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Grimaldi A, Mellor R, Nasser A, Vicenzino B, Hunter DJ. Current and future advances in practice: tendinopathies of the hip. Rheumatol Adv Pract 2024; 8:rkae022. [PMID: 38601140 PMCID: PMC11003818 DOI: 10.1093/rap/rkae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/25/2024] [Indexed: 04/12/2024] Open
Abstract
Tendinopathy describes persistent tendon pain and loss of function related to mechanical loading. Two common hip tendinopathies seen in practice are gluteal tendinopathy and proximal hamstring tendinopathy. Both conditions can be frustrating for patients and clinicians due to the delay in diagnosis, significant disability caused and lack of response to common treatments. Tendinopathy is a clinical diagnosis and can most often be made using findings from the patient interview and pain provocation tests, without the need for imaging. Specific education and progressive exercise offer a low-risk and effective option for gluteal tendinopathy and result in greater rates of treatment success than corticosteroid injection, both in the short term (8 weeks) and at 1 year. Proximal hamstring tendinopathy is a common, but less researched, and under-recognized cause of persistent ischial pain. As research on proximal hamstring tendinopathy is limited, this review summarizes the available evidence on diagnosis and treatment following similar principles to other well-researched tendinopathies.
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Affiliation(s)
- Alison Grimaldi
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
- PhysioTec, Tarragindi, Queensland, Australia
| | - Rebecca Mellor
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
- Gallipoli Medical Research, Greenslopes, Queensland, Australia
| | - Anthony Nasser
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
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Carvalho A, Ferreira AF, Soares M, Santos S, Tomé P, Machado-Simões J, Pais AS, Sousa AP, Paiva A, Almeida-Santos T. Optimization of Platelet-Rich Plasma Preparation for Regenerative Medicine: Comparison of Different Anticoagulants and Resuspension Media. Bioengineering (Basel) 2024; 11:209. [PMID: 38534483 DOI: 10.3390/bioengineering11030209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/15/2024] [Accepted: 02/21/2024] [Indexed: 03/28/2024] Open
Abstract
Platelet-rich plasma (PRP) has emerged as a promising therapy in regenerative medicine. However, the lack of standardization in PRP preparation protocols presents a challenge in achieving reproducible and accurate results. This study aimed to optimize the PRP preparation protocol by investigating the impact of two different anticoagulants, sodium citrate (SC) and ethylenediaminetetraacetic acid (EDTA), and resuspension media, plasma versus sodium chloride (NaCl). Platelet recovery rates were calculated and compared between groups, in addition to platelet activity and vascular endothelial growth factor (VEGF) released into plasma after PRP activation. The platelet recovery rate was higher with EDTA in comparison to SC (51.04% vs. 29.85%, p = 0.005). Platelet activity was also higher, with a higher expression of two platelet antibodies, platelet surface P-Selectin (CD62p) and PAC-1, in the EDTA group. The concentration of VEGF was higher with SC in comparison to EDTA (628.73 vs. 265.44 pg/mL, p = 0.013). Platelet recovery rates and VEGF levels were higher in PRP resuspended in plasma when compared to NaCl (61.60% vs. 48.61%, p = 0.011 and 363.32 vs. 159.83 pg/mL, p = 0.005, respectively). Our study reinforces the superiority of EDTA (as anticoagulant) and plasma (for resuspension) in obtaining a higher platelet recovery and preserving platelet functionality during PRP preparation.
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Affiliation(s)
- Alexandra Carvalho
- Reproductive Medicine Unit, Gynecology, Obstetrics, Reproduction and Neonatology Department, Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, Portugal
- CICS-UBI-Health Sciences Research Centre, University of Beira Interior, 6200-506 Covilhã, Portugal
- CNC-UC-Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
| | - Ana Filipa Ferreira
- Reproductive Medicine Unit, Gynecology, Obstetrics, Reproduction and Neonatology Department, Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, Portugal
- CNC-UC-Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Maria Soares
- CNC-UC-Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- Doctoral Programme in Experimental Biology and Biomedicine (PDBEB), Institute for Interdisciplinary Research, University of Coimbra, 3000-456 Coimbra, Portugal
| | - Susana Santos
- Flow Cytometry Unit, Clinical Pathology Department, Centro Hospitalar e Universitário de Coimbra EPE, 3000-075 Coimbra, Portugal
| | - Patrícia Tomé
- Flow Cytometry Unit, Clinical Pathology Department, Centro Hospitalar e Universitário de Coimbra EPE, 3000-075 Coimbra, Portugal
| | - Juliana Machado-Simões
- CNC-UC-Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- Department of Life Sciences, University of Coimbra, 3000-456 Coimbra, Portugal
| | - Ana Sofia Pais
- Reproductive Medicine Unit, Gynecology, Obstetrics, Reproduction and Neonatology Department, Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, Portugal
- CNC-UC-Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
| | - Ana Paula Sousa
- Reproductive Medicine Unit, Gynecology, Obstetrics, Reproduction and Neonatology Department, Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, Portugal
- CNC-UC-Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
| | - Artur Paiva
- Flow Cytometry Unit, Clinical Pathology Department, Centro Hospitalar e Universitário de Coimbra EPE, 3000-075 Coimbra, Portugal
- Center for Innovative Biomedicine and Biotechnology (CIBB), Institute for Clinical and Biomedical Research (iCBR), University of Coimbra, 3000-548 Coimbra, Portugal
- Ciências Biomédicas Laboratoriais, ESTESC-Coimbra Health School, Instituto Politécnico de Coimbra, 3046-854 Coimbra, Portugal
| | - Teresa Almeida-Santos
- Reproductive Medicine Unit, Gynecology, Obstetrics, Reproduction and Neonatology Department, Centro Hospitalar e Universitário de Coimbra, 3004-561 Coimbra, Portugal
- CNC-UC-Center for Neuroscience and Cell Biology, University of Coimbra, 3004-504 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
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Livadas N, Cuff A, Loughran I, Chesterton P. United Kingdom physiotherapists injection therapy practice for musculoskeletal complaints: A cross-sectional survey. Musculoskelet Sci Pract 2024; 69:102889. [PMID: 38056376 DOI: 10.1016/j.msksp.2023.102889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/09/2023] [Accepted: 11/20/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Physiotherapists in the United Kingdom (UK), who have received additional training can adopt injection therapy for the treatment of musculoskeletal (MSK) disorders. OBJECTIVES The objective of this practice survey was to explore (i) the frequency of use of injection therapy by UK physiotherapists for MSK disorders; and (ii) the clinical reasoning for selection of injectate, dose and pre/post injection practice. DESIGN Cross-sectional online survey. METHODS The online survey was disseminated via social media and professional networks over a 3-month period. Responses to closed multiple choice survey questions were analysed with descriptive data, with reporting of confidence intervals at 95%. Open questions were analysed using content analysis. RESULTS The survey received 320 responses. The majority (86.6%, n = 277) used landmark guided approaches. The highest frequency of injections administered were for trigger digits, sub acromial pain and the knee joint. Corticosteroid drugs were widely used (99.7%, n = 319, CI 95% 98 to 100) with Triamcinolone (Kenalog) being the most frequently utilised for both joints (58.8%, n = 160, 53 to 65) and soft tissues (46.3%, n = 126, 40 to 52). Drug choice was largely based on availability in clinic (47.1%, n = 128, 41 to 53). Drug doses for common injection sites varied among the respondents with variation also evident in pre and post-injection practice. CONCLUSION Marked variation across some elements of injection therapy practice was evident. Notable differences in corticosteroid preparation used, the doses of drug injected, and the use of local anaesthetic were reported by respondents. Injecting physiotherapists should endeavour to ensure practice is aligned to best available evidence.
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Affiliation(s)
- Nick Livadas
- Connect Health, Floor 3, The Lightbox, Q2, Quorum Business Park, Benton Lane, Newcastle upon Tyne, Tyne and Wear, NE12 8EU, UK; School of Health and Life Sciences, Teesside University, TS1 3BX, UK.
| | - Andrew Cuff
- Connect Health, Floor 3, The Lightbox, Q2, Quorum Business Park, Benton Lane, Newcastle upon Tyne, Tyne and Wear, NE12 8EU, UK; Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Brooks Building, 53 Bonsall Street, M15 6GX, UK
| | | | - Paul Chesterton
- School of Health and Life Sciences, Teesside University, TS1 3BX, UK
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Hewavithana PB, Wettasinghe MC, Hettiarachchi G, Ratnayaka M, Suraweera H, Wickramasinghe ND, Kumarasiri PVR. Effectiveness of single intra-bursal injection of platelet-rich plasma against corticosteroid under ultrasonography guidance for shoulder impingement syndrome: a randomized clinical trial. Skeletal Radiol 2024; 53:51-58. [PMID: 37266723 DOI: 10.1007/s00256-023-04373-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/26/2023] [Accepted: 05/28/2023] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To compare the effectiveness of intra-bursal injection of single-dose platelet-rich plasma (PRP) against corticosteroids under ultrasonography guidance in shoulder impingement syndrome (SIS). MATERIALS AND METHODS This single-blind randomized controlled trial was conducted on 60 participants with a clinical diagnosis of SIS from a selected orthopedic clinic. Thirty participants in each arm were given a single dose of either PRP or triamcinolone acetonide into the subacromial sub-deltoid bursa (SASD) under ultrasonography guidance. The outcome variables assessed were the severity score of pain and the degree of shoulder abduction. Post-treatment follow-up was done in 1 week, 3 months, 6 months, and 1 year. RESULTS At 1 week, the triamcinolone arm showed a statistically significant reduction of pain (p = 0.039) when compared to PRP. In the long term, PRP showed statistically significant improvement in shoulder abduction, compared to the triamcinolone injection (p = 0.012). CONCLUSION PRP and triamcinolone in the SASD bursa could be considered as safe treatment options for SIS under ultrasonography guidance. While triamcinolone was effective in short-term pain reduction, PRP was effective in long-term improvement in shoulder abduction.
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Affiliation(s)
| | | | - Gothami Hettiarachchi
- Department of Radiology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Manel Ratnayaka
- Department of Pathology, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka
| | - Hilary Suraweera
- Department of Orthopaedics and Trauma, Teaching Hospital Peradeniya, Kandy, Sri Lanka
| | - Nuwan Darshana Wickramasinghe
- Department of Community Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
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Guszczyn T, Kulesza M, Kicman A, Motyka J, Ławicki S. Enhanced Pain Relief and Function Improvement in Children with Osgood-Schlatter Disease: Leukocyte-Rich Platelet-Rich Plasma (LR-PRP) as a Complementary Treatment to Standard Conservative Therapy. Med Sci Monit 2023; 29:e941523. [PMID: 38105547 PMCID: PMC10740339 DOI: 10.12659/msm.941523] [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: 06/19/2023] [Accepted: 10/05/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Osgood-Schlatter disease (OSD) causes pain and loss of function of the knee in growing children. This study aimed to evaluate pain and function of the knee joint in 152 growing children with chronic OSD before and after treatment with LR-PRP when used with standard conservative treatment. MATERIAL AND METHODS Treatment efficacy was evaluated using the VAS, Tegner, Lyshom, and KOOS scales. Patient satisfaction, post-surgery athletic performance, and X-ray assessment were also used to determine the success of the procedure. RESULTS We found that 75% of the subjects were satisfied with the results of the treatment, and 72% of the subjects returned to full physical activity. The analysis showed a significant decrease in the median VAS score after treatment compared to the pre-treatment score (P<0.05), and an increase in the median scores of the Tegner, Lysholm, and KOOS scales compared to the pre-treatment score (P<0.05; P<0.05; P<0.05, respectively). The results showed that the shorter the duration of the disease, the better the treatment results were received. Return to activity and patient satisfaction were highest in the study group previously rehabilitated. CONCLUSIONS LR-PRP injection of the tibial tuberosity in patients with chronic OSD with open growth cartilage is an effective and uncomplicated method. We did not observe any adverse effects, which suggests the relatively high safety of the procedure. The use of PRP in the earlier phase of the disease and additional rehabilitation before treatment significantly increases the effectiveness of treatment.
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Affiliation(s)
- Tomasz Guszczyn
- Department of Pediatric Orthopaedics and Traumatology, Medical University of Białystok, Białystok, Poland
| | - Monika Kulesza
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Białystok, Białystokn Poland
| | - Aleksandra Kicman
- Departmeent of Aesthetic Medicine, Medical University of Białystok, Białystok, Poland
| | - Joanna Motyka
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Białystok, Białystokn Poland
| | - Sławomir Ławicki
- Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Białystok, Białystokn Poland
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Halm-Pozniak A, Lohmann CH, Awiszus F, Rudolf M, Bertrand J, Berth A. Injection of autologous conditioned plasma combined with a collagen scaffold may improve the clinical outcome in shoulder impingement syndrome: a prospective study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:3623-3630. [PMID: 37253875 PMCID: PMC10651528 DOI: 10.1007/s00590-023-03595-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/17/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Shoulder impingement syndrome (SIS) is one of the most common diseases of the shoulder and can be addressed with various therapeutic concepts. Orthobiological agents such as platelet rich plasma with a low side effect rate gain importance in the conservative treatment of SIS. Currently, the knowledge about success rate influencing factors, such as the growth factors (GF) concentration or acromion type, is limited. The aim of this study was to analyze the clinical outcome in the therapy of external SIS using autologous conditioned plasma combined with recombinant human collagen scaffold (ACP/STR) injection in comparison with a corticosteroid-local anesthetic (CSA) injection. Additionally, the influence of potential limiting factors such as GF concentration, age and acromial morphology was proved. MATERIALS AND METHODS This prospective pseudo-randomized trial recruited 58 patients with external SIS who received an ultrasound-guided subacromial injection either an ACP/STR or a CSA followed by physical therapy. Follow-up (FU) was performed at 6 weeks, 3 and 6 months. The outcome was assessed with Constant-Murley score, disability of arm, shoulder and hand score and simple shoulder test. The concentration of GF was measured using ELISA. RESULTS During the FU, the improvement of outcome measures was observed with no differences between both groups. Shoulder force was significantly increased in the ACP/STR group (p < 0.01). We found no correlation between the amount of GF and age or gender in the ACP/STR patients. An acromion Bigliani type III predisposes for therapy failure (p < 0.001, OR = 56) in both treatment groups. CONCLUSIONS Patients with SIS benefit regarding to PROMs after both ACP/STR and CSA injection and physical therapy. Patients who received ACP/STR obtained superior improvement in force. The quantity of GF did not vary depending on the age, so that ACP/STR can be a treatment option for SIS in elderly patients with multimorbidity. The presence of an acromion type III seems to be a predictive factor for limited effectivity of injections in the clinical management of SIS.
