General

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

    Abstract

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

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

    Abstract

    Osteoarthritis (OA) is a common disease involving joint damage, an inadequate healing response and progressive deterioration of the joint architecture. Autologous blood-derived products, such as platelet-rich plasma (PRP), are key sources of molecules involved in tissue repair and regeneration. These products can deliver a collection of bioactive molecules that have important roles in fundamental processes, including inflammation, angiogenesis, cell migration and metabolism in pathological conditions, such as OA. PRP has anti-inflammatory properties through its effects on the canonical nuclear factor κB signalling pathway in multiple cell types including synoviocytes, macrophages and chondrocytes. PRP contains hundreds of different molecules; cells within the joint add to this milieu by secreting additional biologically active molecules in response to PRP. The net results of PRP therapy are varied and can include angiogenesis, the production of local conditions that favour anabolism in the articular cartilage, or the recruitment of repair cells. However, the molecules found in PRP that contribute to angiogenesis and the protection of joint integrity need further clarification. Understanding PRP in molecular terms could help us to exploit its therapeutic potential, and aid the development of novel treatments and tissue-engineering approaches, for the different stages of joint degeneration.

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  • Autologous Platelet-Rich Plasma Versus Dextrose Prolotherapy for the Treatment of Chronic Recalcitrant Plantar Fasciitis

    Abstract

    OBJECTIVE: To determine the efficacy of autologous platelet-rich plasma (PRP) compared with dextrose prolotherapy (DP) in patients with chronic recalcitrant plantar fasciitis (PF) DESIGN: A single-blinded, randomized, controlled study.

    SETTING: Department of Physical Medicine and Rehabilitation of a university hospital.

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  • Prolotherapy: a clinical review of its role in treating chronic musculoskeletal pain

    Abstract

    Prolotherapy is a technique that involves the injection of an irritant, usually a hyperosmolar dextrose solution, typically in the treatment of chronic painful musculoskeletal conditions. Despite its long history and widespread use as a form of complementary therapy, there still are disparities over its optimal indications and injection preparations. There are, however, numerous studies available regarding the use and efficacy of prolotherapy for various musculoskeletal conditions. The most frequently published indication is in the treatment of chronic low back pain, but there are recent studies that examined its use in the management of refractory tendinopathies as well as osteoarthritis. There is growing evidence to suggest that prolotherapy may be helpful in treating chronic low back pain when coupled with adjunctive therapies, such as spinal manipulation or corticosteroid injections. There is also evidence to suggest that prolotherapy is effective in treating refractory tendinopathies, particularly for lateral epicondylosis and Achilles tendinopathy. Additional larger, randomized controlled trials are needed to make specific recommendations regarding ideal protocols and indications. There is emerging evidence for the use of prolotherapy as a treatment option for osteoarthritis; however, further studies are needed to conclusively demonstrate its efficacy. Overall, prolotherapy remains a promising option for the treatment of painful musculoskeletal conditions, particularly when other standard treatments have proved ineffective.

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  • Supplementation With Platelet-Rich Plasma Improves the In Vitro Formation of Tissue-Engineered Cartilage With Enhanced Mechanical Properties

    Purpose

    This study aimed to determine the effects of platelet-rich plasma (PRP) on the histologic, biochemical, and biomechanical properties of tissue-engineered cartilage.

    Methods

    Chondrocytes isolated from bovine metacarpal-phalangeal articular cartilage were seeded on top of a porous ceramic substrate (calcium polyphosphate [CPP]). Cultures were supplemented with fetal bovine serum (FBS), PRP, or platelet-poor plasma (PPP) at 5%. On day 5, the concentration was increased to 20%. PRP and PPP were obtained through centrifugation of whole blood withdrawn from a mature cow. After 2 weeks, samples (n

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  • Oxygen/ozone as a medical gas mixture. A critical evaluation of the various methods clarifies positive and negative aspects

    Abstract

    Besides oxygen, several other gases such as NO, CO, H2, H2S, Xe and O3 have come to age over the past few years. With regards to O3, its mechanisms of action in medicine have been clarified during the last two decades so that now a comprehensive framework for understanding and recommending ozone therapy in various pathologies is available. O3 used within the determined therapeutic window is absolutely safe and more effective than golden standard medications in numerous pathologies, like vascular diseases. However, ozone therapy is mostly in practitioners\' hands and some recent developments for increasing cost effectiveness and speed of treatment are neither standardized, nor evaluated toxicologically. Hence, the aim of this article is to emphasize the need to objectively assess the pros and cons of oxygen/ozone as a medical gas mixture in the hope that ozone therapy will be accepted by orthodox medicine in the near future.

