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Viganò M, Ragni E, Marmotti A, de Girolamo L. The effects of orthobiologics in the treatment of tendon pathologies: a systematic review of preclinical evidence. J Exp Orthop 2022; 9:31. [PMID: 35394237 PMCID: PMC8994001 DOI: 10.1186/s40634-022-00468-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/24/2022] [Indexed: 02/06/2023] Open
Abstract
Purpose The aim of this systematic review is to explore the current available knowledge about tendon disorders and orthobiologics derived by preclinical experiments to evaluate their role and efficacy in the different stages and conditions related to the tendon healing processes. Methods The systematic review was performed according to the PRISMA guidelines. Different electronic databases (MEDLINE, Web of Science, EMBASE) were searched for studies investigating orthobiologics (PRP and cell-based products from adipose tissue or bone marrow) in animal models or veterinary clinical trials for tendon pathologies (complete/partial tendon ruptures, rotator cuff tears, tendinopathy, enthesis-related injuries). Data regarding the specific product used, the treatment site/pathology, the host and the model were collected. The results were classified into the following categories: histological, biomechanical, molecular and imaging. Results A large pool of preclinical studies on tendon disorders have been found on platelet-rich plasma (PRP), while data about stromal vascular fraction (SVF) and bone marrow concentrate (BMAC) are still limited and frequently focused on expanded cells, rather than orthobiologics prepared at the point of care. The effect of PRP is related to an acceleration of the healing process, without improvements in the final structure and properties of repaired tendon. Cell-based products have been reported to produce more durable results, but the level of evidence is currently insufficient to draw clear indications. Conclusions The preclinical results about orthobiologics applications to tendon pathologies would support the rationale of their clinical use and encourage the performance of clinical trials aimed to confirm these data in human subjects. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-022-00468-w.
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Affiliation(s)
- Marco Viganò
- Orthopaedics biotechnology Lab, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Enrico Ragni
- Orthopaedics biotechnology Lab, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
| | - Antonio Marmotti
- San Luigi Gonzaga Hospital, Orthopedics and Traumatology Department, University of Turin - Medical School, Turin, Italy
| | - Laura de Girolamo
- Orthopaedics biotechnology Lab, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
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2
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Oktaş B, Çırpar M, Şanlı E, Canbeyli İD, Bozdoğan Ö. The effect of the platelet-rich plasma on osteogenic potential of the periosteum in an animal bone defect model. Jt Dis Relat Surg 2021; 32:668-675. [PMID: 34842099 PMCID: PMC8650655 DOI: 10.52312/jdrs.2021.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/19/2021] [Indexed: 12/04/2022] Open
Abstract
Objectives
This study aims to investigate whether plasma-rich plasma (PRP) enhances the osteogenic potential of periosteal grafts used to repair bone defects and maintains both histologically and biomechanically more durable bone tissue. Materials and methods
A standard bone defect was formed to the left femurs of 54 Sprague-Dawley rats and three groups were formed. In the first group (n=18), no periosteal repair was done for bone defect. In the second group (n=18), periosteal graft tissue was sutured to cover the defect entirely. In the third group (n=18), before periosteal repair, a 1 mL of PRP fibrin was applied into the bone defect. All femoral specimens were compared histologically at four and six weeks and biomechanically by three-point bending test at six weeks after treatment. Results
In the PRP applied group, healing of the bone defect at four weeks was significantly better than the other groups in terms of histological new bone formation (p<0.05). At six weeks, new bone formation in both of the periosteum preserved groups was superior to the first group (p<0.05, for both). There was no statistically significant difference between the second and third groups at the end of the sixth week in the biomechanical analysis, although both groups were significantly stronger than the first group (p<0.05). Conclusion
Stimulation of the periosteum with PRP application causes early osteogenic differentiation of precursor cells. Although, at biomechanical basis, PRP application does not create any significant difference, in the recovery of the bone defects at very early period, application of PRP may play a role to accelerate fracture healing and to decrease nonunions.
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Affiliation(s)
- Birhan Oktaş
- Kırıkkale Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji Anabilim Dalı, 71450 Yahşihan, Kırıkkale, Türkiye.
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Williamson PM, Freedman BR, Kwok N, Beeram I, Pennings J, Johnson J, Hamparian D, Cohen E, Galloway JL, Ramappa AJ, DeAngelis JP, Nazarian A. Tendinopathy and tendon material response to load: What we can learn from small animal studies. Acta Biomater 2021; 134:43-56. [PMID: 34325074 DOI: 10.1016/j.actbio.2021.07.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 12/20/2022]
Abstract
Tendinopathy is a debilitating disease that causes as much as 30% of all musculoskeletal consultations. Existing treatments for tendinopathy have variable efficacy, possibly due to incomplete characterization of the underlying pathophysiology. Mechanical load can have both beneficial and detrimental effects on tendon, as the overall tendon response depends on the degree, frequency, timing, and magnitude of the load. The clinical continuum model of tendinopathy offers insight into the late stages of tendinopathy, but it does not capture the subclinical tendinopathic changes that begin before pain or loss of function. Small animal models that use high tendon loading to mimic human tendinopathy may be able to fill this knowledge gap. The goal of this review is to summarize the insights from in-vivo animal studies of mechanically-induced tendinopathy and higher loading regimens into the mechanical, microstructural, and biological features that help characterize the continuum between normal tendon and tendinopathy. STATEMENT OF SIGNIFICANCE: This review summarizes the insights gained from in-vivo animal studies of mechanically-induced tendinopathy by evaluating the effect high loading regimens have on the mechanical, structural, and biological features of tendinopathy. A better understanding of the interplay between these realms could lead to improved patient management, especially in the presence of painful tendon.
