1
|
Nakajima R, Saita Y, Kobayashi Y, Wakayama T, Uchino S, Momoi Y, Yamamoto N, Ishijima M. Comparison of bioactive substances in novel-developed freeze-dried platelet-rich plasma (PRP) and activated normal PRP, and investigation of bioactive substance levels after long-term storage. Regen Ther 2024; 27:200-206. [PMID: 38571893 PMCID: PMC10990710 DOI: 10.1016/j.reth.2024.03.021] [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: 02/08/2024] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction In recent years, biotherapy in orthopedics has become widespread, and platelet-rich plasma (PRP) has been readily used to treat sports injuries and osteoarthritis. Production of freeze-dried PRP (PRP-FD) results in PRP that is in powder form, allowing it to be stored for long periods at room temperature. Using this technology, we have developed Valuable Platelet-Derived Factor Concentrate Freeze Dry (VFD). However, whether VFD contains sufficient levels of bioactive substances (BS) remains unknown and retains the same levels of BS during long-term storage. In this study, we examined whether VFD contains sufficient amounts of BS and whether they retain these BS levels during long-term storage. Methods Peripheral blood was collected from 10 healthy men (mean ± SD: 46.5 ± 15 years old) and various BS, including transforming growth factor β (TGF-β), basic fibroblast growth factor (bFGF), epidermal growth factor (EGF), tissue inhibitors of metalloproteinases-1 (TIMP-1), interleukin-1 receptor antagonist (IL-1ra), matrix metallopeptidase-9 (MMP-9), and interleukin-6 (IL-6), were compared between VFD and normal PRP samples, including both leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP). VFD was prepared using two rounds of centrifugation. LP-PRP and LR-PRP were activated by freezing and thawing before measurement. To evaluate the effects of long-term storage, the BS of VFD purified from five professional football players was compared between baseline and 1 year after storage. Results In terms of the growth factors, the TGF-β and EGF levels were higher in LR-PRP than in VFD and LP-PRP (p < 0.05), while the bFGF levels were higher in VFD than in the LR-PRP and LP-PRP groups (p < 0.01). In terms of anti-inflammatory cytokines, the TIMP-1 level was lower in VFD than that in the other groups (p < 0.01), whereas the IL-1ra levels were higher in VFD than those in LP-PRP (p < 0.05) and lower than those in LR-PRP (p < 0.01). In terms of inflammatory enzymes and cytokines, the IL-1ra level was higher in VFD than that in LP-PRP (p < 0.05) and lower than that in LR-PRP (p < 0.01), whereas the IL-6 levels did not differ among the groups. Furthermore, the TGF-β, bFGF, TIMP-1, and IL-1ra levels were 5.61 → 3.38 (x103 pg/μL), 61.0 → 63.0 (pg/μL), 3.4 → 2.7 (x105 pg/μL), and 14.9 → 14.5 (x103 pg/μL) at baseline and 1 year later, respectively. No significant differences in the BS levels were observed between baseline and 1 year after storage. Conclusions The VFD samples prepared in this study exhibited higher levels of anti-inflammatory cytokines than LP-PRP and contained growth factor levels similar to LP-PRP and LR-PRP. In addition, the BS levels in VFD samples were maintained after one year of storage. These results suggest that VFD can be prepared and stored and may serve as a novel treatment strategy for sports injuries in high-risk groups, such as athletes.
Collapse
Affiliation(s)
- Ryosuke Nakajima
- Department of Orthopaedics, Juntendo University, Faculty of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Yoshitomo Saita
- Department of Orthopaedics, Juntendo University, Faculty of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
- Department of Sports and Regenerative Medicine, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Yohei Kobayashi
- Department of Orthopaedics, Juntendo University, Faculty of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Takanori Wakayama
- Department of Orthopaedics, Juntendo University, Faculty of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Sayuri Uchino
- Department of Orthopaedics, Juntendo University, Faculty of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Yasumasa Momoi
- Department of Orthopaedics, Juntendo University, Faculty of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Nanako Yamamoto
- Department of Orthopaedics, Juntendo University, Faculty of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Muneaki Ishijima
- Department of Orthopaedics, Juntendo University, Faculty of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
- Department of Medicine for Orthopaedics and Motor Organ, Juntendo University Graduate School of Medicine, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
| |
Collapse
|
2
|
Yoshioka T, Arai N, Sugaya H, Taniguchi Y, Kanamori A, Gosho M, Okuno K, Kikuchi N, Hyodo K, Aoto K, Yamazaki M. The Effectiveness of Leukocyte-Poor Platelet-Rich Plasma Injections for Symptomatic Mild to Moderate Osteoarthritis of the Knee With Joint Effusion or Bone Marrow Lesions in a Japanese Population: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial. Am J Sports Med 2024:3635465241263073. [PMID: 39097760 DOI: 10.1177/03635465241263073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2024]
Abstract
BACKGROUND Intra-articular platelet-rich plasma (PRP) injections have been proposed for the treatment of knee osteoarthritis (OA); however, their effectiveness in Japanese patients remains unclear. PURPOSE To investigate whether 3 intra-articular injections of leukocyte-poor PRP (LP-PRP) improve symptoms and joint function in symptomatic Japanese patients with mild to moderate knee OA. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Of 72 patients screened, 30 were included and randomized to receive LP-PRP (n = 15) or saline (placebo; n = 15) injections between March 2019 and February 2023. Patients attended a screening visit and 3 treatment visits at 1 week apart, followed by 3 follow-up visits (at 4, 12, and 24 weeks) after the initial treatment visit. The primary efficacy outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, whereas the secondary efficacy outcome measures were the proportion of patients showing a visual analog scale (VAS) improvement of ≥50%. Magnetic resonance imaging was performed to evaluate joint effusion and bone marrow lesions using the Whole-Organ Magnetic Resonance Imaging Score. Patients were followed for 24 weeks. RESULTS Patients in the PRP group (mean age, 65.9 years) had a mean hip-knee-ankle angle of 5.1°, with 7 and 8 patients demonstrating Kellgren-Lawrence grade 2 and 3 knee OA, respectively. Patients in the placebo group (mean age, 67.9 years) had a mean hip-knee-ankle angle of 3.8°, with 6 and 9 patients showing Kellgren-Lawrence grade 2 and 3 knee OA, respectively. No significant differences were identified in any baseline factors. The percentage change in Western Ontario and McMaster Universities Osteoarthritis Index scores from baseline to 24 weeks was significantly different (P= .032) between the PRP (median, 75.9%; quantile 1 [Q1], 49.6; quantile 3 [Q3], 94.1]) and placebo (median, 27.7%; Q1, -9.4; Q3, 80.9]) groups. Overall, 73.3% and 28.6% of the PRP group and placebo group, respectively, exhibited an improvement in visual analog scale scores of ≥50%, with a significant improvement observed in the PRP group (P = .027). Changes in bone marrow lesions from baseline to 24 weeks, as assessed on magnetic resonance imaging, significantly differed between groups (P = .017), with no significant differences in other secondary endpoints. CONCLUSION In Japanese patients with knee OA, 3 intra-articular LP-PRP injections led to clinical improvements at 24-week follow-up and significant functional improvements and pain relief after 24 weeks.
Collapse
Affiliation(s)
- Tomokazu Yoshioka
- Division of Regenerative Medicine, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Norihito Arai
- Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hisashi Sugaya
- Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yu Taniguchi
- Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akihiro Kanamori
- Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masahiko Gosho
- Department of Biostatistics, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kosuke Okuno
- Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Naoya Kikuchi
- Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Kojiro Hyodo
- Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Katsuya Aoto
- Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Masashi Yamazaki
- Department of Orthopedic Surgery, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|
3
|
Serdarogullari M, Raad G, Makieva S, Liperis G, Fraire-Zamora JJ, Celik-Ozenci C. Revitalizing female fertility: platelet-rich plasma - hype or hope? Reprod Biomed Online 2024; 49:103813. [PMID: 38852205 DOI: 10.1016/j.rbmo.2024.103813] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 06/11/2024]
Abstract
Platelet-rich plasma (PRP) has gained popularity as an experimental tool in regenerative medicine, with potential applications in reproductive medicine. This review will assess the existing literature on the role of PRP in female fertility enhancement, focusing on ovarian rejuvenation and increased endometrial thickness. PRP is being explored as a treatment for recurrent implantation failure, primary ovarian insufficiency and poor ovarian response. While the influence of PRP on endometrial thickness and implantation success is postulated, its effectiveness remains the subject of debate due to protocol variability and unclear patient selection criteria. This narrative review includes 36 articles published before December 2022, and highlights the lack of comprehensive molecular studies examining the impact of PRP on reproductive capacity. This review underscores the importance of standardizing PRP preparation protocols in reproductive medicine. However, challenges persist, and there is a need for well-planned randomized controlled trials and a deeper understanding of the patient population that would gain the greatest benefit from PRP treatment. Clarifying these aspects is crucial to improve outcomes for low-prognosis patients undergoing assisted reproductive technology.
Collapse
Affiliation(s)
- Munevver Serdarogullari
- Department of Histology and Embryology, Faculty of Medicine, Cyprus International University, Northern Cyprus via Mersin 10, Turkey
| | - Georges Raad
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon; Al Hadi Laboratory and Medical Centre, Beirut, Lebanon
| | - Sofia Makieva
- Kinderwunschzentrum, Klinik für Reproduktions-Endokrinologie, Universitätsspital Zürich, Zurich, Switzerland
| | - Georgios Liperis
- Westmead Fertility Centre, Institute of Reproductive Medicine, University of Sydney, Westmead, NSW, Australia
| | | | - Ciler Celik-Ozenci
- Department of Histology and Embryology, School of Medicine, Koc University, Istanbul, Turkey; Koç University Research Centre for Translational Medicine, Istanbul, Turkey.
| |
Collapse
|
4
|
Dinaki K, Grigoriadis N, Vizirianakis IS, Constantinidis J, Triaridis S, Karkos P. The impact of submucosal PRP injection on wound healing after endoscopic sinus surgery: a randomized clinical trial. Eur Arch Otorhinolaryngol 2024; 281:3587-3599. [PMID: 38334783 PMCID: PMC11211195 DOI: 10.1007/s00405-024-08483-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/13/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE Chronic rhinosinusitis (CRS) is a prevalent chronic disease observed on a global scale. The utilization of endoscopic sinus surgery (ESS) has gained significant recognition as an effective intervention for individuals with CRS and nasal polyps who have not responded to conventional treatments. The need (or not) for revision surgery frequently relies on the promotion of optimal wound healing. The impact of platelet-rich plasma (PRP) on tissue healing has been extensively examined in various surgical fields. METHODS The present prospective study involved 30 patients suffering with nasal polyposis who underwent endoscopic sinus surgery. 15 patients were assigned to the PRP group, and 15 patients to the control group. The clinical follow-up of the patients took place at specific intervals, at weeks 1, 2, 3, 4, 8, and 12 after the surgical procedure. The evaluator identified the existence of adhesions, crusting, bleeding, granulation and infection using a visual analogue scale score. The patients also completed the SNOT 22 questionnaire prior to surgery and at each postoperative visit. RESULTS The present study observed a lower incidence of adhesion, infection, hemorrhage and granulation in the PRP group. Furthermore, a statistically significant difference was detected between the groups. CONCLUSION Based on the findings of the present investigation, it seems that platelet-rich plasma (PRP) is beneficial on wound healing during the early stages following the surgical procedure. The technique is characterized by its limited invasiveness, which contributes to its low risk profile and the achievement of clinically good outcomes.
Collapse
Affiliation(s)
- Konstantina Dinaki
- 1st Academic ORL Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Nikolaos Grigoriadis
- Laboratory of Pharmacology, School of Pharmacy, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis S Vizirianakis
- Laboratory of Pharmacology, School of Pharmacy, Aristotle University of Thessaloniki, Thessaloniki, Greece
- Department of Health Sciences, School of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Jannis Constantinidis
- 1st Academic ORL Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefanos Triaridis
- 1st Academic ORL Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Petros Karkos
- 1st Academic ORL Department, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| |
Collapse
|
5
|
Thahir M, Misbah I, Bhaskaran J, Syed NH, Ashraf M, Balasubramanian N. Efficacy of Intraoperative Platelet-Rich Plasma After Meniscal Repair: Systematic Review and Meta-analysis. Indian J Orthop 2024; 58:845-857. [PMID: 38948373 PMCID: PMC11208355 DOI: 10.1007/s43465-024-01155-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/11/2024] [Indexed: 07/02/2024]
Abstract
Background Meniscal injuries frequently require surgical intervention to restore knee joint function and stability. Intraoperative platelet-rich plasma (PRP) injection has emerged as a potential adjunctive therapy to enhance tissue healing post-meniscal repair. This systematic review and meta-analysis aimed to evaluate the efficacy of PRP in terms of pain relief, functional recovery, and overall success rates in patients undergoing meniscal repair procedures. Methods A comprehensive search strategy was employed to identify relevant studies across Scopus, PubMed, Embase, and the Cochrane Library databases. The inclusion criteria encompassed human studies, including randomized controlled trials (RCTs), cohorts, and case-control studies, focusing on intraoperative platelet-rich plasma (PRP) use post-meniscal repair and reporting outcomes related to pain, functionality, and cure rates. Exclusion criteria comprised animal studies, non-English publications, studies lacking relevant outcome measures, and those with insufficient data. Two reviewers independently screened titles and abstracts, resolving disagreements through consensus or consultation with a third reviewer, followed by a full-text assessment for potentially eligible studies. Data extraction was conducted independently by two reviewers using a standardized form. The reliability of observational studies was evaluated using the Newcastle-Ottawa Scale. Subgroup analyses and pooled effect estimates for main outcomes were computed using RevMan 5.3, a meta-analysis tool. Results The demographic analysis revealed that the PRP group had an average age of 41.39 years, while the control group had an average age of 42.1 years. In terms of gender distribution, the PRP group consisted of 61 men and 29 women, while the control group had 62 men and 34 women. Pain ratings showed a preference for PRP with a mean difference of 4.83 (p = 0.13). However, there was no significant difference in Lysholm scores (mean difference: - 0.44, p = 0.91) or IKDC scores (mean difference: 2.80, p = 0.14) between the PRP and control groups. Similarly, ROM measures did not show a statistically significant difference, with a mean difference of 2.80 (p = 0.18). Additionally, there was no significant distinction in failure rates between the PRP and control groups, as indicated by a weighted mean difference of 0.71 (p = 0.52). These findings suggest that while PRP may offer some benefits in pain relief, its impact on functional recovery, range of motion, and failure rates following meniscal repair procedures is inconclusive. Conclusion The current evidence regarding the effect of intraoperative platelet-rich plasma (PRP) injection on patients undergoing meniscal repair remains inconclusive. While some studies suggest potential benefits in terms of pain relief and functional recovery, others show no significant differences compared to control groups. The impact of PRP therapy on overall success rates, including rates of re-tear and revision surgery, is also uncertain. Further well-designed randomized controlled trials with larger sample sizes are needed to provide more robust evidence and guide clinical practice in orthopedic surgery.
