101
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Abstract
Hip and groin pain is commonly experienced by athletes. The differential diagnosis should include both intra-articular and extra-articular sources for pain and dysfunction. A comprehensive history and physical examination can guide the evaluation of hip pain and the potential need for further diagnostics. Treatment of athletes with hip disorders includes education, addressing activities of daily living, pain-modulating medications or modalities, exercise and sports modification, and therapeutic exercise. Surgical techniques for prearthritic hip disorders are expanding and can offer appropriate patients a successful return to athletic endeavors when conservative measures are not effective.
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Affiliation(s)
- Heidi Prather
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO 63110, USA.
| | - Berdale Colorado
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO 63110, USA
| | - Devyani Hunt
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8233, St Louis, MO 63110, USA
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102
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A Hamid MS, Mohamed Ali MR, Yusof A, George J, Lee LPC. Platelet-rich plasma injections for the treatment of hamstring injuries: a randomized controlled trial. Am J Sports Med 2014; 42:2410-8. [PMID: 25073598 DOI: 10.1177/0363546514541540] [Citation(s) in RCA: 123] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A hamstring injury is one of the most common types of injury affecting athletes. Despite this, the optimal management of hamstring muscle injuries is not yet defined. The effect of autologous platelet-rich plasma (PRP) therapy on the recovery of hamstring injuries is unclear. PURPOSE To investigate the effect of a single PRP injection in the treatment of grade 2 hamstring muscle injuries. STUDY DESIGN Randomized controlled trial; Level of evidence, 2. METHODS Twenty-eight patients diagnosed with an acute hamstring injury were randomly allocated to autologous PRP therapy combined with a rehabilitation program or a rehabilitation program only. The primary outcome of this study was time to return to play. In addition, changes in pain severity and pain interference scores over time were examined. RESULTS Patients in the PRP group achieved full recovery significantly earlier than controls (P = .02). The mean time to return to play was 26.7 ± 7.0 days and 42.5 ± 20.6 days for the PRP and control groups, respectively (t(22) = 2.50, P = .02). [corrected]. Significantly lower pain severity scores were observed in the PRP group throughout the study. However, no significant difference in the pain interference score was found between the 2 groups. CONCLUSION A single autologous PRP injection combined with a rehabilitation program was significantly more effective in treating hamstring injuries than a rehabilitation program alone.
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Affiliation(s)
| | - Mohamed Razif Mohamed Ali
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ashril Yusof
- Sports Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - John George
- Research Imaging Centre, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Leena Poh Chen Lee
- Department of Rehabilitation Medicine, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
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103
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Dauty M, Menu P, Dubois C. Uncommon external abdominal oblique muscle strain in a professional soccer player: a case report. BMC Res Notes 2014; 7:684. [PMID: 25270624 PMCID: PMC4192740 DOI: 10.1186/1756-0500-7-684] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 09/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This is the first report of external abdominal oblique muscle injury occurring in a professional soccer player. CASE PRESENTATION A 28-year-old Caucasian professional soccer player presented after experiencing a popping sensation associated with strong parietal pain localized between the left 11th and 12th ribs. Ultrasound examination revealed a collection of fluid under the 11th rib, suggesting injury of the left external oblique muscle. Platelet-rich plasma treatment was administered and the soccer player returned to competition on the 21st day after treatment. CONCLUSION This rare injury results from a sudden intrinsic eccentric contraction of the internal oblique muscle while in a stretched position. Ultrasound can help to confirm the diagnosis and to monitor clinical follow-up. Platelet-rich plasma treatment could aid recovery in high-level athletes.
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Affiliation(s)
- Marc Dauty
- CHU Nantes, Service de MPR Locomoteur, Hôpital Saint Jacques, 85 rue Saint Jacques, 44 035 Nantes, Cedex 01, France.