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Darrieutort-Laffite C, Soslowsky LJ, Le Goff B. Molecular and Structural Effects of Percutaneous Interventions in Chronic Achilles Tendinopathy. Int J Mol Sci 2020; 21:ijms21197000. [PMID: 32977533 PMCID: PMC7582801 DOI: 10.3390/ijms21197000] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/08/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022] Open
Abstract
Achilles tendinopathy (AT) is a common problem, especially in people of working age, as well as in the elderly. Although the pathogenesis of tendinopathy is better known, therapeutic management of AT remains challenging. Various percutaneous treatments have been applied to tendon lesions: e.g., injectable treatments, platelet-rich plasma (PRP), corticosteroids, stem cells, MMP inhibitors, and anti-angiogenic agents), as well as percutaneous procedures without any injection (percutaneous soft tissue release and dry needling). In this review, we will describe and comment on data about the molecular and structural effects of these treatments obtained in vitro and in vivo and report their efficacy in clinical trials. Local treatments have some impact on neovascularization, inflammation or tissue remodeling in animal models, but evidence from clinical trials remains too weak to establish an accurate management plan, and further studies will be necessary to evaluate their value.
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Affiliation(s)
- Christelle Darrieutort-Laffite
- Rheumatology Department, Nantes University Hospital, 44000 Nantes, France;
- INSERM UMR1238, Bone Sarcoma and Remodeling of Calcified Tissue, Nantes University, 44000 Nantes, France
- Correspondence: ; Tel.: +33-2-40-08-48-01
| | - Louis J. Soslowsky
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA 19401-6081, USA;
| | - Benoit Le Goff
- Rheumatology Department, Nantes University Hospital, 44000 Nantes, France;
- INSERM UMR1238, Bone Sarcoma and Remodeling of Calcified Tissue, Nantes University, 44000 Nantes, France
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Mehrabani D, Seghatchian J, Acker JP. Platelet rich plasma in treatment of musculoskeletal pathologies. Transfus Apher Sci 2019; 58:102675. [DOI: 10.1016/j.transci.2019.102675] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Dallaudiere B, Trotier AJ, Ribot EJ, Loubrie S, Miraux S, Hauger O. Early Achilles Enthesis Involvement in a Murine Model of Spondyloarthropathy: Morphological Imaging with Ultrashort Echo-Time Sequences and Ultrasmall Superparamagnetic Iron Oxide (USPIO) Particle Evaluation in Macrophagic Detection. CONTRAST MEDIA & MOLECULAR IMAGING 2019; 2019:2834273. [PMID: 31049042 PMCID: PMC6458856 DOI: 10.1155/2019/2834273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 01/08/2019] [Accepted: 02/14/2019] [Indexed: 12/17/2022]
Abstract
Purpose To confirm the interest of 3-dimensional ultrashort echo-time (3D-UTE) sequences to assess morphologic aspects in normal and pathological Achilles entheses in a rat model of spondyloarthropathy (SpA) with histological correlations, in comparison with conventional RARE T2 Fat-Sat sequences, and, furthermore, to evaluate the feasibility of a 3D multiecho UTE sequence performed before and after the intravenous injection of ultrasmall superparamagnetic iron oxide (USPIO) particles to assess macrophagic involvement in the Achilles enthesis in the same rat model of SpA. Materials and Methods Fourteen rats underwent in vivo MRI of the ankle at 4.7 T, including a 3D RARE T2 Fat-Sat sequence and a 3D ultrashort echo-time (UTE) sequence for morphologic assessment at baseline and day 3 after induction of an SpA model, leading to Achilles enthesopathy in the left paw (right paw serving as a control). A 3D multiecho UTE sequence was also performed at day 3 before and then 24 (4 rats) and 48 (2 rats) hours after intravenous injection of USPIO. Visual analysis and signal intensity measurements of all images were performed at different locations of the Achilles enthesis and preinsertional area. Visual analysis and T2∗ measurements were performed before and after USPIO injection, on the 3D multiecho UTE sequence in the same locations. Normal and pathological values were compared by Wilcoxon signed-rank tests. MR findings were compared against histological data. Results 3D-UTE sequences enabled morphologic identification of the anterior fibrocartilage and posterior collagenic areas of the Achilles enthesis. Visual analysis and signal intensity measurements distinguished SpA-affected entheses from healthy ones at day 3 (P=0.02). After administration of USPIO, no differences in signals were detected. Similarly, both visual analysis and signal T2∗ measurements in the enthesis were unable to distinguish the SpA-affected tendons from healthy ones (P=0.914). Neither the normal anatomy of the enthesis nor its pathological pattern could be distinguished using the standard RARE sequence. Histology confirmed the absence of USPIO in Achilles entheses, despite marked signs of inflammation. Conclusion Unlike conventional RARE T2 Fat-Sat sequences, 3D-UTE sequences enable morphologic assessment of normal enthesis anatomy and early detection of abnormalities in pathological conditions. However, 3D multiecho UTE sequences combined with USPIO injections with T2∗ measurements were unable to detect macrophagic involvement in these pathological conditions.
