Introduction: Temporomandibular joint osteoarthritis (TMJ OA) is a degenerative disease characterized by deterioration of articular tissue with concomitant osseous changes in the condyle and/or articular eminence, joint positive for TMJ noise with jaw movement or function, crepitus detected on palpation on opening, closing, right/left lateral, or protrusive movement. Hyaluronic acid (HA) is a polysaccharide of the family of glycosaminoglycans. HA has been shown to improve and restore normal lubrication in joint, provide nutrition to the avascular articulating disc, and stabilize the joint. Materials and Methods: Twenty patients with OA of TMJ with age limit between 18 and 60 years of age were enrolled in this study. Patients were randomly divided into two groups, in which one group received arthrocentesis only, and another group received arthrocentesis plus intra-articular injection of sodium HA (0.5 ml) in superior joint space in a cycle of 5 weekly arthrocentesis (one per week). Patients were followed at regular interval of 1st day, 5th day, 7th day, 4 weeks, 6 weeks, and 12 weeks. Assessment of clinical outcome was done in terms of reduction in pain (visual analog scale score), maximum mouth opening (MMO) in millimeters, painful/pain-free lateral or protrusive jaw movement, and clicking/crepitus in joint. Results: Significant reduction in pain was observed in both the groups. MMO, lateral and protrusive movements improved significantly in both groups; however, arthrocentesis with sodium HA was superior to arthrocentesis alone. Conclusion: Combination of arthrocentesis with HA injection showed much better outcome than arthrocentesis alone.

Efficacy of arthrocentesis versus arthrocentesis with sodium hyaluronic acid in temporomandibular joint osteoarthritis: A comparison.

Repairing damaged articular cartilage is particularly challenging because of the limited ability of cartilage to perform self-repair. Intra-articular injections of N-acetylglucosamine (GlcNAc) comprise a method of repairing full-thickness articular cartilage defects in the rabbit knee joint model. To date, the effects of administration of GlcNAc and hyaluronic acid (HA) have been investigated only in the context of osteoarthritis treatment. Therefore, we evaluated the therapeutic effects of using cell-free porous poly lactic-co-glycolic acid (PLGA) graft implants and intra-articular injections of GlcNAc or HA in a rabbit model of osteochondral regeneration to investigate whether they have the potential for inducing osteochondral regeneration when used alone or simultaneously. Twenty-four rabbits were randomized into one of four groups: the scaffold-only group (PLGA), the scaffold with intra-articular injections of GlcNAc (PLGA+G) group, twice per week for four weeks; the scaffold with intra-articular injections of HA group (PLGA+HA) group, once per week for three weeks; and the scaffold with intra-articular injections of GlcNAc and HA (PLGA+G+HA) group, once per week for three weeks. Knees were evaluated at 4 and 12 weeks after surgery. At the end of testing, only the PLGA+G+HA group exhibited significant bone reconstruction, chondrocyte clustering, and good interactions with adjacent surfaces at 4 weeks. Additionally, the PLGA+G+HA group demonstrated essentially original hyaline cartilage structures that appeared to have sound chondrocyte orientation, considerable glycosaminoglycan levels, and reconstruction of the bone structure at 12 weeks. Moreover, the PLGA+G+HA group showed organized osteochondral integration and significantly higher bone volume per tissue volume and trabecular thickness. However, there were no significant differences between the PLGA+G and PLGA+HA groups except for gap formation on subchondral bone in the PLGA+G group. This study demonstrated that PLGA implantation combined with intra-articular injections of GlcNAc and HA allowed for cartilage and bone regeneration and significantly promoted osteochondral regeneration in rabbits without supplementation of exogenous growth factors. And the combination of this two supplements with PLGA scaffold could also prolong injection interval and better performance than either of them alone for the reconstruction of osteochondral tissue in the knee joints of rabbits.

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Intra-articular injection of N-acetylglucosamine and hyaluronic acid combined with PLGA scaffolds for osteochondral repair in rabbits

Lower Limb Biomechanics Before and After Anterior Cruciate Ligament Reconstruction: a Systematic Review

Purpose The anterior cruciate ligament (ACL) tear is a common injury in basketball. Its consequence is a long absence from training, being a consequence of surgical treatment and long physiotherapy. The aim of the study was to assess muscle strength, postural stability and functional movements in female basketball players, who returned to professional sport careers after anterior cruciate ligament reconstruction. Methods The study population consisted of 10 female basketball players after surgical reconstruction of anterior cruciate ligament. The control group consisted of 10 players without ACL injury. We used the Biodex System 4 Pro dynamometer to assess the muscle strength of the knee. We used it to conduct the test of flexors and extensors of the knee in isokinetic conditions. We also used Keiser Power Squat A300 in the single leg squat to measure power and the Biodex Balance SD dynamographic platform to assess balance in single leg stance. Results We found deficits in both movement patterns and in muscle strength in the study population, compared to control group. Conclusions The basketball players after ACL reconstruction had significant differences between the operated and non-operated limb. The differences may predispose them towards repeated ACL injuries.

