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Lazzaretti Fernandes T, Taraballi F, Shao Z, Roessler PP, Cardona-Ramírez S. Nonoperative and Operative Soft-Tissue, Cartilage, and Bony Regeneration and Orthopaedic Biologics of the Elbow and Upper Extremity: An Orthoregeneration Network Foundation Review. Arthroscopy 2024:S0749-8063(24)00326-8. [PMID: 38723874 DOI: 10.1016/j.arthro.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 06/10/2024]
Abstract
Orthoregeneration is defined as a solution for orthopaedic conditions that harnesses the benefits of biology to improve healing, reduce pain, improve function, and, optimally, provide an environment for tissue regeneration. Options include drugs, surgical intervention, scaffolds, biologics as a product of cells, and physical and electromagnetic stimuli. The goal of regenerative medicine is to enhance the healing of tissue after musculoskeletal injuries as both isolated treatment and adjunct to surgical management, using novel therapies to improve recovery and outcomes. Various orthopaedic biologics (orthobiologics) have been investigated for the treatment of pathology involving the elbow and upper extremity, including the tendons (lateral epicondylitis, medial epicondylitis, biceps tendonitis, triceps tendonitis), articular cartilage (osteoarthritis, osteochondral lesions), and bone (fractures, nonunions, avascular necrosis, osteonecrosis). Promising and established treatment modalities include hyaluronic acid; botulinum toxin; corticosteroids; leukocyte-rich and leukocyte-poor platelet-rich plasma; autologous blood; bone marrow aspirate comprising mesenchymal stromal cells (alternatively termed medicinal signaling cells and frequently mesenchymal stem cells [MSCs]) and bone marrow aspirate concentrate; MSCs harvested from adipose and skin (dermis) sources; vascularized bone grafts; bone morphogenic protein scaffold made from osteoinductive and conductive β-tricalcium phosphate and poly-ε-caprolactone with hydrogels, human MSCs, and matrix metalloproteinases; and collagen sponge. Autologous blood preparations such as autologous blood injections and platelet-rich plasma show positive outcomes for nonresponsive tendinopathy. In addition, cellular therapies such as tissue-derived tenocyte-like cells and MSCs show a promising ability to regulate degenerative processes by modulating tissue response to inflammation and preventing continuous degradation and support tissue restoration.
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Affiliation(s)
- Tiago Lazzaretti Fernandes
- Sports Medicine Division, Institute of Orthopaedics and Traumatology, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; Hospital Sírio-Libanês, São Paulo, Brazil.
| | - Francesca Taraballi
- Center for Musculoskeletal Regeneration, Orthopedics and Sports Medicine, Houston, Texas, U.S.A.; Methodist Hospital, Houston Methodist Academic Institute, Houston, Texas, U.S.A
| | - Zhenxing Shao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing, China; Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, Beijing, China
| | - Philip P Roessler
- Department of Orthopedics and Trauma Surgery, University Hospital Bonn, Bonn, Germany; Gelenkzentrum Mittelrhein, Koblenz, Germany
| | - Sebastián Cardona-Ramírez
- Grupo de Investigación OHVRI, Escuela de Medicina Veterinaria, Facultad de Ciencias Agrarias, Universidad de Antioquia, Medellín, Colombia
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2
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Pretorius J, Habash M, Ghobrial B, Alnajjar R, Ellanti P. Current Status and Advancements in Platelet-Rich Plasma Therapy. Cureus 2023; 15:e47176. [PMID: 38021947 PMCID: PMC10652151 DOI: 10.7759/cureus.47176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Platelet-rich plasma (PRP) as a treatment modality has been around for the last four decades, but only truly gained popularity over the last 10 to 15 years in medicine, in a variety of fields ranging from regenerative medicine to infertility treatment. It has gained popularity, especially in treating musculoskeletal conditions where the bulk of research has been performed and published. There is level I evidence available supporting its efficacy in the treatment of osteoarthritis (OA), epicondylitis, bursitis, compressive neuropathy, plantar fasciitis, muscular injuries and osteochondral lesions. Most published research with regards to PRP has been focused on knee OA (limited research in shoulder, elbow, and foot and ankle OA), lateral epicondylitis and carpal tunnel syndrome, whereas spinal and hand conditions have limited research available. Tendinopathies and partial tendon tears have conflicting evidence available, with level I evidence supporting PRP's use in rotator cuff tendinopathies and tears, with contradictory level I evidence discouraging its use in patella and Achilles tendinopathies and tears. The available evidence regarding the use of PRP continues to produce conflicting results, but despite this, there is an ongoing increase in the popularity and use of PRP in patients with musculoskeletal conditions.
