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  • Radiological study of the effect of Platelet Rich Plasma (PRP) on experimentally induced Osteoarthritis in Guinea Pig\'s stifle joint

    Abstract

    The purpose of this radiologic, longitudinal study was to estimate the effects of the platelet rich plasma (PRP) on improvement of the defective articular cartilage in an osteoarthritis (OA) model. The PRP is an autologous product that concentrates a high number of platelets in a small volume of plasma. It mimics the last step of the coagulation cascade, leading to formation of a fibrin clot, which consolidates and adheres to the application site in a short period of time. Twenty adult guinea pigs (treatment group, n = 10; control group, n = 10) were anesthetized and the anterior cruciate ligament of the left knee was transected through a para-patellar approach. The animals were allowed to resume normal cage activity for 12 weeks. For the preparation of PRP, 2 ml blood was collected into a Na-citrate tube by direct heart puncture. Twelve weeks post-operation PRP was injected into the OA joint of the treatment group only. The animals were observed for further 8 weeks. At 20 weeks radiological score of OA increased in control group. Reduction in the degree of osteophyte formation, and subchondral bone sclerosis were detected in the PRP-treated joints. In conclusion, this study shows beneficial effects of the PRP on improvement of the defective articular cartilage in the OA joint.

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  • Platelet-rich Plasma for Articular Cartilage Repair

    Abstract

    Platelet concentrates have been gaining popularity for a number of applications in orthopedic surgery as a way to enhance both healing of various tissues and reduce pain. One major area of focus has been the effect of platelet-rich plasma (PRP) on stem cells and chondrocytes and the potential for PRP to enhance cartilage regeneration as well as reduce catabolic factors that lead to cartilage degradation. This article provides an up-to-date review of the current literature regarding the effect of PRP on articular cartilage and its use in the treatment of osteoarthritis. Basic science, animal, and human clinical investigations are presented. In general, PRP has been shown to promote chondrogenic differentiation in vitro and lead to enhanced cartilage repair during animal investigations. Human trials, mostly conducted in the form of injection into knees with osteoarthritis, have shown promise in a number of investigations for achieving symptomatic relief of pain and improving function.

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  • The use of platelet-rich plasma in the nonsurgical management of sports injuries: hype or hope?

    Abstract

    Interest in platelet-rich plasma (PRP) has skyrocketed over the last decade, with a growing body of research contributing to both excitement and skepticism regarding its use. Despite mixed opinions in the medical field, interest from the public has fueled increased utilization of PRP for musculoskeletal conditions, particularly those that are difficult to treat such as chronic, degenerative tendinopathy and osteoarthritis. PRP\'s reputation as a \"natural healer\" and stories in the lay press featuring the use of PRP by professional athletes and celebrities has created a lucrative market for PRP even absent insurance reimbursement, casting further doubt regarding motivation for use by some practitioners. Research of PRP is clouded by the fact that PRP is a heterogeneous term representing a variety of different platelet preparations and there are many variables in technique and postprocedure rehabilitation, all of which may have significant effects on outcome. This article discusses definitions and classification of PRP, reviews rationale and evidence for use of PRP in chronic tendon injuries and osteoarthritis, and looks at future directions.

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  • Ultrasound-guided interventional procedures around the shoulder

    Abstract

    The aim of this review is to illustrate the spectrum of ultrasound-guided procedures around the shoulder. The shoulder is affected by a wide range of both, traumatic and degenerative diseases. Ultrasound guidance is a low-cost and safe tool to perform minimally invasive interventional procedures around the shoulder. The clinical outcome is shown by the use of clinical scores: visual analogue scale (VAS), Constant\'s score and Shoulder Pain Disability Index (SPADI). Rotator cuff calcification is a common painful condition that occurs in up to 7.5

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  • Platelet-rich Plasma in Orthopaedic Applications: Evidence-based Recommendations for Treatment

    From the Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL (Dr. Hsu and Dr. Terry), the Department of Orthopaedic Surgery, Stanford University Medical Center, Stanford, CA (Dr. Mishra), the Department of Orthopaedic Surgery and the Research Department, Hospital for Special Surgery, New York, NY (Dr. Rodeo), the Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA (Dr. Fu), the Department of Orthopaedic Surgery, University of Milan, Milan, Italy (Dr. Randelli), the Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, TN (Dr. Canale), and Forsyth Street Orthopaedics, Macon, GA (Dr. Kelly).

