JBJS

Betamethasone and Triamcinolone Acetonide Have Comparable Efficacy as Single Intra-Articular Injections in Knee Osteoarthritis: A Double-Blinded, Randomized Controlled Trial

J Bone Joint Surg Am. 2025 Nov 21. doi: 10.2106/JBJS.25.00100. Online ahead of print.

ABSTRACT

BACKGROUND: Intra-articular (IA) corticosteroid injections are commonly used for pain relief and improved function in patients with knee osteoarthritis (OA). However, the optimal corticosteroid preparation remains controversial. The aim of this study was to compare the efficacy of single-shot long-acting corticosteroid (betamethasone) and intermediate-acting corticosteroid (triamcinolone acetonide) injections in knee OA.

METHODS: This single-center, double-blinded, randomized controlled trial included 120 patients with symptomatic knee OA who were randomized to receive either a betamethasone (7-mg) or triamcinolone acetonide (40-mg) IA injection and were followed for 6 months. The primary outcomes were the visual analog scale (VAS) pain scores (0 to 100) at rest and during movement at 6 months. The secondary outcomes were the VAS pain during movement, knee flexion angle, modified Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, University of California Los Angeles (UCLA) activity score, Timed Up-and-Go test (TUG), 2-minute walk test (2MWT), and side effects. The analysis focused on between-group comparisons using multilevel regression models.

RESULTS: The study population consisted of 120 Thai individuals. Both the betamethasone and triamcinolone groups demonstrated significant reductions in VAS pain at rest starting from day 1 and lasting for up to 6 months. At 6 months, the between-group mean difference in VAS pain at rest was -1 (95% confidence interval [CI], -11 to 8; p = 0.77), indicating no significant difference. Similarly, at 6 months, no significant between-group differences were observed in VAS pain during movement (-3 [95% CI, -13 to 7]; p = 0.51), flexion angle (6 [95% CI, 1 to 10]; p = 0.20), WOMAC score (-4 [95% CI, -11 to 4]; p = 0.91), UCLA activity score (0 [95% CI, -0.5 to 0.6]; p = 0.46), TUG (-1 second [95% CI, -3 to 1]; p = 0.88), or 2MWT (9 meters [95% CI, -1 to 19]; p = 0.47). Acetaminophen and tramadol use were numerically, but not significantly, lower in the betamethasone group (p > 0.05). No serious adverse events occurred.

CONCLUSIONS: No significant differences were observed between IA betamethasone and triamcinolone acetonide with respect to VAS pain, functional scores, or performance-based outcomes at 6 months.

LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

PMID:41270194 | DOI:10.2106/JBJS.25.00100

Broken But Not Invisible: Identifying Human Trafficking in Victims with Orthopaedic Injuries

J Bone Joint Surg Am. 2025 Nov 20. doi: 10.2106/JBJS.25.00963. Online ahead of print.

ABSTRACT

Human trafficking is a public health crisis with profound physical and psychological consequences. Orthopaedic surgeons, who are often the earliest providers to assess traumatic musculoskeletal injuries, have a unique opportunity to identify victims of trafficking. This article highlights 4 cases of patients with orthopaedic injuries sustained in the context of trafficking or through the subsequent psychological effects of such encounters. Despite the high percentage of human trafficking victims who interact with the health-care system, the recognition and identification of such victims remain low. We advocate for increased awareness of the possibility of patients with orthopaedic injuries having been trafficked and the consideration of human trafficking in trauma-informed care training.

PMID:41265470 | DOI:10.2106/JBJS.25.00963

Normalization of Subchondral Bone Density Patterns After Surgical Treatment for Capitellar Osteochondritis Dissecans: A Quantitative Analysis

J Bone Joint Surg Am. 2025 Nov 18. doi: 10.2106/JBJS.25.00212. Online ahead of print.

ABSTRACT

BACKGROUND: Capitellar osteochondritis dissecans (OCD) is common in adolescent throwing athletes. Surgical treatment yields favorable clinical outcomes. However, the relationship between bone density and clinical outcomes following OCD treatment is not well understood. We hypothesized that surgery normalizes subchondral bone density distribution and that clinical outcome improvements correlate with the bone density changes. This study quantitatively analyzed these changes and compared different surgical techniques.

METHODS: Fifty-one male ethnic Japanese patients with capitellar OCD treated surgically (mean age at surgery: 14.0 ± 1.6 years) were enrolled, with a mean follow-up of 6.7 ± 3.1 years (mean age at final evaluation: 20.7 ± 3.5 years). Subchondral bone density was measured in Hounsfield units using computed tomography preoperatively and postoperatively, as well as in the contralateral elbow. Relative bone densities, expressed as proportions, in the distal humerus, radial head, and proximal ulna were compared among the preoperative, postoperative, and contralateral elbows within their respective anatomical subregions. Subgroups with reconstruction procedures and with preservation procedures were also analyzed separately. Functional outcome changes using Timmerman-Andrews scores were correlated with bone density changes.

RESULTS: In the distal humerus, subchondral bone density at the OCD lesion was significantly lower preoperatively (0.99 ± 0.17) than postoperatively (1.19 ± 0.17, p < 0.001) and in the contralateral elbow (1.17 ± 0.13, p < 0.001), whereas the density of the surrounding sclerotic bone was higher preoperatively (1.24 ± 0.10) than postoperatively (1.14 ± 0.10, p < 0.001) and in the contralateral elbow (1.07 ± 0.08, p < 0.001). The regions within and outside the site of the OCD lesion exhibited similar density distribution patterns postoperatively and in the contralateral elbow. In the radial head, the highest density was in the radial-volar quadrant preoperatively (1.14 ± 0.14) but shifted to the ulnar-volar quadrant postoperatively (1.06 ± 0.12, p = 0.020) and matched the contralateral value (1.02 ± 0.10, p < 0.001). Patterns in subchondral bone density in the regions were comparable between the reconstruction and preservation groups across all conditions. Improvements in Timmerman-Andrews scores correlated moderately with bone density normalization at the lesion site (R = 0.49, p = 0.003) and surrounding sclerotic bone (R = 0.43, p = 0.010).

CONCLUSIONS: Surgical treatment of capitellar OCD effectively restored the subchondral bone density distribution to normal patterns, regardless of the surgical technique. These bone density changes moderately correlated with improvements in functional outcome, providing quantitative evidence supporting the efficacy of surgical intervention for advanced lesions.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

PMID:41252482 | DOI:10.2106/JBJS.25.00212

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