1
|
Oo WM, Linklater J, Bennell KL, Yu SP, Duong V, Hunter DJ. Inflammatory ultrasound features as prognostic factors of pain and functional outcomes following intra-articular platelet-rich plasma in knee osteoarthritis. Int J Rheum Dis 2023; 26:1540-1546. [PMID: 37309612 PMCID: PMC10946528 DOI: 10.1111/1756-185x.14781] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 05/05/2023] [Accepted: 05/26/2023] [Indexed: 06/14/2023]
Abstract
AIM To explore inflammatory ultrasound predictors of improvements in pain and function over 2, 6, and 12 months following administration of intra-articular platelet-rich plasma (PRP) in knee osteoarthritis (OA). METHOD Patients with painful mild-moderate radiographic knee OA from a subset of the RESTORE RCT underwent ultrasound assessment according to the standardized OMERACT scanning protocol to detect inflammatory features such as synovitis, synovial hypertrophy, and effusion with power Doppler. The study knee was treated with 3 once-weekly PRP injections obtained after centrifugation at 1500 g for 5 min. Numerical Rating Score (NRS), Intermittent and Constant Osteoarthritis Pain (ICOAP) questionnaire, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) function sub-score were used to measure pain and functional severity. Separate linear regression models were performed to determine whether baseline ultrasound-detected features of inflammation predicted the improvement in pain and function following PRP injection in both unadjusted and adjusted models for confounders. RESULTS Forty-four participants were included, with 25 (56.8%) being female. In an unadjusted model, higher OMERACT scores for inflammatory features such as global synovitis and/or effusion were significantly associated with greater improvement in all outcomes measured at 2 months but not at 6 and 12 months for pain measures. Only global synovitis showed significant association with functional improvement at 2 and 12 months. Similar findings were observed in the adjusted model. CONCLUSION Ultrasound indices of knee inflammation predicted short-term improvements in pain severity and both short- and longer-term improvements in function following intra-articular PRP injection.
Collapse
Affiliation(s)
- Win Min Oo
- Rheumatology Department, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling InstituteUniversity of SydneySydneyNew South WalesAustralia
- Department of Physical Medicine and Rehabilitation, Mandalay General HospitalUniversity of Medicine, MandalayMandalayMyanmar
| | - James Linklater
- Department of Musculoskeletal ImagingCastlereagh Sports Imaging CentreSt. Leonards, SydneyNew South WalesAustralia
| | - Kim L. Bennell
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, School of Health Sciences, Faculty of Medicine Dentistry & Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Shirley P. Yu
- Rheumatology Department, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling InstituteUniversity of SydneySydneyNew South WalesAustralia
| | - Vicky Duong
- Rheumatology Department, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling InstituteUniversity of SydneySydneyNew South WalesAustralia
| | - David J. Hunter
- Rheumatology Department, Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling InstituteUniversity of SydneySydneyNew South WalesAustralia
| |
Collapse
|
2
|
Saraf A, Hussain A, Singhal A, Arora V, Bishnoi S. Do age, gender, BMI and disease duration influence the clinical outcomes in patients of knee osteoarthritis treated with serial injections of autologous platelet rich plasma? J Clin Orthop Trauma 2023; 43:102226. [PMID: 37533478 PMCID: PMC10393560 DOI: 10.1016/j.jcot.2023.102226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 06/30/2023] [Accepted: 07/13/2023] [Indexed: 08/04/2023] Open
Abstract
Purpose To study whether age, gender, body mass index(BMI) and disease duration influence the clinical outcomes in kellgren-Lawrence(K-L) grade II,III knee osteoarthritis(KOA) patients treated with serial injections of platelet rich plasma(PRP). Patients and methods 65 patients were given three monthly intra-articular injections of PRP in this prospective interventional study. The patients were divided into subgroups depending on the factor studied: by age(in years) into young <45(n = 7), middle age 45-60(n = 35), and elderly >60(n = 23): by BMI(in kg/m2) into; normal <25(n = 25), overweight 25-30(n = 27) and obese >30(n = 13) and disease duration; less(n = 32) or more than 1 year(n = 33) symptom duration. Visual analogue scale (VAS) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) were used as outcome measures and assessed before each injection and then at 6 and 9 months post injection. Groups were homogenous with respect to baseline characteristics. Results Mean VAS and WOMAC scores showed a statistically significant improvement (P < 0.0001) across all groups and subgroups (age,gender,BMI,disease duration) at follow up. On intra-subgroup comparison, we found no significant differences(P > 0.05) among age, BMI or gender subgroups, however the scores were significantly better in patients with disease duration of less than 1 year than those with more than 1 year duration at both 6 and 9 months[P < 0.001(RC = 9.630,95% CI = 4.037-15.222,P = 0.001)]. Conclusion PRP injections if given serially can improve the short term subjective scores of VAS and WOMAC scores in patients with K-L grade II and III KOA irrespective of age, gender, BMI or disease duration, however, clinical benefits can be maximized if given early in the disease course.
