General

  • The Addition of Platelet-Rich Plasma to Scaffolds Used for Cartilage Repair: A Review of Human and Animal Studies

    Purpose

    To review the available literature on studies focusing on platelet-rich plasma (PRP)-enhanced scaffolds for cartilage lesion repair in animals and to analyze the clinical outcomes of similar biologically augmented cartilage regeneration techniques in humans.

    Methods

    We conducted a literature search and subsequent review investigating the potential of PRP to enhance articular cartilage repair using scaffolds or bioengineered implants.

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  • Treatment of Knee Osteoarthritis With Allogeneic Bone Marrow Mesenchymal Stem Cells: A Randomized Controlled Trial

    Abstract

    Background: Osteoarthritis is the most prevalent joint disease and a common cause of joint pain, functional loss, and disability. Conventional treatments demonstrate only modest clinical benefits without lesion reversal. Autologous mesenchymal stromal cell (MSC) treatments have shown feasibility, safety, and strong indications for clinical efficacy. We performed a randomized, active control trial to assess the feasibility and safety of treating osteoarthritis with allogeneic MSCs, and we obtain information regarding the efficacy of this treatment.

    Methods: We randomized 30 patients with chronic knee pain unresponsive to conservative treatments and showing radiological evidence of osteoarthritis into 2 groups of 15 patients. The test group was treated with allogeneic bone marrow MSCs by intra-articular injection of 40 x 106 cells. The control group received intra-articular hyaluronic acid (60 mg, single dose). Clinical outcomes were followed for 1 year and included evaluations of pain, disability, and quality of life. Articular cartilage quality was assessed by quantitative magnetic resonance imaging T2 mapping.

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  • Stimulation of the Superficial Zone Protein and Lubrication in the Articular Cartilage by Human Platelet-Rich Plasma

    Abstract

    Background: Platelet-rich plasma (PRP) contains high concentrations of autologous growth factors that originate from platelets. Intra-articular injections of PRP have the potential to ameliorate the symptoms of osteoarthritis in the knee. Superficial zone protein (SZP) is a boundary lubricant in articular cartilage and plays an important role in reducing friction and wear and therefore is critical in cartilage homeostasis.

    Purpose: To determine if PRP influences the production of SZP from human joint-derived cells and to evaluate the lubricating properties of PRP on normal bovine articular cartilage.

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  • Platelet-rich plasma injection as an effective treatment for temporomandibular joint osteoarthritis

    Abstract

    Purpose

    Emerging evidence suggests that platelet-rich plasma (PRP) might be of assistance in the treatment of degenerative conditions of the joints. The aim of this study was to compare the uses of PRP and the hyaluronic acid (HA) in treatment of temporomandibular joint (TMJ) osteoarthritis with a long-term follow-up.

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  • Cartilage regeneration for treatment of osteoarthritis: a paradigm for nonsurgical intervention

    Abstract

    Osteoarthritis (OA) is associated with articular cartilage abnormalities and affects people of older age: preventative or therapeutic treatment measures for OA and related articular cartilage disorders remain challenging. In this perspective review, we have integrated multiple biological, morphological, developmental, stem cell and homeostasis concepts of articular cartilage to develop a paradigm for cartilage regeneration. OA is conceptually defined as an injury of cartilage that initiates chondrocyte activation, expression of proteases and growth factor release from the matrix. This regenerative process results in the local activation of inflammatory response genes in cartilage without migration of inflammatory cells or angiogenesis. The end results are catabolic and anabolic responses, and it is the balance between these two outcomes that controls remodelling of the matrix and regeneration. A tantalizing clinical clue for cartilage regrowth in OA joints has been observed in surgically created joint distraction. We hypothesize that cartilage growth in these distracted joints may have a biological connection with the size of organs and regeneration. Therefore we propose a novel, practical and nonsurgical intervention to validate the role of distraction in cartilage regeneration in OA. The approach permits normal wake-up activity while during sleep; the index knee is subjected to distraction with a pull traction device. Comparison of follow-up magnetic resonance imaging (MRI) at 3 and 6 months of therapy to those taken before therapy will provide much-needed objective evidence for the use of this mode of therapy for OA. We suggest that the paradigm presented here merits investigation for treatment of OA in knee joints.