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Affiliation(s)
| | - Mohammed Habash
- Orthopaedics and Traumatology, University Hospital Galway, Galway, IRL
| | - Bishoy Ghobrial
- Trauma and Orthopaedics, University Hospital Galway, Galway, IRL
| | - Rafee Alnajjar
- Trauma and Orthopaedics, University Hospital Galway, Galway, IRL
| | - Prasad Ellanti
- Trauma and Orthopaedics, Letterkenny University Hospital, Letterkenny, IRL
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3
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Pechette Markley A. Management of Injuries in Agility Dogs. Vet Clin North Am Small Anim Pract 2023; 53:829-844. [PMID: 36964029 DOI: 10.1016/j.cvsm.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
Agility is a physically demanding sport, and injuries are common. An understanding of the common clinical presentations, frequent injuries, and risk factors for injury is critical when seeing this population of patients in practice. Shoulder injuries and other soft tissue injuries including iliopsoas muscle strains are commonly seen. The Border Collie seems to be at higher risk of developing agility-related injuries. The key to rehabilitation of the agility dog is accurate and expedient diagnosis of the injury, which often involves advanced diagnostics such as musculoskeletal ultrasound, arthroscopy, and/or MRI.
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Affiliation(s)
- Arielle Pechette Markley
- Department of Clinical Sciences, Sports Medicine and Rehabilitation, The Ohio State University College of Veterinary Medicine, 601 Vernon L Tharp Street, Columbus, Ohio 43210, USA.
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4
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Distale Bizepssehnenruptur. ARTHROSKOPIE 2023. [DOI: 10.1007/s00142-022-00568-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
ZusammenfassungDie Ruptur der distalen Bizepssehne tritt am häufigsten bei Männern im mittleren Alter auf (30 bis 50 Jahre). Der typische Mechanismus ist die exzentrische Belastung in strecknaher Ellbogenstellung in Supination, wobei diese Verletzung mit Kraftsport und körperlich belastender Tätigkeit assoziiert ist. Epidemiologische Daten weisen auf eine Zunahme von distalen Bizepsrupturen in den letzten Jahrzehnten hin. Risikofaktoren wie die Verwendung anaboler Steroide, Kraftsport und Nikotinabusus zeigen einen Zusammenhang mit der Verletzung. Bei reduziertem Patientenanspruch oder relevanten Komorbiditäten ist auch unter einer konservativen Behandlung ein gutes funktionelles Ergebnis mit subjektiv guter Patientenzufriedenheit zu erreichen, allerdings unter zu erwartender relevanter Kraftminderung in Flexion (20 %) und Supination (40 %). Durch eine operative Refixation lässt sich das beste funktionelle Resultat erzielen, allerdings einhergehend mit einem nicht unerheblichen Komplikationsrisiko.
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5
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Tendinopathy. Regen Med 2023. [DOI: 10.1007/978-3-030-75517-1_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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6
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Hamoodi Z, Winton J, Bhalaik V. Partial tear of the distal biceps tendon: Current concepts. J Orthop 2022; 32:18-24. [DOI: 10.1016/j.jor.2022.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/01/2022] [Indexed: 02/04/2023] Open
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Cell-based therapy of the elbow: evidence for lateral tendinopathy-a review on current treatments. Knee Surg Sports Traumatol Arthrosc 2022; 30:1152-1160. [PMID: 33885945 DOI: 10.1007/s00167-021-06541-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/16/2021] [Indexed: 12/12/2022]
Abstract
PURPOSE Cell-based therapies are on the rise in treating intra and extraarticular pathologies, trying to avoid surgical intervention and support local repair processes. Therefore, the aim was to summarize current evidence-based treatment options for a cell-based therapy around the elbow. METHODS Through a literature review up-to date treatment algorithms and therapies have been identified and have been rated according to their evidence level for clinical recommendation. RESULTS Regarding the four extraarticular anatomical regions of the elbow (anterior, medial, posterior and lateral) and the joint itself, the lateral elbow and its´ tendinopathies as well as the use of cell-based treatment options have been extensively studied and, therefore, allow for clear and evidence-based recommendations. The remaining three regions as wells as the intraarticular application do not show enough evidence for a clinical recommendation. CONCLUSION In conclusion the cell-based approach for treating elbow pathologies can only be recommended for the lateral elbow, as there has been shown sufficient evidence for the extraarticular application. It has to be mentioned, that the results from the lateral elbow maybe transferred to other extra-articular tendinopathies, as the lack of evidence may be due to the rare appearance of posterior, medial and anterior tendon affection. No recommendation can be given for intra-articular use. LEVEL OF EVIDENCE IV.
