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A New Treatment Option in Osteoarthritis: Prolotherapy Injections
Posted in: General | Posted on: 29-May-2016
Abstract
Osteoarthritis is the most common degenerative disorder, and one of the major causes of physical disability in adults. Unfortunately many people experience arthroplasty or other major surgeries, in spite of improvements of the conservative options. There is a need for efficient treatment methods in this group of patients. Prolotherapy is one of the simple and safe injection-based complementary method and it\'s efficiency was proved in the musculoskeletal problems. The aim of this article is to present current perspectives of prolotherapy in osteoarthritis.
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Effects of ozone therapy on facial nerve regeneration
Posted in: General | Posted on: 25-May-2016
Abstract
Introduction: Ozone may promote moderate oxidative stress, which increases antioxidant endogenous systems. There are a number of antioxidants that have been investigated therapeutically for improving peripheral nerve regeneration. However, no previous studies have reported the effect of ozone therapy on facial nerve regeneration.
Objective: We aimed to evaluate the effect of ozone therapy on facial nerve regeneration.
Methods: Fourteen Wistar albino rats were randomly divided into two groups with experimental nerve crush injuries: a control group, which received saline treatment post-crush, and an experimental group, which received ozone treatment. All animals underwent surgery in which the left facial nerve was exposed and crushed. Treatment with saline or ozone began on the day of the nerve crush. Left facial nerve stimulation thresholds were measured before crush, immediately after crush, and after 30 days. After measuring nerve stimulation thresholds at 30 days post-injury, the crushed facial nerve was excised. All specimens were studied using light and electron microscopy.
Results: Post-crushing, the ozone-treated group had lower stimulation thresholds than the saline group. Although this did not achieve statistical significance, it is indicative of greater functional improvement in the ozone group. Significant differences were found in vascular congestion, macrovacuolization, and myelin thickness between the ozone and control groups. Significant differences were also found in axonal degeneration and myelin ultrastructure between the two groups.
Conclusions: We found that ozone therapy exerted beneficial effect on the regeneration of crushed facial nerves in rats.
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Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: A systematic review and meta-analysis
Posted in: General | Posted on: 25-May-2016
Abstract
Hypertonic dextrose injections (prolotherapy) is an emerging treatment for symptomatic knee osteoarthritis (OA) but its efficacy is uncertain. We conducted a systematic review with meta-analysis to synthesize clinical evidence on the effect of prolotherapy for knee OA. Fifteen electronic databases were searched from their inception to September 2015. The primary outcome of interest was score change on the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Three randomized controlled trials (RCTs) of moderate risk of bias and one quasi-randomized trial were included, with data from a total of 258 patients. In the meta-analysis of two eligible studies, prolotherapy is superior to exercise alone by a standardized mean difference (SMD) of 0.81 (95% CI: 0.18 to 1.45, p = 0.012), 0.78 (95% CI: 0.25 to 1.30, p = 0.001) and 0.62 (95% CI: 0.04 to 1.20, p = 0.035) on the WOMAC composite scale; and WOMAC function and pain subscale scores respectively. Moderate heterogeneity exists in all cases. Overall, prolotherapy conferred a positive and significant beneficial effect in the treatment of knee OA. Adequately powered, longer-term trials with uniform end points are needed to better elucidate the efficacy of prolotherapy.
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Hypertonic dextrose injection (prolotherapy) for knee osteoarthritis: Long term outcomes
Posted in: General | Posted on: 25-May-2016
Abstract
Objective: Knee osteoarthritis (OA) is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. Recent 52-week randomized controlled and open label studies have reported improvement of knee OA-specific outcomes compared to baseline status, and blinded saline control injections and at-home exercise therapy (p<0.05). However, long term effects of prolotherapy for knee OA are unknown. We therefore assessed long-term effects of prolotherapy on knee pain, function and stiffness among adults with knee OA.
Design: Post clinical-trial, open-label follow-up study.
