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  • Patellofemoral and tibiofemoral articular cartilage and subchondral bone health following arthroscopic partial medial meniscectomy

    Abstract

    PURPOSE: To examine articular cartilage and subchondral bone changes in tibiofemoral and patellofemoral joints following partial medial meniscectomy.

    METHODS: For this cross-sectional study, 158 patients aged 30-55 years, without evidence of knee osteoarthritis at arthroscopic partial medial meniscectomy (APMM), and 38 controls were recruited. MRI was performed once on the operated knee for each subcohort of 3 months, 2 or 4 years post-surgery, and the randomly assigned knee of the controls. Cartilage volume, cartilage defects, and bone size were assessed using validated methods.

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  • Chronic Buttock Pain Alleviated with Platelet-Rich Plasma: A Case Report

    Abstract

    Background: Given the potential to augment tissue repair and regeneration, platelet-rich plasma [PRP] has been advocated to treat hamstring injuries.

    Findings: The present report details the case of a 34-year-old physically fit male who presented with chronic pain, localized in the left buttock. This pain had persisted for 3 years. The patient consulted multiple physicians, exhausted conservative treatment modalities, and underwent lumbar laminectomy without success. When treated with a single PRP injection, the patient had significant improvements in pain and quality of life.

    Conclusion: A single PRP injection has potential to treat hamstring injuries and restore pre-injury function in athletes.

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  • Chronic anti-platelet therapy: a contraindication for platelet-rich plasma intra-articular injections?

    Abstract. - We report the case of a 50 yearsold man who complained persisting knee pain that limited almost completely his sport performance. Since he previously underwent multiple aortocoronaric by-passes, he presented a chronic anti-aggregant therapy. In spite of this clinical history, he was still sport active and able to run long-distance races, until knee symptoms limited is activity level. Conservative treatment approaches proved to be unsuccessful, thus we decided to treat him by 3 Plateletrich Plasma (PRP) injections even if chronic anti-aggregant therapy is generally regarded as a contra-indication for PRP, since this kind of drugs impairs platelet function and granules\'release. Despite these premises, the clinical outcome was very satisfactory and the patient was able to rapidly resume intensive running activity. This experience opens new questions regarding the real potential of PRP in treating degenerative musculo-skeletal disorders, and in particular on its range of biological actions and on its limitations for clinical application.

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  • A Comparison between Platelet-Rich Plasma (PRP) and Hyaluronate Acid on the Healing of Cartilage Defects

    Abstract

    Platelet-rich plasma (PRP) has offered great promise for the treatment of cartilage degradation, and has been proved to have positive effects on the restoration of cartilage lesions. But no comparative work has been done between PRP and hyaluronate acid (HA) concerning their restoring effect on cartilage defect, especially by means of animal experiments and histologic assessments. The purpose of the study was to compare the therapeutic effects of P-PRP and HA on osteoarthritis in rabbit knees. Thirty rabbits were used to establish the animal models by creating a cartilage defect of 5 mm in diameter on the condyles of the femurs, and were randomly divided into three groups: the P-PRP group, HA group and the control group. Then each group was treated with P-PRP, HA or saline solution, respectively. Six and twelve weeks later the rabbits were sacrificed and the samples were collected. The platelet number, the concentrations of growth factors of P-PRP and whole blood, and the IL-1β concentration in the joint fluid were investigated, and the histological assessment of the cartilage were performed according to Mankin\'s scoring system. Micro-CT was also used to evaluate the restoration of subchondral bone. The platelet concentration in P-PRP is 6.8 fold of that in the whole blood. The IL-1β level in the P-PRP group was lower than in the HA group (p<0.01) and in the control group (p<0.01). The restoration of the defected cartilage as well as the subchondral bone was better in the P-PRP group than in the HA group or the control group (P<0.05). Our data showed that P-PRP is better than HA in promoting the restoration of the cartilage and alleviating the arthritis caused by cartilage damage.

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  • A MANUAL METHOD TO OBTAIN PLATELET RICH PLASMA

    Abstract

    Objective: This study is to report a manual method to obtain platelet rich plasma (PRP). Methods: For this study 61 ml of peripheral blood was obtained and submitted to centri- fugation at 541g for 5 min. The centrifugation separates the blood into three components: red blood cells, buffy coat and platelet rich plasma. Blood and platelet rich plasma samples were sent to the Hospital\'s Laboratory and platelets and leukocytes were measured. Results: A sample of 637 blood donors was evaluated. The platelet yield efficiency was 86.77% and the increase in platelet concentration factor was 2.89 times. The increase in leukocyte concentration factor was 1.97 times. Conclusion: The method described here produces leukocyte-rich and platelet-rich plasma with a high platelet and leukocyte increased factor. Level of Evidence IV, Controlled Laboratory Study.