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8
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van der Vis J, Janssen SJ, Bleys RLAW, Eygendaal D, van den Bekerom MPJ. Distal biceps tendon injection. Clin Shoulder Elb 2021; 24:93-97. [PMID: 34078017 PMCID: PMC8181841 DOI: 10.5397/cise.2021.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/07/2021] [Indexed: 11/25/2022] Open
Abstract
Background Injection therapy around the distal biceps tendon insertion is challenging. This therapy may be indicated in patients with a partial distal biceps tendon tear, bicipitoradial bursitis and tendinopathy. The primary goal of this study was to determine the accuracy of manually performed injections without ultrasound guidance around the biceps tendon. Methods Seven upper limb specialists, two general orthopedic specialists, and three orthopedic surgical residents manually injected a cadaver elbow with acrylic dye using an anterior and a lateral infiltration approach. After infiltration the cadaveric elbows were dissected to determine the location of the acrylic dye. Results In total, 79% of the injections were localized near the biceps tendon. Of these injections, 20% were localized on the radius near the bicipitoradial bursa. In total, 53% of the performed infiltrations were injected by anterior and 47% by lateral approaches. Of the injections near the distal biceps (79%), 47% were injected by an anterior and 53% by a lateral approach. Of the injections on the radius (20%), 33% were injected by anterior and 67% by lateral approach. Of the inaccurate injections (21%), 75% were injected anterior and 25% lateral. Conclusions Manual infiltration without ultrasound guidance for distal biceps pathology lacks accuracy. We therefore recommend ultrasound guidance for more accurate infiltration.
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Affiliation(s)
| | - Stein J Janssen
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Ronald L A W Bleys
- Department of Anatomy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Academic Medical Center, Amsterdam, The Netherlands.,Department of Orthopedic Surgery, Amphia Ziekenhuis, Breda, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands.,Department of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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9
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Ultrasound of the distal biceps brachii tendon using four approaches: reproducibility and reader preference. Skeletal Radiol 2021; 50:937-943. [PMID: 33033880 DOI: 10.1007/s00256-020-03637-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/18/2020] [Accepted: 09/30/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine which sonographic appearance of the distal biceps brachii tendon (DBBT) is preferred by readers, and if images obtained by two different operators are reproducible. METHODS We performed an IRB-approved prospective sonographic evaluation of the DBBT in 50 healthy elbows using four different approaches (anterior, lateral, medial, posterior) performed by two operators. Five musculoskeletal radiologists independently reviewed the images, and ranked the four approaches based on overall appearance of echogenicity of the tendon, visualized length, and visualization of the insertion. RESULTS The medial approach was preferred in 79.6% of elbows, anterior in 17.6%, lateral in 2.8%, and the posterior approach was never preferred. The difference was statistically significant (P < 0.001). Kappa values for the five readers were 0.61 to 0.8 for choosing the images produced by the medial approach. CONCLUSION The appearance of the DBBT using the medial approach is preferred by readers and is reproducible between different operators.
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10
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Haunschild ED, Gilat R, Fu MC, Condron N, Cole BJ. Biologics in shoulder and elbow pathology. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:1-6. [PMID: 37588635 PMCID: PMC10426570 DOI: 10.1016/j.xrrt.2020.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
In recent years, orthobiologics have been of increasing clinical interest in the treatment of shoulder and elbow pathology. In some conditions, such as rotator cuff injury and lateral epicondylitis, there have been high-quality trials that support the use of platelet-rich plasma in reducing pain, restoring functionality, and improving clinical outcomes. However, as the numbers of both cellular-based biologics and the conditions being augmented by biologics continue to expand, there is a substantial need for high-quality investigations to support their routine use in most shoulder and elbow conditions. The purpose of this review is to summarize the current evidence of orthobiologics in the management of shoulder and elbow injury, as nonoperative treatment and as augments to operative treatment.
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Affiliation(s)
| | - Ron Gilat
- Midwest Orthopaedics at Rush, Chicago, IL, USA
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11
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Townsend C, Von Rickenbach KJ, Bailowitz Z, Gellhorn AC. Post-Procedure Protocols Following Platelet-Rich Plasma Injections for Tendinopathy: A Systematic Review. PM R 2020; 12:904-915. [PMID: 32103599 DOI: 10.1002/pmrj.12347] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Platelet-rich plasma (PRP) has been increasingly studied as a treatment for tendinopathy. Many factors may influence outcomes after PRP, including different protocols following administration. It was hypothesized that there would be heterogeneity in post-PRP protocols. LITERATURE SURVEY A systematized review of the literature on post-PRP protocols for tendinopathy was conducted using an electronic search of MEDLINE and Embase databases through September 2018. METHODOLOGY After duplicates were removed, English language articles involving adult patients who received PRP for tendinopathy were reviewed. Exclusion criteria included studies with fewer than 10 patients, PRP used to treat pathology other than tendinopathy, multiple protocols in one study, and surgical settings. Protocol specifics were extracted including nonsteroidal anti-inflammatory drugs (NSAID) restrictions before and after injection, postinjection restrictions on movement and weight bearing, use of orthoses, activity modifications, and postinjection rehabilitation protocols. Given limitations in the data, a meta-analysis was not performed. SYNTHESIS Eighty-four studies met inclusion criteria. Following PRP injection, weight-bearing restrictions were mentioned rarely (12% of protocols). Orthosis use was uncommon overall (18%) but more common in Achilles tendinopathy protocols (53%). The majority of protocols instituted a period of stretching (51%) and strengthening (54%). Stretching programs generally began 2-7 days following injection, and strengthening programs began within 2-3 weeks. Preinjection NSAID restriction was reported rarely (20%), whereas postinjection NSAID restriction was more common (56%), with a typical restriction of greater than 2 weeks (38%). Return to play or full activity was reported in 42% of protocols, most commonly at 4-6 weeks following injection. CONCLUSION Although the clinical effectiveness of PRP remains controversial, even less is known about the effect of post-PRP protocols, which may affect the outcomes attributed to PRP itself. No studies directly compare post-PRP protocols, and the protocols studied demonstrate substantial heterogeneity. Some consensus regarding post-PRP protocols exists, although the rationale for these recommendations is limited.