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Affiliation(s)
- Agnieszka Halm-Pozniak
- Department of Orthopaedic Surgery, Otto-Von-Guericke-University Magdeburg, 44 Leipziger St., 39120, Magdeburg, Germany.
| | - Christoph H Lohmann
- Department of Orthopaedic Surgery, Otto-Von-Guericke-University Magdeburg, 44 Leipziger St., 39120, Magdeburg, Germany
| | - Friedemann Awiszus
- Department of Orthopaedic Surgery, Otto-Von-Guericke-University Magdeburg, 44 Leipziger St., 39120, Magdeburg, Germany
| | - Margit Rudolf
- Department of Orthopaedic Surgery, Otto-Von-Guericke-University Magdeburg, 44 Leipziger St., 39120, Magdeburg, Germany
| | - Jessica Bertrand
- Department of Orthopaedic Surgery, Otto-Von-Guericke-University Magdeburg, 44 Leipziger St., 39120, Magdeburg, Germany
| | - Alexander Berth
- Department of Orthopaedic Surgery, Otto-Von-Guericke-University Magdeburg, 44 Leipziger St., 39120, Magdeburg, Germany
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Shomal Zadeh F, Shafiei M, Shomalzadeh M, Pierce J, Thurlow PC, Chalian M. Percutaneous ultrasound-guided needle tenotomy for treatment of chronic tendinopathy and fasciopathy: a meta-analysis. Eur Radiol 2023; 33:7303-7320. [PMID: 37148349 DOI: 10.1007/s00330-023-09657-2] [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: 01/24/2023] [Revised: 01/24/2023] [Accepted: 02/26/2023] [Indexed: 05/08/2023]
Abstract
OBJECTIVES To systematically assess the efficacy of percutaneous ultrasound-guided needle tenotomy (PUNT) in the treatment of chronic tendinopathy and fasciopathy. METHODS A comprehensive literature search was performed with the following search terms: tendinopathy, tenotomy, needling, Tenex, fasciotomy, ultrasound-guided, and percutaneous. Inclusion criteria consisted of original studies evaluating pain or function improvement after PUNT. Meta-analyses investigating standard mean differences were performed to assess the pain and function improvement. RESULTS Thirty-five studies with 1674 participants (1876 tendons) were enrolled in this article. Of which 29 articles were included in meta-analysis and the remaining 9 articles without enough numeric data were included in descriptive analysis. PUNT significantly alleviated pain with the standard mean difference of 2.5 (95% CI: 2.0-3.0; p < 0.05), 2.2 (95% confidence interval (CI): 1.8-2.7; p < 0.05), and 3.6 (95% CI: 2.8-4.5; p < 0.05) points in short-term, intermediate-term, and long-term follow-up intervals, respectively. It was also associated with marked improvement in function with 1.4 (95% CI: 1.1-1.8; p < 0.05), 1.8 (95% CI: 1.3-2.2; p < 0.05), and 2.1 (95% CI: 1.6-2.6; p < 0.05) points, respectively in short-term, intermediate-term, and long-term follow-ups. CONCLUSION PUNT improved pain and function at short-term intervals with persistent results on intermediate- and long-term follow-ups. PUNT can be considered an appropriate minimally invasive treatment for chronic tendinopathy with a low rate of complications and failures. CLINICAL RELEVANCE Tendinopathy and fasciopathy are two common musculoskeletal complaints that can cause prolonged pain and disability. PUNT as a treatment option could improve pain intensity and function. KEY POINTS • The best improvement in pain and function was achieved after the first 3 months following PUNT and was continued to the intermediate- and long-term follow-ups. • No significant difference was found between different tenotomy methods in terms of pain and function improvement. • PUNT is a minimally invasive procedure with promising results and low complication rates for treatments of chronic tendinopathy.
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Affiliation(s)
- Firoozeh Shomal Zadeh
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA
| | - Mehrzad Shafiei
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA
| | - Mostafa Shomalzadeh
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA
| | - Jennifer Pierce
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Virginia, Charlottesville, VA, USA
| | - Peter Christian Thurlow
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA
| | - Majid Chalian
- Musculoskeletal Imaging and Intervention, Department of Radiology, University of Washington, Seattle, WA, USA.
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Poff G, Spencer E, Scott B, Sleadd R, Broyles J. Comparison of Clinical Outcomes after Platelet-Rich Plasma and Rotator Cuff Repair in High-Grade Intrasubstance Partial Rotator Cuff Tears. J Clin Med 2023; 12:5554. [PMID: 37685621 PMCID: PMC10488403 DOI: 10.3390/jcm12175554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/12/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023] Open
Abstract
Platelet-rich plasma injections have been shown to have many useful applications in various musculoskeletal pathologies. Research on the use of PRP for intrasubstance partial-thickness rotator cuff tears is lacking, although these tears have unique properties that may increase the efficacy of platelet-rich plasma injections. Patients with MRI-confirmed high-grade intrasubstance partial-thickness rotator cuff tears, that had failed traditional non-operative treatment, were offered either surgical repair (Group 1) or a single ultrasound-guided platelet-rich plasma injection into the tear site (Group 2). Patients were followed at 2 weeks, 6 weeks, 3 months, and a minimum of 2 years post-injection with ASES scores. A total of 25 patients received platelet-rich plasma injections, compared to 20 patients who had rotator cuff repair for intrasubstance tears in the last 3 years. The mean pre-injection ASES score for the platelet-rich plasma group was 53.2 and this improved to 92.9 at a minimum 2-year follow-up. The average convalescence period following platelet-rich plasma injection was 3.3 months. The average post-operative convalescence period for arthroscopic rotator cuff repair was 4.6 months. Both surgical repair and platelet-rich plasma injection into the tear site are equally effective in the treatment of high-grade intrasubstance partial-thickness rotator cuff tears, while platelet-rich plasma provides significantly shorter recovery time.
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Affiliation(s)
- Grayson Poff
- Ortho Tennessee, Knoxville, TN 37923, USA; (E.S.); (B.S.); (R.S.); (J.B.)
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9
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Stewart ZE, Lee K. Lower extremity ultrasound-guided interventions: tendon, ligament, and plantar fascia. Skeletal Radiol 2023; 52:991-1003. [PMID: 36326878 DOI: 10.1007/s00256-022-04212-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Lower extremity tendinopathy and soft tissue injury are common clinical problems that can cause significant disability. Ultrasound-guided minimally invasive treatments using orthobiologics and image-guided percutaneous treatments continue to gain relevance with an ever-growing body of literature. We review the indications, technique, risks, and benefits according to the literature of common ultrasound-guided interventions utilized in the lower extremities.
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Affiliation(s)
- Zachary E Stewart
- Department of Radiology - Musculoskeletal Imaging and Intervention, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, Yawkey Bldg Room 6033, Boston, MA, 02114, USA.
| | - Kenneth Lee
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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10
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Mavrogenis AF, Karampikas V, Zikopoulos A, Sioutis S, Mastrokalos D, Koulalis D, Scarlat MM, Hernigou P. Orthobiologics: a review. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05803-z. [PMID: 37071148 DOI: 10.1007/s00264-023-05803-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/30/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE The use of biologic materials in orthopaedics (orthobiologics) has gained significant attention over the past years. To enhance the body of the related literature, this review article is aimed at summarizing these novel biologic therapies in orthopaedics and at discussing their multiple clinical implementations and outcomes. METHODS This review of the literature presents the methods, clinical applications, impact, cost-effectiveness, and outcomes, as well as the current indications and future perspectives of orthobiologics, namely, platelet-rich plasma, mesenchymal stem cells, bone marrow aspirate concentrate, growth factors, and tissue engineering. RESULTS Currently available studies have used variable methods of research including biologic materials as well as patient populations and outcome measurements, therefore making comparison of studies difficult. Key features for the study and use of orthobiologics include minimal invasiveness, great healing potential, and reasonable cost as a nonoperative treatment option. Their clinical applications have been described for common orthopaedic pathologies such as osteoarthritis, articular cartilage defects, bone defects and fracture nonunions, ligament injuries, and tendinopathies. CONCLUSIONS Orthobiologics-based therapies have shown noticeable clinical results at the short- and mid-term. It is crucial that these therapies remain effective and stable in the long term. The optimal design for a successful scaffold remains to be further determined.
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Affiliation(s)
- Andreas F Mavrogenis
- First Department of OrthopaedicsNational and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
| | - Vasileios Karampikas
- First Department of OrthopaedicsNational and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Alexandros Zikopoulos
- First Department of OrthopaedicsNational and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Spyridon Sioutis
- First Department of OrthopaedicsNational and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitrios Mastrokalos
- First Department of OrthopaedicsNational and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitrios Koulalis
- First Department of OrthopaedicsNational and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Martin SD, Eberlin CT, Kucharik MP, Cherian NJ. Harvest and Application of Bone Marrow Aspirate Concentrate to Address Acetabular Chondral Damage During Hip Arthroscopy. JBJS Essent Surg Tech 2023; 13:e22.00010. [PMID: 38274149 PMCID: PMC10807885 DOI: 10.2106/jbjs.st.22.00010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
Background During hip arthroscopy, managing concomitant cartilage damage and chondrolabral junction breakdown remains an ongoing challenge for orthopaedic surgeons, as previous studies have associated such lesions with inferior postoperative outcomes1-7. Although higher-level studies are needed to fully elucidate the benefits, recent literature has provided supporting preliminary evidence for the utilization of bone marrow aspirate concentrate (BMAC) in patients with moderate cartilage damage and full-thickness chondral flaps undergoing acetabular labral repair7,8. Thus, as the incorporation of orthobiologics continues to advance, there is a clinical demand for an efficient and reliable BMAC-harvesting technique that utilizes an anatomical location with a substantial concentration of connective tissue progenitor (CTP) cells, while avoiding donor-site morbidity and minimizing additional operative time. Thus, we present a safe and technically feasible approach for harvesting bone marrow aspirate from the body of the ilium, followed by centrifugation and application during hip arthroscopy. Description After induction of anesthesia and appropriate patient positioning, a quadrilateral arrangement of arthroscopic portals is established to perform puncture capsulotomy9. Upon arthroscopic visualization of cartilage/chondrolabral junction injury, 52 mL of whole venous blood is promptly obtained from an intravenous access site and combined with 8 mL of anticoagulant citrate dextrose solution A (ACD-A). The mixture is centrifuged to yield approximately 2 to 3 mL of platelet-rich plasma (PRP) and 17 to 18 mL of platelet-poor plasma (PPP). Then, approaching along the coronal plane and aiming toward the anterior-superior iliac spine under fluoroscopic guidance, a heparin-rinsed Jamshidi bone marrow biopsy needle is driven through the lateral cortex of the ilium just proximal to the sourcil. Under a relative negative-pressure vacuum, bone marrow is aspirated into 3 separate heparin-rinsed 50 mL syringes, each containing 5 mL of ACD-A. Slow and steady negative pressure should be used to pull back on the syringe plunger to aspirate a total volume of 40 mL into each syringe. To avoid pelvic cavity compromise and minimize the risk of mobilizing marrow-space contents, care should be taken to ensure that no forward force or positive pressure is applied during the aspiration process. A total combined bone marrow aspirate/ACD-A mixture of approximately 120 mL is consistently harvested and subsequently centrifuged to yield roughly 4 to 6 mL of BMAC. The final mixture containing BMAC, PRP, and PPP is combined with thrombin to generate a megaclot, which is then applied to the central compartment of the hip. Alternatives Currently, strategies to address acetabular cartilage lesions may include microfracture, autologous chondrocyte implantation, matrix-induced autologous chondrocyte implantation, autologous matrix-induced chondrogenesis, osteochondral allografts, and orthobiologics10. Orthobiologics have shown mixed yet promising results for addressing musculoskeletal injuries and may include bone-marrow-derived mesenchymal stromal cells, adipose tissue derivatives, and PRP7,8,11,12. Specifically, bone marrow aspirate can be harvested from numerous locations, such as the iliac crest, the proximal aspect of the humerus, the vertebral body, and the distal aspect of the femur. Moreover, alternative approaches have utilized multiple-site and/or needle-redirection techniques to optimize cellular yield16,17, while also appreciating the potentially variable cellular characteristics of aspirated and/or processed samples18. However, previous literature has demonstrated that the body of the ilium contains a CTP cell concentration that is similar to or greater than other harvest locations when utilizing this outlined single-site and unidirectional aspirating technique13,14. Rationale This versatile and updated technique is a safe and reproducible method for BMAC harvesting, processing, and application that avoids donor-site morbidity, obtains a substantial concentration of CTP cells, minimizes additional operative time, and limits the hip arthroscopy and aspiration to a single procedure15. Specifically, this technique details an evidence-supported approach to addressing chondral injury in patients undergoing acetabular labral repairs7,8. Expected Outcomes Patients with moderate cartilage damage treated with BMAC at the time of labral repair experienced significantly greater improvements in functional outcomes at 12 and 24 months postoperatively compared with similar patients without BMAC augmentation7. Furthermore, patients with full-thickness chondral flaps treated with BMAC at the time of arthroscopic labral repair demonstrated significantly greater improvements in functional outcomes at 12 months compared with microfracture. Moreover, 77.6% of the BMAC cohort reached the minimal clinically important difference threshold for the International Hip Outcome Tool-33 (iHOT-33) compared with 50.0% in the microfracture group8. Important Tips Utilize the previously established Dienst arthroscopic portal for the bone marrow aspiration in order to avoid secondary donor site morbidity.Under fluoroscopic guidance, approach the ilium along the coronal plane, aiming toward the anterior superior iliac spine.With a heparin-rinsed Jamshidi bone marrow biopsy needle, penetrate the lateral cortex of the ilium just proximal to the sourcil in order to consistently harvest a total combined bone marrow aspirate/ACD-A volume of approximately 120 mL.Simultaneously perform the bone marrow aspirate and whole venous blood centrifugation during the hip arthroscopy procedure in order to minimize additional operative time.Bone marrow aspiration should be performed without applied traction in order to minimize the risk of neurovascular complications associated with extended traction time. Acronyms and Abbreviations ACD-A = anticoagulant citrate dextrose solution AADSCs = adipose-derived stem cellsASIS = anterior superior iliac spineBMAC = bone marrow aspirate concentrateCI = confidence intervalCTP = connective tissue progenitorDVT = deep vein thrombosisHOS-ADL = Hip Outcome Score, Activities of Daily LivingiHOT-33 = International Hip Outcome Tool-33MCID = minimal clinically important differenceMRA = magnetic resonance arthrogramMSCs = mesenchymal stromal cellsPPP = platelet-poor plasmaPRP = platelet-rich plasmaRBCs = red blood cellsSD = standard deviationT1 = longitudinal relaxation timeT2 = transverse relaxation timeWBCs = white blood cells.
