A.N. NURIAKHMETOV¹, T.YU. NURIAKHMETOVA^1, 2, I.F. AKHTYAMOV^1, 2, R.Z. SALIKHOV¹

 ¹Republic Clinical Hospital, Kazan

²Kazan State Medical University, Kazan

Contact details:

Nuriakhmetov A.N. — researcher

Address: 138 Orenburgskiy trakt, 420064 Kazan, Russian Federation, tel.: +7-937-520-53-13, e-mail: nurajnur888@mail.ru

Post-arthroscopic prolonged synovitis is a significant problem. Using the predictor assessment, it is possible to select measures and prevent the development of this rather common complication.

The purpose was a comparative assessment of the clinical and functional results of early postoperative intra-articular administration of glucocorticosteroids (GCS) in patients with a high risk of chronic synovitis.

Material and methods. The study included 350 patients with osteoarthritis (OA) of various etiologies and meniscus injuries, of whom 54 were identified as having a high risk of long-term postoperative synovitis. Of these, 48 patients with knee synovitis that persisted two weeks after knee arthroscopy were randomized into two groups: standard anti-inflammatory treatment and similar therapy with early prophylactic intra-articular administration of GCS (14–21 days after the intervention).

Results. There was a significant improvement in the indices of all functional scales with significantly more pronounced changes by the third month in the main group: KOOS pain subscale (78.5 ± 1.97 vs. 72.8 ± 2.27), symptoms (79.7 ± 1.52 vs. 69.8 ± 3.01), Lysholm index (83.6 ± 1.9 vs. 74.8 ± 2.54), and IKDC (70.8 ± 2.02 vs. 64.6 ± 2.2). The frequency of achieving PASS was higher in the group with GCS early administration according to KOOS pain, KOOS symptoms, Lequesne index, and IKDC.

According to a number of publications, postoperative intra-articular administration of GCS is considered risky in terms of infection. Chronic postoperative synovitis is an equally serious and much more common problem in arthroscopy. The possibility of preventive injection therapy in patients with identified predictors of synovitis may increase the treatment effectiveness. The early use of GCS significantly reduced the duration of synovitis, accelerated functional recovery and improved treatment results according to such scales as KOOS, Lysholm, Lequesne and IKDC, without increasing the risk of side effects.

Conclusion. Intra-articular administration of GCS at 14-21 days after arthroscopy is safe. The procedure significantly reduces the persistence and duration of synovitis and accelerates functional recovery.

Key words: synovitis of the knee joint, IKDC scales, KOOS, Lysholm index, Lequesne index, preventive administration of glucocorticosteroids.