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Affiliation(s)
- Christine Townsend
- Department of Rehabilitation Medicine, New York-Presbyterian Rehabilitation Medicine, Weill Cornell Medical College & Columbia University Irving Medical Center, New York, NY, USA
| | - Kristian J Von Rickenbach
- Department of Rehabilitation Medicine, New York-Presbyterian Rehabilitation Medicine, Weill Cornell Medical College & Columbia University Irving Medical Center, New York, NY, USA
| | - Zachary Bailowitz
- Department of Rehabilitation Medicine, New York-Presbyterian Rehabilitation Medicine, Weill Cornell Medical College & Columbia University Irving Medical Center, New York, NY, USA
| | - Alfred C Gellhorn
- Department of Rehabilitation, Weill Cornell Medicine, New York, NY, USA
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12
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Stelter J, Malik S, Chiampas G. The Emergent Evaluation and Treatment of Shoulder, Clavicle, and Humerus Injuries. Emerg Med Clin North Am 2020; 38:103-124. [DOI: 10.1016/j.emc.2019.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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13
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Sconfienza LM, Adriaensen M, Albano D, Aparisi Gómez MP, Bazzocchi A, Beggs I, Bignotti B, Chianca V, Corazza A, Dalili D, De Dea M, Del Cura JL, Di Pietto F, Drakonaki E, Facal de Castro F, Filippiadis D, Gielen J, Gitto S, Gupta H, Klauser AS, Lalam R, Martin S, Martinoli C, Mauri G, McCarthy C, McNally E, Melaki K, Messina C, Mirón Mombiela R, Neubauer B, Obradov M, Olchowy C, Orlandi D, Plagou A, Prada Gonzalez R, Rutkauskas S, Snoj Z, Tagliafico AS, Talaska A, Vasilevska-Nikodinovska V, Vucetic J, Wilson D, Zaottini F, Zappia M, Allen G. Clinical indications for image-guided interventional procedures in the musculoskeletal system: a Delphi-based consensus paper from the European Society of Musculoskeletal Radiology (ESSR)-Part II, elbow and wrist. Eur Radiol 2019; 30:2220-2230. [PMID: 31844963 DOI: 10.1007/s00330-019-06545-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/20/2019] [Accepted: 10/23/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although image-guided interventional procedures of the elbow and wrist are routinely performed, there is poor evidence in the literature concerning such treatments. Our aim was to perform a Delphi-based consensus on published evidence on image-guided interventional procedures around the elbow and wrist and provide clinical indications on this topic. METHODS A board of 45 experts in image-guided interventional musculoskeletal procedures from the European Society of Musculoskeletal Radiology were involved in this Delphi-based consensus study. All panelists reviewed and scored published papers on image-guided interventional procedures around the elbow and wrist updated to September 2018 according to the Oxford Centre for Evidence-based Medicine levels of evidence. Consensus on statements drafted by the panelists about clinical indications was considered as "strong" when more than 95% of panelists agreed and as "broad" if more than 80% agreed. RESULTS Eighteen statements were drafted, 12 about tendon procedures and 6 about intra-articular procedures. Only statement #15 reached the highest level of evidence (ultrasound-guided steroid wrist injections result in greater pain reduction and greater likelihood of attaining clinically important improvement). Seventeen statements received strong consensus (94%), while one received broad consensus (6%). CONCLUSIONS There is still poor evidence in published papers on image-guided interventional procedures around the elbow and wrist. A strong consensus has been achieved in 17/18 (94%) statements provided by the panel on clinical indications. Large prospective randomized trials are needed to better define the role of these procedures in clinical practice. KEY POINTS • The panel provided 18 evidence-based statements on clinical indications of image-guided interventional procedures around the elbow and wrist. • Only statement #15 reached the highest level of evidence: ultrasound-guided steroid wrist injections result in greater pain reduction and greater likelihood of attaining clinically important improvement. • Seventeen statements received strong consensus (94%), while broad consensus was obtained by 1 statement (6%).