Collapse
Affiliation(s)
| | - Altaf Hussain
- Corresponding author. Department of orthopaedics, 4th floor, hospital building, Teerthanker Mahaveer Medical College & Research Centre, Delhi road. Moradabad, Uttar Pradesh, 244001, India.
| | | | | | | |
Collapse
|
3
|
Huda N, Islam MSU, Bishnoi S, Kumar H, Aggarwal S, Ganai AA. Role of Triple Injection Platelet-Rich Plasma for Osteoarthritis Knees: A 2 Years Follow-Up Study. Indian J Orthop 2022; 56:249-255. [PMID: 35140855 PMCID: PMC8789995 DOI: 10.1007/s43465-021-00459-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 07/11/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE To assess the clinical outcomes of intra-articular Platelet-rich plasma (PRP) injection in knee osteoarthritis (OA) at 2 year follow-up. METHODS This was a prospective interventional study. 68 cases (105 knees) with Kellgren-Lawrence (KL) grades I, II and III knee OA received 3 intra-articular injections of PRP 1 month apart. The cases were followed up for 2-years. Outcomes were measured using Western Ontario and McMaster Universities Arthritis Index (WOMAC) score and Visual analog scale (VAS) scores. RESULTS The mean age was 51.7 years. 18 knees had KL grade I, 55 had grade II and 32 had grade III OA. The mean pre-treatment VAS score decreased significantly at 1 year (mean difference - 5.3, p = 0.003) and 2 year follow-up (mean difference - 6, p = 0.007). The mean pre-treatment WOMAC score decreased significantly at 1 year (mean difference - 45.9, p = 0.011) and at 2 year (mean difference - 52.4, p = 0.009). The WOMAC and VAS scores improved significantly from baseline to final follow-up across all KL grades (p = 0.001 and 0.001, 0.009 and 0.007, 0.021 and 0.017 for WOMAC and VAS across KL grade I, II and III, respectively). There was no significant differences in WOMAC and VAS scores between three KL grades at final follow-up (p = 0.17 and 0.09, respectively), although the baseline scores had significant difference (p = 0.001 for both VAS and WOMAC) with worse scores in higher KL grades. The variables like age, sex, BMI, KL grade, baseline VAS and baseline WOMAC did not predict the final VAS and WOMAC scores. CONCLUSION Triple injection of intra-articular PRP given one month apart significantly relieves the symptoms of knee OA till 2 years in KL grade I, II and III. The improvement in symptoms at 2-year follow-up did not differ across different KL grades.