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Setting: Outpatient; adults with mild-to-severe knee OA completing a 52-week prolotherapy study were enrolled.
Intervention And Outcome Measures: Participants received 3-5 monthly interventions and were assessed using the validated Western Ontario McMaster University Osteoarthritis Index, (WOMAC, 0-100 points), at baseline, 12, 26, 52 weeks, and 2.5 years.
Results: 65 participants (58
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Role of PRP in the Treatment of Knee Osteoarthritis
Posted in: General | Posted on: 24-May-2016
Abstract
Platelet-rich plasma (PRP) is one of the many new therapeutic approaches that continues to evolve in the field of general musculoskeletal medicine, sports medicine, and orthopedic medicine. There has been increasing amount of interest particularly in knee osteoarthritis as it is the most common degenerative disease encountered in clinical practice. PRP injections have been found in the majority of recent clinical studies to be helpful for pain and function. The purpose of this article was to provide the readers with the historical perspective of PRP and the most current literature on the use of PRP for the treatment of knee OA.
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Effectiveness and relevant factors of platelet?rich plasma treatment in managing plantar fasciitis: A systematic review
Posted in: General | Posted on: 18-May-2016
Abstract
Background: Plantar fasciitis (PF) is a common foot complaint, affects both active sportsmen and physically inactive middle age group. It is believed that PF results from degenerative changes rather than inflammation. Platelet?rich plasma (PRP) therapy has been introduced as an alternative therapy for PF. This study is aimed to systematically review to the effectiveness and relevant factors of PRP treatment in managing PF. Materials and Methods: A search was conducted in electronic databases, including PubMed,Scopus, and Google Scholar using different keywords. Publications in English?language from 2010 to 2015 were included. Two reviewers extracted data from selected articles after the quality assessment was done. Results: A total of 1126 articles were retrieved,but only 12 articles met inclusion and exclusion criteria. With a total of 455 patients, a number of potentially influencing factors on the effectiveness of PRP for PF was identified. In all these studies, PRP had been injected directly into the plantar fascia, with or without ultrasound guidance. Steps from preparation to injection were found equally crucial. Amount of collected blood, types of blood anti?coagulant, methods in preparing PRP, speed, and numbers of time the blood samples were centrifuged, activating agent added to the PRP and techniques of injection, were varied between different studies. Regardless of these variations, superiority of PRP treatment compared to steroid was reported in all studies. Conclusion: PRP therapy might provide an effective alternative to conservative management of PF with no obvious side effect or complication. The onset of action after PRP injection also greatly depended on the degree of degeneration.
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Sciatica: Treatment with intradiscal and intraforaminal injections of steroid and oxygen-ozone versus steroid only
Posted in: General | Posted on: 15-May-2016
Abstract
Purpose:

To prospectively compare the clinical effectiveness of intraforaminal and intradiscal injections of a mixture of a steroid, a local anesthetic, and oxygen-ozone (O(2)-O(3)) (chemodiscolysis) versus intraforaminal and intradiscal injections of a steroid and an anesthetic in the management of radicular pain related to acute lumbar disk herniation.
Materials And Methods: Medical Ethical Committee approval and informed consent were obtained. One hundred fifty-nine patients (86 men, 73 women; age range, 18-71 years) were included and were randomly assigned to two groups. Seventy-seven patients (group A) underwent intradiscal and intraforaminal injections of a steroid and an anesthetic, and 82 patients (group B) underwent the same treatment with the addition of an O(2)-O(3) mixture. Procedures were performed with computed tomographic guidance. An Oswestry Low Back Pain Disability Questionnaire was administered before treatment and at intervals, the last at 6-month follow-up. Patients and clinicians were blinded as to which treatment was performed. Results were compared with the chi(2) test.
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The Efficacy of Platelet-Rich Plasma in the Treatment of Rib Fractures.
