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  • Platelet-Rich Plasma May Improve Osteochondral Donor Site Healing in a Rabbit Model

    Abstract

    Purpose. The purpose of this study was to assess the effect(s) of platelet-rich plasma (PRP) on osteochondral donor site healing in a rabbit model. Methods. Osteochondral donor sites 3 mm in diameter and 5 mm in depth were created bilaterally on the femoral condyles of 12 New Zealand White rabbits. Knees were randomized such that one knee in each rabbit received an intra-articular injection of PRP and the other received saline (placebo). Rabbits were euthanized at 3, 6, and 12 weeks following surgery. Repair tissue was evaluated using the International Cartilage Repair Society (ICRS) macroscopic and histological scores. Results. No complications occurred as a result of the interventions. There was no significant difference in macroscopic scores between the 2 groups (5.5

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  • Researchers report good first results using blood stem cells, HA to regenerate cartilage

    Scientific investigators from Malaysia reported the first evidence of hyaline cartilage regeneration using intra-articular injections of autologous peripheral blood stem cells in combination with hyaluronic acid.

    In their clinical trial, researchers from the Kuala Lumpur Sports Medicine Centre and the University Putra Malaysia followed 10 patients with full-thickness chondral defects treated with arthroscopic multiple subchondral drilling. The investigators followed the patients for a minimum of 2 years.

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  • Pluripotent Stem Cells and Skeletal Regeneration —Promise and Potential

    Abstract

    The bone is a regenerative tissue, capable of healing itself after fractures. However, some circumstances such as critical-size defects, malformations, and tumor destruction may exceed the skeleton\'s capacity for self-repair. In addition, bone mass and strength decline with age, leading to an increase in fragility fractures. Therefore, the ability to generate large numbers of patient-specific osteoblasts would have enormous clinical implications for the treatment of skeletal defects and diseases. This review will highlight recent advances in the derivation of pluripotent stem cells, and in their directed differentiation towards bone-forming osteoblasts.

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  • Prolotherapy for refractory rotator cuff disease: retrospective case-control study of one year follow-up

    Objective

    To determine the efficacy of prolotherapy for refractory rotator cuff disease.

    Design

    Retrospective case-control study

    Setting

    University-affiliated tertiary-care hospital.

    Participants

    One hundred fifty-one patients with non-traumatic refractory rotator cuff disease that was unresponsive to 3 month-long aggressive conservative treatments. Sixty-three patients received prolotherapies with 16.5% dextrose 10 ml solution (treatment group), and 63 continued conservative treatment (control group).

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  • Histological Evaluation of Bone Marrow Derived Stem Cell Therapy on Experimentally Induced Osteoarthritis in Albino Rats\' Knee Joint

    Abstract:

    Aim of work: This work aims to evaluate the efficacy of intra-articular injection of bone marrow derived-mesenchymal stem cells (MSCs) in treatment of mono-iodoacetate (MIA) induced osteoarthritis in rat knee joint monitored by histological and immunohistochemical methods. Material and methods: this study was carried out on 45 adult male albino rats. They were classified into 4 groups: group I (control group), group II (osteoarthritic group) in which rats received 1 mg of MIA and sacrificed after 2 weeks and after 4 weeks, group III (stem cell treated group) in which rats received MSCs 2 weeks after MIA injection or 4 weeks after MIA and sacrificed 2 weeks later and group IV (untreated group) in which rats received PBS 2 weeks after MIA injection or 4 weeks after MIA and sacrificed 2 weeks later. Sections were taken from rats' knee joints and stained with Hematoxylin and Eosin, toluidine blue, immunohistochemichal stains for collagen type II. Sections were examined by light microscopy. The mean articular cartilage (AC) thickness, optical density of cartilage matrix proteoglycan and area percent of collagen type II immunoreactivity were measured using image analyzer and statistically analyzed.

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  • Doctors Shun Insurance, Offering Care for Cash

    LAREDO, Tex. — For 12 hours a day, the waiting room at Dr. Gustavo Villarreal\'s family practice is packed with patients who pay a flat $50 fee for the convenience — or necessity — of a walk-in, quick-turn doctor\'s visit.