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Affiliation(s)
- Scott D. Martin
- Department of Orthopedics, Sports Medicine Center, Mass General Brigham, Boston, Massachusetts
| | - Christopher T. Eberlin
- Department of Orthopedics, Sports Medicine Center, Mass General Brigham, Boston, Massachusetts
| | - Michael P. Kucharik
- Department of Orthopedics, Sports Medicine Center, Mass General Brigham, Boston, Massachusetts
| | - Nathan J. Cherian
- Department of Orthopedics, Sports Medicine Center, Mass General Brigham, Boston, Massachusetts
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12
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Reddy AK, Lulkovich K, Wirtz A, Thompson JC, Scott JT, Checketts JX, Ottwell R, Hanson CD, Hartwell M, Vassar M. Assessment of Spin in the Abstracts of Systematic Reviews and Meta-analyses on Platelet-Rich Plasma Treatment in Orthopaedics: A Cross-sectional Analysis. Orthop J Sports Med 2023; 11:23259671221137923. [PMID: 36814771 PMCID: PMC9940191 DOI: 10.1177/23259671221137923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Background Systematic reviews on the use of platelet-rich plasma (PRP) in orthopaedic surgery are abundant in current published literature. However, a beautification of results (referred to as spin) has been noted in abstracts across various aspects of medicine. Purpose To determine the prevalence of spin in systematic reviews of PRP-related orthopaedic surgery abstracts. Study Design Cross-sectional study. Methods Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and Murad and Wang guidelines, we conducted a search in Medline, Embase, and the Cochrane Database for reviews on PRP-related orthopaedic surgery. The search included studies published from inception until June 30, 2021. Included were systematic reviews written in English that involved the use of PRP in the treatment of orthopaedic injuries in human participants. The abstracts of the included reviews were evaluated for the top 9 types of spin as described by Yavchitz et al in 2016. We determined the relationship between spin and study characteristics using odds ratios. Results Of an initial 1560 studies, 176 were included. We found that 50 studies (28.4%) contained at least 1 form of spin. The 2 most common forms of spin found in our sample were type 5 ("Conclusion claims the beneficial effect of treatment despite high risk of bias"; n = 27 [15.3%]) and type 3 ("Selective reporting or overemphasis of efficacy in outcomes favoring beneficial effect of intervention"; n = 18 [10.2%]). No statistical significance was found between study characteristics and the presence of spin. Conclusion Spin was present in 28% of the systematic reviews that covered PRP-related orthopaedic treatments. Spin was not associated with general study characteristics, including adherence to PRISMA guidelines or funding. Journals and authors should be aware of spin in articles and avoid its usage.
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Affiliation(s)
- Arjun K. Reddy
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA.,Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA.,Arjun K. Reddy, BA, Oklahoma State University Center for Health Sciences, 1111 W 17th St, Tulsa, OK 74107, USA () (Twitter: @ArjunKot918)
| | - Kaley Lulkovich
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Alexis Wirtz
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Jay C. Thompson
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Jared T. Scott
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Jake X. Checketts
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Ryan Ottwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
| | - Chad D. Hanson
- Department of Orthopedic Surgery, Oklahoma State University Medical Center, Tulsa, Oklahoma, USA
| | - Micah Hartwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences at The Cherokee Nation, Tahlequah, Oklahoma, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, Oklahoma, USA
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13
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Xu J, Du W, Xue X, Chen M, Zhou W, Luo X. Global research trends on platelet-rich plasma for tendon and ligament injuries from the past two decades: A bibliometric and visualized study. Front Surg 2023; 10:1113491. [PMID: 36843990 PMCID: PMC9950278 DOI: 10.3389/fsurg.2023.1113491] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/19/2023] [Indexed: 02/12/2023] Open
Abstract
Background In sports medicine, tendon and ligament injuries are the most prevalent conditions, and with the booming of sports competition, the incidence of sports injuries is gradually increasing, investigating more potent therapeutic options is therefore becoming increasingly crucial. Platelet-rich plasma therapy has gained popularity as an effective and secure treatment in recent years. Currently, a faceted systematic and clear visual analysis is lacking in this research area. Methods The literature related to using platelet-rich plasma to treat ligament and tendon injuries from 2003 to 2022 in the core dataset of the Web of Science database was collected and analyzed visually using Citespace 6.1 software. Research hotspots and development trends were analyzed in terms of high-impact countries or regions, authors, research institutions, keywords, and cited literature. Results The literature comprised a total of 1,827 articles. The annual publication volume of relevant literature has demonstrated a significant development tendency as the field of platelet-rich plasma research for tendon and ligament injuries has heated up in recent years. With 678 papers, the United States came in top place, followed by China with 187 papers. Hosp Special Surg ranked first with 56 papers. The hot research topics analyzed by keywords were tennis elbow, anterior cruciate ligament, rotator cuff repair, achilles tendon, mesenchymal stem cells, guided tissue regeneration, network meta analysis, chronic patellar tendinopathy, and follow up. Conclusion Analysis of the research literature over the past 20 years shows that the United States and China will continue to dominate in terms of volume of publications based on annual volume and trends, with some collaboration among high-impact authors and further collaboration still needed in different countries and institutions. Platelet-rich plasma is widely used in the treatment of tendon ligament injuries. Its clinical efficacy is influenced by a number of factors, the main ones being the inconsistency in the preparation and composition of platelet-rich plasma and its related preparations, and the differences in efficacy due to different activation methods of platelet-rich plasma, as well as factors such as injection time, injection site, administration method, number of administrations, acidity and evaluation methods, In addition, the applicability to different injury diseases remains controversial. In recent years, the molecular biology of platelet-rich plasma for tendon ligament therapy has received increasing attention.
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Affiliation(s)
- Jie Xu
- Department of Sports Medicine, Sichuan Provincial Orthopedics Hospital, Chengdu, China
| | - Wanli Du
- Department of Cervicodynia/Omalgia/Lumbago/Sciatica 2, Sichuan Provincial Orthopedics Hospital, Chengdu, China
| | - Xiali Xue
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Meng Chen
- Department of Emergency Medicine, Nanchong Hospital of Traditional Chinese Medicine, Nanchong, China
| | - Wenqi Zhou
- Department of Sports Medicine, Sichuan Provincial Orthopedics Hospital, Chengdu, China
| | - Xiaobing Luo
- Department of Sports Medicine, Sichuan Provincial Orthopedics Hospital, Chengdu, China,Correspondence: Xiaobing Luo
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14
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Marigi EM, Cummings PE, Marigi IM, Burgos W, Gillett J, Camp CL, Krych AJ, Okoroha KR. Hamstring Injuries: Critical Analysis Review of Current Nonoperative Treatments. JBJS Rev 2022; 10:01874474-202211000-00002. [PMID: 36574459 DOI: 10.2106/jbjs.rvw.22.00095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
➢ Hamstring injuries are common among active and athletic individuals, especially those involved in high-speed running, distance running, or sports requiring sudden directional changes. Acute hamstring strains often occur as an eccentric strain during running or a stretch-type injury caused by simultaneous hip flexion and knee extension. Proximal hamstring tendinopathy is an overuse injury of the hamstring tendon as a result of chronic cicatrization of the musculotendinous unit. ➢ Repeated stress to the hamstring tendon leads to increased cellularity of tendon fibers, disruption of collagen, and subsequent microinjury of the tissue that attaches the tendon to bone. ➢ Management of hamstring injuries generally begins with nonoperative modalities consisting of eccentric rehabilitative exercise programs. Although various other treatment modalities are available, the comparative efficacy of these supportive measures is not well differentiated at this time. ➢ In this article, we review the current literature with regard to the nonoperative treatment of hamstring injuries, specifically focusing on acute hamstring muscle strains and proximal hamstring tendinopathy in order to provide supplementary insight on the effectiveness of current modalities.
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Affiliation(s)
- Erick M Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Paige E Cummings
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ian M Marigi
- School of Medicine, Washington University in St. Louis, St. Louis, Missouri
| | - William Burgos
- Minnesota Timberwolves Basketball Club, Minneapolis, Minnesota
| | - Javair Gillett
- Minnesota Timberwolves Basketball Club, Minneapolis, Minnesota
| | | | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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15
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Autologous conditioned serum in equine and human orthopedic therapy: A systematic review. Res Vet Sci 2022; 146:34-52. [DOI: 10.1016/j.rvsc.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 11/04/2021] [Accepted: 03/07/2022] [Indexed: 01/15/2023]
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16
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Paramanantham M, Seenappa H, Venkataraman S, Shanthappa AH. Functional Outcome of Platelet-Rich Plasma (PRP) Intra-lesional Injection for Tennis Elbow – A Prospective Cohort Study. Cureus 2022; 14:e22974. [PMID: 35415041 PMCID: PMC8990042 DOI: 10.7759/cureus.22974] [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] [Accepted: 03/08/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Platelet-Rich Plasma (PRP) is an autologous human plasma preparation with a higher platelet concentration. Injection of PRP were, found to be effective in treating tendinopathy and arthritis. A few studies only focused in using PRP injection in patients with tennis elbow. This study was conducted to access the functional outcome of PRP injection in tennis elbow patients. Methodology A prospective study was done from June 2020 to June 2021, at R. L. Jalappa Hospital, Kolar, India among 80 individuals diagnosed with tennis elbow. All individuals aged between 18 to 65 years of either gender and the pain symptoms not subsided with oral analgesics or physiotherapy were included in this study. We analysed all the patients with a MAYO elbow performance score and Visual Analogue Pain Scale (VAS) during the follow-up period. Results In total, 80 individuals participated in our study, of which the mean age of the participants was 45.54. There is statistical significance in the difference of means of pain score obtained using both VAS and MAYO score at 12 weeks and 24 weeks. There is high significant positive correlation of age with the pain scores at 12th week and 24th week after the procedure. Conclusion In tennis elbow patients, PRP injection shows an effective reduction in pain according to VAS and MAYO score and especially, younger age patients have shown more benefit in terms of pain reduction with PRP treatment.
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17
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Dyson-Hudson TA, Hogaboom NS, Nakamura R, Terry A, Malanga GA. Ultrasound-guided platelet-rich plasma injection for the treatment of recalcitrant rotator cuff disease in wheelchair users with spinal cord injury: A pilot study. J Spinal Cord Med 2022; 45:42-48. [PMID: 32379581 PMCID: PMC8890529 DOI: 10.1080/10790268.2020.1754676] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Context/Objective: Wheelchair users with spinal cord injury (SCI) have a high risk of developing shoulder pain, caused by rotator cuff disease. Platelet-rich plasma (PRP) is a potential treatment after conservative treatments fail and prior to surgical intervention; however, it has not been tested in wheelchair users who have recalcitrant shoulder pain associated with rotator cuff disease. The objective of this pilot project was to test the safety and potential treatment effect of an ultrasound-guided PRP injection for shoulder pain in the aforementioned population.Design: Prospective, quasi-experimental.Setting: Clinical research center.Participants: Six wheelchair users with SCI (3 paraplegia, 3 tetraplegia) who had chronic shoulder pain due to rotator cuff disease (presence of anterior shoulder pain, positive physical examination tests for rotator cuff disease, and tendinopathy demonstrated by ultrasound) and failed at least six months of conservative treatment.Interventions: Ultrasound-guided PRP injection into pathological shoulder tendons, targeting the supraspinatus. Subjects were provided a standardized stretching and strengthening program and were followed for 4, 8, 12, and 24 weeks post-intervention with outcomes collected at each time-point.Outcome Measures: Wheelchair User's Shoulder Pain Index (WUSPI); pain Numerical Rating Scale (NRS); physical and ultrasound examinations for supraspinatus tendinopathy; 5-point patient global impression of change (PGIC).Results: WUSPI (69.9%, P < 0.001), NRS (49.6%, P < 0.01), and physical exam scores (35.7%, P < 0.01) decreased 24 weeks after treatment. Participants reported overall improvement in their status as a result of the treatment. No adverse events were noted, and no changes in ultrasound markers for tendinopathy were observed.Conclusion: A single, ultrasound-guided PRP injection into the supraspinatus tendon, followed by a stretching and strengthening exercise program, was safe and provided improvements in shoulder pain outcome measures in this sample for 24 weeks. Lack of blinding, short-term follow-up, and a suitable control group warrant a larger randomized controlled trial.Trial Registration: NCT01355549.