Collapse
Affiliation(s)
| | - Iffath Misbah
- Department of Radiodiagnosis, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Jagadeesh Bhaskaran
- Department of Orthopedics, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Nazmul Huda Syed
- Adjunct Faculty, Center for Global Health and Research, Saveetha Institute of Medical and Technical Sciences, Chennai, India
- School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan Malaysia
| | - Munis Ashraf
- Department of Orthopedics, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Navin Balasubramanian
- Department of Orthopedics, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| |
Collapse
|
6
|
Mohammad A, Laboulaye MA, Shenhar C, Dobberfuhl AD. Mechanisms of oxidative stress in interstitial cystitis/bladder pain syndrome. Nat Rev Urol 2024; 21:433-449. [PMID: 38326514 DOI: 10.1038/s41585-023-00850-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2023] [Indexed: 02/09/2024]
Abstract
Interstitial cystitis/bladder pain syndrome (IC/BPS) is characterized by bladder and/or pelvic pain, increased urinary urgency and frequency and nocturia. The pathophysiology of IC/BPS is poorly understood, and theories include chronic inflammation, autoimmune dysregulation, bacterial cystitis, urothelial dysfunction, deficiency of the glycosaminoglycan (GAG) barrier and urine cytotoxicity. Multiple treatment options exist, including behavioural interventions, oral medications, intravesical instillations and procedures such as hydrodistension; however, many clinical trials fail, and patients experience an unsatisfactory treatment response, likely owing to IC/BPS phenotype heterogeneity and the use of non-targeted interventions. Oxidative stress is implicated in the pathogenesis of IC/BPS as reactive oxygen species impair bladder function via their involvement in multiple molecular mechanisms. Kinase signalling pathways, nociceptive receptors, mast-cell activation, urothelial dysregulation and circadian rhythm disturbance have all been linked to reactive oxygen species and IC/BPS. However, further research is necessary to fully uncover the role of oxidative stress in the pathways driving IC/BPS pathogenesis. The development of new models in which these pathways can be manipulated will aid this research and enable further investigation of promising therapeutic targets.
Collapse
Affiliation(s)
- Ashu Mohammad
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Mallory A Laboulaye
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Chen Shenhar
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Amy D Dobberfuhl
- Department of Urology, Stanford University School of Medicine, Palo Alto, CA, USA.
| |
Collapse
|
7
|
Blanco J, García Alonso A, Hermida-Nogueira L, Castro AB. How to explain the beneficial effects of leukocyte- and platelet-rich fibrin. Periodontol 2000 2024. [PMID: 38923566 DOI: 10.1111/prd.12570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/06/2024] [Accepted: 04/15/2024] [Indexed: 06/28/2024]
Abstract
The survival of an organism relies on its ability to repair the damage caused by trauma, toxic agents, and inflammation. This process involving cell proliferation and differentiation is driven by several growth factors and is critically dependent on the organization of the extracellular matrix. Since autologous platelet concentrates (APCs) are fibrin matrices in which cells, growth factors, and cytokines are trapped and delivered over time, they are able to influence that response at different levels. The present review thoroughly describes the molecular components present in one of these APCs, leukocyte- and platelet-rich fibrin (L-PRF), and summarizes the level of evidence regarding the influence of L-PRF on anti-inflammatory reactions, analgesia, hemostasis, antimicrobial capacity, and its biological mechanisms on bone/soft tissue regeneration.
Collapse
Affiliation(s)
- Juan Blanco
- Department of Surgery (Stomatology, Unit of Periodontology), Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Angel García Alonso
- Platelet Proteomics Group, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Santiago de Compostela University, Santiago de Compostela, Spain
| | - Lidia Hermida-Nogueira
- Platelet Proteomics Group, Center for Research in Molecular Medicine and Chronic Diseases (CIMUS), Santiago de Compostela University, Santiago de Compostela, Spain
| | - Ana B Castro
- Department of Oral Health Sciences, Section of Periodontology, KU Leuven & Dentistry, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
8
|
Impieri L, Pezzi A, Hadad H, Peretti GM, Mangiavini L, Rossi N. Orthobiologics in delayed union and non-union of adult long bones fractures: A systematic review. Bone Rep 2024; 21:101760. [PMID: 38618008 PMCID: PMC11010966 DOI: 10.1016/j.bonr.2024.101760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 04/04/2024] [Accepted: 04/05/2024] [Indexed: 04/16/2024] Open
Abstract
Background Fracture healing poses a significant challenge in orthopedics. Successful regeneration of bone is provided by mechanical stability and a favorable biological microenvironment. This systematic review aims to explore the clinical application of orthobiologics in treating aseptic delayed union and non-union of long bones in adults. Methods A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Three databases were explored, with no date restrictions, using keywords related to orthobiologics and delayed union and non-union. Eligible studies included human clinical studies in English, with available full texts, examining orthobiologics such as platelet-rich plasma (PRP), mesenchymal stem cells (MSCs), and bone morphogenetic protein (BMPs) for treating aseptic delayed unions and non-unions in adults. Animal studies, in vitro research, and studies on non-unions due to congenital defects, tumors or infections were excluded. Results The initial search identified 9417 studies, with 20 ultimately included in the review. These studies involved 493 patients affected by non-union and 256 patients affected by delayed union, with an average age respectively of 40.62 years and 41.7 years. The mean follow-up period was 15.55 months for non-unions and 8.07 months for delayed unions. PRP was the most used orthobiologic, and outcomes were evaluated through time to union, functional scores, and clinical examinations. The results indicated that orthobiologics, especially PRP, tended to yield better outcomes compared to surgical procedures without biological factors. Conclusion This systematic review suggests that orthobiologics, such as PRP, BMPs, and MSCs, can be effective and safe in the management of delayed union and non-union fractures. These biological treatments have the potential to improve union rates, reduce healing times, and enhance functional outcomes in patients with non-union fractures. Further research is essential to refine treatment protocols and determine the most suitable orthobiologic for specific patient populations and fracture types.
Collapse
Affiliation(s)
- Lorenzo Impieri
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Andrea Pezzi
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| | - Henrique Hadad
- Department of Diagnosis and Surgery, São Paulo State University (UNESP), Araçatuba School of Dentistry, São Paulo, Brazil
| | - Giuseppe M. Peretti
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Laura Mangiavini
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- IRCCS Ospedale Galeazzi Sant'Ambrogio, Milan, Italy
| | - Nicolò Rossi
- Residency Program in Orthopedics and Traumatology, University of Milan, Milan, Italy
| |
Collapse
|
9
|
Iacono V, Padovani L, Qordja F, De Berardinis L, Screpis D, Gigante AP, Zorzi C. Surgical and Biological Treatment with a Platelet-Rich Fibrin Matrix for Patellar Tendinopathy: Clinical Outcomes and Return to Sport at 2-Year Follow-Up. J Pers Med 2024; 14:567. [PMID: 38929787 PMCID: PMC11204417 DOI: 10.3390/jpm14060567] [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: 04/27/2024] [Revised: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Patellar tendinopathy (PT) involves anterior knee pain and functional. Platelet-rich fibrin matrix (PRFM) is a promising biological therapy for tendinopathies. We examined a cohort of PT patients treated with tendon debridement and autologous PRFM at the 24-month follow-up to assess whether the combined treatment facilitated return to sports and yielded satisfactory clinical and functional scores. METHODS Baseline and 24-month visual analogue scale (VAS), Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P), Tegner Activity Scale (TAS), and Blazina scores were compared to evaluate treatment effectiveness. The Friedman test was used to compare repeated observations of VAS, VISA-P, TAS, and Blazina Score values. Return to sport rate, Tampa Scale of Kinesiophobia (TKS) score and patient satisfaction were collected at 24 months. RESULTS The postoperative clinical scores demonstrated significant improvement compared with their preoperative values (all p < 0.001). Specifically, the VISA-P score was 80.32 (±20.58), 92.10% of patients had resumed sports activities and patient satisfaction was 9.21 (±1.21) at 24 months. CONCLUSIONS Surgical debridement and autologous PRFM application in patients with chronic PT resulted in a higher rate of return to sports when compared to solely surgical treatment, significantly improved clinical outcomes and excellent patient satisfaction at 24 months.
Collapse
Affiliation(s)
- Venanzio Iacono
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy; (V.I.); (L.P.); (D.S.); (C.Z.)
| | - Luca Padovani
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy; (V.I.); (L.P.); (D.S.); (C.Z.)
| | - Fjorela Qordja
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy; (L.D.B.); (A.P.G.)
| | - Luca De Berardinis
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy; (L.D.B.); (A.P.G.)
| | - Daniele Screpis
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy; (V.I.); (L.P.); (D.S.); (C.Z.)
| | - Antonio Pompilio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy; (L.D.B.); (A.P.G.)
| | - Claudio Zorzi
- Department of Orthopaedics, IRCCS Ospedale Sacro Cuore Don Calabria, 37024 Negrar, Italy; (V.I.); (L.P.); (D.S.); (C.Z.)
| |
Collapse
|
10
|
Ye Z, Chen H, Qiao Y, Wu C, Cho E, Wu X, Li Z, Wu J, Lu S, Xie G, Dong S, Xu J, Zhao J. Intra-Articular Platelet-Rich Plasma Injection After Anterior Cruciate Ligament Reconstruction: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2410134. [PMID: 38728032 PMCID: PMC11087838 DOI: 10.1001/jamanetworkopen.2024.10134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/07/2024] [Indexed: 05/12/2024] Open
Abstract
Importance Platelet-rich plasma (PRP) has been considered a promising treatment for musculoskeletal disorders. The effects of PRP on clinical outcomes of anterior cruciate ligament reconstruction (ACLR) are controversial. Objective To compare subjective outcomes and graft maturity in patients undergoing ACLR with and without postoperative intra-articular PRP injection. Design, Setting, and Participants This surgeon- and investigator-masked randomized clinical trial included patients treated at a national medical center in China who were aged 16 to 45 years and scheduled to undergo ACLR. Participants were enrolled between March 21, 2021, and August 18, 2022, and followed up for 12 months, with the last participant completing follow-up on August 28, 2023. Interventions Participants were randomized 1:1 to the PRP group (n = 60), which received 3 doses of postoperative intra-articular PRP injection at monthly intervals, or to the control group (n = 60), which did not receive postoperative PRP injection. Both groups had the same follow-up schedule. Main Outcomes and Measures The primary outcome was the mean score for 4 subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS4) (range, 0-100, with higher scores indicating better knee function and fewer symptoms) at 12 months postoperatively. Secondary outcomes were patient-reported outcomes, graft maturity (on magnetic resonance imaging), and physical examinations at 3, 6, and 12 months. Results Among the 120 randomized participants (mean [SD] age, 29.0 [8.0] years; 84 males [70%]), 114 (95%) were available for the primary outcome analysis. The mean KOOS4 scores at 12 months were 78.3 (SD, 12.0; 95% CI, 75.2-81.4) in the PRP group and 76.8 (SD, 11.9; 95% CI, 73.7-79.9) in the control group (adjusted mean between-group difference, 2.0; 95% CI, -2.3 to 6.3; P = .36). Secondary outcomes were not statistically significantly different between the 2 groups except for sports and recreation level and graft maturity at 6 months. Intervention-related adverse events included pain at the injection site and knee swelling after injection. Conclusions and Relevance In this randomized clinical trial among patients undergoing ACLR, the addition of postoperative intra-articular PRP injection did not result in superior improvement of knee symptoms and function at 12 months compared with no postoperative injection. Further studies are required to determine appropriate indications for PRP in musculoskeletal disorders. Trial Registration Chinese Clinical Trial Registry Identifier: ChiCTR2000040262.
Collapse
Affiliation(s)
- Zipeng Ye
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huiang Chen
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi Qiao
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chenliang Wu
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Eunshinae Cho
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiulin Wu
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziyun Li
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinlong Wu
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Simin Lu
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Guoming Xie
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shikui Dong
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junjie Xu
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhong Zhao
- Department of Sports Medicine, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
11
|
Vale D, Pereira A, Andrade JP, Castro JP. The Role of Platelet-Rich Plasma Injection for Muscle Strains in Athletes. Cureus 2024; 16:e60585. [PMID: 38894806 PMCID: PMC11184543 DOI: 10.7759/cureus.60585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Muscle tears/strains are among the most common musculoskeletal injuries, posing a serious challenge for sports medicine. Aiming to reduce the time to return to play and the rate of reinjuries, apart from the traditional conservative treatments and rehabilitation protocols, new and innovative therapeutic options have emerged, particularly platelet-rich plasma (PRP). This study aims to present the available evidence regarding PRP injection for the treatment of muscle strains in athletes. Two databases were searched for articles published between January 2012 and December 2022 in Portuguese or English. The query used for the PubMed database was ("Muscles/injuries"[Mesh]) AND ("Athletes"[Mesh] OR "Athletic Injuries"[Mesh]) AND "Platelet-Rich Plasma"[Mesh], while for the Web of Science database the search was performed for "Platelet-rich plasma" AND "Muscle injuries" AND ("Athletes" OR "Athletic injuries"). Eleven studies involving athletes diagnosed with muscle injuries who received treatment with PRP injection alone, or in combination with traditional conservative treatment, compared to a control group, were included. Four randomized controlled trials, four systematic reviews/meta-analyses, two retrospective studies, and one comparative study were included. Current evidence from the highest-quality studies does not support the hypothesis of reduction of time to return to play and the rate of reinjuries after PRP injection, even though some studies reported positive results. However, the available evidence suggests that PRP might have a beneficial effect on the pain perceived by athletes following an acute muscle strain. It is challenging to arrive at definitive conclusions and translate these findings into a clinical context for treating muscle strains in athletes. The existing trials present several inconsistencies and limitations, with a heterogeneous set of patients and injuries, as well as the use of different and inconsistent methods for preparing, administering, and measuring the effects of PRP. To achieve consistent outcomes, standardizing PRP administration procedures is essential.
Collapse
Affiliation(s)
- David Vale
- Medical School, Faculty of Medicine, University of Porto, Porto, PRT
| | - Adriana Pereira
- Physical Medicine and Rehabilitation, Centro de Medicina de Reabilitação de Alcoitão, Alcoitão, PRT
| | - José Paulo Andrade
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, PRT
| | - João Paulo Castro
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, PRT
| |
Collapse
|
12
|
Medina-Porqueres I, Martin-Garcia P, Sanz-De-Diego S, Reyes-Eldblom M, Moya-Torrecilla F, Mondragon-Cortes R, Rosado-Velazquez D, Gomez-Caceres A. Platelet-Rich Plasma Injections in Chronic Lateral Ankle Instability: A Case Series. Biomedicines 2024; 12:963. [PMID: 38790925 PMCID: PMC11118008 DOI: 10.3390/biomedicines12050963] [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: 03/28/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024] Open
Abstract
The platelet-rich plasma (PRP) approach may be an effective treatment for joint and cartilage pathologies. However, the rationale for its effectiveness on joint instability is limited. This study aimed to assess the safety and effectiveness of PRP injections in patients with chronic lateral ankle instability (CLAI). This retrospective study was performed at a single-center outpatient clinic between January 2015 and February 2023 and included pre-intervention assessment and short-term follow-up. Patients were excluded if they had received previous surgical treatment or had constitutional hyperlaxity, systemic diseases, or grade II or III osteoarthritis. The clinical and functional evaluation consisted of the Karlsson score, the Cumberland Ankle Instability Tool (CAIT), Good's grading system, the patient's subjective satisfaction level, and the time required to return to exercise. The entire PRP therapy regime consisted of three PRP administrations at 7-day intervals and follow-up appointments. PRP was administered both intraarticularly and into talofibular ligaments. A total of 47 consecutive patients with CLAI were included, 11 were female (23.4%), with a mean age at intervention of 31.19 ± 9.74 years. A statistically significant improvement was found in the CAIT and Karlsson scores at 3 months (27.74 ± 1.68 and 96.45 ± 4.28, respectively) relative to the pre-intervention status (10.26 ± 4.33 and 42.26 ± 14.9, respectively, p < 0.000). The mean follow-up of patients with CLAI was 17.94 ± 3.25 weeks. This study represents successful short-term functional and clinical outcomes in patients with CLAI after PRP treatment, with no adverse effects. It demonstrates the feasibility of a randomized controlled trial to further assess this therapy.
