General

  • Intra-articular Autologous Conditioned Plasma Injections Provide Safe and Efficacious Treatment for Knee Osteoarthritis An FDA-Sanctioned, Randomized, Double-blind, Placebo-controlled Clinical Trial

    Abstract

    Background: Platelet-rich plasma (PRP) injections have become an intriguing treatment option for osteoarthritis (OA), particularly OA of the knee. Despite the plethora of PRP-related citations, there is a paucity of high-level evidence that is comparable, cohort specific, dose controlled, injection protocol controlled, and double-blinded.

    Purpose: To determine the safety and efficacy of leukocyte-poor PRP autologous conditioned plasma (ACP) for knee OA treatment through a feasibility trial regulated by the US Food and Drug Administration (FDA).

    Study Design: Randomized controlled trial; Level of evidence, 1.

    Methods: In accordance with FDA protocol, patient selection was based on strict inclusion/exclusion criteria; 114 patients were screened, and 30 were ultimately included in the study. These patients were randomized to receive either ACP (n = 15) or saline placebo (n = 15) for a series of 3 weekly injections. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores served as the primary efficacy outcome measure. Patients were followed for 1 year.

    Results: No adverse events were reported for ACP administration. Furthermore, the results demonstrated no statistically significant difference in baseline WOMAC scores between the 2 groups. However, in the ACP group, WOMAC scores at 1 week were significantly decreased compared with baseline scores, and the scores for this group remained significantly lower throughout the study duration. At the study conclusion (12 months), subjects in the ACP group had improved their overall WOMAC scores by 78% from their baseline score, compared with 7% for the placebo group.

    Conclusion: ACP is safe and provides quantifiable benefits for pain relief and functional improvement with regard to knee OA. No adverse events were reported for ACP administration. After 1 year, WOMAC scores for the ACP subjects had improved by 78% from their baseline score, whereas scores for the placebo control group had improved by only 7%. Other joints affected with OA may also benefit from this treatment.

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  • Intra-articular Autologous Conditioned Plasma Injections Provide Safe and Efficacious Treatment for Knee Osteoarthritis An FDA-Sanctioned, Randomized, Double-blind, Placebo-controlled Clinical Trial

    Abstract

    Background: Platelet-rich plasma (PRP) injections have become an intriguing treatment option for osteoarthritis (OA), particularly OA of the knee. Despite the plethora of PRP-related citations, there is a paucity of high-level evidence that is comparable, cohort specific, dose controlled, injection protocol controlled, and double-blinded.

    Purpose: To determine the safety and efficacy of leukocyte-poor PRP autologous conditioned plasma (ACP) for knee OA treatment through a feasibility trial regulated by the US Food and Drug Administration (FDA).

    Study Design: Randomized controlled trial; Level of evidence, 1.

    Methods: In accordance with FDA protocol, patient selection was based on strict inclusion/exclusion criteria; 114 patients were screened, and 30 were ultimately included in the study. These patients were randomized to receive either ACP (n = 15) or saline placebo (n = 15) for a series of 3 weekly injections. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores served as the primary efficacy outcome measure. Patients were followed for 1 year.

    Results: No adverse events were reported for ACP administration. Furthermore, the results demonstrated no statistically significant difference in baseline WOMAC scores between the 2 groups. However, in the ACP group, WOMAC scores at 1 week were significantly decreased compared with baseline scores, and the scores for this group remained significantly lower throughout the study duration. At the study conclusion (12 months), subjects in the ACP group had improved their overall WOMAC scores by 78% from their baseline score, compared with 7% for the placebo group.

    Conclusion: ACP is safe and provides quantifiable benefits for pain relief and functional improvement with regard to knee OA. No adverse events were reported for ACP administration. After 1 year, WOMAC scores for the ACP subjects had improved by 78% from their baseline score, whereas scores for the placebo control group had improved by only 7%. Other joints affected with OA may also benefit from this treatment.

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  • High-concentrate PRP Promotes Healing in Long-Bone Nonunions

    A study of patients with nonunited fractures of long bones found that injection of platelet-rich plasma (PRP) enhanced the rate of union, demonstrated by definitive radiographic evidence of healing.