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Lower extremity muscle strength, postural stability and functional movement screen in female basketball players after ACL reconstruction. Preliminary report.

Purpose The objective of the study was assessment of the function of the knee joint after ACL reconstruction using the LARS method and autogenous graft. The study was of a retrospective character and included 96 patients who had undergone reconstruction of the torn ACL. The study was conducted within 36-48 months after surgery. Methods In order to compare the results of the ACL reconstruction performed with 2 types of grafts, the following instruments were used: Lysholm Knee Scoring Scale, SF 36v2 questionnaire for assessment of health-related quality of life, and Biodex System 4 for isokinetic muscle testing. Results No differences in the evaluation of the quality of life measured using SF 36v2 questionnaire were observed between the LARS and ST GR groups. Using the Lysholm Scale, the distribution of knee function scores was compared according to the type of surgery. There are no grounds to confirm the differences in the distribution of knee function scores considering the type of graft (p = 0.756). Isokinetic test showed a significant weakening of muscle strength in the operated limb, compared to the strength of the healthy limb. Conclusions The type of graft used for ACL reconstruction does not exert an effect on the quality of life of patients or the level of their knee joint function. Extensor and flexor muscles strength of the knee joint was lower in the operated limb, irrespective of the type of graft used. Weak relationships were observed between the level of knee joint function and extensor muscle strength of this joint.

Comparison of results of ACL reconstruction using LARS method and autogenous ST/GR graft.

Purpose The aim of the study was to evaluate effectiveness of rehabilitation in patients before and after rACL, based on stabilographic indicators. Methods The research group was comprised of 31 men aged 20-57 with anterior cruciate ligament injury, qualified for reconstruction surgery. A measurement of static stabilometric indicators and muscle strength was taken twice for each patient - before surgery and after 6 months. To assess stabilographic indicators the stabilographic platform was used and to asses muscle strength a dynamometer was used. In order to assess knee function the Lysholm scale and VAS scale were used. Results The rehabilitation programme improved static stability of the knee in the frontal plane, which is manifested by a significant shortening of the SPML path length. Rehabilitation proceedings should focus on improving static stability of the knee joint in the sagittal plane, because the results obtained indicate only a slight shortening of the SPAP length. The results of the Lysholm and VAS scales point to a positive influence of the applied rehabilitation. Conclusion Inclusion into rehabilitation diagnostic tools to assess stabilometric indicators enables for effective verification of rehabilitation proceedings focused on restoring body posture control before and after the rACL.

Stabilometric indicators as an element of verifying rehabilitation of patients before and after reconstruction of anterior cruciate ligament.

Osteoarthritis (OA) is one of the leading causes of disability in the elderly. The changes in the lubricating properties of synovial fluid lead to significant pain and loss of function. Viscosupplemen-tation, in which hyaluronic acid (HA) is injected into the knee joint, has evolved into an important part of our current therapeutic regimen in addressing the patient with knee pain due to OA. Intra-articular HA or hylan have proven to be an effective, safe, and tolerable treatment for symptomatic knee OA. In an effort to limit cardiovascular, gastrointestinal, and renal safety concerns with COX-2 selective and nonselective NSAIDs and maximize HA efficacy, it is even proposed using HA earlier in the treatment paradigm for knee OA and also as part of a comprehensive treatment strategy. Our study reconfirmed effectiveness and safety of intra-articular use of hyaluronic acid (Suplasyn) in the treatment of knee osteoarthritis.

[Effectiveness and safety of intra-articular use of hyaluronic acid (Suplasyn I-Shot) in the treatment of knee osteoarthritis].

