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X Ayral

Publications and source records attributed to X Ayral.

At least 37 records · Page 2Linked to original sources
PubMed1998

Quantitative MR imaging evaluation of chondropathy in osteoarthritic knees.

PURPOSE: To determine the validity and the reliability of T1-weighted three-dimensional gradient-echo magnetic resonance (MR) imaging for quantification of articular cartilage abnormalities of osteoarthritic knees. MATERIALS AND METHODS: Forty-three patients (mean age, 63 years) with knee osteoarthritis (American College of Rheumatology criteria) of the medial tibiofemoral compartment underwent a prospective, cross-sectional study. Knees were examined with a T1-weighted three-dimensional gradient-echo sequence (1.4-mm contiguous sections), with use of a 0.2-T dedicated MR unit, before arthroscopic exploration. The tibiofemoral articular cartilage abnormalities were quantified blindly on both the MR and arthroscopic images with the French Society of Arthroscopy (SFA) score (0-100) and grading scheme (five grades). RESULTS: There was a statistically significant correlation between the SFA-arthroscopic score and the SFA-MR score (r = .83) and between the SFA-arthroscopic grade and the SFA-MR grade (weighted kappa = 0.84). The deepest cartilage lesions graded with arthroscopy and MR imaging showed correlation in the medial femoral condyle (weighted kappa = 0.83) and in the medial tibial plateau (weighted kappa = 0.84). The intraobserver reliability of the SFA-MR score was higher (r = .94) than the interobserver reliability (r = .80). CONCLUSION: Quantification of chondropathy with MR imaging is feasible and well correlated with anatomic cartilage breakdown.

Aged↗
PubMed1998

[Rapid chondrolysis after arthroscopic external meniscectomy. Apropos of 4 cases].

The authors report 4 cases of rapid lateral femoro-tibial chondrolysis following arthroscopic lateral meniscectomy. All patients were young athletes. At the time of meniscectomy, the cartilage of the lateral compartment was normal. Only one meniscectomy was done with the Ho Yag laser. Clinical symptoms were always identical: pain and important swelling, persisting despite intra articular injections of corticosteroids. A second-look arthroscopy was performed after a mean delay of 6 months (5 to 8), showing numerous cartilaginous debris floating in the joint (like in a chondromatosis disease) and a severe cartilaginous damage in the lateral compartment (grade 3 or 4). Swelling disappeared after arthroscopic lavage followed in two cases by a non weight bearing period of one to two months. But X-rays always demonstrated a narrowing of the lateral joint line on flexion-full weight bearing AP views. Rapid chondrolysis is a rare and severe complication of lateral meniscectomy. The etiology, which is mechanical, is not known. It probably represents an acute form of chronic, slow chondrolysis which is frequent after lateral meniscectomy. Rapid chondrolysis should be treated urgently by the following protocol: arthroscopic lavage, intra articular injections of corticosteroids and non weight bearing period.

Adult↗
PubMed1998

Piroxicam therapy: a double blind, randomized, multicenter study comparing 2 versus 4 week treatment in patients with painful knee osteoarthritis with effusion.

OBJECTIVE: To compare the efficacy and safety of piroxicam 20 mg once a day for 14 or 28 days in patients with knee osteoarthritis (OA) and synovial effusion. METHODS: We conducted a multicenter, randomized, double blind study in 1905 outpatients. Efficacy was assessed by changes in synovial effusion, pain on a 100 mm visual analog scale (VAS), and impairment using Lequesne's functional index. Patients were classified at Day 28 as improved (defined as VAS and Lequesne index decrease of at least 30% from Day 14), worsened (defined as VAS and Lequesne index increase of at least 30% from Day 14), or unchanged. Safety was assessed on the basis of adverse events reported by the patients. RESULTS: After 14 days, changes in pain, synovial effusion, and functional impairment significantly decreased from baseline within each group (p < 0.001, respectively), but did not differ between the groups. Between 14 and 28 days, outcome measure changes were significantly better in the 28 day group, p = 0.01, 0.0001, and 0.0001, respectively. In the 28 day and 14 day groups, improvement with regard to pain was observed for 339 (52.4%) and 280 (29.4%) patients, respectively, (p < 0.0001), and with regard to functional impairment for 298 (31.5%) and 233 (24.3%) patients (p < 0.0001). Adverse events accounted for 7.5 and 6.7% of withdrawals in the 28 day and 14 day groups, respectively. CONCLUSION: When administration of piroxicam 20 mg is prolonged to 28 days, continuing benefit is observed for some patients with knee OA with painful synovial effusion without a significant difference in safety.