    The study, \"Platelet Concentrate in Treatment of Non Union of Long Bones,\" was conducted by Vijay Kumar, MD; Anjan Trikha, MD; and Rajesh Malhotra, MS, who presented the results. It was conducted at the All India Institute of Medical Sciences in New Delhi, India.

    Patients in the study had clinical and radiological signs of nonunion of the long bones, stable internal fixation or stable reduction with plaster immobilization, and more than 90 percent contact between the fracture fragments. Nonunion was defined as a fracture that had not shown progressive evidence of healing more than 6 months after injury or more than 4 months from last fracture site operation. Patients with gap nonunions, skin infections, or pseudarthrosis; patients unfit for autologous donation (platelet count <130 ×— 109/L, or age older than 60 years); and patients with thrombocytopenia or hypofibrogenemia, or patients taking medicines known to influence platelet function (like aspirin) were excluded from the study.

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  • Intra-articular platelet-rich plasma for the treatment of osteoarthritis

    Abstract

    Platelet-rich plasma (PRP) is an autologous blood derivative that has been used in different medical fields, ranging from dermatology to ophthalmology and orthopaedic surgery, with the aim of stimulating tissue healing through the local administration of a milieu of platelet-derived growth factors and other bioactive molecules (1). In the orthopaedic practice its main application is in sports medicine (2,3) and in the treatment of degenerative disorders, in particular osteoarthritis (OA) (4). Due to its intrinsic features, PRP is believed to play a beneficial role in joint tissue homeostasis, exerting a positive modulation on all the articular tissues involved in the OA degenerative process, i.e., cartilage, menisci, and synovia (5).

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  • Review Article of Corticosteroid Injections Use in Acute and Chronic Lateral Epicondylgia. An Update of the Currently Available Literature

    Abstract

    Purpose:The aim of this study is to assess the effectiveness of corticosteroid injections (CSI) in treatment of acute and chronic Lateral Epicondylgia (LE) by summarising all recent updates related to this injection in LE.

    Conclusion:Corticosteroid injections have a long record of use in LE, and are frequently requested by patients. However, this review could present a strong argument against the use of CSI, particularly for chronic LE, since no long term benefits were found. This concurs with other reviews. While CSI have a well-documented short-term benefit, they appear to have a detrimental effect with longer follow up, such as an increase in recurrence rate.

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  • The development of submucosal injection of platelet rich plasma for accelerating orthodontic tooth movement and preserving pressure side alve

    Abstract

    Although the surgical-assisted accelerated orthodontic tooth movement has been proved to be the most effective one currently, its disadvantages are it is a bone surgery, and it causes loss of alveolar bone that undermines the periodontal support of the target teeth. The submucosal injection of platelet rich plasma (PRP) is a technique developed for accelerating orthodontic tooth movement by simulating the effects of bone insult without surgery and loss of alveolar bone. We have revealed clinically that submucosal injection of PRP accelerated the mandibular or maxillary alignment 1.7 folds faster in average, and the acceleration was dose-dependent when the PRP fold (platelet count in PRP/platelet count in blood) was <12.5. The optimal PRP fold for a more than 2-fold acceleration of orthodontic alignment ranged from 9.5 to 12.5 folds. On the other hand, the injection of PRP on the pressure side of en masse anterior retraction decreased 71-77% of alveolar bone loss, and this was dose-dependent. The pressure side of en masse anterior retraction had no alveolar bone loss when the PRP fold was higher than 11.0. In conclusion, the optimal PRP fold for the best performance in acceleration of orthodontic tooth movement and preservation of the pressure side alveolar bone is 11.0-12.5.

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  • Antimicrobial properties of platelet-rich preparations. A systematic review of the current pre-clinical evidence

    Abstract

    In recent years autologous platelet concentrates (APCs) have become popular in several medicine fields, representing a valuable adjunct to regenerative surgical procedures. Beneficial effects in the control of postsurgical discomfort and infection have also been frequently reported, suggesting that APC may possess anti-inflammatory and antimicrobial properties. The aim of the present review was to summarize the current evidence regarding the antimicrobial effects of platelet concentrates, investigated by in vitro and animal studies. This review was conducted following a systematic approach. An electronic search was performed on MEDLINE, EMBASE and Scopus databases using appropriate search terms, without language or time restrictions. Preclinical studies assessing the antimicrobial activity of APC were included and divided according to the experimental design. Twenty in vitro studies and four animal studies, investigating APC effects on a broad range of microorganisms, were included. In in vitro studies APC reduced the growth of microorganisms during the first hours of incubation, while they could not completely break down the microbial load. In fact, over time a recovery of bacterial growth was always observed, suggesting that APCs display a bacteriostatic rather than a microbicidal activity. All animal studies showed that APC administered by local injections were able to reduce the infection caused by different microorganisms, although to a lesser extent compared to antibiotics. In conclusion, although the exact action mechanisms of interaction with microbial pathogens need further investigation, platelet concentrates proved to have antimicrobial properties, and therefore could represent a useful natural substance for controlling postoperative infections at surgical sites.

