General

  • The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials

    Abstract

    Background: Quite a few randomized controlled trials (RCTs) investigating the efficacy of platelet-rich plasma (PRP) for treatment of knee osteoarthritis (OA) have been recently published. Therefore, an updated systematic review was performed to evaluate the temporal effect of PRP on knee pain and physical function.

    Methods: Pubmed, Embase, Cochrane library, and Scopus were searched for human RCTs comparing the efficacy and/or safety of PRP infiltration with other intra-articular injections. A descriptive summary and quality assessment were performed for all the studies finally included for analysis. For studies reporting outcomes concerning Western Ontario and McMaster Universities Arthritis Index (WOMAC) or adverse events, a random-effects model was used for data synthesis.

    Results: Fourteen RCTs comprising 1423 participants were included. The control included saline placebo, HA, ozone, and corticosteroids. The follow-up ranged from 12 weeks to 12 months. Risk of bias assessment showed that 4 studies were considered as moderate risk of bias and 10 as high risk of bias. Compared with control, PRP injections significantly reduced WOMAC pain subscores at 3, 6, and 12 months follow-up (p = 0.02, 0.004, <0.001, respectively); PRP significantly improved WOMAC physical function subscores at 3, 6, and 12 months (p = 0.002, 0.01, <0.001, respectively); PRP also significantly improved total WOMAC scores at 3, 6 and 12 months (all p < 0.001); nonetheless, PRP did not significantly increased the risk of post-injection adverse events (RR, 1.40 [95% CI, 0.80 to 2.45], I 2 = 59%, p = 0.24).

    Conclusions: Intra-articular PRP injections probably are more efficacious in the treatment of knee OA in terms of pain relief and self-reported function improvement at 3, 6 and 12 months follow-up, compared with other injections, including saline placebo, HA, ozone, and corticosteroids.

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  • A Randomized Controlled Study to Evaluate the Effectiveness of Local Platelet Rich Plasma (PRP) Injection for the Management of the Cases of Planter Fasciitis - Final Outcome of 179 Cases at 12 Months

    Abstract

    Introduction: Plantar fasciitis is an inflammation of the plantar fascia at the bottom of the foot. Though pathology of plantar fasciitis remains ill understood, there is evidence to suggest that it is probably initiated by repeated micro trauma. Numerous methods have been advocated for treating plantar fasciitis, including rest, NSAID\'s, night splints, foot orthosis, stretching protocols and ESWT (extra corporeal shock wave therapy) ,local laser application, autologous blood injection and local ultrasound application. Platelet rich plasma (PRP) is promoted as an ideal autologous biological blood-derived product, which can be exogenously applied to various tissues where it releases high concentrations of platelet derived growth factors that enhance wound healing, bone healing and also tendon healing. In current study evaluate the effectiveness of local infiltration of autologous platelet rich plasma (PRP) and compared the results with control group.

    Method: Present study conducted in department of orthopedics of a tertiary level 1000 bedded Super specialty Medical Collage situated in rural area of North India. Cases were selected from the patients attending routine OPD from January 2007 to December 2015 at orthopedics department. 10 ml of a patient\'s own blood was collected via blood draw, maintaining sterile technique, with SYRINGE and then mixed with 2 ml Acid citrate dextrose (anticoagulant). This was then put in Autologous Platelet Separator System (1500 RPM for 5 minutes), yielding platelet rich plasma (PRP) as supernatant. Under sterile conditions, patients were receiving a 3 cc PRP injection (consisting of their own PRP) into the origin of the plantar fascia and site of maximum tenderness. We followed up patients at 2 weeks, 4 weeks, 8 weeks, 12 weeks and final at 52 weeks. The results tabulated as per the Performa. We used visual analogue scale (VAS) for assessment of pain relief in two groups.

    Results: At the start of study the mean VAS of control group was 6.5 and mean VAS of case group (PRP) was 6.6. The mean VAS score in case group (PRP) decreases from baseline 6.6 at start to 0.54 at 52 wk during follow up. We noticed that there was maximum decrease in mean VAS score in case group from first week (VAS-6.6) to 12 weeks (VAS-1.7). We concluded that PRP injection at planter fasciitis site have much better outcome in relation to visual analogue score(VAS) and result difference was statistically significant.

