General

  • MRI Documented Improvement in Patient with Juvenile Osteochondritis Dissecans Treated with Platelet Rich Plasma

    Abstract

    Osteochondritis dissecans refers to the separation of osteochondral fragments from the bed of the joint surface. Definition of lesion goes by the existence of an open epiphyseal line in a juvenile form and the absence, representing an adult form. The treatment of osteochondritis dissecans depends on age, on the epiphyseal line, its length, location and stability of the lesion. A conservative treatment is preferred in juvenile cases; a surgical intervention may be necessary for unstable lesions and those not responding to conservative approaches. Showing no positive development in symptoms and physical status for six months, our 16-year-old male patient received two intraarticular platelet rich plasma injections three months apart, focusing on the lesion of steochondritis dissecans localized in the right knee. At the end of the 18th month, the patient did not show any limitation in his physical activities and radiographic examination confirmed the successful treatment. Having obtained positive results, we believe that PRP injections are a safe, simple, and minimally invasive treatment option for juvenile OCD which doesn't respond to conservative therapy before a surgical approach.

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  • Ozone Improves Pain Relief, Function and Quality of Life in Patients with Knee Osteoarthritis: A Prospective Quasi-Experimental Before-After Study

    Abstract

    Background: The study was conducted to: 1) demonstrate the effectiveness of a treatment protocol with Ozone therapy in pain, function, and quality of life in patients with knee osteoarthritis; and 2) apply Ozone as a conservative treatment option with a demonstrable level of scientific evidence.

    Methods: This prospective quasi-experimental before-after study was conducted on 119 patients with knee osteoarthritis, having Kellgren-Lawrence grade 2 or more, who referred to hospital of Santa Cristina's University, from January 2012 to April 2016. The protocol consisted of an intra-articular infiltration of a medical mixture of Oxygen-Ozone (95% - 5%) 20mL, at a 20ug / mL concentration, during a total number of 4 sessions (once per week). Pain and quality of life were measured by visual analogical scale (VAS) and western Ontario and mc master universities index for osteoarthritis (WOMAC) at the beginning and end of the treatment.

    Results: The mean age of participants was 66.29 years. The sample was composed of 70.5% Women (n = 84) and 29.5% men (n = 35). The severity of OA according to Kellgren-Lawrence scale was 2.94

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  • Comparison between intrarticular injection of hyaluronic acid, oxygen ozone, and the combination of both in the treatment of knee osteoarthrosis.

    Abstract

    This study aimed to compare short-term clinical outcomes between intra-articular injection of hyaluronic acid (HA), oxygen ozone (O2O3), and the combination of both, in patients affected by osteoarthrosis (OA) of the knee. Seventy patients (age 45-75 years) with knee OA were randomized to intra-articular injections of HA (n=23), or O2O3 (n=23) or combined (n=24) one per week for 5 consecutive weeks. KOOS questionnaire and visual analog scale (VAS), before treatment (pre) at the end (post), and at 2 months after treatment ended (follow-up) were used as outcome measures. Analysis showed a significant effect (P < 0.05) of the conditions (pre, post and follow-up) in all parameters of the KOOS score and a significant effect (P < 0.05) of groups (HA, O2O3 and combined) for pain, symptoms, activities of daily living and quality of life. The combined group scores were higher compared to the HA and O2O3 groups, especially at follow-up. The combination of O2O3 and HA treatment led to a significantly better outcome especially at 2-month follow-up compared to HA and O2O3 given separately to patients affected by OA of the knee.

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  • Prolotherapy Injections for Diastasis Recti: A Case Report

    Abstract

    This case report detailed the history and treatment of a female postpartum patient with diastasis recti. Treatment for this patient included the use of prolotherapy, an injection-based therapy using dextrose as the active compound. The solution used during the course of therapy was composed of 6 mL of 50% dextrose, 3 mL of 1% lidocaine, and 1 mL of methylcobalamin (1000 mcg/mL). Injections were administered every 2 weeks for a total of 7 prolotherapy sessions. Following the series of prolotherapy injections, there was a marked closure observed in the diastasis, decreasing from 2.7 cm to 0.5 cm. The patient did not report any side effects, and no complications were observed or recorded. This appears to be the first case report documenting an improvement in abdominal diastasis recti following a course of prolotherapy. Within the limitations of the study design, further research is recommended to evaluate prolotherapy for diastasis recti in postpartum patients.

