POS1206 CLINICAL AND FUNCTIONAL BENEFITS OF EARLY INTRA-ARTICULAR CORTICOSTEROID ADMINISTRATION FOR HIGH-RISK PERSISTENT POST-ARTHROSCOPIC SYNOVITIS
Abstract
<h2>Abstract</h2><h3>Background:</h3> Knee synovitis is a common postoperative complication following arthroscopy, typically presenting with swelling, pain, and functional limitations. Chronic synovitis can exacerbate inflammation, accelerate osteoarthritis (OA) progression, and hinder rehabilitation. Early intra-articular corticosteroid (IA CS) administration has shown potential as a promising treatment; however, its optimal timing and functional results with early administration require further investigation. <h3>Objectives:</h3> To evaluate the clinical and functional outcomes, as well as the safety, of early IA corticosteroid injection compared to standard postoperative management in patients at high risk for persistent post-arthroscopic synovitis. <h3>Methods:</h3> This prospective, randomized study included 174 patients (43.7% men, 56.3% women) with a mean age of 56.2 ± 1.67 years and OA stage 1–3, who underwent knee arthroscopy. A previously developed prognostic model [1] was used to identify patients at high risk for prolonged synovitis following arthroscopy. Patients with persistent synovitis at 3 weeks post-surgery were randomly assigned to two groups: the comparison group (receiving standard treatment: aspiration, NSAIDs, physical therapy, orthosis, and IA CS if needed after 6 weeks) and the main group (receiving early IA CS injections between days 21–25 post-surgery). Clinical and ultrasound assessments, along with KOOS, Lysholm, Lequesne, and IKDC scores, were evaluated at 3 weeks, 3 months, and 6 months. <h3>Results:</h3> The prognostic model identified 26 patients at high risk for persistent synovitis after arthroscopy. Of these, 24 (14.9%) had persistent synovitis at 3 weeks post-surgery. Baseline data included KOOS of 49.4 ± 1.3. No infectious complications or serious adverse events occurred following IA CS injection between days 21–25 post-surgery. At 8 weeks, synovitis persisted in 8.3% of patients in the main group compared to 58.3% in the comparison group (p = 0.027). The log-rank test showed faster resolution of synovitis in the main group (χ² = 4.65, p=0.031). At 3 months, the main group demonstrated significantly greater improvements in functional scores on the KOOS scale (from 47.6 ± 2.25 to 85.25 ± 1.95, +40.0 [35.3; 43.0], p=0.000) compared to the comparison group (from 51.8 ± 2.5 to 72.25 ± 5.17, +17.5 [8.0; 34.25], p=0.000). The pain subscale improvement was 26.3 ± 3.03 points in the main group vs. 15.25 ± 2.48 in the comparison group (p = 0.01). By 3 months, the Lequesne index decreased by 3.5 [3.13; 4.0] points in the main group and 2.5 [2.5; 3.38] points in the comparison group (p = 0.009), and Patient Acceptable Symptom State (PASS) was achieved in 91.7% of the main group vs. 66.7% in the comparison group (p = 0.09). IKDC scores improved more significantly in the main group (from 50.1 ± 2.05 to 72.02 ± 2.76, +22.4 [16.55; 27.0], p=0.000) compared to the comparison group (from 49.6 ± 2.21 to 63.4 ± 2.49, +10.35 [7.88; 19.7], p=0.000). At 6 months, the differences between the groups diminished, although the functional improvements remained stable in both groups. <h3>Conclusion:</h3> Early postoperative IA CS administration in patients at high risk for persistent post-arthroscopic synovitis results in faster improvement in functional outcomes and symptom resolution, without increasing the risk of side effects, compared to standard management. <h3>REFERENCES:</h3> [1] Nuriakhmetov A.N., Nuriakhmetova T.Yu., Akhtyamov I.F. Kazan State Medical University, Ministry of Health of the Russian Federation. Method for predicting the risk of long-term postoperative synovitis of the knee joint. Patent No. RU2822328 C1. Application No. 2024112214. Claimed 06.05.24; Published 04.07.24, Bulletin No. 19. (In Russ.) <h3>Acknowledgements:</h3> <b>NIL</b>. <h3>Disclosure of Interests:</h3> <b>None declared</b>. © The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.