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104
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Bashir J, Sherman A, Lee H, Kaplan L, Hare JM. Mesenchymal stem cell therapies in the treatment of musculoskeletal diseases. PM R 2014; 6:61-9. [PMID: 24439148 DOI: 10.1016/j.pmrj.2013.05.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 05/01/2013] [Accepted: 05/03/2013] [Indexed: 12/17/2022]
Abstract
The application of regenerative strategies to musculoskeletal ailments offers extraordinary promise to transform management of the conditions of numerous patients. The use of cell-based therapies and adjunct strategies is under active investigation for injuries and illnesses affecting bones, joints, tendons, and skeletal muscle. Of particular interest to the field is the mesenchymal stem cell, an adult stem cell found in bone marrow and adipose tissue. This cell type can be expanded ex vivo, has allogeneic application, and has the capacity for engraftment and differentiation into mesodermal lineages. Also of major interest in the field is the use of platelet-rich plasma, a strategy to concentrate endogenous cytokines and growth factors with reparative potential. Here we review the biological basis, clinical studies, safety, and current state of mesenchymal stem cell and platelet-rich plasma therapies in the treatment of musculoskeletal disease.
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Affiliation(s)
- Jamil Bashir
- Department of Rehabilitation Medicine, University of Miami Miller School of Medicine, Miami, FL(∗)
| | - Andrew Sherman
- Department of Rehabilitation Medicine, University of Miami Miller School of Medicine, Miami, FL(†)
| | - Henry Lee
- Department of Rehabilitation Medicine, University of Miami Miller School of Medicine, Miami, FL(‡)
| | - Lee Kaplan
- Department of Orthopedics, University of Miami Miller School of Medicine, Miami, FL(§)
| | - Joshua M Hare
- Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine, 1600 NW 10th Ave, Miami, FL 33136(¶).
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105
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Abstract
Pain and dysfunction related to tendinopathy are often refractory to traditional treatments and offer a unique challenge to physicians, because no gold standard treatment exists. Injectable biologics may represent a new modality in conjunction with a multifaceted treatment approach. Platelet-rich plasma (PRP) injections are not associated with the systemic or tendon degradation risks of corticosteroids or the inherent risks of surgery. Studies are promising but have not been replicated with high-powered evidence at the clinical level. Further evidence to expand understanding of the role of PRP in the treatment of tendinopathy is needed.
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Affiliation(s)
- Ken Mautner
- Departments of Physical Medicine and Rehabilitation and Orthopaedics, Emory Orthopaedics and Spine Center, 59 Executive Park Dr South, Suite 1000, Atlanta, GA 30329.
| | - Lee Kneer
- Departments of Physical Medicine and Rehabilitation and Orthopaedics, Emory Orthopaedics and Spine Center, 59 Executive Park Dr South, Suite 1000, Atlanta, GA 30329
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106
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Pihut M, Szuta M, Ferendiuk E, Zeńczak-Więckiewicz D. Evaluation of pain regression in patients with temporomandibular dysfunction treated by intra-articular platelet-rich plasma injections: a preliminary report. BIOMED RESEARCH INTERNATIONAL 2014; 2014:132369. [PMID: 25157351 PMCID: PMC4137492 DOI: 10.1155/2014/132369] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2014] [Accepted: 07/09/2014] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the regression of temporomandibular pain as a result of intra-articular injections of platelet-rich plasma (PRP) to patients with temporomandibular joint dysfunction previously subjected to prosthetic treatment. MATERIALS AND METHODS The baseline study material consisted of 10 patients, both males and females, aged 28 to 53 years, previously treated due to painful temporomandibular joint dysfunction using occlusal splints. All patients were carried out to a specialist functional assessment of the dysfunction using the Polish version of the RDC/TMD questionnaire axis I and II. Intra-articular injections were preceded by a preparation of PRP. The injection sites were determined by the method used during arthroscopic surgical procedures. Following aspiration, 0.5 mL of plasma was injected into each temporomandibular joint. RESULTS The comparison of the intensity of pain during all examinations suggests a beneficial effect of the procedure being performed as the mean VAS score was 6.5 at examination I, 2.8 at examination II, and 0.6 at examination III. CONCLUSION Application of the intra-articular injections of platelet-rich plasma into the temporomandibular joints has a positive impact on the reduction of the intensity of pain experienced by patients treated for temporomandibular joint dysfunction.