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  • The Effect of Subepineural Platelet-rich Plasma on Regeneration of the Sciatic Nerve in a Rat Model

    Abstract

    Background: Peripheral nerve injury is one of the most challenging of modern surgical problem. Recent advances in understanding the physiological and molecular pathways demonstrated the important role of growth factors in peripheral nerve regeneration. Platelet-rich plasma (PRP) is a biological product that has many growth factors. The aim of this study was to investigate the effect of PRP in the regeneration of sciatic nerve crush in the rat model.

    Methods: In this experimental study that established in the animal lab of the Hazrat Fatemeh Hospital in Tehran during September to October 2013, 24 healthy male Sprague-Dawley rats (200-250 g) were randomly divided into two groups. In all rats, the sciatic nerve was cut and then carefully repaired by the tension free method under a light microscope. In group 1, after the repair, 0.05

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  • The Journal of Alternative and Complementary Medicine

    Abstract

    Objective: Randomized and open-label studies assessing prolotherapy for knee osteoarthritis have found quantitative improvement on the validated Western Ontario McMaster University Osteoarthritis Index (WOMAC) compared with baseline status and control therapies. This study assessed the qualitative response of participants receiving prolotherapy, an injection-based complementary treatment for symptomatic knee osteoarthritis (OA).

    Design: Qualitative study using semi-structured in-depth interviews at 52 weeks after enrollment; transcribed responses were discussed by coauthors to identify themes; disagreement was resolved by consensus.

    Results: Participants had baseline demographic and knee OA severity similar to those of participants in three prior intervention trials, as well as similar robust follow-up WOMAC score change (19.9

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  • Protective Nature of Platelet-Rich Plasma Against Chondrocyte Death When Combined With Corticosteroids or Local Anesthetics

    Abstract

    Background: The use of corticosteroids and local anesthetics to treat osteoarthritis has established benefits, including relief of pain and increased range of motion, but may also have the potential to lead to tissue atrophy or degeneration, specifically on chondrocytes. There is growing evidence that platelet-rich plasma (PRP) has anti-inflammatory characteristics that can limit the cytotoxic effects of corticosteroids and local anesthetics.

    Hypothesis/Purpose: The purpose of this study was to determine the effects of PRP in chondrocyte cultures when combined with corticosteroids or local anesthetics. The hypothesis of this study was that PRP would (1) dampen the negative effects on chondrocyte viability and (2) improve chondrocyte proliferation seen with corticosteroid or local anesthetic treatment alone.

    Study Design: Controlled laboratory study.

    Methods: Peripheral blood was obtained from 8 healthy participants, followed by centrifugation to obtain PRP. Human chondrocytes were treated with PRP alone or in combination with corticosteroids or local anesthetics. Saline (concentration of 0.9%) served as the control. Luminescence and radioactive thymidine assays were performed to examine chondrocyte viability and proliferation, respectively. Cell exposures of 0, 5, 10, and 30 minutes were used for viability and 120 hours for proliferation.

    Results: The presence of PRP significantly limited the negative effect on chondrocyte viability at tested time points for the examined corticosteroids and local anesthetics (P < .05). PRP in addition to corticosteroids and local anesthetics significantly improved chondrocyte proliferation (P < .05).

    Conclusion: The addition of PRP can significantly reduce the cytotoxic effects of corticosteroids and/or local anesthetics applied to chondrocytes. PRP can improve the proliferation of chondrocytes compared with corticosteroids or local anesthetics alone.

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  • Platelet-Rich Plasma in Pain Medicine

    Abstract

    For the past 20 years, autologous Platelet-Rich Plasma (PRP) has been safely employed and its use has been documented in many areas, including orthopedics, sports medicine, dentistry, neurosurgery, ophthalmology, urology, wound healing, cosmetics, cardiothoracic, otorhinolaryngology and maxillofacial surgery.

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  • A metaanalysis of the effectiveness and safety of ozone treatments for herniated lumbar discs.

    Abstract

    Purpose: To determine statistically significant effects of oxygen/ozone treatment of herniated discs with respect to pain, function, and complication rate.

