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.
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.
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.
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].
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.
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.
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.
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.
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.
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
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.
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
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.
\nAbstract
Intra-articular injection of platelet-rich plasma (PRP) has been established as a suitable treatment for knee osteoarthritis. Here, we present a double-blind randomized controlled clinical trial, conducted in a public Hospital of the Spanish National Health Care System, to evaluate the efficacy of injecting autologous PRP versus hyaluronic acid (HA) in knee osteoarthritis. PRP was manufactured in Malaga\'s Regional Blood Center (Spain). Patients that met the eligibility criteria were randomized into a PRP group or a HA group. Pain and functional improvements were assessed pre- and post-treatment (three and six months follow-up) using the Visual Analogue Scale (VAS); the Knee and Osteoarthritis Outcome System (KOOS) scale and the European Quality of Life scale (EUROQOL). Both groups presented pain reduction at six months. The VAS scores for the PRP group improved by at least 50% from their initial value, particularly at three months following the final infiltration, with results resembling those of the HA group at six months. PRP was more effective in patients with lower osteoarthritis grades. Both treatments improved pain in knee osteoarthritis patients without statistically significant differences between them. However, PRP injection was proved to improve pain three months after the final infiltration and to be more effective in lower osteoarthritis grades.
Abstract
Autologous injection of platelet rich plasma (PRP) stimulates healing process in degenerated tendons. The purpose of this study is to compare the functional outcome of lateral epicondylitis treated with PRP and steroid injection.
Tennis elbow patients who failed conservative medical therapy were included and were allocated randomly steroid group (n=70) and PRP group (n=63). Data were collected before procedure, at 4, 8, 12 weeks, 1 year and 2 years after procedure. The main outcome measures were visual analogue score, Mayo elbow performance score, DASH score and hand grip strength.
\nAbstract
Introduction: Osteoarthritis (OA) is the most common musculoskeletal disease. Current treatments for OA are mainly symptomatic and inadequate since none results in restoration of fully functional cartilage. Hyaluronic Acid (HA) intra-articular injections are widely accepted for the treatment of pain associated to OA. The goal of HA viscosupplementation is to reduce pain and improve viscoelasticity of synovial fluid. Platelet-rich plasma (PRP) has been also employed to treat OA to possibly induce cartilage regeneration. The combination of HA and PRP could supply many advantages for tissue repair. Indeed, it conjugates HA viscosupplementation with PRP regenerative properties. The aim of this study was to evaluate the rheological and biological properties of different HA compositions in combination with PRP in order to identify (i) the viscoelastic features of the HA-PRP blends, (ii) their biological effect on osteoarthritic chondrocytes and (iii) HA formulations suitable for use in combination with PRP.
\nMaterials and Methods: HA/PRP blends have been obtained mixing human PRP and three different HA at different concentrations: 1) Sinovial, 0.8% (SN); 2) Sinovial Forte 1.6% (SF); 3) Sinovial HL 3.2% (HL); 4) Hyalubrix 1.5% (HX). Combinations of phosphate buffered saline (PBS) and the four HA types were used as control. Rheological measurements were performed on an Anton PaarMCR-302 rheometer. Amplitude sweep, frequency sweep and rotational measurements were performed and viscoelastic properties were evaluated. The rheological data were validated performing the tests in presence of Bovine Serum Albumin (BSA) up to ultra-physiological concentration (7%). Primary osteoarthritic chondrocytes were cultured in vitro with the HA and PRP blends in the culture medium for one week. Cell viability, proliferation and glycosaminoglycan (GAG) content were assessed.
Results: PRP addition to HA leads to a decrease of viscoelastic shear moduli and increase of the crossover point, due to a pure dilution effect. For viscosupplements with HA concentration below 1% the viscoelasticity is mostly lost. Results were validated also in presence of proteins, which in synovial fluid are more abundant than HA.
Chondrocytes proliferated overtime in all different culture conditions. The proliferation rate was higher in chondrocytes cultured in the media containing PRP compared to the cultures with different HA alone. GAG content was significantly higher in chondrocytes cultured in PRP and HL blend.
\n\nAbstract
Introduction: The presence of leukocytes in platelet concentrates is deemed to cause deleterious effects when injected intra articularly. The aim of this study is to analyse both local and systemic effects induced by leukocyte-rich Platelet-rich Plasma (PRP) injections through a proteomic characterization of serial synovial fluid and blood samples obtained from subjects treated for knee OA. Secondary aim was to compare the effects on knee homeostasis and systemic response with those obtained with visco-supplementation.