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Affiliation(s)
- M Pihut
- Department of Dental Prosthetics, Consulting Room of Temporomandibular Joint Dysfunctions, Jagiellonian University, Medical College, 4 Montelupich Street, 31-155 Krakow, Poland
| | - M Szuta
- Department of Cranio-Maxillofacial, Oncological and Reconstructive Surgery, Jagiellonian University, Medical College, 1 Zlotej Jesieni Street, 31-826 Krakow, Poland
| | - E Ferendiuk
- Department of Dental Prosthetics, Consulting Room of Temporomandibular Joint Dysfunctions, Jagiellonian University, Medical College, 4 Montelupich Street, 31-155 Krakow, Poland
| | - D Zeńczak-Więckiewicz
- Department of Dental Surgery, Wroclaw Medical University, 26 Krakowska Street, 50-425 Wroclaw, Poland
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107
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Clinical applications of platelet-rich plasma in patellar tendinopathy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:249498. [PMID: 25136568 PMCID: PMC4127290 DOI: 10.1155/2014/249498] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 06/26/2014] [Accepted: 07/09/2014] [Indexed: 12/16/2022]
Abstract
Platelet-rich plasma (PRP), a blood derivative with high concentrations of platelets, has been found to have high levels of autologous growth factors (GFs), such as transforming growth factor-β (TGF-β), platelet-derived growth factor (PDGF), fibroblastic growth factor (FGF), vascular endothelial growth factor (VEGF), and epidermal growth factor (EGF). These GFs and other biological active proteins of PRP can promote tissue healing through the regulation of fibrosis and angiogenesis. Moreover, PRP is considered to be safe due to its autologous nature and long-term usage without any reported major complications. Therefore, PRP therapy could be an option in treating overused tendon damage such as chronic tendinopathy. Here, we present a systematic review highlighting the clinical effectiveness of PRP injection therapy in patellar tendinopathy, which is a major cause of athletes to retire from their respective careers.
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108
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Regenerative Spinal Therapies for Low Back Pain. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2014. [DOI: 10.1007/s40141-014-0043-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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109
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Khoshbin A, Leroux T, Wasserstein D, Marks P, Theodoropoulos J, Ogilvie-Harris D, Gandhi R, Takhar K, Lum G, Chahal J. The efficacy of platelet-rich plasma in the treatment of symptomatic knee osteoarthritis: a systematic review with quantitative synthesis. Arthroscopy 2013; 29:2037-48. [PMID: 24286802 DOI: 10.1016/j.arthro.2013.09.006] [Citation(s) in RCA: 151] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 09/11/2013] [Accepted: 09/11/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this systematic review was to synthesize the available Level I and Level II literature on platelet-rich plasma (PRP) as a therapeutic intervention in the management of symptomatic knee osteoarthritis (OA). METHODS A systematic review of Medline, Embase, Cochrane Central Register of Controlled Trials, PubMed, and www.clinicaltrials.gov was performed to identify all randomized controlled trials and prospective cohort studies that evaluated the clinical efficacy of PRP versus a control injection for knee OA. A random-effects model was used to evaluate the therapeutic effect of PRP at 24 weeks by use of validated outcome measures (Western Ontario and McMaster Universities Arthritis Index, visual analog scale for pain, International Knee Documentation Committee Subjective Knee Evaluation Form, and overall patient satisfaction). RESULTS Six Level I and II studies satisfied our inclusion criteria (4 randomized controlled trials and 2 prospective nonrandomized studies). A total of 577 patients were included, with 264 patients (45.8%) in the treatment group (PRP) and 313 patients (54.2%) in the control group (hyaluronic acid [HA] or normal saline solution [NS]). The mean age of patients receiving PRP was 56.1 years (51.5% male patients) compared with 57.1 years (49.5% male patients) for the group receiving HA or NS. Pooled results using the Western Ontario and McMaster Universities Arthritis Index scale (4 studies) showed that PRP was significantly better than HA or NS injections (mean difference, -18.0 [95% confidence interval, -28.8 to -8.3]; P < .001). Similarly, the International Knee Documentation Committee scores (3 studies) favored PRP as a treatment modality (mean difference, 7.9 [95% confidence interval, 3.7 to 12.1]; P < .001). There was no difference in the pooled results for visual analog scale score or overall patient satisfaction. Adverse events occurred more frequently in patients treated with PRP than in those treated with HA/placebo (8.4% v 3.8%, P = .002). CONCLUSIONS As compared with HA or NS injection, multiple sequential intra-articular PRP injections may have beneficial effects in the treatment of adult patients with mild to moderate knee OA at approximately 6 months. There appears to be an increased incidence of nonspecific adverse events among patients treated with PRP. LEVEL OF EVIDENCE Level II, systematic review of Level I and II studies.
