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OBJECTIVE: To evaluate the Efficacy and safety of intra-articular injection of mesenchymal stem cells (MSCs) versus Hyaluronic acid (HA) in the treatment of knee osteoarthritis (KOA).
METHODS: Eligible randomized controlled trials (RCTs) were identified through a search of Pubmed, Embase, the Cochrane Library, Web of science, SinoMed and CNKI databases from inception to March 2024. For meta-analysis, data on clinical outcomes were measured using a visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and data on cartilage repair were measured using the Whole-Organ Magnetic Resonance Imaging Score (WORMS); data on safety was evaluated by the incidence of adverse events. Two researchers independently read the included literatures, extracted data and evaluated the quality, and used Cochrane risk bias assessment tool for bias risk assessment, and RevMan5.3 software for Meta-analysis.
RESULTS: Ten RCTs involving 818 patients with KOA ranging from I-Ⅲ Kellgren - Lawrence grading scale were included in this meta-analysis. Meta results showed that compared with the HA control group, at 12months, the WOMAC total score ［MD=-10.22, 95% CI (-14.86∼-5.59), P<0.0001, Z=4.32］;VAS score［MD=-1.31, 95% CI (-1.90∼-0.73), P<0.0001, Z=4.40］; WORMS score ［MD=-26.01,95% CI （-31.88∼-20.14）,P<0.001,Z=8.69］of MSCs group all decreased significantly (P<0.05), and reached the minimum clinically important differences (MCID). Furthermore, there was no significant difference in the incidence of adverse events (RR=1.54, 95% CI= 0.85 ∼ 2.79, P=0.16, I2=0) between the two groups (P >0.05).
CONCLUSIONS: Compared to HA, intra-articular injection of MSCs therapy appears to effectively alleviate joint pain, improve clinical function of KOA patients. These benefits are observed to last for at least 12 months without an increase in adverse events. Due to limited, varied, and lacking MCID results in existing literature，further research is needed.
METHODS: Level I, Meta-analysis of Level I studies.

We report a first case of hallux rigidus successfully treated in an elderly patient by intra-articular infiltration of cross-linked hyaluronic acid (HA) 21 mg/mL with mannitol (Desirial Plus) and review the previous literature on the different compositions of HA infiltrative treatment applied to hallux rigidus. A 77-year-old female patient with moderate unilateral pain of 6 months of evolution and stiffness of the movement of the first metatarsophalangeal joint of the left foot, corresponding to grade 2 of the classification proposed by Coughlin and Shurnas. The objective of the study was to perform a pilot test to (a) evaluate the correct technique of intra-articular infiltration as well as (b) the use of a commercial cross-linked HA 21 mg/mL with mannitol, to a voluntary patient diagnosed with hallux rigidus. A single cross-linked HA infiltration is applied to the first metatarsophalangeal joint with an administered amount of 1 mL. The loaded dorsiflexion, the unloaded dorsiflexion, and the unloaded plantarflexion angles of the first metatarsophalangeal joint improved from 15°, 20°, and 10°, respectively, before injection to 45°, 52°, and 22°, respectively, at 14 days after injection. Moreover, these improvements maintained until the final follow-up (400 days). The intensity of pain, according to the visual analog scale, improved from 7 of 10 before the injection, passing through 4 of 10 at 14 days after the injection, to 1 of 10 at 60 days after the injection. Cross-linked HA 21 mg/mL with mannitol improves symptomatology, joint mobility of the first metatarsophalangeal joint, and quality of life in the patient with stiff hallux submitted to the pilot test. These effects have been maintained for more than 14 months.

Distal humerus intra-articular comminuted open fracture is a challenging injury, with nonunion, infection and stiffness considered as major concerns. We report a 58-year-old woman who was admitted to the emergency department from a car accident, sustaining an open wound with severe comminution of distal humerus and complete articular fracture, classified as AO/OTA 13C2 and Gustillo Anderson type IIIA. Debridement and external fixation was done first, followed by open reduction and internal fixation with fibular strut allograft. The patient showed excellent results in radiological and functional outcomes. Level of Evidence: Level V (Therapeutic).

