General

  • Mesenchymal Stem Cells as an Alternative to Knee Replacement Surgery

    Abstract

    Description: Knee osteoarthritis is a degenerative disease that causes disability and persistent pain. Currently, treatment modalities for osteoarthritis focus on pain reduction and symptom management, but do little to address disease modification. Presently, the treatment of choice for knee osteoarthritis is total knee replacement surgery. Total knee replacement surgery carries significant risks and does not guarantee improvement in joint pain or function. In the last decade, advances in regenerative medicine have proposed the use of mesenchymal stem cells as a treatment strategy for joint preservation, cartilage regeneration and improved joint function in patients with osteoarthritis. The aim of this integrative literature review was to explore the use of mesenchymal stem cells as a treatment modality for the management of knee osteoarthritis and to analyze the safety and effectiveness of the intervention. An extensive search of the academic databases Cumulative Index of Nursing and Allied Health Literature (CINAHL), and PubMed was conducted using the search terms, mesenchymal stem cells and knee osteoarthritis. The findings of this literature review indicate regenerative medicine has the potential to be an effective alternative to knee replacement surgery. Furthermore, the review provides significant evidence that the use of mesenchymal stem cells for the treatment of knee osteoarthritis is safe and effective; however, more research and clinical trials are needed before its use can become standard practice.

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  • Leukocyte-reduced platelet-rich plasma increases proliferation of tenocytes treated with prednisolone: a cell cycle analysis

    Abstract

    Introduction: The purpose of this study was to evaluate the effect of allogenic leukocyte-reduced platelet-rich plasma on human tenocytes after treatment with prednisolone and to develop a standardization of its application for clinical practice.

    Methods: A leukocyte-reduced PRP was produced using the Arthrex Double Syringe (Arthrex, Inc., Naples, FL, USA), in a modified single-spin separation method. Human tenocytes were isolated from discarded rotator cuff segments. Tenocytes were cultured in the presence of PRP and prednisolone, both alone and in combination. Control samples were treated in media containing 2% FCS for 72 h. After 72 h of incubation, cell cycle kinetics of tenocytes were analyzed to assess proliferation.

    Results: Incubation of the tenocytes with PRP alone for 48 h led to high proliferation rate (10% PRP, 28.0

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  • The Histological Effects of Ozone Therapy on Sciatic Nerve Crush Injury in Rats

    Abstract

    Objective: Peripheral nerve injury is a common, important problem that lacks a definitive, effective treatment. It can cause neurologic deficits ranging from paresthesia to paralysis. This study evaluated the effect of ozone therapy on sciatic nerve crush injury in rats.

    Materials and Methods: Twenty-four male rats were divided into control sham surgery, sciatic nerve injury, and sciatic nerve injury with ozone groups (each n = 8). The sciatic nerve injury was inflicted via De Koning\'s crush-force method. The sciatic nerve injury group received medical air and the sciatic nerve injury ozone group received 0.7 mg/kg ozone. Sciatic nerve samples were obtained 4 weeks after injury. Vascular congestion, vacuolization, edema formation, S100 expression, and the thicknesses of the perineurium and endoneurium and diameter of the injured sciatic nerves were evaluated.

    Results: The diameter of the sciatic nerve and thicknesses of the perineurium and epineurium were significantly greater in the sciatic nerve injury group (P < 0.05) and significantly less in the sciatic nerve injury with ozone group (P < 0.001). High S100 immunoreactivity was seen in the sciatic nerve injury group compared with the other 2 groups (P < 0.05). The distributions of vascular congestion and vacuolization were significantly less in the sciatic nerve injury with ozone group (P < 0.05).

    Conclusions: Ozone therapy improved sciatic nerve injury recovery without causing an increase in fibrotic tissue. Ozone reduced fibrosis, vascular congestion, vacuolization, and edema in rodents. Ozone treatment might be used to assist in sciatic nerve injury.