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Affiliation(s)
- Amir Khoshbin
- University of Toronto Orthopaedic Sports Medicine Program, Women's College Hospital, Toronto, Ontario, Canada; The Hospital for Sick Children, Toronto, Ontario, Canada
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110
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Chang KV, Hung CY, Aliwarga F, Wang TG, Han DS, Chen WS. Comparative effectiveness of platelet-rich plasma injections for treating knee joint cartilage degenerative pathology: a systematic review and meta-analysis. Arch Phys Med Rehabil 2013; 95:562-75. [PMID: 24291594 DOI: 10.1016/j.apmr.2013.11.006] [Citation(s) in RCA: 149] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 11/16/2013] [Accepted: 11/18/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To explore the effectiveness of platelet-rich plasma (PRP) in treating cartilage degenerative pathology in knee joints. DATA SOURCES Electronic databases, including PubMed and Scopus, were searched from the earliest record to September 2013. STUDY SELECTION We included single-arm prospective studies, quasi-experimental studies, and randomized controlled trials that used PRP to treat knee chondral degenerative lesions. Eight single-arm studies, 3 quasi-experimental studies, and 5 randomized controlled trials were identified, comprising 1543 participants. DATA EXTRACTION We determined effect sizes for the selected studies by extracting changes in functional scales after the interventions and compared the PRP group pooled values with the pretreatment baseline and the groups receiving placebo or hyaluronic acid (HA) injections. DATA SYNTHESIS PRP injections in patients with knee degenerative pathology showed continual efficacy for 12 months compared with their pretreatment condition. The effectiveness of PRP was likely better and more prolonged than that of HA. Injection doses ≤2, the use of a single-spinning approach, and lack of additional activators led to an uncertainty in the treatment effects. Patients with lower degrees of cartilage degeneration achieved superior outcomes as opposed to those affected by advanced osteoarthritis. CONCLUSIONS PRP application improves function from basal evaluations in patients with knee joint cartilage degenerative pathology and tends to be more effective than HA administration. Discrepancy in the degenerative severity modifies the treatment responses, leading to participants with lower degrees of degeneration benefiting more from PRP injections.
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Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, BeiHu Branch, and National Taiwan University College of Medicine, Taipei, Taiwan; Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Chen-Yu Hung
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Fanny Aliwarga
- Department of Physical Medicine and Rehabilitation, Eka Hospital, Tangerang, Indonesia
| | - Tyng-Guey Wang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Der-Sheng Han
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, BeiHu Branch, and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Shiang Chen
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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111
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Kesikburun S, Tan AK, Yilmaz B, Yaşar E, Yazicioğlu K. Platelet-rich plasma injections in the treatment of chronic rotator cuff tendinopathy: a randomized controlled trial with 1-year follow-up. Am J Sports Med 2013; 41:2609-16. [PMID: 23893418 DOI: 10.1177/0363546513496542] [Citation(s) in RCA: 174] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rotator cuff tendinopathy (RCT) is a significant source of disability and loss of work. Platelet-rich plasma (PRP) has been suggested to be beneficial in the treatment of RCT. PURPOSE To investigate the effect of PRP injections on pain and shoulder functions in patients with chronic RCT. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 40 patients, 18 to 70 years of age, with (1) a history of shoulder pain for >3 months during overhead-throwing activities, (2) MRI findings of RCT or partial tendon ruptures, and (3) a minimum 50% reduction in shoulder pain with subacromial injections of an anesthetic were included in this placebo-controlled, double-blind randomized clinical trial. Patients were randomized into a PRP group (n = 20) or placebo group (n = 20). Patients received an ultrasound-guided injection into the subacromial space that contained either 5 mL of PRP prepared from autologous venous blood or 5 mL of saline solution. All patients underwent a 6-week standard exercise program. Outcome measures (Western Ontario Rotator Cuff Index [WORC], Shoulder Pain and Disability Index [SPADI], 100-mm visual analog scale [VAS] of shoulder pain with the Neer test, and shoulder range of motion) were assessed at baseline and at 3, 6, 12, and 24 weeks and 1 year after injection. RESULTS Comparison of the patients revealed no significant difference between the groups in WORC, SPADI, and VAS scores at 1-year follow-up (P = .174, P = .314, and P = .904, respectively). Similar results were found at other assessment points. Within each group, the WORC, SPADI, and VAS scores showed significant improvements compared with baseline at all time points (P < .001). In the range of motion measures, there were no significant group × time interactions. CONCLUSION At 1-year follow-up, a PRP injection was found to be no more effective in improving quality of life, pain, disability, and shoulder range of motion than placebo in patients with chronic RCT who were treated with an exercise program.