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Affiliation(s)
- Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy. .,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20100, Milan, Italy.
| | - Miraude Adriaensen
- Department of Medical Imaging, Zuyderland Medical Center, Sittard-Geleen, Heerlen, Brunssum, Kerkrade, The Netherlands
| | - Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.,Sezione di Scienze Radiologiche, Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, 90127, Palermo, Italy
| | - Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, 1023, New Zealand.,Department of Radiology, Hospital Vithas Nueve de Octubre, 46015, Valencia, Spain
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, 40136, Bologna, Italy
| | - Ian Beggs
- Department of Radiology, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK
| | - Bianca Bignotti
- Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy
| | - Vito Chianca
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Angelo Corazza
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.,Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Danoob Dalili
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.,The Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK
| | - Miriam De Dea
- UOC Radiologia, Ospedale di Feltre, AULSS1 Dolomiti, Veneto, Italy
| | - Jose Luis Del Cura
- Department of Radiology, Donostia University Hospital, Begiristain Doktorea Pasealekua, 109, 20014, Donostia/San Sebastian, Spain.,University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Francesco Di Pietto
- Dipartimento di Diagnostica per Immagini, Pineta Grande Hospital, Castel Volturno, CE, Italy
| | - Eleni Drakonaki
- Private Institution of Ultrasonography and MSK Radiology, Heraklion, Greece.,Department of Anatomy, Medical School of the European University of Cyprus, Nicosia, Cyprus
| | - Fernando Facal de Castro
- IBERORAD 1895 S.L., 08021, Barcelona, Spain.,Department of Radiology, General University Hospital of Valencia, Valencia, Spain
| | - Dimitrios Filippiadis
- 2nd Department of Radiology, University General Hospital "ATTIKON", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jan Gielen
- University of Antwerp, Antwerp, Belgium.,University of Antwerp Hospital (UZA), Antwerp, Belgium
| | | | | | - Andrea S Klauser
- Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
| | - Radhesh Lalam
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Gobowen, Oswestry, UK
| | - Silvia Martin
- Hospital Son Llatzer, Palma de Mallorca, Spain.,Medicine, Universidad de las Islas Baleares, Palma de Mallorca, Spain
| | - Carlo Martinoli
- DISSAL Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132, Genova, Italy.,Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy
| | - Giovanni Mauri
- Division of Interventional Radiology, European Institute of Oncology, IRCCS, Milan, Italy
| | - Catherine McCarthy
- The Nuffield Orthopaedic Centre, Oxford University Hospitals, Oxford, UK.,Oxford Musculoskeletal Radiology, Oxford, UK
| | | | - Kalliopi Melaki
- Medical School of the National and Kapodistrian University of Athens, Athens, Greece
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, 20100, Milan, Italy
| | - Rebeca Mirón Mombiela
- Department of Physiology, Universidad de Valencia/INCLIVA, Avenida Blasco Ibañez 15, 46010, Valencia, Spain.,Radiologisk Afdeling, Herlev og Gentofte Hospital, Herlev Ringvej 75, opgang 51, 2730, Herlev, Denmark
| | - Benedikt Neubauer
- Radiology, Medical University of Vienna, Vienna, Austria.,Ordensklinkum Linz, Linz, Austria
| | | | - Cyprian Olchowy
- Department of Oral Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Davide Orlandi
- Department of Radiology, Ospedale Evangelico Internazionale Genova, Genova, Italy
| | - Athena Plagou
- Department of Radiology, Private Institution of Ultrasonography, Athens, Greece
| | | | - Saulius Rutkauskas
- Institute of Sport Science and Innovation, Lithuanian Sports University, Kaunas, Lithuania
| | - Ziga Snoj
- University Medical Centre Ljubljana, Zaloška ul. 7, 1000, Ljubljana, Slovenia
| | - Alberto Stefano Tagliafico
- DISSAL Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132, Genova, Italy.,Ospedale Policlinico San Martino, Largo R. Benzi 10, 16132, Genova, Italy
| | | | - Violeta Vasilevska-Nikodinovska
- Medical Faculty, University "Ss.Cyril and Methodius", University Surgical Clinic "St.Naum Ohridski", Skopje, North Macedonia
| | - Jelena Vucetic
- Department of Radiology, General University Hospital of Valencia, Valencia, Spain.,Radiologisk Afdeling, Herlev og Gentofte Hospital, Herlev Ringvej 75, opgang 51, 2730, Herlev, Denmark
| | - David Wilson
- St Luke's Radiology Oxford Ltd, Oxford, UK.,Oxford University, Oxford, UK
| | - Federico Zaottini
- DISSAL Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132, Genova, Italy
| | - Marcello Zappia
- Department of Medicine and Health Sciences, University of Molise, Campobasso, Italy.,Varelli Institute, Naples, Italy
| | - Georgina Allen
- St Luke's Radiology Oxford Ltd, Oxford, UK.,Oxford University, Oxford, UK
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Dragoo JL, Meadows MC. The use of biologics for the elbow: a critical analysis review. J Shoulder Elbow Surg 2019; 28:2053-2060. [PMID: 31585783 DOI: 10.1016/j.jse.2019.07.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 07/28/2019] [Indexed: 02/01/2023]
Abstract
There is significant interest in biologic treatment options to improve the healing environment and more rapidly decrease symptoms in many conditions around the elbow. Despite fairly widespread use of biologic agents such as platelet-rich plasma (PRP) in the elbow, there is a lack of clear evidence in the literature to support its use. The potential impact of these biologic agents must be evaluated with evidence from high-quality studies, particularly considering the high financial burden these treatments often impose on patients. The aim of this review is to provide an evidence-based summary of the biologic augmentation options available for use by the physician treating painful conditions of the elbow and to identify areas where further research is warranted.