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  • Intradiscal O2O3: Rationale, Injection Technique, Short- and Long-term Outcomes for the Treatment of Low Back Pain Due to Disc Herniation

    Abstract

    The management of low back pain should always start with a conservative approach; however, when it fails, intervention is required and at that moment the most appropriate choice remains unclear. Before invasive surgery, minimally invasive techniques can be adopted. In European trials and in a trans-Canadian clinical trial 03 ozone has been used successfully. In total over 50,000 patients have been treated safely. Ozone is a gas normally present in the atmosphere with potent oxidizing power; it has been used for percutaneous intradiscal injection combined with oxygen (O2O3) at very low concentrations for 15 years in Europe. The main indication is back pain with or without radicular pain but without motor deficits, which is refractory to 4-6 weeks of conservative therapies. Its mechanism of action on the disc is mechanical (volume reduction by subtle dehydration of the nucleus pulposis) and antinflammatory. The intradiscal ozone injection is performed with a thin needle (18-22 gauge) image guided by computed tomography or angiofluoroscopy and is usually complimented by periganglionic injection of corticosteroids and anesthetics. This combination gives immediate pain relief and allows time for the ozone to act. It is a cost-effective procedure that presents a very low complication rate (0.1%). The radicular pain is resolved before the back pain does, as is seen with microdiscectomy. Peer-reviewed publications of large randomized trials, case series, and meta analysis from large samples of patients have demonstrated the procedure to be safe and effective in the short and the long terms, with benefits recognized up to 10 years after treatment. We aim to review the principles of action of O2O3 and report the injection techniques, complications, and short- and long-term outcomes.

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  • Platelet-Rich Fibrin Facilitates Rabbit Meniscal Repair by Promoting Meniscocytes Proliferation, Migration, and Extracellular Matrix Synthesis

    Abstract

    Although platelet-rich fibrin (PRF) has been used in clinical practice for some time, to date, few studies reveal its role as a bioactive scaffold in facilitating meniscal repair. Here, the positive anabolic effects of PRF on meniscocytes harvested from the primary culture of a rabbit meniscus were revealed. The rabbit meniscocytes were cultured with different concentrations of PRF-conditioned medium, and were evaluated for their ability to stimulate cell migration, proliferation, and extracellular matrix formation. In vivo, meniscal defects were created via an established rabbit animal model and were evaluated by a histology-based four-stage scoring system to validate the treatment outcome three months ostoperatively. The in vitro results showed that PRF could induce cellular migration and promote proliferation and meniscocyte extracellular matrix (ECM) synthesis of cultured meniscocytes. In addition, PRF increased the formation and deposition of cartilaginous matrix produced by cultured meniscocytes. Morphological and histological evaluations demonstrated that PRF could facilitate rabbit meniscal repair. The data highlight the potential utility of using PRF in augmenting the healing of meniscal injuries. These advantages would benefit clinical translation, and are a potential new treatment strategy for meniscal repair.

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  • Treatment of knee osteoarthritis: platelet-derived growth factors vs. hyaluronic acid. A randomized controlled trial

    Abstract

    Objective:Aim of this trial was to compare efficacy of activated platelet-rich plasma against hyaluronic acid as intra-articular injections to people with osteoarthritis of the knee.

    Design: Phase-2 randomized controlled trial, with blind patients and outcome assessors.

    Setting: Outpatient rehabilitation service; years 2011-2013.

    Subjects: Patients with knee osteoarthritis grades 2-3 at magnetic resonance imaging (MRI) were included after consent and randomized. Target sample size was 25 patients per group.

    Interventions: Patients received three activated platelet-rich plasma (intervention group) or hyaluronic acid (controls) intra-articular injections at 4-week intervals.

    Main measures: Main outcome measure was proportion of patients with >1 grade improvement at six months from last injection, as assessed by a radiologist blind to study group. Patients were evaluated over time clinically and with functional scales (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lysholm, Tegner, American Knee Society Score (AKSS), Lequesne, visual analogue scale (VAS) for pain).

    Results: Overall, 30 patients were randomized to intervention and 28 to control group. For primary outcome, 28 patients (29 knees) in the intervention and 22 (25 knees) in the control group were available. Patients with at least 1 grade improvement at repeat MRI were 14 (48.3%) in the intervention and 2 (8%) in the control group (P < 0.003). Improvement in symptoms and functional scales was consistently higher in the intervention group. No side-effects were observed in either group.

    Conclusion: Activated platelet-rich plasma reduces articular damage as evident at MRI, as soon as six months after treatment; it reduces pain and improves patient\'s function and overall quality of life.

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  • Does platelet-rich plasma have a favorable effect in the early stages of steroid-associated femoral head osteonecrosis in a rabbit model?

    Abstract

    Objectives: This study aims to investigate the effect of platelet-rich plasma (PRP) on femoral head osteonecrosis and compare it with bone marrow injection and core decompression.