Methods: Thirty-six OA patients treated either by autologous L-PRP or HA intra-articular knee injections, administered in series of three at one-week intervals, were analyzed. Just before the injection, 1 ml of synovial fluid was collected through the same needle way. In the same time, a peripheral blood sample was obtained and plasma separated. A further peripheral blood sample was collected at 2, 6, and 12 months. L-PRP, plasma and synovial fluid were tested by multiplex bead-based sandwich immunoassay by means of the Bio-Plex suspension array system (Bio-Rad Laboratories) for the presence of pro- and anti-inflammatory cytokines (IL-1beta, IL-6, IL-8, IL-17 and IL-4, IL-10, IL-13) and growth factors (FGF-b, HGF, PDGF-AB/BB).
Results: In general, pro-inflammatory cytokine levels were similar at basal condition and after treatment whereas anti-inflammatory ones were nearly undetectable. L-PRP administration did not modulate significant changes of cytokine concentrations either in synovial fluid or plasma, whatever the time points analyzed. No different trend was observed between L-PRP and HA administration in terms of pro- and anti-inflammatory cytokines, as well as growth factors.
Conclusions: In contrast with the evidence reported by \"in vitro\" studies, where a cellular pro-inflammatory response appears to be induced by the presence of leukocytes, these results suggest that the presence leukocyte-rich PRP doesn\'t induce a relevant in vivo up regulation of pro-inflammatory mediators.
Abstract
Symptomatic neuromas of the sural nerve are a rare but significant cause of pain and debilitation in athletes. Presentation is usually in the form of chronic pain and dysesthesias or paresthesias of the lateral foot and ankle. Treatment traditionally ranges from conservative measures, such as removing all external compressive forces, to administration of nonsteroidal anti-inflammatory drugs, vitamin B6, tricyclic antidepressants, antiepileptics, or topical anesthetics. This article reports a case of sural nerve entrapment in a 34-year-old male triathlete with a history of recurrent training-induced right-sided gastrocnemius strains. The patient presented with numbness in the right lateral foot and ankle that had persisted for 3 months, after he was treated unsuccessfully with extensive nonoperative measures, including anti-inflammatory drugs, activity modification, and a dedicated physical therapy program of stretching and strengthening. Orthopedic assessment showed worsening pain with forced passive dorsiflexion and manual pressure applied over the distal aspect of the gastrocnemius. Plain radiographs showed normal findings, but in-office ultrasound imaging showed evidence of sural nerve entrapment with edema and neuromatous scar formation in the absence of gastrocnemius or soleus pathology. Percutaneous ultrasound-guided hydrodissection of the sural nerve at the area of symptomatic neuroma and neural edema was performed the same day. The patient had complete relief of symptoms and full return to the preinjury level of participation in competitive sports. This case report shows that hydrodissection, when performed by an experienced physician, can be an effective, minimally invasive technique for neurolysis in the setting of sural nerve entrapment, resulting in improvement in clinical symptoms.
Abstract
Objective: Carpal tunnel syndrome, caused by compression of the median nerve deep to the flexor retinaculum, is the most common entrapment neuropathy. Most patients are initially treated with conservative mea-sures such as splinting. When conservative measures fail, interventional techniques are considered the next step. Many studies have appeared comparing open surgical flexor retinaculum release to blind injections of corticosteroids into the carpal tunnel, but neither technique has proven superior to the other. Advantages of injection are: lower level of invasiveness, faster recovery, and ease of the technique. Occasional failures and complications occur with all techniques.
Conclusion: Ultrasound-guided hydrodis section and fenestration is a viable, easy, relatively non-invasive therapy for carpal tunnel syndrome that can result in pro longed symptom relief, and may be a way to postpone, or even obviate the need for, open release.
Abstract
Human platelet-rich plasma (PRP) is plasma that is enriched with thrombocytes at a concentration of 1000 * 109 per litre, higher than normal (150 - 350 * 109 per litre). Thrombocytes are known to contain growth factors including IGF, PDGF, EGF, FGF, TGF-li, PDEGF, VEGF or PDAF as well as thrombospondin and osteonectin. The release of these growth factors is induced by thrombocyte activation resulting from their exposure to a variety of substances such as thrombin, Calciom chloride or collagen. Growth factors are found in higher concentrations in PRP than in blood, and could be used to facilitate wound healing at a faster rate. Currently, PRP is employed in dentistry, dermatology, traumatology and orthopedics. In developed countries, PRP is also actively used in treating acute and chronic skin lesions. Though commercial devices for clinical preparation of autologous PRP are available, standardized PRP-preparation protocols are yet to be developed. Furthermore, only a handful of research work is aimed at optimizing methods of obtaining platelet-rich plasma. Therefore, two different modifications of the Araki et al method, the most standardized of all available methods, were used to prepare high cytokine-containing platelet-rich plasma.
For all appointments & inquiries