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Affiliation(s)
- Jason L Dragoo
- Department of Orthopaedic Surgery, University of Colorado, Denver, CO, USA.
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Abate M, Di Carlo L, Verna S, Di Gregorio P, Schiavone C, Salini V. Synergistic activity of platelet rich plasma and high volume image guided injection for patellar tendinopathy. Knee Surg Sports Traumatol Arthrosc 2018; 26:3645-3651. [PMID: 29605861 DOI: 10.1007/s00167-018-4930-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 03/26/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE Platelet rich plasma and high volume image guided injections of saline have been used in the treatment of patellar tendinopathy with positive results. As the different mechanisms of action do not interfere each other, it can be hypothesized that they can be used in combination. Aim of this study was twofold: first, to evaluate the efficacy of these two treatments in the management of patellar tendinopathy; second, to verify whether the combination of these therapies could provide further advantages. METHODS Fifty-four patients suffering from patellar tendinopathy were enrolled. After clinical (VAS and VISA-P) and sonographic evaluation, two ultrasound guided injections (2 weeks apart) of platelet rich plasma, high-volume image-guided injections of saline, or both in association were performed. The VAS and VISA-P scores obtained from the three treatments groups (18 patients in each group) were compared across the different follow-up times (3 and 6 months). RESULTS In the short term both treatments showed comparable efficacy, whereas in the medium term the positive effects of high-volume image-guided injections gradually diminished and platelet rich plasma showed greater efficacy. Better results (reduced pain, improved function and increased number of subjects who exhibited optimal recovery [> 20 points in VISA-P score]) were observed when both procedures were associated. CONCLUSIONS The contemporaneous administration of platelet rich plasma and high volume image guided injections of saline treatments, which influence tendon repair by means of different mechanisms, grants a greater improvement for patellar tendinopathy. This finding has clinical relevance, given that this condition has a substantial impact on sports and work performance. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Michele Abate
- Department of Medicine and Science of Aging, University G. d'Annunzio, Chieti-Pescara, Via dei Vestini 31, Chieti Scalo, 66013, Chieti, CH, Italy.
| | - Luigi Di Carlo
- Department of Medicine and Science of Aging, University G. d'Annunzio, Chieti-Pescara, Via dei Vestini 31, Chieti Scalo, 66013, Chieti, CH, Italy
| | - Sandra Verna
- Immunohaematology and Transfusional Medicine Service, "SS. Annunziata" Hospital, Chieti Scalo, Chieti, Italy
| | - Patrizia Di Gregorio
- Immunohaematology and Transfusional Medicine Service, "SS. Annunziata" Hospital, Chieti Scalo, Chieti, Italy
| | - Cosima Schiavone
- Department of Medicine and Science of Aging, University G. d'Annunzio, Chieti-Pescara, Via dei Vestini 31, Chieti Scalo, 66013, Chieti, CH, Italy
| | - Vincenzo Salini
- Department of Medicine and Science of Aging, University G. d'Annunzio, Chieti-Pescara, Via dei Vestini 31, Chieti Scalo, 66013, Chieti, CH, Italy
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Kwapisz A, Prabhakar S, Compagnoni R, Sibilska A, Randelli P. Platelet-Rich Plasma for Elbow Pathologies: a Descriptive Review of Current Literature. Curr Rev Musculoskelet Med 2018; 11:598-606. [PMID: 30255288 PMCID: PMC6220004 DOI: 10.1007/s12178-018-9520-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW Platelet-rich plasma is used in many orthopedic pathologies such as tendinopathies and ligament injuries. The clinical results reported in the scientific literature are, however, confusing. The aim of this manuscript is to provide a narrative literature review regarding the role of PRP in the most common elbow soft tissue pathologies. RECENT FINDINGS The response to PRP seems to be favorable when compared to steroid injection for pain management and for patient-reported outcomes in lateral epicondylitis. PRP injection does not seem to have the potential complications associated with a steroid injection such as skin atrophy, discoloration, and secondary tendon tears. Only a few manuscripts comparing the results of PRP treatment with either extracorporeal shockwave (ESW), dry needling, or even surgical treatments in lateral epicondylitis exist. The use of PRP in other elbow pathologies such as golfer's elbow, ulnar collateral ligament injury, and distal biceps and triceps pathology is examined in few studies, with unclear recommendations. Regarding elbow pathologies, PRP injections in tennis elbow seems to be the best-studied intervention. A major limitation in these studies is the significant heterogeneity in the methods used for preparing PRP, for example employing leukocyte-rich, leukocyte-poor preparations, PRP with or without activation, which makes the results of the studies difficult to compare. Results of this review show that more studies on larger cohorts, with comparable formulations, and with longer follow-up are required to give optimal suggestions concerning the use of PRP in elbow pathologies.