    Materials And Methods: A total of 30 healthy, adult, male New Zealand white rabbits (mean weight 2.25

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  • The Role of Platelet-Rich Plasma in Promoting Cartilage Integration and Chondrocyte Migration

    inBold\">Abstract

    Objectives: Current therapies for cartilage repair either do not result in regeneration of articular cartilage, or there is inadequate integration with the host tissue leading to failure of the repair. Thus, there is an interest in developing alternative approaches. The mechanisms of cartilage integration remain relatively unknown, however it is believed that chondrocyte migration is crucial to this process. Previously, we showed that platelet rich plasma (PRP) enhances in vitro cartilage tissue formation. We hypothesized that PRP will enhance the integration of bioengineered cartilage with native cartilage due to increased matrix accumulation at the interface and that PRP could promote chondrocyte migration.

    Methods: Isolated bovine chondrocytes were seeded on a porous bone substitute and grown in vitro to form osteochondral-like tissue. After 7 days the biphasic constructs were soaked in PRP for 30 minutes prior to implantation into the core of a ring-shaped osteochondral explant. Controls were not soaked in PRP. The resulting implant-explant construct was cultured in a stirring bioreactor for 2 weeks (contact model). Alternatively, the PRP soaked biphasic construct was placed 2mm away from a native cartilage/bone plug of equal dimensions to assess chondrocyte migration between the two tissues (non-contact model). The integration zone was visualized histologically. A push-out test was performed to assess the strength of integration. Matrix accumulation at the zone of integration was assessed biochemically and the gene expression of the cells in this region was assessed by RT-PCR. Cell migration was evaluated by video microscopy over 8 days. Significance (p<0.05) was determined by a χ2 test, a student\'s t-test or one-way ANOVA with tukey\'s post hoc.

    Conclusion: PRP soaked bioengineered cartilage implants showed improved integration with native cartilage compared to non-soaked implants perhaps due to increased matrix accumulation. Chondrocytes grew out from the in vitro formed tissue and migrated along fibers after PRP soaking. The contribution of these cells to integration requires further study.

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  • A Novel Treatment for Carpal Tunnel Syndrome?

    Abstract

    Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and is caused by chronic compression of the median nerve as it enters the carpal tunnel. Although the prevalence and incidence of CTS vary widely depending on the diagnostic criteria used, it is thought that, clinically, approximately 1 in 10 people have development of carpal tunnel syndrome. 1,2 At this time, there is no consensus for the treatment of mild to moderate carpal tunnel syndrome. The American Academy of Orthopedic Surgeons has stated that nonsurgical treatments, such as splinting of the wrist to a neutral position and local corticosteroid injections, are reasonable options for patients early in the course of symptoms when there is no evidence of median nerve denervation.

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  • Six-month Efficacy of Perineural Dextrose for Carpal Tunnel Syndrome

    Abstract

    Objective: To assess the 6-month effectiveness of ultrasound-guided perineural injection therapy (PIT) using 5% dextrose (D5W) in patients with mild-to-moderate carpal tunnel syndrome (CTS).

    Patients and Methods: A prospective, randomized, placebo-controlled, and double-blind study was conducted between May 1, 2016, through March 30, 2017. A total of 49 participants diagnosed with mild-to-moderate CTS were randomized into D5W and control groups. Participants in the D5W group received 1 session of ultrasound-guided PIT with 5 cc of D5W, and the control group received PIT with normal saline. The visual analog scale measured pain as a primary outcome. Secondary outcomes were Boston Carpal Tunnel Syndrome Questionnaire scores, the cross-sectional area of the median nerve, and electrophysiological measurement results. Assessment was performed before injection and at 1, 3, and 6 months post-injection.

    Results: All patients (data from 30 wrists in each group) completed the study. Compared with the control group, at all post-injection time points, the D5W group had a significant reduction in pain and disability, improvement on electrophysiological response measures, and decreased cross-sectional area of the median nerve.

    Conclusion: Our study reveals that ultrasound-guided PIT with D5W is an effective treatment for patients with mild-to-moderate CTS.

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  • Is osteoarthritis a metabolic disease?

    Abstract

    Obesity, together with aging and injury, is among the main risk factors for osteoarthritis. Obesity-related osteoarthritis can affect not only the weight-bearing joints, but also the hands, suggesting a role for circulating mediators released by the adipose tissue and known as adipokines. Thus, osteoarthritis may have a systemic metabolic component. Evidence from both epidemiological and biological studies support the concept of metabolic osteoarthritis, defined as a broad clinical phenotype that includes obesity-related osteoarthritis. Thus, osteoarthritis can be related to metabolic syndrome or to an accumulation of metabolic abnormalities. In addition, studies have demonstrated associations linking osteoarthritis to several components of the metabolic syndrome, such as hypertension and type 2 diabetes, independently from obesity or any of the other known risk factors for osteoarthritis. Both in vitro and in vitro findings indicate a deleterious effect of lipid and glucose abnormalities on cartilage homeostasis. Chronic low-grade inflammation is a feature shared by osteoarthritis and metabolic disorders and may contribute to the genesis of both. Thus, osteoarthritis is emerging as a disease that has a variety of phenotypes including a metabolic phenotype, in addition to the age-related and injury-related phenotypes.

