General

  • Point-Counterpoint: Is PRP Beneficial For Chronic Plantar Fasciitis?

    Plantar fasciosis is heel pain caused by deterioration of the plantar fascia, which occurs as a result of repetitive stress and chronic plantar fasciitis. This is the term used for the non-inflamed phase of plantar fasciopathy. It is much more difficult to treat plantar fasciosis when healthcare providers fail to recognize it as the non-inflamed phase of the condition.

    In plantar fasciitis, there is adequate blood supply to the problematic area as well as an inflammatory response that happens to be painful. In plantar fasciosis, the fascia has a decreased or absent inflammatory response, a reduction in the growth/healing factors, and chronic scar tissue that prevents the healing process.

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  • Effectiveness and safety of prolotherapy injections for management of lower limb tendinopathy and fasciopathy: a systematic review

    Abstract

    Introduction

    The aim of this review was to identify and evaluate existing research to determine the clinical effectiveness and safety of prolotherapy injections for treatment of lower limb tendinopathy and fasciopathy.

    Review

    Nine databases were searched (Medline, Science Direct, AMED, Australian Medical Index, APAIS-Health, ATSIhealth, EMBASE, Web of Science, OneSearch) without language, publication or data restrictions for all relevant articles between January 1960 and September 2014. All prospective randomised and non-randomised trials, cohort studies, case-series, cross-sectional studies and controlled trials assessing the effectiveness of one or more prolotherapy injections for tendinopathy or fasciopathy at or below the superior aspect of the tibia/fibula were included. Methodological quality of studies was determined using a modified evaluation tool developed by the Cochrane Musculoskeletal Injuries Group. Data analysis was carried out to determine the mean change of outcome measure scores from baseline to final follow-up for trials with no comparative group, and for randomised controlled trials, standardised mean differences between intervention groups were calculated. Pooled SMD data were calculated where possible to determine the statistical heterogeneity and overall effect for short-, intermediate- and long-term data. Adverse events were also reported.

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  • Leukocyte-Reduced Platelet-Rich Plasma Normalizes Matrix Metabolism in Torn Human Rotator Cuff Tendons

    Abstract

    Background: The optimal platelet-rich plasma (PRP) for treatment of supraspinatus tendinopathy has not been determined.

    Purpose: To evaluate the effect of low- versus high-leukocyte concentrated PRP products on catabolic and anabolic mediators of matrix metabolism in diseased rotator cuff tendons.

    Study Design: Controlled laboratory study.

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  • Intra-articular Injection for the Management of Rheumatoid Arthritis Patients with Knee Osteoarthritis-Current Evidence and Future Prospects

    Mini Review

    Intra-articular injection of hyaluronic acid (HA) is well known to improved pain and function in patients with osteoarthritis (OA) [1,2]. As for rheumatoid arthritis (RA) patients with knee osteoarthritis, current medication for injection therapy includes steroid, hyaluronic acid, and platelet-rich plasma (PRP). In this article, we collected current studies regarding to this issue and suggest future possible research direction.

    Intra-articular corticosteroid injection is long to be known as a useful adjunct therapy for the management of RA. Intra-articular injection of corticosteroid has been shown to provide clinical benefit up to 6 months and even longer [3]. From a pharmacological point of view, corticosteroid injection is able to decrease the expression of citrullinated proteins, monoclonal antibody F95, and peptidylarginine deiminase [4] in RA synovium, and the side effect is low. According to the subanalyses from the BeSt study, [4] eight-year radiographs showed similar damage in injected joints and noninjected joints. From a clinical point of view, corticosteroid injection remains a safe and cost effective way for managing RA-related OA.

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  • Hyaluronic Acid and Platelet-rich Plasma in the Treatment of Knee Osteoarthritis: A Systematic Review

    Abstract

    Introduction: Due to loss of function and intolerable pain associated with Osteoarthritis (OA), this condition is regarded as one of the major causes of disability, worldwide. Aging and obesity are regarded as two fundamental causes of knee OA. The aim of this study was to review the literature on the efficacy of hyaluronic acid in compression [z1]

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  • Intraosseous infiltration of platelet-rich plasma for severe knee osteoarthritis

    Abstract

    We describe a new technique of platelet-rich plasma (PRP) infiltration for the treatment of severe knee osteoarthritis. PRP intra-articular infiltration is a promising treatment for knee osteoarthritis, but it still has some limitations in high-degree osteoarthritis. Diagnosis of osteoarthritis is based on clinical and radiographic findings, and patients with grade III or IV knee tibiofemoral osteoarthritis based on the Ahlbפck scale are considered candidates for this technique. The technique consists of performing intraosseous infiltration of PRP into the subchondral bone, which acts on this tissue and consequently on cartilage-bone communication. Although the intraosseous injection hinders the conventional knee intra-articular infiltration, it allows an extension of the range of action of the PRP, which acts directly on the subchondral bone, which is involved in the progression of osteoarthritis. Thus this technique involves a new administration of PRP that can delay knee arthroplasty; moreover, it can be applied for not only severe osteoarthritis but also other pathologies in which the subchondral bone is critical in the etiology, such as necrosis and osteochondral lesions.

