Geniculate Artery Embolization for the Treatment of Mild to Moderate Knee Osteoarthritis Improves Pain and Function: A Systematic Review.

IF 4.4 1区医学 Q1 ORTHOPEDICS Arthroscopy-The Journal of Arthroscopic and Related Surgery Pub Date : 2024-08-17 DOI:10.1016/j.arthro.2024.07.033

Rodrigo Saad Berreta, Jared Rubin, Ashwinee Manivannan, Garret Jackson, Eric Cotter, Zeeshan Kahn, Johnathon McCormick, Juan Bernardo Villarreal-Espinosa, Salvador Ayala, Nikhil N Verma, Jorge Chahla

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Abstract

Purpose: To evaluate procedural heterogeneity, patient reported outcomes (PRO), and complications following geniculate artery embolization (GAE) for knee OA.

Methods: A literature search was performed using PubMed, Embase, and Scopus databases from inception to August 2023 according to the 2020 PRISMA guidelines. Human clinical studies reporting PROs following GAE for treatment of knee OA were included and a qualitative comparison across PROs, procedural descriptions and complications was performed. Study quality was assessed using the Cochrane Collaboration's risk of bias tool and the MINORS criteria. The primary outcome measures included changes in PROs at 12 months and variances in procedural methodology.

Results: A total of 17 studies, consisting of 533 patients and 620 knees were identified. The reported mean improvement at 12 months for VAS pain and WOMAC scores ranged from 10-59 and 35.3-47, respectively. At 12 months, median improvements were observed in KOOS subscales such as Pain (range, 8.3-19.5), QOL (15.49-25.0), Sport (7.5-26.3) and Symptoms (1.8-25.0). Decreasing MCID achievement was observed between the 3 month and 6 month follow-up points. Patients with advanced OA and degenerative findings on MRI exhibited lower rates of MCID achievement. Transient adverse events occurred in up to 80% of patients. Limited evidence from serial MRI assessments suggests that GAE improves levels of synovitis. Significant heterogeneity exists among the GAE methodology as 4 different definitions of technical success, 4 distinct embolization targets and use of 5 embolization agents were noted.

Conclusion: GAE results in short-term improvements in pain and function with decreasing MCID achievement observed after 3 to 6 months. Patients with severe OA also demonstrate lower rates of MCID achievement. A high rate of transient complications are reported including skin discoloration and access site hematomas. Significant protocol heterogeneity exists which contributes to variable outcomes.

Level of evidence: IV; Systematic Review of Level IV Studies.

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膝关节膝状动脉栓塞治疗轻度至中度膝关节骨性关节炎可改善疼痛和功能：系统综述》。

目的：评估膝关节OA膝曲动脉栓塞术（GAE）的程序异质性、患者报告结果（PRO）和并发症：方法：根据2020年PRISMA指南，使用PubMed、Embase和Scopus数据库对从开始到2023年8月的文献进行检索。纳入了报告GAE治疗膝关节OA后PROs的人类临床研究，并对PROs、程序描述和并发症进行了定性比较。研究质量采用 Cochrane 协作组织的偏倚风险工具和 MINORS 标准进行评估。主要结果指标包括12个月时PROs的变化和手术方法的差异：共确定了 17 项研究，包括 533 名患者和 620 个膝关节。报告显示，12 个月后，VAS 疼痛和 WOMAC 评分的平均改善幅度分别为 10-59 分和 35.3-47 分。在 12 个月时，KOOS 的疼痛（范围为 8.3-19.5）、QOL（15.49-25.0）、运动（7.5-26.3）和症状（1.8-25.0）等分量表的中位数均有改善。在 3 个月和 6 个月的随访点之间，观察到 MCID 成绩有所下降。OA晚期和MRI检查发现有退行性病变的患者MCID达标率较低。多达80%的患者出现了短暂的不良反应。连续 MRI 评估的有限证据表明，GAE 可改善滑膜炎的程度。GAE方法之间存在显著的异质性，因为有4种不同的技术成功定义、4种不同的栓塞目标以及5种栓塞剂的使用：结论：GAE能在短期内改善疼痛和功能，3至6个月后观察到的MCID成就有所下降。严重 OA 患者的 MCID 达标率也较低。据报道，一过性并发症的发生率很高，包括皮肤变色和入路部位血肿。该方案存在显著的异质性，导致了不同的结果：证据级别：IV；IV 级研究的系统综述。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Arthroscopy-The Journal of Arthroscopic and Related Surgery 医学-外科

CiteScore

9.30

自引率

17.00%

发文量

555

审稿时长

58 days

期刊介绍： Nowhere is minimally invasive surgery explained better than in Arthroscopy, the leading peer-reviewed journal in the field. Every issue enables you to put into perspective the usefulness of the various emerging arthroscopic techniques. The advantages and disadvantages of these methods -- along with their applications in various situations -- are discussed in relation to their efficiency, efficacy and cost benefit. As a special incentive, paid subscribers also receive access to the journal expanded website.