Relationship between Body Mass Index (BMI) and Knee Osteoarthritis at the UKI General Hospital, Jakarta in 2017

Knee osteoarthritis is a degenerative joint disease usually suffered by elderly patients, contributing to the high risk of disability. The risk factors that affect the severity of knee osteoarthritis are obesity, age, sex, occupation, patient's history of the disease, trauma and other factors. Excessive body weight is a factor that exacerbates the disease of Osteoarthritis. Generally, this research is aimed to examine the correlation between Body Mass Index (BMI) and knee osteoarthritis at UKI General Hospital in 2017. The researcher used a descriptive-analytic study with a cross-sectional approach. In this study, the researcher used 30 samples. The results showed that there was a relationship between BMI and the incidence of knee osteoarthritis. This study indicates that BMI values above average (more than 24.9) can affect the occurrence of joint space narrowing in patients. Patients with abnormal BMI have a risk of 6,429 times the risk of joint space narrowing compared to patients with normal BMI. The mean BMI value of patients with knee osteoarthritis at UKI General Hospital is 25.6. Therefore, the researcher concluded that there is a correlation between BMI and knee osteoarthritis, in which a high BMI value (>24.9) may affect the occurrence of joint space narrowing among the patients. The mean BMI value among the osteoarthritis patients at UKI General Hospital is 25.6, indicating that most osteoarthritis patients are pre-obese/overweight. Key words: Knee osteoarthritis, Body Mass Index (BMI), joint space narrowing

MRI analysis of ACL tendon graft Intracanal Incorporation with polypropylene mesh implantation

Hamstring tendon graft remains one of the most popular for ACL reconstruction (ACLR). However, its disadvantage is long term ligamentation process and intracanal incorporation and delayed rehabilitation. One of the methods for stimulation of connective tissue growth is the implantation of polypropylene mesh (PPM), which are widely used in hernioplasty. Objective. To compare the MRI data dynamics of intracanal incorporation of tendon graft with implantation of PPM in bone canals. Methods. For evaluation of graft reconstruction in the femoral and tibial canals we used criteria based on the analysis of MRI images in PD FS and STIR sequences: the nature of the signal from the graft in the center of bone canal; general view of the graft; the nature of the MRI signal from the tissues around the graft on the tendons-bone border; the pre­sence of synovial fluid in the canals and bone edema around them. Results of MRI of 75 patients who underwent «all-inside» ACLR with semitendinosus graft were analyzed. In the study group (40 patients) were compared to control group (35 patients) additionally implanted PPM around the ends of the tendon graft. Results. Intracanal graft incorporation in the group of patients with implantation of PPM occurred faster. The nature of the signal from the center of the bone canal and on the bone-tendon border progressed significantly faster in all observed terms. In the research group there was not presence of synovial fluid in the canals along the graft. Conclusions. Implantation of PPM around the ends of the ACL tendon autograft immersed in bone canals, leads, according to MRI data, to faster intra-canal incorporation. Key words. Knee joint, anterior cruciate ligament, arthroscopy.

Prevalence of Knee Pain in Football Players of Various Age Group

Background: Football is the most commonly played sport at both elite and grassroots level in many countries. Football is a sport that involves intermittent walking, jogging, running, and sprinting. Football players are at high risk for lower extremity injuries because they turn on an axis of rotation, repeatedly jump and land. One of the most common sites of injury is the knee. To identify instruments like pain, function, and activity level fulfilling these criteria, Knee pain were assessed with published reviews of knee instruments IKDC (International Knee Documentation Committee) and self – reported pain questionnaire. This study contains data only applicable to the knee. Aim: To find out the prevalence of knee pain in football players of various age group. Objectives: To find the prevalence of knee pain in football players using self – reported pain questionnaire and IKDC and also to find out influence of gender in football players of various age group. Materials and methods: 250 football players were selected as per the inclusion and exclusion criteria and consent was taken. Knee pain was assessed with the self reported pain questionnaire and IKDC Form. The data were obtained and statistically analysed. Result: The study results show that knee pain is prevalent in football players of various age group. Conclusion: The above study concludes knee pain is prevalent in football players, it’s more prevalent in male also common in dominant side of knee and age of onset is 10-15 years of age group. Key words: Knee pain, IKDC, Pain Questionnaire, Football Players.