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  • Peroneus Longus Rupture at Its Origin Managed With Platelet Rich Plasma

    Abstract

    Tears of the peroneus longus muscle are unusual, and typically involve the distal insertion at the musculotendon junction. Although tears of the mid-portion of the peroneus longus muscle/tendon complex have been reported, no reports of a tear at the origin of the peroneus muscle have been published, to the authors\' knowledge. Herein a case of proximal peroneus longus muscle tear and its subsequent management with platelet rich plasma is reported.

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  • Efficacy and safety profile of a compound composed of platelet-rich plasma and hyaluronic acid in the treatment for knee osteoarthritis (preliminary results)

    Abstract

    Background

    The combined use of hyaluronic acid and platelet-rich plasma has never been reported in the treatment for osteoarthritis. Aim of this paper was to evaluate the efficacy of this association and to compare retrospectively these results with those of a cohort of patients treated with platelet-rich plasma only.

    Materials and methods

    Subjects with mild-to-moderate knee osteoarthritis were enrolled. After clinical and ultrasound evaluation, patients received a weekly intra-articular injection of 2

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  • Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee

    Abstract

    Purpose

    To compare the clinical outcomes of osteoarthritis indices (WOMAC and Lequesne scores) and adverse events in the treatment of osteoarthritis (OA) of the knee with platelet-rich plasma (PRP) versus hyaluronic acid (HA) or placebo.

    Methods

    A systematic review and meta-regression were performed to compare outcomes between PRP injections versus HA or placebo. Relevant randomized control trials were identified from Medline and Scopus from date of inception to 13 August 2015.

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  • Sonographically guided obturator internus injections: techniques and validation

    Abstract

    OBJECTIVES: The primary purpose of this investigation was to describe and validate sonographically guided techniques for injecting the obturator internus (OI) muscle or bursa using a cadaveric model.

    METHODS: A single experienced operator completed 10 sonographically guided OI injections in 5 unembalmed cadaveric pelvis specimens (4 female and 1 male, ages 71-89 years with body mass indices of 15.5-24.2 kg/m2). Four different techniques were used: (1) OI tendon sheath (4 injections), (2) OI intramuscular (2 injections), (3) OI bursa trans-tendinous (2 injections), and (4) OI bursa short-axis (2 injections). In each case, the operator injected 1.5 mL of diluted yellow latex using direct sonographic guidance and a 22-gauge, 87.5-mm (3

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  • Effectiveness of a single platelet-rich plasma injection to promote recovery in rugby players with ankle syndesmosis injury

    Abstract

    Aims To determine whether a single ultrasound-guided platelet-rich plasma (PRP) injection into the anterior inferior tibiofibular ligament (AITFL) reduces the time for rugby athletes to return to function and match play following MRI confirmed ankle syndesmosis injury.

    Methods Cohort controlled pilot study. 10 Rugby Union players were recruited during the 2014 season, and consented to receive a single autologous PRP injection into the AITFL within 14 €…days of MRI confirmed ankle syndesmosis injury. A historical control group included 11 comparable Rugby Union players between 2011 and 2013 who were treated conservatively with the same inclusion criteria and rehabilitation protocol as the intervention group. Participants followed a standardised rehabilitation protocol involving simple milestones for progression. Early functional tests were performed 2 €…weeks after the removal of the CAM (controlled ankle motion) boot. Time to return to play was recorded. Repeat functional testing occurred within 1 €…week of return to play.

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  • Intramuscular oxygen-ozone therapy in the treatment of acute back pain with lumbar disc herniation: a multicenter, randomized, double-blind, clinical trial of active and simulated lumbar paravertebral injection

    Abstract

    STUDY DESIGN: Multicenter randomized, double-blind, simulated therapy-controlled trial in a cohort of patients with acute low back pain (LBP) due to lumbar disc herniation (LDH).

    OBJECTIVE: To assess the benefit of intramuscular-paravertebral injections of an oxygen-ozone (O2O3) mixture.

    SUMMARY OF BACKGROUND DATA: Recent findings have shown that O2O3 therapy can be used to treat LDH that fails to respond to conservative management. However, these findings are based on intradiscal/intraforaminal O2O3 injection, whereas intramuscular-paravertebral injection is the technique used most in clinical practice in Italy and other Western countries.

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  • Platelet-rich plasma for chronic lateral epicondylitis: Is one injection sufficient?

    Abstract

    Introduction

    Chronic lateral epicondylitis is generally treated using nonsurgical methods including physiotherapy and infiltrations of cortisone or platelet-rich plasma (PRP). The latter is known for its simple application as well as associated low risk of adverse events, which lend to its widespread use in treating various musculoskeletal conditions. There is limited evidence on the effectiveness of PRP injections to optimally treat chronic lateral epicondylitis. This study explored the effectiveness of single or repeated injections for patients with symptoms that spanned 6 months or more and were unresponsive to alternate conservative measures.