Posted in: General | Posted on: 11-May-2016
Abstract
Background: €ƒRib fracture is the most common result of thoracic traumas. Intrapulmonary shunt, alveolar capillary membrane damage, intra-alveolar hemorrhage, and hypoxia may develop following rib fractures. Therefore, prompt treatment is important. The aim of this experimental study was to analyze the effects of platelet-rich plasma (PRP) on rib fractures to secure a speedier and more efficient treatment method. Materials and Methods €ƒThe study involved 18 New Zealand white rabbits, randomly divided into three groups as Group 1, the sham group with no surgical intervention; Group 2, the control group in which simple rib fractures were applied and no treatment; and Group 3, in which rib fractures were applied and then PRP treatment was administered. Results €ƒThe mean recovery plate thickness measurements were found to be statistically significantly higher in the PRP group compared with the other groups (p < 0.005). A thicker fibrotic cell proliferation and the formation of many capillaries were observed around the growth plate in the PRP group compared with the other groups. These structures were lesser in the control group compared with the PRP group and at the lowest level in the sham group. Larger and distinct callus formation was observed and a new intramedullary field in the PRP group. Conclusions €ƒPRP is a reliable and effective autologous product with minimal side effects, which can be considered as an alternative treatment in patients with rib fractures and used easily in pseudoarthrosis, surgical fracture, or flail chest.
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Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: A systematic review and meta-analysis
Posted in: General | Posted on: 09-May-2016
Abstract
Hypertonic dextrose injections (prolotherapy) is an emerging treatment for symptomatic knee osteoarthritis (OA) but its efficacy is uncertain. We conducted a systematic review with meta-analysis to synthesize clinical evidence on the effect of prolotherapy for knee OA. Fifteen electronic databases were searched from their inception to September 2015. The primary outcome of interest was score change on the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Three randomized controlled trials (RCTs) of moderate risk of bias and one quasi-randomized trial were included, with data from a total of 258 patients. In the meta-analysis of two eligible studies, prolotherapy is superior to exercise alone by a standardized mean difference (SMD) of 0.81 (95% CI: 0.18 to 1.45, p = 0.012), 0.78 (95% CI: 0.25 to 1.30, p = 0.001) and 0.62 (95% CI: 0.04 to 1.20, p = 0.035) on the WOMAC composite scale; and WOMAC function and pain subscale scores respectively. Moderate heterogeneity exists in all cases. Overall, prolotherapy conferred a positive and significant beneficial effect in the treatment of knee OA. Adequately powered, longer-term trials with uniform end points are needed to better elucidate the efficacy of prolotherapy.
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Platelet-rich Plasma and Bone Marrow-derived Mesenchymal Stem Cells in Sports Medicine
Posted in: General | Posted on: 08-May-2016
Abstract
Regenerative medicine is a fast-growing field in orthopedic sports medicine. Platelet-rich plasma contains multiple factors that have been shown to augment healing, thereby stimulating its use in multiple areas of acute and chronic injuries. Mesenchymal stem cells have pluripotent potential to form into tissues pertinent to orthopedics, such as cartilage and bone. As such, there is been a surge in the research directed toward steering those stem cells into a particular lineage as part of treatment for a variety of soft-tissue, cartilage, and bone pathologies. Overall, there are promising reports of their potential success, but there is a need for continued investigation into the efficacy of platelet-rich plasma and stem cells in sports medicine.
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Impact of platelet-rich plasma injection timing on healing of Achilles tendon injury in a rat model.
Posted in: General | Posted on: 08-May-2016
Abstract
Objective: The aim of this study was to evaluate the impact of the timing of platelet-rich plasma (PRP) application on the healing of Achilles tendon injury in a rat model.
