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Rossi LA, Gorodischer TD, Camino P, Brandariz RN, Tanoira I, Piuzzi NS, Ranalletta M. Leukocyte-Poor Platelet-Rich Plasma as an Adjuvant to Arthroscopic Rotator Cuff Repair Reduces the Retear Rate But Does Not Improve Functional Outcomes: A Double-Blind Randomized Controlled Trial. Am J Sports Med 2024; 52:1403-1410. [PMID: 38587033 DOI: 10.1177/03635465241239062] [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] [Indexed: 04/09/2024]
Abstract
BACKGROUND Whether the use of PRP as an adjuvant of rotator cuff repairs leads to improved tendon healing and better functional outcomes remains unclear in clinical evidence. PURPOSE The main purpose of this study was to assess whether the use of leukocyte-poor platelet-rich plasma (LP-PRP) as an adjuvant to arthroscopic rotator cuff repair (ARCR) decreases the rate of retears compared with a control group. The secondary objective was to analyze whether LP-PRP improves patient-reported outcomes. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS This was a double-blind randomized controlled trial at a single center. A consecutive series of 96 patients with rotator cuff tears <3 cm were enrolled and randomly allocated to the control group (double-row suture-bridge ARCR alone [n = 48]) and the PRP group (double-row suture-bridge repair, followed by 1 LP-PRP injection during surgery [n = 48]). The visual analog scale (VAS) for pain, the American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), and the Pittsburgh Sleep Quality Index (PSQI) were administered preoperatively and at 6- and 12-month follow-up. Magnetic resonance imaging (MRI) was performed to evaluate tendon integrity at 6-month follow-up. Both patients and assessors were blinded to the intervention received during surgery. RESULTS The mean patient age was 56.1 ± 2.98 years. Of the 96 patients, 90 had MRI performed at 6 months after surgery (94% radiological follow-up). The retear rate in the PRP group was 15.2% (7/46 [95% CI, 6%-28%]), which was lower than that in the control group of 34.1% (15/44 [95% CI, 20%-49%]) (P = .037). Therefore, the risk ratio of ruptures in patients exposed to LP-PRP was 0.44 (95% CI, 0.2-0.9; P = .037). Overall, the ASES, VAS, SANE, and PSQI scores showed a statistical improvement after surgery (P < .001). There were no significant differences in functional scores between the groups. Most of the patients exceeded the minimal clinically important difference for the ASES, SANE, and VAS without significant differences between the groups. CONCLUSION In patients with rotator cuff tears <3 cm undergoing double-row suture-bridge repair, a 5-mL dose of LP-PRP injected at the tendon-bone interface significantly reduced the retear rate. However, the use of LP-PRP in terms of postoperative pain and patient-reported outcomes failed to show clinically meaningful effects. REGISTRATION NCT04703998 (ClinicalTrials.gov identifier).
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Affiliation(s)
- Luciano Andres Rossi
- "Carlos E. Ottolenghi" Instituto de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Tomás David Gorodischer
- "Carlos E. Ottolenghi" Instituto de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Pablo Camino
- Department of Hemotherapy, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Rodrigo Nicolás Brandariz
- "Carlos E. Ottolenghi" Instituto de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Ignacio Tanoira
- "Carlos E. Ottolenghi" Instituto de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Nicolás Santiago Piuzzi
- Department of Hemotherapy, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - Maximiliano Ranalletta
- "Carlos E. Ottolenghi" Instituto de Ortopedia y Traumatología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Hurley ET, Sherman SL, Stokes DJ, Rodeo SA, Shapiro SA, Mautner K, Buford DA, Dragoo JL, Mandelbaum BR, Zaslav KR, Cole BJ, Frank RM. Experts Achieve Consensus on a Majority of Statements Regarding Platelet-Rich Plasma Treatments for Treatment of Musculoskeletal Pathology. Arthroscopy 2024; 40:470-477.e1. [PMID: 37625660 DOI: 10.1016/j.arthro.2023.08.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/23/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
PURPOSE To establish consensus statements on platelet-rich plasma (PRP) for the treatment of musculoskeletal pathologies. METHODS A consensus process on the treatment of PRP using a modified Delphi technique was conducted. Thirty-five orthopaedic surgeons and sports medicine physicians participated in these consensus statements on PRP. The participants were composed of representatives of the Biologic Association, representing 9 international orthopaedic and musculoskeletal professional societies invited due to their active interest in the study of orthobiologics. Consensus was defined as achieving 80% to 89% agreement, strong consensus was defined as 90% to 99% agreement, and unanimous consensus was indicated by 100% agreement with a proposed statement. RESULTS There was consensus on 62% of statements about PRP. CONCLUSIONS (1) PRP should be classified based on platelet count, leukocyte count, red blood count, activation method, and pure-plasma versus fibrin matrix; (2) PRP characteristics for reporting in research studies are platelet count, leukocyte count, neutrophil count, red blood cell count, total volume, the volume of injection, delivery method, and the number of injections; (3) the prognostic factors for those undergoing PRP injections are age, body mass index, severity/grade of pathology, chronicity of pathology, prior injections and response, primary diagnosis (primary vs postsurgery vs post-trauma vs psoriatic), comorbidities, and smoking; (4) regarding age and body mass index, there is no minimum or maximum, but clinical judgment should be used at extremes of either; (5) the ideal dose of PRP is undetermined; and (6) the minimal volume required is unclear and may depend on the pathology. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
- Eoghan T Hurley
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, U.S.A.
| | - Seth L Sherman
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, U.S.A
| | - Daniel J Stokes
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Scott A Rodeo
- Hospital for Special Surgery, New York, New York, U.S.A
| | - Shane A Shapiro
- Department of Orthopaedic Surgery, Mayo Clinic, Jacksonville, Florida, U.S.A
| | - Kenneth Mautner
- Department of Physical Medicine & Rehabilitation, Emory University School of Medicine, Atlanta, Georgia, U.S.A
| | | | - Jason L Dragoo
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Bert R Mandelbaum
- Cedars Sinai-Kerlan Jobe Institute, Los Angeles, California, U.S.A.; Clínica Espregueira, FIFA Medical Centre of Excellence, Porto, Portugal
| | - Kenneth R Zaslav
- Lenox Hill Hospital Northwell Health Orthopedic Institute, New York, New York, U.S.A
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Rachel M Frank
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
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Sneed D, Wong C. Platelet-rich plasma injections as a treatment for Achilles tendinopathy and plantar fasciitis in athletes. PM R 2023; 15:1493-1506. [PMID: 36929699 DOI: 10.1002/pmrj.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 03/18/2023]
Abstract
Platelet-rich plasma (PRP) injections represent a growing interest in the use of biologic therapies for treatment of musculoskeletal injuries. One possible application of PRP is in the management of overuse injuries commonly experienced by athletes. The aim of this review is to evaluate and summarize existing evidence regarding the efficacy of PRP in the treatment of Achilles tendinopathy and plantar fasciitis in athletes. Although many lower quality single-armed studies have demonstrated clinical improvement in athletes treated for Achilles tendinopathy with PRP, higher quality randomized controlled trials (RCTs) have shown no clear benefit in athletes. Existing data suggest PRP significantly improves clinical outcomes for plantar fasciitis in the general population, but very few studies and no RCTs are available that specifically analyze outcomes in athletic populations. More research is needed to evaluate how platelet concentration, leukocyte and erythrocyte presence, and sport type may interact to affect clinical outcomes in athletes.