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  • The effectiveness of platelet-rich plasma injections in gluteal tendinopathy - a randomised, double-blind controlled trial comparing a single platelet-rich plasma injection with a single corticosteroid injection.

    Abstract

    Importance: Gluteus medius/minimus tendinopathy is a common cause of lateral hip pain or greater trochanteric pain syndrome.

    Objective: There would be no difference in the modified Harris Hip score between a single Platelet-Rich-Plasma (PRP) injection compared to a corticosteroid injection (CSI) in the treatment of gluteal tendinopathy.

    Design: Randomised Controlled Clinical Trial; Level of evidence 1, recruitment 29 May 2013 to May 2015, follow-up September 2016. Treating/assessing clinicians and subjects were blinded to treatment. PARTICIPANTS: 228 consecutive patients referred with gluteal tendinopathy were screened to enrol 80 participants. 148 excluded (refusal 48, previous surgery 39, sciatica 28, osteoarthritis 17, full thickness tears tendons 17, other 22).

    Conclusion: Patients with chronic gluteal tendinopathy >4 months, diagnosed with both clinical and radiological examinations, achieved greater clinical improvement at 12 weeks when treated with a single PRP injection than those treated with a single corticosteroid injection.

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  • Comparison study between plasma rich in growth factors and platelet-rich plasma for osteoconduction in rat calvaria

    Abstract

    Objective: Plasma rich in growth factors (PRGF) and platelet-rich plasma (PRP) can be rapidly obtained from patient blood. They are a new and potentially useful adjunct in oral and maxillofacial bone repair or regenerative surgery. The aim of this study was to compare the possibility of new bone formation using PRGF and PRP.

    Methods: The osteogenic potential with transplantation of PRGF or PRP onto rat calvaria was evaluated by histologic examination and microCT. PRGF or PRP was prepared by centrifugation of rat whole blood (WB). First, the cells in the blood product were counted; there were no leukocytes in PRGF, and PRP included leukocytes. PRGF contained higher levels of TGF-β1 and PDGF-BB than PRP. Furthermore, PRGF or PRP was transplanted onto calvarial bone of rats.

    Results: MicroCT showed that PRGF promoted an increase in bone volume when compared to PRP. Histological observation demonstrated that the PRGF group showed newly formed bone in a wide range. In addition, the PRP group showed numerous inflammatory cells compared to the PRGF group in HE-stained specimens. This suggests that PRP might delay bone regeneration due to the inflammatory response.

    Conclusions: PRGF has more availability for bone regeneration than PRP, and PRGF may be useful in bone regeneration treatment.

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  • Ultrasound-guided platelet-rich plasma injections for the treatment of osteoarthritis of the hip

    Abstract

    Objective: To assess the safety and symptomatic changes of IA injections of platelet-rich plasma (PRP) in patients with OA of the hip.

    Methods: Forty patients affected by monolateral severe hip OA were included in the study. Each joint received three IA injections of PRP, which were administered once a week. The primary end point was meaningful pain relief, which was described as a reduction in pain intensity of at least 30% from baseline levels as evaluated by the WOMAC subscale at 6-months post-treatment. The visual analogue scale (VAS) and Harris hip score subscale for pain were used to verify the results. Secondary end points included changes in the level of disability of at least 30% and the percentage of positive responders, i.e. the number of patients that achieved a >30% reduction in pain and disability.

    Results: Statistically significant reductions in VAS, WOMAC and Harris hip subscores for pain and function were reported at 7 weeks and 6 months (P < 0.05). Twenty-three (57.5%) patients reported a clinically relevant reduction of pain (45%, range 30-71%) as assessed by the WOMAC subscale. Sixteen (40%) of these patients were classified as excellent responders who showed an early pain reduction at 6-7 weeks, which was sustained at 6 months, and a parallel reduction of disability. Side effects were negligible and were limited to a sensation of heaviness in the injection site.

    Conclusion: This preliminary non-controlled prospective study supported the safety, tolerability and efficacy of PRP injections for pain relief and improved function in a limited number of patients with OA of the hip.

