Medicine and Health Sciences Commons^™

A Trial Of Wound Irrigation In The Initial Management Of Open Fracture Wounds, Mohit Bhandari, Kyle J. Jeray, Brad A. Petrisor, P. J. Devereaux, Diane Heels-Ansdell, Emil H. Schemitsch, Jeff Anglen, Gregory J. Della Rocca, Clifford Jones, Hans Kreder, Susan Liew, Paula Mckay, Steven Papp, Parag Sancheti, Sheila Sprague, Trevor B. Stone, Xin Sun, Stephanie L. Tanner, Paul Tornetta, Ted Tufescu, Stephen Walter, Gordon H. Guyatt

Bone and Joint Institute

Copyright © 2015 Massachusetts Medical Society. BACKGROUND The management of open fractures requires wound irrigation and dridement to remove contaminants, but the effectiveness of various pressures and solutions for irrigation remains controversial. We investigated the effects of castile soap versus normal saline irrigation delivered by means of high, low, or very low irrigation pressure. METHODS In this study with a 2-by-3 factorial design, conducted at 41 clinical centers, we randomly assigned patients who had an open fracture of an extremity to undergo irrigation with one of three irrigation pressures (high pressure [>20 psi], low pressure [5 to 10 psi], …

Greater Magnocellular Saccadic Suppression In High Versus Low Autistic Tendency Suggests A Causal Path To Local Perceptual Style., David P Crewther, Daniel Crewther, Stephanie Bevan, Melvyn A Goodale, Sheila G Crewther

Brain and Mind Institute Researchers' Publications

Saccadic suppression-the reduction of visual sensitivity during rapid eye movements-has previously been proposed to reflect a specific suppression of the magnocellular visual system, with the initial neural site of that suppression at or prior to afferent visual information reaching striate cortex. Dysfunction in the magnocellular visual pathway has also been associated with perceptual and physiological anomalies in individuals with autism spectrum disorder or high autistic tendency, leading us to question whether saccadic suppression is altered in the broader autism phenotype. Here we show that individuals with high autistic tendency show greater saccadic suppression of low versus high spatial frequency gratings …

Trends In Psychotropic Dispensing Among Older Adults With Dementia Living In Long-Term Care Facilities: 2004-2013., Akshya Vasudev, Salimah Z Shariff, Kuan Liu, Amer M Burhan, Nathan Herrmann, Sean Leonard, Muhammad Mamdani

Psychiatry Publications

OBJECTIVE: Guidelines worldwide have cautioned against the use of antipsychotics as first-line agents to treat neuropsychiatric symptoms of dementia. We aimed to investigate the changes over time in the dispensing of antipsychotics and other psychotropics among older adults with dementia living in long-term care facilities.

METHODS: We used drug claims data from Ontario, Canada, to calculate quarterly rates of prescription dispensing of six psychotropic drug classes among all elderly (≥65 years of age) long-term care residents with dementia from January 1, 2004, to March 31, 2013. Psychotropic drugs were classified into the following categories: atypical and conventional antipsychotics, non-sedative and …

An Intra-Bone Axial Load Transducer: Development And Validation In An In-Vitro Radius Model, Nikolas K. Knowles, Michael Gladwell, Louis M. Ferreira

Surgery Publications

Background

Accurate measurement of forces through the proximal radius can assess the effects of some surgical procedures on radioulnar load sharing, but is difficult to achieve given the redundant loading nature of the musculoskeletal system. Previously reported devices have relied on indirect measurements that may alter articular joint location and function. An axial load transducer interposed in the diaphysis of the radius may accurately quantify unknown axial loads of the proximal radius, and maintain articular location.

Methods

An in-vitro radius model was developed by interposing an axial load transducer in the diaphysis of the proximal radius. Static loads of 20, …

Declining Incidence Of Stroke And Dementia: Coincidence Or Prevention Opportunity?, Luciano A. Sposato, Moira K. Kapral, Jiming Fang, Sudeep S. Gill, Daniel G. Hackam, Lauren E. Cipriano, Vladimir Hachinski

Anatomy and Cell Biology Publications

No abstract provided.