Collapse
Affiliation(s)
- Najmul Huda
- Department of Orthopaedic Surgery, Teerthankar Mahaveer University, 4th floor, Moradabad, Uttar Pradesh 244001 India
| | - Mir Shahid Ul Islam
- Department of Orthopaedic Surgery, Teerthankar Mahaveer University, 4th floor, Moradabad, Uttar Pradesh 244001 India
| | - Sandeep Bishnoi
- Department of Orthopaedic Surgery, Teerthankar Mahaveer University, 4th floor, Moradabad, Uttar Pradesh 244001 India
| | - Hemant Kumar
- Department of Orthopaedic Surgery, Teerthankar Mahaveer University, 4th floor, Moradabad, Uttar Pradesh 244001 India
| | - Shubham Aggarwal
- Department of Orthopaedic Surgery, Teerthankar Mahaveer University, 4th floor, Moradabad, Uttar Pradesh 244001 India
| | - Aijaz Ahmad Ganai
- Department of Orthopaedic Surgery, Teerthankar Mahaveer University, 4th floor, Moradabad, Uttar Pradesh 244001 India
| |
Collapse
|
4
|
Lin Z, He L. Intra-Articular Injection of PRP in the Treatment of Knee Osteoarthritis Using Big Data. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:4504155. [PMID: 34745498 PMCID: PMC8564187 DOI: 10.1155/2021/4504155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/13/2021] [Accepted: 10/13/2021] [Indexed: 11/23/2022]
Abstract
Observing data on the characteristics of intra-articular injection of sodium citrate for knee osteoarthritis is an important reference value for human safety and evacuation design. To address the problems of slow data collection and poor accuracy of results of knee osteoarthritis behavior, under intensive conditions of intra-articular injection for knee osteoarthritis, this paper designs a data mining-based feature extraction system for intra-articular injection of sodium citrate for knee osteoarthritis. Using the Hadoop architecture, we extract the basic data of human behavior in the two-dimensional plane by storing and stitching the collected continuous data and discriminate the behavioral categories of knee osteoarthritis. We collected a real dataset from 84 patients with knee osteoarthritis treated in our hospital from October 2019 to October 2020. The dataset was divided into 42 patients in the tretinoin group and 42 patients in the sodium glutamate group according to the randomized number table method. The trimethoprim group was treated with intra-articular injection of trimethoprim, and the sodium citrate group was treated with intra-articular injection of sodium citrate. The clinical efficacy, joint mobility, intra-articular fluid volume, Lysholm score of knee joint, numerical pain intensity scale (NRS) score, and adverse effects of the two groups were compared before and after treatment. In our experiments, we observed that, compared with triamcinolone acetonide intra-articular injection, sodium hyaluronate intra-articular injection is more effective in the treatment of knee osteoarthritis. It can effectively improve knee function and reduce pain and adverse reactions.
Collapse
Affiliation(s)
- Zhijin Lin
- Xingtai People's Hospital, Doctor–Patient Communication Office, Xingtai 054001, China
| | - Ling He
- Hebei Eye Hospital, Otolaryngology Head and Neck Surgery, Xingtai 054001, China
| |
Collapse
|
5
|
Song B, Yeh PC, Jayaram P. Leukocyte-rich platelet-rich plasma application in post-traumatic osteoarthritis with popliteal cyst: a case report. Regen Med 2020; 15:1695-1702. [PMID: 32772820 DOI: 10.2217/rme-2020-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To describe the successful treatment of a Baker's cyst in the setting of post-traumatic osteoarthritis using ultrasound-guided injection of platelet-rich plasma. Setting: Outpatient sports clinic. Patient: 29-year old male basketball player. Case description: The patient presented with 2-months history of right knee pain, 17 months after undergoing right knee anterior cruciate ligament reconstruction surgery. Exam revealed medial joint line and medial collateral ligament tenderness with posterior knee swelling. After aspiration, a corticosteroid injection was administered with temporary symptom relief. Diagnostic ultrasound examination confirmed the Baker's cyst. The patient then underwent two serial leukocyte-rich platelet-rich plasma injections into his right knee. Results: The patient reported complete resolution of pain and cyst size. Conclusion: Leukocyte-rich platelet-rich plasma may be considered as a treatment option for patients with Baker's cysts in the setting of post-traumatic osteoarthritis.