Methods: Fifty-four female Sprague-Dawley rats were divided into 4 groups: PRP preparation group (n=6); Achilles tendon tear and 150
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Efficacy of Platelet-Rich Plasma versus Hyaluronic Acid for treatment of Knee Osteoarthritis: A systematic review and meta-analysis
Posted in: General | Posted on: 03-May-2016
Abstract
Introduction: Knee osteoarthritis is a very common chronic degenerative disease that could impose significant costs to the health system. Although osteoarthritis can affect all joints, knee osteoarthritis is the most common type among adolescents. Non-surgical treatments include corticosteroids injection, hyaluronic acid, and platelet-rich plasma. The aim of this study was to investigate the efficiency of platelet-rich plasma versus hyaluronic acid for the treatment of knee osteoarthritis.
Methods: Pubmed, Cochran library, Scopus and Ovid databases were investigated to identify related studies from 2000 through August 2015. To study the efficiency, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) outcome using the Standard Mean Difference (SMD) index was calculated using a random model and a confidence interval of 95%. In addition, sensitivity and cumulative analysis were conducted. The data were analyzed using RevMan 5.3.5 and Stata 12 software.
Results: Seven studies with 722 subjects (364 participants in PRP and 358 participants in the HA group) were analyzed. The WOMAC PRP compared to HA, SMD = −0.75 (95% CI: −1.33 to −0.18, I2 = 92.6%) in treatment of knee osteoarthritis was statistically significant and PRP was more effective.
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Conclusion: The results of this meta-analysis two years after PRP injection showed the efficacy of PRP versus HA. However, further studies are required to determine the longer-term effects.
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Good prognosis factors after a platelet rich plasma (PRP) injection for tendinopathies ?
Posted in: General | Posted on: 25-Apr-2016
Abstract
Introduction : Platelet-rich plasma injections are a recent treatment for chronic tendinopathies. However, this theraeutic remains controversed in litterature. Up to now, there is no prognosis factors identified to predict a good evolution after injection of PRP.
Purpose: The aims of this study were to evaluate the effect of PRP injection followed by a standardized reeducation protocol among patients suffering from different tendinopathies and to determine the good prognosis factors, if any.
Methods : 51 patients suffering from different tendinopathies and refractory to conventional physiotherapy were treated with a PRP injection. Prior to the injection, a blood sample was drawn and some biological parameters (glycemia, cholesterol level, ...). A pain assessment was then made using a visual analog scale (VAS) and a pressure algometer. The same assessment was carried out after 6 weeks and 12 weeks when possible.
Results : There is an overall significant improvement VAS score at the end of the 12 weeks follow- up. However, no correlation was found between the evolution of the clinical scores and the biological parameters measured.
Discussion and Conclusions : A PRP injection followed by a program of eccentric rehabilitation positively affects the algo-functional scores of patients with tendinopathie who were refractory to conventional physiotherapy, whatever their initial biological parameters.
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Does platelet-rich plasma decrease time to return to sports in acute muscle tear? A randomized controlled trial
Posted in: General | Posted on: 24-Apr-2016
Abstract

Purpose: The aim of this study is to report the effects of autologous PRP injections on time to return to play and recurrence rate after acute grade 2 muscle injuries in recreational and competitive athletes.

Methods: Seventy-five patients diagnosed with acute muscle injuries were randomly allocated to autologous PRP therapy combined with a rehabilitation programme or a rehabilitation programme only. The primary outcome of this study was time to return to play. In addition, changes in pain severity and recurrence rates were evaluated.

Results: Patients in the PRP group achieved full recovery significantly earlier than controls (P = 0.001). The mean time to return to play was 21.1 ± 3.1 days and 25 ± 2.8 days for the PRP and control groups, respectively (P = 0.001). Significantly lower pain severity scores were observed in the PRP group throughout the study. The difference in the recurrence rate after 2-year-follow-up was not statistically significant between groups.

Conclusions: A single PRP injection combined with a rehabilitation programme significantly shortened time to return to sports compared to a rehabilitation programme only. Recurrence rate was not significantly different between groups.