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Affiliation(s)
- Benjamin Dallaudiere
- Department of Radiology, University Hospital of Bordeaux, Bordeaux, France
- Centre de Résonance Magnétique des Systémes Biologiques, UMR 5536, CNRS, University of Bordeaux, Bordeaux, France
| | - Aurelien J. Trotier
- Centre de Résonance Magnétique des Systémes Biologiques, UMR 5536, CNRS, University of Bordeaux, Bordeaux, France
| | - Emeline J. Ribot
- Centre de Résonance Magnétique des Systémes Biologiques, UMR 5536, CNRS, University of Bordeaux, Bordeaux, France
| | - Stéphane Loubrie
- Centre de Résonance Magnétique des Systémes Biologiques, UMR 5536, CNRS, University of Bordeaux, Bordeaux, France
| | - Sylvain Miraux
- Centre de Résonance Magnétique des Systémes Biologiques, UMR 5536, CNRS, University of Bordeaux, Bordeaux, France
| | - Olivier Hauger
- Department of Radiology, University Hospital of Bordeaux, Bordeaux, France
- Centre de Résonance Magnétique des Systémes Biologiques, UMR 5536, CNRS, University of Bordeaux, Bordeaux, France
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Dallaudière B, Trotier A, Ribot E, Verdier D, Lepreux S, Miraux S, Hauger O. Three-dimensional ultrashort echo time (3D UTE) MRI of Achilles tendon at 4.7T MRI with comparison to conventional sequences in an experimental murine model of spondyloarthropathy. J Magn Reson Imaging 2018; 50:127-135. [PMID: 30575218 DOI: 10.1002/jmri.26569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/18/2018] [Accepted: 09/18/2018] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Due to the very short T2 of its components, the normal anatomy of Achilles enthesis is impossible to define with "conventional" long echo time (TE) T2 sequences. However, this is a common site affected by rheumatologic disease. Early abnormalities related to inflammatory processes are impossible to detect in this location. PURPOSE To assess the feasibility of a 3D-UTE (ultrashort echo time) sequence to evaluate normal and pathological Achilles entheses, determining both anterior fibrocartilaginous and posterior collagenic portions at 4.7T, in a rat model of spondyloarthropathy (SpA) with histological correlation. To assess whether this sequence detects SpA enthesopathy prior to long TE T2 sequences, enabling disease monitoring. STUDY TYPE Prospective case-control study. ANIMAL MODEL Twelve immunocompetent Wistar male rats imaged before (controls); the model was induced in eight rats (16 tendons) imaged at day 6, day 13, and day 21 with regular sacrifice for ex vivo imaging and histological correlation. FIELD STRENGTH 4.7T Bruker Biospec Systems. 3D balanced steady-state free precession (bSSFP) and 3D-UTE sequences, performed at baseline (day 0, n = 12 animals / 24 tendons), day 6 (n = 8/16), 13 (n = 4/8), and day 21 (n = 2/4). ASSESSMENT Visual analysis and signal intensity measurements (signal to noise ratio, SNR) of both bSSFP and UTE images were performed by two independent musculoskeletal radiologists at different locations of the Achilles enthesis and preinsertional area. STATISTICAL TESTS Normal and pathological rat values were compared by Wilcoxon signed-rank tests, as well as interobserver differences. MRI findings were compared against histological data. RESULTS The 3D-UTE sequence identified the anterior fibrocartilage and posterior collagenic areas of Achilles entheses in all cases. Visual analysis and signal intensity measurements distinguished SpA-affected entheses from healthy ones at days 6 and 13 (P = 0.002 and P = 0.006, respectively). Neither the normal anatomy of the enthesis nor its pathological pattern could be identified on T2 bSSFP sequences. DATA CONCLUSION Unlike bSSFP T2 sequences, 3D-UTE sequences enable visualization of normal enthesis anatomy and early detection of abnormalities in pathological conditions. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;50:127-135.