Collapse
Affiliation(s)
- Ivan Medina-Porqueres
- Department of Physical Therapy, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain;
- Medical Services, Malaga Football Club, 29011 Malaga, Spain;
| | - Pablo Martin-Garcia
- Onco-Hematology Unit, University Hospital Virgen de la Victoria, 29010 Malaga, Spain;
| | | | | | - Francisco Moya-Torrecilla
- Department of Physical Therapy, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain;
- Vithas Xanit International Hospital, 29630 Benalmadena, Spain;
| | | | | | - Abel Gomez-Caceres
- Department of Physical Therapy, Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain;
- Medical Services, Malaga Football Club, 29011 Malaga, Spain;
- HM Hospitals, 29010 Malaga, Spain;
| |
Collapse
|
13
|
Desouza C, Shetty V. Effectiveness of platelet-rich plasma in partial-thickness rotator cuff tears: a systematic review. J ISAKOS 2024:S2059-7754(24)00080-4. [PMID: 38641254 DOI: 10.1016/j.jisako.2024.04.010] [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: 01/18/2024] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 04/21/2024]
Abstract
IMPORTANCE Partial-thickness rotator cuff tears (PTRCTs) commonly affect overhead athletes, leading to a decline in sports performance. Platelet-rich plasma (PRP) is being explored as an alternative treatment modality for individuals with PTRCTs to reduce discomfort and enhance functional recovery. We conducted a systematic review study of randomized controlled clinical trials to determine the effectiveness of PRP in treating PTRCTs. AIM To determine the effectiveness of PRP in treating PTRCTs. EVIDENCE REVIEW We conducted a comprehensive literature search for randomized controlled trials (RCTs) that compared the effectiveness of PRP with eccentric exercise and placebo injections as treatments for PTRCTs. We searched databases such as the Cochrane Library, Web of Science, PubMed, and EMBASE. The visual analog scale (VAS) score, American Shoulder and Elbow Surgeon (ASES) score, and Constant-Murley Score (CMS) was utilized as an outcome measure. Statistical analysis was performed using RevMan 5.3 software. FINDINGS Our meta-analysis included 12 studies involving 762 patients. At six weeks post-treatment, the PRP group had significantly higher VAS scores compared to the control group, indicating improvement (standard mean difference (SMD): -2.04 [95% confidence interval (CI): -4.00 to -0.08], I2 = 97%, P-value = 0.04). Patients who received PRP showed statistically significant improvements in VAS scores at 3 months and 6 months follow-up (SMD, -1.78 [95% CI: -3.03 to -0.52], I2 = 96%, P-value = 0.005) (SMD: -2.26 [95% CI: -3.77 to -0.76], I2 = 97%, P-value = 0.003). A statistically significant difference was also observed in VAS scores at the long-term 1-year follow-up (SMD: -2.27 [95% CI: -4.07 to -0.47]; I2 = 98%; P-value = 0.031). There were statistically significant differences in ASES scores and CMS scores in the short-term (SMD: 1.21 [95% CI: 0.19 to 2.24], I2 = 96%, P-value = 0.02) (SMD, 2.01 [95% CI: 0.14 to 3.88], I2 = 97%, P-value = 0.04). However, in the long-term ASES and CMS scores did not show any statistical significance (SMD: 2.06 [95% CI: -0.54 to 4.65], I2 = 99%, P-value = 0.12) (SMD: 4.36 [95% CI: -5.48 to 14.21], I2 = 99%, P-value = 0.39). CONCLUSIONS AND RELEVANCE Our findings suggest that PRP treatment is effective in reducing pain for individuals with PTRCTs, providing benefits in the short and long term. However, its impact on functional recovery appears somewhat constrained and doesn't endure over time. Additionally, significant heterogeneity exists among studies, encompassing variations in PRP composition and control group treatments. Consequently, we conclude that compelling evidence for symptom improvement in PTRCT patients following PRP treatment remains elusive. LEVEL OF EVIDENCE Level I.
Collapse
Affiliation(s)
- Clevio Desouza
- SAANVI Orthopaedics, 2003, Sorrento, High Street, Hiranandani Gardens, Powai, Mumbai 400076, India; Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, 400053, India.
| | - Vijay Shetty
- SAANVI Orthopaedics, 2003, Sorrento, High Street, Hiranandani Gardens, Powai, Mumbai 400076, India; Dr L H Hiranandani Hospital, Hiranandani Gardens, Powai, Mumbai, 400076, India
| |
Collapse
|
14
|
Zhang Q, Yao Y, Chen Y, Ren D, Wang P. A Retrospective Study of Biological Risk Factors Associated with Primary Knee Osteoarthritis and the Development of a Nomogram Model. Int J Gen Med 2024; 17:1405-1417. [PMID: 38617053 PMCID: PMC11015847 DOI: 10.2147/ijgm.s454664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 04/04/2024] [Indexed: 04/16/2024] Open
Abstract
Aim A high percentage of the elderly suffer from knee osteoarthritis (KOA), which imposes a certain economic burden on them and on society as a whole. The purpose of this study is to examine the risk of KOA and to develop a KOA nomogram model that can timely intervene in this disease to decrease patient psychological burdens. Methods Data was collected from patients with KOA and without KOA at our hospital from February 2021 to February 2023. Initially, a comparison was conducted between the variables, identifying statistical differences between the two groups. Subsequently, the risk of KOA was evaluated using the Least Absolute Shrinkage and Selection Operator method and multivariate logistic regression to determine the most effective predictive index and develop a prediction model. The examination of the disease risk prediction model in KOA includes the corresponding nomogram, which encompasses various potential predictors. The assessment of disease risk entails the application of various metrics, including the consistency index (C index), the area under the curve (AUC) of the receiver operating characteristic curve, the calibration chart, the GiViTi calibration band, and the model for predicting KOA. Furthermore, the potential clinical significance of the model is explored through decision curve analysis (DCA) and clinical influence curve analysis. Results The study included a total of 582 patients, consisting of 392 patients with KOA and 190 patients without KOA. The nomogram utilized age, haematocrit, platelet count, apolipoprotein a1, potassium, magnesium, hydroxybutyrate dehydrogenase, creatine kinase, and estimated glomerular filtration rate as predictors. The C index, AUC, calibration plot, Giviti calibration band, DCA and clinical influence KOA indicated the ability of nomogram model to differentiate KOA. Conclusion Using nomogram based on disease risk, high-risk KOA can be identified directly without imaging.
Collapse
Affiliation(s)
- Qingzhu Zhang
- Orthopedic Trauma Service Center, Third Hospital of Hebei Medical University, Major Laboratory of Orthopedic Biomechanics in Hebei Province, Shijiazhuang, Hebei Province, People’s Republic of China
- Department of Orthopedics, the Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, People’s Republic of China
| | - Yinhui Yao
- Department of Pharmacy, the Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, People’s Republic of China
| | - Yufeng Chen
- Orthopedic Trauma Service Center, Third Hospital of Hebei Medical University, Major Laboratory of Orthopedic Biomechanics in Hebei Province, Shijiazhuang, Hebei Province, People’s Republic of China
| | - Dong Ren
- Orthopedic Trauma Service Center, Third Hospital of Hebei Medical University, Major Laboratory of Orthopedic Biomechanics in Hebei Province, Shijiazhuang, Hebei Province, People’s Republic of China
| | - Pengcheng Wang
- Orthopedic Trauma Service Center, Third Hospital of Hebei Medical University, Major Laboratory of Orthopedic Biomechanics in Hebei Province, Shijiazhuang, Hebei Province, People’s Republic of China
| |
Collapse
|
15
|
Varela-Margolles D, Milani A, Kamel SI. Percutaneous Interventions for Injuries in Athletes: Implications on Return to Play. Semin Musculoskelet Radiol 2024; 28:146-153. [PMID: 38484767 DOI: 10.1055/s-0043-1778026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
For nonsurgical musculoskeletal (MSK) injuries in athletes, image-guided percutaneous intervention may aid in recovery and decrease return to play (RTP) time. These interventions fall into two major categories: to reduce inflammation (and therefore alleviate pain) or to promote healing. This review describes the risks and benefits of the various percutaneous interventions in MSK athletic injury and surveys the literature regarding the implication of these interventions on RTP.
Collapse
Affiliation(s)
- Diana Varela-Margolles
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Ava Milani
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Sarah I Kamel
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| |
Collapse
|
16
|
Levine OP, Kondapi K, Tjong VK, Gohal C. Postinjection protocols following platelet-rich plasma administration for knee osteoarthritis: A systematic review. PM R 2024. [PMID: 38525952 DOI: 10.1002/pmrj.13139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 12/26/2023] [Accepted: 01/08/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE Platelet-rich plasma (PRP) use in treating orthopedic conditions has increased, yet evidence of its clinical efficacy is inconsistent and limited by heterogeneity in osteoarthritis (OA) severity, PRP preparations and protocols, and clinical outcome measurement. This review aims to characterize the variations in postinjection protocols in studies assessing the clinical efficacy of PRP for knee OA. LITERATURE SURVEY A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search from database inception to February 2023 of CINAHL, MEDLINE, and EMBASE was conducted. METHODOLOGY Article screening, data extraction, and risk of bias assessments were completed in duplicate by two reviewers. Primary outcomes were presence/absence and timing of the following postinjection protocol components: nonsteroidal anti-inflammatory drug (NSAID) restrictions, non-NSAID analgesic and cryotherapy use, immediate knee flexion/extension, immediate rest, activity restriction, return-to-activity guidelines, and rehabilitation protocols. A descriptive analysis was used to analyze the data. Given study heterogeneity, a meta-analysis was not performed. SYNTHESIS A total of 187 studies were included for analysis. Half of all studies (51.9%) excluded patients due to preinjection NSAID use, most often within 5 days of blood sampling or injection. Postinjection NSAID restriction was included in 42.8% of studies, ranging from 1 to 1800 days. Few studies (19.4%) that permitted non-NSAID analgesia restricted their use prior to clinical assessments. Postinjection immediate flexion, extension, and immobilization were rarely (8.6%) mentioned. Activity restriction was included in a third of studies (35.3%), with the most frequent length of restriction being 1 day. Postinjection return-to-activity protocols were less common (20.3%), usually with a "gradual" and/or "as tolerated" recommendation. A minority of studies (16.0%) reported physical therapy protocols and the vast majority (93.3%) were home based. CONCLUSION Significant heterogeneity remains in post-PRP injection protocols, with unclear consensus regarding optimal recommendations and limited rationale for the protocols outlined. Further study is necessary to compare protocols directly and to determine which pre- and postinjection recommendations can result in optimal outcomes.
Collapse
Affiliation(s)
- Oscar Paul Levine
- Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Koushik Kondapi
- Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Vehniah Kristin Tjong
- Department of Orthopaedic Surgery, Northwestern University, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Chetan Gohal
- Rothman Orthopaedic Institute, New York City, New York, USA
| |
Collapse
|
17
|
Liu S, Wu C, Zhang Y. Transcriptomics analyses of IL-1β-stimulated rat chondrocytes in temporomandibular joint condyles and effect of platelet-rich plasma. Heliyon 2024; 10:e26739. [PMID: 38434027 PMCID: PMC10906425 DOI: 10.1016/j.heliyon.2024.e26739] [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] [Revised: 02/09/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
The biological mechanism of action of platelet-rich plasma (PRP) in the treatment of temporomandibular joint (TMJ) osteoarthritis remains unclear. This study explored the mechanisms underlying interleukin (IL)-1β-induced inflammation and investigated the effect of PRP on TMJ condylar chondrocytes. Primary chondrocytes were isolated from the TMJ condyle of 4-week-old rats, and differentially expressed genes among three treatment groups (phosphate-buffered saline [control], IL-1β, and IL-1β + PRP) were identified using RNA-seq and characterized using Gene Ontology and Kyoto Encyclopedia of Genes and Genomes path-enrichment analyses. IL-1β caused inflammatory injury to chondrocytes by upregulating the TNF, NF-κB, and IL-17 signaling pathways and downregulating the MAPK and PI3K/Akt signaling pathways. PRP activated the MAPK and PI3K/Akt signaling pathways, exerting a protective effect on IL-1β-induced chondrocytes. PRP also activated the TNF and IL-17 signaling pathways, producing an inflammatory effect. Additionally, PRP increased the mRNA expression of the matrix catabolism-related genes Mmp3, Mmp9, and Mmp13; the proliferative markers Mki67 and PCNA; and the anti-apoptotic genes of the Bcl-2 family (Bcl2a1 and Bok), while reducing the expression of the pro-apoptotic genes Casp4 and Casp12. The findings suggest that the protective effect of PRP on IL-1β-induced chondrocyte injury is mainly achieved via MAPK-PI3K/Akt signaling, increasing cell proliferation and inhibiting cell apoptosis.
Collapse
Affiliation(s)
- Shasha Liu
- Department of Rehabilitation Medicine, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Department of Rehabilitation Medicine, Sijing Hospital of the Songjiang District of Shanghai, Shanghai, 201600 China
| | - Chaolun Wu
- Department of Rehabilitation Medicine, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yuxin Zhang
- Department of Rehabilitation Medicine, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| |
Collapse
|
18
|
Tan VAK, Tan CC, Yeo NEM, Zhang M, Mehta KV, Tian RHH, Tan B. Consensus statements and guideline for the diagnosis and management of plantar fasciitis in Singapore. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2024; 53:101-112. [PMID: 38920234 DOI: 10.47102/annals-acadmedsg.2023211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Introduction Plantar fasciitis (PF) is a common cause of heel pain among the general population. The lack of standard practice guideline in Singapore presents challenges in education and clinical practice for this painful condition. These consensus statements and guideline were developed to streamline and improve the management of PF, covering key aspects such as diagnosis, investigations, risk factors, treatment modalities, monitoring and return to work/play. Method A multidisciplinary expert panel consisting of 6 sports physicians, 2 orthopaedic surgeons, 2 podiatrists and 1 physiotherapist from SingHealth Duke-NUS Sport & Exercise Medicine Centre (SDSC) was convened based on their clinical and academic experience with PF. The Grading of Recommen-dations, Assessment, Development and Evaluations (GRADE) approach was used to evaluate the quality of the evidence and subsequently prepare a set of clinical recommen-dations pertaining to the manage-ment of PF. A modified Delphi process was used to reach consensus. Results Eighteen consensus statements were developed to cover key components of PF management, from initial diagnosis to treatment modalities and finally, clinical progression. They were subsequently consolidated under a proposed treatment pathway guideline for PF. Conclusion The SDSC consensus statements and guideline provide concise recommendations for the management of PF in Singapore.
Collapse
Affiliation(s)
| | - Chin Chuen Tan
- Department of Sports and Exercise Medicine, Changi General Hospital, Singapore
| | | | - Mandy Zhang
- Department of Sports and Exercise Medicine, Changi General Hospital, Singapore
| | | | - Roger Ho Heng Tian
- Department of Sports and Exercise Medicine, Changi General Hospital, Singapore
| | - Benedict Tan
- Department of Sports and Exercise Medicine, Changi General Hospital, Singapore
| |
Collapse
|
19
|
Mende E, Love RJ, Young JL. A Comprehensive Summary of the Meta-Analyses and Systematic Reviews on Platelet-Rich Plasma Therapies for Knee Osteoarthritis. Mil Med 2024:usae022. [PMID: 38421752 DOI: 10.1093/milmed/usae022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/30/2023] [Accepted: 01/25/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Osteoarthritis (OA), including that of the knee joint, represents a significant proportion of musculoskeletal injuries in the Canadian Armed Forces (CAF) due to the frequent, high-stress physical activity for which member participation is necessary. Platelet-rich plasma (PRP) is a conservative, autologous treatment that has the potential to relieve symptoms and improve functionality of military members to decrease the impact of the disease and ultimately strengthen the CAF. MATERIALS AND METHODS A search of systematic reviews and meta-analyses was conducted to determine the efficacy of PRP injections in treating knee OA. The Scopus database, PubMed database, and Omni academic search tools were scoped for relevant publications. English literature, published up to and including March 2023, that investigated only clinically randomized controlled trials (RCTs) was eligible for inclusion. The results of network meta-analyses were investigated and summarized independent of reviews and non-network meta-analyses. RESULTS A total of 225 unique systematic reviews and meta-analyses were initially identified, of which 39 publications, including 7 network meta-analyses, adhered to the defined inclusion and exclusion criteria. PRP was found to significantly alleviate symptoms of pain based on the visual analog scale and Western Ontario and McMaster Universities Arthritis Index pain scores within the 12-month follow-up. Function, activity, sport, quality of life, and stiffness were additionally determined to generally improve to a greater extent from PRP treatment compared to controls, while adverse effects were minor and temporary. PRP placed in the top 3 in 9 reported surface under the cumulative ranking curves, while individually reported rankings of leukocyte-poor and leukocyte-rich PRP both placed in the top 4. The clinical recommendations made were generally positive, with 17 publications acknowledging the benefits of PRP, 3 supporting possible efficacy, and an additional 8 recommending that it be an option for the conservative treatment of knee OA. CONCLUSION The results of this review support the efficacy of PRP for relieving symptoms of pain and improving function, stiffness, and quality of life for patients experiencing knee OA within 12 months. As a result, leukocyte-poor-PRP could be considered for members of the CAF with mild to moderate knee OA (Kellgren-Lawrence grades 1-3) to slow the progression of OA and extend the military careers of CAF members. There continues to be a need for future studies to investigate the longer-term effects of PRP to verify sustained benefits at follow-up points greater than 12 months, including findings of improvement in a delayed fashion at the 3- and 6-month timeframe compared to hyaluronic acid treatment.