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Affiliation(s)
- Trevor A. Dyson-Hudson
- Kessler Foundation, West Orange, New Jersey, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA,Correspondence to: Trevor A. Dyson-Hudson, Kessler Foundation, 1199 Pleasant Valley Way, West Orange, New Jersey07052, USA.
| | - Nathan S. Hogaboom
- Kessler Foundation, West Orange, New Jersey, USA,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Reina Nakamura
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Alon Terry
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Gerard A. Malanga
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA,Kessler Institute for Rehabilitation, West Orange, New Jersey, USA,New Jersey Regenerative Institute, LLC, Cedar Knolls, New Jersey, USA
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18
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Cecerska-Heryć E, Goszka M, Serwin N, Roszak M, Grygorcewicz B, Heryć R, Dołęgowska B. Applications of the regenerative capacity of platelets in modern medicine. Cytokine Growth Factor Rev 2021; 64:84-94. [PMID: 34924312 DOI: 10.1016/j.cytogfr.2021.11.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/20/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023]
Abstract
Platelets produce platelet growth factors such as PDGF, IGF-1, EGF-, HGF, TGFβ, bFGF, and VEGF, which are crucial in regulating all stages of the wound healing process. The source of these substances is platelet-rich plasma (PRP). Over the past five decades, the interest and use of the regenerative properties of platelets have increased significantly in many different fields of medicine around the world. PRP and PRF plate preparations are used in: 1. Dentistry (they reduce bleeding, facilitate and accelerate soft tissue healing and bone regeneration - FGF 2, IGF-1, IGF-2, TGF-β1, and PDGF); 2. Sports medicine - IGF-1, IGF-2, TGF-β, VEGF, PDGF and bFGF, EGF); 3. dermatology and cosmetology (treatment of alopecia, hair reconstruction - FGF-7, HGF, acne scars, skin rejuvenation and regeneration, treatment of chronic and poorly healing wounds, burns, and acquired vitiligo); 4. Gynecology and reproductive medicine (treatment of infertility, erectile dysfunction - PDGF-β, TGF-β, IGF-1, in sexual dysfunction - PDGF, in vaginal atrophy); 5 Ophthalmology (in the healing of corneal epithelial wounds, in the treatment of dormant corneal ulcers, dry eye syndrome and the reconstruction of the corneal surface; 6. Neurology (regeneration of neurons, pain alleviation, and clinical symptoms - TGF-β 1, IGF-1, PDGF, VEGF) and FGF). Platelet-rich plasma therapy is a very interesting alternative and complement to traditional methods of treatment. However, the potential for using platelets is still not fully understood. The composition of platelet-rich plasma depends on many factors that may affect its use's efficacy and clinical benefits. Further research is necessary to standardize PRP delivery's preparation procedures and methods for a specific disease entity or clinical case.
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Affiliation(s)
- Elżbieta Cecerska-Heryć
- Department of Laboratory Medicine, Pomeranian Medical University of Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland.
| | - Małgorzata Goszka
- Department of Laboratory Medicine, Pomeranian Medical University of Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Natalia Serwin
- Department of Laboratory Medicine, Pomeranian Medical University of Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Marta Roszak
- Department of Laboratory Medicine, Pomeranian Medical University of Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Bartłomiej Grygorcewicz
- Department of Laboratory Medicine, Pomeranian Medical University of Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Rafał Heryć
- Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University of Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland
| | - Barbara Dołęgowska
- Department of Laboratory Medicine, Pomeranian Medical University of Szczecin, Powstancow Wielkopolskich 72, 70-111 Szczecin, Poland
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19
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Evans JP, Maffulli N, Smith C, Watts A, Valderas J, Goodwin V. Even experts cannot agree on the optimal use of platelet-rich plasma in lateral elbow tendinopathy: an international Delphi study. J Orthop Traumatol 2021; 22:47. [PMID: 34825302 PMCID: PMC8617097 DOI: 10.1186/s10195-021-00608-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/31/2021] [Indexed: 11/25/2022] Open
Abstract
Background Platelet-rich plasma (PRP) is widely used in the management of lateral elbow tendinopathy (LET) despite conflicting evidence on its effectiveness. With high levels of user experience, this study aimed to assess consensus amongst experts on its clinical use. Methods A three-round international Delphi study was conducted. Participants were invited through national society mailing lists and contact lists derived from a systematic search of the literature on PRP. In round one, a primary working group developed 40 statements on PRP preparation and clinical application. In rounds two and three, an international group of researchers on PRP and clinical users of the device scored their levels of agreement with the statements on a five-point scale. Consensus was defined as an interquartile range of ≤ 1. Results Consensus of agreement was only reached for 17/40 (42.5%) statements. For statements on PRP formulation, consensus of agreement was reached in 2/6 statements (33%). Only limited consensus on the contraindications, delivery strategy and delivery technique was achieved. Conclusion Experts reached very limited consensus on the use of PRP in LET. High levels of user experience have not resulted in a convergence of opinion on the technical components of PRP formulation and delivery, substantiating the need for further studies and improved trial reporting. Supplementary Information The online version contains supplementary material available at 10.1186/s10195-021-00608-5.
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Affiliation(s)
- Jonathan P Evans
- Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, UK. .,Health Services and Policy Research Group, University of Exeter, Smeal Building, St Luke's, Exeter, UK.
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno, Salerno, Italy.,Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UK.,Institute of Science and Technology in Medicine, Keele University School of Medicine, Thorburrow Drive, Stoke on Trent, UK
| | - Chris Smith
- Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, UK
| | - Adam Watts
- Wrightington Wigan and Leigh NHS Trust, Wrightington Hospital, Hill Lane, Wigan, UK
| | - Jose Valderas
- Health Services and Policy Research Group, University of Exeter, Smeal Building, St Luke's, Exeter, UK
| | - Vicki Goodwin
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, University of Exeter Medical School, Exeter, UK
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20
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Affiliation(s)
- Jeffrey N Katz
- Orthopedic and Arthritis Center for Outcomes Research, Division of Rheumatology, Inflammation and Immunity, Department of Orthopedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
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21
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El-Kadiry AEH, Rafei M, Shammaa R. Cell Therapy: Types, Regulation, and Clinical Benefits. Front Med (Lausanne) 2021; 8:756029. [PMID: 34881261 PMCID: PMC8645794 DOI: 10.3389/fmed.2021.756029] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/01/2021] [Indexed: 12/12/2022] Open
Abstract
Cell therapy practices date back to the 19th century and continue to expand on investigational and investment grounds. Cell therapy includes stem cell- and non-stem cell-based, unicellular and multicellular therapies, with different immunophenotypic profiles, isolation techniques, mechanisms of action, and regulatory levels. Following the steps of their predecessor cell therapies that have become established or commercialized, investigational and premarket approval-exempt cell therapies continue to provide patients with promising therapeutic benefits in different disease areas. In this review article, we delineate the vast types of cell therapy, including stem cell-based and non-stem cell-based cell therapies, and create the first-in-literature compilation of the different "multicellular" therapies used in clinical settings. Besides providing the nuts and bolts of FDA policies regulating their use, we discuss the benefits of cell therapies reported in 3 therapeutic areas-regenerative medicine, immune diseases, and cancer. Finally, we contemplate the recent attention shift toward combined therapy approaches, highlighting the factors that render multicellular therapies a more attractive option than their unicellular counterparts.
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Affiliation(s)
- Abed El-Hakim El-Kadiry
- Laboratory of Thrombosis and Hemostasis, Montreal Heart Institute, Research Center, Montreal, QC, Canada
- Department of Biomedical Sciences, Université de Montréal, Montreal, QC, Canada
| | - Moutih Rafei
- Department of Pharmacology and Physiology, Université de Montréal, Montreal, QC, Canada
- Department of Microbiology, Infectious Diseases and Immunology, Université de Montréal, Montreal, QC, Canada
- Molecular Biology Program, Université de Montréal, Montreal, QC, Canada
- Department of Microbiology and Immunology, McGill University, Montreal, QC, Canada
| | - Riam Shammaa
- Canadian Centre for Regenerative Therapy, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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22
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Barman A, Mishra A, Maiti R, Sahoo J, Thakur KB, Sasidharan SK. Can platelet-rich plasma injections provide better pain relief and functional outcomes in persons with common shoulder diseases: a meta-analysis of randomized controlled trials. Clin Shoulder Elb 2021; 25:73-89. [PMID: 34823313 PMCID: PMC8907495 DOI: 10.5397/cise.2021.00353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 07/26/2021] [Indexed: 11/26/2022] Open
Abstract
Background To evaluate the efficacy of autologous platelet-rich plasma (PRP) injections in the treatment of common shoulder diseases. Methods The PubMed, Medline, and Central databases and trial registries were searched from their inception to October 2020 for randomized controlled trials of autologous PRP injections for shoulder diseases versus placebo or any control intervention. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed in the selection, analysis, and reporting of findings. The primary outcome was pain intensity (visual analog scale), and secondary outcomes were changes in function and quality of life (QoL). Results A total of 17 randomized controlled trials of PRP versus control were analyzed. From 8–12 weeks to ≥1 year, PRP injections were associated with better pain relief and functional outcomes than control interventions. PRP injections were also associated with greater QoL, with an effect size of 2.61 (95% confidence interval, 2.01–14.17) at medium-term follow-up. Compared with placebo and corticosteroid injections, PRP injections provided better pain relief and functional improvement. In subgroup analyses, trials in which PRP was prepared by the double centrifugation technique, the platelet concentration in the PRP was enriched ≥5 times, leucocyte-rich PRP was used, or an activating agent was used before application reported the most effective pain relief at 6–7 months. Conclusions PRP injections could provide better pain relief and functional outcomes than other treatments for persons presenting with common shoulder diseases. PRP injections have a greater capacity to improve shoulder-related QoL than other interventions.
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Affiliation(s)
- Apurba Barman
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Archana Mishra
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Rituparna Maiti
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Jagannatha Sahoo
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Kaustav Basu Thakur
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sreeja Kamala Sasidharan
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, India
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Foo GL, Knudsen JS, Bacon CJ, Mei-Dan O, McConkey MO, Brick MJ. Peri-operative platelet-rich plasma in arthroscopic femoroacetabular impingement surgery: a randomized controlled trial. J Hip Preserv Surg 2021; 8:14-21. [PMID: 34567596 PMCID: PMC8460155 DOI: 10.1093/jhps/hnab001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
This study aimed to determine whether the addition of platelet-rich plasma (PRP) during hip arthroscopy improves functional outcomes in femoroacetabular impingement (FAI) surgery. This was a prospective randomized single-blinded trial of arthroscopic hip patients aged between 16 and 50 years with a diagnosis of FAI conducted at a single centre. Patients with any previous hip surgery and significant osteoarthritic changes (Tonnis grade > 2) were excluded. Before surgery, patients were randomly assigned to receive either a PRP injection or a saline placebo. Efficacy was evaluated at 6 months, 1 year and 2 years post-surgery using patient-reported outcomes. The short version International Hip Outcome Tool (iHOT12) was the primary outcome. Recruited patients (n = 113) were aged 36.0 ± 10.5 (mean ± standard deviation) years and 56% male. At baseline, iHOT12 scores of the PRP (mean 43.8 ± 22.4) and placebo groups (mean 45.2 ± 21.5) were similar. At a minimum follow-up of 2 years, both groups had improved iHOT12 scores (PRP: mean 83.6 ± 13.4, control: mean 77.1 ± 23.3), with no significant difference in change between the two groups (P = 0.19). There were no significant group differences for the change in Non-Arthritic Hip and Hip Disability and Osteoarthritis Outcome Score—Shortform scores between the two groups (P = 0.22 and 0.46, respectively). The present study does not support the peri-operative use of PRP in arthroscopic surgery for FAI for mid-term improvement. There were no significant differences in outcome between PRP and placebo groups at 2-year minimum follow-up after surgery.
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Affiliation(s)
- Gen Lin Foo
- Orthosports North Harbour Ltd., AUT Millenium, 17 Antares Place, Rosedale 0632, New Zealand
| | - Joshua Sapong Knudsen
- New Zealand Orthopaedic Association, Level 12, Ranchhod Tower, 39, The Terrace, Wellington 6011, New Zealand
| | - Catherine Jane Bacon
- Orthosports North Harbour Ltd. & School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Omer Mei-Dan
- Division of Sports Medicine and Hip Preservation, Department of Orthopaedics, University of Colorado School of Medicine, Boulder, Colorado, USA
| | - Mark Owen McConkey
- Division of Arthroscopic, Reconstructive Surgery and Joint Preservation, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada
| | - Matthew John Brick
- Orthosports North Harbour Ltd., AUT Millenium , 17 Antares Place, Rosedale 0632, New Zealand
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Deshmukh V, Seo T, O'Green A, Ibanez M, Hofilena B, KC S, Stewart J, Dellamary L, Chiu K, Ghias A, Barroga C, Kennedy S, Tambiah J, Hood J, Yazici Y. SM04755, a small-molecule inhibitor of the Wnt pathway, as a potential topical treatment for tendinopathy. J Orthop Res 2021; 39:2048-2061. [PMID: 33104243 PMCID: PMC8451793 DOI: 10.1002/jor.24898] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/01/2020] [Accepted: 10/21/2020] [Indexed: 02/04/2023]
Abstract
The Wnt pathway is upregulated in tendinopathy, affecting inflammation and tenocyte differentiation. Given its potential role in tendinopathy, this signaling pathway may be a relevant target for treatment. The current study examined the therapeutic potential of SM04755, a topical, small-molecule Wnt pathway inhibitor, for the treatment of tendinopathy using in vitro assays and animal models. In vitro, SM04755 decreased Wnt pathway activity, induced tenocyte differentiation, and inhibited catabolic enzymes and pro-inflammatory cytokines in human mesenchymal stem cells, rat tendon-derived stem cells, and human peripheral blood mononuclear cells. Evaluation of the mechanism of action of SM04755 by biochemical profiling and computational modeling identified CDC-like kinase 2 (CLK2) and dual-specificity tyrosine phosphorylation-regulated kinase 1A (DYRK1A) as molecular targets. CLK and DYRK1A inhibition by siRNA knockdown or pharmacological inhibition induced tenocyte differentiation and reduced tenocyte catabolism. In vivo, topically applied SM04755 showed therapeutically relevant exposure in tendons with low systemic exposure and no detectable toxicity in rats. Moreover, SM04755 showed reduced tendon inflammation and evidence of tendon regeneration, decreased pain, and improved weight-bearing function in rat collagenase-induced tendinopathy models compared with vehicle control. Together, these data demonstrate that CLK2 and DYRK1A inhibition by SM04755 resulted in Wnt pathway inhibition, enhanced tenocyte differentiation and protection, and reduced inflammation. SM04755 has the potential to benefit symptoms and modify disease processes in tendinopathy.
