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Hurley ET, Lim Fat D, Moran CJ, Mullett H. The Efficacy of Platelet-Rich Plasma and Platelet-Rich Fibrin in Arthroscopic Rotator Cuff Repair: A Meta-analysis of Randomized Controlled Trials. Am J Sports Med 2019; 47:753-761. [PMID: 29466688 DOI: 10.1177/0363546517751397] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Basic science studies suggest that platelet-rich therapies have a positive effect on tendon repair. However, the clinical evidence is conflicted on whether this translates to increased tendon healing and improved functional outcomes. PURPOSE To perform a systematic review of randomized controlled trials (RCTs) in the literature to ascertain whether platelet-rich plasma (PRP) or platelet-rich fibrin (PRF) improved patient outcomes in arthroscopic rotator cuff repair. STUDY DESIGN Meta-analysis. METHODS Two independent reviewers performed the literature search based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, with a third author resolving any discrepancies. RCTs comparing PRP or PRF to a control in rotator cuff repair were included. Quality of evidence was assessed using the Jadad score. Clinical outcomes were compared using the risk ratio for dichotomous variables and the mean difference for continuous variables. A P value <.05 was deemed statistically significant. RESULTS Eighteen RCTs with 1147 patients were included in this review. PRP resulted in significantly decreased rates of incomplete tendon healing for all tears combined (17.2% vs 30.5%, respectively; P < .05), incomplete tendon healing in small-medium tears (22.4% vs 38.3%, respectively; P < .05), and incomplete tendon healing in medium-large tears (12.3% vs 30.5%, respectively; P < .05) compared to the control. There was a significant result in favor of PRP for the Constant score (85.6 vs 83.1, respectively; P < .05) and the visual analog scale score for pain at 30 days postoperatively (2.9 vs 4.3, respectively; P < .05) and at final follow-up (1.2 vs 1.4, respectively; P < .05) compared to the control. PRF did not result in a significantly decreased rate of incomplete tendon healing for all tears combined (23.0% vs 24.6%, respectively; P = .74) or an improved Constant score (80.8 vs 79.8, respectively; P = .27) compared to the control. PRF resulted in a significantly longer operation time (99.1 vs 83.3 minutes, respectively; P< .05) compared to the control. CONCLUSION The current evidence indicates that the use of PRP in rotator cuff repair results in improved healing rates, pain levels, and functional outcomes. In contrast, PRF has been shown to have no benefit in improving tendon healing rates or functional outcomes.
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Affiliation(s)
- Eoghan T Hurley
- Sports Surgery Clinic, Dublin, Ireland.,Department of Trauma & Orthopaedic Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Cathal J Moran
- Sports Surgery Clinic, Dublin, Ireland.,Department of Orthopaedics and Sports Medicine, Trinity College Dublin, Dublin, Ireland
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Vedicherla S, Buckley CT. Cell-based therapies for intervertebral disc and cartilage regeneration- Current concepts, parallels, and perspectives. J Orthop Res 2017; 35:8-22. [PMID: 27104885 DOI: 10.1002/jor.23268] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 04/08/2016] [Indexed: 02/04/2023]
Abstract
Lower back pain from degenerative disc disease represents a global health burden, and presents a prominent opportunity for regenerative therapeutics. While current regenerative therapies such as autologous disc chondrocyte transplantation (ADCT), allogeneic juvenile chondrocyte implantation (NuQu®), and immunoselected allogeneic adipose derived precursor cells (Mesoblast) show exciting clinical potential, limitations remain. The heterogeneity of preclinical approaches and the paucity of clinical guidance have limited translational outcomes in disc repair, lagging almost a decade behind cartilage repair. Advances in cartilage repair have evolved to single step approaches with improved orthopedic repair and regeneration. Elements from cartilage regeneration endeavors could be adopted and applied to harness translatable approaches and deliver a clinically and economically feasible regenerative surgery for back pain. In this article, we trace the developments behind the translational success of cartilage repair, examine elements to consider in achieving disc regeneration, and the need for surgical redesign. We further discuss clinical parameters, objectives, and coordination required to deliver improved regenerative surgery. Cell source, processing, and delivery modalities are key issues to be addressed in considering surgical redesign. Advances in biomanufacturing, tissue cryobanking, and point of care cell processing technology may enable intraoperative solutions for single step procedures. To maximize translational success a triad partnership between clinicians, industry, and researchers will be critical in providing instructive clinical guidelines for design as well as practical and economic considerations. This will allow a consensus in research ventures and add regenerative surgery into the algorithm in managing and treating a debilitating condition such as back pain. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:8-22, 2017.