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  • Dextrose and morrhuate sodium injections (prolotherapy) for knee osteoarthritis: a prospective open-label trial

    Abstract

    Abstract Objectives: This study determined whether injection with hypertonic dextrose and morrhuate sodium (prolotherapy) using a pragmatic, clinically determined injection schedule for knee osteoarthritis (KOA) results in improved knee pain, function, and stiffness compared to baseline status. Design: This was a prospective three-arm uncontrolled study with 1-year follow-up. Setting: The setting was outpatient. Participants: The participants were 38 adults who had at least 3 months of symptomatic KOA and who were in the control groups of a prior prolotherapy randomized controlled trial (RCT) (Prior-Control), were ineligible for the RCT (Prior-Ineligible), or were eligible but declined the RCT (Prior-Declined). Intervention: The injection sessions at occurred at 1, 5, and 9 weeks with as-needed treatment at weeks 13 and 17. Extra-articular injections of 15% dextrose and 5% morrhuate sodium were done at peri-articular tendon and ligament insertions. A single intra-articular injection of 6 mL 25% dextrose was performed through an inferomedial approach. Outcome measures: The primary outcome measure was the validated Western Ontario McMaster University Osteoarthritis Index (WOMAC). The secondary outcome measure was the Knee Pain Scale and postprocedure opioid medication use and participant satisfaction. Results: The Prior-Declined group reported the most severe baseline WOMAC score (p=0.02). Compared to baseline status, participants in the Prior-Control group reported a score change of 12.4

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  • The effects of repeated intra-articular PRP injections on clinical outcomes of early osteoarthritis of the knee

    Abstract

    PURPOSE: To assess the outcome of intra-articular platelet-rich plasma (PRP) injections into the knee in patients with early stages of osteoarthritis (OA) and to determine whether cyclical dosing would affect the end result.

    METHODS: This is a prospective, randomized study in which 93 patients (119 knees) were followed up for a minimum of 2

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  • A Single Platelet-Rich Plasma Injection for Chronic Midsubstance Achilles Tendinopathy A Retrospective Preliminary Analysis

    Abstract

    The purpose of this study was to evaluate a series of patients undergoing a single platelet-rich plasma (PRP) injection for the treatment of chronic midsubstance Achilles tendinopathy, in whom conservative treatment had failed. Thirty-two patients underwent a single PRP injection for the treatment of chronic midsubstance Achilles tendinopathy and were evaluated at a 6-month final follow-up using the Foot and Ankle Outcome Score and Short Form 12 general health questionnaire. Magnetic resonance imaging was performed on all patients prior to and 6 months after injection. Twenty-five of 32 patients (78%) reported that they were asymptomatic at the 6-month follow-up visit and were able to participate in their respective sports and daily activities. The remaining 7 patients (22%) who reported symptoms that did not improve after 6 months ultimately required surgery. Four patients went on to have an Achilles tendoscopy, while the other 3 had an open debridement via a tendon splitting approach. A retrospective evaluation of patients receiving a single PRP injection for chronic midsubstance Achilles tendinopathy revealed that 78% had experienced clinical improvement and had avoided surgical intervention at 6-month follow-up.

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  • Prolotherapy: a clinical review of its role in treating chronic musculoskeletal pain.

    Abstract

    Prolotherapy is a technique that involves the injection of an irritant, usually a hyperosmolar dextrose solution, typically in the treatment of chronic painful musculoskeletal conditions. Despite its long history and widespread use as a form of complementary therapy, there still are disparities over its optimal indications and injection preparations. There are, however, numerous studies available regarding the use and efficacy of prolotherapy for various musculoskeletal conditions. The most frequently published indication is in the treatment of chronic low back pain, but there are recent studies that examined its use in the management of refractory tendinopathies as well as osteoarthritis. There is growing evidence to suggest that prolotherapy may be helpful in treating chronic low back pain when coupled with adjunctive therapies, such as spinal manipulation or corticosteroid injections. There is also evidence to suggest that prolotherapy is effective in treating refractory tendinopathies, particularly for lateral epicondylosis and Achilles tendinopathy. Additional larger, randomized controlled trials are needed to make specific recommendations regarding ideal protocols and indications. There is emerging evidence for the use of prolotherapy as a treatment option for osteoarthritis; however, further studies are needed to conclusively demonstrate its efficacy. Overall, prolotherapy remains a promising option for the treatment of painful musculoskeletal conditions, particularly when other standard treatments have proved ineffective.

