Role of platelet rich plasma in patients of osteoarthritis knee-a prospective study

Abstract

Introduction: In the present study, we evaluated the effects of 2 courses of PRP injections with 3 weeks interval, on patient’s quality of life and functional ability.

Materials and Method: It was a prospective study carried out on 55 patients (14 males & 41 females) in the Department of Orthopedics’, Era’s Lucknow Medical College, Lucknow, and Uttar Pradesh from Sep 2015 to March 2016. Age >40 years, Knee arthralgia (>3 months) and Radiologic evidence of articular damage (grades 1–3 of Kellgren-Lawrence scale) based on knee Osteoarthritis criteria of American College of Rheumatology were enrolled in our study. Two intra-articular injections of Platelet Rich Plasma (PRP) at 3 weeks interval was given and patient was regularly followed up after 3rd week, 6th week, 3 months & 6 months of the 1st injection

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Transition from Deep Regional Blocks toward Deep Nerve Hydrodissection in the Upper Body and Torso: Method Description and Results from a Retrospective Chart Review of the Analgesic Effect of 5% Dextrose Water as the Primary Hydrodissection Injectate to Enhance Safety

Abstract

Deep nerve hydrodissection uses fluid injection under pressure to purposely separate nerves from areas of suspected fascial compression, which are increasingly viewed as potential perpetuating factors in recalcitrant neuropathic pain/complex regional pain. The usage of 5% dextrose water (D5W) as a primary injectate for hydrodissection, with or without low dose anesthetic, could limit anesthetic-related toxicity. An analgesic effect of 5% dextrose water (D5W) upon perineural injection in patients with chronic neuropathic pain has recently been described. Here we describe ultrasound-guided methods for hydrodissection of deep nerve structures in the upper torso, including the stellate ganglion, brachial plexus, cervical nerve roots, and paravertebral spaces. We retrospectively reviewed the outcomes of 100 hydrodissection treatments in 26 consecutive cases with a neuropathic pain duration of months and the mean Numeric Pain Rating Scale (NPRS) 0–10 pain level of . The mean percentage of analgesia during each treatment session involving D5W injection without anesthetic was 88.1%  ±  9.8%. The pretreatment Numeric Pain Rating Scale score of improved to at 2 months after the last treatment. Patients received treatments over months from the first treatment to the 2-month posttreatment follow-up. Pain improvement exceeded 50% in all cases and 75% in half. Our results confirm the analgesic effect of D5W injection and suggest that hydrodissection using D5W provides cumulative pain reduction.

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The effect of Hypertonic Dextrose injection on the control of pain associated with knee osteoarthritis

Abstract

Introduction: The purpose of this study was to evaluate the effect of dextrose injection on controlling pain associated with knee osteoarthritis.

Methods: To achieve the research objectives, available sampling was done using 80 patients with knee osteoarthritis referring to Taleghani Hos pital in 2017 and samples were divided into two groups: 15% dextrose injection and 25% hypertonic dextrose injection. This injection was performed at the beginning of the study, the first week, the fifth week and the ninth week. During these weeks, participants were asked to complete the WOMAC questionnaire implementing the VAS scale. After data collection, independent t-test and two-way variance analysis with repeated measures were
used.

Conclusion: In general, it can be suggested that the use of dextrose prolotherapy is a simple, safe, inexpensive, accessible and less complicated method than other treatments in these patients.

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Comparison between intra-articular ozone and placebo in the treatment of knee osteoarthritis: A randomized, double-blinded, placebo-controlled study

Abstract

OBJECTIVE:

The aim of the trial was to determine the effectiveness of oxygen-ozone injections on knee osteoarthritis concerning pain reduction, joint functional improvement, and quality of life.

METHODS:

In this randomized, double-blinded, placebo controlled clinical trial, 98 patients with symptomatic knee osteoarthritis (OA) were randomized into two groups receiving intra-articular 20 μg/ml of ozone (OZ) or placebo (PBO) for 8 weeks. The efficacy outcomes for knee OA were the Visual Analogue Scale (VAS), Lequesne Index, Timed Up and Go Test (TUG Test), SF-36, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Geriatric Pain Measure (GPM).

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Treatment of First Metacarpophalangeal Joint Instability and Snapping Thumb Using Ultrasound-guided Prolotherapy and Hydrodissection: A Case Report

Abstract:

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Management of Hepple Stage V Osteochondral Lesion of Talus with Platelet-Rich Plasma (PRP) Scaffold

Abstract:

Introduction/Purpose: There is no consensus on treatment or prognosis for Hepple stage V Osteochondral lesion of talus (OLTs), especially for lesion more than 1.5 cm2. This research was to investigate surgical techniques and clinical outcomes of platelet-rich plasma (PRP) scaffold for Hepple stage V OLTs.