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  • Meeting current musculoskeletal health demand through deeper insights into tissue homeostasis and regeneration

    The burden of chronic musculoskeletal disorders is challenging and prompts therapeutic advancements. The notion that chronic conditions such as osteoarthritis and tendinopathy are linked to deficient healing by failure of one or several of the cellular/molecular processes involved is gaining ground. Alterations underpinning disruption of healing mechanisms that contribute to the development of chronic musculoskeletal pathologies include unresolved inflammation, abnormal angiogenic status, alterations in paracrine communication, decline in stem cell functioning and inability to maintain homeostasis in the extracellular matrix compartment. The complexity of failed healing may be challenged with interventions that target multiple biological processes such as cell therapies and/or platelet-rich plasma.

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  • Simulation and Hardware Implementetation of Grid Connected Solar Charge Controller with MPPT

    Abstract

    A renewable energy source plays an important role in electricity generation. Various renewable energy sources like wind, solar, geothermal, ocean thermal, and biomass can be used for generation of electricity and for meeting our daily energy needs. Energy from the sun is the best option for electricitygeneration as it is available everywhere and is free to harness. On an average the sunshine hour in India is about 6hrs annually also the sun shine shines in India for about 9 months in a year. Electricity from the sun can be generated through the solar photovoltaic modules (SPV). The SPV comes in various power output to meet the load requirement [1]. Maximization of power from a solar photo voltaic module (SPV) is of special interest as the efficiency of the SPV module is very low. A peak power tracker and DC-DC Boost Converter is used for Extracting the maximum power from the SPV module. And simulation in PSIM software and hardware result is compare and solar panel maximum efficiencies is increase nearby 85% using dither routine algorithm method use.

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  • Mesenchymal Stem Cell Implantation in Osteoarthritic Knees Is Fibrin Glue Effective as a Scaffold?

    Abstract

    Background: The cell-based tissue engineering approach that uses mesenchymal stem cells (MSCs) has addressed the issue of articular cartilage repair in osteoarthritic (OA) knees. However, to improve outcomes, an advanced surgical procedure with tissue-engineered scaffolds may be needed to treat patients with large cartilage lesions.

    Purpose: To investigate the clinical and second-look arthroscopic outcomes of the implantation of MSCs loaded in fibrin glue as a scaffold in patients with OA knees and to compare these outcomes with those of MSC implantation without a scaffold.

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  • TGF-b1, GDF-5, and BMP-2 Stimulation Induces Chondrogenesis in Expanded Human Articular Chondrocytes and Marrow-Derived Stromal Cells

    Abstract

    Replacement of degenerated cartilage with cell-based cartilage products may offer a long-term solution to halt arthritis\'   degenerative   progression. Chondrocytes   are   frequently   used   in   cell- based   FDA-approved   cartilage   products;   yet   human   marrow-derived   stromal   cells   (hMSCs)   show signicant   translational   potential, reducing   donor   site   morbidity   and   maintaining   their   undiffer- entiated   phenotype   with   expansion.   This   study   sought   to   investigate   the   effects   of   transforming growth   factor     b1   (TGF-b1),   growth/differentiation   factor   5   (GDF-5),   and   bone   morphogenetic protein   2   (BMP-2)   during   postexpansion   chondrogenesis   in   human   articular   chondrocytes   (hACs) and   to   compare   chondrogenesis   in   passaged   hACs   with   that   of   passaged   hMSCs.   Through   serial expansion,   chondrocytes   dedifferentiated,   decreasing   expression   of   chondrogenic   genes   while increasing   expression   of   broblastic   genes.   However,   following   expansion,   10   ng/mL   TGF-b1,   100 ng/mL   GDF-5,   or   100   ng/mL   BMP-2   supplementation   during   three-dimensional   aggregate   culture each   upregulated   one   or   more   markers   of   chondrogenic   gene   expression   in   both   hACs   and hMSCs.   Additionally,   in   both   cell   types,   the   combination   of   TGF-b1,   GDF-5,   and   BMP-2   induced the   greatest   upregulation   of   chondrogenic   genes,   that   is,   Col2A1,   Col2A1/Col1A1   ratio,   SOX9, and   ACAN,   and   synthesis   of   cartilage-specic   matrix,   that   is,   glycosaminoglycans   (GAGs)   and ratio   of   collagen   II/I.   Finally,   TGF-b1,   GDF-5,   and   BMP-2   stimulation   yielded   mechanically   robust cartilage   rich   in   collagen   II   and   GAGs   in   both   cell   types,   following   4   weeks   maturation.   This study   illustrates   notable   success   in   using   the   self-assembling   method   to   generate   robust, scaffold-free   neocartilage   constructs   using   expanded   hACs   and   hMSCs. STEM     CELLS 2015;33:762-773