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  • Considerations for the Use of Platelet-Rich Plasma in Orthopedics

    Abstract

    The use of platelet-rich plasma (PRP) is expanding to numerous medical fields, including orthopedic surgery and sports medicine. The popularity of this new treatment option has prompted a rapid increase in research endeavors; however, the differences in application technique and the composition of PRP have made it difficult to compare results or make any firm conclusions regarding efficacy. The purpose of this article is twofold. First, to recommend details that should be provided in basic science and clinical PRP studies to allow meaningful comparisons between studies which may lead to a better understanding of efficacy. Second, to provide an understanding of the different PRP preparations and their clinical relevance. There are biochemical rationales for the use of PRP because it addresses several aspects of the healing process, including cell proliferation and tissue matrix regeneration, inflammation, nociception, infection, and hemostasis, all of which will be addressed. Given the current understanding of the importance the composition of PRP plays in tissue regeneration, it is likely that our future understanding of PRP will dictate \'customizing\' the PRP preparation to the specific pathology of interest. The potential complications following PRP use are minor, and thus it appears to be a safe treatment option with a variety of potentially beneficial effects to injured musculoskeletal tissues.

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  • Platelet and growth factor concentrations in activated platelet-rich plasma: a comparison of seven commercial separation systems

    Abstract

    Platelet-rich plasma (PRP) is blood plasma that has been enriched with platelets. It holds promise for clinical use in areas such as wound healing and regenerative medicine, including bone regeneration. This study characterized the composition of PRP produced by seven commercially available separation systems (JP200, GLO PRP, Magellan Autologous Platelet Separator System, KYOCERA Medical PRP Kit, SELPHYL, MyCells, and Dr. Shin\'s System THROMBO KIT) to evaluate the platelet, white blood cell, red blood cell, and growth factor concentrations, as well as platelet-derived growth factor-AB (PDGF-AB), transforming growth factor beta-1 (TGF-β1), and vascular endothelial growth factor (VEGF) concentrations. PRP prepared using the Magellan Autologous Platelet Separator System and the KYOCERA Medical PRP Kit contained the highest platelet concentrations. The mean PDGF-AB concentration of activated PRP was the highest from JP200, followed by the KYOCERA Medical PRP Kit, Magellan Autologous Platelet Separator System, MyCells, and GLO PRP. TGF-β1 and VEGF concentrations varied greatly among individual samples, and there was almost no significant difference among the different systems, unlike for PDGF. The SELPHYL system produced PRP with low concentrations of both platelets and growth factors. Commercial PRP separation systems vary widely, and familiarity with their individual advantages is important to extend their clinical application to a wide variety of conditions.

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  • The effects of repeated intra-articular PRP injections on clinical outcomes of early osteoarthritis of the knee

    Abstract

    Purpose

    To assess the outcome of intra-articular platelet-rich plasma (PRP) injections into the knee in patients with early stages of osteoarthritis (OA) and to determine whether cyclical dosing would affect the end result.

    Methods

    This is a prospective, randomized study in which 93 patients (119 knees) were followed up for a minimum of 2

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  • Ultrasound-guided Prolotherapy with Polydeoxyribonucleotide Sodium in Ischiofemoral Impingement Syndrome

    Abstract

    Ischiofemoral impingement syndrome is an uncommon disorder defined by hip pain caused by the narrowing of the space between the ischial tuberosity and lesser trochanter with associated entrapment of the quadratus femoris muscle. We effectively treated two male patients using ultrasound-guided prolotherapy with polydeoxyribonucleotide sodium mixed with local anesthetics. A 24-year-old male patient with no history of trauma or surgery complained of bilateral hip and groin pain; magnetic resonance imaging demonstrated slight narrowing of the bilateral ischiofemoral spaces with mild enhancement of the left quadratus femoris muscle. A 23-year-old male patient with a history of iliotibial band release and iliopsoas tendon release complained of left hip and groin pain; magnetic resonance imaging revealed swelling of the left quadratus femoris muscle. After the fifth treatment session of prolotherapy, the pain severity score using the visual analog scale was found to be minimal (0-1/10), and follow-up magnetic resonance imaging revealed a slightly decreased enhancement of the quadratus femoris muscle compared with that on previous images. Prolotherapy with polydeoxyribonucleotide sodium was an efficacious treatment for two patients with ischiofemoral impingement syndrome who were not candidates for surgery.