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Affiliation(s)
- Dustin Sneed
- Central Virginia VA Health Care System, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Carmen Wong
- Central Virginia VA Health Care System, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Lin M, Li W, Ni X, Sui Y, Li H, Chen X, Lu Y, Jiang M, Wang C. Growth factors in the treatment of Achilles tendon injury. Front Bioeng Biotechnol 2023; 11:1250533. [PMID: 37781529 PMCID: PMC10539943 DOI: 10.3389/fbioe.2023.1250533] [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: 07/03/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023] Open
Abstract
Achilles tendon (AT) injury is one of the most common tendon injuries, especially in athletes, the elderly, and working-age people. In AT injury, the biomechanical properties of the tendon are severely affected, leading to abnormal function. In recent years, many efforts have been underway to develop effective treatments for AT injuries to enable patients to return to sports faster. For instance, several new techniques for tissue-engineered biological augmentation for tendon healing, growth factors (GFs), gene therapy, and mesenchymal stem cells were introduced. Increasing evidence has suggested that GFs can reduce inflammation, promote extracellular matrix production, and accelerate AT repair. In this review, we highlighted some recent investigations regarding the role of GFs, such as transforming GF-β(TGF-β), bone morphogenetic proteins (BMP), fibroblast GF (FGF), vascular endothelial GF (VEGF), platelet-derived GF (PDGF), and insulin-like GF (IGF), in tendon healing. In addition, we summarized the clinical trials and animal experiments on the efficacy of GFs in AT repair. We also highlighted the advantages and disadvantages of the different isoforms of TGF-β and BMPs, including GFs combined with stem cells, scaffolds, or other GFs. The strategies discussed in this review are currently in the early stages of development. It is noteworthy that although these emerging technologies may potentially develop into substantial clinical treatment options for AT injury, definitive conclusions on the use of these techniques for routine management of tendon ailments could not be drawn due to the lack of data.
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Affiliation(s)
- Meina Lin
- Liaoning Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Wei Li
- Liaoning Research Institute of Family Planning, China Medical University, Shenyang, China
- Medical School, Shandong Modern University, Jinan, China
| | - Xiang Ni
- Liaoning Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Yu Sui
- Liaoning Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Huan Li
- Liaoning Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Xinren Chen
- Liaoning Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Yongping Lu
- Liaoning Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Miao Jiang
- Liaoning Research Institute of Family Planning, China Medical University, Shenyang, China
| | - Chenchao Wang
- Department of Plastic Surgery, The First Hospital of China Medical University, Shenyang, China
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Hurley ET, Danilkowicz RM, Klifto CS. Editorial Commentary: Platelet-Rich Plasma Injections Produced a Significant Improvement in Most Patients With Rotator Cuff Tendinopathy. Arthroscopy 2023; 39:2009-2011. [PMID: 37543385 DOI: 10.1016/j.arthro.2023.03.022] [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: 03/27/2023] [Accepted: 03/30/2023] [Indexed: 08/07/2023]
Abstract
Platelet-rich plasma (PRP) is an autologous blood product containing a high concentration of platelets, growth factors, and cytokines, which basic science studies have shown may improve tendinopathy. However, there is controversy over its clinical efficacy with randomized controlled trials and subsequent meta-analysis finding mixed results when treating shoulder rotator cuff tendinopathy. The effect of leukocyte concentration on PRP has been shown to be paramount, with different concentrations being favored for different pathologies. In those with tendinopathy, it is unclear whether leukocyte-rich or leukocyte-poor PRP is superior. Recent research shows that PRP injections produced a significant improvement in most patients with rotator cuff tendinopathy. However, improvement in symptoms and functional outcomes is worse in patients who have a partial-thickness rotator cuff tear compared with isolated tendinopathy without a partial tear. PRP may be more advantageous than corticosteroids. Both function as anti-inflammatories, but PRP may be potentially anabolic, whereas as corticosteroids have a catabolic effect on tendons, which may reduce repairability if patients proceed with surgery. Additionally, there are higher infection rates if patients ultimately go on to surgery within 3 months after corticosteroid injections. Ultimately, we must refine the indications for best use for PRP shoulder injections and determine the 5 R's: right patient, right drug, right dose, right route, and right time. Finally, we must remember that patients can first try conservative management, including physical therapy.
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Lu J, Li H, Zhang Z, Xu R, Wang J, Jin H. Platelet-rich plasma in the pathologic processes of tendinopathy: a review of basic science studies. Front Bioeng Biotechnol 2023; 11:1187974. [PMID: 37545895 PMCID: PMC10401606 DOI: 10.3389/fbioe.2023.1187974] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/10/2023] [Indexed: 08/08/2023] Open
Abstract
Tendinopathy is a medical condition that includes a spectrum of inflammatory and degenerative tendon changes caused by traumatic or overuse injuries. The pathological mechanism of tendinopathy has not been well defined, and no ideal treatment is currently available. Platelet-rich plasma (PRP) is an autologous whole blood derivative containing a variety of cytokines and other protein components. Various basic studies have found that PRP has the therapeutic potential to promote cell proliferation and differentiation, regulate angiogenesis, increase extracellular matrix synthesis, and modulate inflammation in degenerative tendons. Therefore, PRP has been widely used as a promising therapeutic agent for tendinopathy. However, controversies exist over the optimal treatment regimen and efficacy of PRP for tendinopathy. This review focuses on the specific molecular and cellular mechanisms by which PRP manipulates tendon healing to better understand how PRP affects tendinopathy and explore the reason for the differences in clinical trial outcomes. This article has also pointed out the future direction of basic research and clinical application of PRP in the treatment of tendinopathy, which will play a guiding role in the design of PRP treatment protocols for tendinopathy.
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Affiliation(s)
- Jialin Lu
- Department of Pain, The Second Hospital of Jilin University, Changchun, China
- Norman Bethune Health Science Center of Jilin University, Changchun, China
| | - Han Li
- Norman Bethune Health Science Center of Jilin University, Changchun, China
| | - Ziyu Zhang
- Norman Bethune Health Science Center of Jilin University, Changchun, China
| | - Rui Xu
- Department of Endocrinology and Metabolism, Ruijin Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Jincheng Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Hui Jin
- Department of Pain, The Second Hospital of Jilin University, Changchun, China
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
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Kawabata S, Akeda K, Yamada J, Takegami N, Fujiwara T, Fujita N, Sudo A. Advances in Platelet-Rich Plasma Treatment for Spinal Diseases: A Systematic Review. Int J Mol Sci 2023; 24:ijms24087677. [PMID: 37108837 PMCID: PMC10145581 DOI: 10.3390/ijms24087677] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 04/18/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023] Open
Abstract
Spinal diseases are commonly associated with pain and neurological symptoms, which negatively impact patients' quality of life. Platelet-rich plasma (PRP) is an autologous source of multiple growth factors and cytokines, with the potential to promote tissue regeneration. Recently, PRP has been widely used for the treatment of musculoskeletal diseases, including spinal diseases, in clinics. Given the increasing popularity of PRP therapy, this article examines the current literature for basic research and emerging clinical applications of this therapy for treating spinal diseases. First, we review in vitro and in vivo studies, evaluating the potential of PRP in repairing intervertebral disc degeneration, promoting bone union in spinal fusion surgeries, and aiding in neurological recovery from spinal cord injury. Second, we address the clinical applications of PRP in treating degenerative spinal disease, including its analgesic effect on low back pain and radicular pain, as well as accelerating bone union during spinal fusion surgery. Basic research demonstrates the promising regenerative potential of PRP, and clinical studies have reported on the safety and efficacy of PRP therapy for treating several spinal diseases. Nevertheless, further high-quality randomized controlled trials would be required to establish clinical evidence of PRP therapy.
