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  • Stem Cell Therapy for Osteonecrosis of the Femoral Head: Current Trends and Comprehensive Review

    Abstract

    Purpose of Review

    Osteonecrosis of the femoral head (ONFH) is a common and frequently occurring disease. It is caused by interruption of blood supply with different etiologies. ONFH leads to degeneration and necrosis of the subchondral bone of the femoral head and eventually collapse of the femoral head. ONFH has a high disability rate, seriously affecting the quality of living of patients, and often involves middle-aged and younger people.

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  • A Comprehensive Review of Stem Cells for Cartilage Regeneration in Osteoarthritis

    Osteoarthritis (OA) is an age related joint disease associated with degeneration and loss of articular cartilage. Consequently, OA patients suffer from chronic joint pain and disability. Weight bearing joints and joints that undergo repetitive stress and excessive ‘wear and tear’ are particularly prone to developing OA. Cartilage has a poor regenerative capacity and current pharmacological agents only provide symptomatic pain relief.

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  • Peripheral Blood Mononuclear Cells Enhance Cartilage Repair in in vivo Osteochondral Defect Model

    Abstract

    This study characterized peripheral blood mononuclear cells (PBMC) in terms of their potential in cartilage repair and investigated their ability to improve the healing in a pre-clinical large animal model. Human PBMCs were isolated with gradient centrifugation and adherent PBMC’s were evaluated for their ability to differentiate into adipogenic, chondrogenic and osteogenic lineages and also for their expression of musculoskeletal genes. The phenotype of the PBMCs was evaluated using Stro-1, CD34, CD44, CD45, CD90, CD106, CD105, CD146 and CD166 cell surface markers. Osteochondral defects were created in the medial femoral condyle (MFC) of 24 Welsh mountain sheep and evaluated at a six month time point. Four cell treatment groups were evaluated in combination with collagen-GAG-scaffold: (1) MSC alone; (2) MSCs and PBMCs at a ratio of 20:1; (3) MSCs and PBMC at a ratio of 2:1 and (4) PBMCs alone. Samples from the surgical site were evaluated for mechanical properties, ICRS score and histological repair.

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  • A Review of Mesenchymal Stem Cell Injections for Osteoarthritis

    Abstract

    Mesenchymal stem cell (MSC) injections for osteoarthritis is reviewed

    Methods: PubMed search was conducted to identify articles in English from 2003-2018 that used intraarticular injection (IA), cartilage repair, cartilage regeneration, chondral injury, adipose stem cells, bone marrow stem cells, mesenchymal stem cells, or autologous stem cells.

    Osteoarthritis (OA) is a degenerative disease of diarthrodial joints characterized by loss of articular cartilage, deformity, and pain. The two greatest risk factors for OA are obesity and joint injury. Symptomatic OA is reported in 12% of American adults, with as many as 37% of adults demonstrating radiographic evidence of OA.

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  • Comparison of the Regenerative Effects of Platelet Rich Fibrin and Plasma Rich in Growth Factors on Injured Peripheral Nerve: An Experimental Study

    Abstract

    Purpose: The aim of the study was to investigate the effects of platelet rich fibrin (PRF) and plasma rich in growth factors (PRGF) on the injured peripheral nerve in the early period of healing.

    Results: Regarding electrophysiological evaluation, both the latency and amplitude values in D, PRF and PRGF groups were significantly lower than the C group (p> 0,05).

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  • Platelet-rich plasma injections for lateral epicondylitis reduce the need for surgical intervention

    Abstract

    Lateral epicondylitis, also known as “tennis elbow,” is a degenerative disorder of the common extensor origin of the lateral humeral epicondyle. The mainstay of treatment is non-operative and includes physiotherapy, activity modification, bracing, nonsteroidal anti-inflammatory drugs, and injections. There is a subgroup of patients however who do not respond to non-operative measures and require operative intervention.

    Methods: We conducted a retrospective review of prospectively collected data to assess whether the introduction of PRP injections for lateral epicondylitis led to a reduction in patients subsequently undergoing surgical release.