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  • The contribution of leucocytes to the antimicrobial activity of platelet-rich plasma preparations: a systematic review

    Abstract

    The infection of a wound is one of the major contributors to delays in healing and tissue regeneration. As multi-drug resistance to antibiotics is becoming a serious threat, research in this field has focused on finding new agents and strategies to fight infection and additionally to reduce healing times. The topical use of autologous Platelet Rich Plasma (PRP) as a biological accelerator of the healing process, has been safely used as a form of treatment for wounds since the 1990s. Although the presence or absence of leucocytes in PRP preparation was previously neglected, in the last decade more attention has been paid to their role and several studies have been conducted to explore both their immuno-metabolic effects and their antimicrobial properties. In this review, we aim to summarise the literature on the contribution of leucocytes included in PRP preparations in terms of their antimicrobial properties. This should help to inform clinical practice and additional research in this promising field.

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  • Ultrasound-guided perineural injection with platelet-rich plasma improved the neurophysiological parameters of carpal tunnel syndrome: A case report

    Abstract

    Carpal tunnel syndrome (CTS) is a common and sometimes challenging condition, which causes pain; paresthesia; tingling of the thumb, index and long fingers; and even thenar weakness in the hands. The effectiveness of corticosteroid injections seems to be transient, and there is a lack of information around long-term effects in previous studies. In recent years, platelet-rich plasma (PRP) has proven to bean alternative as it encourages tissue regeneration. We hereby describe a patient with CTS showing significant improvements in electrophysiological parameters after receiving PRP injections. The results revealed significant improvements in the distal motor and sensory latencies as well as the sensory nerve action potential and compound muscle action potential amplitudes of the both median nerves. In summary, if patients are refractory to conservative treatments —such as splinting, oral medication, and corticosteroid injection —PRP may be used as an alternative before surgical intervention.

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  • High-resolution ultrasound and magnetic resonance imaging to document tissue repair after prolotherapy: a report of 3 cases

    Abstract

    High-resolution ultrasound imaging of musculoskeletal tissue is increasing in popularity because of patient tolerability, low cost, ability to visualize tissue in real-time motion, and superior resolution of highly organized tissue such as a tendon. Prolotherapy, defined as the injection of growth factors or growth factor production stimulants to grow normal cells or tissue, has been a controversial procedure for decades; it is currently gaining in popularity among physiatrists and other musculoskeletal physicians. This report describes imaging of tendons, ligaments, and medial meniscus disease (from trauma or degeneration). Although these tissues have been poorly responsive to nonsurgical treatment, it is proposed that tissue growth and repair after prolotherapy in these structures can be documented with ultrasound and confirmed with magnetic resonance imaging. Directions for future research application are discussed.

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  • Platelet-Rich Plasma Augmentation for Hip Arthroscopy

    Abstract

    Biological augmentation and therapeutics are being increasingly used in musculoskeletal and orthopaedic care. Platelet-rich plasma (PRP) is produced from centrifugation of peripheral blood, a process that concentrates platelets within autologous plasma. The process of PRP preparation is fundamental in controlling the contents, and it influences its therapeutic potential. Platelets contain alpha granules that store and release a variety of growth factors and other proteins that may augment the healing environment; PRP also has the added benefit of promoting postsurgical hemostasis. The purpose of this report was to detail our institutional preparation protocol and method of administration of PRP during hip arthroscopy.

    Biological augmentation and therapeutics are being increasingly used in musculoskeletal and orthopaedic care1,2,3 Platelet-rich plasma (PRP) has been used by orthopaedic surgeons and other health practitioners to enhance healing and modulate the environment of tendinopathy, surgical repair of tendons, ligament reconstruction, diffuse arthritis, and focal chondral defects4,5,6.

    PRP is produced from centrifugation of peripheral blood, a process that concentrates platelets within autologous plasma.2 Platelets contain alpha granules that store and release a variety of growth factors, such as cytokines and chemokines, as well as other proteins including insulin growth factor 1, transforming growth factor β1, and vascular endothelial growth factor.1 These biological factors can be modulated by the preparation method used to produce the PRP. For example, leukocyte-rich PRP may increase inflammation and catabolic pathways, whereas leukocyte-poor PRP may decrease inflammation and anabolic pathways.7, 8 In addition, PRP can be prepared as a fibrinous product with adhesive hemostatic properties through endogenous or exogenous activation. The PRP-fibrin preparation can enhance endothelial, epithelial, and epidermal regeneration, by stimulating angiogenesis, improving collagen synthesis, and decreasing scarring.9

    PRP has been historically described as \"a volume of plasma with a platelet count above baseline,\"10 but a more recent quantitative definition requires PRP to contain more than 1 million platelets per milliliter of serum or a 5-fold increase from the baseline platelet concentration.11 The preparation of PRP is essential in determining the therapeutic potential for biological augmentation. The purpose of this report was to detail our institutional PRP preparation protocol and method of administration during hip arthroscopy.