The aim of the study was the assessment of the early impact of the selected kinesiotaping technique on the static stability of the knee joint in patients with ACL rupture on the basis of stabilographic parameters. Sixty-two patients with a complete ACL rupture (32 patients in experimental group and 30 patients in placebo group) took part in the randomized single-blind, placebo-controlled trial. The ligament technique of KT was taken into consideration. Application of a KT tape only on the injured knee was to stabilize the knee joint. Experimental group had application of KT on the injured knee and the placebo group had a KT placebo application (with no tension on KT). Intervention and stabilographic test in both groups was the same. Research tools included measurements of static stabilographic parameters on stabilometric platform CQStab2P®. Outcome measures were assessed before intervention and after KT application. The analysis included evaluation of outcome variables – total path length, (SP), statokinesiogram path length in the XY axes (SPML, SPAP), and mean velocities in the XY axes (MV, MVML, MVAP). The results show a statistically significant shortening of the SP, SPAP and SPML variables only in experimental group. In the placebo group the results were not significant. The analysis also showed a significant improvement in all analyzed variables in the experimental group compared to the healthy side. In the placebo group, the results did not improve significantly after KT application compared to the healthy side. Application o f KT in patients after ACL rupture shortened the total path length and improved the value of parameters in the frontal and sagittal planes in experimental group, which may suggest the potentially greater improvement in these parameters. By improving the values of the analyzed variables, the KT application is able to compensate for the loss of static stability of the knee. This study was registered retrospectively in the Australian New Zealand Clinical Trials Registry (ANZCTR). Registration number: ACTRN12616001407482
 .

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Does kinesiotaping can improve static stability of the knee after anterior cruciate ligament rupture? A randomized single-blind, placebo-controlled trial.

BACKGROUND There are no scientific reports clearly describing the effectiveness of the High Tone Power Therapy in patients after ACL reconstruction. This caused that in own research an attempt was made to present the possibilities of using the selected method of electrical stimulation in the treatment of an orthopaedic patient. The aim was to assess the effectiveness of electro stimulation of the quadriceps muscle in patients after ACL reconstruction, with the use of High Tone Power Therapy. METHODS In randomized controlled trial took part thirty-five men, aged 21-50, after ACL reconstruction. The tests were carried prior to and 6 months following the ACL reconstruction. After the surgery, the patients were randomly divided into experimental group (17 patients) with the High Tone Power Therapy in rehabilitation and control group (18 patients) without the High Tone Power Therapy. Patients were subjected to 6-month rehabilitation. Research tools included the measurement of muscle strength torque, ROM, knee and thigh circumference measurements, the Lysholm and the VAS scale. RESULTS After applying HiToP, the analysis showed a statistically significant improvement of muscle torque (p = 0.041, Es = 3.71), knee circumference (p = 0.039, Es = 1.65), thigh circumference (p = 0.049, Es = 1.26), knee extension (p < 0.001, Es = 2.20) in Experimental group compared to the control group. Only the results of the VAS scale did not differ statistically significantly both within a given group and between groups. CONCLUSIONS The results confirm the hypothesis that the use of HiToP in patients after ACLr have a beneficial effect on muscle strength, reduction of joint effusion, muscle mass gain and joint function. The assumption that HiToP significantly reduces pain levels is not supported - the results in both groups are statistically insignificant. TRIAL REGISTRATION The research project was retrospectively registered in the Australian New Zealand Clinical Trials Registry (ANZCTR). Date of first registration 11.10.2016. Registration number: ACTRN12616001416482 .

Quadriceps muscle strength recovery with the use of high tone power therapy after anterior cruciate ligament reconstruction: a randomized controlled trial

Background and objective In the available literature there are no reports on the effectiveness of Kinesio Taping (KT) in the conservative treatment of patients with anterior instability of the knee. The purpose of the present research was to evaluate the influence of the selected KT technique in limiting the anterior translation of the tibia by performing a biomechanical analysis of the gait cycle of patients with anterior instability of the knee. Methods A total of 31 patients qualified for the single group study. In all patients, a total tear of the anterior cruciate ligament was diagnosed. The research tool was a three-dimensional motion analysis BTS SMART system. The effectiveness of KT of the knee with an anterior cruciate ligament tear was assessed based on angular changes in the movement of the knee in three planes of motion during specific phases of the gait cycle. Results The results show that KT does not significantly affect angular values of the knee joint in the sagittal and transverse planes of the affected and healthy limb during selected phases of the gait cycle. Conclusions Due to only observed changes in the frontal plane, the KT method should be modified to also improve knee function in other planes.

Jakub Ślusarski

Papers

Stabilometric indicators as an element of verifying rehabilitation of patients before and after reconstruction of anterior cruciate ligament.

[Effectiveness and safety of intra-articular use of hyaluronic acid (Suplasyn I-Shot) in the treatment of knee osteoarthritis].

Does kinesiotaping can improve static stability of the knee after anterior cruciate ligament rupture? A randomized single-blind, placebo-controlled trial.

Quadriceps muscle strength recovery with the use of high tone power therapy after anterior cruciate ligament reconstruction: a randomized controlled trial

Biomechanical image of the knee motion in patients with chronic anterior instability of the knee joint before and after Kinesio Taping.