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Karami P, Laurent A, Philippe V, Applegate LA, Pioletti DP, Martin R. Cartilage Repair: Promise of Adhesive Orthopedic Hydrogels. Int J Mol Sci 2024; 25:9984. [PMID: 39337473 PMCID: PMC11432485 DOI: 10.3390/ijms25189984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 09/09/2024] [Accepted: 09/13/2024] [Indexed: 09/30/2024] Open
Abstract
Cartilage repair remains a major challenge in human orthopedic medicine, necessitating the application of innovative strategies to overcome existing technical and clinical limitations. Adhesive hydrogels have emerged as promising candidates for cartilage repair promotion and tissue engineering, offering key advantages such as enhanced tissue integration and therapeutic potential. This comprehensive review navigates the landscape of adhesive hydrogels in cartilage repair, discussing identified challenges, shortcomings of current treatment options, and unique advantages of adhesive hydrogel products and scaffolds. While emphasizing the critical need for in situ lateral integration with surrounding tissues, we dissect current limitations and outline future perspectives for hydrogel scaffolds in cartilage repair. Moreover, we examine the clinical translation pathway and regulatory considerations specific to adhesive hydrogels. Overall, this review synthesizes the existing insights and knowledge gaps and highlights directions for future research regarding adhesive hydrogel-based devices in advancing cartilage tissue engineering.
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Affiliation(s)
- Peyman Karami
- Department of Orthopedic Surgery and Traumatology, University Hospital of Lausanne, CH-1011 Lausanne, Switzerland
- Laboratory of Biomechanical Orthopaedics, Institute of Bioengineering, School of Engineering, EPFL, CH-1015 Lausanne, Switzerland
| | - Alexis Laurent
- Manufacturing Department, LAM Biotechnologies SA, CH-1066 Epalinges, Switzerland
- Regenerative Therapy Unit, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland
| | - Virginie Philippe
- Department of Orthopedic Surgery and Traumatology, University Hospital of Lausanne, CH-1011 Lausanne, Switzerland
- Regenerative Therapy Unit, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland
| | - Lee Ann Applegate
- Regenerative Therapy Unit, Reconstructive and Hand Surgery Service, Lausanne University Hospital, University of Lausanne, CH-1066 Epalinges, Switzerland
- Center for Applied Biotechnology and Molecular Medicine, University of Zurich, CH-8057 Zurich, Switzerland
- Oxford OSCAR Suzhou Center, Oxford University, Suzhou 215123, China
| | - Dominique P Pioletti
- Laboratory of Biomechanical Orthopaedics, Institute of Bioengineering, School of Engineering, EPFL, CH-1015 Lausanne, Switzerland
| | - Robin Martin
- Department of Orthopedic Surgery and Traumatology, University Hospital of Lausanne, CH-1011 Lausanne, Switzerland
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Wu H, Shang Y, Sun W, Ouyang X, Zhou W, Lu J, Yang S, Wei W, Yao X, Wang X, Zhang X, Chen Y, He Q, Yang Z, Ouyang H. Seamless and early gap healing of osteochondral defects by autologous mosaicplasty combined with bioactive supramolecular nanofiber-enabled gelatin methacryloyl (BSN-GelMA) hydrogel. Bioact Mater 2023; 19:88-102. [PMID: 35441114 PMCID: PMC9005961 DOI: 10.1016/j.bioactmat.2022.03.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/04/2022] [Accepted: 03/25/2022] [Indexed: 12/02/2022] Open
Abstract
Autologous mosaicplasty is a common approach used to treat osteochondral defects in clinical practice. Gap integration between host and transplanted plugs requires bone tissue reservation and hyaline cartilage regeneration without uneven surface, graft necrosis and sclerosis. However, poor gap integration is a serious concern, which eventually leads to deterioration of joint function. To deal with such complications, this study has developed a strategy to effectively enhance integration of the gap region following mosaicplasty by applying injectable bioactive supramolecular nanofiber-enabled gelatin methacryloyl (GelMA) hydrogel (BSN-GelMA). A rabbit osteochondral defect model demonstrated that BSN-GelMA achieved seamless osteochondral healing in the gap region between plugs of osteochondral defects following mosaicplasty, as early as six weeks. Moreover, the International Cartilage Repair Society score, histology score, glycosaminoglycan content, subchondral bone volume, and collagen II expression were observed to be the highest in the gap region of BSN-GelMA treated group. This improved outcome was due to bio-interactive materials, which acted as tissue fillers to bridge the gap, prevent cartilage degeneration, and promote graft survival and migration of bone marrow mesenchymal stem cells by releasing bioactive supramolecular nanofibers from the GelMA hydrogel. This study provides a powerful and applicable approach to improve gap integration after autologous mosaicplasty. It is also a promising off-the-shelf bioactive material for cell-free in situ tissue regeneration. A novel strategy that can effectively enhance post-mosaicplasty interstitial integration was developed. The bioactive supramolecular nanofibers (BSN) exhibited comparable bioactivity to insulin-like growth factor-1 (IGF-1). The BSN-GelMA hydrogel is a promising off-the-shelf bioactive material for cell-free in situ tissue regeneration.