Collapse
Affiliation(s)
- Bo Song
- H Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
| | - Peter Chia Yeh
- H Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
| | - Prathap Jayaram
- H Ben Taub Department of Physical Medicine & Rehabilitation, Baylor College of Medicine, Houston, TX 77030, USA
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Mariani E, Pulsatelli L. Platelet Concentrates in Musculoskeletal Medicine. Int J Mol Sci 2020; 21:ijms21041328. [PMID: 32079117 PMCID: PMC7072911 DOI: 10.3390/ijms21041328] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/29/2020] [Accepted: 02/06/2020] [Indexed: 12/02/2022] Open
Abstract
Platelet concentrates (PCs), mostly represented by platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are autologous biological blood-derived products that may combine plasma/platelet-derived bioactive components, together with fibrin-forming protein able to create a natural three-dimensional scaffold. These types of products are safely used in clinical applications due to the autologous-derived source and the minimally invasive application procedure. In this narrative review, we focus on three main topics concerning the use of platelet concentrate for treating musculoskeletal conditions: (a) the different procedures to prepare PCs, (b) the composition of PCs that is related to the type of methodological procedure adopted and (c) the clinical application in musculoskeletal medicine, efficacy and main limits of the different studies.
Collapse
Affiliation(s)
- Erminia Mariani
- Laboratorio di Immunoreumatologia e rigenerazione tissutale, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
- Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-051-6366803
| | - Lia Pulsatelli
- Laboratorio di Immunoreumatologia e rigenerazione tissutale, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
| |
Collapse
|
8
|
Therapeutic efficacy of intra-articular injection of platelet–rich plasma and ozone therapy in patients with primary knee osteoarthritis. EGYPTIAN RHEUMATOLOGIST 2019. [DOI: 10.1016/j.ejr.2018.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
9
|
Atwa ET, Esh AM, Abd El Al IT, Awad YM. Platelet-rich plasma versus corticosteroid injections for carpal tunnel syndrome: Clinical and electrophysiological study. EGYPTIAN RHEUMATOLOGIST 2019. [DOI: 10.1016/j.ejr.2018.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
10
|
Ibrahim DH, El-Gazzar NM, El-Saadany HM, El-Khouly RM. Ultrasound-guided injection of platelet rich plasma versus corticosteroid for treatment of rotator cuff tendinopathy: Effect on shoulder pain, disability, range of motion and ultrasonographic findings. EGYPTIAN RHEUMATOLOGIST 2019. [DOI: 10.1016/j.ejr.2018.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
11
|
Badr MEM, Hafez EAR, El-Ghaweet AI, El-Sayed HM. Intra-articular injection of platelet - rich plasma and therapeutic exercise in knee osteoarthritis. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2018. [DOI: 10.4103/err.err_22_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
|
12
|
Biological Treatment for Osteoarthritis of the Knee: Moving from Bench to Bedside-Current Practical Concepts. Arthroscopy 2018; 34:1719-1729. [PMID: 29628381 DOI: 10.1016/j.arthro.2018.01.048] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/08/2018] [Accepted: 01/26/2018] [Indexed: 02/02/2023]
Abstract
Biological-based therapies for cartilage pathology have gained considerable recognition in the last few decades due to their potential benefits including their minimal invasiveness, capacity for unprecedented healing, and potential for rapid recovery. Consequently, these therapies are likely to have the most noteworthy impact on patients with degenerative joint changes who want to remain active. Currently, the most researched treatments include platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and cell-based therapies. Although further basic science research and well-designed randomized clinical trials are needed to elucidate the long-term role of these therapies in the treatment of osteoarthritis, there is compelling evidence for their use for certain indications. This article aims to review the existing literature for biological-based treatment options for osteoarthritis, critically assessing the current evidence-based recommendations and identify potential avenues for development.