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Affiliation(s)
- Srujana Vedicherla
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland.,School of Medicine, Trinity College Dublin, Ireland
| | - Conor T Buckley
- Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin, Ireland.,Department of Mechanical and Manufacturing Engineering, School of Engineering, Trinity College Dublin, Ireland
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Yasui Y, Ando W, Shimomura K, Koizumi K, Ryota C, Hamamoto S, Kobayashi M, Yoshikawa H, Nakamura N. Scaffold-free, stem cell-based cartilage repair. J Clin Orthop Trauma 2016; 7:157-63. [PMID: 27489410 PMCID: PMC4949412 DOI: 10.1016/j.jcot.2016.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 06/03/2016] [Indexed: 01/01/2023] Open
Abstract
Various approaches to treat articular cartilage have been widely investigated due to its poor intrinsic healing capacity. Stem cell-based therapy could be a promising approach as an alternative to chondrocyte-based therapy and some of these therapies have been already applied in clinical condition. This review discusses the current development of stem cell-based therapies in cartilage repair, specifically focusing on scaffold-free approaches.
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Affiliation(s)
- Yukihiko Yasui
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazunori Shimomura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kota Koizumi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Chijimatsu Ryota
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shuichi Hamamoto
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masato Kobayashi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Norimasa Nakamura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan,Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan,Center for Advanced Medical Engineering and Informatics, Osaka University, Osaka, Japan,Corresponding author at: Institute for Medical Science in Sports, Osaka Health Science University, 1-9-27, Tenma, Kita-ku, Osaka city, Osaka 530-0043, Japan. Tel.: +81-6-6352-0093; fax: +81-6-6352-5995.
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Moran CJ, Busilacchi A, Lee CA, Athanasiou KA, Verdonk PC. Biological augmentation and tissue engineering approaches in meniscus surgery. Arthroscopy 2015; 31:944-55. [PMID: 25687715 DOI: 10.1016/j.arthro.2014.11.044] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 11/19/2014] [Accepted: 11/19/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this review was to evaluate the role of biological augmentation and tissue engineering strategies in meniscus surgery. Although clinical (human), preclinical (animal), and in vitro tissue engineering studies are included here, we have placed additional focus on addressing preclinical and clinical studies reported during the 5-year period used in this review in a systematic fashion while also providing a summary review of some important in vitro tissue engineering findings in the field over the past decade. METHODS A search was performed on PubMed for original works published from 2009 to March 31, 2014 using the term "meniscus" with all the following terms: "scaffolds," "constructs," "cells," "growth factors," "implant," "tissue engineering," and "regenerative medicine." Inclusion criteria were the following: English-language articles and original clinical, preclinical (in vivo), and in vitro studies of tissue engineering and regenerative medicine application in knee meniscus lesions published from 2009 to March 31, 2014. RESULTS Three clinical studies and 18 preclinical studies were identified along with 68 tissue engineering in vitro studies. These reports show the increasing promise of biological augmentation and tissue engineering strategies in meniscus surgery. The role of stem cell and growth factor therapy appears to be particularly useful. A review of in vitro tissue engineering studies found a large number of scaffold types to be of promise for meniscus replacement. Limitations include a relatively low number of clinical or preclinical in vivo studies, in addition to the fact there is as yet no report in the literature of a tissue-engineered meniscus construct used clinically. Neither does the literature provide clarity on the optimal meniscus scaffold type or biological augmentation with which meniscus repair or replacement would be best addressed in the future. There is increasing focus on the role of mechanobiology and biomechanical and biochemical cues in this process, however, and it is hoped that this may lead to improvements in this strategy. CONCLUSIONS There appears to be significant potential for biological augmentation and tissue engineering strategies in meniscus surgery to enhance options for repair and replacement. However, there are still relatively few clinical studies being reported in this regard. There is a strong need for improved translational activities and infrastructure to link the large amounts of in vitro and preclinical biological and tissue engineering data to clinical application. LEVEL OF EVIDENCE Level IV, systematic review of Level I-IV studies.
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Affiliation(s)
- Cathal J Moran
- Sports Surgery Clinic and Trinity College Dublin, Dublin, Ireland.
| | - Alberto Busilacchi
- Clinical Orthopaedics, Università Politecnica delle Marche, Ancona, Italy
| | - Cassandra A Lee
- Departments of Orthopaedic Surgery & Biomedical Engineering, University of California, Davis, California, U.S.A
| | - Kyriacos A Athanasiou
- Departments of Orthopaedic Surgery & Biomedical Engineering, University of California, Davis, California, U.S.A
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Trends in the surgical treatment of articular cartilage defects of the knee in the United States. Knee Surg Sports Traumatol Arthrosc 2014; 22:2070-5. [PMID: 23896943 DOI: 10.1007/s00167-013-2614-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 07/15/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to evaluate trends in surgical treatment of articular cartilage defects of the knee in the United States. METHODS The current procedural terminology (CPT) billing codes of patients undergoing articular cartilage procedures of the knee were searched using the PearlDiver Patient Record Database, a national database of insurance billing records. The CPT codes for chondroplasty, microfracture, osteochondral autograft, osteochondral allograft, and autologous chondrocyte implantation (ACI) were searched. RESULTS A total of 163,448 articular cartilage procedures of the knee were identified over a 6-year period. Microfracture and chondroplasty accounted for over 98% of cases. There was no significant change in the incidence of cartilage procedures noted from 2004 (1.27 cases per 10,000 patients) to 2009 (1.53 cases per 10,000 patients) (p = 0.06). All procedures were performed more commonly in males (p < 0.001). This gender difference was smallest in patients undergoing chondroplasty (51 % males and 49% females) and greatest for open osteochondral allograft (61% males and 39% females). Chondroplasty and microfracture were most commonly performed in patients aged 40-59, while all other procedures were performed most frequently in patients <40 years old (p < 0.001). CONCLUSIONS Articular cartilage lesions of the knee are most commonly treated with microfracture or chondroplasty in the United States. Chondroplasty and microfracture were most often performed in middle-aged patients, whereas osteochondral autograft, allograft, and ACI were performed in younger patients, and more frequently in males. LEVEL OF EVIDENCE Cross-sectional study, Level IV.