    Conclusion: Planter fasciitis is a very disabling disorder of foot leaving to very discomforting life and day to activity. Autologous platelet rich plasma (PRP) infiltration at the most tender part of heel is a effective method of management of these cases as compared to conservative management. This method also shown negligible complication rate and low recurrence rate. Conservative management of these cases had shown poor long term results.

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  • Generation of stem cell-based bioartificial anterior cruciate ligament (ACL) grafts for effective ACL rupture repair

    Abstract

    Introduction: Regenerative medicine (RM) is an interdisciplinary field of research and clinical applications focus on the repair, replacement, or regeneration of cells, tissues and organs to restore impaired function. RM employs technological breakthroughs such as those used in tissue engineering (TE) (i.e. biodegradable, biomimetic biopolymers, nanotechnology, biosensors etc) in combination with the powerful differentiation capacity of stemcells. Indeed, adipose tissue (AT) is a rich source ofmultipotential stromal cells (MSCs) that can be successfully differentiated towards mesoderm-related lineages such as osteoblasts, adipocytes, chondroblasts and fibroblasts representing a good overall option for autologous regenerative applications. Adult tissues, however, contain only committed stem cells that are multi- or even oligopotent. The use of human embryonic stem cells (hESCs) for medical applications is prohibited for legal/ethical (commercialization of life) andmedical (immune rejection of heterologous tissue) reasons. Thus, generation of induced pluripotent stem cells (iPSCs) by reprogramming of terminally differentiated cells (Takahashi and Yamanaka, 2006) offers the possibility for autologous regeneration of any tissue using pluripotent stem cells.

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  • Clinical effectiveness in severe knee osteoarthritis after intra-articular platelet-rich plasma therapy in association with hyaluronic acid injection: three case reports

    Abstract

    Osteoarthritis (OA) is a degenerative disorder resulting from loss of joint cartilage and underlying bone and causes pain and loss of function. The treatment ofk:nee OA is still a challenge because of the poor self-regeneration capacity of artilage. The nonslligical interventions include control of the aggravating factor (such as weight control and the use of walking aids), symptomatic treatment (such as acetaminophen or nonsteroidal anti-inflammatory drugs), prolotherapy, and viscosupplementation. However, the combination of platelet-rich plasma (PRP) and hyaluronic acid (HA) has not been widely used because of lack of clinical evidence and several limitations in patients with severe knee OA. Three patients who suffered from knee pain and poor walking endurance were diagnosed with advanced knee OA They underwentPRP treatment in association with intra-articular HA injection and showed pain relief and functional improvement. The follow-up standard weight-bearing X-ray images of knees also confirmed the improvement and indicated the possibility of regeneration of the articular cartilage. These cases provide clinical and radiographic evidence for a new therapy for advanced knee OA This treatment strategy of PRP in association with HA injection can offer a chance to treat severe knee OA, rather than immediate surgery, or a chance for those who cannot undergo surgery. It can also postpone the need of arthroplasty and can significantly improve the daily activity function.

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  • Comparison of different methods of centrifugation for preparation of platelet - rich plasma (PRP)

    Abstract

    Introduction: Platelet-rich plasma(PRP) has wide clinical applications which have been proved by various studies. There are various methods available now a days to prepare PRP but no standard protocol determining the time and centrifugation speed is available. This variation in the reported methods may produce samples with different platelet concentrations which may induce different clinical responses. Hence, the aim of the present study was to compare the different methods of centrifugation for preparation of platelet - rich plasma by estimating the platelet concentration in them.

    Methods: Whole blood was drawn from 50 healthy volunteers into two citrate tubes which were subjected to different centrifugation speed and time. The first tube underwent double spin at 100g (soft spin) and 400g (hard spin) respectively, for 10 minutes; whereas the second tube underwent single spin at 100g for 10 minutes. The platelet counts before and after centrifugations were then compared.

    Results: Single spin method yielded a plate let concentration factor of 2.19 as compared with the double spin method where, actually the platelet counts reduced (platelet concentration factor=0.83).