Collapse
Affiliation(s)
- Emily Mende
- Defence Research and Development Canada, 1133 Sheppard Ave West, Toronto, Ontario M3K2C9, Canada
- Dept. of Systems Design Engineering, University of Waterloo, 200 University Ave. West, Waterloo, Ontario N2L 3G1, Canada
| | - Ryan J Love
- Defence Research and Development Canada, 1133 Sheppard Ave West, Toronto, Ontario M3K2C9, Canada
| | - Jody-Lynn Young
- Canadian Forces Health Services, 101 Colonel By Dr., Ottawa, Ontario K1A 0K2, Canada
| |
Collapse
|
20
|
Moulton SG, Hartwell MJ, Feeley BT. Evaluation of Spin Bias in Systematic Reviews and Meta-analyses of Rotator Cuff Repair With Platelet-Rich Plasma. Am J Sports Med 2024:3635465231213039. [PMID: 38323324 DOI: 10.1177/03635465231213039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
BACKGROUND The use of platelet-rich plasma (PRP) in orthopaedics continues to increase. One common use of PRP is as an adjunct in rotator cuff repair surgery. Multiple systematic reviews and meta-analyses have summarized the data on PRP use in rotator cuff repair surgery. However, systematic reviews and meta-analyses are subject to spin bias, where authors' interpretations of results influence readers' interpretations. PURPOSE To evaluate spin in the abstracts of systematic reviews and meta-analyses of PRP with rotator cuff repair surgery. STUDY DESIGN Systematic review; Level of evidence, 3. METHODS A PubMed and Embase search was conducted using the terms rotator cuff repair and PRP and systematic review or meta-analysis. After review of 74 initial studies, 25 studies met the inclusion criteria. Study characteristics were documented, and each study was evaluated for the 15 most common forms of spin and using the AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews, Version 2) rating system. Correlations between spin types and study characteristics were evaluated using binary logistic regression for continuous independent variables and a chi-square test or Fisher exact test for categorical variables. RESULTS At least 1 form of spin was found in 56% (14/25) of the included studies. In regard to the 3 different categories of spin, a form of misleading interpretation was found in 56% (14/25) of the studies. A form of misleading reporting was found in 48% (12/25) of the studies. A form of inappropriate extrapolation was found in 16% (4/25) of the studies. A significant association was found between misleading interpretation and publication year (odds ratio [OR], 1.41 per year increase in publication; 95% CI, 1.04-1.92; P = .029) and misleading reporting and publication year (OR, 1.41 per year increase in publication; 95% CI, 1.02-1.95; P = .037). An association was found between inappropriate extrapolation and journal impact factor (OR, 0.21 per unit increase in impact factor; 95% CI, 0.044-0.99; P = .048). CONCLUSION A significant amount of spin was found in the abstracts of systematic reviews and meta-analyses of PRP use in rotator cuff repair surgery. Given the increasing use of PRP by clinicians and interest among patients, spin found in these studies may have a significant effect on clinical practice.
Collapse
Affiliation(s)
- Samuel G Moulton
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Matthew J Hartwell
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Brian T Feeley
- Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
21
|
Sahi G, Du JT, Abbas A, Dhotar HS. Current state of systematic reviews for platelet-rich plasma use in knee osteoarthritis. Orthop Traumatol Surg Res 2024; 110:103735. [PMID: 37890526 DOI: 10.1016/j.otsr.2023.103735] [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: 12/23/2022] [Revised: 10/07/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023]
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a highly prevalent musculoskeletal disorder affecting millions of people. To date, there is no curative treatment for KOA other than joint arthroplasty. However, treatments such as platelet-rich plasma (PRP) have been proposed as a possible therapy, with increasing interest over the last decade. To date, there are no evidence-based guidelines in the use of PRP therapy for KOA, but there are numerous studies and systematic reviews (SRs) evaluating the usage of PRP in KOA. Since SRs are of great importance for clinical decision-making, it is necessary to access their methodological quality before any valid conclusions can be made. This study will evaluate the methodological quality of SRs on PRP therapy for KOA using a validated assessment tool known as AMSTAR 2, "A MeaSurement Tool to Assess systematic Reviews". HYPOTHESIS It is hypothesized that the methodological quality of SRs will be moderate, whereby most of the SRs will provide an accurate summary of the results but will include more than one critical weakness as defined by the AMSTAR 2 checklist. PATIENTS AND METHODS The MEDLINE, EMBASE, PubMed and Cochrane databases were searched from inception to May 2023. Two independent reviewers selected SRs that investigated the use of injection therapies for KOA. Descriptive statistical analysis was performed. AMSTAR 2 assessment was completed independently by the same reviewers. Cohen's kappa was calculated to measure interrater reliability. The quality of the studies was rated as "high", "moderate", "low", and "critically low". The overall confidence assessment was tabulated. RESULTS Forty-one SRs were included in the analysis. The Cohen kappa was 0.88, indicating high interrater reliability. There were no "high" quality SRs identified. Seven SRs (17%) were of "low" quality, while the remainder (34 SRs, 83%) were rated as "critically low". CONCLUSION The methodological quality of the selected SRs was suboptimal. Clinicians should critically appraise the SRs and interpret their conclusions with caution before making clinical decisions. This study supports future work of high-quality SRs regarding the use of PRP injections for KOA. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Gurjovan Sahi
- Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada
| | - Jin Tong Du
- Division of Orthopaedic Surgery, University of Toronto, 149 College Street Room 508-A, Toronto, ON, M5T 1P5, Canada
| | - Aazad Abbas
- Division of Orthopaedic Surgery, University of Toronto, 149 College Street Room 508-A, Toronto, ON, M5T 1P5, Canada
| | - Herman S Dhotar
- Department of Orthopaedic Surgery, North York General Hospital, University of Toronto, 4001 Leslie Street, North York, ON, M2K, Canada; Department of Surgery, University of Toronto, 149 College Street 5th Floor, Toronto, ON, M5T 1P5, Canada.
| |
Collapse
|
22
|
Aghajanova L, Zhang A, Lathi RB, Huddleston HG. Platelet-rich plasma infusion as an adjunct treatment for persistent thin lining in frozen embryo transfer cycles: first US experience report. J Assist Reprod Genet 2024; 41:483-491. [PMID: 37996549 PMCID: PMC10894781 DOI: 10.1007/s10815-023-02993-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/16/2023] [Indexed: 11/25/2023] Open
Abstract
PURPOSE To study effect of intrauterine infusion of platelet-rich plasma (PRP) on endometrial growth in the setting of thin endometrial lining in patients with prior cancelled or failed frozen embryo transfer (FET) cycles. MATERIALS AND METHODS Single-arm cohort study of forty-six patients (51 cycles) with endometrial lining thickness (EMT) < 6 mm in prior cancelled or failed FET cycles requesting intrauterine PRP treatment in upcoming FET cycle. The primary outcomes were final EMT in FET cycle and change in EMT after PRP. The secondary outcomes were overall pregnancy rate, clinical pregnancy rate, miscarriage rate, ongoing pregnancy, and live birth rates. RESULTS The mean pre-PRP EMT in all FET cycles was 4.0 ± 1.1 mm, and mean post-PRP EMT (final) was 7.1 ± 1.0 mm. Of 51 cycles, 33 (64.7%) reached ≥ 7 mm after PRP administration. There was a significant difference between pre-PRP EMT and post-PRP EMT in all FET cycles, with mean difference of 3.0 ± 1.5 mm. Three cycles were cancelled for failure to reach adequate lining. Total pregnancy rate was 72.9% in our cohort of 48 cycles that proceeded to transfer. Clinical pregnancy rate was 54.2% (26/48 FET cycles); clinical miscarriage rate was 14.3% (5/35 pregnancies). Twenty six women had live birth (18 with EMT ≥ 7 mm and 8 with EMT < 7 mm). Response to PRP was not correlated with any pre-cycle characteristics. CONCLUSION We demonstrate a significant improvement in lining thickness and pregnancy rates in this challenging cohort of women after PRP infusion, with no adverse events. Cost-effectiveness of PRP with benefits and alternatives should be carefully considered.
Collapse
Affiliation(s)
- Lusine Aghajanova
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford School of Medicine, 1195 West Fremont Avenue, MC 7717, Sunnyvale, CA, 94087, USA.
| | - Amy Zhang
- Quantitative Sciences Unit, Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Ruth B Lathi
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Stanford School of Medicine, 1195 West Fremont Avenue, MC 7717, Sunnyvale, CA, 94087, USA
| | - Heather G Huddleston
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
23
|
Miron RJ, Pikos MA, Estrin NE, Kobayashi-Fujioka M, Espinoza AR, Basma H, Zhang Y. Extended platelet-rich fibrin. Periodontol 2000 2024; 94:114-130. [PMID: 37986559 DOI: 10.1111/prd.12537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 11/22/2023]
Abstract
Platelet-rich fibrin (PRF) has been characterized as a regenerative biomaterial that is fully resorbed within a typical 2-3 week period. Very recently, however, a novel heating process was shown to extend the working properties of PRP/PRF from a standard 2-3 week period toward a duration of 4-6 months. Numerous clinicians have now utilized this extended-PRF (e-PRF) membrane as a substitute for collagen barrier membranes in various clinical applications, such as guided tissue/bone regeneration. This review article summarizes the scientific work to date on this novel technology, including its current and future applications in periodontology, implant dentistry, orthopedics and facial aesthetics. A systematic review was conducted investigating key terms including "Bio-Heat," "albumin gel," "albumin-PRF," "Alb-PRF," "extended-PRF," "e-PRF," "activated plasma albumin gel," and "APAG" by searching databases such as MEDLINE, EMBASE and PubMed. Findings from preclinical studies demonstrate that following a simple 10-min heating process, the transformation of the liquid plasma albumin layer into a gel-like injectable albumin gel extends the resorption properties to at least 4 months according to ISO standard 10 993 (subcutaneous animal model). Several clinical studies have now demonstrated the use of e-PRF membranes as a replacement for collagen membranes in GTR/GBR procedures, closing lateral windows in sinus grafting procedures, for extraction site management, and as a stable biological membrane during recession coverage procedures. Furthermore, Alb-PRF may also be injected as a regenerative biological filler that lasts extended periods with advantages in joint injections, osteoarthritis and in the field of facial aesthetics. This article highlights the marked improvement in the stability and degradation properties of the novel Alb-PRF/e-PRF technology with its widespread future potential use as a potential replacement for collagen membranes with indications including extraction site management, GBR procedures, lateral sinus window closure, recession coverage among others, and further highlights its use as a biological regenerative filler for joint injections and facial aesthetics. It is hoped that this review will pioneer future opportunities and research development in the field, leading to further progression toward more natural and less costly biomaterials for use in medicine and dentistry.
Collapse
Affiliation(s)
- Richard J Miron
- Advanced PRF Education, Jupiter, Florida, USA
- Department of Periodontology, University of Bern, Bern, Switzerland
| | | | | | - Masako Kobayashi-Fujioka
- Department of Oral and Maxillofacial Surgery, School of Life Dentistry at Tokyo, The Nippon Dental University, Tokyo, Japan
| | | | | | - Yufeng Zhang
- Department of Oral Implantology, University of Wuhan, Wuhan, China
| |
Collapse
|
24
|
Bacevich BM, Smith RDJ, Reihl AM, Mazzocca AD, Hutchinson ID. Advances with Platelet-Rich Plasma for Bone Healing. Biologics 2024; 18:29-59. [PMID: 38299120 PMCID: PMC10827634 DOI: 10.2147/btt.s290341] [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: 10/05/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024]
Abstract
Despite significant advances in the understanding and delivery of osteosynthesis, fracture non-union remains a challenging clinical problem in orthopaedic surgery. To bridge the gap, basic science characterization of fracture healing provides a platform to identify and target biological strategies to enhance fracture healing. Of immense interest, Platelet-rich plasma (PRP) is a point of care orthobiologic that has been extensively studied in bone and soft tissue healing given its relative ease of translation from the benchtop to the clinic. The aim of this narrative review is to describe and relate pre-clinical in-vitro and in-vivo findings to clinical observations investigating the efficacy of PRP to enhance bone healing for primary fracture management and non-union treatment. A particular emphasis is placed on the heterogeneity of PRP preparation techniques, composition, activation strategies, and delivery. In the context of existing data, the routine use of PRP to enhance primary fracture healing and non-union management cannot be supported. However, it is acknowledged that extensive heterogeneity of PRP treatments in clinical studies adds obscurity; ultimately, refinement (and consensus) of PRP treatments for specific clinical indications, including repetition studies are warranted.
Collapse
Affiliation(s)
- Blake M Bacevich
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Massachusetts General Brigham, Boston, MA, USA
| | - Richard David James Smith
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Massachusetts General Brigham, Boston, MA, USA
| | - Alec M Reihl
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Massachusetts General Brigham, Boston, MA, USA
| | - Augustus D Mazzocca
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Massachusetts General Brigham, Boston, MA, USA
- Medical Director, Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Brigham, Boston, MA, USA
| | - Ian D Hutchinson
- Division of Sports Medicine, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Massachusetts General Brigham, Boston, MA, USA
| |
Collapse
|
25
|
Darwish YG, Gharbia M, Sobhi AM, Aborady AF. The Benefits of Using Platelet-rich Plasma with Dermal Substitutes for Extremity Posttraumatic Skin Defects: A Short-term Outcome. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5492. [PMID: 38288418 PMCID: PMC10817021 DOI: 10.1097/gox.0000000000005492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 10/24/2023] [Indexed: 01/31/2024]
Abstract
Background Skin injuries are very common. Skin grafting is an ongoing wound management procedure. The artificial dermis, PELNAC, has been considered in the treatment of several acute and chronic skin injuries. Platelet-rich plasma (PRP) is blood plasma with a platelet count higher than the baseline. It is presumed to act in a synergetic pattern to promote the healing of wounds. This study was conducted to assess the potential benefit of adding PRP to PELNAC as adjuvant therapy in treating posttraumatic skin. Methods In this study, adult patients who were admitted to the hospital with extremity traumatic skin and soft tissue defects with exposed bare bone, exposed tendons, or exposed cartilage in the period between October 2019 and March 2021 were allocated to either being managed with dermal substitute (PELNAC) together with PRP (group I) or PELNAC alone (group II). Results Patients in group I showed a higher mean graft take rate and a lower mean time for neovascularization of the acellular dermal matrix, with a statistically highly significant difference. The Vancouver Scar Scale values showed no significant difference in either group. The PRP-treated group showed statistically significant shorter hospital stays. Conclusions The addition of PRP to the treatment protocol showed better outcomes in terms of graft take rate, time for neovascularization of acellular dermal matrix, and length of hospital stay, with no side effects. The present study findings emphasize the promising outcome of PRP in addition to the standard treatment of complex wounds to achieve rapid and safe healing.