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Affiliation(s)
| | - Tim Seo
- Samumed, LLCSan DiegoCaliforniaUSA
| | | | | | | | - Sunil KC
- Samumed, LLCSan DiegoCaliforniaUSA
| | | | | | | | | | | | | | | | - John Hood
- Formerly Samumed, LLCSan DiegoCaliforniaUSA
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de Andrade ALL, Sardeli AV, Garcia TA, Livani B, Belangero WD. PRP does not improve the objective outcomes of anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2021; 29:3049-3058. [PMID: 33169180 DOI: 10.1007/s00167-020-06348-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Platelet rich plasma (PRP) has been used in association with anterior cruciate ligament resconstruction (ACLR) to improve rehabilitation. The purpose was to systematically review the literature to compare the effects of PRP on ACLR in its objective and subjective outcomes. METHODS A systematic review of the MEDLINE, Web of Science, Embase, Scopus, and Cochrane databases was performed. Two independent reviewers included all the English language literature of patients undergoing primary ACLR with autograft combined with PRP. The outcomes analyzed were graft ligamentization (MRI), tibial and femoral tunnel widening (MRI), knee laxity, IKDC, Lysholm, Tegner activity scale and visual analog scale. RESULTS Nine studies were included with a total of 525 patients. PRP did not improve ligamentization of graft (standardized mean difference (SMD): 0.01 [95% CI: - 0.37; 0.39]), did not lead to lesser tunnel widening (SMD: 0.71 [95% CI: - 0.12; 1.54]), or lead to lesser knee laxity (raw mean difference: 0.33 [95% CI: - 0.84; 0.19]). Although there was statistical significance for PRP effects on Lysholm score and VAS (p < 0.01), their magnitude was limited. CONCLUSION PRP showed no improvement in objective outcomes like ligamentization and less tunnel widening, while it showed just small improvements in terms of Lysholm, VAS and knee laxity. Therefore, there is not enough evidence to support a recommendation in favor of PRP and more research is needed. LEVEL OF EVIDENCE I.
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Affiliation(s)
| | - Amanda Veiga Sardeli
- Laboratory of Exercise Physiology-FISEX, University of Campinas-UNICAMP, Campinas, Brazil
| | - Thiago Alves Garcia
- Orthopaedic Biomaterials Laboratory, School of Medical Sciences, University of Campinas-UNICAMP, Campinas, SP, Brazil
| | - Bruno Livani
- Faculty of Medical Sciences, University of Campinas-UNICAMP, Campinas, SP, Brazil
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Niemiec P, Szyluk K, Balcerzyk A, Kalita M, Jarosz A, Iwanicka J, Iwanicki T, Nowak T, Negru M, Francuz T, Garczorz W, Grzeszczak W, Górczyńska-Kosiorz S, Kania W, Żak I. Why PRP works only on certain patients with tennis elbow? Is PDGFB gene a key for PRP therapy effectiveness? A prospective cohort study. BMC Musculoskelet Disord 2021; 22:710. [PMID: 34407802 PMCID: PMC8375168 DOI: 10.1186/s12891-021-04593-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/07/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is variability in individual response to platelet-rich plasma (PRP) therapy in tennis elbow treatment. Genetic variation, especially within genes encoding growth factors may influence the observed inter-individual differences. The purpose of this study was to identify polymorphic variants of the platelet-derived growth factor beta polypeptide gene (PDGFB) that determine an improved individual response to PRP therapy in tennis elbow patients. METHODS This prospective cohort study was designed in accordance with STROBE and MIBO guidelines. A cohort of 107 patients (132 elbows, 25 bilateral) was studied, including 65 females (77 elbows) and 42 males (55 elbows), aged 24-64 years (median 46.00 ± 5.50), with lateral elbow tendinopathy treated with autologous PRP injection. The effectiveness of PRP therapy was recorded in all subjects at 2, 4, 8, 12, 24 and 52 weeks after PRP injection using the Visual Analog Scale (VAS), quick version of Disabilities of the Arm, Shoulder and Hand score (QDASH) and Patient-Rated Tennis Elbow Evaluation (PRTEE). In order to determine the PDGFB variants with the best response to PRP therapy, patient reported outcome measures were compared between individual genotypes within studied polymorphic variants (rs2285099, rs2285097, rs2247128, rs5757572, rs1800817 and rs7289325). The influence of single nucleotide polymorphisms on blood and PRP parameters, including the concentration of PDGF-AB and PDGF-BB proteins was also analyzed. RESULTS Our analysis identified genetic variants of the PDGFB gene that lead to a better response to PRP therapy. The TT (rs2285099) and CC (rs2285097) homozygotes had higher concentration of platelets in whole blood than carriers of other genotypes (p = 0.018) and showed significantly (p < 0.05) lower values of VAS (weeks 2-12), QDASH and PRTEE (weeks 2-24). The rs2285099 and rs2285097 variants formed strong haplotype block (r2 = 98, D'=100). The AA homozygotes (rs2247128) had significantly lower values of VAS (weeks 4-52), QDASH and PRTEE (weeks 8, 12). CONCLUSIONS PDGFB gene's polymorphisms increase the effectiveness of PRP therapy in tennis elbow treatment. Genotyping two polymorphisms of the PDGFB gene, namely rs2285099 (or rs2285097) and rs2247128 may be a helpful diagnostic tool while assessing patients for PRP therapy and modifying the therapy to improve its effectiveness.
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Affiliation(s)
- Paweł Niemiec
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, Medyków 18 str, 40-752, Katowice, Poland.
| | - Karol Szyluk
- District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 str, 41-940, Piekary Śląskie, Poland
| | - Anna Balcerzyk
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, Medyków 18 str, 40-752, Katowice, Poland
| | - Marcin Kalita
- District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 str, 41-940, Piekary Śląskie, Poland
| | - Alicja Jarosz
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, Medyków 18 str, 40-752, Katowice, Poland
| | - Joanna Iwanicka
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, Medyków 18 str, 40-752, Katowice, Poland
| | - Tomasz Iwanicki
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, Medyków 18 str, 40-752, Katowice, Poland
| | - Tomasz Nowak
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, Medyków 18 str, 40-752, Katowice, Poland
| | - Marius Negru
- Trauma and Orthopaedics Departament, St. Bernard's Hospital, Harbour Views Rd, GX11 1AA, Gibraltar, UK
| | - Tomasz Francuz
- Department of Biochemistry, School of Medicine in Katowice, Medical University of Silesia in Katowice, Medyków 18 str, 40-752, Katowice, Poland
| | - Wojciech Garczorz
- Department of Biochemistry, School of Medicine in Katowice, Medical University of Silesia in Katowice, Medyków 18 str, 40-752, Katowice, Poland
| | - Władysław Grzeszczak
- Department of Internal Medicine, Diabetology and Nephrology, School of Medicine, Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, 41-800, Zabrze, Poland
| | - Sylwia Górczyńska-Kosiorz
- Department of Internal Medicine, Diabetology and Nephrology, School of Medicine, Division of Dentistry in Zabrze, Medical University of Silesia in Katowice, 41-800, Zabrze, Poland
| | - Wojciech Kania
- Department of Trauma and Orthopedic Surgery, Multidisciplinary Hospital in Jaworzno, Chełmońskiego 28 Str, 43-600, Jaworzno, Poland
| | - Iwona Żak
- Department of Biochemistry and Medical Genetics, School of Health Sciences in Katowice, Medical University of Silesia in Katowice, Medyków 18 str, 40-752, Katowice, Poland
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Muthu S, Patel S, Selvaraj P, Jeyaraman M. Comparative analysis of leucocyte poor vs leucocyte rich platelet-rich plasma in the management of lateral epicondylitis: Systematic review & meta-analysis of randomised controlled trials. J Clin Orthop Trauma 2021; 19:96-107. [PMID: 34046304 PMCID: PMC8144683 DOI: 10.1016/j.jcot.2021.05.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 02/08/2023] Open
Abstract
STUDY DESIGN Systematic Review & Meta-analysis. OBJECTIVES We aim to comparatively analyse the efficacy and safety of using leucocyte-poor platelet rich plasma (LP-PRP) against leucocyte-rich platelet rich plasma (LR-PRP) in the management of lateral epicondylitis. MATERIALS AND METHODS We conducted independent and duplicate electronic database searches including PubMed, Embase, Web of Science and Cochrane Library till September 2020 for randomised controlled trials analyzing the efficacy and safety of LP-PRP and LR-PRP in the management of lateral epicondylitis. Visual Analog Score(VAS) for pain, Disabilities of the Arm, Shoulder and Hand (DASH) Score, Patient Reported Tennis-Elbow Evaluation (PRETEE) Score, Mayo Elbow Performance Score(MEPS) and adverse events were the outcomes analyzed. Analysis was performed in R-platform using OpenMeta[Analyst] software. RESULTS We performed a single arm meta-analysis of 26 studies involving 2034 patients. On analysis it was noted that significant improvement was noted in the VAS for pain (p < 0.001), DASH score (p < 0.001), PRETEE score (p < 0.001) and MEPS (p < 0.027) compared to their pre-operative state. No significant increase in adverse events were noted compared to the control group (p = 0.170). While stratifying the results based on the type of PRP used, no significant difference was noted between the use of LP-PRP or LR-PRP in any of the above-mentioned outcome measures. CONCLUSION PRP is a safe and effective treatment option for lateral epicondylitis with clinical improvements in pain and functional scores and both types of PRP (LR-PRP & LP-PRP) offer similar results.
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Affiliation(s)
- Sathish Muthu
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
| | - Sandeep Patel
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Preethi Selvaraj
- Department of Community Medicine, SRM Medical College Hospital and Research Centre, SRM University Chennai, Tamil Nadu, India
| | - Madhan Jeyaraman
- Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
- Corresponding author.
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Jayaseelan DJ, T Faller B, H Avery M. The utilization and effects of filiform dry needling in the management of tendinopathy: a systematic review. Physiother Theory Pract 2021; 38:1876-1888. [PMID: 33904812 DOI: 10.1080/09593985.2021.1920076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Tendinopathy is frequently associated with pain, soft tissue impairments and muscle performance limitations. Dry needling (DN) incorporates a fine filiform needle to penetrate the skin and underlying soft tissue in an effort to decrease pain and improve function. While injectable interventions and gauged-needle tendon fenestration for tendinopathy has been reviewed, DN for tendinopathy has yet to be synthesized.Objective: To systematically review the utilization and effects of DN for tendinopathy.Methods: Six electronic databases (PubMed, CINAHL, Scopus, SportDiscus, PEDro and the Cochrane Library) were searched from inception through August 15, 2020, using appropriate keywords and relevant synonyms.Results: After screening 462 articles, 10 studies met inclusion criteria. Study designs included case reports, case series, and randomized clinical trials. DN was used in isolation in 3/10 studies and as part of a multimodal approach in 7/10 studies. DN was associated with improved pain, function, muscle performance and perceived improvement in each study evaluating the relevant outcome. Conflicting results were found in comparative studies evaluating DN.Conclusions: DN may be a useful adjunctive treatment in the conservative management of tendinopathy, although its discrete effect is unclear. Very Low-quality evidence and methodological limitations suggest further investigation is warranted.
