#INJECTIONS SUNOVIAL FLUID IN KNEE SERIES#

#INJECTIONS SUNOVIAL FLUID IN KNEE SERIES#

Autologous biologic products, according to their capability of modulating the joint environment by releasing a series of growth factors and immune-modulatory molecules, could play a beneficial role in reducing the local inflammation and promoting cartilage and synovial anabolism. 5 Conversely, there exists a more limited amount of evidence in support of the use of PRP and MSCs, due to their more recent discovery and introduction as OA treatments. CS and HA are ranked first as the most frequently injected substances and their use is supported by a large amount of literature, although some controversial findings have emerged. Among the most frequently used products we include corticosteroids (CS), hyaluronic acid (HA), polynucleotides, oxygen-ozone therapy, platelet-rich plasma (PRP) and mesenchymal stem cells (MSCs). 4 Injections have therefore gained increasing attention thanks to their more direct effect on the target tissues and reduced side effects due to intra-articular delivery.

2 Pharmacological approaches based for example on non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol have been shown to be effective in controlling pain in OA, 3 but due to their systemic administration, they have also been associated with gastrointestinal, cardiovascular and renal adverse events, especially in patients already presenting with comorbidities.

1 Symptomatic control can be achieved through different therapeutic strategies such as lifestyle modifications, exercise therapy, pharmacological therapies and injections of various substances. The aim of OA treatment is to control symptoms until the severity of the condition mandates surgical intervention an early therapy may be a vital step for delaying the progression to end-stage disease. may see lateral meniscal pathology (e.g.Osteoarthritis (OA) is a degenerative disease with a tendency to worsen over time, characterized by articular cartilage degradation, subchondral damage, and bone remodelling, most commonly affecting weight-bearing joints such as the knee and hip.evaluate the lateral collateral ligament in long axis.evaluate the distal iliotibial band in long axis (located between the anterior and middle third of the lateral knee).normally no fluid in the superficial infrapatellar bursa.small amount of fluid in the deep infrapatellar bursa is normal.tendon may appear enlarged just prior to insertion.anisotropy may falsely indicate a change in echogenicity.tendon should be constant in size and echogenicity through its course without detectable color Doppler flow.evaluate the patellar tendon and patellar bursae.evaluate the medial patellar articular facet (lateral facet not visible on ultrasound).useful for examination of the trochlear cartilage.extent of the medial/lateral suprapatellar recess should also be visualized.suprapatellar recess interdigitates between, distension representing likely effusion, most sensitive region.evaluate the suprapatellar and parapatellar joint recesses.transverse and longitudinal images of the quadriceps tendon from its myotendinous junctions to its attachment on the superior patella (rectus femoris myotendinous junction is more cranial than the vastus junctions).The knee is flexed 20-30° (flexion of the knee tightens the extensor tendons, decreasing the chance of anisotropy occurring in a lax tendon): A typical overall protocol is as follows 1: Anterior knee There are multiple possible approaches to imaging the knee with ultrasound. Knee ultrasound is somewhat limited compared with ultrasound examinations of other joints because the cruciate ligaments and the entirety of the meniscus are usually difficult to visualize. Ultrasound of the knee allows high-resolution imaging of superficial knee anatomy while simultaneously allowing dynamic evaluation of some of the tendons and ligaments.

Injections sunovial fluid in knee