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Affiliation(s)
- Serdar Kesikburun
- Serdar Kesikburun, Department of Physical Medicine and Rehabilitation, Turkish Armed Forces Rehabilitation Center, Gülhane Military Medical Academy, TSK Rehabilitasyon Merkezi 06530 Bilkent, Ankara, Turkey.
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112
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Li H, Usas A, Poddar M, Chen CW, Thompson S, Ahani B, Cummins J, Lavasani M, Huard J. Platelet-rich plasma promotes the proliferation of human muscle derived progenitor cells and maintains their stemness. PLoS One 2013; 8:e64923. [PMID: 23762264 PMCID: PMC3676442 DOI: 10.1371/journal.pone.0064923] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 04/20/2013] [Indexed: 01/01/2023] Open
Abstract
Human muscle-derived progenitor cells (hMDPCs) offer great promise for muscle cell-based regenerative medicine; however, prolonged ex-vivo expansion using animal sera is necessary to acquire sufficient cells for transplantation. Due to the risks associated with the use of animal sera, the development of a strategy for the ex vivo expansion of hMDPCs is required. The purpose of this study was to investigate the efficacy of using platelet-rich plasma (PRP) for the ex-vivo expansion of hMDPCs. Pre-plated MDPCs, myoendothelial cells, and pericytes are three populations of hMDPCs that we isolated by the modified pre-plate technique and Fluorescence Activated Cell Sorting (FACS), respectively. Pooled allogeneic human PRP was obtained from a local blood bank, and the effect that thrombin-activated PRP-releasate supplemented media had on the ex-vivo expansion of the hMDPCs was tested against FBS supplemented media, both in vitro and in vivo. PRP significantly enhanced short and long-term cell proliferation, with or without FBS supplementation. Antibody-neutralization of PDGF significantly blocked the mitogenic/proliferative effects that PRP had on the hMDPCs. A more stable and sustained expression of markers associated with stemness, and a decreased expression of lineage specific markers was observed in the PRP-expanded cells when compared with the FBS-expanded cells. The in vitro osteogenic, chondrogenic, and myogenic differentiation capacities of the hMDPCs were not altered when expanded in media supplemented with PRP. All populations of hMDPCs that were expanded in PRP supplemented media retained their ability to regenerate myofibers in vivo. Our data demonstrated that PRP promoted the proliferation and maintained the multi-differentiation capacities of the hMDPCs during ex-vivo expansion by maintaining the cells in an undifferentiated state. Moreover, PDGF appears to be a key contributing factor to the beneficial effect that PRP has on the proliferation of hMDPCs.