REFERENCES

1. Jawish, R., Najdi, H., Abi Safi, C. et al. The effect of intra-articular Tenoxicam on knee effusion after arthroscopy. International Orthopaedics (SICOT), 2015, vol. 39, pp. 1423–1426. DOI: 10.1007/s00264-014-2640-3
2. Ishibashi K., Sasaki E., Chiba D. et al. Effusion detected by ultrasonography and overweight may predict the risk of knee osteoarthritis in females with early knee osteoarthritis: a retrospective analysis of Iwaki cohort data. BMC Musculoskelet Disord, 2022, vol. 23 (1), p. 1021. DOI: 10.1186/s12891-022-05989-0
3. Nuriakhmetov A.N., Nuriakhmetova T.Yu., Akhtyamov I.F. FGBOU VO Kazanskiy GMU MZ RF. Sposob prognozirovaniya riska dlitel’nogo posleoperatsionnogo sinovita kolennogo sustava. Patent no. RU2822328 C1. Zayavka no. 2024112214. Zayavl.06.05.24; Opubl. 04.07.24, Byul. no. 19 [Kazan State Medical University, Ministry of Health of the Russian Federation. Method for predicting the risk of long-term postoperative synovitis of the knee joint. Patent No. RU2822328 C1. Application No. 2024112214. Claimed 06.05.24; Published 04.07.24, Bulletin No. 19].
4. Ramamoorthy S., Cidlowski J.A. Corticosteroids: mechanisms of action in health and disease. Rheum. Dis. Clin. North Am, 2016, vol. 42 (1), pp. 15–31. DOI: 10.1016/j.rdc.2015.08.002
5. Cancienne J.M., Kew M.E., Smith M.K., Carson E.W., Miller M.D., Werner B.C. The Timing of corticosteroid injections following simple knee arthroscopy is associated with infection risk. Arthroscopy, 2019, vol. 35 (6), pp. 1688–1694. DOI: 10.1016/j.arthro.2019.01.025
6. Nuriakhmetov A.N., Akhtyamov I.F., Tsyplakov D.E., Abdullakh A.M., Nuriakhmetova T.Yu. Dose-dependent effect of betamethasone on articular cartilage (experimental study). Geniy ortopedii, 2021, no. 27 (1), pp. 80–86 (in Russ.).
7. Nuriakhmetov A.N., Akhtyamov I.F., Tsyplakov D.E. et al. Effect of triamcinolone acetonide on articular cartilage. BioNanoSci, 2022, vol. 12, pp. 496–501. DOI: 10.1007/s12668-022-00978-y
8. Roos E.M., Roos H.P., Lohmander L.S., Ekdahl C., Beynnon B.D. Knee injury and osteoarthritis outcome score (KOOS)-development of a self-administered outcome measure. J. Orthop. Sports Phys. Ther, 1998, vol. 28 (2), pp. 88–96. DOI: 10.2519/jospt.1998.28.2.88
9. Lequesne M.G. The algofunctional indices for hip and knee osteoarthritis. J. Rheumatol, 1997, vol. 24 (4), pp. 779–781.
10. Tegner Y., Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin. Orthop. Relat. Res, 1985, vol. 198, pp. 43–49. DOI: 10.1097/00003086-198509000-00007
11. Tubach F., Ravaud P., Baron G. et al. Evaluation of clinically relevant states in patient reported outcomes in knee and hip osteoarthritis: the patient acceptable symptom state. Ann. Rheum. Dis, 2005, vol. 64, pp. 34–37.
12. Jaeschke R., Singer J., Guyatt G.H. Measurement of health status. Ascertaining the minimal clinically important diference. Control Clin. Trials, 1989, vol. 10, pp. 407–415.
13. Gowd A.K., Lalehzarian S.P., Liu J.N., Agarwalla A., Christian D.R., Forsythe B. et al. Factors associated with clinically significant patient-reported outcomes after primary arthroscopic partial meniscectomy. Arthroscopy, 2019, vol. 35 (5), pp. 1567–1575.e3. DOI: 10.1016/j.arthro.2018.12.014
14. Salehi R., Valizadeh L., Negahban H., Karimi M., Goharpey S., Shahali S. The Western Ontario and McMaster Universities osteoarthritis, lequesne algofunctional index, arthritis impact measurement scale-short form, and visual analogue scale in patients with knee osteoarthritis: responsiveness and minimal clinically important differences. Disabil. Rehabil, 2023, vol. 45 (13), pp. 2185–2191. DOI: 10.1080/09638288.2022.2084776
15. Mahler E.A.M., Boers N., Bijlsma J.W.J., van den Hoogen F.H.J., den Broeder A.A., van den Ende C.H.M. Patient acceptable symptom state in knee osteoarthritis patients succeeds across different patient-reported outcome measures assessing physical function, but fails across other dimensions and rheumatic diseases. J. Rheumatol, 2017, vol. 45 (1), pp. 122–127. DOI:10.3899/jrheum.170181
16. Liu J.N., Gowd A.K., Redondo M.L., Christian D.R., Cabarcas B.C., Yanke A.B., Cole B.J. Establishing clinically significant outcomes after meniscal allograft transplantation. Orthop. J. Sports Med, 2019, vol. 7 (1). 2325967118818462. DOI: 10.1177/2325967118818462
17. Smith M.D., Wetherall M., Darby T., Esterman A., Slavotinek J., Roberts-Thomson P. et al. A randomized placebo-controlled trial of arthroscopic lavage versus lavage plus intra-articular corticosteroids in the management of symptomatic osteoarthritis of the knee. Rheumatology, 2003, vol. 42 (12), pp. 1477–1485. DOI: 10.1093/rheumatology/keg398