General

  • The use of lumbar epidural injection of platelet lysate for treatment of radicular pain

    Abstract

    Background: Epidural steroid injections (ESI) are the most common pain management procedure performed in the US, however evidence of efficacy is limited. In addition, there is early evidence that the high dose of corticosteroids used can have systemic side effects. We describe the results of a case series evaluating the use of platelet lysate (PL) epidural injections for the treatment of lumbar radicular pain as an alternative to corticosteroids.

    Methods: Registry data was obtained for patients (N = 470) treated with PL epidural injections presenting with symptoms of lumbar radicular pain and MRI findings that were consistent with symptoms. Collected outcomes included numeric pain score (NPS), functional rating index (FRI), and a modified single assessment numeric evaluation (SANE) rating.

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  • Platelet Rich Plasma Supports Proliferation and Re-differentiation of Chondrocytes during In Vitro Expansion

    Abstract

    Articular cartilage regeneration is insufficient to restore sports injuries or defects that can occur from trauma. Treatment options for cartilage repair include autologous chondrocyte implantation (ACI) by isolation, expansion, and reimplantation of healthy donor chondrocytes. Chondrocyte expansion onto 2D substrates leads to dedifferentiation and loss of the cellular phenotype. We aimed to overcome the state of dedifferentiation by biochemical stimuli with platelet derivatives such as platelet rich plasma (PRP) and hyper acute serum (HAS) to achieve sufficient cell numbers in combination with variable oxygen tension. Human articular chondrocytes from osteoarthritic (OA) cartilage chondrocytes were switched from 10% FCS supplementation to either 10% PRP or 10% HAS after initial passaging for further experiments under normoxic (20%O2) or hypoxic (1%O2) conditions.

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  • Dr Weglein with Dr Stan lam in Hong Kong

    Dr Weglein with Dr Stan lam in Hong Kong

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  • Platelet-rich plasma versus hyaluronic acid to treat tendinopathies

    Abstract

    Introduction: The treatment of patellar tendinopathies could be difficult. This is the reason why new treatments have been developed, among which platelet rich plasma (PRP) injections. Some clinical series have previously evaluated the effect of PRP in the treatment of proximal patellar tendinopathies. Recent systematic review concluded that PRP could be recommend as a treatment in such indication (1). Recently, the viscoelastic properties of hyaluronic acid (HA) on liquid connective tissue have been proposed for the treatment of tendinopathies (2). Some fundamental studies show encouraging results on HA\'s ability to promote tendon gliding and reduce adhesion as well as to improve tendon architectural organisation. Some observations also support its use in a clinical setting to improve pain and function.

    Purpose: We aimed to compare the effect of PRP injection versus two injections of HA after three months on patients who have a proximal patellar tendinopathy.

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  • Efficacy of platelet-rich plasma injections for symptomatic tendinopathy: systematic review and meta-analysis of randomised injection-controlled trials

    Abstract

    Aim To determine the efficacy of platelet-rich plasma (PRP) injections for symptomatic tendinopathy.

    Results: A total of 16 randomised controlled trials (18 groups) of PRP versus control were included. Median sample size was 35 patients, a study size that would require an effect size ≥1.0 to achieve statistical significance. PRP was more efficacious than control in reducing tendinopathy pain, with an effect size of 0.47 (95% CI 0.22 to 0.72, p<0.001), signifying a moderate treatment effect. Heterogeneity among studies was moderate (I2=67%, p<0.001). In subgroup analysis and meta-regression, studies with a higher proportion of female patients were associated with greater treatment benefits with PRP.

    Conclusions: Injection of PRP is more efficacious than control injections in patients with symptomatic tendinopathy.

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  • Hydrodissection of an Achilles Tendinopathy on a Professional Athlete

    Abstract

    We report a case of Achilles tendinosis that was treated with a high volume, hydrodissection visualized by conventional B-mode ultrasound. Prior MRI revealed a thickened right Achilles tendon with a small defect. Ultrasound examination showed a thickened Achilles tendon with physical exam revealing a prominent Haglund\'s deformity, mild fusiform swelling and pain along the posterior Achilles (Figure 1 & 2). The condition had been poorly responsive to standard management including protected ambulation in a cam walker boot, anti-inflammatory medication, modalities and therapeutic exercise, as well as a platelet rich plasma injection. We suggest using high volume ultrasound guided injection adjacent to (anterior to) the Achilles tendon as an adjunct to treat this difficult clinical syndrome.

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  • Platelet rich plasma - A new revolution in medicine

    Abstract

    In the recent years there has been a paradigm shift in consideration of platelets from being just hemostatic cells to actually performing a myrad of diverse functions. The recent use of Platelet Rich Plasma as therapeutic agent is based on its growth factor content and the matrix provided by the platelets themselves. An overview of PRP, its uses in the field of medicine is provided for correct understanding of PRP therapy. Standardization of preparation and administration also remains a challenge due to various variables present. How beneficial are these individually tailored protocols, still remains to be seen.

    Blood is mainly liquid plasma containing small solid components such as RBC, WBC and platelets. Platelets contain different growth factors and cytokines contributing to haemostasis and capable of stimulating healing of both bone and soft tissue.