    Conclusion: From the above findings we conclude that single centrifugation method is better than double centrifugation method in preparation of platelet rich plasma as evidenced by the high platelet concentration factor (2.19).

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  • Efficacy of platelet-rich plasma for clinical outcomes after total knee arthroplasty: a systematic review and meta-analysis

    Abstract

    Objective: The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) and non-RCTs were to evaluate the effect of platelet-rich plasma (PRP) versus placebo on the patients receiving total knee arthroplasty (TKA).

    Methods: In April 2016, a systematic computer-based search was conducted in the Pubmed, ISI Web of Knowledge, Embase, Cochrane Database of Systematic Reviews and Chinese Wanfang data - base. This systematic review and meta-analysis were performed according to the PRISMA statement criteria. The primary endpoint was the range of motion (ROM), which represents the function after TKA. The Western Ontario Mc - Master Universities Osteoarthritis Index Bellamy (WOMAC), pain at 24 h, 48 h and 7 day and hemoglobin (Hb) at 24h after TKA were also to assess the effect of PRP on the function and pain after TKA. The complications of infection were also compiled to assess the safety of PRP. After testing for publication bias and heterogeneity across studies, data were aggregated for random-effects modeling when necessary.

    Results:Ten clinical trials with 1001 patients were included in the meta-analysis. The pooled results indicated that administration of PRP significantly increase ROM at third day (mean difference (MD) = 4.05, 95% CI = 1.58-6.52; P = 0.001) and 3 month postoperatively (MD = 3.12, 95% CI = 0.94-5.29; P = 0.005). There is no statistically difference between the two groups in terms of WOMAC questionnaire score at 3 month, pain intensity at 24 h, 48 h and 7 day and Hb at 24 h after TKA. There is no statistically significant difference between the PRP versus placebo in terms of the occurrence of infection (relative risk (RR) = 0.64, 95% CI = 0.19-2.14, P = 0.464).

    Conclusion: Based on the current meta-analysis, PRP can limitedly increase the ROM after TKA in short and long period. What\'s more, PRP has no effects on the WOMAC score, pain scores and the occurrence of infection. More RCTs and high quality studies are still needed to identify the efficacy and safety of PRP after TKA.

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  • Usefulness of strain elastography of the musculoskeletal system

    Abstract

    Ultrasound elastography is a widely used technique for assessing the mechanical characteristics of tissues. Although there are several ultrasound elastography techniques, strain elastography (SE) is currently the most widely used technique for visualizing an elastographic map in real time. Among its various indications, SE is especially useful in evaluating the musculoskeletal system. In this article, we review the SE techniques for clinical practice and describe the images produced by these techniques in the context of the musculoskeletal system. SE provides information about tissue stiffness and allows real-time visualization of the image; however, SE cannot completely replace gray-scale, color, or power Doppler ultrasonography. SE can increase diagnostic accuracy and may be useful for the follow-up of benign lesions.

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  • Analgesic Effect of Caudal 5% Dextrose in Water in Chronic Low Back Pain. A Randomized Controlled Trial of Epidural Injection

    Abstract

    Background: Hypertonic dextrose injection (prolotherapy) is reported to reduce pain including non-surgical chronic low back pain (CLBP), and subcutaneous injection of 5% dextrose is reported to reduce neurogenic pain hyperalgesia and allodynia. The mechanism in both cases is unclear, though a direct effect of dextrose on neurogenic pain is proposed. This study assessed the short-term analgesic effects of epidural 5% dextrose compared with saline for non-surgical CLBP.

    Methods: Randomized double-blind (injector, participant) controlled trial. Adults with moderate-to-severe non-surgical low back pain with radiation to gluteal or leg areas for at least 6 months received a single epidurogram-confirmed epidural injection of 10 mL of 5% dextrose or 0.9% saline using a published vertical caudal injection technique. The primary outcome was change in a numerical rating scale (NRS, 0 - 10 points) pain score between baseline and 15 minutes; and 2, 4, and 48 hours and 2 weeks post-injection. The secondary outcome was percentage achieving 50% or more pain improvement at 4 hours.