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  • Prolotherapy Induces an Inflammatory Response in Human Tenocytes In Vitro

    Abstract

    Background: Proliferative therapy, or prolotherapy, is a controversial treatment method for many connective tissue injuries and disorders. It involves the injection of a proliferant, or irritant solution, into the site of injury, which causes small-scale cell death. This therapeutic trauma is theorized to initiate the body\'s wound-healing cascade, perhaps leading to tissue repair. The immediate effects of many of these proliferants are poorly characterized, as are the cellular responses to them; here, we sought to evaluate the immediate effects of two common proliferants (dextrose and P2G, a combination of phenol, glucose, and glycerin) on the cellular response of human tenocytes, and begin to explicate the mechanisms with which each proliferant functions.

    QUESTIONS/PURPOSES: We asked: What are the effects of treating cultured tenocytes with proliferative treatment agents on their (1) cellular metabolic activity, (2) RNA expression, (3) protein secretion, and (4) cell migration?

    Methods: Using human hamstring and Achilles tendon cells, we attempted to answer our research questions. We used a colorimetric metabolic assay to assess the effect of dextrose and P2G proliferant treatment on cell mitochondrial activity compared with nontreated tenocytes. Next, using quantitative PCR, ELISA, and a reporter cell line, we assessed the expression of several key markers involved in tendon development and inflammation. In addition, we used a scratch wound-healing assay to evaluate the effect of proliferant treatment on tenocyte migration.

    Results: Results showed that exposure to both solutions led to decreased metabolic activity of tenocytes, with P2G having the more pronounced effect (75% ± 7% versus 95% ± 7% of untreated control cell metabolic levels) (ANOVA; p < 0.01; mean difference, 0.202; 95% CI, 0.052-0.35). Next, gene expression analysis confirmed that treatment led to the upregulation of key proinflammatory markers including interleukin-8 and cyclooxygenase-2 and downregulation of the matrix marker collagen type I. Furthermore, using a reporter cell line for transforming growth factor-β (TGF-β), a prominent antiinflammatory marker, we showed that treatments led to decreased TGF-β bioactivity. Analysis of soluble proteins using ELISA revealed elevated levels of soluble prostaglandin E2 (PGE2), a prominent inducer of inflammation. Finally, both solutions led to decreased cellular migration in the tenocytes.

    Conclusion: Taken together, these results suggest that prolotherapy, more so with P2G, may work by decreasing cellular function and eliciting an inflammatory response in tenocytes. Additional studies are needed to confirm the cellular signaling mechanisms involved and the resulting immediate response in vivo.

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  • Single Platelet-Rich Plasma Injection for Early Stage of Osteoarthritis of the Knee

    Abstract

    Purpose: The purpose of this study was to determine the safety efficacy and outcomes of platelet-rich plasma (PRP) intra-articular injections for early stages of knee osteoarthritis (OA).

    Methods: Twenty-five patients affected by grade I and II knee primary OA according to the Kellgren-Lawrence scale received a single intra-articular PRP injection. Patients were prospectively evaluated for 6 months. Visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and Knee injury and Osteoarthritis Outcome Score (KOOS) scoring scales were used to evaluate clinical outcomes. Wilcoxon signed rank test was used to evaluate significance of improvement of WOMAC, KOOS, and VAS scores.

    Results: Twenty-one patients completed 6-months follow-up. The median WOMAC score improved from 29.1 points (range: 17.4-60.4; standard deviation [SD] = 13.0) at baseline to 42.41 (range: 24.3-71.2; SD = 12.5) at final follow-up. Improvements in median KOOS and VAS score have been also found, from 37.49 points and 64.2 mm before injection to 59.71 points and 42.8 mm, respectively. All these improvements were statistically significant (p < 0.05). No adverse reactions have been observed.

    Conclusion: Treating knee OA with PRP injection is safe. A single dose of PRP seems to be effective in managing pain and improving quality of life in patients with low-grade knee OA.

    Level of Evidence: Level IV, therapeutic case series.

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