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  • Adipose-derived mesenchymal stem cells and platelet-rich plasma synergistically ameliorate the surgical-induced osteoarthritis in Beagle dogs

    Abstract

    Background The purpose of this study is to investigate the clinical effects of platelet-rich plasma (PRP) and adipose-derived mesenchymal stem cell (MSC) as the fundamental treatment of osteoarthritis (OA).

    Methods

    Twenty four Beagle dogs were used as cranial cruciate ligament transection models. The dogs were divided into four groups (n = 6) according to the intra-articular injection materials: the control group with phosphate-buffered saline (PBS), the PRP group with PRP, the MSC group with MSCs emerged in PBS, and the MSC and PRP co-treatment (MP) group with MSCs and PRP.

    Results

    Lameness score, focal compression strength, articular extracellular matrix (ECM) compositions, histopathology, and real-time PCR were used to evaluate the effects of PRP and MSCs on canine OA. In the order of MP, PRP, and MSC group, these all showed positive effects on the evaluated categories. The lameness scores were lower, and the focal compression strengths of the affected femoral articular surface cartilages were higher than those in the OA control group. Also, the inflammatory changes, when evaluated with Mankin scoring and histomorphologic examination, were significantly ameliorated with the treatment of PRP and/or MSCs. The glycosaminoglycan and collagen composition of extracellular matrix was more favorable in the test groups. The ECM-related genes significantly increased through the up-regulation, while the protein expressions of inflammatory cytokines were decreased through the inhibitory effects of PRP and MSCs on chondrocyte apoptosis and inflammatory cytokines.

    Conclusions

    Taken together, this study suggests that PRP and MSCs treatments have a beneficial effect on OA via the stimulation of ECM synthesis and chondrocyte proliferation and via the inhibition of inflammatory reaction.

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  • Use of PRP in Sports Medicine

    Introduction

    Musculoskeletal injuries are one of the most common cause of severe long-term pain and physical disability in sports medicine.Healing of these injuries is often too slow and sometimes incomplete, decreasing performance of athlete and long-standing pain and discomfort.The progressve understanding of mechanisms required for successful tissue repair has set the basis for the possibility of making injured tissues heal faster.

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  • Effectiveness of platelet-rich plasma in the treatment of moderate knee osteoarthritis: a randomized prospective study

    Abstract

    [Purpose] To assess the effects of different numbers of platelet-rich plasma (PRP) applications on pain and physical function in grade 3 knee osteoarthritis (OA). [Subjects and Methods] A total of 102 patients with grade 3 knee OA were randomly divided into three groups: Group 1 received a single injection of PRP, Group 2 received two injections of PRP two weeks apart, Group 3 received three injections of PRP at 2-weeks intervals. All patients were evaluated with a visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), and the Timed-Up and Go test (TUG) before the treatment and at 1, 3 and 6 months after the treatment. [Results] Ninety-eight patients (15 males, 83 females) completed the study. The mean ages of the patients were 53.5 ±6.6, 54.9 ±5.3, and 55.1 ±5.6 €…years in Group 1, Group 2, and Group 3, respectively. Statistically significant improvements were noted in all of the evaluated measures in all of the groups. The mean differences of Group 1-Group 2 and Group 1-Group 3 WOMAC total, WOMAC pain, WOMAC stiffness, and WOMAC function scores were statistically significant. [Conclusion] PRP is an effective treatment for functional status and pain in moderate knee osteoarthritis and a minimum of two injections is appropriate.

