Osteoarthritis (OA) is a degenerative joint disease that primarily affects older adults, characterized by cartilage degradation, synovitis, and osteophyte formation. Despite its prevalence, no medical treatment can reverse the joint cartilage degradation, leading many patients to undergo invasive procedures such as arthroplasty. Mesenchymal stem cells (MSCs), particularly those derived from adipose tissue, have emerged as a promising therapeutic approach due to their ability to differentiate into chondrocytes and potentially regenerate cartilage. While MSCs from bone marrow and umbilical cord have shown efficacy in treating OA, adipose-derived MSCs (ADMSC) are more accessible and cost-effective. This study aims to evaluate the safety and efficacy of allogeneic ADMSC in treating knee OA. This triple-blind, interventional clinical trial included 20 patients with idiopathic knee OA, meeting the American College of Rheumatology (ACR) criteria. Patients were randomly assigned to receive an intra-articular injection of either 0.5 × 108 allogeneic ADMSC or saline (control group). Participants were evaluated for clinical signs of inflammation at baseline, and then at 2 weeks, 2 months, and 6 months post-injection using clinical assessments, the Visual Analogue Scale (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS), range of motion (ROM), and Magnetic Resonance Arthrography (MRA). The ADMSC group exhibited significant improvement in pain reduction as measured by VAS scores compared to the control group (P < 0.05). However, no significant differences were observed between the groups in ROM, and based on KOOS; quality of life, activity of daily living (ADL), recreation and sports activities, symptom and pain. Although there were no significant changes in ADL, recreation, and sports activities between groups, the ADMSC group showed significant improvements between several follow-up periods. Similar improvements were reported in the ADMSC group between several follow-ups’ periods on other scales. Radiological outcomes showed a significant increase in cartilage thickness at specific locations (e.g., middle-lateral patella (P = 0.017), Tibial compartment lateral (P < 0.000)) in the ADMSC group after 6 months, demonstrating the regenerative potential of ADMSC in certain MRA sites. Multivariable analysis underlines the complexity of the interactions among treatment, time, and baseline level of variables. Although ADMSC treatment shows potential for some measures, its effects are not consistently significant for all measures. Allogeneic ADMSC are safe and effective in reducing pain (based on VAS scale) and increasing cartilage thickness in knee OA patients. However, they do not significantly enhance quality of life or daily activity compared to placebo. Further research with larger sample sizes and longer follow-up periods is needed to confirm these findings and determine optimal dosing strategies. Trial registration: Trial Registry Code: IRCT2016021123298N3, 20 February 2016. https://irct.behdasht.gov.ir/trial/19909

Objective: The aim of the study was to compare the efficacy of ultrasound-guided injection of botulinum toxin type A with corticosteroid in patients with chronic plantar fasciitis (PF). Design: This randomized controlled trial was conducted on 35 patients with chronic plantar fasciitis. Participants were randomly allocated into two groups: one group received methylprednisolone in to the plantar fascia (n = 18) and the other group received botulinum toxin type A injection into the flexor digitorum brevis and quadratus plantae (n = 17). All injections were performed under ultrasound guidance. Patients were evaluated using the Visual Analog Scale, Foot and Ankle Ability Measures, and plantar fascia thickness before the intervention, 3 wks, 12 wks, and 6 mos after the treatment. Results: In both groups, patients’ pain and function improved significantly up to 3 wks after injection. In the botulinum toxin type A group, morning Visual Analog Scale improved significantly at 12 wks after intervention and the improvement was sustained for another 3 mos. In the botulinum toxin type A group, Foot and Ankle Ability Measures–sports subscale improved in all evaluated points, whereas in the corticosteroid group, the improvement was significant only when comparing follow-ups values to baseline. Conclusions: Both ultrasound-guided botulinum toxin type A and corticosteroid injection were effective in the treatment of plantar fasciitis. Our study showed that the effects of botulinum toxin type A injection last longer than those of steroid injection.

