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  • Management of Hepple Stage V Osteochondral Lesion of Talus with Platelet-Rich Plasma (PRP) Scaffold

    Abstract

    Introduction/Purpose: There is no consensus on treatment or prognosis for Hepple stage V Osteochondral lesion of talus (OLTs), especially for lesion more than 1.5 cm2. This research was to investigate surgical techniques and clinical outcomes of platelet-rich plasma (PRP) scaffold for Hepple stage V OLTs.

    Methods: 14 patients were treated by cancellous bone graft with PRP gel scaffold between 2013 and 2015 with average age of 38.9 years old and mean set of 23.5 months. Ankle X-ray and MRI were obtained at the final follow-up for evaluation. Functional outcomes were scored by the Visual Analog Scale (VAS) score, American Orthopaedics Foot and Ankle Society (AOFAS) ankle- hindfoot score and Short Form (36) Survey score (SF-36). Range of motion (ROM) of ankle joint and complications were also recorded.

    Results: 13 patients got the final follow-up with a mean duration of 18 months. MRI showed complete regeneration of subchondral bone and cartilage in all patients. The post-operative VAS, AOFAS ankle-hindfoot score and SF-36 score improved significantly (P<0.0001) without obvious complications.

    Conclusion: We suggest that for the patients of Hepple stage V OLTs, cancellous bone graft with PRP scaffold may be a safe and effective treatment.

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  • Clinical and economic effectiveness of the use of platelet-rich plasma in the treatment of chronic wounds

    Abstract

    The paper presents the results of the clinical use of platelet-rich plasma in the treatment of long-term non-healing wounds of various etiologies in patients on inpatient treatment and outpatient monitoring in the department of surgical infections of the State-financed health institution, City clinical hospital No. 13, Moscow Health Department, from 2011 to 2016: test group and control group of 50 patients per each, comparable by gender, age, nature of pathology and area of wounds. When analyzing the data obtained, it was found that a significant reduction in the duration of patients treatment was achieved in the test group: the average epithelialization time for the wounds was 42.3

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  • Musculoskeletal Tissue Regeneration: The Role of the Stem Cells

    Abstract

    Ligament, cartilage, and meniscus injuries often have poor healing due to low vascularity and low proliferative abilities of the resident cells. Drawbacks with conventional treatment methodologies have prompted interest in a new approach we term \"Regenerative Engineering\" to regenerate orthopaedic tissues. The work of cells is of central importance in the Regenerative Engineering paradigm. In this regard, both differentiated cells and stem cells such as bone marrow stromal cells have been studied as sources for orthopaedic tissue regeneration. In addition, other stem cells such as those derived from peripheral blood, synovium, adipose, and other extraembryonic sources have been isolated and characterized and subsequently investigated for regenerating various orthopaedic tissues. In this review, recent developments in the stem cell-mediated regeneration of ligament, cartilage, and menisci are discussed.

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  • Platelet-Rich Plasma Injections as a Treatment for Refractory Patellar Tendinosis: A Meta-Analysis of Randomised Trials

    Purpose: Patellar tendinosis (PT) is a common condition amongst athletes. In this study, we perform a meta-analysis on randomised controlled trials (RCTs) to evaluate the use of platelet-rich plasma (PRP) for refractory PT.

    Methods: A literature search was undertaken in various databases from their year of inception to October 2015. The primary outcome measure was the Victorian Institute of Sports Assessment-Patella (VISA-P) score.

    Results: We identified 2 RCTs comparing PRP injections to alternative treatment options (extracorporeal shockwave therapy [ESWT] and dry needling of the tendon). Meta-analysis showed no significant difference in mean VISA-P scores between PRP injection and control at early assessment (2 or 3 months; estimated difference in means, 11.9; standard error [SE], 7.4; 95% confidence interval [CI], -2.7 to 26.4; p=0.109). However, PRP was statistically better than control with regards to VISA-P scores at longer follow-up (6 months or longer; estimated difference in means, 12.7; SE, 4.4; 95% CI, 4.1 to 21.3; p=0.004).