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Affiliation(s)
- Adam Kwapisz
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland.
| | - Sharad Prabhakar
- Department of Orthopedics Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Riccardo Compagnoni
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, UniversitàdegliStudi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- 1 Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
| | - Aleksandra Sibilska
- Clinic of Orthopedics and Pediatric Orthopedics, Medical University of Lodz, Lodz, Poland
| | - Pietro Randelli
- Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, UniversitàdegliStudi di Milano, Via Mangiagalli 31, 20133, Milan, Italy
- 1 Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Piazza Cardinal Ferrari 1, 20122, Milan, Italy
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Prodromos CC, Finkle S, Dawes A, Baik JY. Treatment of Type Two Slap Lesion With Anatomic Suture Anchor Repair Without Biceps Tenotomy Or Tenodesis. Open Orthop J 2018; 12:324-330. [PMID: 30197714 PMCID: PMC6110052 DOI: 10.2174/1874325001812010324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 04/23/2018] [Accepted: 05/24/2018] [Indexed: 01/02/2023] Open
Abstract
Background: Poor results after repair of type 2 SLAP tears are relatively common and some have reported better results after biceps tenodesis or tenotomy than repair. In addition, some believe that the long head of the biceps is expendable. Therefore, many now favor biceps tenotomy or tenodesis over biceps anchor repair either in all patients or in older patients, reserving SLAP lesion repair only for young athletes. Hypothesis: We hypothesized that repair of the biceps anchor of the labrum would be effective in all patients regardless of age provided that care was taken not to overtighten the labrum and that rotator cuff pain as the primary pain generator had been ruled out. Methods: All patients with type 2 SLAP lesion repair by the senior author since he began repairing them with suture anchors were prospectively evaluated. Patients with more than one other concomitant procedure, simultaneous rotator cuff repair or worker’s compensation status were excluded. Results: 77% of patients were available for minimum two year followup. No patient had subsequent surgery or manipulation under anesthesis as a result of their SLAP repair. Standardized shoulder test score increased by 4 points. Mean SANE score decreased from 53 pre-op to 14 post-op. Results were the same in those over versus under 40 years of age. Conclusion: Anatomic repair of Type 2 SLAP lesions at the biceps anchor without biceps tenodesis or tenotomy can produce good results in patients of all ages.
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Affiliation(s)
- Chadwick C Prodromos
- The Illinois Orthopaedic Foundation, Orthopaedic Surgery Rush University (Ret), Chicago, C.A, United States
| | - Susan Finkle
- The Illinois Orthopaedic Foundation, Orthopaedic Surgery Rush University (Ret), Chicago, C.A, United States
| | - Alexander Dawes
- The Illinois Orthopaedic Foundation, Orthopaedic Surgery Rush University (Ret), Chicago, C.A, United States
| | - Ji Young Baik
- The Illinois Orthopaedic Foundation, Orthopaedic Surgery Rush University (Ret), Chicago, C.A, United States
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Usuelli FG, Grassi M, Maccario C, Vigano' M, Lanfranchi L, Alfieri Montrasio U, de Girolamo L. Intratendinous adipose-derived stromal vascular fraction (SVF) injection provides a safe, efficacious treatment for Achilles tendinopathy: results of a randomized controlled clinical trial at a 6-month follow-up. Knee Surg Sports Traumatol Arthrosc 2018; 26:2000-2010. [PMID: 28251260 DOI: 10.1007/s00167-017-4479-9] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/13/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE Although platelet-rich plasma (PRP) injection has shown controversial results for the treatment of Achilles tendinopathy, it remains the most used biological treatment. Recent findings seem to demonstrate that the stromal vascular fraction (SVF) within adipose tissue may counteract the impaired tendon homeostasis. The aim of this study was to prospectively compare the efficacy of PRP and SVF injection for the treatment of non-insertional Achilles tendinopathy. METHODS Fourty-four patients were recruited in the study; 23 of them were assigned to the PRP group whereas 21 to the SVF group, treated unilaterally or bilaterally for a total of 28 tendons per group. All patients (age 18-55 years) were clinically assessed pre-operatively and at 15, 30, 60, 120 and 180 days from treatment, using the VAS pain scale, the VISA-A, the AOFAS Ankle-Hindfoot Score and the SF-36 form. The patients were also evaluated by ultrasound and magnetic resonance before treatment and after 4 (US only) and 6 months. RESULTS Both treatments allowed for a significant improvement with respect to baseline. Comparing the two groups, VAS, AOFAS and VISA-A scored significantly better at 15 and 30 days in the SVF in comparison to PRP group (p < 0.05). At the following time points the scores were not significantly different between the two groups. No correlation has been found between clinical and radiological findings. CONCLUSIONS Both PRP and SVF were safe, effective treatments for recalcitrant Achilles tendinopathy. The patients treated with SVF obtained faster results, thus suggesting that such a treatment should be taken into consideration for those patients who require an earlier return to daily activities or sport. LEVEL OF EVIDENCE Randomized Controlled Clinical Trial, Level 1.