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Affiliation(s)
- Soya Kawabata
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan
| | - Koji Akeda
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Junichi Yamada
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Norihiko Takegami
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Tatsuhiko Fujiwara
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
| | - Nobuyuki Fujita
- Department of Orthopaedic Surgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu 514-8507, Japan
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Xu J, Du W, Xue X, Chen M, Zhou W, Luo X. Global research trends on platelet-rich plasma for tendon and ligament injuries from the past two decades: A bibliometric and visualized study. Front Surg 2023; 10:1113491. [PMID: 36843990 PMCID: PMC9950278 DOI: 10.3389/fsurg.2023.1113491] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/19/2023] [Indexed: 02/12/2023] Open
Abstract
Background In sports medicine, tendon and ligament injuries are the most prevalent conditions, and with the booming of sports competition, the incidence of sports injuries is gradually increasing, investigating more potent therapeutic options is therefore becoming increasingly crucial. Platelet-rich plasma therapy has gained popularity as an effective and secure treatment in recent years. Currently, a faceted systematic and clear visual analysis is lacking in this research area. Methods The literature related to using platelet-rich plasma to treat ligament and tendon injuries from 2003 to 2022 in the core dataset of the Web of Science database was collected and analyzed visually using Citespace 6.1 software. Research hotspots and development trends were analyzed in terms of high-impact countries or regions, authors, research institutions, keywords, and cited literature. Results The literature comprised a total of 1,827 articles. The annual publication volume of relevant literature has demonstrated a significant development tendency as the field of platelet-rich plasma research for tendon and ligament injuries has heated up in recent years. With 678 papers, the United States came in top place, followed by China with 187 papers. Hosp Special Surg ranked first with 56 papers. The hot research topics analyzed by keywords were tennis elbow, anterior cruciate ligament, rotator cuff repair, achilles tendon, mesenchymal stem cells, guided tissue regeneration, network meta analysis, chronic patellar tendinopathy, and follow up. Conclusion Analysis of the research literature over the past 20 years shows that the United States and China will continue to dominate in terms of volume of publications based on annual volume and trends, with some collaboration among high-impact authors and further collaboration still needed in different countries and institutions. Platelet-rich plasma is widely used in the treatment of tendon ligament injuries. Its clinical efficacy is influenced by a number of factors, the main ones being the inconsistency in the preparation and composition of platelet-rich plasma and its related preparations, and the differences in efficacy due to different activation methods of platelet-rich plasma, as well as factors such as injection time, injection site, administration method, number of administrations, acidity and evaluation methods, In addition, the applicability to different injury diseases remains controversial. In recent years, the molecular biology of platelet-rich plasma for tendon ligament therapy has received increasing attention.
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Affiliation(s)
- Jie Xu
- Department of Sports Medicine, Sichuan Provincial Orthopedics Hospital, Chengdu, China
| | - Wanli Du
- Department of Cervicodynia/Omalgia/Lumbago/Sciatica 2, Sichuan Provincial Orthopedics Hospital, Chengdu, China
| | - Xiali Xue
- Institute of Sports Medicine and Health, Chengdu Sport University, Chengdu, China
| | - Meng Chen
- Department of Emergency Medicine, Nanchong Hospital of Traditional Chinese Medicine, Nanchong, China
| | - Wenqi Zhou
- Department of Sports Medicine, Sichuan Provincial Orthopedics Hospital, Chengdu, China
| | - Xiaobing Luo
- Department of Sports Medicine, Sichuan Provincial Orthopedics Hospital, Chengdu, China,Correspondence: Xiaobing Luo
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Molecular and Biologic Effects of Platelet-Rich Plasma (PRP) in Ligament and Tendon Healing and Regeneration: A Systematic Review. Int J Mol Sci 2023; 24:ijms24032744. [PMID: 36769065 PMCID: PMC9917492 DOI: 10.3390/ijms24032744] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 01/27/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023] Open
Abstract
Platelet-rich plasma (PRP) has been introduced and applied to a wide spectrum of acute and chronic ligament and tendon pathologic conditions. Although the biological effect of PRP has been studied thoroughly in both animal and human studies, there is no consensus so far on the exact mechanism of its action as well as the optimal timing and dosage of its application. Therefore, we conducted a systematic review aiming to evaluate the molecular effect of the administration of PRP in tendoligamentous injuries and degenerative diseases. The literature search revealed 36 in vitro and in vivo studies examining the healing and remodeling response of animal and human ligament or tendon tissues to PRP. Platelet-rich plasma added in the culture media was highly associated with increased cell proliferation, migration, viability and total collagen production of both ligament- and tendon-derived cells in in vitro studies, which was further confirmed by the upregulation of collagen gene expression. In vivo studies correlated the PRP with higher fibroblastic anabolic activity, including increased cellularity, collagen production and vascularity of ligament tissue. Similarly, greater metabolic response of tenocytes along with the acceleration of the healing process in the setting of a tendon tear were noticed after PRP application, particularly between the third and fourth week after treatment. However, some studies demonstrated that PRP had no or even negative effect on tendon and ligament regeneration. This controversy is mainly related to the variable processes and methodologies of preparation of PRP, necessitating standardized protocols for both investigation and ap-plication.
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Advances in the Clinical Application of Platelet-Rich Plasma in the Foot and Ankle: A Review. J Clin Med 2023; 12:jcm12031002. [PMID: 36769649 PMCID: PMC9917505 DOI: 10.3390/jcm12031002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/31/2023] Open
Abstract
Autologous and recombinant biologic substances have been generated as a result of the research into the cellular features of the healing process. Orthobiologics are increasingly being used in sports medicine and musculoskeletal surgery. Nevertheless, clinical data are limited; consequently, further studies are required, particularly in foot and ankle pathologies. This review aims to provide evidence of the most recent literature results and ignite the interest of orthopedic specialists eager for an update about the most current discussion on platelet-rich plasma (PRP) clinical applications in the foot and ankle fields. Previous studies have shown that platelet-rich plasma can be beneficial in treating various conditions, such as chronic foot ulcers, osteoarthritis, Achilles tendinopathy, etc. Despite the positive effects of PRP on various musculoskeletal conditions, more prospective studies are needed to confirm its effectiveness at treating ankle and foot pathologies. In addition to clinical trials, other factors, such as the quality of the research and the procedures involved, must be considered before they can be used in patients. More long-term evaluations are needed to support or oppose its application in treating foot and ankle disorders. We present the most extensive review of PRP's clinical applications in the foot and ankle field.
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Leukocyte and Platelet-Rich Plasma (L-PRP) in Tendon Models: A Systematic Review and Meta-Analysis of in vivo/ in vitro Studies. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:5289145. [PMID: 36569346 PMCID: PMC9780014 DOI: 10.1155/2022/5289145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/16/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022]
Abstract
Purpose To perform a systematic review on the application of leukocyte- and platelet-rich plasma (L-PRP) in tendon models by reviewing in vivo/in vitro studies. Methods The searches were performed via electronic databases including PubMed, Embase, and Cochrane Library up to September 2022 using the following keywords: ((tenocytes OR tendon OR tendinitis OR tendinosis OR tendinopathy OR tendon injury) AND (platelet-rich plasma OR PRP OR autologous conditioned plasma OR leukocyte- and platelet-rich plasma OR L-PRP OR leukocyte-richplatelet-rich plasma Lr-PRP)). Only in vitro and in vivo studies that assessed the potential effects of L-PRP on tendons and/or tenocytes are included in this study. Description of PRP, study design and methods, outcomes measured, and results are extracted from the data. Results A total of 17 studies (8 in vitro studies and 9 in vivo studies) are included. Thirteen studies (76%) reported leukocyte concentrations of L-PRP. Four studies (24%) reported the commercial kits. In in vitro studies, L-PRP demonstrated increased cell proliferation, cell migration, collagen synthesis, accelerated inflammation, and catabolic response in the short term. In addition, most in vivo studies indicated increased collagen type I content. According to in vivo studies reporting data, L-PRP reduced inflammation response in 71.0% of studies, while it enhanced the histological quality of tendons in 67.0% of studies. All 3 studies reporting data found increased biomechanical properties with L-PRP treatment. Conclusions Most evidence indicates that L-PRP has some potential effects on tendon healing compared to control. However, it appears that L-PRP works depending on the biological status of the damaged tendon. At an early stage, L-PRP may accelerate tendon healing, but at a later stage, it could be detrimental.
