Dextrose injection in end-stage knee arthritis will cause growth of cartilage cells in a particular area of complete cartilage loss. Dextrose concentration will be 12.5%. Cartilage status will be monitored by pre and post treatment arthroscopy views with specialized (methylene blue) staining for cartilage.
Historical, compliance, examination,anesthetic injection, radiographic and arthroscopic screening will be completed. One month after arthroscopy completion, the intervention phase will begin. INTERVENTION * Injection of 12.5% dextrose at 0, 1 and 2 months. * Stand up without using only the non-injected leg for 3 days after each injection. * Avoid running and squatting as feasible. * Ensure that the injected knee descends stairs first ascends stairs last for 3 days. * May take Acetaminophen. * No NSAIDS for 2 days before and 10 days after a treatment. PRN NSAIDs only. * No glucosamine or chondroitin should be taken. SECOND ARTHROSCOPY TIMING * A minimum of 4 months after first arthroscopy, when schedulable. * After a minimum of 3 monthly injections of dextrose 12.5% . METHOD OF ARTHROSCOPY * Only the medial compartment will be entered to minimize trauma. * Methylene blue will be applied and allowed to remain in knee for 5 minutes prior to flush. * A standardized method video scan of the medial femoral compartment will be conducted. * At second arthroscopy, the area of heaviest cartilage growth, if any, in the base of the Out-IV lesion will be biopsied with a Jamshidi needle at a 45 degree angle. (Limited by the optics of single port entry ). * Biopsy, if taken, will be sent for decortication to enable specimen to be cut, safranin O application to determine proteoglycan production, polarized light to differentiate fibrous from hyaline cartilage, and immunohistologic straining for Type I and Type Ii cartilage.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
SINGLE
Enrollment
6
9 ml of 12.5% dextrose
Hospital Provincial de Rosario
Rosario, Santa Fe Province, Argentina
Quality of cartilage growth
A Jamshidi needle biopsy will be obtained at 45 degrees in the area of maximum cartilage growth and analyzed for quality/type of cartilage if such growth is seen.
Time frame: 0 to 3 months
Number of sections of medial condyle with loss, no change or growth of cartilage.
Arthroscopy of all 9 sections of the medial condyle for each of 6 knees will be viewed by each of 3 arthroscopers who will render their opinion for each section. They will compare sections from 1st and 2nd arthroscopy side by side, and will be asked to indicate loss of cartilage no change or growth of cartilage for each of sections on each of 6 knees. Still photos of the biopsy study site wiThe photo of the Out IV lesion will be analyzed in a blinded fashion for a visual or computerized assessment of the percentage of lesion size covered by cartilage buds.
Time frame: 7.5 month mean
Walking pain
Subjects will be asked to estimate their walking pain on a 10 point scale over the preceding 2 weeks.
Time frame: 0 to 3 years
Flexion range of motion
The total flexion range of motion of the knee will be measured goniometrically.
Time frame: 0 to 3 months
WOMAC
WOMAC will be administered at time 0 and at time of the 2nd arthroscopy.
Time frame: 7.5 Months
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