    Materials And Methods: Random-effects metaanalyses were used to estimate outcomes for oxygen/ozone treatment of herniated discs. A literature search provided relevant studies that were weighted by a study quality score. Separate metaanalyses were performed for visual analog scale (VAS), Oswestry Disability Index (ODI), and modified MacNab outcome scales, as well as for complication rate. Institutional review board approval was not required for this retrospective analysis.

    Results: Twelve studies were included in the metaanalyses. The inclusion/exclusion criteria, patient demographics, clinical trial rankings, treatment procedures, outcome measures, and complications are summarized. Metaanalyses were performed on the oxygen/ozone treatment results for almost 8,000 patients from multiple centers. The mean improvement was 3.9 for VAS and 25.7 for ODI. The likelihood of showing improvement on the modified MacNab scale was 79.7%. The means for the VAS and ODI outcomes are well above the minimum clinically important difference and the minimum (significant) detectable change. The likelihood of complications was 0.064%.

    Conslusions: Oxygen/ozone treatment of herniated discs is an effective and extremely safe procedure. The estimated improvement in pain and function is impressive in view of the broad inclusion criteria, which included patients ranging in age from 13 to 94 years with all types of disc herniations. Pain and function outcomes are similar to the outcomes for lumbar discs treated with surgical discectomy, but the complication rate is much lower (<0.1%) and the recovery time is significantly shorter.

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  • Platelet-Rich Plasma Can Be Used to Successfully Treat Elbow Ulnar Collateral Ligament Insufficiency in High-Level Throwers.

    Abstract

    We conducted a study to evaluate the effect of platelet-rich plasma (PRP) injections on partial ulnar collateral ligament (UCL) tears in high-level throwing athletes. We retrospectively reviewed the cases of 44 baseball players (6 professional, 14 college, 24 high school) treated with PRP injections for partial-thickness UCL tears. All tears were diagnosed by physical examination and confirmed by magnetic resonance imaging (MRI). Sixteen patients had 1 injection, 6 had 2, and 22 had 3. Once patients became asymptomatic after injection, they were started on an interval throwing program. Physical examination findings at final follow-up were classified according to a modified version of the Conway Scale. Mean age was 17.3 years (range, 16-28 years). All patients were available for follow-up after injection (mean, 11 months). Of the 44 patients, 15 (34%) had an excellent outcome, 17 had a good outcome, 2 had a fair outcome, and 10 had a poor outcome. After injection, 4 (67%) of the 6 professional players returned to professional play. Twenty-two patients had proximally based partial-thickness tears, 7 had distally based partial tears, and 15 had diffuse signal without partial tear on MRI. Mean time from injection to return to throwing was 5 weeks; mean time to return to competition was 12 weeks (range, 5-24 weeks). There were no injection-related complications. Our use of PRP in the treatment of UCL insufficiency produced outcomes much better than earlier reported outcomes of conservative treatment of these injuries. PRP injections may be particularly beneficial in young athletes who have sustained acute damage to an isolated part of the ligament and in athletes unwilling or unable to undergo the extended rehabilitation required after surgical reconstruction of the ligament.

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  • Platelet Rich Plasma in Focal Soft Tissue Rheumatism Including Spinal One

    Abstract

    The first application of platelet-rich plasma (PRP) unveiled by Ferrari in 1987 as an autologous component after an open heart surgery [1]. Now there are at least five thousands registration in National Center for Biotechnology Information (NCBI) concerning PRP in various medical disciplines like orthopedic surgery, sports medicine, physical medicine, dentistry, neurosurgery, ophthalmology, urology, cosmetic, cardiothoracic surgery, etc. From the very launching period, platelet-rich plasma is being considered to be overwhelmingly promising and safe as well, enabling tissue healing through one's own natural growth factors [2]. It serves as a milieu of diverse biological mediators like insulin-like growth factor type I (IGF-I), transforminggrowth factor beta type 1 (TGF-1), platelet-derived growth factor (PDGF), hepatocyte growth factor (HGF), vascular endothelial growth factor (VEGF), epithelial growth factor, and basic fibroblastic growth factors. Among them, IGF-I and HGF are plasmatic proteins and their concentrations are independent of platelet abundance. These growth factors along with cytokines/chemokines (Interleukin-8, IL-8; Macrophage inflammatory protein-1 alpha, MIP-1 α; Epithelial Neutrophil-Activating Peptide 78, ENA-78; Monocyte chemotactic protein-3, MCP-3; Growth regulated oncogene-alpha, GRO alpha; angiopoietin-1, IGF-1 binding protein-3, etc.) and bioactive proteins (Von Willebrand factor, vWF; propeptide; Fibrinogen; Fibronectin; Vitronectin; Thrombospondin 1, TSP-1; laminin-8, alpha 4- and alpha 5- laminin subunits; signal peptide-CUB-EGF domain containing protein 1, SCUBE 1, etc.) are important in tissue repair and regeneration, wound healing, and even organ homeostasis [3].