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Szponder T, Latalski M, Danielewicz A, Krać K, Kozera A, Drzewiecka B, Nguyen Ngoc D, Dobko D, Wessely-Szponder J. Osteoarthritis: Pathogenesis, Animal Models, and New Regenerative Therapies. J Clin Med 2022; 12:jcm12010005. [PMID: 36614806 PMCID: PMC9821671 DOI: 10.3390/jcm12010005] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/14/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
Osteoarthritis (OA) is a chronic, progressive, multifactorial disease resulting in a progressive loss of articular cartilage structure and function that is most common in middle-aged and older patients. OA is involved in the loss of extracellular matrix and cartilage as well as cell number decreases within the matrix, especially in the further stages of the disease. The immune system plays a pivotal role in the pathomechanism of this condition. Both humoral and cellular mediators contribute to cartilage destruction, abnormal bone remodeling, synovitis, and joint effusion. The increasing prevalence of this disease has led to a growing interest in using animal models as the primary way to broaden the knowledge of the pathogenesis of OA and possible therapies at each stage of disease development. This review aims to describe the signs, pathogenesis, and classification of OA as well as discuss the advantages and disadvantages of some animal models. The currently used treatment methods include mesenchymal stem cells, exosomes, gene therapies, and blood-derived products. In addition, exogenous growth factors, platelet-rich plasma (PRP), platelet lysate, and autologous conditioned serum (ACS) are discussed with the application of tissue engineering techniques and biomaterials.
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Affiliation(s)
- Tomasz Szponder
- Department and Clinic of Animal Surgery, Faculty of Veterinary Medicine, University of Life Sciences, 20-612 Lublin, Poland
| | - Michał Latalski
- Children’s Orthopaedic Department, Medical University of Lublin, 20-093 Lublin, Poland
| | - Anna Danielewicz
- Children’s Orthopaedic Department, Medical University of Lublin, 20-093 Lublin, Poland
| | - Katarzyna Krać
- Students Research Group of Veterinary Analysts, Sub-Department of Pathophysiology, Department of Preclinical Veterinary Sciences, University of Life Sciences, 20-033 Lublin, Poland
| | - Aleksandra Kozera
- Students Research Group of Veterinary Analysts, Sub-Department of Pathophysiology, Department of Preclinical Veterinary Sciences, University of Life Sciences, 20-033 Lublin, Poland
| | - Beata Drzewiecka
- Sub-Department of Pathophysiology, Department of Preclinical Veterinary Sciences, Faculty of Veterinary Medicine, University of Life Sciences, 20-033 Lublin, Poland
| | - Dominika Nguyen Ngoc
- Sub-Department of Pathophysiology, Department of Preclinical Veterinary Sciences, Faculty of Veterinary Medicine, University of Life Sciences, 20-033 Lublin, Poland
| | - Dominika Dobko
- Students Research Group of Veterinary Analysts, Sub-Department of Pathophysiology, Department of Preclinical Veterinary Sciences, University of Life Sciences, 20-033 Lublin, Poland
| | - Joanna Wessely-Szponder
- Sub-Department of Pathophysiology, Department of Preclinical Veterinary Sciences, Faculty of Veterinary Medicine, University of Life Sciences, 20-033 Lublin, Poland
- Correspondence:
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Chona DV, Kha ST, Minetos PD, LaPrade CM, Chu CR, Abrams GD, Safran MR, Sherman SL. Biologic Augmentation for the Operative Treatment of Osteochondral Defects of the Knee: A Systematic Review. Orthop J Sports Med 2021; 9:23259671211049756. [PMID: 34778474 PMCID: PMC8573505 DOI: 10.1177/23259671211049756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Various surgical treatment options exist for repairing, replacing, or regenerating tissue to fill osteochondral defects. Biologic augmentation has been increasingly studied as an adjunct in the surgical treatment of osteochondral defects of the knee in animal and human models. Purpose/Hypothesis: The purpose of the study was to systematically review use of platelet-rich plasma (PRP) and bone marrow concentrate (BMC) augmentation in the surgical treatment of osteochondral knee defects and to describe the outcomes. It was hypothesized that both PRP and BMC augmentation will result in improved outcomes in osteochondral knee surgery in both animal and human models. Study Design: Systematic review. Methods: PubMed, MEDLINE, and Embase were searched for studies relating to PRP or BMC and treatment of osteochondral defects of the knee, from database inception to February 1, 2020. Included were articles that (1) studied PRP or BMC augmentation; (2) used osteochondral autograft, allograft, or biologic scaffold; and (3) treated osteochondral defects in the knee. Data on use of PRP or BMC, outcomes assessed, and results were recorded for each publication. Results: Of the 541 articles identified initially, 17 were included in the final review. Five articles studied osteochondral grafts in animals, 5 studied biologic scaffolds in animals, and 7 studied scaffolds or allografts in humans; the combined sample size was 202 patients. Of 4 histologic scaffold studies, 3 PRP-augmented scaffold studies identified histologic improvements in regenerated cartilage in animal models, while 1 BMC study demonstrated similar improvement in histologic scores of BMC-augmented scaffolds compared with controls. Three studies associated greater collagen type 2 and glycosaminoglycan content with PRP treatment. Comparative studies found that both augments increase osteogenic proteins, including bone morphogenetic protein–2 and osteoprotegerin. Two of 3 studies on BMC-augmented osteochondral allografts reported no difference in radiographic features postoperatively. Long-term improvement in clinical and radiographic outcomes of PRP-augmented scaffolds was demonstrated in 1 human study. Conclusion: Animal studies suggest that biologics possess potential as adjuncts to surgical treatment of osteochondral knee defects; however, clinical data remain limited.