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Affiliation(s)
- Benjamin Dallaudière
- Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536, CNRS, Université de Bordeaux, Bordeaux, France.,Département d'Imagerie Musculo-squelettique, Centre Hospitalier Universitaire Pellegrin, 33000, Bordeaux, France
| | - A Trotier
- Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536, CNRS, Université de Bordeaux, Bordeaux, France
| | - E Ribot
- Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536, CNRS, Université de Bordeaux, Bordeaux, France
| | - D Verdier
- Département d'Imagerie Musculo-squelettique, Centre Hospitalier Universitaire Pellegrin, 33000, Bordeaux, France
| | - S Lepreux
- Département d'Anatomopathologie, Centre Hospitalier Universitaire Pellegrin, Bordeaux, France
| | - S Miraux
- Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536, CNRS, Université de Bordeaux, Bordeaux, France
| | - O Hauger
- Centre de Résonance Magnétique des Systèmes Biologiques, UMR 5536, CNRS, Université de Bordeaux, Bordeaux, France.,Département d'Imagerie Musculo-squelettique, Centre Hospitalier Universitaire Pellegrin, 33000, Bordeaux, France
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8
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Intraoperative Local Administration of Platelet-Rich Plasma (PRP) during Neurolysis Surgery for the Treatment of Digital Nerve Crush Injury. Case Rep Orthop 2018; 2018:1275713. [PMID: 30327740 PMCID: PMC6171255 DOI: 10.1155/2018/1275713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/05/2018] [Indexed: 12/21/2022] Open
Abstract
The digital nerves are important for normal hand function. In addition to conventional therapies such as neurolysis, direct repair, and auto/allografts, new treatments administering growth factors and cells for promoting nerve regeneration exist. Platelet-rich plasma (PRP), an autologous product with proven therapeutic effects for musculoskeletal disorders, is a new treatment option for peripheral nerve injury. We hypothesized that PRP could stimulate healing of digital nerve injuries. In the current case report, intraoperative local administration of PRP was performed during neurolysis surgery for a healthy 28-year-old woman with digital nerve crush injury. Five weeks postinjury, surgery was performed due to severe uncontrollable neuropathic pain and no sensory nerve action potential derivation of the index finger. Therapeutic effects were assessed by physical examination, visual analog scale for pain, and nerve conduction study. Postoperatively, early neuropathic pain relief and good functional recovery were obtained with no PRP-related adverse events. This case report demonstrates the therapeutic potential of intraoperative PRP to enhance the healing process of nerve crush injury in the acute phase and to decrease the neuropathic pain, thus enhancing healing of peripheral nerve crush injury.
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9
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Dias LP, Luzo ÂCM, Volpe BB, Durán M, Galdames SEM, Ferreira LAB, Durán N, Fávaro WJ. Effects of intravesical therapy with platelet-rich plasma (PRP) and Bacillus Calmette-Guérin (BCG) in non-muscle invasive bladder cancer. Tissue Cell 2018; 52:17-27. [PMID: 29857824 DOI: 10.1016/j.tice.2018.03.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 03/21/2018] [Accepted: 03/22/2018] [Indexed: 12/19/2022]
Abstract
This study describes the effects of a promising therapeutic alternative for non-muscle invasive bladder cancer (NMIBC) based on Bacillus Calmette-Guerin (BCG) intravesical immunotherapy combined with Platelet-rich plasma (PRP) in an animal model. Furthermore, this study describes the possible mechanisms of this therapeutic combination involving Toll-like Receptors (TLRs) 2 and 4 signaling pathways. NMIBC was induced by treating female Fischer 344 rats with N-methyl-N-nitrosourea (MNU). After treatment with MNU, the animals were distributed into four experimental groups: Control (without MNU) group, MNU (cancer) group, MNU + PRP group, MNU + BCG group and MNU + PRP + BCG group. Our results demonstrated that PRP treatment alone or associated with BCG triggered significant cytotoxicity in bladder carcinoma cells (HTB-9). Animals treated with PRP associated to BCG clearly showed better histopathological recovery from the cancer state and decrease of urothelial neoplastic lesions progression in 70% of animals when compared to groups that received the same therapies administered singly. In addition, this therapeutic association led to distinct activation of immune system TLRs 2 and 4-mediated, resulting in increased MyD88, TRIF, IRF3, IFN-γ immunoreactivities. Taken together, the data obtained suggest that interferon signaling pathway activation by PRP treatment in combination with BCG immunotherapy may provide novel therapeutic approaches for non-muscle invasive bladder cancer.
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Affiliation(s)
- Lara Paro Dias
- Laboratory of Urogenital Carcinogenesis and Immunotherapy, Department of Structural and Functional Biology, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Ângela C Malheiros Luzo
- Public Umbilical Cord Blood Bank, Haematology Hemotherapy Center/INCT do Sangue, University of Campinas (UNICAMP), Campinas, Brazil
| | - Bruno B Volpe
- Public Umbilical Cord Blood Bank, Haematology Hemotherapy Center/INCT do Sangue, University of Campinas (UNICAMP), Campinas, Brazil
| | - Marcela Durán
- Laboratory of Urogenital Carcinogenesis and Immunotherapy, Department of Structural and Functional Biology, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Sofia E M Galdames
- Department of Engineering of Materials and Bioprocesses, School of Chemical Engineering, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Luiz A B Ferreira
- Department of Biochemistry and Tissue Biology, Institute of Biology, University of Campinas (UNICAMP), Campinas, SP, Brazil
| | - Nelson Durán
- NanoBioss, Institute of Chemistry, University of Campinas (UNICAMP), Campinas, SP, Brazil; Nanomedicine Research Unit (Nanomed), Federal University of ABC (UFABC), Santo André, Brazil
| | - Wagner J Fávaro
- Laboratory of Urogenital Carcinogenesis and Immunotherapy, Department of Structural and Functional Biology, University of Campinas (UNICAMP), Campinas, SP, Brazil; NanoBioss, Institute of Chemistry, University of Campinas (UNICAMP), Campinas, SP, Brazil.
