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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Effect of Autologous Fibrin Gel and Platelet Rich Plasma Activated by Ozone Versus Those Activated by Calcium Chloride on Wound Healing and Prevention of Infection in High Risk Cesarean Sections: Randomized Controlled Study.

Abstract:

Background: Cesarean delivery, one of the most common major surgical procedures performed worldwide used for 15% of births around the world and it continues to increase in frequency. It is an important contributor to surgical site complications such as infection, hematoma and dehiscence. Platelet Rich Plasma (PRP) is a volume fraction of blood having a high concentration of platelets above the baseline. This product is a rich source of growth factors. PRP can be activated by CaCl2 or medical Ozone. The induction of growth factors found in PRP by ozone can support and potentiate their action. Aim: The purpose of this study is to compare the effect of application of autologous Fibrin Gel and Platelet Rich Plasma (PRP) activated by medical Ozone (Ozonated PRP) versus those activated by CaCl2 on wound healing and prevention of infection in high risk cesarean sections. Design: 90 high risk pregnant females undergoing cesarean section were selected randomly according to inclusion criteria and divided into 3 groups each contains 30 patients. Group Ca received Autologous PRP and Fibrin gel activated by CaCl2 at the wound site. Group O received Autologous PRP and Fibrin gel activated by Medical Ozone at the wound site while group P (control) did not receive any of them. All patients were examined for wound complications and healing progress on day 1, day 7 and day 21 postoperative by visual analogue scale (VAS), REEDA scale and Vancouver Scar System (VSS). Results: the results revealed statistically significance decrease in pain by VAS in group Ozone compared to group P on day 7 and 21. For REEDA also group O showed significant decrease compared to group Calcl on day 1 and 7 while compared to group P was also decreased on day 1, 7 and 21. Group Cacl was significantly decreased compared to group P on day 7 and 21 only. Regarding VSS both group O and group Cacl were significantly decreased compared to group P on all days. Conclusion: this study gives evidence that applying autologous platelet rich plasma (PRP) promote wound healing and when activated by Ozone gives better results and helps prevention of infection in cesarean section of high risk patients.

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Management of knee osteoarthritis in Italy. A cost-utility analysis of Platelet-Rich-Plasma dedicated kit versus Hyaluronic acid for the intra-articular treatment of knee OA

Abstract:

Background: Osteoarthritis (OA) is a chronic and degenerative pathology that affects joints in particular hands, knees, hip and lower back. It is one of the main causes of disability in most of advanced economy countries. Its prevalence and incidence are increasing for the ageing of population and the presence of risk factors. OA burden of disease implies high costs of care and it has an important social impact. Although more high-quality evidence is needed, recent studies indicate that intra-articular Platelet-Rich Plasma (i.a. PRP) injections can relieve pain, improving knee function and quality of life, especially in younger patients and mild OA cases. Objectives. The aim of this work is to develop a preliminary economic evaluation of i.a. PRP therapy in the treatment of knee OA. The comparator adopted is the Hyaluronic acid (HA) which represents the standard therapy. Both therapies can reduce pain and can help the patient to delay the total knee replacement (TKR) surgical intervention. Methods. A Cost-Utility Analysis (CUA) was performed using a decision tree model. Outcomes are reported in terms of Quality Adjusted Life Year (QALY), while costs are reported in Euro (Û) currency. The adopted perspective is the National Healthcare System. Deterministic and probabilistic sensibility analyses are reported to evaluate the robustness of results under uncertainty. Results. The i.a. PRP-based therapy is cost-effective with respect to HA. Future clinical studies should provide more evidence on the major effectiveness and considering a longer patient follow-up there could be the delay of TKR, reducing consequently the eventual prosthesis revision and reducing costs of knee OA for National Healthcare System.

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Current Treatments for Coccydynia

Abstract:

Purpose of Review: Refractory cases of coccydynia can be functionally debilitating. Here, we summarize the latest advances in interventional options for coccydynia.

Recent Findings: The literature on treatments of coccydynia is sparse, and mostly limited to low-quality studies. Although some of these studies have demonstrated benefit from various treatment options, the lack of high-quality, prospective, controlled trials limits the ability to draw conclusions about efficacy.

Summary: Conservative treatment remains the mainstay of coccydynia. In refractory cases, invasive treatments may be considered, although larger, randomized studies are needed to establish clear efficacy.