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  • Platelet-rich plasma: combinational treatment modalities for musculoskeletal conditions

    Abstract

    Current research on common musculoskeletal problems, including osteoarticular conditions, tendinopathies, and muscle injuries, focuses on regenerative translational medicine. Platelet-rich plasma therapies have emerged as a potential approach to enhance tissue repair and regeneration. Platelet-rich plasma application aims to provide supraphysiological concentrations of platelets and optionally leukocytes at injured/pathological tissues mimicking the initial stages of healing. However, the efficacy of platelet-rich plasma is controversial in chronic diseases because patients\' outcomes show partial improvements. Platelet-rich plasma can be customized to specific conditions by selecting the most appropriate formulation and timing for application or by combining platelet-rich plasma with synergistic or complementary treatments. To achieve this goal, researchers should identify and enhance the main mechanisms of healing. In this review, the interactions between platelet-rich plasma and healing mechanisms were addressed and research opportunities for customized treatment modalities were outlined. The development of combinational platelet-rich plasma treatments that can be used safely and effectively to manipulate healing mechanisms would be valuable and would provide insights into the processes involved in physiological healing and pathological failure.

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  • Role of platelet rich plasma in patients of osteoarthritis knee-a prospective study

    Abstract

    Introduction: In the present study, we evaluated the effects of 2 courses of PRP injections with 3 weeks interval, on patient\'s quality of life and functional ability.

    Materials and Method: It was a prospective study carried out on 55 patients (14 males & 41 females) in the Department of Orthopedics\', Era\'s Lucknow Medical College, Lucknow, and Uttar Pradesh from Sep 2015 to March 2016. Age >40 years, Knee arthralgia (>3 months) and Radiologic evidence of articular damage (grades 1-3 of Kellgren-Lawrence scale) based on knee Osteoarthritis criteria of American College of Rheumatology were enrolled in our study. Two intra-articular injections of Platelet Rich Plasma (PRP) at 3 weeks interval was given and patient was regularly followed up after 3rd week, 6th week, 3 months & 6 months of the 1st injection

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  • Transition from Deep Regional Blocks toward Deep Nerve Hydrodissection in the Upper Body and Torso

    Abstract

    Deep nerve hydrodissection uses fluid injection under pressure to purposely separate nerves from areas of suspected fascial compression, which are increasingly viewed as potential perpetuating factors in recalcitrant neuropathic pain/complex regional pain. The usage of 5% dextrose water (D5W) as a primary injectate for hydrodissection, with or without low dose anesthetic, could limit anesthetic-related toxicity. An analgesic effect of 5% dextrose water (D5W) upon perineural injection in patients with chronic neuropathic pain has recently been described. Here we describe ultrasound-guided methods for hydrodissection of deep nerve structures in the upper torso, including the stellate ganglion, brachial plexus, cervical nerve roots, and paravertebral spaces. We retrospectively reviewed the outcomes of 100 hydrodissection treatments in 26 consecutive cases with a neuropathic pain duration of months and the mean Numeric Pain Rating Scale (NPRS) 0-10 pain level of . The mean percentage of analgesia during each treatment session involving D5W injection without anesthetic was 88.1%

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  • The effect of Hypertonic Dextrose injection on the control of pain associated with knee osteoarthritis

    Abstract

    Introduction: The purpose of this study was to evaluate the effect of dextrose injection on controlling pain associated with knee osteoarthritis.

    Methods: To achieve the research objectives, available sampling was done using 80 patients with knee osteoarthritis referring to Taleghani Hos pital in 2017 and samples were divided into two groups: 15% dextrose injection and 25% hypertonic dextrose injection. This injection was performed at the beginning of the study, the first week, the fifth week and the ninth week. During these weeks, participants were asked to complete the WOMAC questionnaire implementing the VAS scale. After data collection, independent t-test and two-way variance analysis with repeated measures were used.

    Conclusion: In general, it can be suggested that the use of dextrose prolotherapy is a simple, safe, inexpensive, accessible and less complicated method than other treatments in these patients.

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  • Comparison between intra-articular ozone and placebo in the treatment of knee osteoarthritis: A randomized, double-blinded, placebo-controlled study

    Abstract

    OBJECTIVE:

    The aim of the trial was to determine the effectiveness of oxygen-ozone injections on knee osteoarthritis concerning pain reduction, joint functional improvement, and quality of life.

    METHODS:

    In this randomized, double-blinded, placebo controlled clinical trial, 98 patients with symptomatic knee osteoarthritis (OA) were randomized into two groups receiving intra-articular 20 μg/ml of ozone (OZ) or placebo (PBO) for 8 weeks. The efficacy outcomes for knee OA were the Visual Analogue Scale (VAS), Lequesne Index, Timed Up and Go Test (TUG Test), SF-36, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Geriatric Pain Measure (GPM).

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  • Treatment of First Metacarpophalangeal Joint Instability and Snapping Thumb Using Ultrasound-guided Prolotherapy and Hydrodissection: A Case Report

    Abstract

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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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  • 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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