Assessment of the efficiency of arthroscopic laser dual-mode synovectomy in patients with chronic synovitis of the knee joint

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Abstract

BACKGROUND: Osteoarthritis (OA) of the knee joint is a common disease and a significant medical, social, and economic problem. Synovitis can be revealed at all stages of ОА, contributing to the progression of cartilage damage, increased pain, and impaired joint function. In patients with OA, the morphological pattern of the synovial membrane structure has characteristic features, such as hyperplasia, sublimating fibrosis, and stromal vascularization. Laser radiation is widely used in medicine. Exposure of two working wavelengths (0.97 μm and 1.56 μm) to the synovial membrane may lead to good results in the treatment of synovitis.

AIM: This study aimed to improve treatment outcomes in patients with chronic synovitis of the knee joint by applying radiation of two different wavelengths.

MATERIALS AND METHODS: Treatment outcomes of 50 patients with chronic synovitis of the knee joint, aged 23 to 67 years, with stages II–IV gonarthrosis according to the Kellgren–Lawrence classification, were prospectively analyzed. All patients underwent arthroscopic sanation and laser partial synovectomy using LSP-IRE-Polus apparatus (OOO NTO “IRE-Polus,” Russia), with a wavelength of 0.97 μm (pulse 100 ms, pause 50 ms) in a pulsed-periodic mode and 1.56 μm with a power of 5 W in a continuous mode. Surveys were conducted preoperatively and at 3, 6, and 12 months postoperatively using the following scales and questionnaires: Visual Analog Pain Scale (VAS), Lequesne index, Western Ontario and McMaster Universities Arthritis Index (WOMAC), and Knee Injury and Osteoarthritis Outcome Score (KOOS).

RESULTS: The mean age (M±s) of the study subjects, body mass index, and the duration of synovitis were 45.32±13.1, 28.63±4.72 kg/m2, and 2.26±1.91 years, respectively. Statistically significant improvements in the VAS, WOMAC, Lequesne, and KOOS scales were observed three months after surgery, whereas much more better results were obtained at six months and remained the same within 12 months after surgery (p <0.05).

CONCLUSIONS: The results suggest that the proposed technique could be introduced into clinical practice.

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About the authors

Aleksey V. Lychagin

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: dr.lychagin@mail.ru
ORCID iD: 0000-0002-2202-8149

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Yang Yanbin

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Author for correspondence.
Email: yanbin.yang@bk.ru
ORCID iD: 0000-0003-1933-7511
Russian Federation, 8, Trubetskaya str., Moscow, 119991

Sergey V. Ivannikov

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: dr.lychagin@mail.ru
ORCID iD: 0000-0002-6865-3337

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow

Rosa Ch. Yavlieva

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: hazbulatovna@mail.ru
ORCID iD: 0000-0001-8517-7216

MD, Cand. Sci (Med.), assistant professor

Russian Federation, Moscow

Marina M. Lipina

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: marli-05@mail.ru
ORCID iD: 0000-0003-1240-4064

MD, Cand. Sci. (Med.), assistant professor

Russian Federation, Moscow

Yuliya R. Goncharuk

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: julia.goncharuk@mail.ru
ORCID iD: 0000-0002-0015-0266
Russian Federation, Moscow

Ivan A. Vyazankin

I.M. Sechenov First Moscow State Medical University (Sechenov University)

Email: vzvzvzvan@mail.ru
ORCID iD: 0000-0002-8020-2950
Russian Federation, Moscow

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Supplementary files

Supplementary Files
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1. Fig. 1. Dynamics of the patients’ mean visual analog pain scale scores (mm), p < 0.05.

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2. Fig. 2. Dynamics of the patients’ mean WOMAC scale scores (in points), p < 0.05.

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3. Fig. 3. Dynamics of the mean Lequesne index total scores (in points), p < 0.05.

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4. Fig. 4. Comparative assessment of the dynamics of the KOOS subscale scores (in points), p < 0.05.

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