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  • Glenoid Labral Tear: follow up case series on ultrasound guided autologous platelet rich plasma in conjunction with a progressive rehabilitation program [version 1; referees: 1 approved, 1 approved with reservations, 1 not approved]

    Abstract

    Background: Labral tears commonly occur in both the general and sporting population, often leading to significant pain and dysfunction. Patients often engage in progressive rehabilitative programs, and surgical intervention may be required in severe cases. Autologous platelet rich plasma (PRP) injections have been growing in popularity in musculoskeletal medicine as an alternative to corticosteroid injections. This paper looks at the effectiveness of PRP injections in glenoid labral lesions.

    Methods: The clinical and radiological findings are presented for two patients who have been treated with autologous PRP into the glenohumeral joint adjacent to the labral tear, in conjunction with a progressive rehabilitative program. Follow up occurred at 18 months and 13 months, respectively.

    Results: Both subjects tolerated the PRP injection well with no adverse effects, and were compliant with their rehabilitative programs. On initial presentation, pain on the visual analogue scale (VAS) was 7/10 and 6/10 and at follow up it was reported as 0/10. Both subjects have now returned to normal sporting and work activities.

    Conclusions: The findings from this case series suggest that PRP in conjunction with appropriate rehabilitation can assist in the clinical recovery of glenoid labral tears. Further research is required with greater sample numbers and improved methodological parameters.

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  • Platelet-Rich Plasma for Frozen Shoulder: A Case Report

    Abstract

    Frozen shoulder is a glenohumeral joint disorder that perturbs movement because of adhesion and the existence of fibrosis in the shoulder capsule. Platelet-rich plasma can produce collagen and growth factors, which increases stem cells and consequently enhances the healing. To date, there is no evidence regarding the effectiveness of platelet-rich plasma in frozen shoulder. A 45-year-old man with shoulder adhesive capsulitis volunteered for this treatment. He underwent two consecutive platelet-rich plasma injections at the seventh and eighth month after initiation of symptoms. We measured pain, function, and ROM by the visual analogue scale (VAS), and scores from the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and goniometer; respectively. After the first injection, the patient reported 60% improvement regarding diurnal shoulder pain, and no night pains. Also, two-fold improvement for ROM and more than 70% improvement for function were reported. This study suggests the use of platelet-rich plasma in frozen shoulder to be tested in randomized trials.

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  • The effect of sub-epineural platelet-rich plasma (PRP) on regeneration of the sciatic nerve in a rat model

    Abstract:

    Background: Peripheral nerve injury is one of the most challenging of modern surgical problem. Recent advances in understanding the physiological and molecular pathways demonstrated the important role of growth factors in peripheral nerve regeneration. Platelet-rich plasma (PRP) is a biological product that has many growth factors. The aim of this study was to investigate the effect of PRP in the regeneration of sciatic nerve crush in the rat model.Methods: In this experimental study that established in the animal lab of the Hazrat Fatemeh Hospital in Tehran from September to October 2013, Twenty-four healthy male Sprague-Dawley rats (200-250 g) were randomly divided into two groups. In all rats the sciatic nerve was cut and then carefully repaired by the tension free method under a light microscope. In group 1, after the repair, 0.05

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  • Short term results comparison of intraarticular platelet-rich plasma (prp) and hyaluronic acid (ha) applications in early stage of knee osteoarthritis

    Abstract

    Objective:

    The aim of this study is to compare the short-term results of intra-articular platelet-rich plasma (PRP) and hyaluronic acid (HA) administrations in early knee osteoarthritis. Materials and methods: One hundred and eighteen patients (mean age: 59.3

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  • Single injection of platelet-rich plasma as a novel treatment of carpal tunnel syndrome

    Abstract

    Both in vitro and in vivo experiments have confirmed that platelet-rich plasma has therapeutic effects on many neuropathies, but its effects on carpal tunnel syndrome remain poorly understood. We aimed to investigate whether single injection of platelet-rich plasma can improve the clinical symptoms of carpal tunnel syndrome. Fourteen patients presenting with median nerve injury who had suffered from mild carpal tunnel syndrome for over 3 months were included in this study. Under ultrasound guidance, 1-2 mL of platelet-rich plasma was injected into the region around the median nerve at the proximal edge of the carpal tunnel. At 1 month after single injection of platelet-rich plasma, Visual Analogue Scale results showed that pain almost disappeared in eight patients and it was obviously alleviated in three patients. Simultaneously, the disabilities of the arm, shoulder and hand questionnaire showed that upper limb function was obviously improved. In addition, no ultrasonographic manifestation of the carpal tunnel syndrome was found in five patients during ultrasonographic measurement of the width of the median nerve. During 3-month follow-up, the pain was not greatly alleviated in three patients. These findings show very encouraging mid-term outcomes regarding use of platelet-rich plasma for the treatment of carpal tunnel syndrome.