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Comparative Analysis of Different Platelet Lysates and Platelet Rich Preparations to Stimulate Tendon Cell Biology: An In Vitro Study. Int J Mol Sci 2018; 19:ijms19010212. [PMID: 29320421 PMCID: PMC5796161 DOI: 10.3390/ijms19010212] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/05/2018] [Accepted: 01/08/2018] [Indexed: 02/07/2023] Open
Abstract
The poor healing potential of tendons is still a clinical problem, and the use of Platelet Rich Plasma (PRP) was hypothesized to stimulate healing. As the efficacy of PRPs remains unproven, platelet lysate (PL) could be an alternative with its main advantages of storage and characterization before use. Five different blood products were prepared from 16 male donors: human serum, two PRPs (Arthrex, (PRP-ACP); RegenLab (PRP-BCT)), platelet concentrate (apheresis, PC), and PL (freezing-thawing destruction of PC). Additionally, ten commercial allogenic PLs (AlloPL) from pooled donors were tested. The highest concentration of most growth factors was found in AlloPL, whereas the release of growth factors lasted longer in the other products. PRP-ACP, PRP-BCT, and PC significantly increased cell viability of human tenocyte-like cells, whereas PC and AlloPL increased Col1A1 expression and PRP-BCT increased Col3A1 expression. MMP-1, IL-1β, and HGF expression was significantly increased and Scleraxis expression decreased by most blood products. COX1 expression significantly decreased by PC and AlloPL. No clear positive effects on tendon cell biology could be shown, which might partially explain the weak outcome results in clinical practice. Pooled PL seemed to have the most beneficial effects and might be the future in using blood products for tendon tissue regeneration.
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Orliac S, Serfaty JM, Perozziello A, Zurlinden O, Louedec L, Dallaudière B. Efficacy of subcutaneous injection of platelet-rich plasma in alopecia: A clinical and histological pilot study on a rat model with a six-month long-term follow-up experience. J Cosmet Dermatol 2017; 17:214-219. [PMID: 29130636 DOI: 10.1111/jocd.12425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2017] [Indexed: 01/01/2023]
Abstract
PURPOSE To assess the potential of platelet-rich plasma (PRP) subcutaneous injection of to treat alopecia and to evaluate local toxicity. MATERIALS-METHODS Twelve Hairless rats were used. At D0, we performed systematic clinical examination and divided the rat back into four quadrants (Q). We initiated subcutaneous injection using either PRP in PRPQ+, platelet-poor plasma (PPP) in PPPQ+, physiological serum (PS) in PSQ+, or no treatment (Q4). At D7, D14, D21, and D28 but also second month (M2), M3, M4, M5, rats had exactly the same injection procedure. Follow-up with PRP efficacy and toxicity at D28 and M6 using clinical and histological evaluation was performed. RESULTS Hair density was significantly improved at D28 and at M6 for PRPQ+ vs PSQ+ (respectively, P = .0156 and P = .0313), PPPQ+ (respectively, P = .042 and P = .046). Significant histological improvement was observed between D28 and M6, for PRPQ+ vs PPPQ+ and PSQ+ for vessels (respectively, P = .0160 and P = .021), collagen (respectively, P = .0036 and P = .032), and epithelium (respectively, P = .0138 and P = .022) with no local toxicity. CONCLUSION Our study suggests that subcutaneous PRP injections using controlled concentration of platelets and leukocytes improve hair growth.
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Affiliation(s)
- Sophie Orliac
- Centre de Médecine Esthétique, Bordeaux, France.,Université Paris Diderot, Paris, France.,Unité Inserm U698, Hôpital universitaire Bichat, Paris, France
| | - Jean-Michel Serfaty
- Université Paris Diderot, Paris, France.,Unité Inserm U698, Hôpital universitaire Bichat, Paris, France.,Service de Radiologie, Hôpital universitaire Bichat, Paris, France
| | | | | | - Liliane Louedec
- Unité Inserm U698, Hôpital universitaire Bichat, Paris, France
| | - Benjamin Dallaudière
- Université Paris Diderot, Paris, France.,Unité Inserm U698, Hôpital universitaire Bichat, Paris, France.,Service de Radiologie, Hôpital universitaire Bichat, Paris, France
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Ikumi A, Hara Y, Yoshioka T, Kanamori A, Yamazaki M. Effect of local administration of platelet-rich plasma (PRP) on peripheral nerve regeneration: An experimental study in the rabbit model. Microsurgery 2017; 38:300-309. [DOI: 10.1002/micr.30263] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 09/19/2017] [Accepted: 10/20/2017] [Indexed: 12/28/2022]
Affiliation(s)
- Akira Ikumi
- Department of orthopaedic surgery, Faculty of medicine; University of Tsukuba; Ibaraki Japan
| | - Yuki Hara
- Department of orthopaedic surgery, Faculty of medicine; University of Tsukuba; Ibaraki Japan
| | - Tomokazu Yoshioka
- Department of orthopaedic surgery, Faculty of medicine; University of Tsukuba; Ibaraki Japan
| | - Akihiro Kanamori
- Department of orthopaedic surgery, Faculty of medicine; University of Tsukuba; Ibaraki Japan
| | - Masashi Yamazaki
- Department of orthopaedic surgery, Faculty of medicine; University of Tsukuba; Ibaraki Japan
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Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6492597. [PMID: 27885357 PMCID: PMC5112330 DOI: 10.1155/2016/6492597] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/20/2016] [Indexed: 12/30/2022]
Abstract
Achilles tendinopathy is one of the most frequently ankle and foot overuse injuries, which is a clinical syndrome characterized by the combination of pain, swelling, and impaired performance. The two main categories of Achilles tendinopathy are classified according to anatomical location and broadly include insertional and noninsertional tendinopathy. The etiology of Achilles tendinopathy is multifactorial including both intrinsic and extrinsic factors. Failed healing response and degenerative changes were found in the tendon. The failed healing response includes three different and continuous stages (reactive tendinopathy, tendon disrepair, and degenerative tendinopathy). The histological studies have demonstrated an increased number of tenocytes and concentration of glycosaminoglycans in the ground substance, disorganization and fragmentation of the collagen, and neovascularization. There are variable conservative and surgical treatment options for Achilles tendinopathy. However, there has not been a gold standard of these treatments because of the controversial clinical results between various studies. In the future, new level I researches will be needed to prove the effect of these treatment options.