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Affiliation(s)
- Deepak V Chona
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Stephanie T Kha
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Paul D Minetos
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Christopher M LaPrade
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Constance R Chu
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Geoffrey D Abrams
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
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Field LD. Editorial Commentary: Elbow Lateral Epicondylitis Treatment Using Platelet-Rich Plasma. Arthroscopy 2021; 37:3368-3370. [PMID: 34740411 DOI: 10.1016/j.arthro.2021.05.048] [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: 05/12/2021] [Accepted: 05/16/2021] [Indexed: 02/02/2023]
Abstract
The best treatment for elbow lateral epicondylitis is controversial. Multiple treatment interventions are used commonly, including physical therapy, corticosteroid injections, nonsteroidal anti-inflammatory drugs, bracing, acupuncture, ultrasound-guided percutaneous tenotomy, open or arthroscopic surgical debridement, and recently, platelet-rich plasma (PRP) or autologous blood injections. Patients in whom more traditional conservative measures have failed may benefit from PRP injections, although long-term outcomes after such injections are unclear. The complication rates of PRP injections are low. One PRP injection, if successful, could be a cost-effective alternative to surgery, but multiple injections are often recommended and third-party payers have historically rarely paid those medical claims, thus placing an increased financial burden on the patient.
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6
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Fletcher AN, Johnson AH. Biologic Adjuvants for Foot and Ankle Conditions. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Romano AM, Edwards TB, Nastrucci G, Casillo P, Di Giunta A, Zappia M, Susanna M, Ascione F. Arthroscopic reduction and subscapularis remplissage (ARR) of chronic posterior locked shoulder dislocation leads to optimized outcomes and low rate of complications. Knee Surg Sports Traumatol Arthrosc 2021; 29:2348-2355. [PMID: 33074421 DOI: 10.1007/s00167-020-06317-6] [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: 05/04/2020] [Accepted: 10/02/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Unrecognized posterior shoulder dislocation with a concomitant humeral head fracture affects joint function and no consensus exists regarding treatment. The present study analyses clinical and radiographic outcomes of a novel arthroscopic technique for reducing chronic locked posterior shoulder dislocation associated with subscapularis remplissage. METHODS The study comprises a retrospective analysis of consecutive chronic posterior locked shoulders (CPLS) with minimum 2-years follow-up of patients who had undergone McLaughlin technique arthroscopic modification for the treatment of CPLS with a reverse Hill-Sachs lesion. Active range of motion (ROM), Western Ontario (WOSI) and Constant Score (CS), were evaluated pre- and postoperatively. Plain radiographs and magnetic resonance imaging (MRI) scans were collected pre- and post-operatively, recording bone defect, osteoarthritis, cuff integrity/fatty infiltration, and the grade of filling of the reverse Hill-Sachs. RESULTS Twelve male patients with a mean follow-up of 37.3 months ± 10.5 (range, 24-58) were included. Mean WOSI and CS scores improved from 41 to 92 and 28 to 94 points, respectively. ROM measurements all had significantly increased at final follow-up, with no significant differences in arm rotation. No defects were left unfilled at final MRI examination. CONCLUSION The results of this uncontrolled study with a limited number of patients confirm that arthroscopic reduction and subscapularis remplissage is a highly effective and satisfactory treatment method resulting in no shoulder rotation deficits. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Alfonso M Romano
- Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy.,Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via A. Manzoni 220, 80123, Napoli, Italy
| | - T Bradley Edwards
- Fondren Orthopedic Group, Texas Orthopedic Hospital, Houston, TX, USA
| | | | - Pasquale Casillo
- Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy
| | - Angelo Di Giunta
- Orthopaedic Division of Policlinico 'G.B. Morgagni', Catania, Italy
| | - Marcello Zappia
- Department of Medicine and Health Sciences, Università del Molise, Campobasso, Italy
| | | | - Francesco Ascione
- Orthopedics and Sport Medicine Unit, Campolongo Hospital, Salerno, Italy. .,Department of Orthopaedic and Trauma Surgery, Ospedale Buon Consiglio Fatebenefratelli, Via A. Manzoni 220, 80123, Napoli, Italy.
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Berney M, McCarroll P, Glynn L, Lenehan B. Platelet-rich plasma injections for hip osteoarthritis: a review of the evidence. Ir J Med Sci 2020; 190:1021-1025. [PMID: 33015749 DOI: 10.1007/s11845-020-02388-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/23/2020] [Indexed: 12/26/2022]
Abstract
Osteoarthritis is a significant cause of chronic pain in the elderly population with hip osteoarthritis as one of the main causes of functional disability and joint pain in adults older than 55 years. Recently, platelet rich plasma (PRP) injections have been introduced for treatment of osteoarthritis. The aim of this systematic review is to assess its effectiveness in the management of hip osteoarthritis. We performed a search of the literature for published prospective studies that assessed the effectiveness of PRP injections in the treatment of hip osteoarthritis, with a minimum follow-up of 3 months. Primary outcome measures were WOMAC and VAS scores. Five trials were identified with 185 patients undergoing treatment with ultrasound-guided intra-articular injections of PRP, compared with patients treated with hyaluronic acid alone (n = 148) or hyaluronic acid combined with PRP (n = 31) in one study. PRP was shown to improve patient outcome scores at follow-up at 6 and 12 months; however, there was no significant difference seen between patients treated with PRP or hyaluronic acid alone. Following this systematic review, we cannot currently recommend the use of intra-articular injections of PRP for the treatment of hip OA. Given that intra-articular steroid injections are the only such injection recommended by international guidelines for the treatment of hip OA, further studies comparing PRP to steroid would be of benefit to determine the value of PRP injections in hip OA.