    Conclusions: There is a paucity of RCTs evaluating the role of PRP in PT. Our results suggest that, based on limited evidence, PRP is superior over other established non-surgical treatments (dry needling and ESWT) for refractory PT. Larger RCTs may allow better characterisation of the role of PRP in this condition.

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  • Use of Platelet Rich Fibrin for the Treatment of Muco-Gingival Recessions: Novel Improvements in Plastic Aesthetic Surgery Utilizing The Fibrin Assisted Soft Tissue Promotion (FASTP) Technique

    Abstract

    The use of platelet rich fibrin (PRF) has been utilized for a wide variety of procedures in both the medical and dental fields. Results from many randomized clinical trials have now pointed to its marked ability to promote soft-tissue wound healing where PRF has been documented to facilitate wound closure and speed regeneration of muco-gingival recessions. Within this chapter, a systematic review of the various clinical studies utilizing PRF for recession coverage procedures is presented. Furthermore, a new surgical concept is introduced following years of clinical experience with PRF described as the \"Fibrin Assisted Soft Tissue Promotion\" FASTP technique.

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  • Effect of Autologous Fibrin Gel and Platelet Rich Plasma Activated by Ozone Versus Those Activated by Calcium Chloride on Wound Healing and Prevention of Infection in High Risk Cesarean Sections: Randomized Controlled Study.

    Abstract

    Background: Cesarean delivery, one of the most common major surgical procedures performed worldwide used for 15% of births around the world and it continues to increase in frequency. It is an important contributor to surgical site complications such as infection, hematoma and dehiscence. Platelet Rich Plasma (PRP) is a volume fraction of blood having a high concentration of platelets above the baseline. This product is a rich source of growth factors. PRP can be activated by CaCl2 or medical Ozone. The induction of growth factors found in PRP by ozone can support and potentiate their action. Aim: The purpose of this study is to compare the effect of application of autologous Fibrin Gel and Platelet Rich Plasma (PRP) activated by medical Ozone (Ozonated PRP) versus those activated by CaCl2 on wound healing and prevention of infection in high risk cesarean sections. Design: 90 high risk pregnant females undergoing cesarean section were selected randomly according to inclusion criteria and divided into 3 groups each contains 30 patients. Group Ca received Autologous PRP and Fibrin gel activated by CaCl2 at the wound site. Group O received Autologous PRP and Fibrin gel activated by Medical Ozone at the wound site while group P (control) did not receive any of them. All patients were examined for wound complications and healing progress on day 1, day 7 and day 21 postoperative by visual analogue scale (VAS), REEDA scale and Vancouver Scar System (VSS). Results: the results revealed statistically significance decrease in pain by VAS in group Ozone compared to group P on day 7 and 21. For REEDA also group O showed significant decrease compared to group Calcl on day 1 and 7 while compared to group P was also decreased on day 1, 7 and 21. Group Cacl was significantly decreased compared to group P on day 7 and 21 only. Regarding VSS both group O and group Cacl were significantly decreased compared to group P on all days. Conclusion: this study gives evidence that applying autologous platelet rich plasma (PRP) promote wound healing and when activated by Ozone gives better results and helps prevention of infection in cesarean section of high risk patients.

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  • Current Treatments for Coccydynia

    Abstract

    Purpose of Review: Refractory cases of coccydynia can be functionally debilitating. Here, we summarize the latest advances in interventional options for coccydynia.

    Recent Findings: The literature on treatments of coccydynia is sparse, and mostly limited to low-quality studies. Although some of these studies have demonstrated benefit from various treatment options, the lack of high-quality, prospective, controlled trials limits the ability to draw conclusions about efficacy.

    Summary: Conservative treatment remains the mainstay of coccydynia. In refractory cases, invasive treatments may be considered, although larger, randomized studies are needed to establish clear efficacy.