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Yoshida M, Funasaki H, Marumo K. Efficacy of autologous leukocyte-reduced platelet-rich plasma therapy for patellar tendinopathy in a rat treadmill model. Muscles Ligaments Tendons J 2016; 6:205-215. [PMID: 27900294 DOI: 10.11138/mltj/2016.6.2.205] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND An autologous platelet-rich plasma (PRP) therapy has currently been applied for the tendinopathy; however, its efficacy and an optimal platelets concentration in PRP were uncertain. We analyzed them in an animal model prepared using a repetitive running exercise. METHODS We made the tendinopathy rat model of patellar tendon using a rodent treadmill machine. Rats with tendinopathy were injected with leukocyte-reduced PRP at the platelets concentration of 1.0×106/μL (P10 group), PRP at the platelets concentration of 5.0×105/μL (P5 group) or normal saline (control group) into the space between the patellar tendon and the fat pad bilaterally or were multiply dry-needled at the tibial insertion site (MN group) at once. To assess the pain-reliving effect, the spontaneous locomotor activities at night (12 h) were measured every day. Histological sections of the patellar tendon stained with hematoxylineosin or prepared by TdT-mediated dUTP nick end labeling were microscopically analyzed. RESULTS The numbers of spontaneous locomotor activities in the P10 group were significantly larger than those in the P5, MN or control groups and they recovered up to a healthy level. On histologic examinations, the numbers of microtears, laminations, or apoptotic cells in the patellar tendons in the P10 or P5 groups were significantly lower than those in the MN or control groups, although no significant differences were observed between the P10 and P5 groups. CONCLUSIONS The injections of an autologous leukocyte-reduced PRP were effective for pain relief and for partial restoration of the patellar tendon in the tendinopathy rat model. The injections of a PRP at the platelets concentration of 1.0×106/μL completely relieved the pain and were more effective than those at the platelets concentration of 5.0×105/μL whereas there was no difference for the effect of histological restoration or apoptosis inhibition between them.
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Affiliation(s)
- Mamoru Yoshida
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroki Funasaki
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Keishi Marumo
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
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PRP Treatment Efficacy for Tendinopathy: A Review of Basic Science Studies. BIOMED RESEARCH INTERNATIONAL 2016; 2016:9103792. [PMID: 27610386 PMCID: PMC5004020 DOI: 10.1155/2016/9103792] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 07/08/2016] [Accepted: 07/20/2016] [Indexed: 11/18/2022]
Abstract
Platelet-Rich Plasma (PRP) has been widely used in orthopaedic surgery and sport medicine to treat tendon injuries. However, the efficacy of PRP treatment for tendinopathy is controversial. This paper focuses on reviewing the basic science studies on PRP performed under well-controlled conditions. Both in vitro and in vivo studies describe PRP's anabolic and anti-inflammatory effects on tendons. While some clinical trials support these findings, others refute them. In this review, we discuss the effectiveness of PRP to treat tendon injuries with evidence presented in basic science studies and the potential reasons for the controversial results in clinical trials. Finally, we comment on the approaches that may be required to improve the efficacy of PRP treatment for tendinopathy.
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Kaux JF, Drion P, Croisier JL, Crielaard JM. Tendinopathies and platelet-rich plasma (PRP): from pre-clinical experiments to therapeutic use. J Stem Cells Regen Med 2015. [PMID: 26195890 PMCID: PMC4498322 DOI: 10.46582/jsrm.1101003] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The restorative properties of platelets, through the local release of growth factors, are used in various medical areas. This article reviews fundamental and clinical research relating to platelet-rich plasma applied to tendinous lesions. MATERIALS AND METHOD Articles in French and English, published between 1 January 2012 and 31 December 2014. dealing with PRP and tendons were searched for using the Medline and Scopus data bases. RESULTS Forty-seven articles were identified which addressed pre-clinical and clinical studies: 27 relating to in vitro and in vivo animal studies and 20 relating to human studies. Of these, five addressed lateral epicondylitis, two addressed rotator cuff tendinopathies, ten dealt with patellar tendinopathies and three looked at Achilles tendinopathies. CONCLUSIONS The majority of pre-clinical studies show that PRP stimulates the tendon's healing process. However, clinical series remain more controversial and level 1, controlled, randomised studies are still needed.