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Affiliation(s)
- Dhinu J Jayaseelan
- Department of Health, Human Function and Rehabilitation Sciences, Program in Physical Therapy, George Washington University, . Washington DC, USA
| | - Brian T Faller
- Department of Health, Human Function and Rehabilitation Sciences, Program in Physical Therapy, George Washington University, . Washington DC, USA
| | - Melinda H Avery
- International Spine Pain and Performance Center, Washington DC, USA
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Nasser AM, Vicenzino B, Grimaldi A, Anderson J, Semciw AI. Proximal Hamstring Tendinopathy: A Systematic Review of Interventions. Int J Sports Phys Ther 2021; 16:288-305. [PMID: 33842025 PMCID: PMC8016446 DOI: 10.26603/001c.21250] [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] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/11/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Proximal hamstring tendinopathy affects athletic and non-athletic populations and is associated with longstanding buttock pain. The condition is common in track and field, long distance running and field-based sports. Management options need to be evaluated to direct appropriate clinical management. PURPOSE/HYPOTHESIS To evaluate surgical and non-surgical interventions used in managing proximal hamstring tendinopathy. STUDY DESIGN Systematic review. METHODS Electronic databases were searched to January 2019. Studies (all designs) investigating interventions for people with proximal hamstring tendinopathy were eligible. Outcomes included symptoms, physical function, quality of life and adverse events. Studies were screened for risk of bias. Reporting quality was assessed using the Cochrane Risk of Bias Tool (Randomized Controlled Trials [RCT]) and the Joanna Briggs Institute Checklist (Case Series). Effect sizes (Standard mean difference or Standard paired difference) of 0.2, 0.5 and 0.8 were considered as small, medium and large respectively. Overall quality of evidence was rated according to GRADE guidelines. RESULTS Twelve studies (2 RCTs and 10 case series) were included (n=424; males 229). RCTs examined the following interventions: platelet-rich plasma injection (n=1), autologous whole-blood injection (n=1), shockwave therapy (n=1) and multi-modal intervention (n=1). Case series included evaluation of the following interventions: platelet-rich plasma injection (n=3), surgery (n=4), corticosteroid injection (n=2), multi-modal intervention + platelet-rich plasma injection (n=1). Very low-level evidence found shockwave therapy was more effective than a multi-modal intervention, by a large effect on improving symptoms (-3.22 SMD; 95% CI -4.28, -2.16) and physical function (-2.42 SMD; 95% CI-3.33, -1.50) in the long-term. There was very low-level evidence of no difference between autologous whole-blood injection and platelet-rich plasma injection on physical function (0.17 SMD; 95% CI -0.86, 1.21) to (0.24 SMD; 95% CI -0.76, 1.24) and quality of life (-0.04 SMD; 95%CI -1.05, 0.97) in the medium-term. There was very low-quality evidence that surgery resulted in a large reduction in symptoms (-1.89 SPD; 95% CI -2.36, -1.41) to (-6.02 SPD; 95% CI -8.10, -3.94) and physical function (-4.08 SPD; 95%CI -5.53, -2.63) in the long-term. CONCLUSIONS There is insufficient evidence to recommend any one intervention over another. A pragmatic approach would be to initially trial approaches proven successful in other tendinopathies. LEVEL OF EVIDENCE Level 2a.
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Affiliation(s)
- Anthony Michael Nasser
- Department of Rehabilitation, Nutrition and Sport, La Trobe University; Graduate School of Health, University of Technology Sydney
| | | | | | | | - Adam Ivan Semciw
- Department of Rehabilitation, Nutrition and Sport, La Trobe University; Northern Centre for Health Education and Research, Northern Health
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30
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Challoumas D, Millar NL. Do we need to improve the reporting of evidence in tendinopathy management? A critical appraisal of systematic reviews with recommendations on strength of evidence assessment. BMJ Open Sport Exerc Med 2021; 7:e000920. [PMID: 33692904 PMCID: PMC7907875 DOI: 10.1136/bmjsem-2020-000920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To critically appraise the quality of published systematic reviews (SRs) of randomised controlled trials (RCTs) in tendinopathy with regard to handling and reporting of results with special emphasis on strength of evidence assessment. Data sources Medline from inception to June 2020. Study eligibility All SRs of RCTs assessing the effectiveness of any intervention(s) on any location of tendinopathy. Data extraction and synthesis Included SRs were appraised with the use of a 12-item tool devised by the authors arising from the Preferred Reporting Items in Systematic Reviews and Meta-Analyses statement and other relevant guidance. Subgroup analyses were performed based on impact factor (IF) of publishing journals and date of publication. Results A total of 57 SRs were included published in 38 journals between 2006 and 2020. The most commonly used risk-of-bias (RoB) assessment tool and strength of evidence assessment tool were the Cochrane Collaboration RoB tool and the Cochrane Collaboration Back Review Group tool, respectively. The mean score on the appraisal tool was 46.5% (range 0%–100%). SRs published in higher IF journals (>4.7) were associated with a higher mean score than those in lower IF journals (mean difference 26.4%±8.8%, p=0.004). The mean score of the 10 most recently published SRs was similar to that of the first 10 published SRs (mean difference 8.3%±13.7%, p=0.54). Only 23 SRs (40%) used the results of their RoB assessment in data synthesis and more than half (n=30; 50%) did not assess the strength of evidence of their results. Only 12 SRs (21%) assessed their strength of evidence appropriately. Conclusions In light of the poor presentation of evidence identified by our review, we provide recommendations to increase transparency and reproducibility in future SRs.
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Affiliation(s)
- Dimitris Challoumas
- Institute of Infection, Immunity and Inflammation College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Neal L Millar
- Institute of Infection, Immunity and Inflammation College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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31
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Kirschner JS, Cheng J, Hurwitz N, Santiago K, Lin E, Beatty N, Kingsbury D, Wendel I, Milani C. Ultrasound-guided percutaneous needle tenotomy (PNT) alone versus PNT plus platelet-rich plasma injection for the treatment of chronic tendinosis: A randomized controlled trial. PM R 2021; 13:1340-1349. [PMID: 33644963 DOI: 10.1002/pmrj.12583] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 02/11/2021] [Accepted: 02/15/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Tendinosis is a chronic degenerative condition. Current research suggests both percutaneous needle tenotomy (PNT) and leukocyte-rich platelet-rich plasma (LR-PRP) may be effective treatments for chronic tendinosis, but no studies have assessed the effectiveness of PNT alone versus PNT with intratendinous LR-PRP for multiple tendon types in a single study. OBJECTIVE To assess the efficacy of PNT versus PNT + LR-PRP to treat chronic tendinosis. STUDY DESIGN Double-blind, randomized, controlled comparative treatment study. SETTING Primary academic institution. PARTICIPANTS A convenience sample of 40 participants who had chronic tendinosis (rotator cuff, wrist extensor, wrist flexor, hip abductor, proximal hamstring, patellar, or Achilles) confirmed via ultrasound, failed conservative treatment, and did not have tendon tears, known coagulopathy, or systemic illnesses. INTERVENTIONS Participants were randomly assigned to PNT (n = 19) or PNT + LR-PRP (n = 21). Participants and outcomes assessors were blinded to treatment assignments. PNT was performed with 20-30 passes of a 22-gauge needle under ultrasound guidance, with 1% lidocaine given outside the tendon. LR-PRP was processed from whole blood (30-60 mL) and injected into the affected tendon using the same PNT technique. MAIN OUTCOME MEASURES Primary outcome was current numerical rating scale pain at 6 weeks. Secondary outcomes were average pain, function, general well-being, and sleep quality at 6, 52, and 104 weeks. RESULTS Baseline characteristics were similar between groups. Overall, there were no significant differences between groups over time for any of the outcomes (P > .05). Between-group analyses showed significantly lower current and average pain after PNT compared to PNT + LR-PRP at 6 weeks (estimated-mean [SE]: 3.1[0.4] vs. 4.6[0.6], P = .04; 3.4[0.4] vs. 4.9[0.5], P = .03) only. Adverse event rates were low (PNT-3.9%; PNT + LR-PRP-5.0%) and related primarily to postprocedural pain and inflammation. CONCLUSIONS Although pain scores were lower after PNT compared to PNT + LR-PRP at 6 weeks, there were no between-group differences in outcomes at 52 or 104 weeks.
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Affiliation(s)
| | - Jennifer Cheng
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Nicole Hurwitz
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Kristen Santiago
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Emerald Lin
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Nicholas Beatty
- Department of Rehabilitation Medicine, Mount Sinai Hospital, New York, New York, USA
- Regenerative SportsCare Institute, New York, New York, USA
| | - Dallas Kingsbury
- Department of Rehabilitation Medicine, NYU Langone Health, New York, New York, USA
| | - Ian Wendel
- Tri-County Orthopedics, Cedar Knolls, New Jersey, USA
| | - Carlo Milani
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
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Huang YC, Wu CT, Chen MF, Kuo YH, Li JM, Shi CS. Intracavernous Injection of Autologous Platelet-Rich Plasma Ameliorates Hyperlipidemia-Associated Erectile Dysfunction in a Rat Model. Sex Med 2021; 9:100317. [PMID: 33529811 PMCID: PMC8072173 DOI: 10.1016/j.esxm.2020.100317] [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] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/23/2020] [Accepted: 12/28/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Hyperlipidemia is associated with an increased risk of erectile dysfunction (ED) mediated by endothelial damage. Platelet-rich plasma (PRP) contains numerous angiogenic growth factors. Currently, evidence supporting the use of PRP for ED treatment is limited. Aim We investigated PRP in a rat model of hyperlipidemia-associated ED. Methods Thirty 2-month-old male Sprague–Dawley rats were randomly divided into 3 groups. 20 rats were fed a high-fat diet for 5 months and were randomly divided into 2 groups: (i) rats in the H group received supernatant injection into the corpus cavernosum weekly for 4 weeks; (ii) rats in the H + PRP group received PRP injection into the corpus cavernosum weekly for 4 weeks. 10 rats were fed a standard diet for 5 months and received supernatant injection into the corpus cavernosum weekly for 4 weeks (N group). 7 days after the 4th injection, all rats underwent erectile function testing and then euthanasia. Main outcome measures Erectile function was evaluated by measuring intracavernous pressure (ICP) and mean arterial pressure (MAP). Serum and penile tissue were collected for metabolic variable assessment and histochemical examination, respectively. Results Intracavernous pressure/MAP and area under the curve/MAP ratios were significantly higher in the N and H + PRP groups than in the H group. Insulin-like growth factor-1, brain-derived neurotrophic factor, and vascular endothelial growth factor levels were significantly higher in the H + PRP group than in the N and H groups. Corporal neuronal nitric oxide synthase, endothelial nitric oxide synthase, and endothelial cells were weakly expressed in the H group compared with the N and H + PRP groups. Intracorporal oxidative stress and apoptotic index were significantly higher in the H group than in the N and H + PRP groups. Conclusions This preclinical evidence suggests that clinical trials of PRP in men with ED should be considered. PRP may play a role in ED management. Huang YC, Wu CT, Chen MF, et al. Intracavernous Injection of Autologous Platelet-Rich Plasma Ameliorates Hyperlipidemia-Associated Erectile Dysfunction in a Rat Model. Sex Med 2021;9:100317.
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Affiliation(s)
- Yun-Ching Huang
- Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Chun-Te Wu
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Miao-Fen Chen
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yi-Hung Kuo
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jhy-Ming Li
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Sheng Shi
- Division of Colon and Rectal Surgery, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Abstract
The Gaelic sports of hurling and football, native to Ireland, are increasing in popularity worldwide. The injury profile of these sports requires multidisciplinary management by sports physicians, orthopaedic surgeons, and musculoskeletal (MSK) radiologists, among others. Advances in imaging modalities and interventional techniques have aided the diagnosis and treatment of sport injuries. In this article, we review the literature and our own institutional experience to describe common injury patterns identified in Gaelic games athletes, their main imaging features and relevant therapeutic interventions. We discuss the increasing prevalence of imaging services at sporting events and the central role of MSK radiologists in sports injury management.
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Affiliation(s)
- Charles J Sullivan
- Department of Radiology, National Orthopaedic Hospital Cappagh, Finglas, Dublin, Ireland
| | - Eoin C Kavanagh
- Department of Radiology, National Orthopaedic Hospital Cappagh, Finglas, Dublin, Ireland.,Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland
| | - Stephen J Eustace
- Department of Radiology, National Orthopaedic Hospital Cappagh, Finglas, Dublin, Ireland.,Department of Radiology, Mater Misericordiae University Hospital, Eccles Street, Dublin, Ireland
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Challoumas D, Millar NL. Risk of bias in systematic reviews of tendinopathy management: Are we comparing apples with oranges? TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Dimitris Challoumas
- Institute of Infection, Immunity and Inflammation College of Medicine, Veterinary and Life Sciences University of Glasgow Glasgow UK
| | - Neal L. Millar
- Institute of Infection, Immunity and Inflammation College of Medicine, Veterinary and Life Sciences University of Glasgow Glasgow UK
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Huang K, Giddins G, Wu LD. Platelet-Rich Plasma Versus Corticosteroid Injections in the Management of Elbow Epicondylitis and Plantar Fasciitis: An Updated Systematic Review and Meta-analysis. Am J Sports Med 2020; 48:2572-2585. [PMID: 31821010 DOI: 10.1177/0363546519888450] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Platelet-rich plasma (PRP), as a promising alternative to traditional corticosteroid (CS), is now increasingly used in the treatment of elbow epicondylitis (EE) and plantar fasciitis (PF). To date, however, the synthesis of information on the clinical efficacy of PRP versus CS is limited with divergent conclusions. PURPOSE To compare the clinical efficacy of PRP and CS injections in reducing pain and improving function in EE and PF. STUDY DESIGN Systematic review and meta-analysis. METHODS Online databases were searched from inception to October 2018 for prospective studies evaluating PRP versus CS injections for EE or PF. Independent reviewers undertook searches, screening, and risk-of-bias appraisals. The primary outcomes of interest were pain and function in both the short term (1-3 months) and the long term (≥6 months). RESULTS Twenty trials with 1268 participants were included. For EE, PRP provides a statistically and clinically meaningful long-term improvement in pain, with a very large effect size of -1.3 (95% CI, -1.9 to -0.7) when compared with CS, but the evidence level was low. For EE, there was moderate evidence that CS provides a statistically meaningful improvement in pain in the short term, with a medium effect size of 0.56 (95% CI, 0.08-1.03) as compared with PRP; this improvement might not be clinically significant. For PF, there was low evidence that PRP provides a statistically and clinically meaningful long-term improvement in function (American Orthopedic Foot & Ankle Society score), with a very large effect size of 1.94 (95% CI, 0.61-3.28). There were no significant differences between the groups in improvement in function in EE and pain and short-term function in PF, but the quality of the evidence was low. CONCLUSION The use of PRP yields statistically and clinically better improvement in long-term pain than does CS in the treatment of EE. The use of PRP yields statistically and clinically better long-term functional improvement than that of CS in the treatment of PF.