    Results and Conclusions: No baseline differences existed between groups; 35 participants (54 ± 10.7 years old; 11 female) with moderate-to-severe CLBP (6.7 ± 1.3 points) for 10.6 ± 10.5 years. Dextrose participants reported greater NRS pain score change at 15 minutes (4.4 ± 1.7 vs 2.4 ± 2.8 points; P = 0.015), 2 hours (4.6 ± 1.9 vs1.8 ± 2.8 points; P = 0.001), 4 hours (4.6 ± 2.0 vs 1.4 ± 2.3 points; P = 0.0001), and 48 hours (3.0 ± 2.3 vs 1.0 ± 2.1 points; P = 0.012), but not at 2 weeks (2.1 ± 2.9 vs 1.2 ± 2.4 points; P = 0.217). Eighty four percent (16/19) of dextrose recipients and 19% (3/16) of saline recipients reported ≥ 50% pain reduction at 4 hours (P < 0.001). These findings suggest a neurogenic effect of 5% dextrose on pain at the dorsal root level; waning pain control at 2 weeks suggests the need to assess the effect of serial dextrose epidural injections in a long-term study with robust outcome assessment.

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  • Distribution of Platelet-rich Plasma after Ultrasound-Guided Injection for Chronic Elbow Tendinopathies

    Abstract

    Characteristics of the spreads of platelet-rich plasma (PRP) are not widely known despite commonly use. This study aims to evaluate whether PRP stays within the injected area by using ultrasonography, to improve understanding of the spreads of intratendinous injected PRP. Thirty-nine patients (15 males, 24 females; mean age, 49.3 years), who had symptoms on their elbows (> 6 months) and diagnosed as lateral (25 elbows) or medial (14 elbows) tendinopathies of elbow, were included. The severity of tendon pathology was assessed by ultrasonography as tear or no tear. Immediately after ultrasound-guided PRP injection, ultrasound images were evaluated to assess the area of PRP distribution, which was defined as the presence of fluid or microbubbles. Ultrasound revealed that 13 elbows had tendon tear and 26 had no tear, respectively. Post-injection ultrasound confirmed the injected PRP was within the tendon in all cases. The mean distance of distribution from the injection site was 12.6 mm (5.0-26.0 mm). There was no difference in the distance of PRP distribution between tendon tear and no tear. Injected PRP spread to soft tissue outside the tendon in 20 of 39 cases. Intra-articular extension of PRP was observed in 5 cases. Although PRP remained intratendinous after the injection in all cases, some portion tended to spread outside from the injection site in a short space of time. Postinjection ultrasonographic imaging has a value for observing the spreading patterns of intratendinous PRP injection.

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  • Platelt-Rich Plasma Enhances Cartilage Integration: A BioEngineered In Vitro Model

    Abstract

    Osteoarthritis (OA) is a debilitating disease characterised by degradation of articular cartilage and subchondral bone remodeling. Current therapies for early or midstage disease do not regenerate articular cartilage, or fail to integrate the repair tissue with host tissue, and therefore there is great interest in developing biological approaches to cartilage repair. We have shown previously that platelet-rich plasma (PRP) can enhance cartilage tissue formation. PRP is obtained from a patient\'s own blood, and is an autologous source of many growth factors and other molecules which may aid in healing. This raised the question as to whether PRP could enhance cartilage integration. We hypothesise that PRP will enhance integration of bioengineered cartilage with native cartilage.

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  • Prolotherapy for Lumbar Segmental Instability Associated with Degenerative Disc Disease

    Abstract

    Prolotherapy is an injection-based therapy that may be used in the management of chronic low back pain. In principle, injection solutions are formulated to produce an inflammatory response, which in turn promotes ligamentous and tendinous regeneration.

    This case study series offers some ideas as to how Prolotherapy might be advantageous in the management of discogenic low back pain through improving vertebral segmental stability.

    When the disc is of normal height, the ligaments that hold the spine together remain at normal length. As the disc height decreases as in degenerative disc disease, the vertebrae move closer together. The resultant loss of spinal ligament tension may allow vertebral segmental instability, leading to chronic pain.