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Affiliation(s)
- Jean-François Kaux
- Physical Medicine and Sports Traumatology Department, University and University Hospital of Liège, Liège, Belgium
| | - Pierre Drion
- ULg-GIGA-R, Experimental Surgery, University of Liège, Belgium
| | - Jean-Louis Croisier
- Physiotherapy Service, Department of Motility Sciences, University of Liège, Liège, Belgium
| | - Jean-Michel Crielaard
- Physical Medicine and Sports Traumatology Department, University and University Hospital of Liège, Liège, Belgium
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Brossi PM, Moreira JJ, Machado TSL, Baccarin RYA. Platelet-rich plasma in orthopedic therapy: a comparative systematic review of clinical and experimental data in equine and human musculoskeletal lesions. BMC Vet Res 2015; 11:98. [PMID: 25896610 PMCID: PMC4449579 DOI: 10.1186/s12917-015-0403-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/20/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND This systematic review aimed to present and critically appraise the available information on the efficacy of platelet rich plasma (PRP) in equine and human orthopedic therapeutics and to verify the influence of study design and methodology on the assumption of PRP's efficacy. We searched Medline, PubMed, Embase, Bireme and Google Scholar without restrictions until July 2013. Randomized trials, human cohort clinical studies or case series with a control group on the use of PRP in tendons, ligaments or articular lesions were included. Equine clinical studies on the same topics were included independently of their design. Experimental studies relevant to the clarification of PRP's effects and mechanisms of action in tissues of interest, conducted in any animal species, were selected. RESULTS This review included 123 studies. PRP's beneficial effects were observed in 46.7% of the clinical studies, while the absence of positive effects was observed in 43.3%. Among experimental studies, 73% yielded positive results, and 7.9% yielded negative results. The most frequent flaws in the clinical trials' designs were the lack of a true placebo group, poor product characterization, insufficient blinding, small sampling, short follow-up periods, and adoption of poor outcome measures. The methods employed for PRP preparation and administration and the selected outcome measures varied greatly. Poor study design was a common feature of equine clinical trials. From studies in which PRP had beneficial effects, 67.8% had an overall high risk of bias. From the studies in which PRP failed to exhibit beneficial effects, 67.8% had an overall low risk of bias. CONCLUSIONS Most experimental studies revealed positive effects of PRP. Although the majority of equine clinical studies yielded positive results, the human clinical trials' results failed to corroborate these findings. In both species, beneficial results were more frequently observed in studies with a high risk of bias. The use of PRP in musculoskeletal lesions, although safe and promising, has still not shown strong evidence in clinical scenarios.
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Affiliation(s)
- Patrícia M Brossi
- Department of Internal Medicine, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP, Brazil.
| | - Juliana J Moreira
- Department of Internal Medicine, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP, Brazil.
| | - Thaís S L Machado
- Department of Internal Medicine, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP, Brazil.
| | - Raquel Y A Baccarin
- Department of Internal Medicine, School of Veterinary Medicine and Animal Science, University of São Paulo, São Paulo, SP, Brazil.
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Pesquer L, Reboul G, Silvestre A, Poussange N, Meyer P, Dallaudière B. Imaging of adductor-related groin pain. Diagn Interv Imaging 2015; 96:861-9. [PMID: 25823982 DOI: 10.1016/j.diii.2014.12.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/22/2014] [Accepted: 12/30/2014] [Indexed: 10/23/2022]
Abstract
Groin pain is a common condition in athletes and results from various causes. Osteitis pubis, adductor dysfunction, inguinal hernia, or a combination of all three entities, generally explains the onset of symptoms. Adductor longus tendinopathy is the main cause of adductor-related groin pain. It leads to a significant reduction of sports participation and can require surgical management. Diagnosis is based on ultrasonography and magnetic resonance imaging. Asymptomatic findings (tendinosis, calcifications, cortical erosions) are common in athletes and care should be taken when assessing groin pain. The most specific sign of tendinopathy is an intratendinous tear of the adductor longus.
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Affiliation(s)
- L Pesquer
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France.
| | - G Reboul
- Centre de chirurgie orthopédique et sportive, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - A Silvestre
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - N Poussange
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - P Meyer
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France
| | - B Dallaudière
- Centre d'imagerie ostéo-articulaire, clinique du sport de Bordeaux, 2, rue Georges-Negrevergne, 33700 Mérignac, France; Département d'imagerie musculo-squelettique, centre hospitalier universitaire Pellegrin, place Amélie-Léon-Rabat, 33000 Bordeaux, France
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Abstract
Injuries of the Achilles tendon are relatively common with potentially devastating outcomes. Healing Achilles tendons form a fibrovascular scar resulting in a tendon which may be mechanically weaker than the native tendon. The resulting strength deficit causes a high risk for reinjury and other complications. Treatments using biologics aim to restore the normal properties of the native tendon and reduce the risk of rerupture and maximize tendon function. The purpose of this review was to summarize the current findings of various therapies using biologics in an attempt to improve the prognosis of Achilles tendon ruptures and tendinopathies. A PubMed search was performed using specific search terms. The search was open for original manuscripts and review papers limited to publication within the last 10 years. From these searches, papers were included in the review if they investigated the effects of biological augmentation on Achilles tendon repair or healing. Platelet-rich plasma may assist in the healing process of Achilles tendon ruptures, while the evidence to support its use in the treatment of chronic Achilles tendinopathies remains insufficient. The use of growth factors such as hepatocyte growth factor, recombinant human platelet-derived growth factor-BB, interleukin-6, and transforming growth factor beta as well as several bone morphogenetic proteins have shown promising results for Achilles tendon repair. In vitro and preclinical studies have indicated the potential effectiveness of bone marrow aspirate as well. Stem cells also have positive effects on Achilles tendon healing, particularly during the early phases. Polyhydroxyalkanoates (PHA), decellularized tendon tissue, and porcine small intestinal submucosa (SIS) are biomaterials which have shown promising results as scaffolds used in Achilles tendon repair. The application of biological augmentation techniques in Achilles tendon repair appears promising; however, several techniques require further investigation to evaluate their clinical application.