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  • Leukocyte-poor platelet-rich plasma is more effective than the conventional therapy with acetaminophen for the treatment of early knee osteoarthritis

    Abstract

    Introduction: Knee osteoarthritis (OA) is a degenerative and progressive articular cartilage disease. Infiltration of autologous platelet-rich plasma (PRP) has been proposed as a therapeutic alternative due to the content of biologically active cytokines in PRP. We aimed to compare the clinical response of acetaminophen and intra-articular leukocyte-poor PRP (LP-PRP) in early knee OA.

    Materials and methods: A total of 65 patients with clinically and radiographically documented knee OA (grade 1-2) were analyzed. Patients were randomized into two groups: 32 were treated with acetaminophen (500 mg/8 h) over 6 weeks, and 33 received three intra-articular injections of autologous LP-PRP (once every 2 weeks). All patients were evaluated by the Visual Analogue Scale (VAS), the Western Ontario and McMaster Universities (WOMAC) score, and the SF-12 health survey at baseline and 6, 12, and 24 weeks of follow-up. All LP-PRP preparations were analyzed for the platelet, leukocyte, IL-1ra, and TGF-β concentrations.

    Results: The decrease in the VAS pain level in the LP-PRP group was greater than that in the acetaminophen group (p < 0.05). Patients treated with LP-PRP showed a sustained improvement in knee function at week 24 (p < 0.01). The SF-12 results only indicated an improvement in quality-of-life in the LP-PRP group at 6, 12, and 24 weeks of follow-up (p < 0.01). Both IL-1ra and TGF-β were detected in the LP-PRP samples (313.8 ± 231.6 and 21,183.8 ± 8556.3 pg/mL, respectively).

    Conclusions: Treatment with LP-PRP injections resulted in a significantly better clinical outcome than did treatment with acetaminophen, with sustained lower EVA and WOMAC scores and improvement in quality-of-life (higher SF-12 score). Therapy with LP-PRP may positively modify the inflammatory joint environment by counteracting IL-1β action.

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  • Study of Platelet Rich Plasma Injections in Patients of Tendinopathy in South Gujarat Population

    Abstract

    Introduction: Tendinopathy is a major medical problem associated with sports and physical activity in active people over 25 years of age. We study about the effect of PRP in the patients of chronic Tendinopathy. Methods: The patients of chronic tendinopathy come to OPD at government medical college, surat who failed medical treatment for last 3 months. After getting informed consent platelet rich plasma is prepared from patient's own blood. After giving platelet rich plasma injection, patient is advised to take rest for 3 weeks with analgesics. Physiotherapy is started after 3 weeks of injection as this is causing pain for first 3 weeks. Patients are advised to join their duty after 3 weeks of injection. All the patients were followed up in OPD at 3 weeks, 6 weeks, 3 months and 6 months. At every follow up, range of motion, visual analogue scale and functional activity score recorded. Results: The follow up shows that most of the patients do not get relief within 3 weeks after injection. Follow up shows that 16 patients out of 50 got relief within 6 weeks after injection. Result shows that 46 patients out of 50 get relief within 6 months after injection. That means 94% of patients are having relief within 6 months of injection. Conclusion: The findings of this study shows that platelet rich plasma injection under ultrasound guidance at the tendon is effective mode of treatment for patients and takes time but result in gradual decrease in symptoms.

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  • Randomized controlled trial comparing hyaluronic acid, platelet-rich plasma and the combination of both in the treatment of mild and moderate osteoarthritis of the knee

    Abstract

    Objective: This study aims at evaluating the clinical effects of Platelet Rich Plasma (PRP) and Hyaluronic Acid (HA) as individual treatments for mild to moderate Osteoarthritis (OA) and it also examines the potential synergistic effects of PRP in combination with HA. Research continues to emerge examining the potential therapeutic efficacy of HA and PRP as autologous injectable treatments for joint arthritis. However, there is a paucity of research investigating the effects of combining HA and PRP on pain and functional status in patients with OA.

