Thanks to @lorenzo_masci and @sonoskills for an excellent 2 day advanced ultrasound guided injection course in Holland. Lots of pearls for @DrSOF_ and I to take home to our Sports Medicine practice @ClinicBlackrock

A gem here 👍 enhorabuena por un gran artículo informativo y conciso todo deberían léelo

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Would you like to learn more on mid foot pathologies and Rheumatology of foot. https://t.co/l9l9GRhntN

A super paper from too many tendon experts to actually link to all their profiles - have a read 📚 😀

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addendum: by my calculations, the PRP group obtained, on average, about 5-6 billion platelets, so approaching consenus re appropriate platelet dose.

Interesting study: PRP (3 injections) vs. exercise vs. (PRP + Exercise) for knee OA. Exercise is superior to PRP (no surprises), but adding PRP to exercise does NOT enhance the exercise effect. One to bookmark. We need more of these studies. https://t.co/Aufo1T5q90

There is no evidence that mesenchymal cell injections provide a benefit at 6 and 12 months compared to controls or conservative management in knee osteoarthritis. No surprises here.

I am fascinated by (proximal) hamstring injuries. Always challenging for patients and clinicians. Can we do better? @lorenzo_masci & Prof Fares Haddad @bjjeditor will update us and share their insights. Bringing together the best in Sports Medicine: https://t.co/C7EENRBaVd

distribution of HA with different approaches using methylene blue as dye : A and C - medial mid-portal approach while B and D anteromedial approach

Using medial mid-portal approach injection resulted in greater coverage of the PF chondral surfaces in cadavers and better WOMAC scores in RCT Vs infra-patellar approach. So, perhaps we should consider the optimal needle placement for patellofemoral OA to improve outcomes.

If you are injecting patellofemoral OA, should we consider needle placement to improve effectiveness? Yes If you're using a highly viscous substance HA or Arthrosamid. The neat study examined the distribution of viscous HA after different approaches: 1/ https://t.co/96k8KFiuBc

How do we reduce the risk? First, get the HA product in the joint. Using ultrasound guidance will improve accuracy, especially pertinent in larger obese patients. If performing palpation-guided, use the superolateral approach - studies suggest it's more accurate 8/8 END

If severe and higher risk profile (older, systemic features, more co-morbidities) think about blood and synovial work up - limited aspiration might be necessary (without compromising HA effect). 7/8

So if you have a patient who presents with SALR after a HA, what do you do? It depends on the situation including risk profile: if mild to moderate pain and swelling in younger patients, treat with rest and simple analgesia and observe; 6/8

What else could it be? In severe cases, think about septic arthritis and pseudogout - both cause similar symptoms 5/8

What are the potential causes - 2 reasons postulated: 1) immunological response to HA, although we still don't know the exact mechanism and 2) accidental placement of HA in extra-articular tissue such as fat pad, - which is why accurate placement in the joint is critical 4/8

How common is SALR? Big data on HA suggests it's exceptionally rare. It can occur in ANY HA and is not confined to cross-linked or avian products. However, I'd still counsel patients about this possible side effect. 3/8