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Affiliation(s)
- Evan Shapiro
- Orthopedics Department, Feinstein Institute for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
| | - Daniel Grande
- Orthopedics Department, Feinstein Institute for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA.
| | - Mark Drakos
- Orthopedics Department, Feinstein Institute for Medical Research, 350 Community Dr, Manhasset, NY, 11030, USA
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Kim SJ, Lee SM, Kim JE, Kim SH, Jung Y. Effect of platelet-rich plasma with self-assembled peptide on the rotator cuff tear model in rat. J Tissue Eng Regen Med 2015; 11:77-85. [PMID: 25643855 DOI: 10.1002/term.1984] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 11/13/2014] [Accepted: 12/09/2014] [Indexed: 12/31/2022]
Abstract
Several trials have been carried out to improve the healing of rotator cuff tear, but their effects remain controversial. In this study, we examined the therapeutic effect of platelet-rich plasma (PRP) in combination with self-assembled peptide (SAP) on the healing of rotator cuff tear in the rat. Twenty-seven Sprague-Dawley rats, aged 15 weeks, were used for the rotator cuff tear model. The supraspinatus muscle at the insertion site was dissected and truncated, leaving the cut edge free. A week after the surgery, the rats were randomly divided into SAP, PRP, SAP-PRP and control groups and 0.2 ml SAP, PRP, SAP-PRP and saline were injected, respectively. Bonar scores and synovial inflammation grade were checked 5 weeks after the injection. Immunofluorescence staining for heat shock protein (HSP)-70 and caspase-3 was conducted. Furthermore, maximum stride length was measured before and at 2 and 4 weeks after the injection. The Bonar scores were 6.4 ± 1.8 in the SAP group, 5.9 ± 2.0 in the PRP group, 4.7 ± 1.1 in the SAP-PRP group and 8.3 ± 2.3 in the control group. There was significant difference between the SAP-PRP and control groups in post hoc multiple comparison analysis. Among four categories of Bonar scores, collagen arrangement and vascular infiltration showed improvement after SAP-PRP injection. Immunofluorescence images showed that HSP-70 and caspase-3 were much less expressed in the SAP-PRP group than in the other groups. In conclusion, SAP-PRP can be effective in healing a rotator cuff tear by enhancing the collagen arrangement and inhibiting inflammatory changes and apoptosis. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Sang Jun Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Centre, Seoul, Republic of Korea
| | - Sang Mok Lee
- Department of Physical and Rehabilitation Medicine, Samsung Medical Centre, Seoul, Republic of Korea
| | - Ji Eun Kim
- Centre for Biomaterials, Korea Institute of Science and Technology, Seoul, Republic of Korea.,NBIT, KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul, Korea
| | - Soo Hyun Kim
- Centre for Biomaterials, Korea Institute of Science and Technology, Seoul, Republic of Korea.,NBIT, KU-KIST Graduate School of Converging Science and Technology, Korea University, Seoul, Korea.,Department of Biomedical Engineering, Korea University of Science and Technology (UST), Daejeon, Korea
| | - Youngmee Jung
- Centre for Biomaterials, Korea Institute of Science and Technology, Seoul, Republic of Korea.,Department of Biomedical Engineering, Korea University of Science and Technology (UST), Daejeon, Korea
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Drug-induced tendinopathy: From physiology to clinical applications. Joint Bone Spine 2014; 81:485-92. [DOI: 10.1016/j.jbspin.2014.03.022] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2014] [Indexed: 11/22/2022]
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Dallaudière B, Pesquer L, Meyer P, Silvestre A, Perozziello A, Peuchant A, Durieux MHM, Loriaut P, Hummel V, Boyer P, Schouman-Claeys E, Serfaty JM. Intratendinous Injection of Platelet-Rich Plasma under US Guidance to Treat Tendinopathy: A Long-Term Pilot Study. J Vasc Interv Radiol 2014; 25:717-23. [DOI: 10.1016/j.jvir.2014.01.026] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 01/15/2014] [Accepted: 01/16/2014] [Indexed: 11/27/2022] Open
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McCarrel TM, Mall NA, Lee AS, Cole BJ, Butty DC, Fortier LA. Considerations for the Use of Platelet-Rich Plasma in Orthopedics. Sports Med 2014; 44:1025-36. [DOI: 10.1007/s40279-014-0195-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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