Estimating Osteoporotic Fracture Risk Following A Wrist Fracture: A Tale Of Two Systems, Karen Beattie, Jonathan Adachi, George Ioannidis, Alexandra Papaioannou, William D. Leslie, Ruby Grewal, Joy Macdermid, Anthony B. Hodsman

Bone and Joint Institute

© 2015, The Author(s). Summary: The WHO fracture risk assessment (FRAX) and Canadian Association of Radiologists and Osteoporosis Canada (CAROC) tools can both be used to determine an individual’s 10-year risk of osteoporotic fracture. However, these tools differ in their risk calculation. For participants fracture, FRAX provides a lower fracture risk estimate than CAROC resulting in fewer decisions to initiate therapy.Purpose: The purpose of the current report is to compare fracture risk prediction rates using the CAROC and the FRAX® tools.Methods: Individuals ≥50 years with a distal radius fracture resulting from a fall from standing height or less were recruited …

Functional Outcomes Of Acutely Infected Knee Arthroplasty: A Comparison Of Different Surgical Treatment Options, Ivan Dzaja, James Howard, Lyndsay Somerville, Brent Lanting

Bone and Joint Institute

© 2015 8872147 Canada Inc. Background: An infected total knee arthroplasty (TKA) can be treated with irrigation and débridement with polyethylene exchange (IDPE) or a 2-staged revision (2SR). Although research has examined infection eradication rates of both treatments, patient outcomes have not been reported. We examined patient-reported outcomes following treatment compared with matched, noninfected controls. Methods: We retrospectively identified patients with infected TKAs who had undergone the index procedure between May 1991 and November 2011. Patient-reported outcomes included the 12-item Short Form Health Survey, Western Ontario and McMaster Universities Arthritis Index, and Knee Society Scores as well as range of …

The Child And Adolescent Scale Of Environment (Case): Further Validation With Youth Who Have Chronic Conditions, Gary Bedell, Janette Mcdougal

Occupational Therapy Publications

Objective: To further validate the Child and Adolescent Scale of Environment (CASE).

Methods: Baseline data (n = 430) were analyzed from a longitudinal study on quality of life for youth with chronic conditions ages 11–17 in Ontario, Canada. Internal consistency and structure, and convergent and discriminant validity were examined via Cronbach’s alpha (α), exploratory factor analyses, correlation analyses and ANOVA.

Results: The CASE had high internal consistency (α = 0.89). A three-factor solution was produced with 55% variance explained: (1) Community/Home Resources, (2) School Resources and (3) Physical Design/Access). CASE total and factor …

Methods And Considerations For The Analysis And Standardization Of Assessing Muscle Sympathetic Nerve Activity In Humans, Daniel W. White, J. Kevin Shoemaker, Peter B. Raven

Bone and Joint Institute

© 2015 Elsevier B.V.. The technique of microneurography and the assessment of muscle sympathetic nerve activity (MSNA) are used in laboratories throughout the world. The variables used to describe MSNA, and the criteria by which these variables are quantified from the integrated neurogram, vary among studies and laboratories and, therefore, can become confusing to those starting to learn the technique. Therefore, the purpose of this educational review is to discuss guidelines and standards for the assessment of sympathetic nervous activity through the collection and analysis of MSNA. This review will reiterate common practices in the collection of MSNA, but will …

Factors Impacting Transgender Patients’ Discomfort With Their Family Physicians: A Respondent-Driven Sampling Survey, Greta R. Bauer, Xuchen Zong, Ayden I. Scheim, Rebecca Hammond, Amardeep Thind

Epidemiology and Biostatistics Publications

BACKGROUND: Representing approximately 0.5% of the population, transgender (trans) persons in Canada depend on family physicians for both general and transition-related care. However, physicians receive little to no training on this patient population, and trans patients are often profoundly uncomfortable and may avoid health care. This study examined factors associated with patient discomfort discussing trans health issues with a family physician in Ontario, Canada.