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  • Comparative Effectiveness of Platelet-Rich Plasma Injections for Treating Knee Joint Cartilage Degenerative Pathology: A Systematic Review and Meta-analysis

    Abstract

    Objectives

    To explore the effectiveness of platelet-rich plasma (PRP) in treating cartilage degenerative pathology in knee joints.

    Data Sources

    Electronic databases, including PubMed and Scopus, were searched from the earliest record to September 2013.

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  • Platelet-Rich Plasma for the Treatment of Chronic Plantar Fasciopathy in Adults

    Abstract

    Plantar fasciopathy (PF) is a common source of pain and disability that is often refractory to conservative management. There are no uniformly effective standard-of-care treatments for chronic recalcitrant PF. Corticosteroid injection is considered a viable treatment option when traditional therapies fail, but is limited by suboptimal long-term efficacy and potential adverse effects. Platelet-rich plasma (PRP) is an emerging injection-based treatment for various chronic degenerative soft-tissue diseases. It is postulated to promote native tissue regeneration; however, consistent scientific evidence remains lacking. A prospective case series, including 24 consecutive PF cases, was conducted to report patient-rated pain and disability following PRP injection. Foot and Ankle Ability Measure (FAAM) scores were the primary clinical outcome measure. Foot-Single Assessment Numeric Evaluation (Foot-SANE) scores, Short Form-12 Health Survey version 2 (SF-12v2) questionnaires, and PRP treatment satisfaction surveys were secondary outcome measures. Statistical analysis compared baseline and 32 weeks post-injection time points. Patients receiving PRP injection reported clinically and statistically significant improvement in all outcome measures during this interval. There were no serious adverse events associated with treatment. PRP is considered a safe therapeutic option with the ability to decrease heel pain in patients with chronic PF refractory to appropriate conservative management.

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  • Modified dextrose prolotherapy for recurrent temporomandibular joint dislocation

    Abstract

    Conservative interventions with simple procedures and predictable benefits are expected by patients with recurrent dislocation of the temporomandibular joint (TMJ). We have introduced a modified technique of prolotherapy that comprises injection of lignocaine and 50% dextrose at a single site in the posterior periarticular tissues. We studied the effects in 45 younger patients (age range 17-59 years) with non-neurogenic recurrent dislocation of the TMJ, and confirmed the therapeutic effect after more than a year\'s follow-up. There were appreciable improvements in the number of episodes of dislocation and clicking after the injection. The overall success rate, defined as the absence of any further dislocation or subluxation for more than 6 months, was 41/45 (91%). Of the 41 rehabilitated patients, 26 (63%) required a single injection, 11 (27%) had 2 treatments, and 4 (10%) needed a third injection. All patients tolerated the injections well. The modified dextrose prolotherapy is simple, safe, and cost-effective for the treatment of recurrent dislocation of the TMJ.

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  • Platelet-rich plasma: why intra-articular? A systematic review of preclinical studies and clinical evidence on PRP for joint degeneration

    Abstract

    Purpose

    The aim of this review was to analyze the available evidence on the clinical application of this biological approach for the injective treatment of cartilage lesions and joint degeneration, together with preclinical studies to support the rationale for the use of platelet concentrates, to shed some light and give indications on what to treat and what to expect from intra-articular injections of platelet-rich plasma (PRP).

    Methods

    All in vitro, in vivo preclinical and clinical studies on PRP injective treatment in the English language concerning the effect of PRP on cartilage, synovial tissue, menisci, and mesenchymal stem cells were considered. A systematic review on the PubMed database was performed using the following words: (platelet-rich plasma or PRP or platelet concentrate or platelet lysate or platelet supernatant) and (cartilage or chondrocytes or synoviocytes or menisci or mesenchymal stem cells).

