Mehmet ÜNAL, Tomris DUYMAZ, İbrahim Halil URAL, Mehmet Tolgahan HAKAN

Diz Osteoartritli Hastalarda Eklem İçi Viskosuplement Enjeksiyonunun İzokinetik Kas Gücü Üzerine Etkileri

GİRİŞ ve AMAÇ: Diz osteoartriti hayat kalitesini önemli derecede etkileyen yaygın bir hastalıktır. Rehabilitasyon protokolleri diz eklemi üzerindeki yükü azaltmak amacıyla kas güçlendirme egzersizleri içermelidir. bu çalışmada intraartiküler olarak uygulanan hyaluronik asit, kondroitin sülfat ve glukozamin içeren viskosuplementasyon enjeksiyonlarının diz kaslarının izokinetik kuvvetleri üzerindeki etkilerini araştırdık. YÖNTEM ve GEREÇLER: Çift-kör ve randomize yapılan bu çalışmada demografik veriler ve izokinetik kas gücü ölçümü Biodex (System 3) ile yapıldı. Enjeksiyondan önce ve 3 ay sonra kuadriseps kasının 60°/sn ve 240°/sn açısal hızlarında izokinetik kas gücü testi uygulandı. SPSS for Windows programı ile istatistiksel analizler yapıldı. BULGULAR: 60°/sn ve 240°/sn açısal hızlarında yapılan izokinetik testlerde istatistiksel olarak anlamlı fark bulundu. Diz osteoartriti tedavisinde hyaluronik asit, kondroitin sülfat ve glukozamin içeren viskosuplementasyon enjeksiyonlarının kuadriseps ve hamstring kaslarında total ve fonksiyonel izokinetik kas gücünü arttırdığı saptandı. TARTIŞMA ve SONUÇ: Hyaluronik asit, kondroitin sülfat ve glukozamin içeren viskosuplementasyon enjeksiyonları kuadriseps ve hamstring kaslarında 60°/sn ve 240°/sn açısal hızlarında izokinetik kas gücünün artmasını sağlamaktadır. Tedavi protokollerinde daha fazla yer alabileceği düşünülebilir.

Effects of Intra-Articular Viscosuplement Injection on The Isokinetic Muscle Test Values of Patients with Knee Osteoarthritis

INTRODUCTION: Knee osteoarthritis is a common disease that seriously decrease the quality of life. Rehabilitation protocols include muscle strenthening exercises to decrease loading of the knee joint. We aimed to identify and analyse the outcome of the isokinetic muscle test of the knee joint after injection of intra-articular viscosupplement containing hyaluronic acid, chondroitin sulphate and glucosamine. METHODS: This study is designed as a prospective and double-blind study. Demographic data was recorded, and the isokinetic test was measured with Biodex (System 3) for the measurement of quadriceps muscle strength before and 3 months after the injection. The device is set to measure at angular velocities of 60°/s and 240°/s. SPSS for Windows was used for statistical analyses. RESULTS: There were statistically significant results with isokinetic measurements were evaluated at angular velocities of 60°/s and 240°/s. In the treatment of knee osteoarthritis, the hyaluronic acid, chondroitin sulphate and glucosamine injection were found to increase total and functional strength in isokinetic quadriceps and hamstring muscle strength. DISCUSSION AND CONCLUSION: Hyaluronic acid, chondroitin sulphate and glucosamine injection were found to increase total and functional strength at angular velocities of 60°/s and 240°/s in isokinetic quadriceps and hamstring muscle strength.