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Mesenchymal Stem Cells as an Alternative to Knee Replacement Surgery

Abstract:

Description: Knee osteoarthritis is a degenerative disease that causes disability and persistent pain. Currently, treatment modalities for osteoarthritis focus on pain reduction and symptom management, but do little to address disease modification. Presently, the treatment of choice for knee osteoarthritis is total knee replacement surgery. Total knee replacement surgery carries significant risks and does not guarantee improvement in joint pain or function. In the last decade, advances in regenerative medicine have proposed the use of mesenchymal stem cells as a treatment strategy for joint preservation, cartilage regeneration and improved joint function in patients with osteoarthritis. The aim of this integrative literature review was to explore the use of mesenchymal stem cells as a treatment modality for the management of knee osteoarthritis and to analyze the safety and effectiveness of the intervention. An extensive search of the academic databases Cumulative Index of Nursing and Allied Health Literature (CINAHL), and PubMed was conducted using the search terms, mesenchymal stem cells and knee osteoarthritis. The findings of this literature review indicate regenerative medicine has the potential to be an effective alternative to knee replacement surgery. Furthermore, the review provides significant evidence that the use of mesenchymal stem cells for the treatment of knee osteoarthritis is safe and effective; however, more research and clinical trials are needed before its use can become standard practice.

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Leukocyte-reduced platelet-rich plasma increases proliferation of tenocytes treated with prednisolone: a cell cycle analysis

Abstract:

Introduction: The purpose of this study was to evaluate the effect of allogenic leukocyte-reduced platelet-rich plasma on human tenocytes after treatment with prednisolone and to develop a standardization of its application for clinical practice.

Methods: A leukocyte-reduced PRP was produced using the Arthrex Double Syringe (Arthrex, Inc., Naples, FL, USA), in a modified single-spin separation method. Human tenocytes were isolated from discarded rotator cuff segments. Tenocytes were cultured in the presence of PRP and prednisolone, both alone and in combination. Control samples were treated in media containing 2% FCS for 72 h. After 72 h of incubation, cell cycle kinetics of tenocytes were analyzed to assess proliferation.

Results: Incubation of the tenocytes with PRP alone for 48 h led to high proliferation rate (10% PRP, 28.0 ± 10.5%; 20% PRP, 40.9 ± 3.3%). Incubation in the presence of prednisolone led to a significant decrease of the proliferation rate (5.2 ± 3.1%; p < 0.05). Treatment with PRP for 48 h significantly increased the proliferation of tenocytes in a dose-dependent manner (10% PRP, 28.0 ± 10.5%; 20% PRP, 40.9 ± 3.3%; p < 0.05). The presence of prednisolone resulted in a decreased tenocyte proliferation (5.2 ± 3.1%; p < 0.05), whereas addition of PRP for 24 and 48 h after prednisolone exposure did not show any compensating effect independent of PRPs concentration (10% PRP, 3.7 ± 3.0%; 20% PRP, 2.5 ± 2.5%). However, a significantly increased cell proliferation of tenocytes was evident when PRP was applied 24 h after prednisolone incubation for 48 h (31.0 ± 3.4 and 34.3 ± 4.7%).

Conclusion: The use of leukocyte-reduced PRP stimulates the proliferation of tenocytes and antagonizes the negative effect of prednisolone 24 h after treatment. Addition of PRP 48 h after treatment with prednisolone has no positive effect on the proliferation rate of tenocytes.

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Treatment of knee osteoarthritis: platelet-derived growth factors vs. hyaluronic acid. A randomized controlled trial

Abstract:

Objective:Aim of this trial was to compare efficacy of activated platelet-rich plasma against hyaluronic acid as intra-articular injections to people with osteoarthritis of the knee.

Design: Phase-2 randomized controlled trial, with blind patients and outcome assessors.

Setting: Outpatient rehabilitation service; years 2011–2013.

Subjects: Patients with knee osteoarthritis grades 2–3 at magnetic resonance imaging (MRI) were included after consent and randomized. Target sample size was 25 patients per group.

Interventions: Patients received three activated platelet-rich plasma (intervention group) or hyaluronic acid (controls) intra-articular injections at 4-week intervals.

Main measures: Main outcome measure was proportion of patients with >1 grade improvement at six months from last injection, as assessed by a radiologist blind to study group. Patients were evaluated over time clinically and with functional scales (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lysholm, Tegner, American Knee Society Score (AKSS), Lequesne, visual analogue scale (VAS) for pain).

Results: Overall, 30 patients were randomized to intervention and 28 to control group. For primary outcome, 28 patients (29 knees) in the intervention and 22 (25 knees) in the control group were available. Patients with at least 1 grade improvement at repeat MRI were 14 (48.3%) in the intervention and 2 (8%) in the control group (P < 0.003). Improvement in symptoms and functional scales was consistently higher in the intervention group. No side-effects were observed in either group.

Conclusion: Activated platelet-rich plasma reduces articular damage as evident at MRI, as soon as six months after treatment; it reduces pain and improves patient’s function and overall quality of life.

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