METHODS: 433 trans people age 16 and over were surveyed using respondent-driven sampling for the Trans PULSE Project; 356 had a family physician. Weighted logistic regression models were fit to produce prevalence risk ratios (PRRs) via …

Thermosensitive Polymer-Grafted Iron Oxide Nanoparticles Studied By In Situ Dynamic Light Backscattering Under Magnetic Hyperthermia, Gauvin Hemery, Elisabeth Garanger, Sébastien Lecommandoux, Andrew D. Wong, Elizabeth R. Gillies, Boris Pedrono, Thomas Bayle, David Jacob, Olivier Sandre

Bone and Joint Institute

© 2015 IOP Publishing Ltd. Thermometry at the nanoscale is an emerging area fostered by intensive research on nanoparticles (NPs) that are capable of converting electromagnetic waves into heat. Recent results suggest that stationary gradients can be maintained between the surface of NPs and the bulk solvent, a phenomenon sometimes referred to as 'cold hyperthermia'. However, the measurement of such highly localized temperatures is particularly challenging. We describe here a new approach to probing the temperature at the surface of iron oxide NPs and enhancing the understanding of this phenomenon. This approach involves the grafting of thermosensitive polymer chains to …

The Transient Receptor Potential Melastatin 2 (Trpm2) Channel Contributes To Beta-Amyloid Oligomer-Related Neurotoxicity And Memory Impairment, Valeriy G. Ostapchenko, Megan Chen, Monica S. Guzman, Yu-Feng Xie, Natalie Lavine, Jue Fan, Flavio H. Beraldo, Amanda C. Martyn, Jillian C. Belrose, Yasuo Mori, John F. Macdonald, Vania F. Prado, Marco A. M. Prado, Michael F. Jackson

Anatomy and Cell Biology Publications

In Alzheimer's disease, accumulation of soluble oligomers of beta-amyloid peptide is known to be highly toxic, causing disturbances in synaptic activity and neuronal death. Multiple studies relate these effects to increased oxidative stress and aberrant activity of calcium-permeable cation channels leading to calcium imbalance. The transient receptor potential melastatin 2 (TRPM2) channel, a Ca2+-permeable nonselective cation channel activated by oxidative stress, has been implicated in neurodegenerative diseases, and more recently in amyloid-induced toxicity. Here we show that the function of TRPM2 is augmented by treatment of cultured neurons with beta-amyloid oligomers. Aged APP/PS1 Alzheimer's mouse model showed increased levels of …

Functional Differences Between Statistical Learning With And Without Explicit Training., Laura J Batterink, Paul J Reber, Ken A Paller

Brain and Mind Institute Researchers' Publications

Humans are capable of rapidly extracting regularities from environmental input, a process known as statistical learning. This type of learning typically occurs automatically, through passive exposure to environmental input. The presumed function of statistical learning is to optimize processing, allowing the brain to more accurately predict and prepare for incoming input. In this study, we ask whether the function of statistical learning may be enhanced through supplementary explicit training, in which underlying regularities are explicitly taught rather than simply abstracted through exposure. Learners were randomly assigned either to an explicit group or an implicit group. All learners were exposed to …

Dual Optimization Method Of Radiofrequency And Quasistatic Field Simulations For Reduction Of Eddy Currents Generated On 7t Radiofrequency Coil Shielding., Yujuan Zhao, Tiejun Zhao, Shailesh B Raval, Narayanan Krishnamurthy, Hai Zheng, Chad T Harris, William B Handler, Blaine A Chronik, Tamer S Ibrahim

Brain and Mind Institute Researchers' Publications

PURPOSE: To optimize the design of radiofrequency (RF) shielding of transmit coils at 7T and reduce eddy currents generated on the RF shielding when imaging with rapid gradient waveforms.

METHODS: One set of a four-element, 2 × 2 Tic-Tac-Toe head coil structure was selected and constructed to study eddy currents on the RF coil shielding. The generated eddy currents were quantitatively studied in the time and frequency domains. The RF characteristics were studied using the finite difference time domain method. Five different kinds of RF shielding were tested on a 7T MRI scanner with phantoms and in vivo human subjects. …

Renal Oncocytosis In A Pediatric Patient: Case Report And Review Of The Literature, Stacey Speer, Daniele Wiseman, Madeleine Moussa, Andreana Bütter

Surgery Publications

Renal oncocytosis is a rare condition in which the kidney develops numerous oncocytomas. We present a case of a 12-year-old female who presented with right-sided flank pain of one-year duration. Imaging revealed several masses in the right kidney. Tissue biopsy confirmed multiple benign oncocytomas. Due to the presence of multiple oncocytomas throughout the kidney, a radical nephrectomy was performed. Given the rarity of this condition, as well as its known association with von Hippel-Lindau disease and Birt-Hogg-Dube syndrome, genetic investigations were pursued but failed to identify any abnormalities. This patient remains well and disease free six years after surgery. A …