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Moran CJ, Pascual-Garrido C, Chubinskaya S, Potter HG, Warren RF, Cole BJ, Rodeo SA. Restoration of articular cartilage. J Bone Joint Surg Am 2014; 96:336-44. [PMID: 24553893 DOI: 10.2106/jbjs.l.01329] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
➤ Novel (i.e., quantitative and semiquantitative) cartilage imaging techniques can evaluate cartilage composition to augment information obtained from traditional magnetic resonance imaging sequences that detail morphology.➤ A well-defined role for drugs leading to chondroprotection has not yet been determined.➤ Shortcomings of bone marrow stimulation include limited production of hyaline repair tissue, unpredictable repair cartilage volume, and a negative impact on later cellular transplantation if required.➤ The role of biological augments, such as cellular concentrates or platelet-rich plasma, remains undefined. When their use is reported in the literature, it is important that their process of production and characterization be detailed.➤ Rehabilitation programs, incorporating controlled exercise and progressive partial weight-bearing, are an important part of cartilage repair surgery and should be detailed in reports on operative techniques applied.➤ Malalignment, meniscal injury, and ligament deficiency should be corrected in a staged or concomitant fashion to reduce the overall likelihood of mechanical failure in cartilage repair surgery.
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Affiliation(s)
- Cathal J Moran
- Sports Medicine and Shoulder Service (C.J.M., C.P.-G., R.F.W., and S.A.R.) and Department of Radiology and Imaging (H.G.P.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for C.J. Moran:
| | - Cecilia Pascual-Garrido
- Sports Medicine and Shoulder Service (C.J.M., C.P.-G., R.F.W., and S.A.R.) and Department of Radiology and Imaging (H.G.P.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for C.J. Moran:
| | - Susan Chubinskaya
- Department of Biochemistry, Rush University Medical Center, Cohn Research Building, Suite 522, 1735 West Harrison Street, Chicago, IL 60612
| | - Hollis G Potter
- Sports Medicine and Shoulder Service (C.J.M., C.P.-G., R.F.W., and S.A.R.) and Department of Radiology and Imaging (H.G.P.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for C.J. Moran:
| | - Russell F Warren
- Sports Medicine and Shoulder Service (C.J.M., C.P.-G., R.F.W., and S.A.R.) and Department of Radiology and Imaging (H.G.P.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for C.J. Moran:
| | - Brian J Cole
- Division of Sports Medicine, Cartilage Restoration Center, Midwest Orthopedics at Rush, Rush University Medical Center, 1611 West Harrison Street, Suite 300, Chicago, IL 60612
| | - Scott A Rodeo
- Sports Medicine and Shoulder Service (C.J.M., C.P.-G., R.F.W., and S.A.R.) and Department of Radiology and Imaging (H.G.P.), Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. E-mail address for C.J. Moran:
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Abstract
The intrasynovial bone-tendon interface is a gradual transition from soft tissue to bone, with two intervening zones of uncalcified and calcified fibrocartilage. Following injury, the native anatomy is not restored, resulting in inferior mechanical properties and an increased risk of re-injury. Recent in vivo studies provide evidence of improved healing when surgical repair of the bone-tendon interface is augmented with cells capable of undergoing chondrogenesis. In particular, cellular therapy in bone-tendon healing can promote fibrocartilage formation and associated improvements in mechanical properties. Despite these promising results in animal models, cellular therapy in human patients remains largely unexplored. This review highlights the development and structure-function relationship of normal bone-tendon insertions. The natural healing response to injury is discussed, with subsequent review of recent research on cellular approaches for improved healing. Finally, opportunities for translating in vivo findings into clinical practice are identified.
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Affiliation(s)
- Benjamin B Rothrauff
- Center for Cellular and Molecular Engineering; Department of Orthopaedic Surgery; University of Pittsburgh School of Medicine; Pittsburgh, PA USA
| | - Rocky S Tuan
- Center for Cellular and Molecular Engineering; Department of Orthopaedic Surgery; University of Pittsburgh School of Medicine; Pittsburgh, PA USA
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