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  • Histochemical and Functional Improvement of Adipose-Derived Stem Cell-Based Tissue-Engineered Cartilage by Hyperbaric Oxygen/Air Treatment in a Rabbit Articular Defect Model

    Cartilage is exposed to compression forces during joint loading. Therefore, exogenous stimuli are frequently used in cartilage tissue engineering strategies to enhance chondrocyte differentiation and extracellular matrix (ECM) secretion. In this study, human adipose-derived stem cells were seeded on a gelatin/polycaprolactone scaffold to evaluate the histochemical and functional improvement of tissue-engineered cartilage after hyperbaric oxygen/air treatment in a rabbit articular defect model. Behavior tests showed beneficial effects on weight-bearing and rear leg-supporting capacities after treatment of tissue-engineered cartilage with 2.5 ATA oxygen or air. Moreover, positron emission tomography images and immunohistochemistry staining demonstrated hydroxyapatite formation and increased ECM synthesis, respectively, at the tissue-engineered cartilage graft site after high pressure oxygen/air treatment. Based on these results, we concluded that hyperbaric oxygen and air treatment can improve the quality of tissue-engineered cartilage in vivo by increasing the synthesis of ECM.

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  • Platelet-rich Plasma as an Effective Treatment for Proximal Hamstring Injuries

    Abstract

    Proximal hamstring injuries can be disabling, and several traditional conservative treatments, including physiotherapy and nonsteroidal anti-inflammatory drugs, have been inconsistent. Corticosteroid injections have demonstrated success but can adversely affect local tissues. Platelet-rich plasma (PRP) has emerged as a safe, effective treatment for several orthopedic pathologies. The authors propose a PRP injection at the muscle origin as a novel treatment for proximal hamstring injuries.

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  • Platelet-rich Plasma Modulates the Secretion of Inflammatory/Angiogenic Proteins by Inflamed Tenocytes

    Abstract

    BACKGROUND: Platelet-rich plasma therapies for tendinopathy appear to provide moderate pain reduction. However, the biological mechanisms behind the observed clinical effects remain poorly characterized. QUESTIONS

    PURPOSES: The purpose of this study was to explore whether platelet-rich plasma modifies the inflammatory/angiogenic status of already inflamed tenocytes by examining (1) gene expression; (2) modulation of chemokine and interleukin secretion; and (3) differences between healthy and tendinopathic tenocytes.

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  • Platelet-rich plasma to treat ankle cartilage pathology - from translational potential to clinical evidence: a systematic review

    Abstract

    Platelet-rich Plasma (PRP) is a fascinating biological treatment showing promising results for the management of cartilage disorders. However, despite the step forwards in this research area and the increasing use of PRP in clinical practice, its use remains still controversial and especially its application as injective treatment for ankle cartilage pathology have been scarcely investigated.

    The aim of this paper is to describe the translational evidence for the use of PRP in cartilage treatment and to systematically review all the available evidence regarding the clinical application of PRP for ankle cartilage disorders, in order to understand what is the current state of the art for this specific clinical indication, underlining both limits and potential of this biological strategy.