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Affiliation(s)
- Hongshuai Li
- Department of Orthopedic Surgery, Stem Cell Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Arvydas Usas
- Department of Orthopedic Surgery, Stem Cell Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Minakshi Poddar
- Department of Orthopedic Surgery, Stem Cell Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Chien-Wen Chen
- Department of Orthopedic Surgery, Stem Cell Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Seth Thompson
- Department of Orthopedic Surgery, Stem Cell Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Bahar Ahani
- Department of Orthopedic Surgery, Stem Cell Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - James Cummins
- Department of Orthopedic Surgery, Stem Cell Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Mitra Lavasani
- Department of Orthopedic Surgery, Stem Cell Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Johnny Huard
- Department of Orthopedic Surgery, Stem Cell Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
- * E-mail:
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113
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Zheng C, Zhu Q, Liu X, Huang X, He C, Jiang L, Quan D, Zhou X, Zhu Z. Effect of platelet-rich plasma (PRP) concentration on proliferation, neurotrophic function and migration of Schwann cellsin vitro. J Tissue Eng Regen Med 2013; 10:428-36. [PMID: 23723151 DOI: 10.1002/term.1756] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Revised: 02/06/2013] [Accepted: 03/25/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Canbin Zheng
- Department of Orthopaedics and Microsurgery; First Affiliated Hospital of Sun Yat-Sen University; Guangzhou People's Republic of China
| | - Qingtang Zhu
- Department of Orthopaedics and Microsurgery; First Affiliated Hospital of Sun Yat-Sen University; Guangzhou People's Republic of China
| | - Xiaolin Liu
- Department of Orthopaedics and Microsurgery; First Affiliated Hospital of Sun Yat-Sen University; Guangzhou People's Republic of China
| | - Xijun Huang
- Department of Orthopaedics and Microsurgery; First Affiliated Hospital of Sun Yat-Sen University; Guangzhou People's Republic of China
| | - Caifeng He
- Guangzhou ZhongDa Medical Equipment Co. Ltd; Guangzhou People's Republic of China
| | - Li Jiang
- Orthopaedic Institute of the First Affiliated Hospital; Sun Yat-Sen University; Guangzhou People's Republic of China
| | - Daping Quan
- School of Chemistry and Chemical Engineering; Sun Yat-Sen University; Guangzhou People's Republic of China
| | - Xiang Zhou
- Department of Orthopaedics and Microsurgery; First Affiliated Hospital of Sun Yat-Sen University; Guangzhou People's Republic of China
| | - Zhaowei Zhu
- Department of Orthopaedics and Microsurgery; First Affiliated Hospital of Sun Yat-Sen University; Guangzhou People's Republic of China
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114
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Fredericson M. On the horizon: defining the future of sports medicine and the role of the physiatrist. PM R 2013; 4:707-10. [PMID: 23093214 DOI: 10.1016/j.pmrj.2012.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 08/27/2012] [Indexed: 10/27/2022]
Affiliation(s)
- Michael Fredericson
- Division of Physical Medicine & Rehabilitation, Stanford University, Stanford, CA, USA.
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115
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Wang AW, Bauer S, Goonatillake M, Breidahl W, Zheng MH. Autologous tenocyte implantation, a novel treatment for partial-thickness rotator cuff tear and tendinopathy in an elite athlete. BMJ Case Rep 2013; 2013:bcr-2012-007899. [PMID: 23314880 DOI: 10.1136/bcr-2012-007899] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Tendinopathy and small partial-thickness tears of the rotator cuff tendon are common presentations in sports medicine. No promising treatment has yet been established. Corticosteroid injections may improve symptoms in the short term but do not primarily treat the tendon pathology. Ultrasound-guided autologous tenocyte implantation (ATI) is a novel bioengineered treatment approach for treating tendinopathy. We report the first clinical case of ATI in a 20-year-old elite gymnast with a rotator cuff tendon injury. The patient presented with 12 months of increasing pain during gymnastics being unable to perform most skills. At 1 year after ATI the patient reported substantial improvement of clinical symptoms. Pretreatment and follow-up MRIs were reported and scored independently by two experienced musculoskeletal radiologists. Tendinopathy was improved and the partial-thickness tear healed on 3 T MRI. The patient was able to return to national-level competition.
