Background & Aims
The objective of this study is to describe the thermographic and pain evaluation after genicular block and BMA injection in a case of osteoarthritis.
Methods
For the bibliographic review were made research in Pubmed and Cochrane databases with the keywords “BMA”, “genicular block” and “infrared thermography”, selecting just articles published after 2013. For the International Knee Documentation Committee Scale (IKDC) evaluation it was used the “OrthoToolKit IKDC Score”. For the thermographic, 20-minutes thermolysis was made before getting the images.
Results
Patient M.D.T., female, 72 years old, with chronic bilateral knee pain due to grade 4 osteoarthritis in both knees; related VAS (Visual Analogical Scale) pain of 7, Pain Severity (PS) and Interference (PI) of 8,25 and 7,85 in Brief Pain Inventory (BPI), and were also evaluated the IKDC in 5.7%. The infrared thermography images shown a high thermic gradient in both knees. For the treatment, a genicular block with ropivacaine and BMA injection from iliac crest in both knees was performed on October 14, 2019. The second analysis showed 29,9% IKDC scale, 40% VAS score, 45% PS-BPI and 72,8% PI-BPI improvement eight days after the intervention, exceeding the expected improvement compared with the literature (11,03% in IKDC scale and 27% in VAS score).
Conclusions
The BMA injections are a potentially promising treatment for the OA. In this case BMA was associated with genicular blocks and showed an expressive clinical improvement in the VAS, IKDC and BPI scores compared with other conservative therapies.
References
1. Centeno, C., Pitts, J., Al-Sayegh, H., & Freeman, M. (2014). Efficacy of Autologous Bone
Marrow Concentrate for Knee Osteoarthritis with and without Adipose Graft. BioMed
Research International, 2014, 1–9.
2. Ferreira, M.C.; Oliveira, J.C.P.; Zidan, F.F.; et al. Total knee and hip arthroplasty: the reality of
assistance in Brazilian public health care. rev bras ortop. 2018;53(4):432–440.2.
3. Cotter, E. J., Wang, K. C., Yanke, A. B., & Chubinskaya, S. (2017). Bone Marrow Aspirate
Concentrate for Cartilage Defects of the Knee: From Bench to Bedside Evidence. CARTILAGE,
9(2), 161–170.
4. Imam, M.A.; Mahmoud, S.S.S.; Holton, J.; et al. A systematic review of the concept and
clinical applications of Bone Marrow Aspirate Concentrate in Orthopaedics. SICOT J 2017, 3,
17.
5. Hyer, C.F.; Berlet, G.C.; Bussewitz, B.W.; et al. Quantitative assessment of the yield of osteoblastic connective tissue progenitors in bone marrow aspirate from the iliac crest, tibia, and
calcaneus. J Bone Joint Surg Am. 2013;95(14):1312-6.
6. Kim, J.D., Lee, G. W., Jung, G. H., et al. Clinical outcome of autologous bone marrow
aspirates concentrate (BMAC) injection in degenerative arthritis of the knee. European Journal
of Orthopaedic Surgery & Traumatology, 24(8), 1505–1511.
7. Lee, W.S.; Kim, H.J.; Kim, K.I.; et al. Intra-Articular Injection of Autologous Adipose TissueDerived Mesenchymal Stem Cells for the Treatment of Knee Osteoarthritis: A Phase IIb,
Randomized, Placebo-Controlled Clinical Trial. STEM CELLS TRANSLATIONAL MEDICINE
2019;8:504–511.
8. Collins, N. J., Misra, D., Felson, D. T., Crossley, K. M., & Roos, E. M. (2011). Measures of knee
function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation
Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis
Outcome Score Physical Function Short Form (KOOS-PS), Knee Ou. Arthritis Care &
Research, 63(S11), S208–S228. doi:10.1002/acr.20632.
9. Jayaram, P., Ikpeama, U., Rothenberg, J. B., et al. Bone Marrow–Derived and Adipose-Derived
Mesenchymal Stem Cell Therapy in Primary Knee Osteoarthritis: A Narrative Review. PM&R,
2018.
10. Kim, D.H.; Choi, S.S.; Yoon, S.H.; et al. Ultrasound-Guided Genicular Nerve Block for Knee
Osteoarthritis: A Double-Blind, Randomized Controlled Trial of Local Anesthetic Alone or in
Combination with Corticosteroid. Pain Physician. 2018 Jan;21(1):41-52.
11. Metsavaht, L.; Leporace, G.; Sposito, M.M.M.; et al. What is the best questionnaire for
monitoring the physical characteristics of patients with knee osteoarthritis in the brazilian
population? Rev Bras Ortop. 2011;46(3):256-61.
Presenting Author
Luisa Mesquita de Morais
Poster Authors
Victor Giacomini
MD
Centro Avançado de Dor e Especialidades Médicas - Distrito Federal
Lead Author
Lucio Gusmão Rocha
MD
Centro Avançado de Dor e Especialidades Médicas - Distrito Federal
Lead Author
Luisa Mesquita de Morais
MD
Centro Avançado de Dor e Especialidades Médicas - Distrito Federal
Lead Author
Rafael Vieira Rocha
MD
Centro Avançado de Dor e Especialidades Médicas - Distrito Federal
Lead Author
Gulliver Rezende Teodoro Ribeiro
MD
Centro Avançado de Dor e Especialidades Médicas - Distrito Federal
Lead Author
Robson Nunes da Silva
MD
Centro Avançado de Dor e Especialidades Médicas - Distrito Federal
Lead Author
Pedro Vinicius Araújo de Abreu
Student/trainee
Escola Superior de Ciências da Saúde (ESCS) - Distrito Federal
Lead Author
Frederico Barra de Moraes
MD
Centro Avançado de Dor e Especialidades Médicas - Distrito Federal
Lead Author
Topics
- Treatment/Management: Interventional Therapies – Injections/Blocks