Lawrence P. Lai

Use of Platelet-Rich Plasma in Intra-Articular Knee Injections for Osteoarthritis: A Systematic Review

To systematically analyze the literature on the use of platelet‐rich plasma (PRP) for intra‐articular injections of the knee and its efficacy in the treatment of knee osteoarthritis (OA).

The impact of intrathecal baclofen on the natural history of scoliosis in cerebral palsy.

Background: Intrathecal baclofen (ITB) is an effective treatment of spasticity in patients with cerebral palsy. However, several recent reports have raised concerns that the treatment may be associated with a rapid progression of scoliosis. The objective of this study was to further examine the effect of ITB treatment on the progression of scoliosis in patients with cerebral palsy. Methods: Spastic cerebral palsy patients who were ITB candidates were followed radiographically. Baseline Cobb angles of the primary curve were measured during the period of ITB pump insertion and at the most recent follow-up visit. Each patient was matched with a control patient by the diagnosis of cerebral palsy, age, sex, topographic involvement, and initial Cobb angle. The mean rate of change in Cobb angle was compared between ITB and control patients using paired t test. A multiple linear regression model was used to examine the difference, controlling for age, sex, topographic involvement, and initial Cobb angle. Results: Fifty ITB patients and 50 controls were included in the analysis. There was no statistically significant difference between the mean change in Cobb angle in ITB patients (6.6 degrees per year) compared with the matched control patients (5.0 degrees per year, P = 0.39). The results from the multiple regression analysis also failed to show a statistically significant difference (0.92 degrees per year difference between ITB patients and controls, P = 0.56). Conclusions: The progression of scoliosis in cerebral palsy patients with ITB treatment is not significantly different from those without ITB treatment. The findings suggest that patients receiving ITB experience a natural progression of scoliosis similar to the natural history reported in the literature. Level of Evidence: Level III.

Optimal Needle Placement for Ultrasound-Guided Knee Joint Injections orAspirations

Although the inferomedial and inferior midline approaches are commonly used for intra-articular injection or aspiration of the knee joint, they may not be ideal for optimal needle placement. With these approaches, the fat pad may be contacted, which may lead to the injection of medication in the incorrect region, cause severe pain during the injection procedure, or present a false sign of low yield of fluid aspiration. Therefore, the objective of this study was to compare various approaches for knee injection and aspiration to identify the optimal one for needle placement. In this retrospective study, the ultrasound images of bilateral knee joints in 33 consecutive patients with knee pain were studied. This patient population was divided into two groups: Group A with knee effusions (n=10) and Group B without knee effusions (n=23). The results showed that among 90% of patients in Group A and 100% of patients in Group B, the superolateral view allowed visualization of the greatest amount of intra-articular knee fluid and the least amount of fat pad. In conclusion, the ultrasound-guided superolateral approach appears to be an optimal approach for knee intra-articular injection or aspiration compared to the conventional inferomedial and inferior midline approaches.

Ganglion cyst at the fibular head causing common peroneal neuropathy diagnosed with ultrasound and electrodiagnostic examination: a case report.

ABSTRACTThe common peroneal nerve is a major source of innervation to the lower limb, but it is sometimes compressed or entrapped at the fibular head. The authors present what they believe is the first reported case where peroneal nerve impingement caused by ganglion cyst compression of the nerve at the fibular head was diagnosed using a combination of ultrasound imaging and electrodiagnostic studies. The authors described the history, physical examination, electrodiagnostic findings, and musculoskeletal ultrasound findings of a patient with a left foot drop caused by a ganglion cyst compressing the common peroneal nerve at the fibular head. The increasing role of ultrasound imaging to evaluate musculoskeletal pathology is discussed.