    A systematic review of the clinical literature was performed on the use of PRP to treat ankle cartilage disorders and 7 papers were identified. PRP has been used in two different ways: 5 of the available papers focus on its use as an augmentation procedure to various surgical techniques for cartilage regeneration, while only two studies report its conservative application through intra-articular injections. Based on the limited number of clinical studies available on this topic, this systematic review showed the lack of major adverse events related to PRP and overall good results for the treatment of ankle cartilage pathology, thus confirming the translational potential of this biological treatment suggested by several preclinical studies. Further high quality clinical trials in the ankle are still needed to clarify proper indications and best applicative modalities.

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  • Plantar fasciitis: Outcome evaluation of plantar fasciitis treated with PRP against steroid injection

    Abstract

    Plantar fasciitis is the most common cause of heel pain which seems difficult to treat in its most chronic and severe forms. Earlier treatments, including orthoses, non steroidal anti-inflammatory drugs, and steroid injections are paucity of supportive clinical evidence but carry the potential for serious

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  • Mesenchymal stromal cells and rheumatic diseases: new tools from pathogenesis to regenerative therapies

    Abstract

    In recent years, mesenchymal stromal cells (MSCs) have been largely investigated and tested as a new therapeutic tool for several clinical applications, including the treatment of different rheumatic diseases. MSCs are responsible for the normal turnover and maintenance of adult mesenchymal tissues as the result of their multipotent differentiation abilities and their secretion of a variety of cytokines and growth factors. Although initially derived from bone marrow, MSCs are present in many different tissues such as many peri-articular tissues. MSCs may exert immune-modulatory properties, modulating different immune cells in both in

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  • New and Emerging Strategies in Platelet-Rich Plasma Application in Musculoskeletal Regenerative Procedures: General Overview on Still Open Questions and Outlook

    Abstract

    Despite its pervasive use, the clinical efficacy of platelet-rich plasma (PRP) therapy and the different mechanisms of action have yet to be established. This overview of the literature is focused on the role of PRP in bone, tendon, cartilage, and ligament tissue regeneration considering basic science literature deriving from in vitro and in vivo studies. Although this work provides evidence that numerous preclinical studies published within the last 10 years showed promising results concerning the application of PRP, many key questions remain unanswered and controversial results have arisen. Additional preclinical studies are needed to define the dosing, timing, and frequency of PRP injections, different techniques for delivery and location of delivery, optimal physiologic conditions for injections, and the concomitant use of recombinant proteins, cytokines, additional growth factors, biological scaffolds, and stems cells to develop optimal treatment protocols that can effectively treat various musculoskeletal conditions.

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  • Systemic and local administration of allogeneic bone marrow derived mesenchymal stem cells promotes fracture healing in rats

    Abstract

    Mesenchymal stem cells (MSCs) are immune-privileged and a cell source for tissue repair. Previous studies showed that there is systemic mobilization of osteoblastic precursors to the fracture site, we hypothesized that both systemic and local administration of allogeneic MSCs may promote fracture healing. Bone marrow derived MSCs and skin fibroblasts were isolated from the GFP-Sprague-Dawley rats, cultured and characterized. Closed transverse femoral fracture with internal fixation was established in 48 adult male Sprague-Dawley rats, whom were randomly assigned into 4 groups receiving: PBS injection; MSCs systemic injection; Fibroblasts systemic injection and MSCs fracture site injection. 2x106 cells were injected at 4 days after fracture. All animals were terminated at 5 weeks after fracture; examinations included weekly radiograph; Micro-CT; mechanical testing; histology, immunohistochemistry and double immunofluorescence. The callus size of MSCs injection groups were significant larger among all the groups. Radiographs and 3D-reconstruction images showed that the fracture gaps united in the MSCs injected groups, while gaps were still seen in the fibroblast and PBS injection groups. The mechanical properties were significantly higher in the MSCs injection groups than those in the fibroblast and PBS groups, but no difference was found between the MSCs local and systemic injection groups. Immunohistochemistry and double immunofluorescence demonstrated that GFP-positive MSCs were present in the callus in the MSCs injection groups at 5 weeks after fracture, and some have differentiated into osteoblasts. Quantitative analysis revealed the number of GFP-positive cells in the callus in the MSCs systemic injection group was significantly lower than that of the MSCs local injection group. The proportion of GFP-osteoblasts in GFP-positive cells in the MSCs systemic injection group was significantly lower than that of the MSCs local injection group. These findings provide critical insight for developing MSC-based therapies and systemic injection of allogeneic MSCs may be a novel treatment method for promoting fracture repair.

