الفهرس 
Anatomy of the KneeOnly 14 pages are availabe for public view
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Abstract
SUMMARY AND CONCLUSION
Osteoarthritis (OA) is a leading cause of musculoskeletal pain
worldwide and the knee is one of the most commonly affected joints
in which the whole joint is involved leading to damage and loss of
articular cartilage, subchondral bone thickening, osteophyte
formation, ligamentous laxity, weakening of surrounding muscles
and synovial inflammation.
Joint pain is the primary symptoms of OA, some of the pain
does not originate from the joint itself but relatively from the periarticular
structures around the knee joint that contain pain fibers,
including; patellar tendinopathy, friction of the iliotibial band (ITBF),
contracture or stretch of medial collateral ligament (MCL) and lateral
collateral ligament (LCL) and pressure of osteophytes against them
and other capsular structures.
The use of platelet-rich plasma (PRP) as a biological solution
treatment of knee joint intra-articular and peri-articular pain has
gained popularity over the last several years.
PRP is a whole blood fraction containing high platelet
concentrations that, once activated, provides a release of various
growth factors (GFs) that enhance the healing process, decrease
inflammation and reduce pain. The efficacy of this treatment
modality remains unproven, and there is little and often inconclusive
evidence to guide clinicians as to the value of this therapy.
Ultrasonography imaging is a non-invasive, safe and relatively
low cost tool and is more sensitive than clinical examination in picking up peri-articular and intra-articular soft tissue lesions. US
provides fast and less invasive real-time monitoring during needle
placement for joint injection.
The aim of this study was: 1-Ultrasonic evaluation of primary
knee osteoarthritis.2-Evaluation of clinical & functional therapeutic
effect of intra-articular or peri-articular PRP injection guided by
ultrasound in treatment of patients with primary knee osteoarthritis.
This study include 80 knees of 59 patients with primary knee
osteoarthritis diagnosed according to the criteria of the American
College of Rheumatology, selected from the outpatient clinic of
Physical medicine, Rheumatology and Rehabilitation, Tanta
University Hospitals. They were divided according to the cause of
pain diagnosed clinically and by ultrasound into two groups: group I
were treated by intra-articular injection of platelet-rich plasma and
group II were treated by peri-articular injection of PRP guided by
ultrasound.
All patients were assessed before and six weeks
after treatment by the following:
1- Complete history taking.
2- Clinical evaluation:
Visual analogue scale (VAS) at rest
Morning Stiffness
Tenderness: A) Joint line tenderness.
B)Tenderness in patello femoral compression.
knee effusion using patellar tap test or by the elicitation of a
fluid thrill (wave test). Range of motion using universal goniometer.
Physical Performance testes: Chair Stand Test (CST) and
Stair Climb Test (SCT)
Functional Assessment By:
Western Ontario Mcmaster Universities index (WOMAC).
Knee injury and Osteoarthritis Outcome Score (KOOS).
3-Ultrasonic assessment of the knee.
The results of this study could be summarized as
follows:
As regards VAS at rest, morning stiffness (0-30 minutes),
joint line and patello femoral tenderness, active and passive range of
motion (flexion), physical Performance data (Chair stand test and
Stair climb test) and functional assessment, (KOOS and WOMAC)
scores in our study, there was significant clinical improvement after
treatment as compared to before treatment in each group with no
significant difference between the two groups.
According to ultrasonic assessment before and six weeks after
treatment in both groups, There was statistically significant
improvement in total US score in both groups and there was
significant improvement knee effusion in group I only after treatment
compared with before treatment.
Conclusion:
The results of this study have shown the application of
ultrasound guided single dose PRP to be a safe, effective and lowcost
method for treating all grades of knee OA mainly mild to moderate affection and peri-articular pain generator structures aiming
to reduce pain and improve knee function and quality of life.
Recommendations:
Further studies are required with large number of patients
for each cause of pain in OA patients for a more clear
result.
Further studies regarding, frequency of PRP injection will
be needed.