Aged↗
PubMed1997

Arthroscopic evaluation of potential structure modifying activity of hyaluronan (Hyalgan) in osteoarthritis of the knee.

OBJECTIVE: Several reported studies suggest that repeated intra-articular injections of hyaluronan result in sustained relief from pain and functional disability in patients with knee osteoarthritis. Several in vivo data suggest that hyaluronan might have a beneficial structural effect in osteoarthritis. The objective of the study was to evaluate the potential structure-modifying effects of Hyalgan (500-730 kDa molecular weight), a highly-purified sodium hyaluronate. DESIGN: Patients with painful knee osteoarthritis (ACR criteria) were enrolled in a prospective, controlled study of 1-year duration. After randomization, either conventional therapy or three cycles (every 3 months) of three intra-articular injections of Hyalgan (once a week during 2 weeks) were given. Clinical outcome was added using pain visual analog score (VAS), functional impairment: Lequesne's index, quality of life: arthritis impact measurement scale (AIMS2) and structural outcome using X-rays: joint space narrowing and arthroscopy: global assessment using VAS, SFA scoring and grading systems. RESULTS: Of the 39 recruited patients, 36 completed the 1-year trial (19 in the Hyalgan group and 17 in the control group). There was no difference between groups at entry. Between-group comparison for changes in clinical parameters reached statistical significance for the quality of life index (AIMS2: -0.4 +/- 0.7 vs 0.2 +/- 0.9 in the Hyalgan and control groups respectively, P < 0.05). Deterioration in the structural parameters was less in the Hyalgan group, with a statistically significant difference for two of the three evaluated parameters (overall assessment of chondropathy: +5.1 +/- 12.7 vs 16.7 +/- 18.3, P = 0.016; SFA scoring system: +3.7 +/- 7.3 vs +9.0 +/- 11.5, P = 0.05) in the Hyalgan and control groups, respectively. CONCLUSIONS: This study supports existing data concerning the favorable symptomatic effect of intra-articular injections of Hyalgan in osteoarthritis of the knee and suggests that repeated intra-articular injections of Hyalgan might delay the structural progression of the disease. Other studies are required to confirm these results and to determine the long-term monitoring of osteoarthritic patients using such local therapy.

Analysis of Variance↗
PubMed1997

Arthroscopy-assisted synovectomy in the treatment of chronic synovitis of the knee.

The place of arthroscopy-assisted synovectomy in the treatment of inflammatory synovitis of the knee was evaluated by studying 26 patients who underwent this procedure between November 1992 and September 1995. Half the patients had rheumatoid arthritis. Twenty-three patients (28 knees) were reevaluated after a mean follow-up of 32 months (range, 4-50 months). The arthroscopic synovectomy was done either as the first-line synovectomy procedure, after failure of triamcinolone hexacetonide injection into the joint, or as the second-line synovectomy procedure, after failure of osmic acid or yttrium-90 synovectomy. Except in one patient with severe arthritis, arthroscopic synovectomy produced statistically significant improvements regarding pain (visual scale), function (Lequesne's index), range of flexion, amount of joint fluid and knee circumference. The range of extension of the knee was normal at baseline and remained so after the procedure. Overall efficacy was similar for first-line and second-line procedures. Results were rated good to very good by 71% of the patients and 61% of the physicians overall and the overall improvement in knee arthritis as perceived by the patients was 60%. The procedure was well tolerated in 93% of cases. The mean time needed to achieve a stable improvement was 3.2 weeks for pain, 4.7 weeks for swelling and 3.6 weeks for range of motion. One case each of hemarthrosis and stiffness of the knee were recorded, with a full recovery in both cases. Arthroscopic synovectomy is effective and safe but more burdensome and expensive than osmic acid or radiation synovectomy, and consequently deserves a place of choice in patients who have failed to respond to either of the last two methods.