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Mesenchymal stem cells (MSCs) as skeletal therapeutics-an update
Posted in: Stem Cell Treatment Houston | Posted on: 20-Apr-2016
Abstract
Mesenchymal stem cells hold the promise to treat not only several congenital and acquired bone degenerative diseases but also to repair and regenerate morbid bone tissues. Utilizing MSCs, several lines of evidences advocate promising clinical outcomes in skeletal diseases and skeletal tissue repair/regeneration. In this context, both, autologous and allogeneic cell transfer options have been utilized. Studies suggest that MSCs are transplanted either alone by mixing with autogenous plasma/serum or by loading onto repair/induction supportive resorb-able scaffolds. Thus, this review is aimed at highlighting a wide range of pertinent clinical therapeutic options of MSCs in the treatment of skeletal diseases and skeletal tissue regeneration. Additionally, in skeletal disease and regenerative sections, only the early and more recent preclinical evidences are discussed followed by all the pertinent clinical studies. Moreover, germane post transplant therapeutic mechanisms afforded by MSCs have also been conversed. Nonetheless, assertive use of MSCs in the clinic for skeletal disorders and repair is far from a mature therapeutic option, therefore, posed challenges and future directions are also discussed. Importantly, for uniformity at all instances, term MSCs is used throughout the review.
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Return to Sports After Bone Marrow-Derived Cell Transplantation for Osteochondral Lesions of the Talus
Posted in: General | Posted on: 20-Apr-2016
Abstract
Objective: Arthroscopic \"one-step\" technique based on bone marrow-derived cell transplantation (BMDCT) have achieved good results in repairing osteochondral lesions of the talus (OLT), overcoming important drawbacks of older techniques. It may be particularly adequate for the treatment of athletes in order to permit a safe and stable return to sports. The aim of this study was to report the results at 48 months of a series of athletes and the factors influencing the return to sports.
Design: Case series. A total of 140 athletes underwent a \"one-step\" BMDCT repair of OLT. All the patients had the cells harvested from the iliac crest, condensed and loaded on a scaffold, and then implanted. Patients were evaluated clinically by the American Orthopaedic Foot and Ankle Society (AOFAS) scores and Halasi score.
Results: AOFAS score improved from 58.7
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Dr Weglein with Dr Lytgot from new zealand at annual orthopedic prolotherapy meeting
Posted in: General | Posted on: 18-Apr-2016
Dr Weglein with Dr Lytgot from new zealand at annual orthopedic prolotherapy meeting
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Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options
Posted in: General | Posted on: 12-Apr-2016
Abstract
Purpose: This study was performed to compare the efficacy of treatment in three groups of patients with knee osteoarthritis (OA) given an intra-articular injection of platelet-rich plasma (PRP), hyaluronic acid (HA) or ozone gas.
Methods: A total of 102 patients with mild-moderate and moderate knee OA who presented at the polyclinic with at least a 1-year history of knee pain and VAS score ≥4 were randomly separated into three groups. Group 1 (PRP group) received intra-articular injection of PRP ×— 2 doses, Group 2 (HA group) received a single dose of HA, and Group 3 (Ozone group) received ozone ×— four doses. Weight-bearing anteroposterior-lateral and Merchant\'s radiographs of both knees were evaluated. WOMAC and VAS scores were applied to all patients on first presentation and at 1, 3, 6 and 12 months.
Results: At the end of the 1st month after injection, significant improvements were seen in all groups. In the 3rd month, the improvements in WOMAC and VAS scores were similar in Groups 1 and 2, while those in Group 3 were lower (p < 0.001). At the 6th month, while the clinical efficacies of PRP and HA were similar and continued, the clinical effect of ozone had disappeared (p < 0.001). At the end of the 12th month, PRP was determined to be both statistically and clinically superior to HA (p < 0.001).
Conclusion: In the treatment of mild-moderate knee OA, PRP was more successful than HA and ozone injections, as the application alone was sufficient to provide at least 12 months of pain-free daily living activities.