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  • Management of knee osteoarthritis in Italy. A cost-utility analysis of Platelet-Rich-Plasma dedicated kit versus Hyaluronic acid for the intra-articular treatment of knee OA

    Abstract

    Background: Osteoarthritis (OA) is a chronic and degenerative pathology that affects joints in particular hands, knees, hip and lower back. It is one of the main causes of disability in most of advanced economy countries. Its prevalence and incidence are increasing for the ageing of population and the presence of risk factors. OA burden of disease implies high costs of care and it has an important social impact. Although more high-quality evidence is needed, recent studies indicate that intra-articular Platelet-Rich Plasma (i.a. PRP) injections can relieve pain, improving knee function and quality of life, especially in younger patients and mild OA cases. Objectives. The aim of this work is to develop a preliminary economic evaluation of i.a. PRP therapy in the treatment of knee OA. The comparator adopted is the Hyaluronic acid (HA) which represents the standard therapy. Both therapies can reduce pain and can help the patient to delay the total knee replacement (TKR) surgical intervention. Methods. A Cost-Utility Analysis (CUA) was performed using a decision tree model. Outcomes are reported in terms of Quality Adjusted Life Year (QALY), while costs are reported in Euro (×›) currency. The adopted perspective is the National Healthcare System. Deterministic and probabilistic sensibility analyses are reported to evaluate the robustness of results under uncertainty. Results. The i.a. PRP-based therapy is cost-effective with respect to HA. Future clinical studies should provide more evidence on the major effectiveness and considering a longer patient follow-up there could be the delay of TKR, reducing consequently the eventual prosthesis revision and reducing costs of knee OA for National Healthcare System.

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  • Mesenchymal Stem Cells as an Alternative to Knee Replacement Surgery

    Abstract

    Description: Knee osteoarthritis is a degenerative disease that causes disability and persistent pain. Currently, treatment modalities for osteoarthritis focus on pain reduction and symptom management, but do little to address disease modification. Presently, the treatment of choice for knee osteoarthritis is total knee replacement surgery. Total knee replacement surgery carries significant risks and does not guarantee improvement in joint pain or function. In the last decade, advances in regenerative medicine have proposed the use of mesenchymal stem cells as a treatment strategy for joint preservation, cartilage regeneration and improved joint function in patients with osteoarthritis. The aim of this integrative literature review was to explore the use of mesenchymal stem cells as a treatment modality for the management of knee osteoarthritis and to analyze the safety and effectiveness of the intervention. An extensive search of the academic databases Cumulative Index of Nursing and Allied Health Literature (CINAHL), and PubMed was conducted using the search terms, mesenchymal stem cells and knee osteoarthritis. The findings of this literature review indicate regenerative medicine has the potential to be an effective alternative to knee replacement surgery. Furthermore, the review provides significant evidence that the use of mesenchymal stem cells for the treatment of knee osteoarthritis is safe and effective; however, more research and clinical trials are needed before its use can become standard practice.

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  • Leukocyte-reduced platelet-rich plasma increases proliferation of tenocytes treated with prednisolone: a cell cycle analysis

    Abstract

    Introduction: The purpose of this study was to evaluate the effect of allogenic leukocyte-reduced platelet-rich plasma on human tenocytes after treatment with prednisolone and to develop a standardization of its application for clinical practice.

    Methods: A leukocyte-reduced PRP was produced using the Arthrex Double Syringe (Arthrex, Inc., Naples, FL, USA), in a modified single-spin separation method. Human tenocytes were isolated from discarded rotator cuff segments. Tenocytes were cultured in the presence of PRP and prednisolone, both alone and in combination. Control samples were treated in media containing 2% FCS for 72 h. After 72 h of incubation, cell cycle kinetics of tenocytes were analyzed to assess proliferation.

    Results: Incubation of the tenocytes with PRP alone for 48 h led to high proliferation rate (10% PRP, 28.0

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  • The Histological Effects of Ozone Therapy on Sciatic Nerve Crush Injury in Rats

    Abstract

    Objective: Peripheral nerve injury is a common, important problem that lacks a definitive, effective treatment. It can cause neurologic deficits ranging from paresthesia to paralysis. This study evaluated the effect of ozone therapy on sciatic nerve crush injury in rats.

    Materials and Methods: Twenty-four male rats were divided into control sham surgery, sciatic nerve injury, and sciatic nerve injury with ozone groups (each n = 8). The sciatic nerve injury was inflicted via De Koning\'s crush-force method. The sciatic nerve injury group received medical air and the sciatic nerve injury ozone group received 0.7 mg/kg ozone. Sciatic nerve samples were obtained 4 weeks after injury. Vascular congestion, vacuolization, edema formation, S100 expression, and the thicknesses of the perineurium and endoneurium and diameter of the injured sciatic nerves were evaluated.