    Materials & Methods: The study analysed twenty-one male & female patients aged 35 to 73 years with chronic low back pain and MRI-confirmed low lumbar DDD (some with multi-level disease). They underwent 3 sets of fluoroscopically-guided Prolotherapy injections 1-3 weeks apart. Oswestry scores were analysed pre-Prolotherapy, at 3 months and at 1 year. All Oswestry scores were recorded on 14 patients, with the remainder only having pre and 1 year follow-up scores reported.

    Results: Pre-Prolotherapy Oswestry scores ranged in all patients from 12 to 44. 12 patients reported ADL or functional improvement scores of 80% or greater. 3 patients reported ADL or functional improvement scores of 70% at 1 year follow up. 3 patients also reported complete resolution of LBP and 100% ADL improvement at one-year follow-up with one of these patients becoming symptom-free at 3 months with results maintained at one-year follow-up. On patients for whom 3-month follow-up data was available, there was typically further improvement on ADLs and pain reduction on one-year follow-up. 3 patients reported no ADL or pain reduction benefit at all from the Prolotherapy with one of these patients actually reporting worse LBP and ADL scores at both 3 month and one-year post Prolotherapy. An inverse pattern of reduced pain scores in relation to improved ADL function was noted.

    Conclusions: These findings are consistent with the conclusions of other studies, in that Prolotherapy, in conjunction with rehabilitation would appear to be an effective part of the management pathway for discogenic low back pain associated with degenerative disc disease of the lumbar spine.

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  • Injection Therapy: Intra-articular Platelet-Rich Plasma and Stem Cell Therapy

    Abstract

    Platelet-rich plasma (PRP) has been touted in the sports medicine and orthopaedic surgery communities as a remedy with the ability to bridge the gap between conservative, pain relieving therapies and surgical interventions. Its theoretical advantages include its ability to enhance wound healing, decrease pain and improve function.

    There has also been much excitement about the multipotential nature of mesenchymal stem cells (MSCs), with the potential to regenerate different types of musculoskeletal tissue from cartilage to meniscus.

    Problems with both therapies abound. As yet, there is no common consensus as to what constitutes PRP, its preparation, or the method of its activation. Similarly, MSCs can have multiple origins, be induced in different methods and delivered in a variety of forms. Thus, at present, the evidence to substantiate the claims of either therapy is sparse or fails to be robust enough to support the arguments for its use.

    Our chapter provides an evidence-based insight into the background, preparation and clinical use of both PRP and MSCs, two therapies which have much to offer in regenerating and preserving tissue within the adult knee.

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  • Comparative effectiveness of dextrose prolotherapy versus control injections and exercise in the management of osteoarthritis pain: a systematic review and meta-analysis

    Abstract

    Background: Increasing evidence has supported the use of dextrose prolotherapy for patients with osteoarthritis. However, the real benefits may be affected by differences in injection protocols, comparative regimens, and evaluation scales.

    Methods: PubMed and Scopus were searched from the earliest record until February 2016. One single-arm study and five randomized controlled trials were included, comprising 326 participants. We estimated the effect sizes of pain reduction before and after serial dextrose injections and compared the values between dextrose rolotherapy, comparative regimens, and exercise 6 months after the initial injection.

    Results: Regarding the treatment arm using dextrose prolotherapy, the effect sizes compared with baseline were 0.65 (95% confidence interval [CI], 0.14-1.17), 0.84 (95% CI, 0.40-1.27), 0.85 (95% CI, 0.60-1.10), and 0.87 (95% CI, 0.53-1.21) after the first, second, third, and fourth or more injections, respectively. The overall effect of dextrose was better than control injections (effect size, 0.36; 95% CI, 0.10-0.63). Dextrose prolotherapy had a superior effect compared with local anesthesia (effect size, 0.38; 95% CI, 0.07-0.70) and exercise (effect size, 0.71; 95% CI, 0.30-1.11). There was an insignificant advantage of dextrose over corticosteroids (effect size, 0.31; 95% CI, -0.18 to 0.80) which was only estimated from one study.

    Conclusion: Dextrose injections decreased pain in osteoarthritis patients but did not exhibit a positive dose-response relationship following serial injections. Dextrose prolotherapy was found to provide a better herapeutic effect than exercise, local anesthetics, and probably corticosteroids when patients were retested 6 months following the initial injection.