Role of PRP in the Treatment of Knee Osteoarthritis

Platelet-rich plasma (PRP) is one of the many new therapeutic approaches that continues to evolve in the field of general musculoskeletal medicine, sports medicine, and orthopedic medicine. There has been increasing amount of interest particularly in knee osteoarthritis as it is the most common degenerative disease encountered in clinical practice. PRP injections have been found in the majority of recent clinical studies to be helpful for pain and function. The purpose of this article was to provide the readers with the historical perspective of PRP and the most current literature on the use of PRP for the treatment of knee OA.

Poster 148 Role of PRP in the Treatment of Knee Osteoarthritis

Disclosures: Kathleen Bell: Consulting fees or other remuneration (payment) Avanir Pharmaceutical Objective: To examine gender differences in post-injury symptom reporting for adolescents enrolled in the ConTex study, a longitudinal concussion registry in North Texas. Design: Consecutive enrollment of clinical cohort using self-report. Setting: Four outpatient concussion or sports medicine clinics in North Texas. Participants: Subjects were 56 female and 47 male full-time students aged 13-19 years (M1⁄415.2, SD1⁄41.6) who consecutively presented 0-110 days (M1⁄417.7, SD1⁄420.0) after sports-related concussion. Interventions: Not applicable. Main Outcome Measures: Generalized Anxiety Disorders-7 (GAD-7), Patient Health Questionnaire (PHQ-9), and a Concussion Symptom Log. Results: Across 31 individual anxiety, depression, and concussion items examined, females tended to endorse symptoms somewhat more often, but only two items were significantly different by gender: 1) “Not being able to stop or control worrying” and 2) “Feeling bad about yourselfeor that you are a failure or have let yourself or your family down” (P1⁄4.024 and .046, respectively), with higher frequency endorsement by females (29% vs 11% and 20% vs 6%, respectively). No significant gender differences were found in total anxiety, depression or concussion symptom log scores (P>.05). Conclusions: Using global anxiety and depression self-report scores, we found no significant differences between the level of symptom reporting in females and males. However, females reported two items with greater frequency, suggesting the possibility of different psychological sequelae post sports concussion in female versus male adolescents. Level of Evidence: Level I

Reply: To PMID 25687110.

1. Lai LP, Stitik TP, Foye PM, Georgy JS, Patibanda V, Chen B. Use of platelet rich plasma in intra-articular knee injections for osteoarthritis: A systematic review. PM R 2015;7:637-648. 2. Braun HJ, Kim HJ, Chu CR, Dragoo JL. The effect of platelet-rich plasma formulations and blood products on human synoviocytes: Implications for intra-articular injury and therapy. Am J Sports Med 2014;42:1204-1210. 3. Kon E, Mandelbaum B, Buda R, et al. Platelet-rich plasma intraarticular injection versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: From early degeneration to osteoarthritis. Arthroscopy 2011;27:1490-1501. 4. Sampson S, Reed M, Silvers H, Meng M, Mandelbaum B. Injection of platelet-rich plasma in patients with primary and secondary knee

Hydronephrosis: An Unusual Complication of Neurogenic Bowel in a Patient With Spinal Cord Injury: A Case Report

were significant improvement of Fourier transformation in normal eyes open, pillow with eyes open position and of weight distribution in pillow with eyes open and pillow with eyes closed position after VR program than treatment using tetra-ataxiometric posturography. Conclusions: This study suggests that virtual reality program may be more effective therapeutic technique on stroke patients with impaired standing balance than tetra-ataxiometric posturography.

Successful Treatment of Sciatica and Associated Proximal Hamstring Tendinopathy with Ultrasound-Guided Hydrodissection

of his pain and weakness but persistent numbness in the superficial peroneal distribution. Discussion: Although previous studies have demonstrated transiently decreased function in the peroneal nerve after activity associated with chronic exertional compartment syndrome, this is, to our knowledge, the first case report describing persistent bilateral peroneal neuropathies associated with chronic exertional compartment syndrome. Conclusions: Untreated chronic exertional compartment syndrome may lead to persistent peroneal neuropathies.