    Results: The diameter of the sciatic nerve and thicknesses of the perineurium and epineurium were significantly greater in the sciatic nerve injury group (P < 0.05) and significantly less in the sciatic nerve injury with ozone group (P < 0.001). High S100 immunoreactivity was seen in the sciatic nerve injury group compared with the other 2 groups (P < 0.05). The distributions of vascular congestion and vacuolization were significantly less in the sciatic nerve injury with ozone group (P < 0.05).

    Conclusions: Ozone therapy improved sciatic nerve injury recovery without causing an increase in fibrotic tissue. Ozone reduced fibrosis, vascular congestion, vacuolization, and edema in rodents. Ozone treatment might be used to assist in sciatic nerve injury.

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  • Intradiscal O2O3: Rationale, Injection Technique, Short- and Long-term Outcomes for the Treatment of Low Back Pain Due to Disc Herniation

    Abstract

    The management of low back pain should always start with a conservative approach; however, when it fails, intervention is required and at that moment the most appropriate choice remains unclear. Before invasive surgery, minimally invasive techniques can be adopted. In European trials and in a trans-Canadian clinical trial 03 ozone has been used successfully. In total over 50,000 patients have been treated safely. Ozone is a gas normally present in the atmosphere with potent oxidizing power; it has been used for percutaneous intradiscal injection combined with oxygen (O2O3) at very low concentrations for 15 years in Europe. The main indication is back pain with or without radicular pain but without motor deficits, which is refractory to 4-6 weeks of conservative therapies. Its mechanism of action on the disc is mechanical (volume reduction by subtle dehydration of the nucleus pulposis) and antinflammatory. The intradiscal ozone injection is performed with a thin needle (18-22 gauge) image guided by computed tomography or angiofluoroscopy and is usually complimented by periganglionic injection of corticosteroids and anesthetics. This combination gives immediate pain relief and allows time for the ozone to act. It is a cost-effective procedure that presents a very low complication rate (0.1%). The radicular pain is resolved before the back pain does, as is seen with microdiscectomy. Peer-reviewed publications of large randomized trials, case series, and meta analysis from large samples of patients have demonstrated the procedure to be safe and effective in the short and the long terms, with benefits recognized up to 10 years after treatment. We aim to review the principles of action of O2O3 and report the injection techniques, complications, and short- and long-term outcomes.

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  • Platelet-Rich Fibrin Facilitates Rabbit Meniscal Repair by Promoting Meniscocytes Proliferation, Migration, and Extracellular Matrix Synthesis

    Abstract

    Although platelet-rich fibrin (PRF) has been used in clinical practice for some time, to date, few studies reveal its role as a bioactive scaffold in facilitating meniscal repair. Here, the positive anabolic effects of PRF on meniscocytes harvested from the primary culture of a rabbit meniscus were revealed. The rabbit meniscocytes were cultured with different concentrations of PRF-conditioned medium, and were evaluated for their ability to stimulate cell migration, proliferation, and extracellular matrix formation. In vivo, meniscal defects were created via an established rabbit animal model and were evaluated by a histology-based four-stage scoring system to validate the treatment outcome three months ostoperatively. The in vitro results showed that PRF could induce cellular migration and promote proliferation and meniscocyte extracellular matrix (ECM) synthesis of cultured meniscocytes. In addition, PRF increased the formation and deposition of cartilaginous matrix produced by cultured meniscocytes. Morphological and histological evaluations demonstrated that PRF could facilitate rabbit meniscal repair. The data highlight the potential utility of using PRF in augmenting the healing of meniscal injuries. These advantages would benefit clinical translation, and are a potential new treatment strategy for meniscal repair.

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  • Treatment of knee osteoarthritis: platelet-derived growth factors vs. hyaluronic acid. A randomized controlled trial

    Abstract

    Objective:Aim of this trial was to compare efficacy of activated platelet-rich plasma against hyaluronic acid as intra-articular injections to people with osteoarthritis of the knee.