    Design: In this multi-center, randomized, controlled, double blind, prospective trial, 105 patients with mild to moderate knee osteoarthritis, who met the study criteria, were randomly allocated to one of three interventions: HA (n=36), PRP (n=36), or HA+PRP (n=33). Each patient received 3 intra-articular knee injections of their assigned substance, with 2 week intervals between each injection. Clinical outcomes were evaluated using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and Visual Analogue Scale (VAS) questionnaire at baseline and after 1,3,6 and 12 months.

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  • Interleukin-6, Creatine Kinase, and Antioxidant Enzyme Activities following Platelet- Rich Plasma Treatment on Muscle Injury: A Pilot Study

    Abstract

    The aim of this study was to investigate the effect of autologous platelet-rich plasma (PRP) treatment alongside rehabilitation compared with rehabilitation alone on inflammatory cytokine (interleukin-6, IL-6), creatine kinase muscle type (CKM), and antioxidant enzymes (superoxide dismutase, SOD; catalase, CAT) following hamstring injury. This study was a randomised control trial. Participants diagnosed with grade-2 acute hamstring injury (n=16) were divided into 2 groups of PRP treatment with rehabilitation program (PRP-T) and rehabilitation program (CON). Blood samples were collected at baseline, and 2 fortnightly for the various biochemical assessments. Participants were certified to have recovered upon fulfilling return to play (RTP) criteria. Level of IL-6 and the activities of CKM, SOD, and CAT were measured. PRP-T group benefited from earlier time to RTP with significantly lower IL-6 level and CAT activity compared to CON group. There was no significant difference in CKM and SOD activities between the groups, though a trend of lower values in all variables was observed at week 4 compared to week 0. PRP treatment potentially improves muscle healing process by altering both the inflammatory and oxidative responses, hence hastens time to RTP.

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  • Treatment of knee osteoarthritis with platelet-rich plasma plus hyaluronic acid in comparison with platelet-rich plasma only

    Abstract

    Background: The exact outcome of the combined use of hyaluronic acid (HA) and platelet-rich plasma (PRP) in the treatment for osteoarthritis remains unclear. The goal of this paper was to compare the efficacy of PRP + HA with those of a cohort of patients treated with platelet-rich plasma only. Materials and methods: A total of 126 Subjects with knee osteoarthritis were enrolled: 63 cases in PRP plus HA group and 63 cases in PRP group. After clinical and radiographic evaluation, patients received a weekly intra-articular injection of HA added with PRP or of only PRP for 3 weeks. Follow-up was carried out at 1, 3, 6, and 12 months. Results: In the participants treated with PRP plus HA and with PRP only, VAS scores decreased significantly, and accordingly, knee function (WOMAC) improved, compared to the status of patients prior to treatment. Regarding to VAS and WOMAC, no significant difference were observed between the two groups; however, there is a trend that could obtain better functional scores in PRP plus HA group (VAS, P = 0.392; WOMAC, P = 0.082). Six failures occurred in the PRP plus HA group and 11 in PRP group. No major adverse events or complications were observed in both groups. Conclusions: The association of PRP and HA is effective and safe in the management of patients suffering from mild to moderate KOA. Although no differences in functional outcomes were shown between the groups, there is a trend that PRP plus HA could obtain relatively better functional scores.

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  • The Effect of plasma preparation rich in growth factors on patellar stability after medical patellofemoral ligament reefing

    Abstract

    Introduction: Although more than 100 operative procedures have been described for the treatment of patellar instability, there is no single universally successful procedure. For the most patients with lateral patellar instability medial patellofemoral ligament (MPFL) reefing is recommended. When we perform MPFL reefing we are not aware of the quality and strength of the MPFL tissue. In the presence of recurrent patellar instability,the quality and strength of MPFL tissue is often compromised and it disturbs patellar stability after MPFL reefing. Biomedicine development,recognizing the ligament healing process show us that autologous blood products, particularly PRP can enhance healing in soft tissue injuries.

