population. In addition to pain and disability, osteoarthritis is associated with depression, comorbid conditions such as diabetes, and increased caregiver burden. It is predicted to cost the Canadian healthcare system $7.6 billion dollars by 2031. Despite its high cost and prevalence, controversy persists in the medical community regarding optimal therapies to treat knee osteoarthritis. A variety of medications like nonsteroidal anti-inflammatories and opioids can cause severe side effects with limited benefits. Total knee arthroplasty, although a definitive management, comes with risk such as postoperative infections, revisions, and chronic pain. Newer injectable therapies are gaining attention as alternatives to medications because of a safer side effect profile and are much less invasive than a joint replacement. Platelet-rich plasma is beginning to replace the more common injectable therapies of intra-articular corticosteroids and hyaluronic acid, but larger trials are needed to confirm this effect. Small studies have examined prolotherapy and stem cell therapy and demonstrate some benefits. Trials involving genicular nerve block procedures have been successful. As treatments evolve, injectable therapies may offer a safe and effective pathway for patients suffering from knee osteoarthritis.

/pdf/procedural-treatments-for-knee-osteoarthritis-a-review-of-4ruullt724.pdf

Procedural Treatments for Knee Osteoarthritis: A Review of Current Injectable Therapies

Background:The number of systematic reviews and meta-analyses published on the rotator cuff (RC) has increased markedly.Purpose:To quantify the number of systematic reviews and meta-analyses publis...

https://journals.sagepub.com/doi/pdf/10.1177/2325967118797891

A Systematic Summary of Systematic Reviews on the Topic of the Rotator Cuff

Introduction

Osteoarthritis (OA) often leads to symptoms such as pain, stiffness and decreased function. OA is treated with a wide range of modalities, both conservatively and surgically. Prolotherapy has been used to treat various musculoskeletal problems and has shown some promise.

Sources of data

Searches of the electronic databases, PubMed, ISI web of science, PEDro and SPORTDiscus, were conducted for all Level 1-4 studies published from inception through to December 2016.

Areas of agreement

Ten studies were evaluated and results show significant improvement in scores for pain, function and range of motion, both in the short term and long term. Patient satisfaction was also high in these patients (82%).

Areas of controversy

Meta-analysis was not possible due to heterogeneity of outcome measures and populations.

Growing points

Moderate evidence suggests that prolotherapy is safe and can help achieve significant symptomatic control in individuals with OA.

Areas for developing research

Future research should focus on larger sample size, standardization of treatment protocol and basic science evidence.

The effectiveness of prolotherapy in treating knee osteoarthritis in adults: a systematic review.

Background rotator cuff tear affects many people. Natural history, and evidence for non-operative treatment remains limited. Our objective is to assess evidence available for the efficacy and morbidity of commonly used systemic medications, physiotherapy, and injections alongside evaluating any negative long-term effects. Methods a systematic search was performed of PubMed, Cochrane, EMBASE and CINAHL dates (1 January 1960 - 1 December 2014), search terms: 'rotator cuff tear', 'natural history', 'atraumatic', 'injection', 'physiotherapy' or 'physical therapy', 'injection', 'corticosteroid', 'PRP', 'MSC', risk of conservative treatment', and 'surgical indication'. Results eleven studies were included. The mean Coleman Methodology Score modified for conservative therapy is 69.21 (range 88-44) (SD 12.31). This included 2 RCTs, 7 prospective, and 2 retrospective studies. Evidence suggests it is safe to monitor symptomatic rotator cuff tears, as tear size and symptoms are not correlated with pain, function, and/or ultimate outcome. Conclusions complete rotator cuff tears may be effectively treated with injections, exercise in the short and intermediate terms respectively. Negative effect of corticosteroids on rotator cuff tissue has not been demonstrated. Timing to end conservative treatment is unknown, but likely indicated when a patient demonstrates increased weakness and loss of function not recoverable by physiotherapy.

/pdf/initial-treatment-of-complete-rotator-cuff-tear-and-1xvyg0kdvw.pdf

Initial treatment of complete rotator cuff tear and transition to surgical treatment: systematic review of the evidence.

Osteoarthritis is a progressive multifactorial condition of the musculoskeletal system with major symptoms including pain, loss of function, damage of articular cartilage and other tissues in the affected area. Knee osteoarthritis imposes major individual and social burden, especially with the cost and complexity of surgical interventions. Mesenchymal stem/stromal cells have been indicated as a treatment for degenerative musculoskeletal conditions given their capacity to differentiate into tissues of the musculoskeletal system. A systematic search will be conducted in Medline, Embase, Cochrane Library, Scopus and relevant trial databases of English, Japanese, Korean, German, French, Italian, Spanish and Portuguese language papers published or in press to June 2018, with no restrictions on publication year applied. References will be screened and assessed for eligibility by two independent reviewers as per PRISMA guidelines. Cohort, cross-sectional or case controlled studies will be included for the analysis. Data extraction will be conducted using a predefined template and quality of evidence assessed. Statistical summaries and meta-analyses will be performed as necessary. Results will be published in relevant peer-reviewed scientific journals and presented at national or international conferences by the investigators. The protocol was registered on the PROSPERO international prospective register of systematic reviews prior to commencement, CRD42018091763
 .

/pdf/efficacy-and-safety-of-culture-expanded-mesenchymal-stem-54o5ty0pe8.pdf

Efficacy and Safety of Culture-Expanded, Mesenchymal stem/stromal Cells for the Treatment of Knee Osteoarthritis: A Systematic Review Protocol

Background:Knee osteoarthritis (KOA) is a common condition encountered by physicians. KOA is addressed by a wide array of modalities including a number of nonbiological treatments.Methods:PubMed, ISI Web of Science, and SPORTDiscus were searched for level 1 to 4 studies published from inception to A

Fadi Hassan

Papers

The effectiveness of prolotherapy in treating knee osteoarthritis in adults: a systematic review.

Initial treatment of complete rotator cuff tear and transition to surgical treatment: systematic review of the evidence.

Efficacy and Safety of Culture-Expanded, Mesenchymal stem/stromal Cells for the Treatment of Knee Osteoarthritis: A Systematic Review Protocol

Alternatives to Biologics in Management of Knee Osteoarthritis: A Systematic Review.