Objective: Extracorporeal shockwave therapy (ESWT) emerged recently for the treatment of musculoskeletal conditions owing to its regenerative and anti-inflammatory effects. In this study, the aim was to compare the efficacies of ESWT and steroid injection in patients with coccydynia. Design: Thirty-four patients with coccydynia were randomized into two groups. In the ESWT group, patients received radial shockwave for three weekly sessions. The second treatment group received an injection of steroid in the tip of the coccyx or sacrococcygeal junction. Outcome measures were visual analog scale, Short-Form Health Survey, and Dallas Pain Questionnaire. Visual analog scale was measured at baseline and 1 wk, 1 mo, 2 mos, and 6 mos after the intervention. Short-Form Health Survey and Dallas Pain Questionnaire were assessed before and 1 mo after treatment. Results: The visual analog scale score was significantly decreased in all follow-ups in both groups. There was also a significant decrease between 1 wk and three other posttreatment visits in the ESWT treatment group. Time and group interaction effect was significant on the visual analog scale (F _{2.64, 84.63} = 2.95, P = 0.043), in favor of ESWT. Concerning the Short-Form Health Survey and Dallas Pain Questionnaire, only some dimensions improved. Conclusions: ESWT is an effective intervention in patients with coccydynia and had more long-lasting efficacy than steroid in terms of pain relief over 6 mos of observation.

Background and objective: Chronic ankle instability (CAI) is one of the most common sports injuries, and whole-body vibration (WBV) training has been used lately as a potential rehabilitation modality for these patients. The authors conducted a systematic review and meta-analysis to assess whether WBV training positively affects patients with CAI. Materials and methods: The authors systematically searched four databases, including MEDLINE (PubMed), Scopus, Web of Science, and Cochrane Central Register of Controlled Trials, for randomized and non-randomized trials evaluating the effects of WBV on individuals with CAI. The authors used Cochrane RoB2 to assess the risk of bias in randomized trials. A meta-analysis was conducted if three or more studies measured the same outcome. Effect estimates were pooled using a random-effects model. Results: Results were retrieved from seven articles encompassing 288 participants who had CAI. The reach distance of the Star Excursion Balance Test (SEBT) was regarded as the study’s main finding. The authors saw a significant training effect on certain planes of motion on dynamic balance. The findings showed that the post-intervention measurements in the WBV group compared to control groups showed improvements in the posterolateral, posteromedial, and medial directions, respectively. There were also promising results on improvements in muscle activity, strength, and proprioception sense measurements with a great diversity in the reported parameters. Conclusion: The authors observed a significant WBV training effect on dynamic balance over posterolateral, posteromedial, and medial reach distances. These findings suggest future studies on the effects of WBV on muscle activity, strength, and proprioception in addition to dynamic and static balance.

Background: Soccer is associated with substantial injury risk, with reported between 13 to 35 injuries per 1000 player-hours of competitive play. Notably, approximately 77% of soccer-related ankle injuries are attributed to ankle sprain injuries (ASIs). ASI can lead to chronic ankle instability, obesity, and post-traumatic osteoarthritis. This study focuses on identifying factors such as gender, age, body mass index (BMI), and a history of ASIs, which contribute to the development of ASI in soccer players. Methods: A systematic literature search was conducted in October 2023 across databases, including PubMed, Web of Science, Scopus, Cochrane Library, and ProQuest, without applying any filters. Keywords included ankle, ankle joint, sprain, risk factors, etc. Data extraction was performed on the included studies, with findings standardized and analyzed using Stata Statistical Software: Release 17 to determine a weighted treatment effect. Results: Our systematic review included 26 studies. The meta-analysis revealed that a history of ankle sprain is the most significant risk factor for future ASIs. BMI emerged as a risk factor in three out of seven studies, while age and height were significant in one out of six studies each. Gender and weight were not found to significantly affect ASI occurrence. Other factors identified but not subjected to a meta-analysis due to methodological heterogeneity or insufficient studies included playing surface, joint laxity, muscle weakness, match congestion, strength asymmetries, ground reaction forces, balance maintenance, skill level, and playing position. Conclusions: This research contributes valuable insights into the prevention of ASIs in soccer, highlighting the importance of previous ankle sprains and playing surface quality. These findings assist sports professionals in developing optimal conditions and strategies for effective ankle sprain prevention.