    Efforts at both the state and federal level are underway to decrease Texas\' sky-high rate of residents without health coverage. But in a city where nearly a third of the population lives below the poverty line, Dr. Villarreal does not accept health insurance. Instead, he has switched to a cash-based model, eschewing the laborious practice of filing out insurance forms in order to get paid.

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  • Platelet-rich Plasma: Applications in Sports Medicine

    Abstract

    The use of platelet-rich plasma (PRP) in sports medicine is a recently developed technique in which concentrated autologous blood is used to increase the healing rate of various tissues. PRP has been most extensively used in the treatment of different musculoskeletal disorders, particularly in athletic injuries. Owing to its apparent safety and ease of preparation and administration, there has been an increased interest in the efficacy of PRP in a large number of different clinical settings. PRP has been used to treat conditions such as lateral epicondylitis, ligamentous strains, muscular strains, and fracture nonunion in athletes. PRP can be injected to the site of the pathology, either during surgery or in the physician\'s office. The benefits of PRP in the clinical field appear to be promising, and many investigators are still exploring new ways to use this therapy effectively. However, the clinical evidence for the benefits of PRP in the field of sports medicine is unclear. The purpose of this article was to review the current evidence on PRP therapy in this field.

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  • Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial

    Abstract

    Purpose

    To compare the effectiveness of intraarticular (IA) multiple and single platelet-rich plasma (PRP) injections as well as hyaluronic acid (HA) injections in different stages of osteoarthritis (OA) of the knee.

    Methods

    A total of 162 patients with different stages of knee OA were randomly divided into four groups receiving 3 IA doses of PRP, one dose of PRP, one dose of HA or a saline injection (control). Then, each group was subdivided into two groups: early OA (Kellgren-Lawrence grade 0 with cartilage degeneration or grade I-III) and advanced OA (Kellgren-Lawrence grade IV). The patients were evaluated before the injection and at the 6-month follow-ups using the EuroQol visual analogue scale (EQ-VAS) and International Knee Documentation Committee (IKDC) subjective scores. Adverse events and patient satisfaction were recorded.

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  • Mesenchymal stem cells reside in anterior cruciate ligament remnants in situ

    Abstract

    Purpose

    It has been reported that the anterior cruciate ligament (ACL) has certain self-healing ability after acute injury or with primary suture repair. Many studies have confirmed that a remnant preservation technique with ACL reconstruction contributes to biological augmentation for ACL healing. However, it remains unclear whether mesenchymal stem cells (MSC) reside in ACL remnants in situ. The aim of this study was to investigate the methods of culture and identification of MSC derived from the remnants of ACL rupture patients and to analyse these MSC\'s properties.

    Methods

    The cells of ACL remnants from the ACL rupture patients were isolated by the methods of enzymatic digestion and cultured in vitro to the third passage under the microscope to observe their morphology and growth status. The third passage of isolated cells was analysed for the identification of immunophenotype, osteogenic, adipogenic and chondrogenic differentiation.

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  • Minimally manipulated autologous adherent bone marrow cells (ABMCs): a promising cell therapy of spinal cord injury

    Spinal cord injury (SCI) is a devastating ailment that results in drastic life style alterations for the patients and their family members (McDonald and Sadowsky, 2002). Damage post injury causes necrosis, edema, hemorrhage and vasospasm. Post injury, secondary damage is caused by ischemia, excitotoxicity, lipid peroxidation, free radicals production, and inflammation. Collectively, damage to multiple neuronal and glia sub-types leads to severed axonal connections, demyelination and scar tissue formation. Interventions therefore require regeneration of multiple axonal projections to recreate the lost neuronal diversity originally achieved through an elaborate, tightly regulated transcriptional code during development. Neuronal repair and regeneration post injury is impeded due to absence of such supportive environment in the adult spinal cord (Misra et al., 2014).