Background Knee osteoarthritis (KOA) is the most typical cause of knee pain and impairment worldwide. It is typified by slow and progressive degeneration of the articular cartilage of the knee joint. Although KOA is being managed with a variety of therapies, the comparison of the effectiveness of different intra-articular injections in KOA treatment in Pakistan is still not thoroughly investigated. Therefore, the purpose of this current study is to compare the efficacy of intra-articular administration of platelet-rich plasma (PRP) and corticosteroids (CSs) in the treatment of KOA. Methods This prospective comparative study was performed among one hundred patients diagnosed with KOA in Benazir Bhutto Hospital, Rawalpindi, for one year from April 2022 to March 2023. Specified inclusion and exclusion criteria were employed for patient enrollment. Patients were divided into two equal groups through simple random sampling. Group A patients received an intra-articular injection of PRP solution whereas group B patients received an intra-articular injection of CSs. Informed consent and ethical approval were also acquired prior to data collection. A self-designed proforma based on interviews was used to collect data. The data analysis in Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 25.0, Armonk, NY) was carried out via descriptive statistics and an independent t-test. Results Women (N=71, 71%) had a higher prevalence of KOA than men (N=29, 29%). The means of study variables like age, Visual Analog Scale (VAS) score, and Western Ontario and McMaster Universities (WOMAC) score were 56.10 ± 8.70 years, 8.08 ± 1.6, and 70.08 ± 8.76 respectively. The frequency of KOA on the right side was 62% (N=62) while it was 38% (N=38) on the left side. In the study population, 69% (N=69) patients had grade II KOA, and 31% (N=31) patients had grade III KOA. At the first-month, second-month, and third-month follow-up visits, there were statistically significant differences in the mean scores of the WOMAC and VAS between the study groups. However, at the first-month follow-up visit, mean scores of VAS and WOMAC were lower in group B than in group A while these were lower in group A as compared to group B, at the second-month and third-month follow-up appointments. Conclusions Intra-articular infiltration of both PRP and CSs was efficacious in the treatment of KOA-related pain and functional limitations; however, overall improvement in the PRP group was higher than CS group.

Intra-articular lipomas are infrequently reported, with most reported cases occurring in the knee joint. A case of intra-articular lipoma in the small joints of the hand, specifically in the pisotriquetral joint, has been documented for the first time. A 24-year-old male visited the emergency department after a road traffic accident with a painful and swollen wrist. Radiographic examination revealed fractures of the distal radius and triquetrum. A subsequent wrist computed tomography scan identified an intra-articular lipoma within the pisotriquetral joint, further confirmed by ultrasonography. This article underscores the importance of recognizing that, though exceedingly rare, intra-articular lipomas should be considered in the differential diagnosis of soft-tissue tumors affecting the hand and wrist.

OBJECTIVE: To establish the pharmacokinetics of the cyclin-dependent kinase-9 inhibitor flavopiridol in equine middle carpal joints, using an extended-release poly lactic-co-glycolic acid (PLGA) microparticle formulation.
METHODS: 4 healthy horses without evidence of forelimb lameness.
METHODS: A 6-week longitudinal pharmacokinetic study was conducted in 2 phases (6 weeks each) in 4 healthy horses. The PLGA microparticles containing 122 μg flavopiridol in 3 mL saline were administered by intra-articular injection into 1 middle carpal joint, with empty PLGA microparticles injected into the contralateral joint as a control. Synovial fluid and plasma were collected at time points out to 6 weeks, and drug concentrations in synovial fluid and plasma were determined using validated protocols. Synovial fluid total protein and total nucleated cell count and differential, CBC, serum biochemistry, and lameness exams were performed at each of the time points.
RESULTS: Synovial fluid flavopiridol averaged 19 nM at week 1, gradually reduced to 1.4 nM by 4 weeks, and was generally below the detection limit at 5 and 6 weeks. There was no detectable flavopiridol in the plasma samples, and no adverse effects were observed at any time point.
CONCLUSIONS: Intra-articular injection of PLGA microparticle-encapsulated flavopiridol was well tolerated in horses, with detectable levels of flavopiridol in the synovial fluid out to 4 weeks with negligible systemic exposure. Flavopiridol is a cyclin-dependent kinase-9 inhibitor with potent anti-inflammatory and analgesic activity. The extended-release microparticle formulation promotes intra-articular retention of the drug and it may be an alternative to other intra-articular medications for treatment of equine joint disease.