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  • Use of Platelet-rich Plasma in an Experimental Rheumatoid Arthritis Model

    separated into: Control Group 7 (CG7) and 21 (CG21) days; Experimental Group 7 (EG7) and 21 (EG21) days. RA was induced through intraarticular knee with 100 μL Freud\'s complete adjuvant. On day 10, in GE7 and 21 were injected 100 μL PRP while those in GC7 and CG21 were injected 100 μL phosphate-buffered saline (PBS). On day 8 animals in EG7 and CG7 groups were euthanized. A second injection of 100 μL PRP and 100 μL PBS were performed on day 8 in EG21 and CG21, respectively. As result, we observed that granulation and necrosis tissue were intensely formed in CG7 while in EG7 was lightly formed with moderate osteogenesis and neovascularization. CG21 still presented moderate necrosis tissue, polymorphonuclear cells, and moderate emergence of capillaries, while EG21 showed decreased intensity of capillaries with low granulation tissue. EG21 showed bone tissue cells at a moderate level and subchondral bone formation. In conclusion, PRP intra-articular can be used as a co-adjuvant RA treatment because it was effective in controlling osteogenesis and stimulating the deposit of collagen fibers in cartilage

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  • Valutazione economica sull\'utilizzo de; plasma arricchito di piastrine vs acide ialuronico per iltrattamento dell\'osteoartrosi al ginocchio.

    Abstract

    Porpose: The incresing the incidence of total joint arthroplasty reflects the rises of osteoarthritis (OA) prevalence. OA is a degenerative pathalogy affecting joints with a significant impact on quality of life causing pain, leading to social lfe limitations and loss of work productivity. According to the worls Health Organization, OA is one of the most important causes of proples disability. The burden of the dusease is a correlated with a huge economic impact on the health care systems. Intra-articular infiltration therapies are used between the pharmacological and the surgical phases, in order to delay surgery. This work aims to carry out an economic evaluation on the use of the platelet-Rich-Plasma (PRP) therapy in the treatment of knee OA. The comparator is the hyaluronic acid,i.e. the standard therapy for drug-resistant OA that does not benefit or has short term benefits (<1 month) with intra-articular corticosteroids.

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  • Intradiscal and intra articular facet infiltrations with plasma rich in growth factors reduce pain in patients with chronic low back pain

    Abstract

    Context: Low back pain (LBP) is a complex and disabling condition, and its treatment becomes a challenge.
    Aims: The aim of our study was to assess the clinical outcome of plasma rich in growth factors (PRGF Endoret) infiltrations (one intradiscal, one intra articular facet, and one transforaminal epidural injection) under fluoroscopic guidance control in patients with chronic LBP. PRGF Endoret which has been shown to be an efficient treatment to reduce joint pain. Settings and Design: The study was designed as an observational retrospective pilot study. Eighty six patients with a history of chronic LBP and degenerative disease of the lumbar spine who met inclusion and exclusion criteria were recruited between December 2010 and January 2012. Subjects and Methods: One intradiscal, one intra articular facet, and one transforaminal epidural injection of PRGF Endoret under fluoroscopic guidance control were carried out in 86 patients with chronic LBP in the operating theater setting. Statistical Analysis Used: Descriptive statistics were performed using absolute and relative frequency distributions for qualitative variables and mean values and standard deviations for quantitative variables. The nonparametric Friedman statistical test was used to determine the possible differences between baseline and different follow up time points on pain reduction after treatment.

    Results: Pain assessment was determined using a visual analog scale (VAS) at the first visit before (baseline) and after the procedure at 1, 3, and 6 months. The pain reduction after the PRGF Endoret injections showed a statistically significant drop from 8.4

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  • Prospective randomized clinical study for the treatment of laterat epicondylitis: Comparison among PRP (Platelet-Rich-Plasma), Prolotherapy Physiotherapy and ESWT