Collapse
Affiliation(s)
- Yasmine G. Darwish
- From the Department of Plastic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Gharbia
- Assistant Lecturer of Plastic Surgery El Sahel Hospital, Cairo, Egypt
| | - Ahmed M. Sobhi
- From the Department of Plastic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed F. Aborady
- From the Department of Plastic Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
26
|
Chen LS, Chen CK, Pang JHS, Lin LP, Yu TY, Tsai WC. Leukocyte-poor platelet-rich plasma and leukocyte-rich platelet-rich plasma promote myoblast proliferation through the upregulation of cyclin A, cdk1, and cdk2. J Orthop Res 2024; 42:32-42. [PMID: 37442643 DOI: 10.1002/jor.25666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/15/2023]
Abstract
Muscle injuries are common among athletes and often treated with platelet-rich plasma (PRP). However, whether the leukocyte concentration affects the efficacy of PRP in treating muscle injuries remains unclear. This study investigated the effects of leukocyte-poor platelet-rich plasma (LP-PRP) and leukocyte-rich platelet-rich plasma (LR-PRP) on myoblast proliferation and the molecular mechanisms underlying these effects. Myoblasts were treated with 0.5% LP-PRP, 0.5% LR-PRP, 1% LP-PRP, or 1% LR-PRP for 24 h. The gene expression of the LP-PRP- and LR-PRP-treated myoblasts was determined using RNA sequencing analysis. Cell proliferation was evaluated using an bromodeoxyuridine (BrdU) assay, and cell cycle progression was assessed through flow cytometry. The expression of cyclin A, cyclin-dependent kinase 1 (cdk1), and cdk2 was examined using Western blotting. The expression of myoblast determination protein 1 (MyoD1) was examined through Western blotting and immunofluorescence staining. The LP-PRP and LR-PRP both promoted the proliferation of myoblasts and increased differential gene expression of myoblasts. Moreover, the LP-PRP and LR-PRP substantially upregulated the expression of cyclin A, cdk1, and cdk2. MyoD1 expression was induced in the LP-PRP and LR-PRP-treated myoblasts. Our results corroborate the finding that LP-PRP and LR-PRP have similar positive effects on myoblast proliferation and MyoD1 expression.
Collapse
Affiliation(s)
- Li-Siou Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Kuang Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jong-Hwei Su Pang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Li-Ping Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Tung-Yang Yu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wen-Chung Tsai
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Center of Comprehensive Sports Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| |
Collapse
|
27
|
Godbout C, Ryan G, Ramnaraign DJ, Hegner C, Desjardins S, Gagnon S, Bates BD, Whatley I, Schemitsch EH, Nauth A. Optimal delivery of endothelial progenitor cells in a rat model of critical-size bone defects. J Orthop Res 2024; 42:193-201. [PMID: 37416978 DOI: 10.1002/jor.25658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/21/2023] [Accepted: 07/01/2023] [Indexed: 07/08/2023]
Abstract
Nonunion and segmental bone defects are complex issues in orthopedic trauma. The use of endothelial progenitor cells (EPCs), as part of a cell-based therapy for bone healing is a promising approach. In preclinical studies, culture medium (CM) is commonly used to deliver EPCs to the defect site, which has the potential for immunogenicity in humans. The goal of this study was to find an effective and clinically translatable delivery medium for EPCs. Accordingly, this study compared EPCs delivered in CM, phosphate-buffered saline (PBS), platelet-poor plasma (PPP), and platelet-rich plasma (PRP) in a rat model of femoral critical-size defects. Fischer 344 rats (n = 35) were divided into six groups: EPC+CM, EPC+PBS, EPC+PPP, EPC+PRP, PPP alone, and PRP alone. A 5 mm mid-diaphyseal defect was created in the right femur and stabilized with a miniplate. The defect was filled with a gelatin scaffold impregnated with the corresponding treatment. Radiographic, microcomputed tomography and biomechanical analyses were performed. Overall, regardless of the delivery medium, groups that received EPCs had higher radiographic scores and union rates, higher bone volume, and superior biomechanical properties compared to groups treated with PPP or PRP alone. There were no significant differences in any outcomes between EPC subgroups or between PPP and PRP alone. These results suggest that EPCs are effective in treating segmental defects in a rat model of critical-size defects regardless of the delivery medium used. Consequently, PBS could be the optimal medium for delivering EPCs, given its low cost, ease of preparation, accessibility, noninvasiveness, and nonimmunogenic properties.
Collapse
Affiliation(s)
- Charles Godbout
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Gareth Ryan
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - David J Ramnaraign
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Christian Hegner
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Sarah Desjardins
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Stéphane Gagnon
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Brent D Bates
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Ian Whatley
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| | - Emil H Schemitsch
- Department of Surgery, Division of Orthopaedic Surgery, University of Western Ontario, London, Ontario, Canada
| | - Aaron Nauth
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, Division of Orthopaedic Surgery, St. Michael's Hospital-Unity Health Toronto, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
28
|
Fareez IM, Liew FF, Widera D, Mayeen NF, Mawya J, Abu Kasim NH, Haque N. Application of Platelet-Rich Plasma as a Stem Cell Treatment - an Attempt to Clarify a Common Public Misconception. Curr Mol Med 2024; 24:689-701. [PMID: 37171013 DOI: 10.2174/1566524023666230511152646] [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: 01/10/2023] [Revised: 03/29/2023] [Accepted: 04/03/2023] [Indexed: 05/13/2023]
Abstract
In recent years, there has been a significant increase in the practice of regenerative medicine by health practitioners and direct-to-consumer businesses globally. Among different tools of regenerative medicine, platelet-rich plasma (PRP) and stem cell-based therapies have received considerable attention. The use of PRP, in particular, has gained popularity due to its easy access, simple processing techniques, and regenerative potential. However, it is important to address a common misconception amongst the general public equating to PRP and stem cells due to the demonstrated efficacy of PRP in treating musculoskeletal and dermatological disorders. Notably, PRP promotes regeneration by providing growth factors or other paracrine factors only. Therefore, it cannot replenish or replace the lost cells in conditions where a large number of cells are required to regenerate tissues and/or organs. In such cases, cellbased therapies are the preferred option. Additionally, other tools of regenerative medicine, such as bioprinting, organoids, and mechanobiology also rely on stem cells for their success. Hence, healthcare and commercial entities offering direct-to-customer regenerative therapies should not mislead the public by claiming that the application of PRP is a stem cell-based therapy. Furthermore, it is important for regulatory bodies to strictly monitor these profit-driven entities to prevent them from providing unregulated regenerative treatments and services that claim a broad variety of benefits with little proof of efficacy, safety concerns, and obscure scientific justification.
Collapse
Affiliation(s)
- Ismail M Fareez
- School of Biology, Faculty of Applied Sciences, Universiti Teknologi MARA, Shah Alam, 40450, Selangor, Malaysia
| | - Fong Fong Liew
- Department of Oral Biology and Biomedical Sciences, Faculty of Dentistry, MAHSA University, Selangor, 42610, Malaysia
| | - Darius Widera
- Stem Cell Biology and Regenerative Medicine Group, School of Pharmacy, University of Reading, Reading, UK
| | - Naiyareen Fareeza Mayeen
- Faculty of Biology, Ludwig-Maximilians-University of Munich, Planegg- Martinsried, 82152, Germany
- TotiCell Limited, Dhaka, 1209, Bangladesh
| | | | - Noor Hayaty Abu Kasim
- Faculty of Dentistry, University of Malaya, Kuala Lumpur, 50603, Malaysia
- Faculty of Dentistry, University Kebangsaan Malaysia, Kuala Lumpur, 50300, Malaysia
| | | |
Collapse
|
29
|
Suresh A, Balouch B, Martha VV, Sataloff RT. Laryngeal Applications of Platelet Rich Plasma and Platelet Poor Plasma: A Systematic Review. J Voice 2024; 38:248.e1-248.e13. [PMID: 34384663 DOI: 10.1016/j.jvoice.2021.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/12/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Platelet rich plasma (PRP) and platelet poor plasma (PPP) are regenerative therapies that offer the potential for improving care for disorders of the larynx. The laryngeal applications of these substances have been examined in both animals and humans. The goal of this systematic review is to examine the various applications of PRP and PPP in laryngology, assess the protocols for preparation and application of these substances and evaluate the outcomes and complications in both humans and animals. METHODS A search of PUBMED was conducted in April 2021 using combinations of keywords of "platelet rich plasma" and "platelet poor plasma" with keywords such as "larynx," "vocal folds," "laryngology," and others. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIMSA) guidelines were followed. Articles were reviewed by two independent coauthors and included based on selection criteria pertinent to the goals of this study. The risk of bias in the included studies was assessed by two independent co-authors using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Randomized Controlled Trials and JBI Critical Appraisal Checklist for Quasi-Experimental Studies. Data regarding the pathologies treated using PRP and PPP, PRP, and PPP preparation protocols, application protocols, human voice outcomes, histopathological animal outcomes, and complications were extracted from each of the studies and presented in tables. RESULTS Seven studies were included based on the selection criteria. PRP or PPP were used for vocal fold scar, sulcus, atrophy and palsy; acute vocal fold injury; glottic insufficiency, and graft healing. PRP or PPP were derived from autologous blood in a one- or two-step centrifugation process and administered via injection, soaking of cartilage grafts or topical application. Mean and median voice handicap index-10 (VHI-10) and voice handicap index (VHI) scores decreased following PRP or PPP injections in two human studies and one human study showed a similar VHI-10 score before and after PRP treatment. Videostroboscopy showed the absence of injection site reactions and at least temporary improvement in glottic gap or vibratory function following treatment in some patients. Other objective measures of voice outcomes in human studies showed improved phonatory function in the one-to-four-month period following PRP or PPP injections, with some patients experiencing a subjective decrease or return to baseline in phonatory function following the initial improvement period. Animal studies found elevated levels of growth factors, organized collagen deposition, decreased granulation tissue, increased vascularization, and increased cartilage proliferation in PRP treated laryngeal tissue. DISCUSSION PRP and PPP might have the potential to be safely used in the larynx and at least temporarily influence wound healing and vocal function. Further study using comparable outcome measurement tools is required to assess their role and efficacy in treating acute vocal fold injury, chronic vocal fold pathologies, graft healing, and other laryngeal applications.
Collapse
Affiliation(s)
- Aishwarya Suresh
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Bailey Balouch
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Vishnu V Martha
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Robert T Sataloff
- Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, Department of Otolaryngology and Communication Sciences Research, Lankenau Institute for Medical Research, Philadelphia, Pennsylvania.
| |
Collapse
|
30
|
Campolo A, Heider C, Verdugo-Paiva MF, Bravo-Jeria R, Morovic CG, Rada G. Use of autologous platelet derivatives for secondary alveoloplasty in patients with cleft lip and palate: a systematic review and meta-analysis. Int J Oral Maxillofac Surg 2024; 53:18-27. [PMID: 37730524 DOI: 10.1016/j.ijom.2023.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 08/07/2023] [Accepted: 08/30/2023] [Indexed: 09/22/2023]
Abstract
This study aimed to evaluate the effectiveness of autologous platelet derivatives (APD), specifically platelet-rich plasma (PRP) or platelet-rich fibrin (PRF), combined with autogenous iliac crest bone grafts in secondary alveoloplasty for patients with cleft lip and palate. Electronic databases, relevant journals, and reference lists of included studies were searched until July 2022. Best-evidence synthesis was performed to draw conclusions. After the search strategies, 12 randomized controlled trials were included that provided data on six outcomes: newly formed bone, mean bone loss in height and width, bone density, functionality, and postoperative complications. Two authors independently assessed the risk of bias, and the certainty of evidence was assessed using the GRADE approach. The pooled results suggest that there is uncertainty as to whether the combination of APDs with autogenous iliac crest bone grafts improves the percentage of newly formed bone, as the certainty of the evidence was assessed as very low. It may slightly improve the functionality of patients (with low certainty of the evidence) and probably slightly reduces the incidence of postoperative complications (with moderate certainty of evidence). Further randomized clinical trials with standardized methodologies are required to validate these findings.
Collapse
Affiliation(s)
- A Campolo
- Oncologic and Maxillofacial Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
| | - C Heider
- Otolaryngology Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - M F Verdugo-Paiva
- UC Evidence Centre, Cochrane Chile Associated Centre, Pontificia Universidad Católica de Chile, Santiago, Chile; Epistemonikos Foundation, Santiago, Chile
| | - R Bravo-Jeria
- UC Evidence Centre, Cochrane Chile Associated Centre, Pontificia Universidad Católica de Chile, Santiago, Chile; Epistemonikos Foundation, Santiago, Chile
| | - C G Morovic
- Paediatric Surgery Department, School of Medicine, Universidad de Chile, Santiago, Chile; Division of Plastic and Reconstructive Surgery, Luis Calvo Mackenna Children's Hospital, Santiago, Chile
| | - G Rada
- UC Evidence Centre, Cochrane Chile Associated Centre, Pontificia Universidad Católica de Chile, Santiago, Chile; Epistemonikos Foundation, Santiago, Chile
| |
Collapse
|
31
|
Kothari U, Shah S, Pancholi D, Chaudhary C. Efficacy and Safety of Platelet-Rich Plasma Injection for Chronic Plantar Fasciitis: A Prospective Study on Functional Restoration and Pain Relief. Cureus 2024; 16:e52414. [PMID: 38371014 PMCID: PMC10869993 DOI: 10.7759/cureus.52414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2024] [Indexed: 02/20/2024] Open
Abstract
Background Heel discomfort and functional impairment are frequently caused by plantar fasciitis, and treating it can be extremely difficult for clinicians and occasionally have unfavorable clinical consequences. Recently, platelet-rich plasma (PRP) has been used as an alternative therapy for plantar fasciitis (PF) to reduce heel pain and improve functional restoration. We evaluated the current evidence concerning the efficacy and safety of PRP as a treatment for PF. Methodology This was a hospital-based prospective study on patients with plantar fasciitis with a symptom duration of six months or more with failed conservative therapy. All patients included in the study were assessed clinically and by a visual analog score (VAS) for heel pain, the Ankle-Hindfoot Scale (AHS) component of the American Orthopedic Foot and Ankle Society (AOFAS) and Foot and Ankle Ability Measure (FAAM) scores before injection, and at three weeks, three and six-months post-PRP treatment follow-up. Ultrasonography (USG) measurement of plantar fascia thickness was done pre-injection and at the six-month follow-up for clinical outcomes and any complications. Results The study included 25 patients with plantar fasciitis, with the majority (48%) in the age group of 21-30 years. Females accounted for 64% of the patients while males accounted for 36%. Most patients (56%) had a moderately active daily activity level. The study found that 16 patients had bilateral plantar fasciitis while nine had unilateral plantar fasciitis. Among the patients with bilateral plantar fasciitis, a total of 32 heels were affected while the 9 patients with unilateral plantar fasciitis had 9 affected heels. Most female patients (75%) had bilateral plantar fasciitis while most male patients (56%) had unilateral plantar fasciitis. Before PRP therapy, both male and female patients reported high pain scores on the VAS for both heels. However, after PRP infiltration, the VAS scores significantly decreased at three weeks, three months, and six months post-injection, indicating pain relief. The AOFAS hindfoot and ankle scores and FAAM scores showed improvement over the follow-up period. Both male and female patients experienced significant improvements in functional outcomes, with increases in AOFAS (p-value 0.45) and FAAM scores (p-value 0.31) at three weeks, three months, and six months post-injection compared to baseline. Statistical analysis revealed a significant decrease in pain scores (73% pain relief), as well as significant improvements in AOFAS scores with an average of 22.33 from baseline (mean = 67.75±9.7) to final follow-up (mean = 90.08±7.9) and FAAM scores with an average of 23.72 from baseline (mean = 49.38±5.2) to final follow-up (mean = 73.10±5.2) after PRP infiltration. Conclusion The outcomes of a single dosage of PRP injections demonstrate clinically and statistically substantial improvements in functional outcome scores, plantar fascia thickness evaluated by USG, and VAS scores for heel pain. According to the results of this study, local PRP injection is an effective treatment for chronic plantar fasciitis.