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The Chondrogenic Effect of Intra-articular Hypertonic-dextrose (prolotherapy) in Severe Knee Osteoarthritis
Posted in: General | Posted on: 10-Apr-2016
Abstract
Background: Dextrose injection is reported to improve KOA-related clinical outcomes, but its effect on articular cartilage is unknown. A chondrogenic effect of dextrose injection has been proposed.
Objective: To assess biological and clinical effects of intra-articular hypertonic dextrose injections (prolotherapy) in painful knee osteoarthritis (KOA).
Design: Case series with blinded arthroscopic evaluation before and after treatment.
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Setting: Physical medicine and day surgery practice.
Participants: Symptomatic KOA for at least 6 months, arthroscopy-confirmed medial compartment exposed subchondral bone, and temporary pain relief with intra-articular lidocaine injection.
Intervention: Four to six monthly 10 mL intra-articular injections with 12.5% dextrose.
Main outcome measures: Visual cartilage growth assessment of 9 standardized medial condyle zones in each of 6 participants by three arthroscopy readers masked to pre/post injection status (total 54 zones evaluated per reader); biopsy of a cartilage growth-area post-treatment, evaluated using H&E and Safranin-O stains, quantitative polarized light microscopy, and immunohistologic cartilage typing; self-reported knee specific quality of life using the Western Ontario McMaster University Osteoarthritis Index (WOMAC, 0-100 points).
Results: Six participants (1 female) with median age of 71, WOMAC composite score of 57.5 points and a 9-year pain duration received a median 6 dextrose injections and follow-up arthroscopy at 7.75 (4.5-9.5) months. In 19 of 54 zone comparisons all three readers agreed that the post-treatment zone showed cartilage growth compared with the pre-treatment zone. Biopsy specimens showed metabolically active cartilage with variable cellular organization, fiber parallelism, and cartilage typing patterns consistent with fibro- and hyaline-like cartilage. Compared with baseline status, the median WOMAC score improved 13 points (p=.013). Self-limited soreness after methylene-blue instillation was noted.
Conclusions: Positive clinical and chondrogenic effects were seen after prolotherapy with hypertonic dextrose injection in symptomatic grade IV KOA participants suggesting disease-modifying effects and the need for confirmation in controlled studies. Minimally invasive arthroscopy (single-compartment, single-portal) enabled collection of robust intra-articular data.
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Five and ten year follow-up on intradiscal ozone injection for disc herniation
Posted in: General | Posted on: 03-Apr-2016
Abstract
Background: Disc herniation is the most common cause for spinal surgery and many clinicians employ epidural steroid injections with limited success. Intradiscal injection of ozone gas has been used as an alternative to epidural steroids and surgical discectomy. Early results are positive but long-term data are limited.
Methods: One hundred and eight patients with confirmed contiguous disc herniation were treated with intradiscal injection of ozone in 2002-2003. One-hundred seven patients were available for telephone follow-up at 5 years. Sixty patients were available for a similar telephone follow-up at ten years. Patients were asked to describe their clinical outcome since the injection. Surgical events were documented. MRI images were reviewed to assess the reduction in disc herniation at six months.
Results: MRI films demonstrated a consistent reduction in the size of the disc herniation. Seventy-nine percent of patients had a reduction in herniation volume and the average reduction was 56%. There were 19 patients that ultimately had surgery and 12 of them occurred in the first six months after injection. One of these 12 was due to surgery at another level. Two surgeries involved an interspinous spacer indicated by stenosis or DDD. All other surgeries were discectomies. Of the patients that avoided surgery 82% were improved at 5 years and 88% were improved at 10 years. Other than subsequent surgeries, no spine-related complications were experienced.
Conclusions/Level of Evidence: We conclude that ozone is safe and effective in approximately 75% of patients with disc herniation and the benefit is maintained through ten years. This is a retrospective review and randomized trials are needed.
Clinical Relevance: Intradiscal ozone injection may enable patients to address their pain without multiple epidural injections and surgery. The benefit of ozone is durable and does not preclude future surgical options. The risk reward profile for this treatment is favorable.
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