Intra-articular calcaneal fractures are debilitating injuries that can result in a dramatic effect on quality of life post-injury. Surgical intervention is generally advised when significant displacement or comminution is present but can present a host of complications secondary to the limited blood supply and fragility to the soft tissues following injury. Surgical approaches to calcaneal fractures generally include the lateral extensile approach, minimal incision (sinus tarsi approach), or percutaneous approach. Each approach presents risks and benefits; therefore, determining the optimal incisional approach should be based on patient comorbidities, fracture pathoanatomy, soft tissue envelope concerns, and patient pre-injury functional status.

OBJECTIVE: There are few effective osteoarthritis (OA) therapies. A novel injectable polyacrylamide hydrogel (iPAAG) previously demonstrated efficacy and safety up to week 26 in an open-label study of knee OA. Here we report longer-term effectiveness and safety data.
METHODS: This multi-centre, open-label study included patients with symptomatic and radiographic knee OA. Primary outcome was WOMAC pain (0-100 scale) at 13 weeks, and patients continued to 26 weeks before entering a further 26-week extension phase. Secondary efficacy outcomes included WOMAC stiffness and function subscales, Patient Global Assessment (PGA) and proportion of OMERACT-OARSI responders. Safety outcomes were adverse events (AEs).
RESULTS: 49 participants (31 women, mean age 70) received an ultrasound-guided, intra-articular injection of 6 ml iPAAG; 46 completed the extension phase to 52 weeks. There was a significant reduction in the WOMAC pain score from baseline to 52 weeks (- 17.7 points (95% CI - 23.1; - 12.4); p < 0.0001). Similar sustained improvements were observed for WOMAC stiffness (11.0 points; 95% CI - 17.0; - 4.9), physical function (18.0 points; 95% CI - 19.1; - 10.6), and PGA (16.3 points; 95% CI - 23.1; - 9.4). At 52 weeks 62.2% of patients were OMERACT-OARSI responders. From 26 to 52 weeks, 8 adverse effects (AE), including 1 serious AE (cerebrovascular accident) were reported in 5 subjects. None of the new adverse events were thought to be device related.
CONCLUSIONS: This open-label study suggests persistent benefits and safety of iPAAG through 52 weeks after a single injection.
BACKGROUND: Clinicaltrials.gov NCT04179552.

Dorsal spanning plates are frequently utilized to manage comminuted intra-articular distal radius fractures, but there is little literature on combining them with augmented fixation in complex cases. We present a 43-year-old man who fell 5 ft onto his outstretched right hand. On examination, there was gross swelling and tenderness of the right wrist with no neurovascular deficit. Radiographs confirmed a comminuted intra-articular displaced distal radius fracture. He was treated with a dorsal spanning plate fixation combined with radiostyloid and volar buttress plates. Follow-up at 2 months showcased intact hardware with good fracture healing. The dorsal spanning plate was removed 4 months after the procedure with radiographs demonstrating adequate alignment and healing without failure. The patient reported no complaints and minimal functional disability. We highlight a case of augmenting a dorsal spanning plate with fragment-specific plate fixation for a comminuted intra-articular displaced distal radius fracture.