PDF

___

1. Sun SF, Hsu CW, Hwang CW et al. Hyaluronate improves pain, physical function and balance in the geriatric osteoarthritic knee: a 6-month follow-up study using clinical tests. Osteoarthritis and Cartilage. 2006; 14 (7): 696–701.
2. Huang TL, Chang CC, Lee CH, Chen SC, Lai CH, Tsai CL. Intra-articular injections of sodium hyaluronate (Hyalgan) in osteoarthritis of the knee. a randomized, controlled, double-blind, multicenter trial in the asian population. BMC Musculoskeletal Disorders, 2011; 12: 221.
3. Coudeyre E, Jegu AG, Giustanini M, Marrel JP, Edouard P, Pereira B. Isokinetic muscle strengthening for knee osteoarthritis: A systematic review of randomized controlled trials with meta-analysis. Ann Phys Rehabil Med. 2016;59(3):207-15.
4. Khalaj N, Abu Osman NA, Mokhtar AH, George J, Abas WA. Effect of intra-articular hyaluronic injection on postural stability and risk of fall in patients with bilateral knee osteoarthritis. Scientific World Journal. 2014;2014:815184.
5. Hsieh RL, Lee WC, Lo MT, Liao WC. Postural stability in patients with knee osteoarthritis: comparison with controls and evaluation of relationships between postural stability scores and international classification of functioning, disability andhealth components. Arch Phys Med Rehabil. 2013; 94 (2): 340–346.
6. Pandya NK, Piotrowski GA, Pottenger L, Draganich LF. Pain relief in knee osteoarthritis reduces the propensity to trip on an obstacle. Gait and Posture, 2007; 25 (1): 106–111.
7. Ruhdorfer A, Wirth W, Eckstein F. Association of knee pain with a reduction in thigh muscle strength - a cross-sectional analysis including 4553 osteoarthritis initiative participants. Osteoarthritis Cartilage. 2017; 25(5):658-666.
8. Kocahan T, Kaya E, Akınoğlu B, Karaaslan Y, Yıldırım NU, Hasanoğlu A. The Effects of Isokinetic Strength Training on Strength at Different Angular Velocities: a Pilot Study. Turkish Journal of Sports Medicine. 2017; 52(3): 077-083.
9. Evanich JD, Evanich JC, Wright MB, Rydlewicz JA. Efficacy of Intraarticular Hyaluronic Acid Injections in Knee Osteoarthritis. Clinical Orthopaedics and Related Research. 2001; 390(390):173-81.
10. Chevalier X. Intraarticular treatments for osteoarthritis: new perspectives. Curr Drug Targets. 2010; 11(5):546-560.
11. Gallagher B, Tjoumakaris FP, Harwood MI, Good RP, Ciccotti MG, Freedman KB. Chondroprotection and the prevention of osteoarthritis progression of the knee: a systematic review of treatment agents. Am J Sports Med. 2015;43(3):734-744.
12. Hussain SM, Neilly DW, Baliga S, Patil S, Meek R. Knee osteoarthritis: a review of management options. Scott Med J. 2016;61(1):7-16.
13. Tang SFT, Chen CPC, Chen MJL, Hong WH, Yu TY, Tsai WC: Improvement of muscle strength in osteoarthritic knee patients after intraarticular knee injection of hyaluronan. Am J Phys Med Rehabil. 2005; 84: 274–277.
14. Tammachote N, Kanitnate S, Yakumpor T, Panichkul P. Intra-Articular, Single-Shot Hylan G-F 20 Hyaluronic Acid Injection Compared with Corticosteroid in Knee Osteoarthritis: A Double-Blind, Randomized Controlled Trial. J Bone Joint Surg Am. 2016;98(11):885-92.
15. Tang SF, Chen CP, Chen MJ, et al: Changes in sagittal ground reaction forces after intraarticular hyaluronate injections for knee osteoarthritis. Arch Phys Med Rehabil. 2004; 85: 951–5.
16. Ünal M, Kuran B, Bilen FE. Spor yaralanmaları ve Rehabilitasyonu (1. Baskı). Bölüm: Sporcularda izokinetik değerlendirmeler (İoakim Ipseftal, Mehmet Ünal), İstanbul tıp kitabevi. 2018: pp 527-537.
17. Anandkumar S, Sudarshan S, Nagpal P. Efficacy of kinesio taping on isokinetic quadriceps torque in knee osteoarthritis: a double blinded randomized controlled study. Physiother Theory Pract. 2014;30(6):375-83.
18. Nguyen C, Lefèvre-Colau MM, Poiraudeau S, Rannou F. Evidence and recommendations for use of intra-articular injections for knee osteoarthritis. Ann Phys Rehabil Med. 2016;59(3):184-9.
19. Rainer F, Katzer H, Ribitsch V. Correlation between molecular parameters of hyaluronic acid and viscoelasticity of synovia. Acta Med Austriaca. 1996; 23:133–6.
20. Brandt KD, Douglas KH, Slemenda C, Katz BP, Mazzuca S, Braunstein EM, et al. A comparison of lower extremity muscle stength, obesity, and depression scores in elderly subjects with pain with and without radiographic evidence of osteoarthritis. J Rheumatol. 2000; 27: 1937–46.
21. Schneider U, Miltner O, Graf J, Thomsen M, Niethard FU. The efficacy of hyaluronic acid in patients with osteoarthritis of both knees in right/left comparisonexamination with dynamometry, synovial oxygen partial pressure, intraarticular temperature and Lequesne Score. Z Orthop. 1997; 135: 341-7.
22. Diracoglu D, Vural M, Baskent A, Dikici F, Aksoy C. The effect of viscosupplementation on neuromuscular control of the knee in patients with osteoarthritis. J Back Musculoskelet Rehabil. 2009;22(1):1-9
23. Miltner O, Schneider U, Siebert CH, Niedhart C, Niethard FU. Efficacy of intraarticular hyaluronic acid in patients with osteoarthritis-a prospective clinical trial. Osteoarthritis Cartilage. 2002; 10(9): 680-6.