Collapse
Affiliation(s)
- Udit Kothari
- Orthopedics, Ashray Orthopaedic Hospital, Modasa, IND
| | - Samarth Shah
- Orthopedics, GMERS (Gujarat Medical Education and Research Society) Medical College, Vadnagar, IND
| | - Deval Pancholi
- Orthopedics, Smt. NHL Municipal Medical College, Ahmedabad, IND
| | - Chintan Chaudhary
- Orthopedics, GMERS (Gujarat Medical Education and Research Society) Medical College, Gandhinagar, IND
| |
Collapse
|
32
|
Chigurupati VS, Khanna S, Kumar S, Khanna R. Efficacy of platelet-rich plasma in alleviating split skin graft morbidities. J Cutan Aesthet Surg 2024; 17:50-54. [PMID: 38736856 PMCID: PMC11086927 DOI: 10.4103/jcas.jcas_14_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Introduction Skin grafting is a routinely employed technique to cover the skin defect. Though the skin grafts are technically effortless, they are tiresome because of the prolonged duration of hospital stay, labor-intensive, demanding repeated dressings, and also create a second wound. Platelet-rich plasma (PRP) is one that has a higher concentration of platelets than the blood. Alpha granules of the platelets are rich in growth factors. Aims and Objectives To assess the effect of PRP on split-thickness skin graft uptake and donor site healing. Materials and Methods In a single-center-based prospective study done from August 2018 to June 2020, 60 patients with acute and chronic wounds were divided into two equal groups. Autologous PRP was applied on the recipient wound bed and donor site in PRP group, and conventional methods like staples/sutures were used to anchor the skin grafts and standard of care of the donor site in a control group. Results Instantaneous graft adhesion was observed in all patients of PRP group. The first graft inspection was delayed. Seroma, hematoma, total number of dressings, and duration of stay in hospital were significantly reduced in the PRP group. Donor site pain in the postoperative period was notably reduced in PRP group. PRP also remarkably hastened the donor site healing. Conclusion The application of PRP promotes graft take, minimizes complications, enhances donor site wound healing, mitigates donor site pain, and has immense economic benefits due to the reduced number of dressing changes and shorter hospital stay.
Collapse
Affiliation(s)
- Veda Samhitha Chigurupati
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Seema Khanna
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sandip Kumar
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rahul Khanna
- Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| |
Collapse
|
33
|
Costa FR, Santos MDS, Martins RA, Costa CB, Hamdan PC, Da Silva MB, Azzini GOM, Pires L, Menegassi Z, Santos GS, Lana JF. The Synergistic Effects of Hyaluronic Acid and Platelet-Rich Plasma for Patellar Chondropathy. Biomedicines 2023; 12:6. [PMID: 38275367 PMCID: PMC10813186 DOI: 10.3390/biomedicines12010006] [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: 11/01/2023] [Revised: 11/23/2023] [Accepted: 12/06/2023] [Indexed: 01/27/2024] Open
Abstract
Musculoskeletal disorders are increasingly prevalent worldwide, causing significant socioeconomic burdens and diminished quality of life. Notably, patellar chondropathy (PC) is among the most widespread conditions affecting joint structures, resulting in profound pain and disability. Hyaluronic acid (HA) and platelet-rich plasma (PRP) have emerged as reliable, effective, and minimally invasive alternatives. Continuous research spanning from laboratory settings to clinical applications demonstrates the numerous advantages of both products. These encompass lubrication, anti-inflammation, and stimulation of cellular behaviors linked to proliferation, differentiation, migration, and the release of essential growth factors. Cumulatively, these benefits support the rejuvenation of bone and cartilaginous tissues, which are otherwise compromised due to the prevailing degenerative and inflammatory responses characteristic of tissue damage. While existing literature delves into the physical, mechanical, and biological facets of these products, as well as their commercial variants and distinct clinical uses, there is limited discussion on their interconnected roles. We explore basic science concepts, product variations, and clinical strategies. This comprehensive examination provides physicians with an alternative insight into the pathophysiology of PC as well as biological mechanisms stimulated by both HA and PRP that contribute to tissue restoration.
Collapse
Affiliation(s)
- Fábio Ramos Costa
- Department of Orthopedics, FC Sports Traumatology Clinic, Salvador 40296-210, Brazil; (F.R.C.); (C.B.C.)
| | | | | | - Cláudia Bruno Costa
- Department of Orthopedics, FC Sports Traumatology Clinic, Salvador 40296-210, Brazil; (F.R.C.); (C.B.C.)
| | - Paulo César Hamdan
- Department of Orthopedics, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-630, Brazil; (P.C.H.); (M.B.D.S.); (Z.M.)
| | - Marcos Britto Da Silva
- Department of Orthopedics, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-630, Brazil; (P.C.H.); (M.B.D.S.); (Z.M.)
| | - Gabriel Ohana Marques Azzini
- Department of Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, Brazil; (G.O.M.A.); (L.P.); (J.F.L.)
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, Brazil
| | - Luyddy Pires
- Department of Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, Brazil; (G.O.M.A.); (L.P.); (J.F.L.)
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, Brazil
| | - Zartur Menegassi
- Department of Orthopedics, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro 21941-630, Brazil; (P.C.H.); (M.B.D.S.); (Z.M.)
| | - Gabriel Silva Santos
- Department of Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, Brazil; (G.O.M.A.); (L.P.); (J.F.L.)
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, Brazil
| | - José Fábio Lana
- Department of Orthopedics, Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, Brazil; (G.O.M.A.); (L.P.); (J.F.L.)
- Regenerative Medicine, Orthoregen International Course, Indaiatuba 13334-170, Brazil
- Medical School, Max Planck University Center (UniMAX), Indaiatuba 13343-060, Brazil
- Clinical Research, Anna Vitória Lana Institute (IAVL), Indaiatuba 13334-170, Brazil
| |
Collapse
|
34
|
Bagheri K, Krez A, Anastasio AT, Adams SB. The use of platelet-rich plasma in pathologies of the foot and ankle: A comprehensive review of the recent literature. Foot Ankle Surg 2023; 29:551-559. [PMID: 37516651 DOI: 10.1016/j.fas.2023.07.010] [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: 05/15/2023] [Revised: 06/27/2023] [Accepted: 07/23/2023] [Indexed: 07/31/2023]
Abstract
Platelet-rich plasma (PRP) is an autologous serum containing higher concentrations of platelets and growth factors above normal blood. The process of obtaining PRP involves the extraction of blood from the patient which is then centrifuged to obtain a concentrated suspension of platelets. PRP continues to evolve as a potential treatment modality with many applications in orthopaedic surgery. The therapeutic components of PRP possess numerous theoretical regenerative properties. The present manuscript outlines how PRP is prepared, noting the tremendous variability between preparation protocols. Given the growing body of evidence examining the use of PRP in pathologies of the foot and ankle, we assess its efficacy as it relates to our field. Specifically, we evaluate the literature in the past five years regarding the role of PRP in treating plantar fasciitis, Achilles tendinopathy, insertional Achilles tendinitis, Achilles tendon ruptures, osteochondral lesions of the talus, hallux rigidus, and ankle osteoarthritis.
Collapse
Affiliation(s)
- Kian Bagheri
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA.
| | | | - Albert T Anastasio
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
| | - Samuel B Adams
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
| |
Collapse
|
35
|
George T, Curley AJ, Saeed SK, Kuhns BD, Parsa A, Domb BG. Orthobiologics as an adjunct in treatment of femoroacetabular impingement syndrome: cell-based therapies facilitate improved postoperative outcomes in the setting of acetabular chondral lesions-a systematic review. Knee Surg Sports Traumatol Arthrosc 2023; 31:6020-6038. [PMID: 37906291 DOI: 10.1007/s00167-023-07624-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 10/09/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE To evaluate studies utilizing orthobiologics in the management of femoroacetabular impingement syndrome (FAIS) to (1) assess the indications for usage, and (2) analyze patient-reported outcome measures (PROM) following treatment. It was hypothesized that orthobiologics would (1) be utilized for symptomatic FAIS in the setting of labral or chondral pathology, and (2) improve PROM at most recent follow-up. METHODS The Pubmed, Ovid Medline, Cochrane, and Web of Science databases were searched for clinical studies evaluating orthobiologics [hyaluronic acid (HA), platelet-rich plasma (PRP), or cell-based therapy (CBT) for treatment of FAIS. Exclusion criteria included orthobiologics used in conjunction with cartilage transfer or scaffolding procedures and a primary indication other than FAIS. Data collection included patient demographics, indications, and baseline and most recent PROM. RESULTS Eleven studies (one level I, four level II, four level III, and two level IV evidence) met inclusion criteria, consisting of 440 patients with mean ages ranging from 32.8 to 47 years. All 11 studies demonstrated an improvement in PROM from baseline to most-recent follow-up. Four studies administered PRP either intraoperatively or the day after surgery as an adjunct to labral repair. CBT was used intraoperatively in the setting of acetabular chondral lesions (three studies) and labral repair (one study). When comparing to a control group at most recent follow-up, three PRP cohorts demonstrated similar PROM (n.s.), while one PRP group exhibited worse visual analog pain scores (2.5 vs. 3.4, p = 0.005) and modified Harris Hip Scores (mHHS) (82.6 vs. 78.7, p = 0.049). The four CBT studies reported favorable results compared to a control group, with a significantly higher mHHS at most recent follow-up or mean improvement from baseline in Hip Outcome Score-Activities of Daily Living (p < 0.05). Three studies reported on HA, which was utilized exclusively in the nonoperative setting. CONCLUSIONS Intraoperative PRP and CBT have been commonly reported in the setting of hip arthroscopy for labral repairs and acetabular chondral lesions, respectively. The CBT cohorts demonstrated more favorable PROM at most recent follow-up when compared to a control group, though these results should be interpreted with caution due to heterogeneity of orthobiologic preparations. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Tracy George
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | - Andrew J Curley
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | - Sheema K Saeed
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | - Benjamin D Kuhns
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | - Ali Parsa
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, IL, 60018, USA.
- American Hip Institute, Chicago, IL, 60018, USA.
- , 999 E Touhy Ave, Suite 450, Des Plaines, IL, 60018, USA.
| |
Collapse
|
36
|
Wu Q, Yu S, Wang Y, Zhang X. Effect of thermal manipulation on the biological and mechanical characteristics of horizontal platelet rich fibrin membranes. BMC Oral Health 2023; 23:956. [PMID: 38041031 PMCID: PMC10693106 DOI: 10.1186/s12903-023-03412-1] [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: 03/10/2023] [Accepted: 09/12/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUD Regardless of application scenarios, proper mechanical characteristics and degradation properties are prerequisites for horizontal platelet rich fibrin (H-PRF) to manifest its ability. Among the methods used to modify PRF, thermal manipulation is promising as it is easy to handle without adding extra additives. Yet there is no consensus on optimal temperature treatment. This study aimed to investigate the effects of heating on the biological and mechanical characteristics of H-PRF and explore the optimum heating temperature for H-PRF thermal treatment. METHODS We employed a series of temperature gradients, room temperature, 50℃, 75℃, 90℃, 105℃. The microstructure and the mechanical properties were recorded by Scanning Electron Microscope (SEM) and tensile strength tests respectively. The degradation rate of H-PRF membranes was examined by digestion assay with plasmin and trypsin. The viability of cells within H-PRF membranes and the proliferation of osteoblasts cultured with extracts from different H-PRF groups was evaluated using CCK-8 assays. RESULTS Compared with the nonheated group, overheated manipulation beyond 90℃ can significantly prolong the degradation properties for up to 3 to 4 weeks and enhance the mass stress of H-PRF membranes. A high-temperature treatment of 105℃ accompanied by the cell activity beneath H-PRF reduced more than half, and thus, the biological effect on human osteoblasts (hFOBs) also reduced dramatically. CONCLUSIONS High thermal manipulation can prolong the degradation properties and enhance the mechanical properties of PRF membranes accompanied by the loss of biological effect.
Collapse
Affiliation(s)
- Qian Wu
- Department of Stomatology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430079, China
| | - Shimin Yu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Yulan Wang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Xiaoxin Zhang
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, China.
| |
Collapse
|
37
|
Saginova D, Tashmetov E, Tuleubaev B, Kamyshanskiy Y. Effect of autologous platelet-rich plasma on new bone formation and viability of a Marburg bone graft. Open Life Sci 2023; 18:20220761. [PMID: 38027231 PMCID: PMC10668114 DOI: 10.1515/biol-2022-0761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 07/13/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
This study aimed to compare the new bone formation, the process of remodeling, and the viability of bone grafts, using a combination of platelet-rich plasma (PRP) and Marburg bone graft versus bone grafts without any additional elements. For this study, 48 rabbits (with 24 rabbits in each group) were used. Bone defects were made in the femur, and the bone graft used was the human femoral head prepared according to the Marburg Bone Bank. Rabbits were divided into the following groups: heat-treated bone graft (HTBG group) and HTBG with PRP (HTBG + PRP group). After 14, 30, and 60 days post-surgery, the assessment of the results involved X-ray, histopathological, and histomorphometric analyses. The greater new bone formation was detected in the HTBG + PRP group on the 14 and 30 day (p < 0.001). Furthermore, the group using bone grafts with PRP demonstrated notably enhanced remodeling, characterized by stronger bone integration, more significant graft remineralization, and a circular pattern of newly formed bone. The PRP-bone graft complex improves bone tissue repair in the bone defect in the initial stages of bone regeneration. PRP has been identified to enhance the remodeling process and amplify the osteoconductive and osteoinductive capabilities of HTBGs.
Collapse
Affiliation(s)
- Dina Saginova
- The Center for Applied Scientific Research, National Scientific Center of Traumatology and Orthopaedics Named After Academician N.D. Batpenov, Astana010000, Kazakhstan
| | - Elyarbek Tashmetov
- Department of Surgical Diseases, Karaganda Medical University, Karaganda100000, Kazakhstan
| | - Berik Tuleubaev
- Department of Surgical Diseases, Karaganda Medical University, Karaganda100000, Kazakhstan
| | - Yevgeniy Kamyshanskiy
- Pathology Unit of the University Clinic, Karaganda Medical University, Karaganda100000, Kazakhstan
| |
Collapse
|
38
|
Liu SS, Xu LL, Liu LK, Lu SJ, Cai B. Platelet-rich plasma therapy for temporomandibular joint osteoarthritis: A randomized controlled trial. J Craniomaxillofac Surg 2023; 51:668-674. [PMID: 37852892 DOI: 10.1016/j.jcms.2023.09.014] [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: 07/29/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023] Open
Abstract
The study aimed to compare the efficacy of platelet-rich plasma (PRP) injections for the treatment of temporomandibular joint osteoarthritis (TMJ-OA) with hyaluronic acid (HA) therapy. This randomized controlled trial included 70 patients with TMJ-OA, randomly divided into either a PRP or HA group. The pain intensity, maximum mouth opening (MMO), TMJ sound score, and proportion of crepitus were recorded and compared at baseline and at 1, 3, and 6 months. Both groups showed statistically significant improvements in pain intensity, MMO, TMJ sound, and scale scores during the 6-month follow-up period. The improvements in pain intensity during mouth opening at 1 month, MMO at 1, 3, and 6 months, TMJ sound score at 1 and 3 months, and GAD-7 score at 6 months in the PRP group were greater than in the HA group (p < 0.05). Compared with the HA group, imaging improvement in the PRP group was also higher (p < 0.05). Within the limitations of the study it seems that the application of PRP therapy in TMJ-OA is should be considered whenever possible.