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  • Corticosteroid and platelet-rich plasma injection therapy in tennis elbow (lateral epicondylalgia): a survey of current UK specialist practice and a call for clinical guidelines

    Abstract

    Background Tennis elbow is a common condition with a variety of treatment options, but little is known about which of these options specialists choose most commonly. Corticosteroid injections in tennis elbow may reduce pain in the short-term but delay long-term recovery. We have undertaken a UK-wide survey of upper limb specialists to assess current practice.

    Methods Cross-sectional electronic survey of current members of the British Elbow and Shoulder Society (BESS) and the British Society for Surgery of the Hand (BSSH).

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  • The Anti-inflammatory and Matrix Restorative Mechanisms of Platelet-Rich Plasma in Osteoarthritis

    Abstract

    Background: Intra-articular (IA) treatment with platelet-rich plasma (PRP) for osteoarthritis (OA) results in improved patient-reported pain and function scores.

    Purpose: To measure the effects of PRP and high molecular weight hyaluronan (HA) on the expression of anabolic and catabolic genes and on the secretion of nociceptive and inflammatory mediators from OA cartilage and synoviocytes.

    Study Design: Controlled laboratory study.

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  • The Anti-inflammatory and Matrix Restorative Mechanisms of Platelet-Rich Plasma in Osteoarthritis

    Abstract

    Background: Intra-articular (IA) treatment with platelet-rich plasma (PRP) for osteoarthritis (OA) results in improved patient-reported pain and function scores.

    Purpose: To measure the effects of PRP and high molecular weight hyaluronan (HA) on the expression of anabolic and catabolic genes and on the secretionof nociceptive and inflammatory mediators from OA cartilage and synoviocytes.

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  • The treatment of intractable plantar fasciitis with platelet-rich plasma injection

    Abstract

    BACKGROUND: Whilst most cases of plantar fasciitis can be settled with existing conservative treatment, a few intractable cases can be difficult to resolve. New biologic treatments have been proposed for a variety of soft tissue problems.

    OBJECTIVE: Evaluate the effectiveness of platelet rich plasma (PRP) in chronic cases of plantar fasciitis.

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  • Platelet Rich Plasma Practical Use in Non-Surgical Musculoskeletal Pathology

    Abstract

    Platelet Rich Plasma is a new emerging treatment modality with fantastic potential to heal both in the surgical and non surgical arenas. This chapter focuses on the Non- surgical applications of Platelet Rich Plasma, primarily in the clinic setting. We have reviewed the current status of PRP preparation, PRP sub types and clinical utilization. It is our intent that this chapter will serve as a guide to those interested in Conservative utilization of PRP in musculoskeletal Medicine.

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  • Platelet Rich Plasma and Its Growth Factors: The State of the Art

    Abstract

    This study aims to offer a general idea of the current progress and discussions about the aspects of technical preparation and biological foundation of PRP for clinical application. We seek to gather the best therapeutic indications that have a scientific foundation on the use of this new tool of Regenerative Medicine. The articles of this study were acquired from the leading data bases of medical literature.

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  • A novel hypothesis: the application of platelet-rich plasma can promote the clinical healing of white-white meniscal tears

    Abstract

    The white-white tears (meniscus lesion completely in the avascular zone) are without blood supply and theoretically cannot heal. Basal research has demonstrated that menisci are unquestionably important in load bearing, load redistribution, shock absorption, joint lubrication and the stabilization of the knee joint. It has been proven that partial or all-meniscusectomy results in an accelerated degeneration of cartilage and an increased rate of early osteoarthritis. Knee surgeons must face the difficult decision of removing or, if possible, retaining the meniscus; if it is possible to retain the meniscus, surgeons must address the difficulties of meniscal healing. Some preliminary approaches have progressed to improve meniscal healing. However, the problem of promoting meniscal healing in the avascular area has not yet been resolved. The demanding nature of the approach as well as its low utility and efficacy has impeded the progress of these enhancement techniques. Platelet-rich plasma (PRP) is a platelet concentration derived from autologous blood. In recent years, PRP has been used widely in preclinical and clinical applications for bone regeneration and wound healing. Therefore, we hypothesize that the application of platelet-rich plasma for white-white meniscal tears will be a simple and novel technique of high utility in knee surgery.