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  • Biological Augmentation of Meniscus Repair and Restoration

    Abstract

    Meniscus tears in the knee lead to significant pain and disability. The ability of meniscus tears to heal after repair is limited, particularly within the avascular zone. While meniscectomy is a commonly performed and a relatively straightforward treatment option, it is less desirable compared to repair as meniscus deficiency is a predisposing factor for the development of osteoarthritis. Most efforts to augment meniscal repairs in human studies have centered on the use of mechanical stimulation, fibrin clot, and platelet-rich plasma (PRP). When meniscal replacement is needed, allograft transplantation is currently the most viable treatment option. Stem cell and growth factor augmentation remain promising alternatives but require further research prior to use in humans.

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  • Regenerative Injection Therapy with Whole Bone Marrow Aspirate for Degenerative Joint Disease: A Case Series

    Abstract

    Regenerative therapeutic strategies for joint diseases usually employ either enriched concentrates of bone marrow-derived stem cells, chondrogenic preparations such as platelet-rich plasma, or irritant solutions such as hyperosmotic dextrose. In this case series, we describe our experience with a simple, cost-effective regenerative treatment using direct injection of unfractionated whole bone marrow (WBM) into osteoarthritic joints in combination with hyperosmotic dextrose. Seven patients with hip, knee or ankle osteoarthritis (OA) received two to seven treatments over a period of two to twelve months. Patient-reported assessments were collected in interviews and by questionnaire. All patients reported improvements with respect to pain, as well as gains in functionality and quality of life. Three patients, including two whose progress under other therapy had plateaued or reversed, achieved complete or near-complete symptomatic relief, and two additional patients achieved resumption of vigorous exercise. These preliminary findings suggest that OA treatment with WBM injection merits further investigation.

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  • Ultrasound Guided Platelet Rich Plasma and Autologous Stem Cells Injections: An Emerging Alternative Treatment for Osteochondral Defects

    Abstract

    Osteochondral defects are a frequent cause of knee pain in the population. The majority of the diagnosed cases of osteochondral defects (OCD) are treated with surgical procedures. However, there are emerging alternative and integrative medicine options which have appeared on the horizon. These alternative treatment options are minimally invasive with a significant cost reduction and the potential for an earlier return on function due to a shorter rehabilitation period. The focus of this report will be to demonstrate the efficacy of Ultrasound (US) guided Platelet Rich Plasma (PRP) and Autologous Stem Cell Injections in the treatment of osteochondral Defects.

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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.

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  • Synovial fluid growth factor and cytokine concentrations after intra-articular injection of a platelet-rich product in horses

    Abstract

    Platelet-rich plasma (PRP) products may be useful for treatment of joint disease in horses, but may contain undesirable pro-inflammatory cytokines in addition to growth factors. This study investigated whether autologous PRP increases synovial fluid growth factor and cytokine concentrations when injected into normal equine metacarpophalangeal and metatarsophalangeal (fetlock) joints. Fetlock joints of seven healthy horses received one of four treatments: saline, resting PRP, CaCl2-activated PRP or thrombin-activated PRP. Synovial fluid was sampled prior to injection and at 6, 24, 48 and 96  h post-injection. Platelet-derived growth factor (PDGF-BB), transforming growth factor β1 (TGFβ1), interleukin (IL)-6 and tumor necrosis factor α (TNFα) concentrations in synovial fluid and PRP were measured by ELISA. Synovial fluid PDGF-BB, TGFβ1, IL-6, TNFα and IL-1 concentrations were also measured in vitro after incubation for 6  h with resting PRP only. Growth factor concentrations, but not cytokine concentrations, were significantly higher in activated PRP than in resting PRP samples. After intra-articular injection with resting or thrombin-activated PRP, synovial TGFβ1 increased significantly compared to baseline levels. TNFα and IL-6 were significantly increased in synovial fluid after thrombin-activated PRP injection. In vitro, growth factor concentrations increased significantly in synovial fluid after mixing with PRP, indicating that exogenous activation of PRP for intra-articular injection may be unnecessary, whereas cytokine levels did not. In conclusion, thrombin-activated PRP induced an inflammatory cytokine response in joints, whereas resting or CaCl2-activated PRP did not. Synovial growth factor levels were low overall; the reported benefits of intra-articular PRP may not be attributable to changes in local PDGF or TGFβ1 concentrations.