Collapse
Affiliation(s)
- Sha-Sha Liu
- Department of Rehabilitation Medicine, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Rehabilitation Medicine, Sijing Hospital of the Songjiang District of Shanghai, Shanghai, China
| | - Li-Li Xu
- Department of Rehabilitation Medicine, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Rehabilitation Medicine, Sijing Hospital of the Songjiang District of Shanghai, Shanghai, China
| | - Li-Kun Liu
- Department of Rehabilitation Medicine, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shen-Ji Lu
- Department of Rehabilitation Medicine, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Rehabilitation Medicine, Sijing Hospital of the Songjiang District of Shanghai, Shanghai, China
| | - Bin Cai
- Department of Rehabilitation Medicine, The Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| |
Collapse
|
39
|
Yates KM, Stilwell NK, Fontenot RL, Betbeze CM. In vitro antibacterial efficacy of autologous conditioned plasma and amniotic membrane eye drops. Vet Ophthalmol 2023; 26:548-554. [PMID: 37317517 DOI: 10.1111/vop.13120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 04/18/2023] [Accepted: 06/04/2023] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To determine the in vitro antibacterial efficacy of equine and canine autologous conditioned plasma (ACP) and amniotic membrane extract eye drops (AMEED) against aerobic bacteria common to the corneal surface. PROCEDURES Canine (n = 4) and equine (n = 4) anticoagulated whole blood samples were sterilely collected, pooled for each species, and processed using the Arthrex ACP® Double-Syringe System. Platelet counts were performed on ACP and pooled blood. AMEED were obtained from a commercial source. An electronic medical records search (2013-2022) identified aerobic bacteria cultured from canine and equine corneal ulcers at Mississippi State University College of Veterinary Medicine (MSU-CVM). Ten commonly isolated bacteria for each species were collected from cultures submitted to the MSU-CVM Microbiology Diagnostic Service and frozen at -80°C. The Kirby-Bauer disk diffusion method was used to determine the sensitivities of these isolates to ACP and AMEED. Bacterial isolates were plated onto Mueller-Hinton +5% sheep blood agar and blank sterile discs saturated with 20 μL of ACP or AMEED were tested in duplicate. Imipenem discs served as positive controls and blank discs as negative controls. Zones of inhibition were measured at 18 h. RESULTS ACP platelet counts were 1.06 and 1.65 times higher than blood for equine and canine samples, respectively. Growth of a multi-drug resistant Enterococcus faecalis was partially inhibited by canine and equine ACP. AMEED did not inhibit growth of any examined bacteria. CONCLUSIONS Canine and equine ACP partially inhibited E. faecalis growth in vitro. Further studies using varying concentrations of ACP against bacterial isolates from corneal ulcers are warranted.
Collapse
Affiliation(s)
- Kelsey M Yates
- Department of Clinical Sciences, Mississippi State University, Mississippi State, Mississippi, USA
| | - Natalie K Stilwell
- Department of Pathobiology and Population Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Robin L Fontenot
- Department of Pathobiology and Population Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Caroline M Betbeze
- Department of Clinical Sciences, Mississippi State University, Mississippi State, Mississippi, USA
| |
Collapse
|
40
|
Aljefri AM, Brien CO, Tan TJ, Sheikh AM, Ouellette H, Bauones S. Clinical Applications of PRP: Musculoskeletal Applications, Current Practices and Update. Cardiovasc Intervent Radiol 2023; 46:1504-1516. [PMID: 37783774 DOI: 10.1007/s00270-023-03567-y] [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: 08/30/2022] [Accepted: 09/14/2023] [Indexed: 10/04/2023]
Abstract
Musculoskeletal tissues are often subjected to deleterious effects stemming from traumatic injuries or degenerative pathologies, which can impede the body's natural repair response. The advent of regenerative medicine has emerged as a promising therapeutic approach in modern patient care. Among the interventions in this cutting-edge field, platelet-rich plasma (PRP) and cell-based therapies, such as mesenchymal stem cells, have garnered significant attention. In this article, we endeavor to provide an overview of the current practices and recent developments in PRP therapy, with a particular emphasis on the clinical applications for musculoskeletal pathologies.
Collapse
Affiliation(s)
- Ahmad M Aljefri
- Department of Musculoskeletal and Interventional Radiology, King Fahad Medical City, 11525, Riyadh, Saudi Arabia
| | - Cormac O Brien
- Department of Radiology, Vancouver General Hospital/University of British Columbia, Vancouver, BC, Canada
| | - Tien Jin Tan
- Department of Radiology, Changi General Hospital, Singapore, Singapore
| | - Adnan M Sheikh
- Department of Radiology, Vancouver General Hospital/University of British Columbia, Vancouver, BC, Canada
| | - Hugue Ouellette
- Department of Radiology, Vancouver General Hospital/University of British Columbia, Vancouver, BC, Canada
| | - Salem Bauones
- Department of Musculoskeletal and Interventional Radiology, King Fahad Medical City, 11525, Riyadh, Saudi Arabia.
| |
Collapse
|
41
|
Pretorius J, Habash M, Ghobrial B, Alnajjar R, Ellanti P. Current Status and Advancements in Platelet-Rich Plasma Therapy. Cureus 2023; 15:e47176. [PMID: 38021947 PMCID: PMC10652151 DOI: 10.7759/cureus.47176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Platelet-rich plasma (PRP) as a treatment modality has been around for the last four decades, but only truly gained popularity over the last 10 to 15 years in medicine, in a variety of fields ranging from regenerative medicine to infertility treatment. It has gained popularity, especially in treating musculoskeletal conditions where the bulk of research has been performed and published. There is level I evidence available supporting its efficacy in the treatment of osteoarthritis (OA), epicondylitis, bursitis, compressive neuropathy, plantar fasciitis, muscular injuries and osteochondral lesions. Most published research with regards to PRP has been focused on knee OA (limited research in shoulder, elbow, and foot and ankle OA), lateral epicondylitis and carpal tunnel syndrome, whereas spinal and hand conditions have limited research available. Tendinopathies and partial tendon tears have conflicting evidence available, with level I evidence supporting PRP's use in rotator cuff tendinopathies and tears, with contradictory level I evidence discouraging its use in patella and Achilles tendinopathies and tears. The available evidence regarding the use of PRP continues to produce conflicting results, but despite this, there is an ongoing increase in the popularity and use of PRP in patients with musculoskeletal conditions.
Collapse
Affiliation(s)
| | - Mohammed Habash
- Orthopaedics and Traumatology, University Hospital Galway, Galway, IRL
| | - Bishoy Ghobrial
- Trauma and Orthopaedics, University Hospital Galway, Galway, IRL
| | - Rafee Alnajjar
- Trauma and Orthopaedics, University Hospital Galway, Galway, IRL
| | - Prasad Ellanti
- Trauma and Orthopaedics, Letterkenny University Hospital, Letterkenny, IRL
| |
Collapse
|
42
|
Fazekas D, Campbell K, Ledesma B, Masterson T. Platelet-rich plasma for erectile dysfunction: a review of the current research landscape. Sex Med Rev 2023; 11:369-374. [PMID: 37786350 DOI: 10.1093/sxmrev/qead032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 06/20/2023] [Accepted: 07/04/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Erectile dysfunction (ED) is the inability to achieve or maintain erection for satisfactory sexual performance. ED drastically reduces the quality of life for men and their partners and is commonly linked to comorbid conditions such as diabetes and cardiovascular disease. As a result, clinicians and researchers are working to improve treatments for ED. Current guideline-approved ED treatments include oral phosphodiesterase type 5 inhibitors, intraurethral alprostadil, penile intracavernosal injections, and penile prosthesis surgery. Today, there is increasing interest in restorative therapies such as intracavernosal platelet-rich plasma (PRP) for the management of ED. OBJECTIVES This narrative review describes the current trials investigating intracavernosal PRP for ED and proposes future directions to increase the strength of evidence to support use of PRP in this population. METHODS A comprehensive literature search of PubMed, Science Direct, and Scopus was performed to identify all randomized clinical trials using PRP for the treatment of ED. RESULTS We identified 4 randomized clinical trials investigating the safety and efficacy of PRP for ED. We found significant heterogeneity among study protocols, including collection of PRP, dosing of PRP, and follow-up. CONCLUSION While intracavernosal PRP is considered safe, its efficacy for the management of ED remains unknown due to variability among clinical trials.
Collapse
Affiliation(s)
- Dylan Fazekas
- Desai Sethi Urology Institute, University of Miami, Miami, FL 33136, United States
| | - Katherine Campbell
- Desai Sethi Urology Institute, University of Miami, Miami, FL 33136, United States
| | - Braian Ledesma
- Desai Sethi Urology Institute, University of Miami, Miami, FL 33136, United States
| | - Thomas Masterson
- Desai Sethi Urology Institute, University of Miami, Miami, FL 33136, United States
| |
Collapse
|
43
|
Burnouf T, Chou ML, Lundy DJ, Chuang EY, Tseng CL, Goubran H. Expanding applications of allogeneic platelets, platelet lysates, and platelet extracellular vesicles in cell therapy, regenerative medicine, and targeted drug delivery. J Biomed Sci 2023; 30:79. [PMID: 37704991 PMCID: PMC10500824 DOI: 10.1186/s12929-023-00972-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/23/2023] [Indexed: 09/15/2023] Open
Abstract
Platelets are small anucleated blood cells primarily known for their vital hemostatic role. Allogeneic platelet concentrates (PCs) collected from healthy donors are an essential cellular product transfused by hospitals to control or prevent bleeding in patients affected by thrombocytopenia or platelet dysfunctions. Platelets fulfill additional essential functions in innate and adaptive immunity and inflammation, as well as in wound-healing and tissue-repair mechanisms. Platelets contain mitochondria, lysosomes, dense granules, and alpha-granules, which collectively are a remarkable reservoir of multiple trophic factors, enzymes, and signaling molecules. In addition, platelets are prone to release in the blood circulation a unique set of extracellular vesicles (p-EVs), which carry a rich biomolecular cargo influential in cell-cell communications. The exceptional functional roles played by platelets and p-EVs explain the recent interest in exploring the use of allogeneic PCs as source material to develop new biotherapies that could address needs in cell therapy, regenerative medicine, and targeted drug delivery. Pooled human platelet lysates (HPLs) can be produced from allogeneic PCs that have reached their expiration date and are no longer suitable for transfusion but remain valuable source materials for other applications. These HPLs can substitute for fetal bovine serum as a clinical grade xeno-free supplement of growth media used in the in vitro expansion of human cells for transplantation purposes. The use of expired allogeneic platelet concentrates has opened the way for small-pool or large-pool allogeneic HPLs and HPL-derived p-EVs as biotherapy for ocular surface disorders, wound care and, potentially, neurodegenerative diseases, osteoarthritis, and others. Additionally, allogeneic platelets are now seen as a readily available source of cells and EVs that can be exploited for targeted drug delivery vehicles. This article aims to offer an in-depth update on emerging translational applications of allogeneic platelet biotherapies while also highlighting their advantages and limitations as a clinical modality in regenerative medicine and cell therapies.
Collapse
Affiliation(s)
- Thierry Burnouf
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, 250 Wu-Xing Street, Taipei, 11031, Taiwan.
- International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan.
- International Ph.D. Program in Cell Therapy and Regenerative Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Ming-Li Chou
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, 250 Wu-Xing Street, Taipei, 11031, Taiwan
- Institute of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| | - David J Lundy
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, 250 Wu-Xing Street, Taipei, 11031, Taiwan
- International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Er-Yuan Chuang
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, 250 Wu-Xing Street, Taipei, 11031, Taiwan
- International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Ching-Li Tseng
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, 250 Wu-Xing Street, Taipei, 11031, Taiwan
- International Ph.D. Program in Biomedical Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Hadi Goubran
- Saskatoon Cancer Centre and College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| |
Collapse
|
44
|
Mercader Ruiz J, Beitia M, Delgado D, Sánchez P, Arnaiz MJ, López de Dicastillo L, Benito-Lopez F, Basabe-Desmonts L, Sánchez M. New Formulation of Platelet-Rich Plasma Enriched in Platelet and Extraplatelet Biomolecules Using Hydrogels. Int J Mol Sci 2023; 24:13811. [PMID: 37762114 PMCID: PMC10530784 DOI: 10.3390/ijms241813811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Platelet-rich plasma (PRP) is an autologous biologic product used in several fields of medicine for tissue repair due to the regenerative capacity of the biomolecules of its formulation. PRP consists of a plasma with a platelet concentration higher than basal levels but with basal levels of any biomolecules present out of the platelets. Plasma contains extraplatelet biomolecules known to enhance its regenerative properties. Therefore, a PRP containing not only a higher concentration of platelets but also a higher concentration of extraplatelet biomolecules that could have a stronger regenerative performance than a standard PRP. Considering this, the aim of this work is to develop a new method to obtain PRP enriched in both platelet and extraplatelet molecules. The method is based on the absorption of the water of the plasma using hydroxyethyl acrylamide (HEAA)-based hydrogels. A plasma fraction obtained from blood, containing the basal levels of platelets and proteins, was placed in contact with the HEAA hydrogel powder to absorb half the volume of the water. The resulting plasma was characterized, and its bioactivity was analyzed in vitro. The novel PRP (nPRP) showed a platelet concentration and platelet derived growth factor (PDGF) levels similar to the standard PRP (sPRP), but the concentration of the extraplatelet growth factors IGF-1 (p < 0.0001) and HGF (p < 0.001) were significantly increased. Additionally, the cells exposed to the nPRP showed increased cell viability than those exposed to a sPRP in human dermal fibroblasts (p < 0.001) and primary chondrocytes (p < 0.01). In conclusion, this novel absorption-based method produces a PRP with novel characteristics compared to the standard PRPs, with promising in vitro results that could potentially trigger improved tissue regeneration capacity.
Collapse
Affiliation(s)
- Jon Mercader Ruiz
- Arthroscopic Surgery Unit, Hospital Vithas Vitoria, 01008 Vitoria-Gasteiz, Spain; (J.M.R.); (P.S.); (M.J.A.); (L.L.d.D.)
- Microfluidics Cluster UPV/EHU, BIOMICs Microfluidics Group, Lascaray Research Center, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain
| | - Maider Beitia
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, 01008 Vitoria-Gasteiz, Spain; (M.B.); (D.D.)
| | - Diego Delgado
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, 01008 Vitoria-Gasteiz, Spain; (M.B.); (D.D.)
| | - Pello Sánchez
- Arthroscopic Surgery Unit, Hospital Vithas Vitoria, 01008 Vitoria-Gasteiz, Spain; (J.M.R.); (P.S.); (M.J.A.); (L.L.d.D.)
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, 01008 Vitoria-Gasteiz, Spain; (M.B.); (D.D.)
| | - María Jesús Arnaiz
- Arthroscopic Surgery Unit, Hospital Vithas Vitoria, 01008 Vitoria-Gasteiz, Spain; (J.M.R.); (P.S.); (M.J.A.); (L.L.d.D.)
| | - Leonor López de Dicastillo
- Arthroscopic Surgery Unit, Hospital Vithas Vitoria, 01008 Vitoria-Gasteiz, Spain; (J.M.R.); (P.S.); (M.J.A.); (L.L.d.D.)
| | - Fernando Benito-Lopez
- Microfluidics Cluster UPV/EHU, Analytical Microsystems & Materials for Lab-on-a-Chip (AMMa-LOAC) Group, Analytical Chemistry Department, University of the Basque Country UPV/EHU, 48940 Leioa, Spain;
| | - Lourdes Basabe-Desmonts
- Microfluidics Cluster UPV/EHU, BIOMICs Microfluidics Group, Lascaray Research Center, University of the Basque Country UPV/EHU, 01006 Vitoria-Gasteiz, Spain
- Basque Foundation of Science, IKERBASQUE, 48009 Bilbao, Spain
| | - Mikel Sánchez
- Arthroscopic Surgery Unit, Hospital Vithas Vitoria, 01008 Vitoria-Gasteiz, Spain; (J.M.R.); (P.S.); (M.J.A.); (L.L.d.D.)