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Affiliation(s)
- Kai Huang
- Department of Orthopaedic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Grey Giddins
- Department of Orthopaedic Surgery, Royal United Hospital Bath, Bath, UK
| | - Li-Dong Wu
- Department of Orthopaedic Surgery, The Second Hospital of Medical College, Zhejiang University, Hangzhou, China
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Irby A, Gutierrez J, Chamberlin C, Thomas SJ, Rosen AB. Clinical management of tendinopathy: A systematic review of systematic reviews evaluating the effectiveness of tendinopathy treatments. Scand J Med Sci Sports 2020; 30:1810-1826. [PMID: 32484976 DOI: 10.1111/sms.13734] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 05/18/2020] [Accepted: 05/25/2020] [Indexed: 12/11/2022]
Abstract
While the pathoetiology is disputed, a wide array of treatments is available to treat tendinopathy. The most common treatments found in the literature include therapeutic modalities, exercise protocols, and surgical interventions; however, their effectiveness remains ambiguous. The purpose of this study was to perform a systematic review of systematic reviews to determine the ability of therapeutic interventions to improve pain and dysfunction in patients with tendinopathy regardless of type or location. Five databases were searched for systematic reviews containing only randomized control trials to determine the effectiveness of treatments for tendinopathies based on pain and patient-reported outcomes. Systematic reviews were assessed via the Assessment of Multiple Systematic Reviews (AMSTAR) for methodological quality. From the database search, 3,295 articles were found, 107 passed the initial inclusion criteria. After further review, 25 systematic reviews were included in the final qualitative analysis. The AMSTAR scores were relatively high (8.8 ± 1.0) across the 25 systematic reviews. Eccentric exercises were the most common and consistently effective treatment for tendinopathy across systematic reviews. Low-level laser therapy and extracorporeal shockwave therapy demonstrated moderate effectiveness, while platelet-rich plasma injections demonstrated inconclusive evidence on their ability to decrease tendinopathy-related pain and improve function. Corticosteroids also showed some effectiveness for short-term pain, but for the long-term use deemed ineffective and at times contraindicated. Regarding surgical options, minimally invasive procedures were more effective compared to open surgical interventions. When treating tendinopathy regardless of location, eccentric exercises were the best treatment option to improve tendinopathy-related pain and improve self-reported function.
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Affiliation(s)
- Alyssa Irby
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Jacqueline Gutierrez
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Claressa Chamberlin
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska, USA
| | - Stephen J Thomas
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania, USA
| | - Adam B Rosen
- School of Health and Kinesiology, University of Nebraska at Omaha, Omaha, Nebraska, USA
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38
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Trull-Ahuir C, Sala D, Chismol-Abad J, Vila-Caballer M, Lisón JF. Efficacy of platelet-rich plasma as an adjuvant to surgical carpal ligament release: a prospective, randomized controlled clinical trial. Sci Rep 2020; 10:2085. [PMID: 32034241 PMCID: PMC7005701 DOI: 10.1038/s41598-020-59113-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 01/24/2020] [Indexed: 01/04/2023] Open
Abstract
The purpose of this study is to evaluate the efficiency of local platelet-rich plasma (PRP) injection as an adjuvant treatment after carpal ligament release. We conducted a prospective randomized, triple-blinded, controlled trial. Fifty participants with mild to extreme carpal tunnel syndrome (CTS) were randomly assigned either to the PRP (n = 25) or the platelet-poor plasma (PPP, n = 25) group. After performing open surgical release of the carpal ligament, the inside of the carpal tunnel was irrigated with 3 mL of PRP or PPP according to each participant’s group allocation. The primary outcome was hand grip strength (HGS). Secondary outcomes were the time taken off work after surgery (in days) and scores on the Wong–Baker Faces Scale, Boston Carpal Tunnel Questionnaire, and Southampton Wound Assessment Scale. We evaluated patients before treatment and at 6-weeks. As expected, the pain levels, symptom severity, and functional status improved in all the patients after surgery. However, intragroup analysis revealed that only the participants in the PRP group had regained their pre-operative HGS levels at 6-weeks follow-up. These findings indicate that PRP is an effective adjuvant treatment in patients with mild to severe CTS who require surgery.
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Affiliation(s)
- Carmen Trull-Ahuir
- Department of Nursing, Faculty of Health Sciences, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Diego Sala
- Department of Orthopedic Surgery and Traumatology, Umivale MATEPSSN.15, Valencia, Spain
| | - Joaquín Chismol-Abad
- Department of Orthopedic Surgery and Traumatology, Umivale MATEPSSN.15, Valencia, Spain
| | - Marian Vila-Caballer
- Department of Biomedical Sciences, Faculty of Health Sciences, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain.
| | - Juan Francisco Lisón
- Department of Medicine, Faculty of Health Sciences, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain. .,Centre of Physiopathology of Obesity and Nutrition (CIBERobn), CB06/03 Carlos III Health Institute, Valencia, Spain.
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Melo P, Navarro C, Jones C, Coward K, Coleman L. The use of autologous platelet-rich plasma (PRP) versus no intervention in women with low ovarian reserve undergoing fertility treatment: a non-randomized interventional study. J Assist Reprod Genet 2020; 37:855-863. [PMID: 32030554 DOI: 10.1007/s10815-020-01710-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/30/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To investigate the impact of a 3-month course of intracortical injections of autologous platelet-rich plasma (PRP) upon ovarian reserve markers versus no intervention in women with low ovarian reserve prior to undergoing assisted reproductive technology (ART). METHODS Prospective controlled, non-randomized comparative study conducted in a private fertility clinic, in Venezuela. Women with abnormal ovarian reserve markers (FSH, AMH and AFC) who declined oocyte donation were allocated to one of the following groups according to patient choice: monthly intracortical ovarian PRP injections for three cycles, or no intervention. Primary outcomes were the change in FSH, AMH and AFC pre- and post-treatment. Secondary outcomes included the number of oocytes collected and fertilized, biochemical/clinical pregnancy rates and miscarriage and live birth rates. RESULTS Eighty-three women were included, of which 46 received PRP treatment and 37 underwent no intervention. Overall median age was 41 years (IQR 39-44). There were no demographic differences between the study groups. At the 3-month follow-up, women treated with PRP experienced a significant improvement in FSH, AMH and AFC, whereas there was no change in the control group. Furthermore, overall rates of biochemical (26.1% versus 5.4%, P = 0.02) and clinical pregnancy (23.9% versus 5.4%, P = 0.03) were higher in the PRP group, while there was no difference in the rates of first trimester miscarriage and live birth between groups. CONCLUSION PRP injections are effective and safe to improve markers of low ovarian reserve prior to ART, although further evidence is required to evaluate the impact of PRP on pregnancy outcomes.
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Affiliation(s)
- P Melo
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, OX3 9DU, UK.
| | - C Navarro
- Fertiaguerrevere Fertility Clinic, Caracas, 1012, Venezuela
| | - C Jones
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, OX3 9DU, UK
| | - K Coward
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, OX3 9DU, UK
| | - L Coleman
- Fertiaguerrevere Fertility Clinic, Caracas, 1012, Venezuela
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Travers MJ, Murphy MC, Debenham JR, Chivers P, Bulsara MK, Bagg MK, Palsson TS, Gibson W. Should this systematic review and meta-analysis change my practice? Part 2: exploring the role of the comparator, diversity, risk of bias and confidence. Br J Sports Med 2019; 53:1493-1497. [PMID: 30962181 DOI: 10.1136/bjsports-2018-099959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 03/08/2019] [Accepted: 03/18/2019] [Indexed: 02/01/2023]
Affiliation(s)
- Mervyn J Travers
- School of Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Myles Calder Murphy
- School of Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
- Sports Science Sports Medicine Department, Western Australian Cricket Association, Perth, Western Australia, Australia
| | - James Robert Debenham
- School of Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Paola Chivers
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Max K Bulsara
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Matthew K Bagg
- Pain Research, Education and Management Program, Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia
- UNSW Prince of Wales Clinical School, Randwick, New South Wales, Australia
| | - Thorvaldur Skulli Palsson
- Laboratory for Musculoskeletal Pain and Motor Control, Center for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - William Gibson
- School of Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
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Robinson PG, Murray IR, Maempel J, Rankin CS, Hamilton D, Gaston P. Use of Biologics as an Adjunct Therapy to Arthroscopic Surgery for the Treatment of Femoroacetabular Impingement: A Systematic Review. Orthop J Sports Med 2019; 7:2325967119890673. [PMID: 31909055 PMCID: PMC6937539 DOI: 10.1177/2325967119890673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There has been a recent increase in the use of biologics in hip arthroscopy to assist in the management of femoroacetabular impingement (FAI). PURPOSE To analyze the current use of biologics for the treatment of FAI and its associated lesions. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A search of the PubMed, Medline, and EMBASE databases was performed in March 2019 with use of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The criterion for inclusion was observational, published research articles studying the therapeutic use of biologics as an adjuvant therapy during arthroscopic surgery for FAI; treatments included bone marrow aspirate concentrate, mesenchymal stem cells (MSCs), platelet-rich plasma (PRP), hyaluronic acid, growth factors, and autologous chondrocyte implantation (ACI) or autologous matrix-induced chondrogenesis (AMIC). RESULTS There were 9 studies that met the inclusion criteria, and a total of 674 patients were included across all studies. FAI was studied in all articles. Further, 7 studies (78%) also analyzed chondral injuries, and 3 studies also analyzed labral tears (33%). ACI or AMIC was used in 56% of studies and showed superior functional outcomes at short- and midterm follow-up versus debridement or microfracture. PRP did not improve the outcome of labral repairs at short-term follow-up. CONCLUSION The current literature regarding biologic adjuncts in hip arthroscopy is varied in quality, with only one level 1 study. The use of ACI/AMIC for medium-sized chondral lesions showed promising results in individual studies; however, these were of lower quality. To enable comparisons among future studies, investigators must ensure accuracy in the reporting of biologic preparations and formulations used and homogeneity in the type and severity of lesion treated.
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Affiliation(s)
- Patrick G. Robinson
- Department of Trauma and Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - Iain R. Murray
- Department of Trauma and Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - Julian Maempel
- Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Conor S. Rankin
- Department of Trauma and Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - David Hamilton
- Department of Trauma and Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - Paul Gaston
- Department of Trauma and Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
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Pachito DV, Latorraca CDOC, Riera R. Efficacy of platelet-rich plasma for non-transfusion use: Overview of systematic reviews. Int J Clin Pract 2019; 73:e13402. [PMID: 31408240 DOI: 10.1111/ijcp.13402] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Platelet-rich plasma (PRP) is a blood component therapy with a supraphysiological concentration of platelets derived from allogenic or, more commonly, autologous blood. PRP has been used in different non-transfusion indications because of its role in the promotion of tissue repair and healing, in fields such as Traumatology, Dermatology and Dentistry. OBJECTIVE To provide a synthesis of the efficacy of PRP for different clinical situations. METHODS Systematic searches were carried out in MEDLINE, Embase, Cochrane Library and LILACS in July 2018 to identify systematic reviews (SRs) of randomized clinical trials (RCTs) focusing on PRP for non-transfusion use. Two authors independently screened all retrieved references in two stages (titles and abstracts at a first stage and full texts at a second stage). The methodological quality of SRs that met the eligibility criteria was appraised by AMSTAR 2. Conclusions were based on the most recent SRs with highest quality. RESULTS One thousand two hundred and forty references were retrieved. After checking the inclusion criteria, 29 SRs of RCTs related to three different fields (wound care, Orthopedics and Dentistry) were included. The results suggest the benefit of PRP for different clinical situations, such as diabetic wounds, acute lesions of musculoskeletal system, rotator cuff lesions, tendinopathies, knee and hip osteoarthritis, total knee arthroplasty, allogenic bone graft for dental implants and periodontal intrabony defects. CONCLUSION There is low to moderate quality evidence supporting the efficacy of PRP for specific clinical situations. The low quality of the evidence limits the certainty of these findings. Well-planned and well-conducted RCTs are still needed to further assess the efficacy of PRP.
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Affiliation(s)
- Daniela Vianna Pachito
- Hospital Sírio-Libanês, Núcleo de Avaliação de Tecnologias de Saúde, São Paulo, Brazil
- Disciplina de Economia e Gestão da Saúde, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Rachel Riera
- Hospital Sírio-Libanês, Núcleo de Avaliação de Tecnologias de Saúde, São Paulo, Brazil
- Evidence Based Health Program, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Martin JI, Atilano L, Bully P, Iglesias G, Merino J, Grandes G, Andia I. Needle tenotomy with PRP versus lidocaine in epicondylopathy: clinical and ultrasonographic outcomes over twenty months. Skeletal Radiol 2019; 48:1399-1409. [PMID: 30826853 DOI: 10.1007/s00256-019-03193-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/17/2019] [Accepted: 02/18/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate whether pathological changes in elbow epicondylopathy, as assessed by conventional ultrasonography and clinical outcomes, could be modified following tenotomy with platelet-rich plasma (PRP) versus tenotomy with lidocaine. METHODS This prospective sub-study was part of a patient- and assessor-blinded, superiority-type, randomized, lidocaine-controlled trial that was performed in a tertiary hospital to assess the effectiveness of PRP versus lidocaine as tenotomy adjuvants in patients with epicondylopathy. Patients were followed after two sessions of tenotomy with either PRP or lidocaine adjuvants (4 ml) within a 2-week interval. Tendon thickness, echotexture, and neovascularization were assessed as secondary outcome measurements at baseline and at 3, 6, 12, and 20 months after treatment, and correlations with clinical outcomes were examined. RESULTS Twenty months after treatment, tenotomy induced changes in tendon structure, thickness (± = 0.0006), vascularity (p < 0.0001), and echotexture (p < 0.0001). In Disabilities of the Arm, Shoulder and Hand (DASH-E) and pain (VAS-P) scores, 80.85% and 90.91% of patients showed a meaningful clinical improvement, respectively, without differences between PRP and lidocaine. There were significant differences in between-group changes in vascularity over time, p = 0.037 and p = 0.049 in the unadjusted and adjusted models, respectively. There was no relationship between pain or function and sonographic entities at the various time points. CONCLUSIONS Two successive needle tenotomies induced structural changes in recalcitrant epicondylopathy, with PRP displaying more vascularization and increased thickness over time compared to lidocaine. PRP compared with lidocaine did not result in improved function or decreased pain over 20 months.