Methods: 14 patients were treated by cancellous bone graft with PRP gel scaffold between 2013 and 2015 with average age of 38.9 years old and mean set of 23.5 months. Ankle X-ray and MRI were obtained at the final follow-up for evaluation. Functional outcomes were scored by the Visual Analog Scale (VAS) score, American Orthopaedics Foot and Ankle Society (AOFAS) ankle- hindfoot score and Short Form (36) Survey score (SF-36). Range of motion (ROM) of ankle joint and complications were also recorded.

Results: 13 patients got the final follow-up with a mean duration of 18 months. MRI showed complete regeneration of subchondral bone and cartilage in all patients. The post-operative VAS, AOFAS ankle-hindfoot score and SF-36 score improved significantly (P<0.0001) without obvious complications.

Conclusion: We suggest that for the patients of Hepple stage V OLTs, cancellous bone graft with PRP scaffold may be a safe and effective treatment.

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Clinical and economic effectiveness of the use of platelet-rich plasma in the treatment of chronic wounds

Abstract:

The paper presents the results of the clinical use of platelet-rich plasma in the treatment of long-term non-healing wounds of various etiologies in patients on inpatient treatment and outpatient monitoring in the department of surgical infections of the State-financed health institution, City clinical hospital No. 13, Moscow Health Department, from 2011 to 2016: test group and control group of 50 patients per each, comparable by gender, age, nature of pathology and area of wounds. When analyzing the data obtained, it was found that a significant reduction in the duration of patients treatment was achieved in the test group: the average epithelialization time for the wounds was 42.3 ± 5.7 days, while in the control group, this index was many times higher and averaged 123.8 ± 25.3 days. The average length of hospitalization at the stage of the treatment of patients in the test group was 8.4 ± 1.5 days, in the control group it was 18.1 ± 1.6 days (p < 0.0001). The economic effect averaged 736.81 Euro in savings per patient.

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Platelet-Rich Plasma Injections as a Treatment for Refractory Patellar Tendinosis: A Meta-Analysis of Randomised Trials

Purpose: Patellar tendinosis (PT) is a common condition amongst athletes. In this study, we perform a meta-analysis on randomised controlled trials (RCTs) to evaluate the use of platelet-rich plasma (PRP) for refractory PT.

Methods: A literature search was undertaken in various databases from their year of inception to October 2015. The primary outcome measure was the Victorian Institute of Sports Assessment-Patella (VISA-P) score.

Results: We identified 2 RCTs comparing PRP injections to alternative treatment options (extracorporeal shockwave therapy [ESWT] and dry needling of the tendon). Meta-analysis showed no significant difference in mean VISA-P scores between PRP injection and control at early assessment (2 or 3 months; estimated difference in means, 11.9; standard error [SE], 7.4; 95% confidence interval [CI], –2.7 to 26.4; p=0.109). However, PRP was statistically better than control with regards to VISA-P scores at longer follow-up (6 months or longer; estimated difference in means, 12.7; SE, 4.4; 95% CI, 4.1 to 21.3; p=0.004).

Conclusions: There is a paucity of RCTs evaluating the role of PRP in PT. Our results suggest that, based on limited evidence, PRP is superior over other established non-surgical treatments (dry needling and ESWT) for refractory PT. Larger RCTs may allow better characterisation of the role of PRP in this condition.

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Musculoskeletal Tissue Regeneration: The Role of the Stem Cells

Abstract:

Ligament, cartilage, and meniscus injuries often have poor healing due to low vascularity and low proliferative abilities of the resident cells. Drawbacks with conventional treatment methodologies have prompted interest in a new approach we term “Regenerative Engineering” to regenerate orthopaedic tissues. The work of cells is of central importance in the Regenerative Engineering paradigm. In this regard, both differentiated cells and stem cells such as bone marrow stromal cells have been studied as sources for orthopaedic tissue regeneration. In addition, other stem cells such as those derived from peripheral blood, synovium, adipose, and other extraembryonic sources have been isolated and characterized and subsequently investigated for regenerating various orthopaedic tissues. In this review, recent developments in the stem cell-mediated regeneration of ligament, cartilage, and menisci are discussed.

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Use of Platelet Rich Fibrin for the Treatment of Muco-Gingival Recessions: Novel Improvements in Plastic Aesthetic Surgery Utilizing The Fibrin Assisted Soft Tissue Promotion (FASTP) Technique

Abstract:

The use of platelet rich fibrin (PRF) has been utilized for a wide variety of procedures in both the medical and dental fields. Results from many randomized clinical trials have now pointed to its marked ability to promote soft-tissue wound healing where PRF has been documented to facilitate wound closure and speed regeneration of muco-gingival recessions. Within this chapter, a systematic review of the various clinical studies utilizing PRF for recession coverage procedures is presented. Furthermore, a new surgical concept is introduced following years of clinical experience with PRF described as the “Fibrin Assisted Soft Tissue Promotion” FASTP technique.

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