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  • Autologous platelet rich plasma versus corticosteroid injection for chronic plantar fasciitis: a prospective controlled randomized comparative clinical study

    Abstract

    Primary objective was to evaluate and compare the effectiveness of autologous platelet rich plasma (PRP) and steroid injections in chronic cases of plantar fasciitis.

    Methods: The present study was a prospective cohort study; 140 consecutive patients with chronic plantar fasciitis were enrolled and randomized in two groups: One receives the Platelet rich plasma (PRP) therapy (study group) and another receiving corticosteroid injection (control group). The outcomes in both groups are then evaluate and compared using visual analogue scale (VAS) and American Orthopaedic foot and Ankle Society (AOFAS) scale at 1month, 3month and 6 month post injection. The level of significance was set at p < 0.05.

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  • Platelet-rich plasma and corticosteroids in the treatment of rotator cuff impingement syndrome: randomized clinical trial

    Abstract

    Objective: This research aimed to study the effectiveness of PRP in the treatment of patients with impact of rotator cuff syndrome compared to treatment with subacromial corticosteroid injection.

    Methods: This was a double-blinded, randomized, comparative clinical trial. Patients were clinically evaluated by the DASH score, the UCLA Shoulder Rating Scale, and the Constant Shoulder Score on the day of application, and after one month, 3 months, and 6 months.

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  • Intradiscal Injection of Autologous Platelet-Rich Plasma Releasate to Treat Discogenic Low Back Pain: A Preliminary Clinical Trial

    Abstract

    Purpose: To determine the safety and initial efficacy of intradiscal injection of autologous platelet-rich plasma (PRP) releasate in patients with discogenic low back pain.

    Conclusions: We demonstrated that intradiscal injection of autologous PRP releasate in patients with low back pain was safe, with no adverse events observed during follow-up. Future randomized controlled clinical studies should be performed to systematically evaluate the effects of this therapy.

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  • The effect of corticosteroid versus platelet-rich plasma injection therapies for the management of lateral epicondylitis: A systematic review

    Abstract

    Introduction:Lateral epicondylitis is a common musculoskeletal disorder of the upper limb.Corticosteroid injection has been widely used as a major mode of treatment. However, better understanding of the pathophysiology of the disease led to a major change in treating the disease, with new options including platelet-rich plasma (PRP) are currently used. Objectives/research aim : To systematically evaluate the effect of corticosteroid versus PRP injections for the treatment of LE.

    Conclusion: Corticosteroid injections provide rapid therapeutic effect in the short-term with recurrence of symptoms afterwards, compared to the relatively slower but longer-term effect of platelet-rich plasma.

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  • Allogeneic Platelet Releasate Preparations Derived via a Novel Rapid Thrombin Activation Process Promote Rapid Growth and Increased BMP-2 and BMP-4 Expression in Human Adipose-Derived Stem Cells

    Abstract

    The administration of human adipose-derived stem cells (ASCs) represents a promising regenerative therapy for the treatment of orthopedic injuries. While ASCs can be easily isolated from liposuction-derived adipose tissue, most clinical applications will likely require in vitro culture expansion of these cells using nonxenogeneic components. In this study, platelet releasate was generated using a novel rapid thrombin activation method (tPR). ASCs grown in media supplemented with tPR proliferated much faster than ASCs grown in media supplemented with 10% fetal bovine serum. The cells also retained the ability to differentiate along chondrogenic, adipogenic, and osteogenic lineages. The tPR cultured ASCs displayed elevated expression of BMP-4 (5.7 ± 0.97-fold increase) and BMP-2 (4.7 ± 1.3-fold increase) and decreased expression of PDGF-B (4.0 ± 1.4-fold decrease) and FGF-2 (33 ± 9.0-fold decrease). No significant changes in expression were seen with TGF-β and VEGF. This pattern of gene expression was consistent across different allogeneic tPR samples and different ASC lines. The use of allogeneic rapidly activated tPR to culture ASCs is associated with both an increased cell yield and a defined gene expression profile making it an attractive option for cell expansion prior to cell-based therapy for orthopedic applications.