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Affiliation(s)
- Jose Ignacio Martin
- Interventional Sonography, Department of Radiology, Cruces University Hospital, Barakaldo, Spain.,Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Leire Atilano
- Interventional Sonography, Department of Radiology, Cruces University Hospital, Barakaldo, Spain.,Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Paola Bully
- Primary Care Research Unit of Bizkaia, BioCruces Health Research Institute, Bilbao, Spain
| | - Gotzon Iglesias
- Interventional Sonography, Department of Radiology, Cruces University Hospital, Barakaldo, Spain.,Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Josu Merino
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain.,Department of Orthopedic Surgery, Cruces University Hospital, Barakaldo, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, BioCruces Health Research Institute, Bilbao, Spain.,Enkarterrri-Ezkerraldea-Cruces Health Region, Basque Health Service (Osakidetza), Basque, Spain
| | - Isabel Andia
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain.
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Gaehwiler R, Weisskopf L, Hirschmüller A. [Conservative Therapy of Achilles Tendinopathy in Sports Medicine]. PRAXIS 2019; 108:851-858. [PMID: 31571547 DOI: 10.1024/1661-8157/a003296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Conservative Therapy of Achilles Tendinopathy in Sports Medicine Abstract. Due to its key role in power transmission, the Achilles tendon is a common site of acute and overuse injuries in running athletes. Therefore, a sports physician needs to know some anatomic, diagnostic and therapeutic key points to be able to establish an individualized therapy approach. With regard to the «in» and «out of season» period, there is a primary focus on physio- and shock-wave therapy. Additionally, peritendinous infiltration might be re-evaluated in individual cases. In this review we focus on «midportion» and «insertional» tendinopathy. Nevertheless, conservative treatment of Achilles tendon ruptures will be discussed as well. This concise overview should provide the sports physician with basic knowledge of these common pathologies.
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Affiliation(s)
| | | | - Anja Hirschmüller
- ALTIUS Swiss Sportmed Center AG, Rheinfelden
- Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Deutschland
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Abstract
The most common source of shoulder pain is thought to involve the tendons of the rotator cuff and associated structures around the subacromial space. A generic diagnostic term has been suggested, rotator cuff-related shoulder pain (RCRSP), which is an overarching clinical term that includes a number of conditions, such as subacromial impingement syndrome, subacromial pain syndrome, and rotator cuff tendinopathy. The management of RCRSP may include exercise, surgery, or injection therapy. Those who perform or recommend injection therapy for RCRSP have a duty of care to provide advice on the expected benefits and outcomes, as well as the potential risks and associated harms. Clinicians also need to consider what medication to inject, where to inject it, and how to inject it. The aim of this Viewpoint is to discuss these issues. J Orthop Sports Phys Ther 2019;49(5):289-293. doi:10.2519/jospt.2019.0607.
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Martin JI, Atilano L, Merino J, Gonzalez I, Iglesias G, Areizaga L, Bully P, Grandes G, Andia I. Platelet-rich plasma versus lidocaine as tenotomy adjuvants in people with elbow epicondylopathy: a randomized controlled trial. J Orthop Surg Res 2019; 14:109. [PMID: 31014382 PMCID: PMC6480601 DOI: 10.1186/s13018-019-1153-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 04/12/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES To determine the efficacy of platelet-rich plasma (PRP) compared to lidocaine as a tenotomy adjuvant for people with elbow tendinopathy. METHODS Our study was a parallel-group, double-blind, randomized trial involving 71 patients with recalcitrant elbow tendinopathy who received two sessions of ultrasound-guided tenotomy with either PRP or lidocaine in a tertiary public hospital. The primary end point was the percentage of patients with an improvement exceeding 25% reduction in disability (Spanish version of the Disabilities of the Arm, Shoulder and Hand questionnaires-DASH-E) at 6 and 12 months; the secondary outcome was the percentage of patients exceeding 25% reduction in pain (VAS-P). RESULTS There was no evidence of significant differences in the proportion of patients who experienced clinically relevant improvements. After 6 months, 18 patients (78.59%) in the lidocaine group and 19 patients (73.08%) in the PRP group showed improved function above 25% (unadjusted odds ratio, 0.90; 95% confidence interval [CI], 0.90 (0.17 to 4.60)); 21 patients (72.21%) in the lidocaine group versus 22 patients (84.62%) in the PRP group achieved more than 25% pain reduction (unadjusted odds ratio, 0.48; 95% CI, 0.10 to 2.37). After 12 months, 17 patients (70.83%) in the lidocaine group versus 19 patients (76%) in the PRP group had improved function (unadjusted odds ratio, 0.71; 95% CI, 0.13 to 3.84), and 19 patients (76%) in the lidocaine group versus 20 patients (90.91%) in the PRP group had improved pain above 25% (unadjusted odds ratio, 0.35; 95% CI, 0.06 to 2.51). Hypercholesterolemia and baseline vascularization influenced outcomes. There were no differences between groups in the adjusted odds ratios. CONCLUSION PRP results in similar improvements to those obtained with lidocaine. Selecting patients according to their pretreatment status can improve treatment efficacy. TRIAL REGISTRATION NCT01945528 , EudraCT 2013-000478-32. Registered 18 August 2013, enrolment of the first participant 10 March 2014.
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Affiliation(s)
- Jose Ignacio Martin
- Interventional Sonography, Department of Radiology, Cruces University Hospital, Barakaldo, Spain.,Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Leire Atilano
- Interventional Sonography, Department of Radiology, Cruces University Hospital, Barakaldo, Spain.,Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Josu Merino
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain.,Department of Orthopaedic Surgery, Cruces University Hospital, Barakaldo, Spain
| | - Igor Gonzalez
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain.,Department of Orthopaedic Surgery, Cruces University Hospital, Barakaldo, Spain
| | - Gotzon Iglesias
- Interventional Sonography, Department of Radiology, Cruces University Hospital, Barakaldo, Spain.,Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Luis Areizaga
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain.,Department of Orthopaedic Surgery, Cruces University Hospital, Barakaldo, Spain
| | - Paola Bully
- Primary Care Research Unit of Bizkaia (Basque Healthcare Service), BioCruces Health Research Institute, Bilbao, Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia (Basque Healthcare Service), BioCruces Health Research Institute, Bilbao, Spain
| | - Isabel Andia
- Regenerative Medicine, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain.
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Scott S, Roberts M, Chung E. Platelet-Rich Plasma and Treatment of Erectile Dysfunction: Critical Review of Literature and Global Trends in Platelet-Rich Plasma Clinics. Sex Med Rev 2019; 7:306-312. [PMID: 30833169 DOI: 10.1016/j.sxmr.2018.12.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/16/2018] [Accepted: 12/16/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Platelet-rich plasma (PRP) injections have recently been marketed as a form of autologous cell therapy under the banner of regenerative medicine despite limited scientific evidence on its use for treating erectile dysfunction (ED). AIM To evaluate the evidence on PRP treatment for ED and determine the current trends in provision of this treatment. METHODS A critical review of the literature on PRP using the PubMed and Embase databases. OUTCOMES This narrative review focuses on the clinical use of, regulation of, and evidence for PRP in the treatment of ED. RESULTS There is a limited number of published peer-reviewed articles demonstrating clinical outcomes pertaining to the use of PRP for ED in human. The technique of PRP application for ED is currently patented, with a global total of 683 registered clinics. The majority of PRP clinics do not provide cost estimates on their websites. CONCLUSION Despite a global presence of PRP clinics and ongoing active marketing and public interest in regenerative medicine, no scientific evidence has been published to establish an evidence-based risk-benefit profile for PRP use for ED in humans. Given the limited data on clinical efficacy and potential harmful side effects, there is a need for a proper clinical trial to examine the role of PRP before it is accepted as standard of care in treatment for ED. Scott S, Roberts M, Chung E. Platelet-Rich Plasma and Treatment of Erectile Dysfunction: Critical Review of Literature and Global Trends in Platelet-Rich Plasma Clinics. Sex Med Rev 2019;7:306-312.
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Affiliation(s)
- Susan Scott
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Matthew Roberts
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Eric Chung
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; AndroUrology Centre, Brisbane, QLD, Australia; Department of Urology, Macquarie University Hospital, Sydney, NSW, Australia.
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Berger DR, Centeno CJ, Steinmetz NJ. Platelet lysates from aged donors promote human tenocyte proliferation and migration in a concentration-dependent manner. Bone Joint Res 2019; 8:32-40. [PMID: 30800297 PMCID: PMC6359887 DOI: 10.1302/2046-3758.81.bjr-2018-0164.r1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objectives Platelet-rich plasma (PRP) is being used increasingly often in the clinical setting to treat tendon-related pathologies. Yet the optimal PRP preparations to promote tendon healing in different patient populations are poorly defined. Here, we sought to determine whether increasing the concentration of platelet-derived proteins within a derivative of PRP, platelet lysate (PL), enhances tenocyte proliferation and migration in vitro, and whether the mitogenic properties of PL change with donor age. Methods Concentrated PLs from both young (< 50 years) and aged (> 50 years) donors were prepared by exposing pooled PRP to a series of freeze-thaw cycles followed by dilution in plasma, and the levels of several platelet-derived proteins were measured using multiplex immunoassay technology. Human tenocytes were cultured with PLs to simulate a clinically relevant PRP treatment range, and cell growth and migration were assessed using DNA quantitation and gap closure assays, respectively. Results Platelet-derived protein levels increased alongside higher PL concentrations, and PLs from both age groups improved tenocyte proliferation relative to control conditions. However, PLs from aged donors yielded a dose-response relationship in tenocyte behaviour, with higher PL concentrations resulting in increased tenocyte proliferation and migration. Conversely, no significant differences in tenocyte behaviour were detected when increasing the concentration of PLs from younger donors. Conclusion Higher PL concentrations, when prepared from the PRP of aged but not young donors, were more effective than lower PL concentrations at promoting tenocyte proliferation and migration in vitro. Cite this article: D. R. Berger, C. J. Centeno, N. J. Steinmetz. Platelet lysates from aged donors promote human tenocyte proliferation and migration in a concentration-dependent manner. Bone Joint Res 2019;8:32–40. DOI: 10.1302/2046-3758.81.BJR-2018-0164.R1.
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Affiliation(s)
- D R Berger
- Interventional Orthopedics Foundation, Broomfield, Colorado, USA
| | - C J Centeno
- Centeno-Schultz Clinic, Broomfield, Colorado, USA; Board Chairman, Interventional Orthopedics Foundation, Broomfield, Colorado, USA; Chief Medical Officer, Regenexx, LLC, Broomfield, Colorado, USA
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Abstract
Platelet-rich plasma (PRP) is a promising treatment for musculoskeletal maladies and clinical data to date have shown that PRP is safe. However, evidence of its efficacy has been mixed and highly variable depending on the specific indication. Additional future high-quality large clinical trials will be critical in shaping our perspective of this treatment option. The heterogeneity of PRP preparations, both presently and historically, leads sweeping recommendations about its utility impossible to make. This heterogeneity has also made interpreting existing literature more complicated.
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Affiliation(s)
- Adrian D K Le
- Department of Orthopedic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA 94063, USA
| | - Lawrence Enweze
- Department of Orthopedic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA 94063, USA
| | - Malcolm R DeBaun
- Department of Orthopedic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA 94063, USA
| | - Jason L Dragoo
- Department of Orthopedic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA 94063, USA.
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50
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Le ADK, Enweze L, DeBaun MR, Dragoo JL. Current Clinical Recommendations for Use of Platelet-Rich Plasma. Curr Rev Musculoskelet Med 2018; 11:624-634. [PMID: 30353479 PMCID: PMC6220007 DOI: 10.1007/s12178-018-9527-7] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW This review evaluates current clinical literature on the use of platelet-rich plasma (PRP), including leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP), in order to develop evidence-based recommendations for various musculoskeletal indications. RECENT FINDINGS Abundant high-quality evidence supports the use of LR-PRP injection for lateral epicondylitis and LP-PRP for osteoarthritis of the knee. Moderate high-quality evidence supports the use of LR-PRP injection for patellar tendinopathy and of PRP injection for plantar fasciitis and donor site pain in patellar tendon graft BTB ACL reconstruction. There is insufficient evidence to routinely recommend PRP for rotator cuff tendinopathy, osteoarthritis of the hip, or high ankle sprains. Current evidence demonstrates a lack of efficacy of PRP for Achilles tendinopathy, muscle injuries, acute fracture or nonunion, surgical augmentation in rotator cuff repair, Achilles tendon repair, and ACL reconstruction. PRP is a promising treatment for some musculoskeletal diseases; however, evidence of its efficacy has been highly variable depending on the specific indication. Additional high-quality clinical trials with longer follow-up will be critical in shaping our perspective of this treatment option.
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Affiliation(s)
- Adrian D. K. Le
- Department of Orthopedic Surgery, Stanford University, 450 Broadway St, Redwood City, CA USA
- Lifemark Health Group, Toronto, ON Canada
| | - Lawrence Enweze
- Department of Orthopedic Surgery, Stanford University, 450 Broadway St, Redwood City, CA USA
| | - Malcolm R. DeBaun
- Department of Orthopedic Surgery, Stanford University, 450 Broadway St, Redwood City, CA USA
| | - Jason L. Dragoo
- Department of Orthopedic Surgery, Stanford University, 450 Broadway St, Redwood City, CA USA
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