Background: Meniscal tear surgeries have many long term sequelae. Intra-articular platelet rich plasma injection is thought to stimulate repair and increase meniscal function. Objectives: To assess the effect of 6-monthly intra-articular injection of platelet rich plasma (PRP) on the pain assessment and functional status of knee joint undergone meniscal repair. Methods: A randomized controlled trial was carried out on thirty patients who had undergone arthroscopic meniscal repair and presented with persistent pain within 4 months after surgery. Half of the patients were randomly intra-articularly injected with 5 mL PRP at 1 month intervals for 6 injections and the other half were not injected and taken as a control group. Clinical examination, visual analogue scale (VAS), knee injury and osteoarthritis outcome score (KOOS) score and Doppler ultrasonography were performed before and after PRP treatment. Results: After 6 months, in the PRP injected group, there was a significant improvement in VAS score (1 (1 -3)) and KOOS score (86.2 ± 4) compared to baseline values (9 (7 -10) and 62 ± 9.8 respectively; P < 0.001) as well as significant decrease in the percentage of degeneration of medial femoral condyle (MFC), lateral femoral condyle (LFC), medial tibial condyle (MTC), lateral tibial condyle (LTC) measured by Doppler Ultrasonography (US), (6.16 ± 3.33 and 9.07 ± 3.66, respectively; P = 0.031). Conclusions:This study showed that intra-articular PRP injection following meniscal repair can be effective in reducing pain, improving knee function, and slowing the rate of cartilage degeneration that accounts for early osteoarthritis.

Background Platelet-derived lyophilized growth factors (L-GFs) use a standardized number of allogenic pathogen-free platelets instead of autologous platelets used in PRP as a source of growth factors. This study aimed to evaluate the efficacy of L-GF injection versus placebo in subacromial impingement (SIS) treatment. Methods The current randomized double-blind placebo-controlled study included sixty patients (40 females and 20 males, aged between 24 and 75 years) diagnosed with SIS (both clinically and sonographically). Patients were randomly assigned to two equal groups. Under ultrasound guidance, group 1 received subacromial saline injection, and group 2 received L-GF injection. Clinical examination, pain visual analogue scale (VAS), shoulder pain and disability index (SPADI) and shoulder ultrasound were performed before and at the 8th week after injection. Results Follow-up assessment showed statistically significant improvement in the L-GF group regarding active flexion, active and passive internal rotation and extension, SPADI-disability scale, VAS and thickness of the supraspinatus tendon by US. Regression analysis showed that group 1 was approximately 30 times more likely than the L-GF group to experience painful arc at follow-up. Both groups showed statistically significant improvement in SPADI-pain scale and SPADI-total, flexion and abduction (still the mean value of abduction was significantly higher in the L-GF group). Conclusions L-GF injection resulted in clinically significant reductions in pain and functional disability outcomes in patients with SIS. An objective significant reduction in the thickness of the supraspinatus tendon, measured by ultrasound, in the L-GF group hopefully encourages proper healing and functioning in SIS. Trial registration: The identification number is NCT04330027, date of first registration (01/04/2020). Unique on 21/11/2019, Protocol ID: 0106178.

Background Interleukin-17 (IL-17) is a cytokine that promotes activation of multiple catabolic pathways resulting in cartilage and tissue damage. It has features making it increasingly attractive as a biological marker, especially in rheumatoid arthritis (RA) and osteoarthritis (OA). However, its expression is heterogeneous; not all patients’ exhibit high IL-17 levels, and its level along the disease course is still challenging to predict. Aim of the work The objectives of this study were to compare serum IL-17 levels in patients with early knee OA and in RA patients, to determine its correlation with disease activity in RA and to determine if it is correlated with functional scores in both RA and OA. Subjects and methods Twenty early knee OA patients (32.7 ± 3.7) years were included. Diagnosis of early OA was based on Luyten et al. 2012 early knee OA classification (early OA 2012). This study also included 25 RA patients aged 32.8 ± 5.1 years, and the diagnosis was according to 2010 ACR-EULAR classification criteria for RA. The current work also included a control group of 20 healthy volunteers aged 31.9 ± 3.2 years. The serum IL-17 level was assessed by using the ELISA technique. Results Serum IL-17 level was significantly high in early knee OA patients (5.2 pg/ml) and was significantly higher in RA patients (5.9 pg/ml) compared to the control group (4.9 pg/ml) (P < 0.001). Conclusions The increased serum IL-17 level in patients with early knee OA suggests its pathogenic role in the disease. Serum IL-17 positive correlation with the severity of knee OA-related pain proposes that it may be a potential marker to target for early treatment of knee OA-related pain.