Collapse
|
13
|
Comparative analysis of conventional and biological treatment in healing of bone disease. Saudi J Biol Sci 2018; 25:162-166. [PMID: 29379374 PMCID: PMC5775086 DOI: 10.1016/j.sjbs.2017.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2016] [Revised: 02/02/2017] [Accepted: 02/12/2017] [Indexed: 11/22/2022] Open
Abstract
The healing of Bone tissue consists of a complex process. Hence, we designed our study to evaluate chondrial diseases, which are as they have a very low healing capacity. Seventy two elderly osteoarthritis (OA) and 54-paediatric juvenile idiopathic arthritis (JIA) patients were included. The group was divided as 24 OA patients and 18 JIA patients in each group. Group I received Hyualuronic acid and glucocorticoides. Group II received platelet rich plasma and fibrin glue. Group III received PRP, fibrin glue, and MSC. 40 control patients received only PRP treatment. Out of 72 OA patients 35 (48.6%) male and 37 (51.4%) female with mean age of 48 ± 6.5 years. 64 (88.9%) Patients had pain and swelling. 52 (72.2%) lacked flexibility. 42 (58.3%) had hypertrophy. 28 (38.9%) had less cartilage thickness. 34 (47.2%) were in grade 3, grade 2 has 28 (38.9%) and grade 1 has 10 (13.9%) patients respectively. Among 54 JIA patients 28 (51.9%) male and 26 (48.1%) female patients with mean, age 4.6 ± 3.8 years. 39 (72.2%) had pain and swelling. 32 (59.3%) lacked flexibility. 29 (53.7%) children’s had functional disability. Group I patients showed 30% improvement with no statistical significance (P < 0.21). Group II showed 45% improvement with statistical significance (P < 0.01). In Group III 80%, improvement was observed with statistical significance (P < 0.001). In 40 control patients, 60% improvement was observed. In conclusion, use of these MSC, PRP, and PPP are safe and less cost effective for treating OA and JIA.
Collapse
|
14
|
Samuel S, Ahmad RE, Ramasamy TS, Karunanithi P, Naveen SV, Kamarul T. Platelet-rich concentrate in serum-free medium enhances cartilage-specific extracellular matrix synthesis and reduces chondrocyte hypertrophy of human mesenchymal stromal cells encapsulated in alginate. Platelets 2017; 30:66-74. [PMID: 29090639 DOI: 10.1080/09537104.2017.1371287] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Platelet-rich concentrate (PRC), used in conjunction with other chondroinductive growth factors, have been shown to induce chondrogenesis of human mesenchymal stromal cells (hMSC) in pellet culture. However, pellet culture systems promote cell hypertrophy and the presence of other chondroinductive growth factors in the culture media used in previous studies obscures accurate determination of the effect of platelet itself in inducing chondrogenic differentiation. Hence, this study aimed to investigate the effect of PRC alone in enhancing the chondrogenic differentiation potential of human mesenchymal stromal cells (hMSC) encapsulated in three-dimensional alginate constructs. Cells encapsulated in alginate were cultured in serum-free medium supplemented with only 15% PRC. Scanning electron microscopy was used to determine the cell morphology. Chondrogenic molecular signature of hMSCs was determined by quantitative real-time PCR and verified at protein levels via immunohistochemistry and enzyme-linked immunosorbent assay. Results showed that the cells cultured in the presence of PRC for 24 days maintained a chondrocytic phenotype and demonstrated minimal upregulation of cartilaginous extracellular matrix (ECM) marker genes (SOX9, TNC, COL2, ACAN, COMP) and reduced expression of chondrocyte hypertrophy genes (Col X, Runx2) compared to the standard chondrogenic medium (p < 0.05). PRC group had correspondingly higher levels of glycosaminoglycan and increased concentration of chondrogenic specific proteins (COL2, ACAN, COMP) in the ECM. In conclusion, PRC alone appears to be very potent in inducing chondrogenic differentiation of hMSCs and offers additional benefit of suppressing chondrocyte hypertrophy, rendering it a promising approach for providing abundant pool of chondrogenic MSCs for application in cartilage tissue engineering.
