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The semimembranosus insertion syndrome causes pain at the medial aspect of the knee. This pain is aggravated by exercise, walking downstairs and sharp bending of the knee. The patient experiences tender, moderately puffy swelling at the lowest part of the medial hamstrings muscles and painful passive rotation of the knee, while finger pressure over the insertion of the semimembranosus tendon elicits sharp pain. One hundred patients with semimembranosus insertion syndrome were treated with local injection of lidocaine hydrochloride and triamcinolone. All experienced temporary relief of pain immediately. Long-lasting relief of signs and symptoms was achieved in 58 patients, 30 of whom required repeat injections in 3 to 5 months. Pain decreased and disability was less severe in 9 other patients. There were 18 treatment failure, and 15 patients were lost to follow-up.
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Popliteal cysts are usually associated with abnormalities of the knee joint such as osteoarthritis, chronic inflammation or cartilage tears. 15 patients with popliteal cysts demonstrated by arthrography are described who had no obvious lesion of the knee. They had consulted their physician for symptoms without a clearcut relation to the knee joint, such as tenderness on the external side of the calf, ankle edema or paresthesia in the toes. Standard X-rays and clinical examination of the knee were normal except for tender swelling of the popliteal area. The symptoms improved after injection of triamcinolone into the knee joint. Unexplained symptoms of the lower leg may be due to popliteal cysts even in the absence of obvious knee pathology.
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A comparison of intra-articular methotrexate and intra-articular triamcinolone hexacetonide was made in 42 arthritic patients with persistent bilateral knee effusions. One knee was injected with either 5 mg methotrexate (two injections of 2.5 mg a week apart) or a single injection of 20 mg triamcinolone. An objective assessment of both knees was made by quantitative thermography at 0,3,7,14 and 21 days. Joints injected with triamcinolone showed a greater fall in thermographic index (T.I) than the joints injected with methotrexate, which showed similar change to the non-injected knee joints in both groups. Four patients received larger doses of methotrexate, up to 20 mg, though the fall in T.I. was still less than the mean fall for triamcinolone injected joints. Peak venous blood levels of methotrexate were reached 1 hour after intra-articular injection, and a sphygmomanometer cuff inflated around the leg above the injected knee for periods of up to 1 hour did not appreciably delay this. Methotrexate had no immediate anti-inflammatory effect, even in psoriatic arthropathy, and did not give the relief of intra-articular steroid.
Full-grown rabbits were injected in the knee joints with solutions of trypsin of various concentrations. The animals were sacrificed 2 weeks after the trypsin injection. Twenty-four hours before sacrifice they received 40 muCi 3H-thymidine intra-articularly. The changes in the knee joints were then studied by histological and autoradiographical methods. The injection of trypsin did not result in the development of osteoarthritis. However, autoradiography revealed that the chondrocytes started to divide after the injection. The mitosis of the chondrocytes can thus not be due to degeneration of the cartilage. The explanation put forward is that the mitosis of the chondrocytes may be the result of a decrease in the concentration of a growth controlling factor (chalone) initiated by the administration of trypsin.
Nine inflamed knee joints out of eight patients were examined before and after intraarticular injection of yttrium-90 silicate colloid, in order to find out the effect of radiation synovectomy on the perfusion of the joints. These joints and the untreated contralateral knee joints were examined as to the clinical status and the fast component Tf of the xenon-133 clearance was determined as a means of the perfusion of the synovium. A linear correlation exists between the clinical status of the knee joint and the perfusion as determined by Tf measured three months before and after injection of yttrium-90. Also the joints without any radiation synovectomy showed this correlation. Three months after radiation synovectomy with yttrium-90 there was still no therapeutic effect apparent in the majority of the inflamed knee joints (seven out of nine). At this stage there still existed a hyperaemia. Therefore, it seems that on the whole three months are too short a period to judge the therapeutic effect.