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Affiliation(s)
- Mark Berney
- University Hospital Limerick, Limerick, Ireland.
| | | | - Liam Glynn
- University Limerick Graduate Entry Medical School, Limerick, Ireland
| | - Brian Lenehan
- University Hospital Limerick, Limerick, Ireland.,University Limerick Graduate Entry Medical School, Limerick, Ireland
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Mickevicius T, Pockevicius A, Kucinskas A, Gudas R, Maciulaitis J, Usas A. Nondestructive Assessment of Articular Cartilage Electromechanical Properties after Osteochondral Autologous and Allogeneic Transplantation in a Goat Model. Cartilage 2020; 11:348-357. [PMID: 29998744 PMCID: PMC7298600 DOI: 10.1177/1947603518786543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To determine the applicability of a minimally invasive diagnostic device to evaluate the quality of articular cartilage following autologous (OAT) and allogeneic (OCA) osteochondral graft transplantation in goat model. DESIGN OAT grafts were harvested from lateral femoral condyles (LFCs) and transplanted into osteochondral defects created in medial femoral condyles (MFCs) of contralateral knees. OCA grafts were transplanted into MFC condyles after in vitro storage. Autologous platelet-rich plasma (PRP) was administered intraarticularly after the surgery and at 1 and 2 months postoperatively. OAT and OCA grafts were evaluated macroscopically (Oswestry arthroscopy score [OAS]), electromechanically (quantitative parameter, QP), and histologically (O'Driscoll score, safranin O staining intensity) at 3 and 6 months after transplantation. Results were compared with preoperative graft evaluation. RESULTS Transplanted cartilage deteriorated within 6 months in all groups. Cartilage quality was better retained in OAT group compared with a decline in OCA group. QP and OAS scores were comparable in OAT and OCA groups at 3 months, but superior in OAT group at 6 months, according to all the methods applied. PRP injections significantly improved QP and OAS score at 6 months compared with 3 months in OAT group. QP moderately correlated with OAS, O'Driscoll score, and safranin O staining intensity. CONCLUSIONS Grafts did not retain preoperative quality parameters at 6 months follow-up; however, OAT were superior to OCA grafts. PRP may have a beneficial effect on macroscopic and electromechanical properties of cartilage; however, histological improvement is yet to be proved. Electromechanical diagnostic device enables reliable assessment of transplanted cartilage.
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Affiliation(s)
- Tomas Mickevicius
- Department of Orthopaedics and
Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics,
Kaunas, Lithuania
| | - Alius Pockevicius
- Pathology Center, Department of
Veterinary Pathobiology, Veterinary Academy, Lithuanian University of Health
Sciences, Kaunas, Lithuania
| | - Audrius Kucinskas
- Biological Research Center Lithuanian
University of Health Sciences, Kaunas, Lithuania
| | - Rimtautas Gudas
- Department of Orthopaedics and
Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics,
Kaunas, Lithuania,Institute of Sports, Lithuanian
University of Health Sciences, Kaunas, Lithuania
| | - Justinas Maciulaitis
- Department of Orthopaedics and
Traumatology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics,
Kaunas, Lithuania,Institute of Sports, Lithuanian
University of Health Sciences, Kaunas, Lithuania
| | - Arvydas Usas
- Institute of Physiology and
Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania,Arvydas Usas, Institute of Physiology and
Pharmacology, Lithuanian University of Health Sciences, Mickeviciaus 9, Kaunas,
LT-44307, Lithuania.