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Affiliation(s)
- Allan W Wang
- Department of Orthopaedics, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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116
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Musculoskeletal Ultrasound in Physical Medicine and Rehabilitation. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2013. [DOI: 10.1007/s40141-012-0003-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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117
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The Accuracy and Efficacy of Palpation versus Image-Guided Peripheral Injections in Sports Medicine. Curr Sports Med Rep 2013; 12:296-303. [DOI: 10.1097/01.csmr.0000434103.32478.36] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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118
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Browning SR, Weiser AM, Woolf N, Golish SR, SanGiovanni TP, Scuderi GJ, Carballo C, Hanna LS. Platelet-rich plasma increases matrix metalloproteinases in cultures of human synovial fibroblasts. J Bone Joint Surg Am 2012; 94:e1721-7. [PMID: 23224392 DOI: 10.2106/jbjs.k.01501] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The effect of platelet-rich plasma on chondrocytes has been studied in cell and tissue culture. Less attention has been given to the effect of platelet-rich plasma on nonchondrocytic cell lineages within synovial joints, such as fibroblast-like synoviocytes, which produce cytokines and matrix metalloproteinases (MMPs) that mediate cartilage catabolism. The purpose of the present study was to determine the effect of platelet-rich plasma on cytokines and proteases produced by fibroblast-like synoviocytes. METHODS Platelet-rich plasma and platelet-poor plasma from harvested autologous blood were prepared with a commercially available system. Fibroblast-like synoviocytes were treated with platelet-rich plasma, platelet-poor plasma, recombinant PDGFββ (platelet-derived growth factor ββ), or phosphate-buffered saline solution and incubated at 37°C for forty-eight hours. The concentrations of IL-1β (interleukin-1β), IL-1RA (IL-1 receptor antagonist), IL-6, IFN-γ (interferon-γ), IP-10 (interferon gamma-induced protein 10), MCP-1 (monocyte chemotactic protein-1), MIP-1β (macrophage inflammatory protein-1β), PDGFββ, RANTES, TNF-α (tumor necrosis factor-α), VEGF (vascular endothelial growth factor), MMP-1, MMP-3, and MMP-9 in the culture medium were determined by multiplex immunoassay. RESULTS Platelet-rich plasma cultured in medium contained multiple catabolic mediators in substantial concentrations, including MMP-9 (15.8 ± 2.3 ng/mL) and MMP-1 (2.5 ± 0.8 ng/mL), as well as proinflammatory mediators IL-1β, IL-6, IFN-γ, IP-10, MCP-1, MIP-1β, RANTES, and TNF-α in concentrations between 20 pg/mL and 20 ng/mL. Platelet-poor plasma contained significantly lower concentrations of these compounds. Platelet-rich plasma was used to treat human fibroblast-like synoviocytes, and the resulting concentrations of mediators were corrected for the concentrations in the platelet-rich plasma alone. Compared with untreated fibroblast-like synoviocytes, synoviocytes treated with platelet-rich plasma exhibited significantly greater levels of MMP-1 (363 ± 94.0 ng/mL, p = 0.018) and MMP-3 (278 ± 90.0 ng/mL, p = 0.018). In contrast, platelet-poor plasma had little effect on mediators secreted by the synoviocytes. PDGFββ-treated fibroblast-like synoviocytes exhibited a broad proinflammatory cytokine response at four and forty-eight hours. CONCLUSIONS Platelet-rich plasma was shown to contain a mixture of anabolic and catabolic mediators. Synoviocytes treated with platelet-rich plasma responded with substantial MMP secretion, which may increase cartilage catabolism. Synoviocytes responded to PDGF with a substantial proinflammatory response.
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Affiliation(s)
- Shawn R Browning
- Cytonics Corporation, 555 Heritage Drive, Suite 115, Jupiter, FL 33458, USA
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119
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Vora A, Borg-Stein J, Nguyen RT. Regenerative injection therapy for osteoarthritis: fundamental concepts and evidence-based review. PM R 2012; 4:S104-9. [PMID: 22632688 DOI: 10.1016/j.pmrj.2012.02.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Accepted: 02/01/2012] [Indexed: 11/26/2022]
Abstract
Regenerative therapy involves the injection of a small volume of solution into multiple sites of painful ligament and tendon insertions (entheses) and adjacent joint spaces, with the goal of reducing pain and ostensibly promoting tissue repair and growth. Dextrose and platelet-rich plasma solutions have been shown to increase expression of growth factors in vivo and have shown promising clinical results in the treatment of tendinosus. In the treatment of osteoarthritis, small clinical trials and case series to date suggest safety, symptomatic improvement, and functional improvement at up to a year of follow-up; however, most of these studies are uncontrolled. Given the methodological limitations of clinical research on regenerative injections for osteoarthritis to date, this treatment should be considered only after execution of a comprehensive assessment and treatment plan, including optimization of biomechanics, weight loss, cardiovascular exercise, resistance training, and judicious use of more established topical, oral, and injectable medications.