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Intra-articular injections of platelet-rich plasma decrease pain and improve functional outcomes than sham saline in patients with knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2022; 30:4063-4071. [PMID: 35124707 DOI: 10.1007/s00167-022-06887-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/10/2022] [Indexed: 02/08/2023]
Abstract
PURPOSE To compare the long-term clinical efficacy provided by intra-articular injections of either Pure Platelet-rich Plasma (P-PRP) or sham saline to treat knee osteoarthritis (KOA). METHODS This prospective, parallel-group, double-blind, multi-center, sham-controlled randomized clinical trial recruited participants with KOA from orthopedic departments at nine public hospitals (five tertiary medical centers, four secondary medical units) starting January 1, 2014, with follow-up completed on February 28, 2021. Participants were randomly allocated to interventions in a 1:1 ratio. Data were analyzed from March 1, 2021, to July 15, 2021. Three sessions (1 every week) of P-PRP or sham saline injected by physicians. The primary outcome was the Western Ontario and McMaster Universities Arthritis Index (WOMAC) at 3, 6, 12, 24, 60 months of follow-up. Secondary outcomes included the International Knee Documentation Committee (IKDC) subjective score, visual analogue scale (VAS) score, intra-articular biochemical marker concentrations, cartilage volume, and adverse events. Laboratory of each hospital analyzed the content and quality of P-PRP. RESULTS 610 participants (59% women) with KOA who received three sessions of P-PRP (n = 308, mean age 53.91 years) or sham saline (n = 302, mean age 54.51 years) injections completed the trial. The mean platelet concentration in PRP is 4.3-fold (95% confidence interval 3.6-4.5) greater than that of whole blood. Both groups showed significant improvements in IKDC, WOMAC, and VAS scores at 1 month of follow-up. However, only the P-PRP group showed a sustained improvement in clinical outcome measurements at month 24 (P < 0.001). There were statistically significant differences between the P-PRP and sham saline groups in all clinical outcome measurements at each follow-up time point (P < 0.001). The benefit of P-PRP was clinically better in terms of WOMAC-pain, WOMAC-physical function and WOMAC-total at 6, 12, 24, and 60 months of follow-up. No clinically significant differences between treatments were documented in terms of WOMAC-stiffness at any follow-up. A clinically significant difference favoring P-PRP group against saline in terms of IKDC and VAS scores was documented at 6, 12, 24 and 60 months of follow-up. At 6 months after injection, TNF-α and IL-1β levels in synovial fluid were lower in the P-PRP group (P < 0.001). Tibiofemoral cartilage volume decreased by a mean value of 1171 mm3 in the P-PRP group and 2311 mm3 in the saline group over 60 months and the difference between the group was statistically significant (intergroup difference, 1140 mm3, 95% CI - 79 to 1320 mm3; P < 0.001). CONCLUSIONS In this randomized clinical trial of patients with KOA, P-PRP was superior to sham saline in treating KOA. P-PRP was effective for achieving at least 24 months of symptom relief and slowing the progress of KOA, with both P-PRP and saline being comparable in safety profiles.
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Daley P, Menu P, Louguet B, Crenn V, Dauty M, Fouasson-Chailloux A. Interest of platelet rich plasma in Achilles tendon rupture management: a systematic review. PHYSICIAN SPORTSMED 2022; 50:463-470. [PMID: 34392780 DOI: 10.1080/00913847.2021.1969216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Acute Achilles tendon rupture (ATR) is a disabling sport-related injury. Its management involves conservative treatment with early weight-bearing or surgical treatment. Platelet-rich plasma (PRP) has raised interest as an adjuvant for treatment, given its properties on tendon repair and its anti-inflammatory effect. We aimed to assess clinical impact of PRP use in surgical or non-surgical treatment of acute ATR: range of motion, muscle strength, function, return to sport and adverse events. METHOD A systematic literature research was performed using PubMed, ScienceDirect, and Google Scholar databases to collect studies reporting clinical outcomes after acute ATR treated with PRP. RESULTS Eight studies were eligible and included 543 acute ATR. Four were randomized comparative studies. A total of 128 patients were treated surgically and 415 were treated conservatively, 271 received PRP injection. Five studies described the type of PRP used, which was variable. Only one study including 12 patients found significant outcomes in favor of the PRP group, with a 4-week earlier recovery of a normal range of motion and a 7-week earlier return to running. No difference in clinical or morphological evaluations, strength measurement, and functional outcomes was found in other studies both at short and long-term. PRP did not seem to modify the frequency of adverse events. CONCLUSIONS Data are not clearly in favor of a significant effect of the PRP use for treatment of ATR. There might be a slight effect on evolution during the first months. Its interest should be assessed in future studies with strong methodology.
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Affiliation(s)
- Pauline Daley
- Chu Nantes, Service De Médecine Physique Et Réadapatation Locomotrice Et Respiratoire, Nantes, France.,Chu Nantes, Service De Médecine Du Sport, Nantes, France
| | - Pierre Menu
- Chu Nantes, Service De Médecine Physique Et Réadapatation Locomotrice Et Respiratoire, Nantes, France.,Chu Nantes, Service De Médecine Du Sport, Nantes, France.,Irms, Institut Régional De Médecine Du Sport, Nantes, France.,Inserm, Umr 1229, RMeS, Regenerative Medicine and Skeleton, Université De Nantes, Oniris, Nantes, France
| | - Bastien Louguet
- Chu Nantes, Service De Médecine Du Sport, Nantes, France.,Irms, Institut Régional De Médecine Du Sport, Nantes, France
| | - Vincent Crenn
- Chu Nantes, Clinique Chirurgicale Orthopédique Et Traumatologique, Nantes, France
| | - Marc Dauty
- Chu Nantes, Service De Médecine Physique Et Réadapatation Locomotrice Et Respiratoire, Nantes, France.,Chu Nantes, Service De Médecine Du Sport, Nantes, France.,Irms, Institut Régional De Médecine Du Sport, Nantes, France.,Inserm, Umr 1229, RMeS, Regenerative Medicine and Skeleton, Université De Nantes, Oniris, Nantes, France
| | - Alban Fouasson-Chailloux
- Chu Nantes, Service De Médecine Physique Et Réadapatation Locomotrice Et Respiratoire, Nantes, France.,Chu Nantes, Service De Médecine Du Sport, Nantes, France.,Irms, Institut Régional De Médecine Du Sport, Nantes, France.,Inserm, Umr 1229, RMeS, Regenerative Medicine and Skeleton, Université De Nantes, Oniris, Nantes, France
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Nakagawa H, Sung K, Ashkani-Esfahani S, Waryasz G, May T, Sussman WI. Plantar fasciitis: a comparison of ultrasound-guided fasciotomy with or without amniotic membrane allograft injection. Regen Med 2022; 17:931-940. [PMID: 36222008 DOI: 10.2217/rme-2022-0094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: The purpose of this study was to evaluate the clinical response to augmenting an ultrasound-guided percutaneous plantar fasciotomy (UGPF) with an amniotic membrane (AM) allograft injection. Design: Retrospective, single-center, matched, case-controlled study. Methods: Patients underwent either an UGPF (n = 15) or a combined UGPF and AM injection (n = 16). Results: The UGPF plus AM group demonstrated a significant reduction in pain (p = 0.02) from baseline at the short-term follow-up, but there was no significant difference in pain or patient satisfaction between groups at the 52-week follow-up. Conclusion: Both groups demonstrated a significant reduction in pain and high level of patient satisfaction, but the combination of UGPF with an AM injection may provide a greater reduction in pain earlier in the post-operative period.