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  • Regenerative treatment in osteochondral lesions of the talus: autologous chondrocyte implantation versus one-step bone marrow derived cells transplantation

    Abstract

    Purpose

    Osteochondral lesions of the talus (OLT) usually require surgical treatment. Regenerative techniques for hyaline cartilage restoration, like autologous chondrocytes implantation (ACI) or bone marrow derived cells transplantation (BMDCT), should be preferred. The aim of this work is comparing two clusters with OLT, treated with ACI or BMDCT.

    Methods

    Eighty patients were treated with regenerative techniques, 40 with ACI and 40 with BMDCT. The two groups were homogenous regarding age, lesion size and depth, previous surgeries, etiology of the lesion, subchondral bone graft, final follow-up and pre-operative AOFAS score. The two procedures were performed arthroscopically. The scaffold was a hyaluronic acid membrane in all the cases, loaded with previously cultured chondrocytes (ACI) or with bone marrow concentrated cells, harvested in the same surgical session (BMDCT). All the patients were clinically and radiologically evaluated, using MRI Mocart score and T2 mapping sequence.

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  • Case-control study on therapeutic effects of ozone and triamcinolone acetonide on the treatment of meniscal injury

    Abstract

    OBJECTIVE: To compare the clinical therapeutic effects between ozone and triamcinolone acetonide for the treatment of mild meniscal injury.

    METHODS: From January 2008 to December 2012, 119 patients with meniscal injury diagnosed as type I or II by MRI were divided into three groups. In the triamcinolone acetonide (A) group, there were 38 males and 2 females, with an average age of (25.34 +/- 6.34) years old, ranging from 18 to 48 years old; 36 patients had single knee injuries, 4 patients had double knee injuries and 44 knees with joint effusion. In the ozone (B) group,there were 37 males and 2 females, with an average age of (26.98 +/- 7.20) years old, ranging from 19 to 50 years old; 33 patients had single knee injuries, 6 patiens had double knees injuries and 40 knees with joint effusion. In the combination of ozone and triamcinolone acetonide (C) group, there were 37 males and 3 females,with an average age of (26.44 +/- 6.38) years old, ranging from 18 to 47 years old; 33 patients had single knee injuries, 7 patients had double knees injuries and 39 knees with joint effusion. The patients were treated with injection of 3 mg triamcinolone acetonide alone, 30 ml (30 microg/ml) ozone alone, or both two drugs respectively in knee joint cavity. All the treatment methods were carried out weekly and 4 times injections were required for a treatment course. Knee joint function was evaluated by Lysholm scale and knee joint effusion was examined by MRI before and after treatment.

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  • Management of Chronic Plantar Fasciitis using Hyperosmolar Dextrose Injection

    Abstract

    Plantar fasciitis is most common cause of heel pain. More than 90% of patients are managed by conservative treatment. Chronic recalcitrant cases of plantar fasciitis not responding to other treatment modalities can be managed by Hyperosmolar dextrose injections with no or minimal complications. Hyperosmolar dextrose injection has been shown to increase Beta-1 platelet derived growth factor expression and upregulation of multiple mitogenic factors that may act as signaling mechanisms in tissue repair. We recommend Hyperosmolar dextrose solution for the management of chronic plantar fasciitis in place of local corticosteroid injection, so as to avoid the complications like rupture of plantar fascia and fat pad atrophy which are associated with local corticosteroid injections.

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