Adult↗
PubMed1996

Diagnostic and quantitative arthroscopy: quantitative arthroscopy.

Arthroscopy still remains the 'gold standard' for the assessment of articular cartilage and synovium because it provides direct and magnified evaluation of these anatomical structures. Thus, alongside the use of arthroscopy as a diagnostic or therapeutic procedure in knee disorders, a further function of knee arthroscopy, performed under local anaesthesia on an outpatient basis, has been proposed: the monitoring and follow-up of knee chondropathy and synovitis conducted for research purposes on patients suffering from knee osteoarthritis or chronic synovitis. This function is used in order (1) to evaluate the natural history of these diseases, (2) to assess 'de visu' the effect on chondral or synovial lesions of medical treatments or surgical interventions, and (3) to validate non-invasive imaging techniques such as plain radiographs or magnetic resonance imaging. The development of this arthroscopic outcome measurement of chondropathy and synovitis required the establishment and validation of systems for scoring the severity of chondral and synovial lesions. The author reviews both earlier and newer arthroscopic classifications and underlines the need for a quantitative description of cartilage and synovial abnormalities, either global and based on the investigator's overall assessment by using a visual analogue scale of severity, or, more analytically, taking into account the baseline parameters of the lesions, i.e. depth/intensity, extent and location.

Arthroscopy↗
PubMed1996

Proposed scoring system for assessing synovial membrane abnormalities at arthroscopy in knee osteoarthritis.

The synovial membrane is thought to play an important role in both the clinical and the anatomical evolution of osteoarthritis. Arthroscopy performed under local anaesthesia on an outpatient basis has been proposed as a means of cartilage and synovial assessment for research purposes. The authors propose a scoring system for assessing anterior synovial abnormalities at arthroscopy in knee osteoarthritis. This synovitis score takes into account the intensity and the extent of synovial lesions.

Arthroscopy↗
PubMed1996

Arthroscopic evaluation of chondropathy in osteoarthritis of the knee.

OBJECTIVE: To evaluate arthroscopic findings as a potential measurement of severity and outcome of chondropathy. METHODS: 110 patients with knee osteoarthritis (OA) were included in a cross sectional study and 41 of them in a one year longitudinal study. The evaluation of OA performed once in the cross sectional study and twice (at entry and after one year) in the longitudinal study, included clinical, radiological and arthroscopic variables evaluating disease activity and severity. Arthroscopy was performed. under local anesthesia in an outpatient procedure using a small arthroscope. Chondropathy was evaluated by the overall assessment of the investigator by visual analog scale and the Société Française d'Arthroscopie (SFA) scoring and grading systems, which represent a composite index taking into account depth, size, and localization of the articular cartilage lesions. RESULTS: The intrinsic validity of the arthroscopic variables was suggested by highly significant correlation (R2 = 80-85%) between the overall assessment of the investor and the SFA systems. There was also highly significant correlation (p < 0.01) between the arthroscopic and radiological variables. Intraobserver reliability of the arthroscopic quantification of chondropathy was better than interobserver reliability. In the cross sectional study, severity of chondropathy correlated with both age and body mass index. In the longitudinal study there was statistically significant worsening in the severity of chondropathy and statistically significant correlation between the changes in the severity of chondropathy and changes in functional impairment. CONCLUSION: We conclude that arthroscopy might be considered a relevant measurement of OA outcome for research purposes.

Arthroscopy↗
PubMed1996

Radiographic assessment of knee osteoarthritis: reproducibility and sensitivity to change.