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Affiliation(s)
- Hirotaka Nakagawa
- Department of Orthopedics & Rehabilitation, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Kyungje Sung
- Department of Orthopedics & Rehabilitation, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
| | - Soheil Ashkani-Esfahani
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.,Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Gregory Waryasz
- Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.,Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Tabitha May
- Department of Radiation Oncology, UMass Chan Medical School, 55 N Lake Ave, Worcester, MA 01655, USA
| | - Walter I Sussman
- Department of Orthopedics & Rehabilitation, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA
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15
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Zhang C, Cai YZ, Wang Y. Injection of Leukocyte-Poor Platelet-Rich Plasma for Moderate-to-Large Rotator Cuff Tears Does Not Improve Clinical Outcomes but Reduces Retear Rates and Fatty Infiltration: A Prospective, Single-Blinded Randomized Study. Arthroscopy 2022; 38:2381-2388.e1. [PMID: 35247512 DOI: 10.1016/j.arthro.2022.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 02/06/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine whether leukocyte-poor platelet-rich plasma (Lp-PRP) reduced retear rates, reduced fatty infiltration, and improved functional outcomes in patients with degenerative moderate-to-large rotator cuff tears. METHODS This was a randomized controlled study at a single center. A consecutive series of 104 patients with moderate-to-large rotator cuff tears was enrolled and randomly allocated to a control group (double-row suture-bridge arthroscopic rotator cuff repair alone, n = 52) and a study group (double-row suture-bridge repair followed by 3 Lp-PRP injections at the tendon repair site during surgery, at days 7 and 14 after surgery, n = 52). All patients were followed up for 27.2 months (range 24-36 months), with University of California at Los Angeles (UCLA) shoulder rating scale, the Constant score, and a visual analog scale (VAS) evaluated respectively. The integrity and fatty infiltration of repaired tissue were assessed by magnetic resonance imaging using the Sugaya classification and Goutallier grade classification at 24 months after surgery. Statistical analysis was performed based on the t test, χ2 test, and the Kendall tau-b correlation coefficient. RESULTS Four patients refused follow-up, and 11 patients had incomplete data. Eventually, a total of 89 patients were available for 24 months follow-up. The mean UCLA score increased from 14.80 ± 2.53 to 29.37 ± 2.06 in control group and from 13.74 ± 3.30 to 30.14 ± 2.32 in study group (P = .103). The mean Constant score increased from 46.56 ± 5.90 to 86.83 ± 4.94 in control group and from 44.37 ± 7.92 to 88.80 ± 4.92 in study group (P = .063). The VAS score decreased from 3.22 ± 1.24 to 0.97 ± 1.12 in control group and in 3.49 ± 1.52 to 1.16 ± 0.99 in study group (P = .41). All differences in UCLA score, Constant score, and VAS between pre- and postoperation achieved minimal clinically important differences proposed for arthroscopic rotator cuff repair. Of the 89 patients, 76 had magnetic resonance imaging performed at 24 months after surgery. The retear rate was 17.6% in study group, which was lower than that in control group (38.1%, P = .049). In addition, the Goutallier grade was found to be significant difference between groups postoperatively (Kendall tau-b -0.24, P = .03) but no significant difference preoperatively (Kendall tau-b -0.18, P = .11). There were no complications in the patients. CONCLUSIONS Our procedures involving repeated injections of Lp-PRP during surgery and at days 7 and 14, as described in this study, have positive effects on reducing retear rate and promoting Goutallier grade in patients following arthroscopic rotator cuff repair and could also provide substantial clinical outcomes that reach the minimal clinically important difference for surgical treatment. However, given the numbers available for analysis, it did not promote better clinical results when compared with the control group. LEVEL OF EVIDENCE II, randomized controlled study.
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Affiliation(s)
- Chi Zhang
- Center for Sports Medicine, Hangzhou, China; First Affiliated Hospital, Zhejiang University School of Medicine and Institute of Sports Medicine of Zhejiang University, Hangzhou, China
| | - You-Zhi Cai
- Center for Sports Medicine, Hangzhou, China; First Affiliated Hospital, Zhejiang University School of Medicine and Institute of Sports Medicine of Zhejiang University, Hangzhou, China.
| | - Yue Wang
- Spine Lab, Department of Orthopedic Surgery, Hangzhou, China.
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16
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Li S, Yang G, Zhang H, Li X, Lu Y. A systematic review on the efficacy of different types of platelet-rich plasma in the management of lateral epicondylitis. J Shoulder Elbow Surg 2022; 31:1533-1544. [PMID: 35337955 DOI: 10.1016/j.jse.2022.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Platelet-rich plasma (PRP) is reported as an effective treatment for lateral epicondylitis (LE). Theoretically, different types of PRP have different therapeutic effects. However, there is controversy on the effects of different types of PRP in the treatment of LE. The purpose of this study was to systematically compare pain relief, functional improvement, and the success rate of treatment using 2 different types of PRP by reviewing and summarizing the data available in the current literature on LE after PRP injection. METHODS The PubMed, MEDLINE, Embase, Cochrane Library, and Web of Science databases were reviewed. A computerized literature search was performed for related studies published from database inception to August 2021 using the following terms: lateral epicondylitis, tennis elbow, tendinopathy, lateral elbow pain, PRP, and platelet-rich plasma. The PRP patients included in our study were divided into those receiving leukocyte-poor PRP (LP-PRP) and those receiving leukocyte-rich PRP (LR-PRP) according to the different preparation methods. Outcomes of interest included patient characteristics, types and preparations of PRP, clinical outcomes, success rates, and the safety of treatment at short- and long-term follow-up. RESULTS A total of 33 studies were evaluated in our analysis, including 2420 LE patients. LP-PRP was used in 19 of these studies, LR-PRP was used in 13, and both LP-PRP and LR-PRP were used in 1. Patients in both PRP groups showed significantly improved clinical outcomes after treatment compared with before treatment. The mean visual analog scale scores ranged from 6.1 to 8.0 before treatment, ranged from 1.5 to 4.0 at short-term follow-up, and ranged from 0.6 to 3.3 at long-term follow-up in the LR-PRP group. The mean visual analog scale scores ranged from 4.2 to 8.4 before treatment, 1.6 to 5.9 at short-term follow-up, and 0.7 to 2.7 at long-term follow-up in the LP-PRP group. The Disabilities of the Arm, Shoulder and Hand scores in the LR-PRP and LP-PRP groups ranged from 47.0 to 54.3 and 30.0 to 67.7, respectively, before treatment and ranged from 20.0 to 22.0 and 5.5 to 19.0, respectively, at long-term follow-up. The success rates in the LR-PRP and LP-PRP groups ranged from 70% to 100% and 36% to 100%, respectively. The complication rate was lower in the LP-PRP group (3.9%) than in the LR-PRP group (6.4%, P = .029), with the main complication being temporary pain after PRP treatment. CONCLUSION PRP treatment demonstrated significant improvements in terms of pain relief and functional improvement in LE patients regardless of the type of PRP. There were no significant differences in pain relief and functional improvement between LR-PRP and LP-PRP. The main complication was temporary pain after PRP injection, and the complication rate in the LP-PRP group was lower than that in the LR-PRP group.