    Purpose: The purpose of this study was to determine the potential effect of Plasma preparation rich in growth factorson patellar stability after MPFL reefing.

    Material and Methods: Plasma preparationrich in growth factors was produced from a unit of autologous whole blood using Arthrex ACP double syringe system.Platelet gel was prepared by adding bovine thrombin and 10% solution of calcium chloride.The platelet gel was applied locally into the place where suturing of the MPFL was performed. In this prospective, randomized and double blindstudy12 patients were included:6 patients in the PG group who received platelet gel and 6 patients in the control group who were not treated with platelet gel. Patellar stability was evaluated before surgery and 3 months after surgery with Axial stress radiographs.

    Results: The calculated 3 month improvement was 12.67

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  • Case series of ultrasound-guided platelet-rich plasma injections for sacroiliac joint dysfunction

    Abstract

    Background: Two-thirds of adults worldwide will experience low back pain at some point in their life. In the following case series, we present four patients with sacroiliac (SI) joint instability and severe chronic low back pain, which was refractory to other treatment modalities.

    Objective: We investigated the efficacy of platelet-rich plasma (PRP) injections, a novel orthobiologic therapy, for reducing SI joint pain, improving quality of life, and maintaining a clinical effect.

    Methods: Short-form McGill Pain Questionnaire (SFM), Numeric Rating Scale (NRS), and Oswestry Low Back Pain and Disability Index were used for evaluation of treatment at pretreatment, 12-months and 48-months after treatment. RESULTS: At follow-up 12-months post-treatment, pooled data from all patients reported a marked improvement in joint stability, a statistically significant reduction in pain, and improvement in quality of life. The clinical benefits of PRP were still significant at 4-years post-treatment.

    Conclusions: Platelet-rich plasma therapy exhibits clinical usefulness in both pain reduction and for functional improvement in patients with chronic SI joint pain. The improvement in joint stability and low back pain was maintained at 1- and 4-years post-treatment.

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  • Leukocyte-Reduced Platelet-Rich Plasma Treatment of Basal Thumb Arthritis: A Pilot Study

    Abstract

    A positive effect of intra-articular platelet-rich plasma (PRP) injection has been discussed for osteoarthritic joint conditions in the last years. The purpose of this study was to evaluate PRP injection into the trapeziometacarpal (TMC) joint. We report about ten patients with TMC joint osteoarthritis (OA) that were treated with 2 intra-articular PRP injections 4 weeks apart. PRP was produced using the Double Syringe System (Arthrex Inc., Naples, Florida, USA). A total volume of 1.47

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  • Combination of Intra-Articular and Intraosseous Injections of Platelet Rich Plasma for Severe Knee Osteoarthritis: A Pilot Study

    Abstract

    The aim of this study was to assess a novel approach to treating severe knee osteoarthritis by targeting synovial membrane, superficial articular cartilage, synovial fluid, and subchondral bone by combining intra-articular injections and intraosseous infiltrations of platelet rich plasma. We explored a new strategy consisting of intraosseous infiltrations of platelet rich plasma into the subchondral bone in combination with the conventional intra-articular injection in order to tackle several knee joint tissues simultaneously. We assessed the clinical outcomes through osteoarthritis outcome score (KOOS) and the inflammatory response by quantifying mesenchymal stem cells in synovial fluid. There was a significant pain reduction in the KOOS from baseline (61.55 ± 14.11) to week 24 (74.60 ± 19.19) , after treatment (p = 0.008), in the secondary outcomes (symptoms, p=0.004 ; ADL, p = 0.022 ; sport/rec., p = 0.017 ; QOL, p = 0.012), as well as VAS score (p < 0.001) and Lequesne Index (p = 0.008). The presence of mesenchymal stem cells in synovial fluid and colony-forming cells one week after treatment decreased substantially from 7.98 ± 8.21 MSC/μL 4.04 ± 5.36 to MSC/μL (p = 0.019) and from 601.75 ± 312.30 to 139.19 ± 123.61 (p = 0.012), respectively. Intra-articular injections combined with intraosseous infiltrations of platelet rich plasma reduce pain and mesenchymal stem cells in synovial fluid, besides significantly improving knee joint function in patients with severe knee osteoarthritis. This trial is registered on EudraCT with the number 2013-003982-32.

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