    Design: Phase-2 randomized controlled trial, with blind patients and outcome assessors.

    Setting: Outpatient rehabilitation service; years 2011-2013.

    Subjects: Patients with knee osteoarthritis grades 2-3 at magnetic resonance imaging (MRI) were included after consent and randomized. Target sample size was 25 patients per group.

    Interventions: Patients received three activated platelet-rich plasma (intervention group) or hyaluronic acid (controls) intra-articular injections at 4-week intervals.

    Main measures: Main outcome measure was proportion of patients with >1 grade improvement at six months from last injection, as assessed by a radiologist blind to study group. Patients were evaluated over time clinically and with functional scales (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lysholm, Tegner, American Knee Society Score (AKSS), Lequesne, visual analogue scale (VAS) for pain).

    Results: Overall, 30 patients were randomized to intervention and 28 to control group. For primary outcome, 28 patients (29 knees) in the intervention and 22 (25 knees) in the control group were available. Patients with at least 1 grade improvement at repeat MRI were 14 (48.3%) in the intervention and 2 (8%) in the control group (P < 0.003). Improvement in symptoms and functional scales was consistently higher in the intervention group. No side-effects were observed in either group.

    Conclusion: Activated platelet-rich plasma reduces articular damage as evident at MRI, as soon as six months after treatment; it reduces pain and improves patient\'s function and overall quality of life.

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  • Does platelet-rich plasma have a favorable effect in the early stages of steroid-associated femoral head osteonecrosis in a rabbit model?

    Abstract

    Objectives: This study aims to investigate the effect of platelet-rich plasma (PRP) on femoral head osteonecrosis and compare it with bone marrow injection and core decompression.

    Materials And Methods: A total of 30 healthy, adult, male New Zealand white rabbits (mean weight 2.25

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  • The Role of Platelet-Rich Plasma in Promoting Cartilage Integration and Chondrocyte Migration

    inBold\">Abstract

    Objectives: Current therapies for cartilage repair either do not result in regeneration of articular cartilage, or there is inadequate integration with the host tissue leading to failure of the repair. Thus, there is an interest in developing alternative approaches. The mechanisms of cartilage integration remain relatively unknown, however it is believed that chondrocyte migration is crucial to this process. Previously, we showed that platelet rich plasma (PRP) enhances in vitro cartilage tissue formation. We hypothesized that PRP will enhance the integration of bioengineered cartilage with native cartilage due to increased matrix accumulation at the interface and that PRP could promote chondrocyte migration.

    Methods: Isolated bovine chondrocytes were seeded on a porous bone substitute and grown in vitro to form osteochondral-like tissue. After 7 days the biphasic constructs were soaked in PRP for 30 minutes prior to implantation into the core of a ring-shaped osteochondral explant. Controls were not soaked in PRP. The resulting implant-explant construct was cultured in a stirring bioreactor for 2 weeks (contact model). Alternatively, the PRP soaked biphasic construct was placed 2mm away from a native cartilage/bone plug of equal dimensions to assess chondrocyte migration between the two tissues (non-contact model). The integration zone was visualized histologically. A push-out test was performed to assess the strength of integration. Matrix accumulation at the zone of integration was assessed biochemically and the gene expression of the cells in this region was assessed by RT-PCR. Cell migration was evaluated by video microscopy over 8 days. Significance (p<0.05) was determined by a χ2 test, a student\'s t-test or one-way ANOVA with tukey\'s post hoc.

    Conclusion: PRP soaked bioengineered cartilage implants showed improved integration with native cartilage compared to non-soaked implants perhaps due to increased matrix accumulation. Chondrocytes grew out from the in vitro formed tissue and migrated along fibers after PRP soaking. The contribution of these cells to integration requires further study.

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  • A Novel Treatment for Carpal Tunnel Syndrome?

