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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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  • Can the combination of localized \

    Summary

    Regenerative injection therapy (RIT), also known as proliferative therapy, has been used for over 30 years in the USA in patients with spinal and peripheral joint and ligamentous pathologies. It involves the injection of mildly irritating medications onto ligaments and tendons, most commonly at origins and insertions. These injections cause a mild inflammatory response which \"turns on\" the normal healing process and results in the regeneration of these structures. At the same time they strengthen and become less sensitive to pain through a combination of neurolysis of small nerve fibers (C-fibers) and increased stability of the underlying structures.

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  • Intraarticular injection of platelet-rich plasma reduces inflammation in a pig model of rheumatoid arthritis of the knee joint

    Abstract

    OBJECTIVE: Treatment options for rheumatoid arthritis range from symptomatic approaches to modern molecular interventions such as inhibition of inflammatory mediators. Inhibition of inflammation by platelet-rich plasma (PRP) has been proposed as a treatment for tendinitis and osteoarthritis. The present study was undertaken to investigate the effect of PRP on antigen-induced arthritis (AIA) of the knee joint in a large animal model.

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  • Stem cell knee injection shown to regenerate meniscus, reduce pain

    Results of a randomized, double-blind controlled study in the Journal of Bone and Joint Surgery supported the use of human mesenchymal stem cell for meniscal regeneration and the control of knee pain.

    \"There was evidence of meniscus regeneration and improvement in knee pain following treatment with allogeneic human mesenchymal stem cells,\" C. Thomas Vangsness Jr., MD, and colleagues wrote in the study. \"These results support the study of human mesenchymal stem cells for the apparent knee-tissue regeneration and protective effects. € The study followed 55 patients at seven institutions who underwent partial medial meniscectomy and received the study treatment 7 days to 10 days after meniscectomy via a superolateral knee injection.

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  • Human fibroblast-like cultures in the presence of platelet-rich plasma as a single growth factor source: clinical implications

    OBJECTIVE: The purpose of this study was to compare the proliferation, morphology, and antigenic expression of human fibroblast-like cells between primary cultures treated with platelet-rich plasma (PRP) or fetal bovine serum (FBS) as the growth factor source.

    DESIGN: Cells from human gingival tissue samples obtained from healthy volunteers during oral surgery were studied. Isolated cells were cultured in media supplemented with 10% PRP or FBS. Platelet-rich plasma was prepared from the venous blood of each patient. The authors studied short- and long-term cell cultures in the presence of PRP or FBS as the sole growth factor source in order to determine (a) cell growth rate, by MTT (3-[4,5-Dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) assay; (b) cell morphology, by electronic microscopy; and (c) antigenic expression, by flow cytometry and confocal microscopy.

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  • Knee osteoarthritis: hyaluronic acid, platelet-rich plasma or both in association?

    Introduction: Bidirectional interactions between cells and fluidic surroundings regulate cellular functions and maintain tissue or organ architecture. Accordingly, the synovial fluid is the primary source of environmental signals and determines to a great extent the molecular interactions within the joint capsule, both in homeostasis and pathology.

    Areas covered: We provided an update on hyaluronic acid (HA) and platelet-rich plasma (PRP) concepts necessary to build the rationale for creating a combined treatment. The information is based on a PubMed search using the terms \'platelet-rich plasma\', \'hyaluronic acid\', \'knee pathology\', \'knee osteoarthritis\' (OA).

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  • Orthobiologics and platelet rich plasma

    Abstract

    Orthobiologics have evolved to the extent that they significantly influence modern orthopedic surgical practice. A better understanding of the role of various growth factors and cells in the process of tendon healing, ligament repair, cartilage regeneration and bone formation has stimulated focused research in many chronic musculoskeletal ailments. Investigators have published results of laboratory as well as clinical studies, using orthobiologics like platelet rich plasma, stem cells, autologous conditioned serum etc., with variable results. However, a clear consensus over the best orthobiologic substance and the method of preparation and usage of these substances is lacking. Much of the confusion is due to the fact that studies ranging from RCTs to case reports present variable results, and the interpretations are wide-ranging. We have reviewed the available orthobiologics related data with a focus on platelet rich plasma in orthopedic conditions.

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  • Are Multiple Platelet-Rich Plasma Injections Useful for Treatment of Chronic Patellar Tendinopathy in Athletes?

    Abstract

    Background: Chronic patellar tendinopathy (PT) is one of the most common overuse knee disorders. Platelet-rich plasma (PRP) appears to be a reliable nonoperative therapy for chronic PT.

    Purpose: To evaluate clinical and radiological outcomes of 3 consecutive ultrasound (US)-guided PRP injections for the treatment of chronic PT in athletes.

    Study Design: Case series; Level of evidence, 4.

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  • Platelet-Rich Plasma (PRP) Promotes Fetal Mesenchymal Stem/Stromal Cell Migration and Wound Healing Process

    Abstract

    Numerous studies have shown the presence of high levels of growth factors during the process of healing. Growth factors act by binding to the cell surface receptors and contribute to the subsequent activation of signal transduction mechanisms. Wound healing requires a complex of biological and molecular events that includes attraction and proliferation of different type of cells to the wound site, differentiation and angiogenesis. More specifically, migration of various cell types, such as endothelial cells and their precursors, mesenchymal stem/stromal cells (MSCs) or skin fibroblasts (DFs) plays an important role in the healing process. In recent years, the application of platelet rich plasma (PRP) to surgical wounds and skin ulcerations is becoming more frequent, as it is believed to accelerate the healing process. The local enrichment of growth factors at the wound after PRP application causes a stimulation of tissue regeneration. Herein, we studied: (i) the effect of autologous PRP in skin ulcers of patients of different aetiology, (ii) the proteomic profile of PRP, (iii) the migration potential of amniotic fluid MSCs and DFs in the presence of PRP extract in vitro, (iv) the use of the PRP extract as a substitute for serum in cultivating AF-MSCs. Considering its easy access, PRP may provide a valuable tool in multiple therapeutic approaches.

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  • Inhibition of Chondrocyte and Synovial Cell Death After Exposure to Commonly Used Anesthetics: Chondrocyte Apoptosis After Anesthetics

    Background:

    An intra-articular injection of local anesthetics is a common procedure for diagnostic and therapeutic purposes. It has been shown that these agents are toxic to articular cartilage and synovial tissue in a dose- and time-dependent fashion, and in some cases, they may lead to postarthroscopic glenohumeral chondrolysis (PAGCL). However, the role of apoptosis in cell death is still unclear, and the potential role of apoptosis inhibition in minimizing chondrocyte and synovial cell death has not been reported.

    Purpose: (1) To quantify the degree of apoptotic cell death in chondrocytes and synovial cells exposed to local anesthetics, and(2) to determine whether caspase inhibition could reduce cell death.

    Study Design: Controlled laboratory study.

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