Effectiveness of Genicular Nerve Radiofrequency Ablation: A Case Series and Considerations for Future Research

Background: Postherpetic neuralgia (PHN) is the most common complication of shingles and can be a significant burden to patients due to pain and disability. Currently, treatment options are limited. In refractory cases, neuromodulation using spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS) have been used but is considered experimental due to limited evidence. Case Report: We report 2 cases who experienced successful treatment of refractory PHN. Patients underwent dorsal root ganglion (DRG) stimulation at the thoracic level for the treatment of refractory PHN. Conclusion: Both patients showed significant improvement in pain at 24 and 36 months after a DRG stimulation trial and implantation. We report the successful use of DRG stimulation for the treatment of PHN. Key words: Knee, genicular, radiofrequency ablation, osteoarthritis, pain, block, cooled

Efficacy of intra-articular hyaluronic acid injections in the rehabilitation programme of Knee Osteoarthritis

Knee osteoarthritis (KOA) is a disease of wear and tear, leading to disability and ultimate surgical treatment. KOA has multiple etiologies and is considered a disorder of physiological processes that is manifested by progressive lesions of articular cartilage caused by chondrolysis, synovial membrane inflammation and subchondral osteophytes production. Modalities that limit the progression of the KOA and rehabilitation are a constant interest for clinicians and medical researchers. Various physical therapies and pharmacological strategies are currently used for pain management, with no clear benefit in terms of inhibiting disease progression. In this context, the use of exogenous hyaluronic acid (HA) (that is a vital component of the synovial fluid and involved in lubricating all synovial joints) has been explored as viable alternative to alleviate knee pain and temporarily restore knee function. In the following, we will review the use of HA injections associated with the physiotherapeutic recovery plan in the treatment of KOA. The therapeutic effects of the HA is still a matter of debate in the field, with no consensus being reached so far and thus, difficult to evaluate. However, much research has to be done to understand the therapeutic efficacy of HA alone or in combination with physical therapies and the role that other factors may play in unraveling its beneficial effects on the KOA. Key words: knee, osteoarthritis, hyaluronic acid, physiotherapy, rehabilitation,

EFFECTIVENESS OF MANUAL TRACTION IN COMPARISON TO ELECTROTHERAPY (TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION - TENS) IN THE TREATMENT OF KNEE OSTEOARTHRITIS

OBJECTIVE To determine the effects of manual traction in knee arthritis patients in comparison to electrotherapy (TENS). STUDY DESIGN Randomized Control Trial (Experimental Study). STUDY SETTINGS & PARTICIPANTS Study was conducted in a Tertiary Care Hospital with a sample of 310 participants. INTERVENTIONS Manual traction and Electrotherapy Transcutaneous electrical nerve stimulation (TENS) will be used to manage pain in patients with Knee Osteoarthritis. OUTCOME MEASURES Oxford Knee Pain Scale was used to measure pain and functional activities. RESULTS Improvements were seen in both groups but results of manual traction were more significant. There were major differences present in knee pain intensity before and after treatment. The group that received manual traction reported a decrease in the severity of pain of mean 15.01 which is comparatively better than the group that received electro therapy and reported a decrease in severity of pain of mean 12.42. CONCLUSION The result of this research supports the application of manual TF joint traction as a mean of stretching shortened articular and periarticular tissues with decreased in levels of pain either during the treatment or at the end of session. There is significant improvement in knee flexion AROM. Pain level decreases during every treatment session. KEY WORDS Knee Pain, Traction, Mobilization, Tibio-Femoral Joint, TENS, Knee OA.

INTRAARTICULAR MORPHINE FOR POST OPERATIVE KNEE ARTHROSCOPY ANALGESIA

Key Words: Knee arthroscopy, Morphine, Opioid receptors, Post-operative pain.The Arthroscopy has dramatically changed the orthopedic surgeon's approach to the diagnosis and treatmentof variety of joint ailments. A degree of clinical accuracy, combined with low morbidity has encouraged theuse of arthroscopy to assist in diagnosis to determine prognosis and often to provide treatment. Recentwork has described peripheral opioid receptors in skin and synovium. The later may respond to the use ofintra-articular morphine for analgesia following knee arthroscopy.Two hundred and twenty five patients who had undergone different arthroscopic procedures for the last 3and half years were prospectively evaluated. Of the total arthroscopic procedures evaluated, meniscalpathology was found in 154 patients, synovial pathology in 14 patients, Anterior CruciateLigament (ACL)and Posterior Cruciate Ligament (PCL) insufficiency in 18 patients, chondral lesions in 25 patients, tightlateral structures in 6 patients and loose bodies in 8 patients. All the patients were operated on outpatientbasis. Routine intra-articular morphine (2 mg.) was used for postoperative pain relief. Drain was not putfollowing the procedures. All the patients were seen on the 5th postoperative day. Most patients were satisfiedwith the pain relief modality and needed analgesics in few patients. Postoperative low dose intra-articularmorphine injection has been found to be good alternative to other pain management modalities.