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Affiliation(s)
- Shangzhe Li
- Department of Sports Medicine, Beijing Ji Shui Tan Hospital, School of Medicine, Peking University, Beijing, China
| | - Guang Yang
- Department of Sports Medicine, Beijing Ji Shui Tan Hospital, School of Medicine, Peking University, Beijing, China
| | - Hailong Zhang
- Department of Sports Medicine, Beijing Ji Shui Tan Hospital, School of Medicine, Peking University, Beijing, China
| | - Xu Li
- Department of Sports Medicine, Beijing Ji Shui Tan Hospital, School of Medicine, Peking University, Beijing, China
| | - Yi Lu
- Department of Sports Medicine, Beijing Ji Shui Tan Hospital, School of Medicine, Peking University, Beijing, China.
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Zhu S, He Z, Ji L, Zhang W, Tong Y, Luo J, Zhang Y, Li Y, Meng X, Bi Q. Advanced Nanofiber-Based Scaffolds for Achilles Tendon Regenerative Engineering. Front Bioeng Biotechnol 2022; 10:897010. [PMID: 35845401 PMCID: PMC9280267 DOI: 10.3389/fbioe.2022.897010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 05/20/2022] [Indexed: 11/22/2022] Open
Abstract
The Achilles tendon (AT) is responsible for running, jumping, and standing. The AT injuries are very common in the population. In the adult population (21–60 years), the incidence of AT injuries is approximately 2.35 per 1,000 people. It negatively impacts people’s quality of life and increases the medical burden. Due to its low cellularity and vascular deficiency, AT has a poor healing ability. Therefore, AT injury healing has attracted a lot of attention from researchers. Current AT injury treatment options cannot effectively restore the mechanical structure and function of AT, which promotes the development of AT regenerative tissue engineering. Various nanofiber-based scaffolds are currently being explored due to their structural similarity to natural tendon and their ability to promote tissue regeneration. This review discusses current methods of AT regeneration, recent advances in the fabrication and enhancement of nanofiber-based scaffolds, and the development and use of multiscale nanofiber-based scaffolds for AT regeneration.
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Affiliation(s)
- Senbo Zhu
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zeju He
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Lichen Ji
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wei Zhang
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Yu Tong
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Junchao Luo
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Yin Zhang
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Yong Li
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Xiang Meng
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
| | - Qing Bi
- Center for Rehabilitation Medicine, Department of Orthopedics, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital, Hangzhou Medical College), Hangzhou, China
- Department of Orthopedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
- *Correspondence: Qing Bi,
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Viganò M, Ragni E, Marmotti A, de Girolamo L. The effects of orthobiologics in the treatment of tendon pathologies: a systematic review of preclinical evidence. J Exp Orthop 2022; 9:31. [PMID: 35394237 PMCID: PMC8994001 DOI: 10.1186/s40634-022-00468-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/24/2022] [Indexed: 02/06/2023] Open
Abstract
Purpose The aim of this systematic review is to explore the current available knowledge about tendon disorders and orthobiologics derived by preclinical experiments to evaluate their role and efficacy in the different stages and conditions related to the tendon healing processes. Methods The systematic review was performed according to the PRISMA guidelines. Different electronic databases (MEDLINE, Web of Science, EMBASE) were searched for studies investigating orthobiologics (PRP and cell-based products from adipose tissue or bone marrow) in animal models or veterinary clinical trials for tendon pathologies (complete/partial tendon ruptures, rotator cuff tears, tendinopathy, enthesis-related injuries). Data regarding the specific product used, the treatment site/pathology, the host and the model were collected. The results were classified into the following categories: histological, biomechanical, molecular and imaging. Results A large pool of preclinical studies on tendon disorders have been found on platelet-rich plasma (PRP), while data about stromal vascular fraction (SVF) and bone marrow concentrate (BMAC) are still limited and frequently focused on expanded cells, rather than orthobiologics prepared at the point of care. The effect of PRP is related to an acceleration of the healing process, without improvements in the final structure and properties of repaired tendon. Cell-based products have been reported to produce more durable results, but the level of evidence is currently insufficient to draw clear indications. Conclusions The preclinical results about orthobiologics applications to tendon pathologies would support the rationale of their clinical use and encourage the performance of clinical trials aimed to confirm these data in human subjects. Supplementary Information The online version contains supplementary material available at 10.1186/s40634-022-00468-w.
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Affiliation(s)
- Marco Viganò
- Orthopaedics biotechnology Lab, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
| | - Enrico Ragni
- Orthopaedics biotechnology Lab, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy.
| | - Antonio Marmotti
- San Luigi Gonzaga Hospital, Orthopedics and Traumatology Department, University of Turin - Medical School, Turin, Italy
| | - Laura de Girolamo
- Orthopaedics biotechnology Lab, IRCCS Istituto Ortopedico Galeazzi, Via Riccardo Galeazzi 4, 20161, Milan, Italy
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Rani N, Perut F, Granchi D, Sante GD, Pennello E, Mazzotta A, Dallari D, Baldini N. Ultrasound-guided injection of platelet-rich plasma or cord blood platelet-rich plasma in nonunion: a randomized controlled trial. Regen Med 2022; 17:271-281. [PMID: 35291806 DOI: 10.2217/rme-2021-0103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To compare the ability of autologous platelet-rich plasma (PRP) and cord blood PRP (PRPc) to accelerate bone healing. Patients & methods: 71 patients with mechanically stable nonunion were treated weekly (3 consecutive weeks) with ultrasound-guided percutaneous injections of PRP or PRPc in a controlled randomized clinical trial. The primary outcome was healing (12 months) and secondary outcomes were radiological evolution (2 and 6 months) and changes in pain intensity (6 months). Results & conclusion: Bone consolidation was assessed over time without significant differences between PRP and PRPc treatment. In patients with persistent nonunion, pain perception decreased more after PRP treatment. PRPc appears to be a valid alternative when specific clinical conditions suggest avoiding the use of autologous blood products.