    Impressive research advances using cell therapies have ushered in an era of new hope and today we are witnessing the translation of studies utilizing mesenchymal stem cells (MSCs) into mainline therapies for patients with SCIs. A testimonial to this trend is the surge in clinical studies using cellular transplantation for SCI (Tetzlaff et al., 2011). A search within (clinical trail.gov) using \"MSCs transplantation\" as search terms yielded ~400 studies, with only 6% of them related to SCI repair. Studies at EU clinical trial registry follow similar trends. Within the SCI domain, the majority of studies (69%) utilize BM-derived cells, followed by adipose tissue-derived MSCs (23%) and umbilical cord-derived cells ([Figure 1]a). While exciting at a first glance, a deeper analysis only highlights the confusion that prevails in the field of adult stem cells. The types of cells used and standards for study design and reporting are far from being well defined, despite organized efforts (Steeves et al., 2007). Given the variability in cell derivation protocols, it is extremely difficult to draw valid conclusions from these different (MSCs) cell therapy studies. Additionally, beyond the registered studies, there is alarming number of studies and treatments that are carried out without any controls or standards for safety and outcome measures, creating wrong perceptions in the public outlook. In this perspective, we have extrapolated the documented studies of cellular therapy for SCI to objectively draw inferences on the mechanisms of injury repair, and provide an outlook for bone marrow (BM)-derived cell therapy in the context of SCI.

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  • Role of PRP and Stem Cell Injections in Osteoarthritic Patients of Knee Joint

    Abstract

    : INTRODUCTION: Osteoarthritis of the knee (also called degenerative joint disease and osteoarthrosis) (4) is the most common joint disease after 50 years of age. It is characterized by progressive loss of articular cartilage (4) with subchondral bone sclerosis, osteophyte formation, inflammation of synovial membrane, and an increase in the synovial fluid with decreased viscosity and lubrication properties One approach to regenerative therapy is to supply affected joints with either autologous chondrocytes or chondrogenic bone marrow-derived mesenchymal stem cells (9) (BMSC) in combinations with platelet rich plasma. MATERIALS AND METHODS: In our study we treated 65 cases of osteoarthritis of knees in different age groups. Inour study moderate to severe arthritis cases were studied. Among 65 cases, 45 were females, 20 were males. Among the test group of 65 cases of age group ranging to 56-87yrs, 45 patients were with unilateral knee joint involvement, 10 patients were with bilateral knee joint involvement. On the other side a Control group consists of 50 cases: 30 with unilateral knee joint involvement, 10 patients with bilateral knee joint involvement.

    RESULTS: Both the groups were observed from time to time and analyzed based on the pain scores at 3 days, 1 week, 4 weeks, 3 months and 6 months intervals. At 3days- No difference in the pain scores and mobility noted in both the groups. At 1 week- Improvement in pain scores with increase in mobility reported in 59 of 65 cases in test group. On the other side, improvement in pain scores reported in 41 of 50 cases in control group. At 4 weeks- Improvement in pain scores reported in 63 of 65 cases in test group. And 44 of 50 cases in control group. At 3 months- Improvement in pain scores reported in 62 cases in test group and 30 cases in control group. At 6 months- Improvement in pain scores reported in 56 cases in test group and 26 cases in control group. CONCLUSION: PRP and stem cells injections in to the osteoarthritic knees, produces good results and safe. If the patient is not opting for surgical procedures and this is the only better treatment modality for controlling the pain and improvement of joint function. Hence use of PRP and stem cells injections in osteoarthritic patients is great value in preventing the further damage of the cartilage. By repairing the damaged cartilage with the PRP and stem cells, pain is greatly reduced, increase in the function of joint and patients will have better quality of life.

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  • Role of autologous platelet-rich plasma in treatment of long-bone nonunions: a prospective study

    Abstract

    Purpose

    Fracture union is a complex biological process, which depends upon several systemic and local factors. Disturbance of any of these factors may lead to nonunion of the fracture. These nonunions have a huge impact on quality of life as well as socioeconomical aspects. The platelets on activation release a number of growth factors and differentiation factors, which play important role in fracture healing. This study aimed to look for efficacy of platelet-rich plasma in the treatment of established fracture nonunions of long bones.

    Methods

    A total of 94 patients with established nonunion of long bone (35 tibia, 30 femur, 11 humerus, 4 radius, 12 ulna, 2 with both radius and ulna) were included in this study. We injected 15-20  ml of autologous platelet-rich plasma (>2,000,000  platelets/μl) under image intensifier at each nonunion site. The fracture union was evaluated clinically and radiologically regularly at monthly interval till 4  months.

