Efficacy and safety of treating symptomatic, primary focal osteochondral lesions of the patella with a combination of intra-articular injection of hyaluronic acid (HAi) and radial extracorporeal shock wave therapy (rESWT) or HAi alone: a retrospective two-cohort study
Bibliographic record
Abstract
ABSTRACT Background This study tested the hypothesis that a combination of intra-articular injection of hyaluronic acid (HAi) and radial extracorporeal shock wave therapy (rESWT) is more effective than HAi alone in the treatment of symptomatic, primary focal osteochondral lesions of the patella (sPFOLP). Methods We performed a retrospective analysis of n=81 subjects with unilateral sPFOLP who were treated with respectively HAi+rESWT (n=36) or HAi alone (n=45) at the outpatient department of our hospital between January 1 st , 2014 and January 31 th , 2018. Subjects in both cohorts also received education with special attention to reduction of going up and down the stairs, squatting and specific activities, as well as non-opioid analgesics if necessary. Efficacy was assessed using the pain visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, which were examined at baseline (BL) and six weeks (W6), three months (M3) and six months (M6) after BL, as well as during a last follow-up examination (LE) which was performed at 37.6 ± 1.7 (mean ± standard error of the mean) months after BL (range, 12-59 months). In addition, measurements of the area of the patellar bone marrow edema (PBME) on sagittal, fat suppression sequence magnetic resonance imaging (MRI) scans of the knee were performed at BL, M3, M6 and LE. Results Subjects who were treated with HAi+rESWT showed significantly smaller mean VAS pain scores at W6, M3 and M6, significantly smaller mean WOMAC scores at W6, M3 and LE and significantly smaller mean PBME areas at M3, M6 and LE than subjects who were treated with HAi alone. No severe adverse events were observed. Discussion The results of this study suggest that HAi+rESWT is safe and more effective than HAi alone in the treatment of sPFOLP. This result should be verified in adequate randomized controlled trials. Level of evidence Level III; retrospective two-cohort study.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".