    Abstract

    Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and is caused by chronic compression of the median nerve as it enters the carpal tunnel. Although the prevalence and incidence of CTS vary widely depending on the diagnostic criteria used, it is thought that, clinically, approximately 1 in 10 people have development of carpal tunnel syndrome. 1,2 At this time, there is no consensus for the treatment of mild to moderate carpal tunnel syndrome. The American Academy of Orthopedic Surgeons has stated that nonsurgical treatments, such as splinting of the wrist to a neutral position and local corticosteroid injections, are reasonable options for patients early in the course of symptoms when there is no evidence of median nerve denervation.

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  • Six-month Efficacy of Perineural Dextrose for Carpal Tunnel Syndrome

    Abstract

    Objective: To assess the 6-month effectiveness of ultrasound-guided perineural injection therapy (PIT) using 5% dextrose (D5W) in patients with mild-to-moderate carpal tunnel syndrome (CTS).

    Patients and Methods: A prospective, randomized, placebo-controlled, and double-blind study was conducted between May 1, 2016, through March 30, 2017. A total of 49 participants diagnosed with mild-to-moderate CTS were randomized into D5W and control groups. Participants in the D5W group received 1 session of ultrasound-guided PIT with 5 cc of D5W, and the control group received PIT with normal saline. The visual analog scale measured pain as a primary outcome. Secondary outcomes were Boston Carpal Tunnel Syndrome Questionnaire scores, the cross-sectional area of the median nerve, and electrophysiological measurement results. Assessment was performed before injection and at 1, 3, and 6 months post-injection.

    Results: All patients (data from 30 wrists in each group) completed the study. Compared with the control group, at all post-injection time points, the D5W group had a significant reduction in pain and disability, improvement on electrophysiological response measures, and decreased cross-sectional area of the median nerve.

    Conclusion: Our study reveals that ultrasound-guided PIT with D5W is an effective treatment for patients with mild-to-moderate CTS.

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  • Is osteoarthritis a metabolic disease?

    Abstract

    Obesity, together with aging and injury, is among the main risk factors for osteoarthritis. Obesity-related osteoarthritis can affect not only the weight-bearing joints, but also the hands, suggesting a role for circulating mediators released by the adipose tissue and known as adipokines. Thus, osteoarthritis may have a systemic metabolic component. Evidence from both epidemiological and biological studies support the concept of metabolic osteoarthritis, defined as a broad clinical phenotype that includes obesity-related osteoarthritis. Thus, osteoarthritis can be related to metabolic syndrome or to an accumulation of metabolic abnormalities. In addition, studies have demonstrated associations linking osteoarthritis to several components of the metabolic syndrome, such as hypertension and type 2 diabetes, independently from obesity or any of the other known risk factors for osteoarthritis. Both in vitro and in vitro findings indicate a deleterious effect of lipid and glucose abnormalities on cartilage homeostasis. Chronic low-grade inflammation is a feature shared by osteoarthritis and metabolic disorders and may contribute to the genesis of both. Thus, osteoarthritis is emerging as a disease that has a variety of phenotypes including a metabolic phenotype, in addition to the age-related and injury-related phenotypes.

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  • The effectiveness of platelet-rich plasma injections in gluteal tendinopathy - a randomised, double-blind controlled trial comparing a single platelet-rich plasma injection with a single corticosteroid injection.

    Abstract

    Importance: Gluteus medius/minimus tendinopathy is a common cause of lateral hip pain or greater trochanteric pain syndrome.

    Objective: There would be no difference in the modified Harris Hip score between a single Platelet-Rich-Plasma (PRP) injection compared to a corticosteroid injection (CSI) in the treatment of gluteal tendinopathy.

    Design: Randomised Controlled Clinical Trial; Level of evidence 1, recruitment 29 May 2013 to May 2015, follow-up September 2016. Treating/assessing clinicians and subjects were blinded to treatment. PARTICIPANTS: 228 consecutive patients referred with gluteal tendinopathy were screened to enrol 80 participants. 148 excluded (refusal 48, previous surgery 39, sciatica 28, osteoarthritis 17, full thickness tears tendons 17, other 22).

    Conclusion: Patients with chronic gluteal tendinopathy >4 months, diagnosed with both clinical and radiological examinations, achieved greater clinical improvement at 12 weeks when treated with a single PRP injection than those treated with a single corticosteroid injection.

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