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  • Leukocyte depletion does not affect the in vitro healing ability of platelet rich plasma

    Abstract

    The clinical use of platelet-rich plasma (PRP) containing or deprived of leukocytes remains a subject of debate and a controversial issue. It is not yet clear whether leukocyte content has a positive or negative effect on tissue healing processes. Several studies, conducted mainly in the orthopedic field, support the use of leukocyte‑poor (LP) PRP, whereas other studies have not identified any significant differences between the use of LP and leukocyte‑rich PRP. In the present study, the role of leukocytes contained in PRP was assessed to verify their in vitro effect on fibroblasts and endothelial cells, which have a leading role in the biological processes associated with wound healing (including angiogenesis and matrix remodeling). The original sample of PRP was divided into two aliquots, one of which remained unaltered, while the other was deprived of leukocytes. The two aliquots were used in in vitro tests in order to verify the effects of leukocytes on proliferation, wound healing and tube formation, and in molecular analyses of growth factor and enzyme content. The present results highlighted a substantial overlap between the two formulations.

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  • Platelet lysate enhances synovial fluid multipotential stromal cells functions: Implications for therapeutic use

    Abstract

    Background Aims: Although intra-articular injection of platelet products is increasingly used for joint regenerative approaches, there are few data on their biological effects on joint-resident multipotential stromal cells (MSCs), which are directly exposed to the effects of these therapeutic strategies. Therefore, this study investigated the effect of platelet lysate (PL) on synovial fluid-derived MSCs (SF-MSCs), which in vivo have direct access to sites of cartilage injury.

    Methods: SF-MSCs were obtained during knee arthroscopic procedures (N = 7). Colony forming unit-fibroblast (CFU-F), flow-cytometric phenotyping, carboxyfluorescein succinimidyl ester-based immunomodulation for T-cell and trilineage differentiation assays were performed using PL and compared with standard conditions.

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  • PRP for Degenerative Cartilage Disease: A Systematic Review of Clinical Studies

    Abstract

    Objective: To explore the utilization of platelet-rich plasma (PRP) for degenerative cartilage processes and evaluate whether there is sufficient evidence to better define its potential effects.

    Results: The final result yielded 29 articles. Twenty-six studies examined PRP administration for knee OA and 3 involved PRP administration for hip OA. The results included 9 prospective randomized controlled trials (RCTs) (8 knee and 1 hip), 4 prospective comparative studies, 14 case series, and 2 retrospective comparative studies. Hyaluronic acid (HA) was used as a control in 11 studies (7 RCTs, 2 prospective comparative studies, and 2 retrospective cohort). Overall, all RCTs reported on improved symptoms compared to baseline scores. Only 2 RCTs-one for knee and one for hip-did not report significant superiority of PRP compared to the control group (HA).

    Conclusions: Conclusions:Current clinical evidence supports the benefit in PRP treatment for knee and hip OA, proven to temporarily relieve pain and improve function of the involved joint with superior results compared with several alternative treatments. Further research to establish the optimal preparation protocol and characteristics of PRP injections for OA is needed.

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  • A New Technique for the Treatment of Lumbar Facet Joint Syndrome Using Intra-articular Injection with Autologous Platelet Rich Plasma

    Abstract

    Background and Objectives: Lumbar facet joint syndrome is currently suggested to be a main source of axial low back pain, and a large portion of axial low back pain is caused by disorders in lumbar facet joints. Intra-articular injection is one of the most common treatment methods in the early clinical application. Therefore, we attempt to seek a new injectable material, autologous platelet rich plasma (PRP), to treat lumbar facet syndrome, as well as to assess its therapeutic effectiveness and safety.

    Conclusions: In the short-term period of 3 months, the new technique of lumbar facet joint injection with autologous PRP is effective and safe for patients with lumbar facet joint syndrome. Key words: Low back pain, lumbar facet joint syndrome, autologous platelet rich plasma, intra-articular injection.