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Scognamiglio F, Travan A, Borgogna M, Donati I, Marsich E. Development of biodegradable membranes for the delivery of a bioactive chitosan‐derivative on cartilage defects: A preliminary investigation. J Biomed Mater Res A 2020; 108:1534-1545. [DOI: 10.1002/jbm.a.36924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 03/02/2020] [Accepted: 03/09/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Francesca Scognamiglio
- Department of Life SciencesUniversity of Trieste Trieste Italy
- Department of Medical, Surgical and Health SciencesUniversity of Trieste Trieste Italy
| | | | | | - Ivan Donati
- Department of Life SciencesUniversity of Trieste Trieste Italy
| | - Eleonora Marsich
- Department of Medical, Surgical and Health SciencesUniversity of Trieste Trieste Italy
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Yausep OE, Madhi I, Trigkilidas D. Platelet rich plasma for treatment of osteochondral lesions of the talus: A systematic review of clinical trials. J Orthop 2020; 18:218-225. [PMID: 32071508 PMCID: PMC7013135 DOI: 10.1016/j.jor.2020.01.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/26/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The ankle is the second most frequent site, following the knee, that requires cartilage repair. Osteochondral lesion of the talus (OLT) is common among athletes and is a result of talar cartilage detachment with or without subchondral bone fragmentation after a traumatic event. Treatment strategies for OLT can be classified as reparative or replacement interventions, with the former taking precedence. Recent studies show that the growth factors and bioactive components in platelet rich plasma (PRP) could improve cartilage regeneration. The prospect of using autologous blood to obtain a product that could enhance regeneration in damaged cartilage has been regarded as innovative, as it could circumvent the need for a replacement, and potentially join the ranks of first line reparative interventions against cartilage diseases. METHODS Literature searches were performed across seven search engines for randomized controlled trials using PRP to treat patients with OLT. Outcomes extracted included ankle function and pain measures. Level of evidence and methodological quality were evaluated using relevant guidelines. RESULTS Four studies met the eligibility criteria and were systematically appraised. Two studies scored Level 1 and 2 scored Level 2 based on the LOE assessment. MQOE evaluation revealed one study with excellent quality, and three with good quality. Overall results showed that PRP, as an adjunct to microfracture surgery, significantly improved function and reduced pain compared to microfracture surgery alone. Intra-articular PRP injection also demonstrated significantly enhanced recovery of function, and decreased pain scores compared to HA. CONCLUSION PRP improves joint function, and reduces pain in patients with OLT regardless of the method of implementation. In addition, inter-study comparison demonstrated that patients that received surgery along with PRP injections improved more than those that received PRP only. The studies that corroborate this conclusion have high levels of evidence with satisfactory methodological quality. LEVEL OF EVIDENCE Level 2, systematic review of Level 1 and 2 studies.
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Affiliation(s)
| | - Imad Madhi
- Orthopedic Division, South Tyneside District Hospital, South Shields, United Kingdom
| | - Dionysios Trigkilidas
- Orthopedic Division, South Tyneside District Hospital, South Shields, United Kingdom
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12
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Wessely-Szponder J, Michalska J, Szponder T, Żylińska B, Tarczyńska M, Szubstarski M. The Role of Antimicrobial Neutrophil Extract in Modification of the Inflammatory Response During Osteochondral Autograft and Allograft Transplantation in Rabbits. J Comp Pathol 2020; 175:49-63. [PMID: 32138842 DOI: 10.1016/j.jcpa.2019.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 12/21/2019] [Indexed: 01/05/2023]
Abstract
Osteochondral autograft or allograft transplantation is one of the surgical options for the management of large cartilage defects; however, the mechanisms of cartilage healing after this procedure, especially the immunological mechanisms, are not fully understood. The present study examined whether a grafting procedure changed the in-vitro responses of neutrophils and monocyte-derived macrophages (MDMs). Additionally, antimicrobial neutrophil extract (ANE) was assessed for its ability to modulate excessive cellular responses during and after implantation. The neutrophil secretory response was tested by measuring enzyme release and free radical generation, while the MDM response was evaluated by assessing morphological and functional changes of the cells after polarization. Osteochondral implantation evoked a transient secretory response by circulating neutrophils, but MDMs were not activated postoperatively. ANE from rabbit blood may be considered as a modulator of the inflammatory response because of its influence on neutrophils and MDMs. Inhibition of the neutrophil secretory response prevents complications that may arise following excessive activity of these cells. Stimulation of MDMs with ANE induces formation of a partial anti-inflammatory phenotype with enhanced regenerative properties.
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Affiliation(s)
- J Wessely-Szponder
- Sub-Department of Pathophysiology, Department of Preclinical Veterinary Sciences, University of Life Sciences, Lublin, Poland
| | - J Michalska
- Sub-Department of Pathophysiology, Department of Preclinical Veterinary Sciences, University of Life Sciences, Lublin, Poland.
| | - T Szponder
- Department and Clinic of Animal Surgery, Faculty of Veterinary Medicine, University of Life Sciences, Lublin, Poland
| | - B Żylińska
- Department and Clinic of Animal Surgery, Faculty of Veterinary Medicine, University of Life Sciences, Lublin, Poland
| | - M Tarczyńska
- Department of Orthopaedics and Traumatology, Medical University of Lublin, Lublin, Poland
| | - M Szubstarski
- Department of Orthopaedics and Traumatology, Medical University of Lublin, Lublin, Poland
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Abstract
Hyaline articular cartilage is critical for the normal functioning of the knee joint. Untreated focal cartilage defects have the potential to rapidly progress to diffuse osteoarthritis. Over the last several decades, a variety of interventions aiming at preserving articular cartilage and preventing osteoarthritis have been investigated. Reparative cartilage procedures, such as microfracture, penetrate the subchondral bone plate in effort to fill focal cartilage defects with marrow elements and stimulate fibrocartilaginous repair. In contrast, restorative cartilage procedures aim to replace the defective articular surface with autologous or allogeneic hyaline cartilage. This review focuses on the preservation of articular cartilage, and discusses the current reparative and restorative surgical techniques available for treating focal cartilage defects.