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  • Treatment of advanced stage gonarthrosis with prolotherapy: case report

    Abstract

    INTRODUCTION: This case report aims to discuss the clinical and radiological outcomes of prolotherapy at a patient whom to total knee prosthesis had been planned but surgery couldn\'t be performed due to co-morbidities.

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  • Arquivo Brasileiro de Medicina Veterinסria e Zootecnia

    Platelet rich plasma associated with heterologous fresh and thawed chondrocytes on osteochondral lesions of rabbits

    Associaקףo de plasma rico em plaquetas e condr

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  • Intratendinous Injection of Platelet-Rich Plasma under US Guidance to Treat Tendinopathy: A Long-Term Pilot Study

    Abstract

    Purpose

    To assess the potential therapeutic effect of intratendinous injection of platelet-rich plasma (PRP) under ultrasound (US) guidance to treat tendon tears and tendinosis in a pilot study with long-term follow-up.

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  • The Effect of Platelet-Rich Plasma Formulations and Blood Products on Human Synoviocytes Implications for Intra-articular Injury and Therapy

    Abstract

    Background: The effect of platelet-rich plasma (PRP) on chondrocytes has been studied in cell and tissue culture, but considerably less attention has been given to the effect of PRP on synoviocytes. Fibroblast-like synoviocytes (FLS) compose 80% of the normal human synovium and produce cytokines and matrix metalloproteinases that can mediate cartilage catabolism.

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  • Outcomes of prolotherapy in chondromalacia patella patients: improvements in pain level and function

    Abstract

    We retrospectively evaluated the effectiveness of prolotherapy in resolving pain, stiffness, and crepitus, and improving physical activity in consecutive chondromalacia patients from February 2008 to September 2009. Sixty-nine knees that received prolotherapy in 61 patients (33 female and 36 male) who were 18-82 years old (average, 47.2 years) were enrolled. Patients received 24 prolotherapy injections (15% dextrose, 0.1% procaine, and 10% sarapin) with a total of 40 cc in the anterior knee. At least 6 weeks after their last prolotherapy session, patients provided self-evaluation of knee pain upon rest, activities of daily living (ADL) and exercise, range of motion (ROM), stiffness, and crepitus. Symptom severity, sustained improvement of symptoms, number of pain pills needed, and patient satisfaction before treatment and improvement after treatment were recorded. Following prolotherapy, patients experienced statistically significant decreases in pain at rest, during ADL, and exercise. Stiffness and crepitus decreased after prolotherapy, and ROM increased. Patients reported improved walking ability and exercise ability after prolotherapy. For daily pain level, ROM, daily stiffness, crepitus, and walking and exercise ability, sustained improvement of over 75% was reported by 85% of patients. Fewer patients required pain medication. No side effects of prolotherapy were noted. The average length of time from last prolotherapy session was 14.7 months (range, 6 months to 8 years). Only 3 of 16 knees were still recommended for surgery after prolotherapy. Prolotherapy ameliorates chondromalacia patella symptoms and improves physical ability. Patients experience long-term improvement without requiring pain medications. Prolotherapy should be considered a first-line, conservative therapy for chondromalacia patella.

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  • Platelet-rich plasma in regenerative medicine

    Abstract

    Platelet-rich plasma (PRP) contains at least seven growth factors including epidermal growth factor, platelet-derived growth factor, transforming growth factor-beta, vascular endothelial growth factor, fibroblast growth factor, insulin-like growth factor, and keratinocyte growth factor. The therapeutic effect of PRP occurs because of the high concentration of these growth factors compared with that in normal plasma. In recent years, has been widely used across many clinical fields, especially regenerative medicine. This review will present an overview of applications of PRP in regenerative medicine. The mechanisms of PRP effects on healing also are mentioned in this review.

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  • Comparison of Platelet-Rich Plasma Formulations for Cartilage Healing: An in Vitro Study

    Background:

    Platelet-rich plasma (PRP) has been advocated as one treatment for cartilage tissue regeneration. To date, several different platelet-rich formulations have been available, but a deep knowledge of their composition and mechanism of action in a specific clinical use is needed. The aim of this study was to investigate the effect of various PRP formulations on human chondrocytes in vitro.

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