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  • Bone Marrow-derived Mesenchymal Stem Cells for the Treatment of Knee Osteoarthritis

    Introduction

    Knee osteoarthritis (knee OA) is characterised by joint space narrowing, osteophyte formation, and subchondral sclerosis and manifests primarily as joint pain(1), resulting in the physical disability of patients. Around 40% of people over 70 years of age suffer from this condition(2). Knee OA in particular is a major cause of morbidity and is the primary diagnostic indication for total knee replacement(3), the volume of which continues to grow unabated globally. However, the procedure is a major operation and may pose several complications(4). Recently, scientific evidence has strongly demonstrated that novel treatments can modify or change the disease progression of knee OA(5-8). One potential strategy in osteoarthritis treatment is stem cell based therapy. The fundamental knowledge of stem cells is very important prior to translating this technology into clinical practice. Thus, the objectives of this review are to describe stem cells, including bone marrow derived mesenchymal stem cells (MSCs), and to summarise the recent evidence from animal to clinical studies in stem cell based approaches in treating knee osteoarthritis.

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  • Effect of single injection of Platelet-Rich Plasma in comparison with corticosteroid on knee osteoarthritis: a double-blind randomized clinical trial

    Abstract

    AIM: Evidence on the effect of Platelet-Rich Plasma (PRP) in treating osteoarthritis (OA) is insufficient. Therefore, the present study compares the effects of a one-time injection of PRP and corticosteroid (CS) as two types of treatment for the patients suffering from osteoarthritis. METHODS: In the present randomized double blind clinical trial, the participants who suffered from knee osteoarthritis (Grades II/III), were randomly divided into two groups: intra articular injection of PRP and CS. Knee injury and osteoarthritis outcome score (KOOS), the 20-meter-walk test, active and passive ranges of motions (ROM), flexion contracture, and pain intensity based on Visual Analog Scale (VAS) were assessed before, 2-months, and 6-months after interventions. RESULTS: 41 participants (48 knees) were involved in the research (66.7% women; average age of 61.1 ±7.0 years old). Compared to the group treated with corticosteroid, pain relief (df:6 ,35 ;F=11.0 ;p=0.007), symptom free (df:6 ,35 ;F=23.0 ;p<0.001), activities of daily living (ADL) (df:6 ,35 ;F=10.7 ;p=0.005) and quality of life (df:6 ,35 ;F=5.2 ;p=0.02) in the RPR group were significantly higher, but sporting ability was not different between the 2 groups (df:6 ,35 ;F=0.6 ;p=0.55). PRP prescription was significantly more helpful for relieving patients\' pain (VAS) compared to corticosteroids (df:6,35;F=32.0 ;p,0.001).It\'s also notable that using PRP was more helpful in improving the 20-meter-walk test than corticosteroid treatment (df:6 ,35 ;F=7.4 ;p=0.04) but none of the treatments had any impact on active flexion ROM ØŒpassive flexion ROM and flexion contracture (p>0.05).

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  • Combination therapy with intra-articular injection of mesenchymal stem cells and articulated joint distraction for repair of a chronic osteochondral defect in the rabbit

    Abstract

    The present study investigated intra-articular injection of bone-marrow-derived mesenchymal stem cells (MSCs) combined with articulated joint distraction as treatment for osteochondral defects. Large osteochondral defects were created in the weight-bearing area of the medial femoral condyle in rabbit knees. Four weeks after defect creation, rabbits were divided into six groups: control group, MSC group, distraction group, distraction + MSC group, temporary distraction group, and temporary distraction + MSC group. Groups with MSC received intra-articular injection of MSCs. Groups with distraction underwent articulated distraction arthroplasty. Groups with temporary distraction discontinued the distraction after 4 weeks. The rabbits were euthanized at 4, 8, and 12 weeks after treatment except temporary distraction groups which were euthanized at only 12 weeks. Histological scores in the distraction + MSC group were significantly better than in the control, MSC group or distraction group at 4 and 8 weeks, but showed no further improvement. At 12 weeks, the temporary distraction + MSC group showed the best results, demonstrating hyaline cartilage repair with regeneration of the osteochondral junction. In conclusion, joint distraction with intra-articular injection of MSCs promotes early cartilage repair, and compressive loading of the repair tissue after temporary distraction stimulates articular cartilage regeneration.