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14
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Smyth NA, Ross KA, Haleem AM, Hannon CP, Murawski CD, Do HT, Kennedy JG. Platelet-Rich Plasma and Hyaluronic Acid Are Not Synergistic When Used as Biological Adjuncts with Autologous Osteochondral Transplantation. Cartilage 2018; 9:321-328. [PMID: 29156980 PMCID: PMC6042028 DOI: 10.1177/1947603517690022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
UNLABELLED Introduction Autologous osteochondral transplantation (AOT) is a treatment for osteochondral lesions with known concerns, including histological degradation of the graft and poor cartilage integration. Platelet-rich plasma (PRP) and hyaluronic acid (HA) have been described has having the potential to improve results. The aim of this study was to evaluate the effect of PRP and HA on AOT in a rabbit model. Methods Thirty-six rabbits underwent bilateral knee AOT treated with either the biological adjunct (PRP, n = 12; HA, n = 12; PRP + HA, n = 12) or saline (control). PRP and HA were administered as an intra-articular injection. The rabbits were euthanized at 3, 6, or 12 weeks postoperatively. The graft sections were assessed using the modified International Cartilage Repair Society (ICRS) scoring system. The results from the PRP alone group is from previously published data. Results The mean modified ICRS histological score for the PRP-treated group was higher than its control ( P = 0.002). The mean modified ICRS histological score for the HA-treated group showed no difference compared with its control ( P = 0.142). The mean modified ICRS histological score for the PRP + HA-treated group was higher than its control ( P = 0.006). There was no difference between the mean modified ICRS scores of the PRP- and the PRP + HA-treated grafts ( P = 0.445). Conclusion PRP may decrease graft degradation and improve chondral integration in an animal model. In this model, the addition of HA was not synergistic for the parameters assessed. LEVEL OF EVIDENCE Basic science, Level V. CLINICAL RELEVANCE PRP can be used as an adjunct to AOT, which may decrease graft degeneration and improve clinical outcomes. HA may not influence AOT.
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Affiliation(s)
- Niall A. Smyth
- University of Miami Miller School of Medicine, Miami, FL, USA,Niall A. Smyth, University of Miami Miller School of Medicine, 1611 NW 12th Avenue, Miami, FL 33136, USA.
| | - Keir A. Ross
- University of Maryland School of Medicine, New York, NY, USA
| | - Amgad M. Haleem
- University of Oklahoma School of Medicine, New York, NY, USA
| | | | | | - Huong T. Do
- Hospital for Special Surgery, New York, NY, USA
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da Silva Morais A, Oliveira JM, Reis RL. Small Animal Models. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1059:423-439. [DOI: 10.1007/978-3-319-76735-2_19] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Abstract
UNLABELLED Osteochondral lesions remain as a clinical challenge despite the advances in orthopedic regenerative strategies. Biologics, in particular, platelet-rich plasma, has been applied for the reparative and regenerative effect in many tissues, and osteochondral tissue is not an exception. Platelet-rich plasma is an autologous concentrate prepared from the collected blood; thus, this safe application is free of immune response or risk of transmission of disease. It has a high potential to promote regeneration, thanks to its content, and can be applied alone or can reinforce a tissue engineering strategy. The relevant works making use of platelet-rich plasma in osteochondral lesions are overviewed herein. The practical success of platelet-rich plasma is uncertain since there are many factors involved including but not limited to its preparation and administration method. Nevertheless, today, the issues and challenges of platelet-rich plasma have been well acknowledged by researchers and clinicians. Thus, it is believed that a consensus will be built it, and then with high-quality randomized controlled trials and standardized protocols, the efficacy of platelet-rich plasma therapy can be better evaluated. HIGHLIGHTS The need of treating the osteochondral lesions has not been yet met in the clinics. Thanks to being an autologous source of growth factors, interleukins, and other cytokines and relative ease of clinical application, i.e., during a single-step surgical procedure, the use of platelet-rich plasma is of great interest. The high theoretical potential of the role of platelet-rich plasma in the regeneration process of osteochondral lesions is known, and the efficiency needs to be confirmed by high-quality randomized controlled trials for a robust position in the treatments of osteochondral lesions in the clinics.
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Maruyama M, Satake H, Suzuki T, Honma R, Naganuma Y, Takakubo Y, Takagi M. Comparison of the Effects of Osteochondral Autograft Transplantation With Platelet-Rich Plasma or Platelet-Rich Fibrin on Osteochondral Defects in a Rabbit Model. Am J Sports Med 2017; 45:3280-3288. [PMID: 28853913 DOI: 10.1177/0363546517721188] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although osteochondral autograft transplantation (OAT) provides satisfactory outcomes for osteochondral defects, for large defects OAT is often inadequate because of graft availability. Osteochondral allograft transplantation is an alternative treatment for large defects, but this approach is limited by graft storage constraints and carries disease transmission risks. Platelet-rich fibrin (PRF) is a second-generation platelet concentrate, and its positive effect on articular cartilage has been reported. However, the effect of PRF with OAT of osteochondral defects is unknown. PURPOSE To compare the effects of OAT with platelet-rich plasma (PRP) and PRF on osteochondral defects in a rabbit model. STUDY DESIGN Controlled laboratory study. METHODS Forty-two juvenile rabbits were divided into control, PRP, and PRF groups. In the control and PRP groups, a cylindrical osteochondral defect (5 mm in diameter and 2 mm in depth) was created on the patellar groove, and an osteochondral graft (3.5 mm in diameter and 5 mm in length) harvested from the contralateral side was inserted into the distal portion of the defect. After wound closure, either normal saline or PRP was injected in the knee. In the PRF group, a PRF clot was placed in the defect before grafting. The surgical site was macroscopically and histologically assessed after 3 and 12 weeks. RESULTS At 3 weeks, the PRF group (n = 8) was macroscopically healed compared with the other 2 groups (control, n = 7; PRP, n = 6) ( P < .005). Histologically, osteochondral graft cartilage of the PRF group had normal cellularity and higher amounts of safranin O staining relative to the other 2 groups ( P < .005). At 12 weeks, all 3 groups (n = 8 per group) were macroscopically healed with normal or nearly normal cartilage, and osteochondral graft cartilage was histologically hyaline cartilage. In contrast, the PRF group healed with hyaline-like cartilage at nongrafted defects, whereas the other 2 groups healed with fibrocartilage ( P < .001). CONCLUSION OAT with PRF maintained hyaline cartilage, and the nongrafted defect healed with hyaline-like cartilage. CLINICAL RELEVANCE PRF has the potential to improve clinical outcomes of OAT used to treat osteochondral lesions.