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  • Prolotherapy case

    Regenerative injection therapy with whole bone marrow aspirate for degenerative joint disease: a case series. Hauser RA, et al. Clin Med Insights Arthritis Musculoskelet Disord. 2013

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  • A metaanalysis of the effectiveness and safety of ozone treatments for herniated lumbar discs

    Abstract

    PURPOSE: To determine statistically significant effects of oxygen/ozone treatment of herniated discs with respect to pain, function, and complication rate.

    MATERIALS AND METHODS: Random-effects metaanalyses were used to estimate outcomes for oxygen/ozone treatment of herniated discs. A literature search provided relevant studies that were weighted by a study quality score. Separate metaanalyses were performed for visual analog scale (VAS), Oswestry Disability Index (ODI), and modified MacNab outcome scales, as well as for complication rate. Institutional review board approval was not required for this retrospective analysis.

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  • Autologous bone marrow concentrate: review and application of a novel intra-articular orthobiologic for cartilage disease

    Abstract

    Younger adults, aged < 65 years, increasingly present to their physicians with advanced cartilage disease or post-traumatic osteoarthritis. A number of treatments exist for lessening patient pain and improving patient function. However, many patients are becoming aware of the potential of regenerative therapies and are now seeking solutions to the impaired biology underlying their conditions rather than addressing only their symptoms. Patients do not want to merely lessen their symptoms temporarily with a surgical procedure that replaces damaged tissue, but instead seek correction and repair of the underlying biology to regenerate damaged tissue and alleviate their symptoms altogether. Current therapies for patients with cartilage disease or osteoarthritis range from non-surgical intra-articular injections with biologics, such as hyaluronic acid (HA), to total joint arthroplasty for advanced stages of disease. Total joint arthroplasty is a successful procedure for patients aged > 65 years; however, the limited long-term durability of implanted prostheses decreases the preference of using such methods in more active patients aged < 65 years. The potential of cell-based orthobiologic injection therapies (pertaining to therapeutic injectables that aim to restore the biologic environment and/or structural components of diseased or damaged musculoskeletal tissue) is of tremendous interest for younger, more active patients, and is even more appealing in that such therapy can be delivered at point-of-care in the clinic during an office visit. Notably, the exponential rate of progress in biotechnology has allowed for immediate application of myriad novel therapies prior to clear evidence of benefit from randomized clinical trials. Orthobiologic intra-articular injection therapies include HA and platelet-rich plasma (PRP). We report on current, available findings for a third-generation intra-articular orthobiologic injectable therapy for cartilage disease, bone marrow concentrate (BMC). Bone marrow concentrate contains mesenchymal stem cells (MSCs), hematopoetic stem cells, platelets (containing growth factors), and cytokines. The anti-inflammatory and immunomodulatory properties of bone marrow stem cells (BMSCs) can facilitate regeneration of tissue. Additionally, BMSCs enhance the quality of cartilage repair by increasing aggrecan content and tissue firmness. Following bone marrow aspiration (BMA), BMC is easily prepared using centrifugation, and is available for a same-day procedure with minimal manipulation of cells, thus complying with US Food and Drug Association (FDA) restrictions. To date, there are no published randomized controlled trials on the efficacy of use of autologous BMC intra-articular injections performed as a same-day in-office procedure for treating patients with cartilage disease; however, several publications have reported the ease of use of this method, its strong safety profile, and the fundamental science suggesting great therapeutic potential.

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  • Platelet-rich plasma for managing pain and inflammation in osteoarthritis

    Abstract

    Osteoarthritis (OA) is a common disease involving joint damage, an inadequate healing response and progressive deterioration of the joint architecture. Autologous blood-derived products such as plateletrich plasma (PRP) are key sources of molecules involved in tissue repair and regeneration. In pathological conditions such as OA, these products can deliver a collection of bioactive molecules that have important roles in fundamental processes, including inflammation, angiogenesis, cell migration and metabolism. PRP has anti-inflammatory properties through its effects on the canonical nuclear factor κB signalling pathway in multiple cell types including synoviocytes, macrophages and chondrocytes. PRP contains thousands of different molecules; cells within the joint add to this milieu by secreting additional biologically active molecules in response to PRP.

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