    Abstract

    As recent knowledge proved that pathology of lateral epicondylitis is no more an inflammatory condition, but angiofibroblastic degeneration, steroid injection is no more recommended for lateral epicondylitis. It seems to be inappropriate that most of the comparative study used steroid injection as control group, as steroid injection is no more accepted as a treatment option. As control group should be treated with widely accepted proven method, the authors concluded that physiotherapy is the optimal control group treatment in designing prospective randomized control study. Ideal treatment option for lateral epicondylitis should have potential to promote healing of collagen fibres as basic pathology of lateral epicondylitis is the presence of degenerative changes including disorganized collagen fibres. Among recently highlighted treatments which have healing potential theoretically. The authors chose PRP (Platelet-Rich Plasma), prolotherapy and ESWT (Extracorpeal Shockwave Therapy) considering accessibility and national regulations. Consecutive patients who had refractory elbow pain more than 6 months were recruited into the study and randomized into 4 groups. Group A: Physiotherapy, B: ESWT, C: Prolotherapy, D: PRP. A power analysis performed before data collection indicated that a sample size of 200 patients (50 patients per group) will have 80% power which is able to detect 30% difference in DASH scoring system at a significance level of .05 (effect size=0.64). Mean and standard deviation for power analysis was determined according to preliminary study. Mean age was 52 years and mean Follow-up was 29 months (24-39). All 4 groups showed a decrease of DASH score after treatments (A: from 41.2 to 33.2, B: from 41.3 to 28.0, C: from 37.1to 16.3, D: from 41.2 to 10.6). Difference among DASH scores were not significant at initial point, 3 months and 6 months after the treatments (p>0.01). Post hoc comparisons at 18 and 24 months after treatment indicated that DASH score was better in the PRP group (p<0.01) than in the ESWT or the physiotherapy group and in the prolotherapy group (p<0.01) than in the physiotherapy group. In summary, prolotherapy and PRP showed better clinical outcome compared to ESWT and physiotherapy group and PRP showed most superior results.

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  • Physical Medicine and Rehabilitation Clinics of North America

    Abstract

    The clinical application of platelet-rich plasma (PRP) and other regenerative therapies in sports, spine, and musculoskeletal medicine has soared in the last decade. Over this period, many factors have converged to fuel this development. Advances in sci-entific understanding of tendinopathy as a degenerative cellular and connective tissue process; lack of long-term efficacy of steroid injection therapies, which has prompted the need for alternative therapies; advances in musculoskeletal ultrasound (US) to facilitate diagnosis and guide interventions; as well as translation of treatment para-digms from colleagues in oral and veterinary surgery have all contributed to the advancement of this regenerative field

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  • In vivo clinical and radiological effects of platelet-rich plasma on interstitial supraspinatus lesion: Case series

    Abstract

    Background:Rotator cuff tear (RCT) is a frequent condition of clinical relevance that can be managed with a symptomatic conservative treatment, but surgery is often needed. Biological components like leukocytes and platelet rich plasma (L-PRP) could represent an alternative curative method for interstitial RCT.

    Hypotheses:It has been hypothesized that an ultrasound guided L-PRP injection in supraspinatus interstitial RCT could induce radiological healing.

    Material and methods:A prospective case series including 25 patients was performed in order to assess the effect of L-PRP infiltration into supraspinatus interstitial RCTs. Primary outcome was tear size change determined by magnetic resonance imaging arthrogram (MRA) before and 6 months after L-PRP infiltration. Secondary outcomes were Constant score, SANE score, and pain visual analog scale (VAS) after L-PRP infiltration.

    Results:Tear volume diminution was statistically significant (P = .007), and a >50% tear volume diminution was observed in 15 patients. A statistically significant improvement of Constant score (P < .001), SANE score (P = .001), and VAS (P < .001) was observed. In 21 patients, Constant score improvement reached the minimal clinical important difference of 10.4 points.

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  • Dextrose Prolotherapy: A Narrative Review of Basic Science, Clinical Research, and Best Treatment Recommendations

    Abstract

    Background:Prolotherapy is an injection-based treatment of chronic musculoskeletal pain. A general surgeon in the United States, George Hackett, formalized injection protocols in the 1950s, based on 30 years of clinical experience.1 Prolotherapy has been identified as a regenerative injection therapy2 but is differentiated from other regenerative injection therapies, such as platelet-rich plasma (PRP) and stem cell injection by the absence of a biologic agent.

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