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Affiliation(s)
- Nicola Rani
- Reconstructive Orthopaedic Surgery & Innovative Techniques, Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
| | - Francesca Perut
- BST Biomedical Sciences & Technologies Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
| | - Donatella Granchi
- BST Biomedical Sciences & Technologies Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
| | - Giuseppe Di Sante
- Reconstructive Orthopaedic Surgery & Innovative Techniques, Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
| | - Enrico Pennello
- Reconstructive Orthopaedic Surgery & Innovative Techniques, Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
| | - Alessandro Mazzotta
- Reconstructive Orthopaedic Surgery & Innovative Techniques, Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
| | - Dante Dallari
- Reconstructive Orthopaedic Surgery & Innovative Techniques, Musculoskeletal Tissue Bank, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy
| | - Nicola Baldini
- BST Biomedical Sciences & Technologies Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, 40136, Italy.,Department of Biomedical & Neuromotor Sciences, University of Bologna, Bologna, 40136, Italy
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Lin KY, Chen P, Chen ACY, Chan YS, Lei KF, Chiu CH. Leukocyte-Rich Platelet-Rich Plasma Has Better Stimulating Effects on Tenocyte Proliferation Compared With Leukocyte-Poor Platelet-Rich Plasma. Orthop J Sports Med 2022; 10:23259671221084706. [PMID: 35309233 PMCID: PMC8928403 DOI: 10.1177/23259671221084706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/31/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Rotator cuff (RC) tendinopathy is one of the most common causes of shoulder pain. Platelet-rich plasma (PRP) has been frequently used in clinical scenarios, but its efficacy remains inconsistent. Purpose: To investigate the different responses of human tenocytes from torn RCs to leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP) in a 2-chamber coculture device. Study Design: Controlled laboratory study. Methods: PRP was prepared using different platelet and leukocyte concentrations according to 5 groups: (1) LR-PRP with 5000 platelets/µL, (2) LR-PRP with 10,000 platelets/µL, (3) LP-PRP with 5000 platelets/µL, (4) LP-PRP with 10,000 platelets/µL, and (5) control with only culture medium supplementation and without PRP stimulation. Platelet-derived growth factor–AB (PDGF-AB) and transforming growth factor–β1 (TGF-β1) were measured in LR-PRP and LP-PRP via enzyme-linked immunosorbent assay. Microscopy, water-soluble tetrazolium salt assay, and quantitative real-time polymerase chain reaction were used to investigate the morphology, proliferation, and gene expression of RC tenocytes exposed to different PRP formulations. Data were collected from at least 3 independent measurements. The results were analyzed via 1-way analysis of variance, followed by the post hoc Bonferroni test. Results: The ratio of leukocytes to 5000 platelets/µL was 29.5 times higher in LR-PRP than in LP-PRP (P < .05). In the 5000 platelets/µL groups, the levels of TGF-β1 and PDGF-AB were both significantly higher in LR-PRP versus LP-PRP (TGF-β1: 367.0 ± 16.5 vs 308.6 ± 30.3 pg/mL, respectively [P = .043]; PDGF-AB: 172.1 ± 1.8 vs 94.1 ± 4.2 pg/mL, respectively [P < .001]). Compared with the control group, RC tenocyte proliferation was 1.42 ± 0.01 and 1.41 ± 0.03 times higher in the LR-PRP groups with 5000 platelets/µL and 10,000 platelets/µL, respectively (P < .05). The expression of tenocyte-related genes was higher in tenocytes cultured in LR-PRP. Conclusion: Both the LR-PRP groups with 5000 platelets/µL and 10,000 platelets/µL induced more growth factor release and increased RC tenocyte proliferation than did the LP-PRP groups. Clinical Relevance: In RC repair, LR-PRP may be better than LP-PRP for increasing the proliferation of tenocytes.
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Affiliation(s)
- Keng-Yi Lin
- Department of Medicine, Chang Gung University, Taoyuan
| | - Poyu Chen
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan
| | - Alvin Chao-Yu Chen
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
| | - Yi-Sheng Chan
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
| | - Kin Fong Lei
- Graduate Institute of Biomedical Engineering, Chang Gung University, Taoyuan
| | - Chih-Hao Chiu
- Bone and Joint Research Center, Chang Gung Memorial Hospital, Linkou
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Taoyuan
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital, Taoyuan
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21
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Shim JW, Lee JS, Park YB, Cho HC, Jung HS. The effect of leucocyte concentration of platelet-rich plasma on outcomes in patients with lateral epicondylitis: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31:634-645. [PMID: 34861405 DOI: 10.1016/j.jse.2021.10.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/21/2021] [Accepted: 10/23/2021] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The concentration of leukocytes influences the quality of platelet-rich plasma (PRP). However, there is no consensus on which type of PRP based on the concentration of leukocytes is the best for lateral epicondylitis (LE). METHODS We systematically searched the MEDLINE, Embase, and Cochrane Library databases until March 1, 2020. Studies involving randomized controlled trials, patients with LE, and treatment with PRP injections were included. PRP was classified into leukocyte-poor (LP) PRP and leukocyte-rich (LR) PRP. LR-PRP was defined as PRP with a white blood cell concentration exceeding that of whole blood (4.0-10.0 per μL3), whereas LP-PRP was defined as PRP with a lower white blood cell concentration than that of whole blood. The efficacy of PRP was assessed using the visual analog scale (VAS) and success rates. RESULTS Eleven randomized controlled trials (six involving LP-PRP and five involving LR-PRP) were eligible for inclusion in this review. Eight studies were included in the meta-analysis to evaluate the VAS score. Regarding short-term follow-up, there was no difference in the VAS scores between the LP-PRP and control groups (standard mean difference [SMD], 0.01; 95% confidence interval [CI], -0.29 to 0.30; P = 0.97), with no heterogeneity (I2 = 0%). There was also no difference in the VAS scores between the LR-PRP and control groups (SMD, -0.19; 95% CI, -0.57 to 0.20; P = 0.34), with substantial heterogeneity (I2 = 56.7%). Regarding long-term follow-up, there was no difference in the VAS scores between the LP-PRP and control groups (SMD, -0.73; 95% CI, -1.69 to 0.23; P = 0.134) with substantial heterogeneity (I2 = 88.4%). The LR-PRP group had lower VAS scores than the control group (SMD, -1.06; 95% CI, -2.02 to -0.09; P = 0.032) with substantial heterogeneity (I2 = 92%). In the LP-PRP group, there was no significant difference in the success rate (odds ratio, 1.08; 95% CI, 0.07-16.47; P = 0.956) with substantial heterogeneity (I2 = 87.7%). In the LR-PRP group, however, the patients who received PRP had a higher success rate than those in the control group (odds ratio, 2.85; 95% CI, 1.67-4.85; P < 0.01) with substantial heterogeneity (I2 = 82.9%). CONCLUSION LR-PRP may provide pain relief and successful outcomes for patients with LE compared with alternative local injections. Better results were observed with the use of LR-PRP than with the use of LP-PRP.
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Affiliation(s)
- Jae Woo Shim
- Department of Orthopedic Surgery, Sungkyunkwan University College of Medicine, Samsung Medical Center, Seoul, Republic of Korea
| | - Jae-Sung Lee
- Department of Orthopaedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, Republic of Korea
| | - Yong-Beom Park
- Department of Orthopaedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, Republic of Korea
| | - Hyung-Chul Cho
- Department of Orthopaedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, Republic of Korea
| | - Hyoung-Seok Jung
- Department of Orthopaedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, Republic of Korea.
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de Melo Viveiros ME, Viveiros MMH, da Silva MG, Rainho CA, Schellini SA. In vitro effect of triamcinolone and platelet-rich plasma on cytokine levels of elbow lateral epicondylitis-derived cells. J Orthop Surg Res 2022; 17:94. [PMID: 35168647 PMCID: PMC8848654 DOI: 10.1186/s13018-022-02990-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 02/03/2022] [Indexed: 12/04/2022] Open
Abstract
Background The pathogenesis and treatment of lateral elbow epicondylitis (LEE) are still controversial. The purpose of the current study was to evaluate the production of inflammatory cytokines by LEE-derived cells and to compare the anti-inflammatory effect of triamcinolone acetonide with platelet-rich plasma (PRP) on cytokines production in primary culture of these cells.