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Affiliation(s)
- Masahiro Maruyama
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Hiroshi Satake
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Tomoto Suzuki
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Ryusuke Honma
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yasushi Naganuma
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Yuya Takakubo
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
| | - Michiaki Takagi
- Department of Orthopaedic Surgery, Yamagata University Faculty of Medicine, Yamagata, Japan
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Field LD. Editorial Commentary: The Needle or the Knife? Platelet-Rich Plasma Versus Surgery for Lateral Epicondylitis. Arthroscopy 2017; 33:1330-1331. [PMID: 28669470 DOI: 10.1016/j.arthro.2017.03.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 02/02/2023]
Abstract
The most efficacious treatment for patients with lateral epicondylitis who have not adequately improved despite being treated for extended periods with commonly used nonoperative measures is controversial. Are locally applied platelet-rich plasma (PRP) injections more effective than a surgical procedure, such as arthroscopic lateral epicondylitis debridement, in reducing symptoms for such patients? Level II evidence shows that long-term clinical benefits are much less likely to occur in patients receiving PRP injections. Moreover, in patients treated with PRP injection, progressively worsening pain is more likely to develop during activity at 1 and 2 years of follow-up in contradistinction to arthroscopically managed patients.
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Management of Hepple Stage V Osteochondral Lesion of the Talus with a Platelet-Rich Plasma Scaffold. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6525373. [PMID: 28401159 PMCID: PMC5376404 DOI: 10.1155/2017/6525373] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2016] [Accepted: 03/08/2017] [Indexed: 12/14/2022]
Abstract
There has been no consensus on the treatment or prognosis of Hepple stage V osteochondral lesions of the talus (OLTs), especially for lesions greater than 1.5 cm2 in size. The objective of this study was to investigate the clinical outcomes achieved upon application of a platelet-rich plasma (PRP) scaffold with a cancellous bone autograft for Hepple stage V OLTs. Fourteen patients (mean age, 39 years) were treated with a cancellous bone graft and a PRP scaffold between 2013 and 2015. The mean time to surgical treatment was 23.5 months. Ankle X-ray and magnetic resonance imaging were performed at the final follow-up. Functional outcomes were evaluated according to the Visual Analog Scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Short Form 36 (SF-36) score. The range of motion (ROM) of the ankle joint and complications also were recorded. Thirteen patients completed the full follow-up, with a mean follow-up duration of 18 months. MRI demonstrated the complete regeneration of subchondral bone and cartilage in all patients. The postoperative VAS, AOFAS ankle and hindfoot, and SF-36 scores were improved significantly (all P < 0.001) without obvious complications. We suggest that, for the Hepple stage V OLTs, management with cancellous bone graft and PRP scaffold may be a safe and effective treatment.
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Boakye LA, Ross KA, Pinski JM, Smyth NA, Haleem AM, Hannon CP, Fortier LA, Kennedy JG. Platelet-rich plasma increases transforming growth factor-beta1 expression at graft-host interface following autologous osteochondral transplantation in a rabbit model. World J Orthop 2015; 6:961-969. [PMID: 26716092 PMCID: PMC4686443 DOI: 10.5312/wjo.v6.i11.961] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/09/2015] [Accepted: 10/08/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the effect of platelet-rich plasma on protein expression patterns of transforming growth factor-beta1 (TGF-β1) in cartilage following autologous osteochondral transplantation (AOT) in a rabbit knee cartilage defect model.
METHODS: Twelve New Zealand white rabbits received bilateral AOT. In each rabbit, one knee was randomized to receive an autologous platelet rich plasma (PRP) injection and the contralateral knee received saline injection. Rabbits were euthanized at 3, 6 and 12 wk post-operatively. Articular cartilage sections were stained with TGF-β1 antibody. Histological regions of interest (ROI) (left, right and center of the autologous grafts interfaces) were evaluated using MetaMorph. Percentage of chondrocytes positive for TGF-β1 was then assessed.
RESULTS: Percentage of chondrocytes positive for TGF-β1 was higher in PRP treated knees for selected ROIs (left; P = 0.03, center; P = 0.05) compared to control and was also higher in the PRP group at each post-operative time point (P = 6.6 × 10-4, 3.1 × 10-4 and 7.3 × 10-3 for 3, 6 and 12 wk, respectively). TGF-β1 expression was higher in chondrocytes of PRP-treated knees (36% ± 29% vs 15% ± 18%) (P = 1.8 × 10-6) overall for each post-operative time point and ROI.