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  • Growth Factors Levels Determine Efficacy of Platelets Rich Plasma Injection in Knee Osteoarthritis: A Randomized Double Blind Noninferiority Trial Compared With Viscosupplementation

    Abstract

    Purpose: To assess the noninferiority of a single platelet-rich plasma (PRP) injection compared with hyaluronic acid (HA), to alleviate pain and enhance functional capacity in knee osteoarthritis, and identify biological characteristics of PRP that may affect their efficacy.

    Conclusions: Current results indicated that a single injection of very pure PRP offers a significant clinical improvement in the management of knee osteoarthritis, equivalent to a single HA injection in this patient population. Moreover, a significant correlation between the doses of TGF-β1 and PDGF-AB and the worsening of WOMAC score 3 months after the procedure was found.

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  • Platelet‑rich plasma shows beneficial effects for patients with knee osteoarthritis by suppressing inflammatory factors

    Abstract

    Knee osteoarthritis is a degenerative disease that may develop due ageing, obesity, strain, congenital abnormal joints, joint deformity or trauma. It is caused by many factors, such as degradation of articular cartilage injury, joint edge and subchondral bone hyperplasia of reactivity.

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  • Platelet-rich plasma shows beneficial effects for patients with knee osteoarthritis by suppressing inflammatory factors

    Abstract

    Knee osteoarthritis is a degenerative disease that may develop due ageing, obesity, strain, congenital abnormal joints, joint deformity or trauma. It is caused by many factors, such as degradation of articular cartilage injury, joint edge and subchondral bone hyperplasia of reactivity. Platelet-rich plasma (PRP) is an autologous blood sample that contains highly concentrated platelets and multiple cell growth factors. PRP promotes synovial cell proliferation and differentiation and may recover cartilage morphology. In the present study, the clinical efficacy of PRP was investigated in patients with knee osteoarthritis aged between 18 and 30 years in a phase-III clinical study. Following an 8-week baseline, patients with knee osteoarthritis were randomized into once-weekly, double-blind treatment with PRP (2-14 ml) or placebo groups. The results indicated that patients with osteoarthritis treated with PRP had modulated plasma concentrations of inflammatory factors and pro-angiogenic factors compared with the placebo group.

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  • Lateral Ankle sprain (LAS) is a common sports injury associated with recurrent ankle sprain

    Abstract

    Lateral a nkle sprain (LAS) is the most common musculoskeletal injury in the physically active population; it is also a common condition in the general population. Apart from the pain and temporary period of reduced functioning and disability, it is also associated with increased risk of recurrent ankle sprain, the development of chronic ankle stability (CAI) and post - traumatic ankle osteoarthritis (PTOA). While the direct costs for treatment of an isolated LAS are relatively low, compounding these are indirect costs from follow up care, loss of pro ductivity, time loss of activity and care of its long - term consequences. Therefore, it becomes apparent that the healthcare burden that emerges from so called "simple" LAS is substantial.

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  • The efficacy of using platelet rich plasma in treating chronic tendinopathies

    Abstract

    As a common source of long-term pain and physical disability, overuse injuries, such as chronic tendinopathies, severely impact a patient's quality of life. Caused by repetitive trauma, chronic tendinopathies affect hundreds of millions of people each year. The exact pathogenic mechanism in developing this musculoskeletal injury is still largely unknown, making clinical recommendations on the best course of treatment highly debatable. Nonetheless, advancements in biotechnology have made autologous blood products, specifically the use of platelet rich plasma injections, an increasingly popular method in the orthopedic field. Studies have shown that the concentrated platelet sample harbors a number of bioactive mediators. Once activated and injected at the site of injury, these growth factors and cytokines augment the natural healing process in tendinopathic cases. With limited reported complications, many clinicians believe that platelet rich plasma therapy is a safe and accessible treatment option for patients diagnosed with chronic tendinopathy. As such, the primary purpose of this paper is to determine the efficacy of platelet rich plasma injections in treating chronic tendinopathies.

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