Collapse
Affiliation(s)
- Shani Samuel
- a Department of Physiology, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia.,b Tissue Engineering Group (TEG), National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia
| | - Raja Elina Ahmad
- a Department of Physiology, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia
| | - Thamil Selvee Ramasamy
- c Department of Molecular Medicine, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia
| | - Puvanan Karunanithi
- b Tissue Engineering Group (TEG), National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia
| | - Sangeetha Vasudevaraj Naveen
- b Tissue Engineering Group (TEG), National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia
| | - Tunku Kamarul
- b Tissue Engineering Group (TEG), National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine , University of Malaya , Kuala Lumpur , Malaysia
| |
Collapse
|
15
|
Muchedzi TA, Roberts SB. A systematic review of the effects of platelet rich plasma on outcomes for patients with knee osteoarthritis and following total knee arthroplasty. Surgeon 2017; 16:250-258. [PMID: 28943099 DOI: 10.1016/j.surge.2017.08.004] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Revised: 08/12/2017] [Accepted: 08/15/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Platelet rich plasma (PRP) has been suggested to be effective in the management of knee osteoarthritis. Review of current literature reveals conflicting evidence regarding the benefits of PRP in treating knee OA. Preclinical evidence supports the use of PRP injections to promote a favorable environment for joint tissue healing, targeting not only cartilage but also synovial and meniscal tissues which has a positive effect on delaying the progression of OA. Growth factors found in platelet granules are postulated to influence outcomes in knee OA and after total knee arthroplasty (TKA). METHODOLOGY A systematic review of studies investigating the use of PRP in knee osteoarthritis and following TKA, was performed by searching the following databases for randomised clinical trials and pseudo-randomised clinical and comparative trials comparing the use of PRP to treat knee osteoarthritis and following TKA: MedLine, EMBASE, Science Direct, PubMed, and the Cochrane Library. The primary outcomes were patient reported measures including pain (visual analog scale (VAS)), quality of life scores, and knee function. RESULTS A total of 2328 participants were analyzed across 17 included studies and pooled results showed a statistically significant reduction in pain in favor of PRP following TKA but not in non-surgical management of knee OA (P < 0.0001 and 0.13 respectively). No clinical benefit of PRP was found on quality of life and knee function (P = 0.07 and 0.05) following TKA, although a statistical improvement in knee function was demonstrated in patients with knee OA after PRP injection (P < 0.0001). There was no statistically significant clinical benefit of PRP on secondary outcomes including wound scores and length of hospital stay (p = 0.33 and 0.31, respectively). There was no statistically significant difference in respect to blood loss and overall symptoms in favor of PRP compared to control group following TKA (p = 0.37). CONCLUSION This systematic review demonstrated no long-term statistically significant improvement in patient validated outcomes and secondary outcomes both in patients with knee OA or following TKA for OA. However PRP has been shown to have short to medium-term benefits in pain control after TKA and activities of daily living in patients with OA.
Collapse
Affiliation(s)
| | - Simon B Roberts
- Trauma and Orthopaedics, University of Edinburgh, South Eastern Scotland Deanery, UK.
| |
Collapse
|
16
|
Dhillon MS, Patel S, John R. PRP in OA knee - update, current confusions and future options. SICOT J 2017; 3:27. [PMID: 28322719 PMCID: PMC5360094 DOI: 10.1051/sicotj/2017004] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/10/2017] [Indexed: 12/21/2022] Open
Abstract
Positive results have been uniformly observed by various researchers for platelet-rich plasma (PRP) in early osteoarthritis (OA) knee in the past few years. PRP has clearly demonstrated its supremacy in comparison to hyaluronic acid (HA) and placebo in various clinical trials and is undoubtedly the best option available for symptomatic treatment in early OA. The release of growth factors from PRP occurs immediately and lasts for around three weeks and the clinical effect tends to wane down by the end of the year. Prolonged and sustained release of growth factors from platelets could possibly help in much better biological healing and sustained clinical effects. PRP in combination with biocompatible carriers could be one way of achieving this. Gelatin hydrogel PRP and chitosan PRP seem to be promising based on early in vitro studies and animal studies. PRP in combination with hyaluronic acid also seems to be additive. This article intends to discuss the present status of the PRP, confusions surrounding its use, upcoming trends and ideas for improvising PRP for use early OA knees based on available evidence.
Collapse
Affiliation(s)
- Mandeep S Dhillon
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Sandeep Patel
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rakesh John
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| |
Collapse
|
17
|
Ayaz SB, Rathore FA, Ahmad K, Matee S. The use of complementary health approaches among patients with knee osteoarthritis in Pakistan: A hospital based survey. EGYPTIAN RHEUMATOLOGIST 2016. [DOI: 10.1016/j.ejr.2015.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
18
|
Correlation between synovial vascular endothelial growth factor, clinical, functional and radiological manifestations in knee osteoarthritis. EGYPTIAN RHEUMATOLOGIST 2016. [DOI: 10.1016/j.ejr.2015.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|