Rapid Fecal Calprotectin Testing To Assess For Endoscopic Disease Activity In Inflammatory Bowel Disease: A Diagnostic Cohort Study, Lukasz Kwapisz, Mahmoud Mosli, Nilesh Chande, Brian Yan, Melanie Beaton, Jessica Micsko, Pauline W. Mennill, William Barnett, Kevin Bax, Terry Ponich, John Howard, Anthony Tirolese, Robert Lannigan, James Gregor

Paediatrics Publications

Background and Aim: With increasing numbers of patients diagnosed with inflammatory bowel disease (IBD), it is important to identify noninvasive methods of detecting disease activity. The aim of this study is to examine the diagnostic accuracy of fecal rapid calprotectin (FC) testing in the detection of endoscopically active IBD. Patients and Methods: All consecutive patients presenting to outpatient clinics with lower gastrointestinal symptoms were prospectively recruited. Patients provided FC samples. Sensitivity (Sn), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) for FC were calculated. Receiver-operator characteristics (ROC) curve was used to identify the ideal FC cutoff that …

Hyperactivity And Attention Deficits In Mice With Decreased Levels Of Stress-Inducible Phosphoprotein 1 (Stip1), Flavio H. Beraldo, Anu Thomas, Benjamin Kolisnyk, Pedro H. Hirata, Xavier De Jaeger, Amanda C. Martyn, Jue Fan, Daniela F. Goncalves, Matthew F. Cowan, Talal Masood, Vilma R.. Martins, Robert Gros, Vania F. Prado, Marco A. M. Prado

Anatomy and Cell Biology Publications

Stress-inducible phosphoprotein I (STIP1, STI1 or HOP) is a cochaperone intermediating Hsp70/Hsp90 exchange of client proteins, but it can also be secreted to trigger prion protein-mediated neuronal signaling. Some mothers of children with autism spectrum disorders (ASD) present antibodies against certain brain proteins, including antibodies against STIP1. Maternal antibodies can cross the fetus blood-brain barrier during pregnancy, suggesting the possibility that they can interfere with STIP1 levels and, presumably, functions. However, it is currently unknown whether abnormal levels of STIP1 have any impact in ASD-related behavior. Here, we used mice with reduced (50%) or increased STIP1 levels (fivefold) to test …

Identification And Survival Outcomes Of A Cohort Of Patients With Cancer Of Unknown Primary In Ontario, Canada., Chong S Kim, Malek B Hannouf, Sisira Sarma, George B Rodrigues, Peter K Rogan, Salaheddin M Mahmud, Eric Winquist, Muriel Brackstone, Gregory S Zaric

Epidemiology and Biostatistics Publications

BACKGROUND: Cancer of unknown primary origin (CUP) is defined by the presence of pathologically identified metastatic disease without clinical or radiological evidence of a primary tumour. Our objective was to identify incident cases of CUP in Ontario, Canada, and determine the influence of histology and sites of metastases on overall survival (OS).

MATERIAL AND METHODS: We used the Ontario Cancer Registry (OCR) and the Same-Day Surgery and Discharge Abstract Database (SDS/DAD) to identify patients diagnosed with CUP in Ontario between 1 January 2000, and 31 December 2005. Patient diagnostic information, including histology and survival data, was obtained from the OCR. …

Behavioral, Perceptual, And Neural Alterations In Sensory And Multisensory Function In Autism Spectrum Disorder., Sarah H Baum, Ryan A Stevenson, Mark T Wallace

Brain and Mind Institute Researchers' Publications

Although sensory processing challenges have been noted since the first clinical descriptions of autism, it has taken until the release of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013 for sensory problems to be included as part of the core symptoms of autism spectrum disorder (ASD) in the diagnostic profile. Because sensory information forms the building blocks for higher-order social and cognitive functions, we argue that sensory processing is not only an additional piece of the puzzle, but rather a critical cornerstone for characterizing and understanding ASD. In this review we discuss what …

A Review Of Transcranial Magnetic Stimulation And Multimodal Neuroimaging To Characterize Post-Stroke Neuroplasticity, Angela M. Auriat, Jason L. Neva, Sue Peters, Lara A. Boyd