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Affiliation(s)
- Ariana Vora
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA.
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120
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Sell SA, Ericksen JJ, Bowlin GL. The incorporation and controlled release of platelet-rich plasma-derived biomolecules from polymeric tissue engineering scaffolds. POLYM INT 2012. [DOI: 10.1002/pi.4372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Scott A Sell
- Physical Medicine and Rehabilitation Service; Hunter Holmes McGuire VA Medical Center; Richmond VA 23249 USA
- Department of Biomedical Engineering; Virginia Commonwealth University; Richmond VA 23284 USA
| | - Jeffery J Ericksen
- Physical Medicine and Rehabilitation Service; Hunter Holmes McGuire VA Medical Center; Richmond VA 23249 USA
- Department of Physical Medicine and Rehabilitation; Virginia Commonwealth University; Richmond VA 23284 USA
| | - Gary L Bowlin
- Department of Biomedical Engineering; Virginia Commonwealth University; Richmond VA 23284 USA
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121
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Sclafani AP, Saman M. Platelet-rich fibrin matrix for facial plastic surgery. Facial Plast Surg Clin North Am 2012; 20:177-86, vi. [PMID: 22537785 DOI: 10.1016/j.fsc.2012.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Platelets are known primarily for their role in hemostasis, but there is increasing interest in the effect of platelets on wound healing. Platelet isolates such as platelet-rich plasma have been advocated to enhance and accelerate wound healing. This article describes the use of a novel preparation, platelet-rich fibrin matrix (PRFM), for facial plastic surgery applications such as volume augmentation, fat transfer supplementation, and as an adjunct to open surgical procedures.
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Affiliation(s)
- Anthony P Sclafani
- Division of Facial Plastic and Reconstructive Surgery, The New York Eye and Ear Infirmary, 310 East 14th Street, New York, NY 10003, USA.
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122
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Steinert AF, Middleton KK, Araujo PH, Fu FH. Platelet-Rich Plasma in Orthopaedic Surgery and Sports Medicine: Pearls, Pitfalls, and New Trends in Research. ACTA ACUST UNITED AC 2012. [DOI: 10.1053/j.oto.2011.10.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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123
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Mautner K, Malanga G, Colberg R. Optimization of ingredients, procedures and rehabilitation for platelet-rich plasma injections for chronic tendinopathy. Pain Manag 2011; 1:523-32. [DOI: 10.2217/pmt.11.56] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
SUMMARY There is considerable interest amongst clinicians and researchers to create the optimal platelet product to maximize outcomes with platelet-rich plasma (PRP) injections. PRP has been widely introduced as a safe alternative for treating tendinopathies. However, there is still limited clinical evidence describing the components of the platelet product and supporting its use in clinical trials. This article reviews the current literature regarding the role of PRP injections in the treatment of recalcitrant tendinopathies and the different factors in the platelet product that could affect the outcome, including the platelet count, presence of leukocytes, activators used, pH of solution and delivery method, among others. In addition, we address important concepts regarding rehabilitation after PRP procedures, which has little consensus to date and is the subject of much debate. Based on the phases of soft tissue healing, basic science research on platelets, as well as our clinical experience in treating over 500 patients with PRP, we will suggest guidelines regarding the optimal progression of rehabilitation and timing for return to previous activity following the procedure.
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Affiliation(s)
| | - Gerard Malanga
- Department of Physical Medicine & Rehabilitation, University of Medicine & Dentistry, 30 Bergen Street, Newark, NJ, USA
| | - Ricardo Colberg
- Department of Physical Medicine & Rehabilitation & Department of Orthopedics, Emory University, Atlanta, GA, USA
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