CONCLUSION: Articular cartilage of rabbits treated with AOT and PRP exhibit increased TGF-β1 expression compared to those treated with AOT and saline. Our findings suggest that adjunctive PRP may increase TGF-β1 expression, which may play a role in the chondrogenic effect of PRP in vivo.
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Samy AM. The role of platelet rich plasma in management of fracture neck femur: new insights. INTERNATIONAL ORTHOPAEDICS 2015; 40:1019-24. [PMID: 26156712 DOI: 10.1007/s00264-015-2844-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/31/2015] [Indexed: 01/21/2023]
Abstract
PURPOSE The aim of this study is evaluation of the efficacy of the use of platelet rich plasma (PRP) in management of femoral neck fractures. MATERIALS AND METHODS This is a prospective study that was conducted between February 2010 and March 2013. A total of 60 patients were included in this study, categorized randomly into two groups. Group A included fracture neck femur treated by closed reduction and internal fixation with three cannulated screws and group B by addition of PRP to internal fixation. We planned to compare time of healing, need for revision and incidence of complications between the two groups. RESULTS Union occurred in 53 patients (88.33 %) in both groups, 25 cases (83.3 %) in group A and 28 cases (93.3 %) in group B, including three cases (5 %) with avascular necrosis (AVN): two in group A (6.7 %) and one case in group B (3.3 %).Revision surgery was done for six cases (20 %) in group A and for two cases (6.7 %) in group B. In both groups, all united cases had good to excellent clinical outcome as regards Harris hip score (HHS) at the end of the follow up. CONCLUSION Despite advances in surgical techniques and medical care, the risk of nonunion and avascular necrosis (AVN) after treatment of femoral neck fractures have not been changed appreciably in the last 50 years. Results of this study generally showed that both the median clinical and radiographic healing time were lower in group B compared to group A.
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Affiliation(s)
- Ahmed Mohamed Samy
- Orthopaedic Department, Tanta University, Elnady St., Kasr Elnady A, Tanta, Egypt.
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Platelet-Rich-Plasma Injections in Treating Lateral Epicondylosis: a Review of the Recent Evidence. J Hand Microsurg 2015; 7:320-5. [PMID: 26578837 DOI: 10.1007/s12593-015-0193-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 07/02/2015] [Indexed: 10/23/2022] Open
Abstract
Lateral epicondylosis is common, with various treatment modalities. Platelet-rich-plasma injections from autologous blood have recently been used in centres worldwide for the treatment of tennis elbow. We review and present the recent published evidence on the effectiveness of PRP injections for lateral epicondylosis. Nine studies met our inclusion criteria including 6 RCT's for the purpose of analysis. PRP injections have an important and effective role in the treatment of this debilitating pathology, in cases where physiotherapy has been unsuccessful.
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Filardo G, Kon E, Perdisa F, Balboni F, Marcacci M. Autologous osteochondral transplantation for the treatment of knee lesions: results and limitations at two years' follow-up. INTERNATIONAL ORTHOPAEDICS 2014; 38:1905-12. [PMID: 24663398 DOI: 10.1007/s00264-014-2322-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 03/07/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Focal chondral and osteochondral knee lesions are a common condition, particularly hard to treat, and often involve young active patients with high expectations in terms of symptomatic relief and return to sports. Autologous osteochondral transplantation allows the defect area to be restored with hyaline cartilage. The aim of this study is to analyse whether it represents a safe and effective treatment option for small-medium-sized knee chondral and osteochondral lesions in a young and active population. METHODS Thirty-one patients (18 men, 13 women; mean age 32 ± ten; mean BMI 24 ± 3) affected by focal knee chondral and osteochondral lesions were enrolled and treated with autologous osteochondral transplantation. They were prospectively followed-up for 24 months with the IKDC-subjective, IKDC-objective, and Tegner scores. Adverse events and failures were also reported, as well as the Bandi score to detect symptoms from the donor area. RESULTS A significant increase was reported in all the clinical scores adopted. In particular, the IKDC-subjective score increased from a basal value of 40.3 ± 16.2 to 62.6 ± 18.0 at the 12 months' evaluation, with a further significant increase up to 71.6 ± 20.5 at the final 24 months' follow-up (p < 0.0005). A positive trend was also found by analysing the IKDC-objective score. The Tegner score revealed a significant improvement from a basal value of 2.2 ± 1.8 to 3.7 ± 1.5 at the final evaluation (p = 0.003), although it was not possible to regain the same pre-injury sports activity level of 5.0 ± 2.2. Two failures were reported. The Bandi score revealed patients complaining of mild and moderate symptoms, not correlated to the lesion size. The presence of symptoms ascribable to the donor area was significantly correlated with a lower clinical outcome. CONCLUSIONS Autologous osteochondral transplantation proved to be, at short-term evaluation, a suitable option to treat small-medium sized chondral and osteochondral lesions. However, clinical improvement is slow and a significant percentage of patients develop symptoms attributable to the donor area, thus reducing the overall benefit of this procedure.
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Affiliation(s)
- Giuseppe Filardo
- Nano-Biotechnology Laboratory, II Clinic, Rizzoli Orthopaedic Institute, Via di Barbiano 1/10, 40136, Bologna, Italy
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