Physical Therapy Publications

Following stroke, the brain undergoes various stages of recovery where the central nervous system can reorganize neural circuitry (neuroplasticity) both spontaneously and with the aid of behavioral rehabilitation and non-invasive brain stimulation. Multiple neuroimaging techniques can characterize common structural and functional stroke-related deficits, and importantly, help predict recovery of function. Diffusion tensor imaging (DTI) typically reveals increased overall diffusivity throughout the brain following stroke, and is capable of indexing the extent of white matter damage. Magnetic resonance spectroscopy (MRS) provides an index of metabolic changes in surviving neural tissue after stroke, serving as a marker of brain function. The neural …

Differential Modification Of Cortical And Thalamic Projections To Cat Primary Auditory Cortex Following Early- And Late-Onset Deafness., Nicole Chabot, Blake E Butler, Stephen G Lomber

Brain and Mind Institute Researchers' Publications

Following sensory deprivation, primary somatosensory and visual cortices undergo crossmodal plasticity, which subserves the remaining modalities. However, controversy remains regarding the neuroplastic potential of primary auditory cortex (A1). To examine this, we identified cortical and thalamic projections to A1 in hearing cats and those with early- and late-onset deafness. Following early deafness, inputs from second auditory cortex (A2) are amplified, whereas the number originating in the dorsal zone (DZ) decreases. In addition, inputs from the dorsal medial geniculate nucleus (dMGN) increase, whereas those from the ventral division (vMGN) are reduced. In late-deaf cats, projections from the anterior auditory field (AAF) …

Chronic Pain Self-Management Support With Pain Science Education And Exercise (Commence): Study Protocol For A Randomized Controlled Trial, Jordan Miller, Joy C. Macdermid, David M. Walton, Julie Richardson

Bone and Joint Institute

© 2015 Miller et al. Background: Previous research suggests that self-management programs for people with chronic pain improve knowledge and self-efficacy but result in negligible effects on function. This study will investigate the effectiveness self-management support with pain science education and exercise on improving function for people with chronic pain in comparison to a wait-list control. A secondary objective is to determine which variables help to predict response to the intervention. Methods/Design: This study will be an unblinded, randomized controlled trial with 110 participants comparing a 6-week program that includes self-management support, pain science education and exercise to a wait-list …

Noninvasive Quantification Of Alveolar Morphometry In Elderly Never- And Ex-Smokers, Gregory A Paulin, Alexei Ouriadov, Eric Lessard, Khadija Sheikh, David G Mccormack, Grace Parraga

Medical Biophysics Publications

Diffusion-weighted magnetic resonance imaging (MRI) provides a way to generate in vivo lung images with contrast sensitive to the molecular displacement of inhaled gas at subcellular length scales. Here, we aimed to evaluate hyperpolarized (3)He MRI estimates of the alveolar dimensions in 38 healthy elderly never-smokers (73 ± 6 years, 15 males) and 21 elderly ex-smokers (70 ± 10 years, 14 males) with (n = 8, 77 ± 6 years) and without emphysema (n = 13, 65 ± 10 years). The ex-smoker and never-smoker subgroups were significantly different for FEV1/FVC (P = 0.0001) and DLCO (P = 0.009); while ex-smokers …

Preserved Haptic Shape Processing After Bilateral Loc Lesions., Jacqueline C Snow, Melvyn A Goodale, Jody C Culham

Brain and Mind Institute Researchers' Publications

UNLABELLED: The visual and haptic perceptual systems are understood to share a common neural representation of object shape. A region thought to be critical for recognizing visual and haptic shape information is the lateral occipital complex (LOC). We investigated whether LOC is essential for haptic shape recognition in humans by studying behavioral responses and brain activation for haptically explored objects in a patient (M.C.) with bilateral lesions of the occipitotemporal cortex, including LOC. Despite severe deficits in recognizing objects using vision, M.C. was able to accurately recognize objects via touch. M.C.'s psychophysical response profile to haptically explored shapes was also …

Maternal Postsecondary Education Associated With Improved Cerebellar Growth After Preterm Birth., Mikaela L Stiver, Daphne Kamino, Ting Guo, Angela Thompson, Emma G Duerden, Margot J Taylor, Emily W Y Tam