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  • Painkilling effect of ozone-oxygen injection on spine and joint osteoarthritis

    Abstract

    OBJECTIVE: To analyze the painkilling effect of ozone-oxygen injection on joint and spine osteoarthritis.

    METHODS: This prospective study was completed at the Ozone Clinic, Rashid Hospital, Dubai, United Arab Emirates on 220 mainly local patients 122 women, mean age 47.05 years; 98 men, mean age 52.8 years with radiographic documented spine or extremities osteoarthritis. The patients were treated over 3 years September 2002 to August 2005 by ozone-oxygen injection twice a week for at least 12 sessions. Using the 6 faces pain scale; the patients\' pain was recorded at the beginning and at the 4th, 8th, and 12th sessions. They were followed for a mean of 8.48 months and their pain scale was recorded at that time too.

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  • Short-term results of prolotherapy in the management of temporomandibular joint dislocation

    Abstract

    OBJECTIVE: Prolotherapy, the rehabilitation of ligaments or tendons by induced proliferation of cells by using dextrose, is a noninvasive and effective method for the treatment of temporomandibular joint (TMJ) dislocation. The aim of this study was to evaluate the efficacy of prolotherapy method for the management of acute or chronic dislocation of TMJ.

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  • Ozone oxidative postconditioning ameliorates joint damage and decreases pro-inflammatory cytokine levels and oxidative stress in PG/PS-induced arthritis in rats

    Abstract

    Rheumatoid Arthritis (RA) is the most prevalent chronic condition present in ~1% of the adult population. Many pro-inflammatory mediators are increased in RA, including Reactive Oxygen Species such as nitric oxide NO, pro-inflammatory cytokines as tumor necrosis factor alpha (TNF-α), interleukin-1beta (IL-1β) and other molecules. Ozone oxidative postconditioning has regulatory effects on some pathological targets associated with RA. Thus, the aim of this study was to investigate the efficacy of ozone therapy in PG/PS-induced arthritis in rats in point of joints inflammation and morphology. Moreover, cytokines, nitric oxide and oxidative stress levels in spleen homogenates were evaluated. Ozone treatment ameliorated joint damage, reduced TNF-α concentrations as well as TNF-α and IL-1β mRNA levels. Besides, cellular redox balance, nitric oxide and fructolysine levels were reestablished after ozone oxidative postconditioning. It was concluded that pleiotropic ozone\'s effects clarify its therapeutic efficacy in RA. Decreasing inflammation and joint injury, reduction of pro-inflammatory cytokines, TNF-α and IL-1β transcripts and re-establishment of cellular redox balance after ozone treatment were demonstrated.

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  • The effect of intra-articular injection of different concentrations of ozone on the level of TNF-α, TNF-R1, and TNF-R2 in rats with rheumatoid arthritis

    Abstract

    The objectives of this study were to observe the therapeutic effect of ozone (O3) of different concentrations on rat with rheumatoid arthritis (RA), and to investigate the role of O3 in regulating the level of TNF-α (tumor necrosis factor), TNF-R1 (tumor necrosis factor receptor 1), and TNF-R2. Forty-eight Wistar rats were randomly divided into eight groups. There are five O3 groups which were marked by 10, 20, 30, 40, and 50 μg/mL, respectively, control group, oxygen group, and RA model group. RA was induced in all rats by hypodermic injection of collagen II and complete Freund\'s adjuvant except that in the control group. At 21 days after modeling, the rats in oxygen group were given an injection of oxygen in the knee joint weekly for 3 weeks, and the rats in O3 groups were injected the concentration of O3 as they marked weekly for 3 weeks. The thickness of hind paw, as well as the serum and synovial levels of TNF-α, TNF-R1, and TNF-R2 was observed. At the end of treatments, the thickness of the hind paws in O3-40 group is much less compared to RA group (P < 0.01). The serum levels of TNF-α, TNF-R1, and TNF-R2 showed no significant difference among all the groups (P > 0.05). However, the synovial levels of TNF-α and TNF-R2 in O3-40 and O3-50 groups are lower than those in RA group (P < 0.01). The synovial level of TNF-R1 in O3-40 group is higher than that in RA group (P < 0.05). In conclusion, intra-articular injection of O3 at 40 μg/mL can effectively suppress the joint swelling caused by RA. This mechanism is probably mediated by down-regulating synovial TNF-α and TNF-R2 and up-regulating TNF-R1 in the joint.