- Advanced Biological Therapy Unit, Hospital Vithas Vitoria, 01008 Vitoria-Gasteiz, Spain; (M.B.); (D.D.)
| |
Collapse
|
45
|
Hohmann E, Tetsworth K, Glatt V. Corticosteroid injections for the treatment of lateral epicondylitis are superior to platelet-rich plasma at 1 month but platelet-rich plasma is more effective at 6 months: an updated systematic review and meta-analysis of level 1 and 2 studies. J Shoulder Elbow Surg 2023; 32:1770-1783. [PMID: 37247780 DOI: 10.1016/j.jse.2023.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND The purpose of this study was to perform a systematic review and meta-analysis of studies comparing local injections of either platelet-rich plasma (PRP) or corticosteroid for the treatment of lateral elbow epicondylitis. METHODS A systematic review of MEDLINE, Embase, Scopus, and Google Scholar was performed, and all level 1 and 2 randomized studies from 2000 to 2022 were included. Clinical symptoms, patient perceived outcomes, and pain were assessed by the DASH (disabilities of the arm, shoulder and hand questionnaire) and pain by the visual analog scale (VAS). Publication bias and risk of bias were assessed using the Cochrane Collaboration's tools. The modified Coleman Methodology Score (CMS) and the GRADE system were used to assess the quality of the body of evidence. Heterogeneity was assessed using χ2 and I2 statistics. RESULTS Thirteen studies were included in the analysis. Five studies had a high risk of bias, and the risk of bias across studies was assessed as unclear. There was no publication bias identified. Two of the four GRADE domains (inconsistency of results, imprecision of results) were downgraded to low quality, and the final GRADE assessment was downgraded to a low quality of evidence. The mean CMS score was 62.8, indicating fair quality. The pooled estimate for VAS at 1 month favored corticosteroids (P = .75) but favored PRP at three (P = .003) and six months (P = .0001). The pooled estimate for the DASH score favored corticosteroids at 1 month (P = .028) but favored PRP at three (P = .01) and six months (P = .107) CONCLUSION: The results of this meta-analysis suggest that PRP has no advantage over steroid injections within the first month of treatment, but that it is superior to steroids at both 3 and 6 months. These results also suggest that corticosteroids have a short-term beneficial effect during the early treatment period, although the quality of the available evidence is not very robust in support of this finding. However, these findings must all be viewed with caution as the high risk of bias and moderate to low quality of the included studies may not justify a recommendation of one treatment over another.
Collapse
Affiliation(s)
- Erik Hohmann
- Medical School, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa; Department of Orthopaedic Surgery and Sports Medicine, Valiant Clinic/Houston Methodist Group, Dubai, United Arab Emirates.
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia; Department of Surgery, School of Medicine, University of Queensland, Australia; Limb Reconstruction Center, Macquarie University Hospital, Macquarie Park, Australia Orthopaedic Research Centre of Australia, Brisbane, Australia
| | - Vaida Glatt
- Department of Orthopaedics, University of Texas Health Science Center, San Antonio, TX, USA; Orthopaedic Research Centre of Australia, Brisbane, Australia
| |
Collapse
|
46
|
Vasalou V, Kotidis E, Tatsis D, Boulogeorgou K, Grivas I, Koliakos G, Cheva A, Ioannidis O, Tsingotjidou A, Angelopoulos S. The Effects of Tissue Healing Factors in Wound Repair Involving Absorbable Meshes: A Narrative Review. J Clin Med 2023; 12:5683. [PMID: 37685753 PMCID: PMC10488606 DOI: 10.3390/jcm12175683] [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: 06/21/2023] [Revised: 08/17/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
Wound healing is a complex and meticulously orchestrated process involving multiple phases and cellular interactions. This narrative review explores the intricate mechanisms behind wound healing, emphasizing the significance of cellular processes and molecular factors. The phases of wound healing are discussed, focusing on the roles of immune cells, growth factors, and extracellular matrix components. Cellular shape alterations driven by cytoskeletal modulation and the influence of the 'Formin' protein family are highlighted for their impact on wound healing processes. This review delves into the use of absorbable meshes in wound repair, discussing their categories and applications in different surgical scenarios. Interleukins (IL-2 and IL-6), CD31, CD34, platelet rich plasma (PRP), and adipose tissue-derived mesenchymal stem cells (ADSCs) are discussed in their respective roles in wound healing. The interactions between these factors and their potential synergies with absorbable meshes are explored, shedding light on how these combinations might enhance the healing process. Recent advances and challenges in the field are also presented, including insights into mesh integration, biocompatibility, infection prevention, and postoperative complications. This review underscores the importance of patient-specific factors and surgical techniques in optimizing mesh placement and healing outcomes. As wound healing remains a dynamic field, this narrative review provides a comprehensive overview of the current understanding and potential avenues for future research and clinical applications.
Collapse
Affiliation(s)
- Varvara Vasalou
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
- Andreas Syggros Hospital, 11528 Athens, Greece
| | - Efstathios Kotidis
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Dimitris Tatsis
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
- Oral and Maxillofacial Surgery Department, School of Dentistry, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Kassiani Boulogeorgou
- Department of Pathology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (K.B.)
| | - Ioannis Grivas
- Laboratory of Anatomy, Histology & Embryology, School of Veterinary Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Georgios Koliakos
- Department of Biochemistry, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Angeliki Cheva
- Department of Pathology, School of Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece; (K.B.)
| | - Orestis Ioannidis
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| | - Anastasia Tsingotjidou
- Laboratory of Anatomy, Histology & Embryology, School of Veterinary Medicine, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Stamatis Angelopoulos
- Fourth Surgical Department, School of Medicine, Aristotle University of Thessaloniki, 57010 Thessaloniki, Greece
| |
Collapse
|
47
|
Vun J, Iqbal N, Jones E, Ganguly P. Anti-Aging Potential of Platelet Rich Plasma (PRP): Evidence from Osteoarthritis (OA) and Applications in Senescence and Inflammaging. Bioengineering (Basel) 2023; 10:987. [PMID: 37627872 PMCID: PMC10451843 DOI: 10.3390/bioengineering10080987] [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: 06/08/2023] [Revised: 07/21/2023] [Accepted: 08/15/2023] [Indexed: 08/27/2023] Open
Abstract
Aging and age-related changes impact the quality of life (QOL) in elderly with a decline in movement, cognitive abilities and increased vulnerability towards age-related diseases (ARDs). One of the key contributing factors is cellular senescence, which is triggered majorly by DNA damage response (DDR). Accumulated senescent cells (SCs) release senescence-associated secretory phenotype (SASP), which includes pro-inflammatory cytokines, matrix metalloproteinases (MMPs), lipids and chemokines that are detrimental to the surrounding tissues. Chronic low-grade inflammation in the elderly or inflammaging is also associated with cellular senescence and contributes to ARDs. The literature from the last decade has recorded the use of platelet rich plasma (PRP) to combat senescence and inflammation, alleviate pain as an analgesic, promote tissue regeneration and repair via angiogenesis-all of which are essential in anti-aging and tissue regeneration strategies. In the last few decades, platelet-rich plasma (PRP) has been used as an anti-aging treatment option for dermatological applications and with great interest in tissue regeneration for orthopaedic applications, especially in osteoarthritis (OA). In this exploration, we connect the intricate relationship between aging, ARDs, senescence and inflammation and delve into PRP's properties and potential benefits. We conduct a comparative review of the current literature on PRP treatment strategies, paying particular attention to the instances strongly linked to ARDs. Finally, upon careful consideration of this interconnected information in the context of aging, we suggest a prospective role for PRP in developing anti-aging therapeutic strategies.
Collapse
Affiliation(s)
- James Vun
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7TF, UK; (J.V.); (E.J.)
- Leeds Orthopaedic & Trauma Sciences, Leeds General Infirmary, University of Leeds, Leeds LS97TF, UK
| | - Neelam Iqbal
- School of Chemical and Process Engineering, University of Leeds, Leeds LS2 9JT, UK;
| | - Elena Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7TF, UK; (J.V.); (E.J.)
| | - Payal Ganguly
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS9 7TF, UK; (J.V.); (E.J.)
| |
Collapse
|
48
|
Debuc B, Gendron N, Cras A, Rancic J, Philippe A, Cetrulo CL, Lellouch AG, Smadja DM. Improving Autologous Fat Grafting in Regenerative Surgery through Stem Cell-Assisted Lipotransfer. Stem Cell Rev Rep 2023; 19:1726-1754. [PMID: 37261667 DOI: 10.1007/s12015-023-10568-4] [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] [Accepted: 05/19/2023] [Indexed: 06/02/2023]
Abstract
Autologous fat transplantation -i.e., lipofilling- has become a promising and popular technique in aesthetic and reconstructive surgery with several application such as breast reconstruction, facial and hand rejuvenation. However, the use of this technology is still limited due to an unpredictable and low graft survival rate (which ranges from 25%-80%). A systematic literature review was performed by thoroughly searching 12 terms using the PubMed database. The objective of this study is to present the current evidence for the efficacy of adjuvant regenerative strategies and cellular factors, which have been tested to improve fat graft retention. We present the main results (fat retention rate, histological analysis for pre-clinical studies and satisfaction/ complication for clinical studies) obtained from the studies of the three main fat grafting enrichment techniques: platelet-rich plasma (PRP), the stromal vascular fraction (SVF) and adipose-derived stem cells (ADSCs) and discuss the promising role of recent angiogenic cell enrichment that could induce early vascularization of fat graft. All in all, adding stem or progenitor cells to autologous fat transplantation might become a new concept in lipofilling. New preclinical models should be used to find mechanisms able to increase fat retention, assure safety and transfer these technologies to a good manufacturing practice (GMP) compliant facility, to manufacture an advanced therapy medicinal product (ATMP).
Collapse
Affiliation(s)
- Benjamin Debuc
- Department of Plastic Surgery, European Georges Pompidou Hospital, AP-HP, Paris, France
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France
| | - Nicolas Gendron
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France
- Department of Hematology, European Georges Pompidou Hospital, AP-HP, 20 Rue Leblanc, F-75015, Paris, France
| | - Audrey Cras
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France
- Department of Cell Therapy, Saint Louis Hospital, AP-HP, F-75010, Paris, France
| | - Jeanne Rancic
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France
| | - Aurélien Philippe
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France
- Department of Hematology, European Georges Pompidou Hospital, AP-HP, 20 Rue Leblanc, F-75015, Paris, France
| | - Curtis L Cetrulo
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Shriners Hospitals for Children-Boston, Boston, MA, USA
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Alexandre G Lellouch
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France
- Vascularized Composite Allotransplantation Laboratory, Center for Transplantation Sciences, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Shriners Hospitals for Children-Boston, Boston, MA, USA
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - David M Smadja
- Innovative Therapies in Haemostasis, INSERM UMR-S 1140, University of Paris, F-75006, Paris, France.
- Department of Hematology, European Georges Pompidou Hospital, AP-HP, 20 Rue Leblanc, F-75015, Paris, France.
| |
Collapse
|
49
|
Park H, Jo SM, Dasari S, Moon YL. Comparison of Clinical Outcomes of Platelet-Rich Plasma for Epicondylitis, Elbow: Simultaneous Lateral and Medial Versus Lateral Versus Medial. Orthop Surg 2023; 15:2110-2115. [PMID: 37052071 PMCID: PMC10432457 DOI: 10.1111/os.13732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/23/2022] [Accepted: 01/25/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE Lateral and medial epicondylitis are relatively common diseases, but they do not improve quickly and are known to reduce patients' quality of life. Much research has been done on Platelet-Rich Plasma (PRP) as a treatment for lateral epicondylitis, but research on medial epicondylitis is lacking. The purpose of this study is to compare: (i) the pain intensity; and (ii) the functional outcome between the simultaneous treatment of medial and lateral epicondylitis and the treatment of only lateral or medial epicondylitis using PRP. METHODS In this retrospective study, 209 patients treated with PRP on epicondylitis between March 2018 and December 2021 were enrolled. Simultaneous treatment was underwent 68 patients (group I). Seventy patients were treated for lateral epicondylitis (group II). The remaining 71 patients were treated for medial epicondylitis (group III). The visual analogue scale for pain (VAS) and the Mayo elbow performance score (MEPS) were evaluated for clinical outcomes at the initial visit and 6 months after injection. RESULTS VAS for pain and MEPS showed significant improvement in all three groups compared to before treatment. There was no significant difference between three groups on -ΔVAS (P > 0.05). However, in case of ΔMEPS, group III showed significantly lower compared to groups II and III (P < 0.05). No patients showed worsening of symptoms or complications during the treatment. CONCLUSION PRP injection for the patient with elbow medial and lateral epicondylitis can be treated effectively simultaneously in terms of pain. From a functional point of view, the effect of simultaneous treatment may be lessened than in the case of only lateral and medial treatment.
Collapse
Affiliation(s)
- Hyung‐Seok Park
- Department of Orthopedic SurgeryChosun University HospitalGwangjuSouth Korea
| | - Sung Min Jo
- Department of Orthopedic SurgeryChosun University HospitalGwangjuSouth Korea
| | | | | |
Collapse
|
50
|
Lana JF, Purita J, Everts PA, De Mendonça Neto PAT, de Moraes Ferreira Jorge D, Mosaner T, Huber SC, Azzini GOM, da Fonseca LF, Jeyaraman M, Dallo I, Santos GS. Platelet-Rich Plasma Power-Mix Gel (ppm)-An Orthobiologic Optimization Protocol Rich in Growth Factors and Fibrin. Gels 2023; 9:553. [PMID: 37504432 PMCID: PMC10379106 DOI: 10.3390/gels9070553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/29/2023] Open
Abstract
Platelet- and fibrin-rich orthobiologic products, such as autologous platelet concentrates, have been extensively studied and appreciated for their beneficial effects on multiple conditions. Platelet-rich plasma (PRP) and its derivatives, including platelet-rich fibrin (PRF), have demonstrated encouraging outcomes in clinical and laboratory settings, particularly in the treatment of musculoskeletal disorders such as osteoarthritis (OA). Although PRP and PRF have distinct characteristics, they share similar properties. The relative abundance of platelets, peripheral blood cells, and molecular components in these orthobiologic products stimulates numerous biological pathways. These include inflammatory modulation, augmented neovascularization, and the delivery of pro-anabolic stimuli that regulate cell recruitment, proliferation, and differentiation. Furthermore, the fibrinolytic system, which is sometimes overlooked, plays a crucial role in musculoskeletal regenerative medicine by regulating proteolytic activity and promoting the recruitment of inflammatory cells and mesenchymal stem cells (MSCs) in areas of tissue regeneration, such as bone, cartilage, and muscle. PRP acts as a potent signaling agent; however, it diffuses easily, while the fibrin from PRF offers a durable scaffolding effect that promotes cell activity. The combination of fibrin with hyaluronic acid (HA), another well-studied orthobiologic product, has been shown to improve its scaffolding properties, leading to more robust fibrin polymerization. This supports cell survival, attachment, migration, and proliferation. Therefore, the administration of the "power mix" containing HA and autologous PRP + PRF may prove to be a safe and cost-effective approach in regenerative medicine.
Collapse
Affiliation(s)
- José Fábio Lana
- OrthoRegen Group, Max-Planck University, Indaiatuba 13343-060, Brazil
| | | | | | | | | | - Tomas Mosaner
- Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, Brazil
| | - Stephany Cares Huber
- Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, Brazil
| | | | | | - Madhan Jeyaraman
- Department of Orthopaedics, Faculty of Medicine, Sri Lalithambigai Medical College and Hospital, Tamil Nadu 600095, India
| | - Ignacio Dallo
- SportMe Medical Center, Department of Orthopaedic Surgery and Sports Medicine, Unit of Biological Therapies and MSK Interventionism, 41013 Seville, Spain
| | - Gabriel Silva Santos
- Brazilian Institute of Regenerative Medicine (BIRM), Indaiatuba 13334-170, Brazil
| |
Collapse
|