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Affiliation(s)
| | - Miriam Grassi
- USPeC, Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
| | - Camilla Maccario
- CASCO Department, Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy.,Universita' degli Studi di Milano, Milano, Italy
| | - Marco Vigano'
- Orthopaedic Biotechnology Laboratory, Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
| | - Luciano Lanfranchi
- Plastic Surgery Department, Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
| | | | - Laura de Girolamo
- Orthopaedic Biotechnology Laboratory, Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milano, Italy
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Abstract
In the past 30 years, the use of ultrasonography in the field of orthopaedics has evolved. As ultrasonography has been refined, smaller machines with higher fidelity and better transducers have become available at a lower cost. Diagnostic and therapeutic applications of ultrasonography in the shoulder and elbow have expanded imaging options and provided alternatives to surgical management. Ultrasonography is a dynamic tool that affords immediate diagnostic assessment for clinical correlation and can be used for serial examinations and image guidance during therapeutic procedures. This imaging modality is highly reliable and accurate and may limit the need for costly imaging referrals, particularly in geographic areas where advanced imaging is not readily available. However, clinical expertise is paramount for ultrasonography, which is an operator-dependent modality. Ultrasonography is an effective educational resource; therefore, the curriculum in orthopaedic residency training programs should include education on this modality as the use of ultrasonography increases among orthopaedic surgeons.
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Ikpe S, Lesniak B. Biologics and Cell-Based Treatments for Upper Extremity Injuries. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.oto.2016.06.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Andia I, Maffulli N. Clinical Outcomes of Biologic Treatment for Chronic Tendinopathy. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.oto.2015.12.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Roh YH, Kim W, Park KU, Oh JH. Cytokine-release kinetics of platelet-rich plasma according to various activation protocols. Bone Joint Res 2016; 5:37-45. [PMID: 26862077 PMCID: PMC4852788 DOI: 10.1302/2046-3758.52.2000540] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objectives This study was conducted to evaluate the cytokine-release kinetics of platelet-rich plasma (PRP) according to different activation protocols. Methods Two manual preparation procedures (single-spin (SS) at 900 g for five minutes; double-spin (DS) at 900 g for five minutes and then 1500 g for 15 minutes) were performed for each of 14 healthy subjects. Both preparations were tested for platelet activation by one of three activation protocols: no activation, activation with calcium (Ca) only, or calcium with a low dose (50 IU per 1 ml PRP) of thrombin. Each preparation was divided into four aliquots and incubated for one hour, 24 hours, 72 hours, and seven days. The cytokine-release kinetics were evaluated by assessing PDGF, TGF, VEGF, FGF, IL-1, and MMP-9 concentrations with bead-based sandwich immunoassay. Results The concentration of cytokine released from PRP varied over time and was influenced by various activation protocols. Ca-only activation had a significant effect on the DS PRPs (where the VEGF, FGF, and IL-1 concentrations were sustained) while Ca/thrombin activation had effects on both SS and DS PRPs (where the PDGF and VEGF concentrations were sustained and the TGF and FGF concentrations were short). The IL-1 content showed a significant increase with Ca-only or Ca/thrombin activation while these activations did not increase the MMP-9 concentration. Conclusion The SS and DS methods differed in their effect on cytokine release, and this effect varied among the cytokines analysed. In addition, low dose of thrombin/calcium activation increased the overall cytokine release of the PRP preparations over seven days, relative to that with a calcium-only supplement or non-activation. Cite this article: Professor J. H. Oh. Cytokine-release kinetics of platelet-rich plasma according to various activation protocols. Bone Joint Res 2016;5:37–45. DOI: 10.1302/2046-3758.52.2000540
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Affiliation(s)
- Y H Roh
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
| | - W Kim
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
| | - K U Park
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
| | - J H Oh
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University School of Medicine, Incheon, Korea
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Gosens T, Funk L. Re: Ultrasound-guided platelet-rich-plasma injection for distal biceps tendinopathy. Shoulder Elbow 2015; 7:298. [PMID: 27582991 PMCID: PMC4935121 DOI: 10.1177/1758573215595955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Taco Gosens
- Department of Orthopaedic Surgery and Traumatology, St Elisabeth Hospital Tilburg, Tilburg, the Netherlands;,Taco Gosens, Department of Orthopaedic Surgery and Traumatology, St Elisabeth Hospital Tilburg, Hilvarenbeekseweg 60, P.O. Box 90151, 5000 LC, Tilburg, the Netherlands. Tel: +31 13 5392942
| | - Len Funk
- Department of Orthopaedic Surgery and Traumatology, Wrightington Hospital, Wigan, UK
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