Brain and Mind Institute Researchers' Publications

The preterm cerebellum is vulnerable to impaired development impacting long-term outcome. Preterm newborns (<32 >weeks) underwent serial magnetic resonance imaging (MRI) scans. The association between parental education and cerebellar volume at each time point was assessed, adjusting for age at scan. In 26 infants, cerebellar volumes at term (P = .001), but not birth (P = .4), were associated with 2-year volumes. For 1 cm(3) smaller cerebellar volume (4% total volume) at term, the cerebellum was 3.18 cm(3) smaller (3% total volume) by 2 years. Maternal postsecondary education was not associated with cerebellar volume at term (P = .16). Maternal …

Pulmonary Sequestration Causing Severe Cardiac Failure Requiring Lobectomy In An Extreme Preterm Infant, Rohit Nagar, Andreana Bütter, Gary Brahm, April Price

Surgery Publications

We report a case of a large, extralobar pulmonary sequestration in a preterm infant born at 25 weeks gestational age. A computed tomography (CT) angiogram demonstrated that the arterial supply arose from the celiac trunk while an abnormally large, single left pulmonary vein drained the sequestration. This, along with the large patent ductus arteriosus (PDA), created a double left to right shunt, which resulted in severe, high output cardiac failure. Despite aggressive medical management for 3 weeks, he remained critically ill and developed renal failure. Therefore, after multiple, extensive multi-disciplinary discussions with the family, resection was offered as the only …

Quality Of Life In Children With Adverse Drug Reactions: A Narrative And Systematic Review, Blanca R. Del Pozzo-Magaña, Michael J. Rieder, Alejandro Lazo-Langner

Paediatrics Publications

Aims Adverse drug reactions are a common problem affecting adults and children. The economic impact of the adverse drug reactions has been widely evaluated; however, studies of the impact on the quality of life of children with adverse drug reactions are scarce. The aim was to evaluate studies assessing the health-related quality of life of children with adverse drug reactions. Methods We conducted a systematic review that included the following electronic databases: MEDLINE, EMBASE and the Cochrane Library (including the Cochrane Database of Systematic Reviews, the Database of Abstracts of Reviews of Effects, the Cochrane Controlled Trials Register and the …

Maternal Factors And The Emotional And Behavioural Functioning Of Adolescents With Chronic Health Conditions, Nicole Etherington, Janette Mcdougall, David Dewit, Virginia Wright

Occupational Therapy Publications

Purpose: This study investigated the association between mothers’ mental health and education and the emotional and behavioural functioning of adolescents with chronic health conditions over time.

Methods: Data were drawn from an ongoing study. Study participants (N¼363) were recruited through eight children’s rehabilitation centres. Logistic regression models were estimated.

Results: There were significantly reduced odds that girls would display clinical signs of hyperactivity/inattention one year later compared to boys when a maternal mental health condition was present (OR¼0.10; p50.01). Where low maternal education was present, girls were more likely to display peer relationship problems one year later (OR¼3.72; …

Motor And Visuospatial Attention And Motor Planning After Stroke: Considerations For The Rehabilitation Of Standing Balance And Gait, Sue Peters, Todd C. Handy, Bimal Lakhani, Lara A. Boyd, S. Jayne Garland

Physical Therapy Publications

Attention and planning can be altered by stroke, which can influence motor performance. Although the influence of these factors on recovery from stroke has been explored for the upper extremity (UE), their impact on balance and gait are unknown. This perspective article presents evidence that altered motor and visuospatial attention influence motor planning of voluntary goal-directed movements poststroke, potentially affecting balance and gait. Additionally, specific strategies for rehabilitation of balance and gait poststroke in the presence of these factors are discussed. Visuospatial attention selects relevant sensory information and supports the preparation of responses to this information. Motor attentional impairments may …

Assessment Of Clinical Practice Guideline Methodology For The Treatment Of Knee Osteoarthritis With Intra-Articular Hyaluronic Acid, Roy D. Altman, Emil Schemitsch, Asheesh Bedi

Bone and Joint Institute

© 2015 The Authors. Published by Elsevier HS Journals ,Inc. Introduction: Clinical practice guidelines are of increasing importance in the decision making for the treatment of knee osteoarthritis. Inconsistent recommendations regarding the use of intra-articular hyaluronic acid for the treatment of knee osteoarthritis have led to confusion among treating physicians. Methods: Literature search to identify clinical practice guidelines that provide recommendations regarding the use of intra-articular hyaluronic acid treatment for knee osteoarthritis was conducted. Included guidelines were appraised using the AGREE II instrument. Guideline development methodologies, how the results were assessed, the recommendation formation, and work group composition were summarized. …