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  • The effect of platelet-rich plasma injection on lateral epicondylitis following failed conservative management

    Abstract

    Objective

    We assessed the effect PRP injection on pain and function in patients with lateral epicondylitis where conservative management had failed.

    Methods

    We prospectively reviewed 34 patients. The mean follow-up was 26 weeks (range 6-114 weeks). We used the Oxford Elbow Score (OES) and progression to surgery to assess outcomes.

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  • Endoscopic plantar fasciotomy versus injection of platelet-rich plasma for resistant plantar fasciopathy

    Abstract

    Background

    Resistant plantar fasciopathy is a common orthopedic problem.

    Aim

    Comparing two different methods of treatment.

    Methods

    Fifty patients with chronic resistant plantar fasciopathy were divided into two groups. The first included 23 patients treated by endoscopic release of plantar fascia (EPF) and the second included 27 patients treated by injection of platelet-rich plasma (PRP).

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  • Platelet-Rich Plasma in Muscle Injuries: When and How It Can Be Used

    Abstract

    Presenting a significant problem in clinical medicine, skeletal muscle regeneration (after injuries, in atrophic disorders, etc.) is limited by fibrous scar formation, slow healing time, and a high rate of injury recurrence. Unfortunately, not many alternatives exist to the generally accepted conservative RICE principle for treating muscle injuries. Local platelet-rich plasma (PRP) application is popular in the field of sports medicine as an autologous source of growth factors that are believed to have potential therapeutic implications. However, several concerns have been raised as to whether high concentrations of TGF-β contained in PRP itself may have a negative effect in regard to fibrosis and the lack of any preclinical data. Although it is believed to be already used by many sports physicians, there is no evidence-based protocol for using PRP in treating muscle injuries. This chapter explains the reason behind it and proposes the best time frame to use PRP in muscle injuries according to physiological healing processes.

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  • The Effects of Prolotherapy With Hypertonic Dextrose Versus Prolozone (Intraarticular Ozone) in Patients With Knee Osteoarthritis

    Abstract

    Background: Knee osteoarthritis (KOA) is a common disabling disease. Limited studies have demonstrated that prolotherapy with dextrose or with prolozone can be helpful in the treatment of patients with KOA.

    Objectives: In the current study, we compared the results between these two treatment methods.

    Patients and Methods: In the current randomized clinical trial, 80 patients with mild to moderate KOA were randomly assigned equally into two groups (ozone group and dextrose group). In each group, injections were repeated three times with 10-day intervals. Before the treatment and 3 months after the injections, the pain intensity was measured by using a visual analogue scale and the Western Ontario and McMaster university arthritis index scores. Finally, the results were compared between the two groups.

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  • Comparison of the Cellular Composition and Cytokine-Release Kinetics of Various Platelet-Rich Plasma Preparations

    Abstract

    Background: Variations in formulations used to prepare platelet-rich plasmas (PRPs) result in differences in the cellular composition and biomolecular characteristics.

    Purpose: To evaluate the cellular composition and the cytokine-release kinetics of PRP according to differences in the preparation protocols.

    Study Design: Controlled laboratory study.

    Methods: Five preparation procedures were performed for 14 healthy subjects, including 2 manual procedures (single-spin [SS] at 900g for 5 minutes; double-spin [DS] at 900g for 5 minutes and then 1500g for 15 minutes) and 3 methods with commercial kits (Arthrex ACP, Biomet GPS, and Prodizen Prosys). After evaluation of cellular composition, each preparation was divided into 4 aliquots and incubated for 1 hour, 24 hours, 72 hours, and 7 days for the assessment of cytokine release over time. The cytokine-release kinetics were evaluated by assessing platelet-derived growth factor (PDGF), transforming growth factor (TGF), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), interleukin-1 (IL-1), and matrix metalloproteinase-9 (MMP-9) concentrations of each aliquot with bead-based sandwich immunoassay.

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