OBJECTIVE: To determine the cross sectional and longitudinal reproducibility of various measures used for assessing radiographic knee osteoarthritis (OA) and to compare the sensitivity to change over a one year period of these measures. METHODS: We studied 55 patients referred to hospital with knee OA (clinical and radiographic ACR criteria). Anteroposterior radiographs at baseline and after 12 months were read by methods both qualitative (Kellgren and Lawrence grading scale, joint space narrowing scale) and quantitative (joint space width measurement at 3 different points). All qualitative methods used standardized atlases. The intraclass correlation coefficient and the graphical method of Bland and Altman were used to assess cross sectional and longitudinal reproducibility. Reproducibility was tested using 2 readers (interreader) and 2 readings for one of the readers (intrareader). Sensitivity to change was assessed using standardized response mean (SRM). RESULTS: All methods tested were shown to be reproducible both for cross sectional and longitudinal data. Intrareader was higher than interreader reproducibility for most radiographic features. Significant changes were observed after one year for methods measuring joint space narrowing. The sensitivity to change of the methods assessing joint space narrowing (joint space narrowing scale and joint space width measurement) was higher, with SRM varying from 0.37 to 0.57, than for the Kellgren and Lawrence grading system (SRM 0.19 and 0.23). CONCLUSION: These data suggest that methods measuring narrowing should be preferred as outcome measures in clinical trials or longitudinal epidemiologic studies; and show that in a particular subset of patients with very active disease, significant radiographic changes in knee OA can be detected after a one year period.

Aged↗
PubMed1995

Joint lavage.

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Animals↗
PubMed1994

[Chondroscopy: a new method for measuring osteoarthritis?].

Arthroscopy allows direct visual examination of joint cavity components and is useful for the diagnosis, treatment and evaluation of lesions. We investigated the contribution of arthroscopy to the evaluation of joint cartilage. The severity of cartilage lesions can be assessed using a total 100-mm visual analog scale (0 = no chondropathy; 100 = the worst possible lesions) or a more objective system based on the site, depth, and surface area of the lesions. This latter system was developed by the French Society for Arthroscopy (Société Française d'Arthroscopie) and provides a score and a class (SFA score and SFA grade). We investigated whether this system has the characteristics required of an evaluation tool, i.e., simplicity, reproducibility, clinical relevance, sensitivity to change, and discriminant capacity. Arthroscopy is an invasive procedure. However, we introduced several simplifications, including use of local rather than general anesthesia, performance on an outpatient basis, elimination of the tourniquet (to avoid muscular dysfunction), and use of a small arthroscope. This simplified technique is called chondroscopy. Intra-observer reproducibility is far better than inter-observer reproducibility. We found a good correlation between the two arthroscopy scales (visual analog scale and SFA scale). Chondroscopy and roentgenographic evaluations of cartilage lesions were closely correlated. Changes in the severity of cartilage lesions were correlated with changes in functional impairment. Chondroscopy proved capable of demonstrating statistically significant changes in cartilage lesions due to knee osteoarthritis between two evaluations done only one year apart, even in a small sample of patients (less than 20). A preliminary study of repeated hyaluronic acid injections suggested that chondroscopy may be capable of identifying truly chondromodulating agents.

Arthroscopes↗
PubMed1994

The SFA system for assessing articular cartilage lesions at arthroscopy of the knee.

We proposed to establish a system of assessing severity of chondropathy taking into account localization, size, and depth of cartilage lesions. The design of the study was prospective and multicenter. The subjects were 755 patients who had undergone arthroscopy of the knee. Criteria for assessment of severity of chondropathy were as follows: (a) Physician's overall assessment using a 100-mm-long Visual Analogue Scale, and (b) size, grade, and localization of cartilage lesions recorded on a diagram. We used multivariate parametric and nonparametric analyses. The analyses resulted in two systems of assessing severity of chondropathy: SFA scoring for the three compartments of the knee, which is a continuous variable, and SFA grading, which is a semiquantitative variable. These systems seem to be of clinical relevance. However, more studies are required to further validate them and their capacity to detect changes in severity of chondropathy.

Adult↗