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  • Autologous blood versus corticosteroid local injection for treatment of Lateral Epicondylosis: A Randomized Clinical Trial

    Abstract

    Objective: The objective of the present single blinded prospective randomized control trial was assessment of efficacy of autologous blood injection versus local steroid injection in treatment of lateral epicondylosis of elbow. Methodology: Using a pre-post experimental design, a total of sixty patients of previously untreated lateral epicondylosis were selected; Group 1 (n=30) was administered single injection of autologous blood and Group 2 (n=30) single local corticosteroid injection. Assessment was done at baseline, 2 weeks, 6 weeks and 12 weeks using PRTEE (Patient Rated Tennis Elbow Evaluation) score. Results: Pre injection parameters showed no difference between groups (chi square test, p > 0.005). Analysis between groups showed significant decrease in steroid group at very short term - 2 weeks (unpaired t test, p < 0.005).There was no difference between groups at 6 weeks. There was a significant improvement in blood group at medium term -12 weeks (unpaired t test, p < 0.05). Conclusion: Both the interventions were effective in reducing pain and improving functional status of patients in short term, but autologous blood was more effective in longer run.

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  • Platelets in tissue repair: control of apoptosis and interactions with regenerative cells

    Besides mediating primary hemostasis and thrombosis, platelets play a critical role in tissue repair and regeneration. They regulate fundamental mechanisms involved in the healing process including cellular migration, proliferation, and angiogenesis. Control of apoptosis/cell survival and interaction with progenitor cells, which are clinically relevant but poorly understood aspects of platelets in tissue repair, will be highlighted in this review. Gaining deeper insight into the less well characterized molecular mechanisms is necessary to develop new therapeutic platelet-based options.

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  • A study to compare the efficacy of corticosteroid therapy with platelet-rich plasma therapy in recalcitrant plantar fasciitis: A preliminary report

    Abstract

    Background

    Plantar fasciitis is one of the commonest, and most frustrating, foot ailments seen in a regular orthopaedic clinic. There are a number of modalities available to treat this condition, of which corticosteroid injection is, perhaps, the most popular. However, recent years have seen an increased interest in the use of platelet-rich plasma (PRP) injections in various clinical situations such as plantar fasciitis.

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  • Autologous Platelet-Rich Plasma Versus Dextrose Prolotherapy for the Treatment of Chronic Recalcitrant Plantar Fasciitis.

    Abstract

    OBJECTIVE: To determine the efficacy of autologous platelet-rich plasma (PRP) compared with dextrose prolotherapy (DP) in patients with chronic recalcitrant plantar fasciitis (PF) DESIGN: A single-blinded, randomized, controlled study.

    SETTING: Department of Physical Medicine and Rehabilitation of a university hospital.

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  • HGF mediates the anti-inflammatory effects of PRP on injured tendons.

    Platelet-rich plasma (PRP) containing hepatocyte growth factor (HGF) and other growth factors are widely used in orthopaedic/sports medicine to repair injured tendons. While PRP treatment is reported to decrease pain in patients with tendon injury, the mechanism of this effect is not clear. Tendon pain is often associated with tendon inflammation, and HGF is known to protect tissues from inflammatory damages. Therefore, we hypothesized that HGF in PRP causes the anti-inflammatory effects. To test this hypothesis, we performed in vitro experiments on rabbit tendon cells and in vivo experiments on a mouse Achilles tendon injury model. We found that addition of PRP or HGF decreased gene expression of COX-1, COX-2, and mPGES-1, induced by the treatment of tendon cells in vitro with IL-1β. Further, the treatment of tendon cell cultures with HGF antibodies reduced the suppressive effects of PRP or HGF on IL-1β-induced COX-1, COX-2, and mPGES-1 gene expressions. Treatment with PRP or HGF almost completely blocked the cellular production of PGE2 and the expression of COX proteins. Finally, injection of PRP or HGF into wounded mouse Achilles tendons in vivo decreased PGE2 production in the tendinous tissues. Injection of platelet-poor plasma (PPP) however, did not reduce PGE2 levels in the wounded tendons, but the injection of HGF antibody inhibited the effects of PRP and HGF. Further, injection of PRP or HGF also decreased COX-1 and COX-2 proteins. These results indicate that PRP exerts anti-inflammatory effects on injured tendons through HGF. This study provides basic scientific evidence to support the use of PRP to treat injured tendons because PRP can reduce inflammation and thereby reduce the associated pain caused by high levels of PGE2.

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