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  • Platelet-Rich Plasma Injection for Symptomatic Knee Osteoarthritis

    Abstract

    Background: Platelet-rich plasma (PRP) is plasma of enriched platelets with high concentration of platelet granules and growth factors. The platelet growth factors have a great potential of wound and connective tissue healing used to treat cartilage lesions and retarding the progression of knee osteoarthritis

    .

    Objectives: This study was designed to evaluate PRP injection results in knee osteoarthritis.

    Patients and Methods: This was a case-series study of 39 patients and all of them had three injections of PRP for the involved knee (every two weeks) and they were followed up at two weeks, two months and six months post-injection of PRP. All included patients filled the WOMAC (western Ontario and Mcmaster universities arthritis index) standardized and translated to our national language and culture. We analyzed the collected scores of before initiation of PRP injections, the second week, the second month and the sixth month after injections into the knees.

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  • Characteristics of canine platelet-rich plasma prepared with five commercially available systems

    OBJECTIVE To characterize platelet-rich plasma (PRP) products obtained from canine blood by use of a variety of commercially available devices.

    SAMPLE Blood samples from 15 dogs between 18 months and 9 years of age with no concurrent disease, except for osteoarthritis in some dogs.

    PROCEDURES PRP products were produced from blood obtained from each of the 15 dogs by use of each of 5 commercially available PRP-concentrating systems. Complete blood counts were performed on each whole blood sample and PRP product. The degree of platelet, leukocyte, and erythrocyte concentration or reduction for PRP, compared with results for the whole blood sample, was quantified for each dog and summarized for each concentrating system.

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  • Management of a One-wall Intrabony Osseous Defect with Combination of Platelet Rich Plasma and Demineralized BoneMatrix- a Two-year Follow up Case Report

    Abstract

    Periodontal regeneration in a one-wall intrabony defect is a challenging and complex phenomenon. The combination therapy of commercially available bone grafts with the innovative tissue engineering strategy, the platelet rich plasma, has emerged as a promising grafting modality for two and three walled intrabony osseous defects. The application of this combination approach was attempted in a most challenging one-wall intrabony defect. Open flap debridement and placement ofcombination of autologous platelet rich plasma(PRP) and demineralized bone matrix was done in one-wall intrabony defect in relation to tooth #21 in a 30 yearold female patient. The 6-month follow- up results showed significant improvement in clinical parameters. Radiographic evidence of bone formation was observedas early as 3 months with almost complete fill by 6 months postoperatively. The results were maintained over a period of 2 years.

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  • Platelet rich plasma versus corticosteroid injection for plantar fasciitis: A comparative study

    Abstract

    Introduction

    Intractable plantar fasciitis can be a difficult condition to treat. Early results of platelet rich plasma (PRP) injection have been promising. We compared PRP to traditional cortisone injection in the treatment of chronic cases of plantar fasciitis resistant to traditional nonoperative management. The aim of the study was to compare the efficacy of PRP to that of Steroid at 3, 6 and 12 months after injection.

    Methods

    60 heels with intractable plantar fasciitis who had failed conservative treatment were randomized to receive either PRP or Steroid injection. All patients were assessed with the Roles-Maudsley (RM) Score, Visual Analogue Score (VAS) for pain and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Data was collected prospectively on the cohort, pre-treatment, at 3, 6 and 12 months post injection and the results were compared.

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  • Dextrose Prolotherapy versus Control Injections in Painful Rotator Cuff Tendinopathy

    Abstract

    Objective

    To compare the effect of dextrose prolotherapy on pain levels and degenerative changes in painful rotator cuff tendinopathy against two potentially active control injection procedures.

    Design

    Randomized controlled trial, blinded to participants and evaluators.

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  • Platelet-Rich Plasma May Improve Osteochondral Donor Site Healing in a Rabbit Model

    Abstract

    Purpose. The purpose of this study was to assess the effect(s) of platelet-rich plasma (PRP) on osteochondral donor site healing in a rabbit model. Methods. Osteochondral donor sites 3 mm in diameter and 5 mm in depth were created bilaterally on the femoral condyles of 12 New Zealand White rabbits. Knees were randomized such that one knee in each rabbit received an intra-articular injection of PRP and the other received saline (placebo). Rabbits were euthanized at 3, 6, and 12 weeks following surgery. Repair tissue was evaluated using the International Cartilage Repair Society (ICRS) macroscopic and histological scores. Results. No complications occurred as a result of the interventions. There was no significant difference in macroscopic scores between the 2 groups (5.5

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  • Prolotherapy for refractory rotator cuff disease: retrospective case-control study of one year follow-up

    Objective

    To determine the efficacy of prolotherapy for refractory rotator cuff disease.

    Design

    Retrospective case-control study

    Setting

    University-affiliated tertiary-care hospital.

    Participants

    One hundred fifty-one patients with non-traumatic refractory rotator cuff disease that was unresponsive to 3 month-long aggressive conservative treatments. Sixty-three patients received prolotherapies with 16.5% dextrose 10 ml solution (treatment group), and 63 continued conservative treatment (control group).

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