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Background Platelet-derived lyophilized growth factors (L-GF) uses a standardized number of allogenic pathogen-free platelets instead of autologous platelets used in PRP as a source of growth factors. This study aimed to evaluate the efficacy of L-GF injection versus placebo in the treatment of subacromial impingement (SIS). Methods The current randomized double-blind placebo-controlled study included sixty patients (40 females and 20 males, aged between 24-75 years) diagnosed with SIS (both clinically and sonographically). Patients were randomly assigned to two equal groups. Group 1 received subacromial saline injection, and group 2 received L-GF injection. Both groups were injected under ultrasound guidance. Clinical examination, Visual analogue scale (VAS) of pain, Shoulder Pain and Disability Index (SPADI), and shoulder ultrasound were performed before and at the 8th week after injection. Results Follow-up assessment showed statistically significant improvement in the L-GF group with regard to active flexion, active and passive internal rotation and extension, SPADI-Disability scale, VAS of pain and thickness of the supraspinatus tendon by US. Concerning painful arc, regression analysis showed that the placebo group was approximately 30 times more likely than the L-GF group to experience painful arc at follow-up. Both groups showed statistically significant improvement regarding the SPADI-Pain scale and SPADI-Total as well as passive flexion and abduction (still the mean value of abduction was significantly higher in the L-GF group). Conclusions L-GF injection resulted in clinically significant reductions in pain and functional disability outcomes in patients with SIS. An objective significant reduction in the thickness of the supraspinatus tendon, measured by ultrasound, in the L-GF group hopefully encourages proper healing and functioning in SIS. Trial registration: The identification number is NCT04330027, date of first registration (01/04/2020). Unique on 21/11/2019, Protocol ID: 0106178,

ObjectiveEvaluate efficacy of platelet-derived lyophilized growth factors (L-GF) injection versus placebo in treatment of subacromial impingement (SIS).MethodsSixty patients with SIS (clinically and sonographically) were included in this randomized double blind placebo controlled study. Patients were randomly divided to receive either saline (group 1) or L-GF (group 2) injection, under US-guidance. Clinical examination, Visual analogue scale of pain, Shoulder Pain and Disability Index (SPADI), and shoulder ultrasound were done before and at 8th week after injection. ResultsFollow up assessment showed statistically significant improvement in L-GF group as regards active flexion & active and passive internal rotation and extension, SPADI-Disability scale, VAS of pain as well as thickness of the supraspinatus tendon by US. Concerning painful arc, regression analysis has shown that placebo group is about 30 times more than the L-GF group to get painful arc at follow up. On the other hand, both groups showed statistically significant improvement regarding SPADI-Pain scale and SPADI-Total as well as passive flexion & abduction (still mean value of abduction was significantly higher in LG-F group). ConclusionsL-GF injection in patients with SIS has resulted in significant improvement as regards pain and disability according to the improvement in shoulder range of movement, painful arc sign, VAS, SPADI, as well as significant reduction in the thickness of the supraspinatus tendon as measured by ultrasound compared to the saline group. Trial registration: Identification number is NCT04330027, date of first registration (01/04/2020)Unique on 21/11/ 2019, Protocol ID: 0106178,

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Chronic low back pain (CLBP) is a very common disorder with various management strategies. There is still debate regarding treatment alternatives for axial CLBP. This study aimed to compare the effect of epidural steroid injection (ESI), interferential current (IFC) therapy and core strengthening exercises in a prospective randomized controlled manner. Hence, sixty patients complaining of axial CLBP were included and randomly assigned into either a group of ESI and exercises (group A) or IFC and exercises (group B) or exercises only (group C); each group was of 20 patients. Outcomes were visual analogue scale (VAS) for pain, Oswestry disability index (ODI) for function and Beck's depression inventory (BDI) for depression, assessed at baseline and 3-, 6- and 12-week follow-ups. At the start of the study, there were no significant differences between the three groups in age, gender, cause and duration of CLBP, body mass index, abdominal muscle power, muscle spasm or tenderness (p > 0.05). Significant improvement in VAS and ODI at 3-, 6- and 12-weeks was observed compared to baseline assessment in the three studied groups. The improvement was higher for group A compared to B and C. BDI was significantly improved in group A and C at 3 weeks, and in all groups at 6- and 12-weeks compared to baseline. However, at the end of the study, there was no significant difference in the BDI between the three groups. From this study and over a period of 3 months, all studied groups showed improvement in pain, function, and depression but the group who received epidural steroid injection with core strengthening exercises was statistically better than the other two groups, with significant improvement in pain and function, but not in depression. Early effective assessment and dealing with depression, even prophylactic treatment and cognitive behavioral therapy should be addressed. Trial registration: The Pan African Clinical Trial Registry (www.pactr.org) identification number is PACTR201901523042787 on 16 January 2019.