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  • Treatment of Articular Cartilage Injury Using Mesenchymal Stem Cells.

    Abstract

    Articular cartilage lesions can be a debilitating disease resulting in the development of osteoarthritis (OA). In recent years, mesenchymal stem cell (MSC) strategies combined with the microfracture technique are emerging as a powerful tool for cartilage repair. Even though there are some successful reports of MSCs treatments, many aspects have to be optimized such as best cell source and application method. The interest in this field is growing and randomized controlled trials are needed to show the potential of MSC treatment.

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  • Chondrogenically Primed Mesenchymal Stem Cell-Seeded Alginate Hydrogels Promote Early Bone Formation in Critically-Sized Defects

    Abstract

    Hypertrophic cartilaginous grafts can be engineered in vitro using bone marrow derived Mesenchymal Stem Cells (MSCs). When such engineered tissues are implanted in vivo they have been shown to induce bone formation by recapitulating aspects of the developmental process of endochondral ossification. Alginate, a naturally sourced and biocompatible hydrogel, offers an attractive 3D environment to facilitate the in vitro chondrogenesis of MSCs. Furthermore, such alginate hydrogels can potentially be used to engineer cartilage tissues of scale to promote endochondral bone regeneration in large bone defects. The aim of this study was to investigate the ability of chondrogenically-primed MSC-laden alginate hydrogels to induce healing in two distinct critically-sized defect models. Bone marrow derived MSCs were seeded into alginate hydrogels, chondrogenically primed in vitro in the presence of TGF-β3 and then implanted into either a critically-sized rat cranial or femoral defect. μCT analysis 4 weeks post-implantation revealed significantly higher levels of mineralization within the femoral defects treated with MSC-laden alginate hydrogels compared to untreated empty controls, with similar results observed within the cranial defects. However, any newly deposited bone was generated appositional to the alginate material, and occurred only superficially or where the alginate was seen to degrade. Alginate material was found to persist within both orthotopic locations 8 weeks post-implantation, with its slow rate of degradation appearing to prevent complete bone regeneration. In conclusion, while chondrogenically primed MSC-alginate constructs can act as templates to treat critically-sized defects within bones formed through either intramembranous or endochondral ossification, further optimization of the degradation kinetics of the hydrogel itself will be required to accelerate bone tissue deposition and facilitate complete regeneration of such defects.

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  • Re: Ultrasound-guided platelet-rich-plasma injection for distal biceps tendinopathy

    We would like to congratulate Barker et

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  • Treatment of Knee Osteoarthritis with Autologous Expanded Bone Marrow Mesenchymal Stem Cells: 50 Cases Clinical and MRI Results at One Year Follow-Up

    Abstract

    Knee osteoarthritis is one of the most prevalent joint diseases, causing pain, function loss and disability, leading to a progressive cartilage degeneration induced by biochemical changes in its composition. Current available treatments focus on addressing symptoms and joint replacement is the last treatment option.

    Advanced therapies with mesenchymal stem cells build new expectations to improve the results of OA treatments. MSC applied in animal models, show encouraging results in modulating inflammation and joint cartilage repair. Several studies applied autologous mesenchymal stem cells to treat knee osteoarthritis in humans by means of an intra-articular injection.

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  • A randomized controlled trial of intra-articular prolotherapy versus steroid injection for sacroiliac joint pain

    Abstract

    OBJECTIVES: Controversy exists regarding the efficacy of ligament prolotherapy in alleviating sacroiliac joint pain. The inconsistent success rates reported in previous studies may be attributed to variability in patient selection and techniques between studies. It was hypothesized that intra-articular prolotherapy for patients with a positive response to diagnostic block may mitigate the drawbacks of ligament prolotherapy. The purpose of this study was to evaluate the efficacy and long-term effectiveness of intra-articular prolotherapy in relieving sacroiliac joint pain, compared with intra-articular steroid injection.

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