Methods Third passage cells from primary cultures of LEE were assessed for the production of the cytokines IL-1β, IL-6, IL-8, IL-10 and TNF-α by immune-enzymatic assay (ELISA), after the treatment with 1, 10 and 100 μM triamcinolone compared to no treated controls at the time points 6, 12, 18, 24, 48, 72 and 96 h, and to PRP at 48, 72 and 96 h. Results The cytokines IL-6 and IL-8 were produced in high concentrations by LEE cells. One, 10 and 100 μM triamcinolone induced significant decrease in the production of IL-6 and IL-8 at 48, 72 and 96 h, adding the time point 12 h for IL-8. Compared to controls, PRP caused a significant increase in the production of IL-6 and IL-8 and there was a significant increase in IL-10 production with the use of 100 μM triamcinolone at 48 h. The production of IL1-β and TNF-α was very low and did not change when the cultures were treated with triamcinolone or PRP. Conclusion LEE-derived cells produce IL-6 and IL-8, confirming the inflammatory nature of this condition. While triamcinolone inhibited the production of IL-6 and IL-8 by LEE cells, PRP induced an increase in these cytokines compared with controls. Supplementary Information The online version contains supplementary material available at 10.1186/s13018-022-02990-0.
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Affiliation(s)
- Márcio Eduardo de Melo Viveiros
- Department of Orthopedics and Traumatology, School of Medicine of Botucatu, São Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Magda Massae Hata Viveiros
- Department of Ophthalmology, School of Medicine of Botucatu, São Paulo State University - UNESP, Botucatu, SP, 18618-970, Brazil
| | - Márcia Guimarães da Silva
- Department of Pathology, School of Medicine of Botucatu, São Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Cláudia Aparecida Rainho
- Department of Chemical and Biological Sciences, Institute of Biosciences of Botucatu, São Paulo State University - UNESP, Botucatu, SP, Brazil
| | - Silvana Artioli Schellini
- Department of Ophthalmology, School of Medicine of Botucatu, São Paulo State University - UNESP, Botucatu, SP, 18618-970, Brazil.
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Kim CH, Park YB, Lee JS, Jung HS. Platelet-rich plasma injection vs. operative treatment for lateral elbow tendinosis: a systematic review and meta-analysis. J Shoulder Elbow Surg 2022; 31:428-436. [PMID: 34656779 DOI: 10.1016/j.jse.2021.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 09/12/2021] [Accepted: 09/17/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although surgical treatment is considered reliable for lateral elbow tendinosis, local injection therapy may be preferable, as it avoids surgery. Among a number of local injections, platelet-rich plasma has been used successfully to treat lateral elbow tendinosis. The purpose of this study was to compare the outcomes in patients treated with either platelet-rich plasma injections or surgery for lateral elbow tendinosis using a systematic literature review and meta-analysis. METHODS MEDLINE, Embase, and Cochrane Library databases were systematically searched for studies published before March 1, 2021, that compared platelet-rich plasma with operative treatment for lateral elbow tendinosis. The pooled analysis was designed to compare the visual analog scale scores and the Patient-Related Tennis Elbow Evaluation scores between the platelet-rich plasma and surgical treatment groups at serial time points. RESULTS We included 5 studies involving 340 patients with lateral elbow tendinosis, comprising of 154 patients treated with platelet-rich plasma and 186 patients who underwent surgical treatment. The pooled analysis showed no statistically significant differences in the visual analog scale scores at any of the follow-up time points, namely, 2 months (mean difference [MD] 1.11, 95% confidence interval [CI] -2.51 to 4.74, P = .55, I2 = 94%), 6 months (MD 0.80, 95% CI -2.83 to 4.42, P = .67, I2 = 92%), and 12 months (MD -0.92, 95% CI -4.63 to 2.80, P = .63, I2 = 93%) postintervention and in the Patient-Related Tennis Elbow Evaluation scores at 12 weeks (MD -1.86, 95% CI -22.30 to 18.58, P = .86, I2 = 81%), 24 weeks (MD -3.33, 95% CI -21.82 to 15.17, P = .72, I2 = 74%), and 52 weeks (MD -3.64, 95% CI -19.65 to 12.37, P = .66, I2 = 69%) postintervention. CONCLUSIONS Local platelet-rich plasma injections and surgical treatment produced equivalent pain scores and functional outcomes in patients with lateral elbow tendinosis. Thus, platelet-rich plasma injections may represent a reasonable alternative treatment for patients who are apprehensive to proceed with surgery or for poor surgical candidates.
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Affiliation(s)
- Chul-Ho Kim
- Department of Orthopedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, Republic of Korea
| | - Yong-Beom Park
- Department of Orthopedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, Republic of Korea
| | - Jae-Sung Lee
- Department of Orthopedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, Republic of Korea
| | - Hyoung-Seok Jung
- Department of Orthopedic Surgery, Hospital of Chung-Ang University of Medicine, Seoul, Republic of Korea.
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24
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Hurley ET. Editorial Commentary: Platelet-Rich Plasma for Rotator Cuff Repairs: No Evidence for Improved Long-Term Outcomes … Yet! Arthroscopy 2022; 38:62-64. [PMID: 34972559 DOI: 10.1016/j.arthro.2021.06.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/18/2021] [Accepted: 06/29/2021] [Indexed: 02/02/2023]
Abstract
Platelet-rich plasma (PRP) is an autologous blood product containing a high concentration of platelets, growth factors, and cytokines, which basic science studies have shown may improve tendon healing by promoting angiogenesis, cellular migration, proliferation, and matrix deposition. However, there is still controversy over its clinical efficacy, with randomized controlled trials and subsequent meta-analyses finding mixed results when PRP is used to augment rotator cuff repair. Meta-analyses have found that leukocyte-poor PRP significantly reduces the rate of incomplete tendon healing and retear, but the evidence does not support the use of leukocyte-rich PRP or platelet-rich fibrin matrix compositions. Optimizing PRP use may be as simple as the right PRP preparation or the right concentration of the important cytokines.
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25
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Rhim HC, Kwon J, Park J, Borg-Stein J, Tenforde AS. A Systematic Review of Systematic Reviews on the Epidemiology, Evaluation, and Treatment of Plantar Fasciitis. Life (Basel) 2021; 11:life11121287. [PMID: 34947818 PMCID: PMC8705263 DOI: 10.3390/life11121287] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/17/2021] [Accepted: 11/19/2021] [Indexed: 12/20/2022] Open
Abstract
The number of systematic review and meta-analyses on plantar fasciitis is expanding. The purpose of this review was to provide a comprehensive summary of reviews on the topic pertaining to plantar fasciitis, identify any conflicting and inconsistent results, and propose future research direction. A qualitative review of all systematic reviews and meta-analyses related to plantar fasciitis up to February 2021 was performed using PubMed, Embase, Web of Science, and the Cochrane Database. A total of 1052 articles were initially identified and 96 met the inclusion criteria. Included articles were summarized and divided into the following topics: epidemiology, diagnosis, and treatment. While the majority of reviews had high level of heterogeneity and included a small number of studies, there was general consensus on certain topics, such as BMI as a risk factor for plantar fasciitis and extracorporeal shockwave therapy as an effective mode of therapy. A qualitative summary of systematic reviews and meta-analyses published on plantar fasciitis provides a single source of updated information for clinicians. Evidence on topics such as the epidemiology, exercise therapy, or cost-effectiveness of treatment options for plantar fasciitis are lacking and warrant future research.
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Affiliation(s)
- Hye Chang Rhim
- MetroWest Medical Center, Tufts University School of Medicine, Framingham, MA 01702, USA;
| | - Jangwon Kwon
- Department of Physical Therapy, University of Delware, Newark, DE 19716, USA;
| | - Jewel Park
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205, USA;
| | - Joanne Borg-Stein
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02115, USA;
- Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
| | - Adam S. Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA 02115, USA;
- Spaulding Rehabilitation Hospital, Charlestown, MA 02129, USA
- Correspondence:
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26
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de Marcos Carpio I, Sanghani-Kerai A, Solano MA, Blunn G, Jifcovici A, Fitzpatrick N. Clinical Cohort Study in Canine Patients, to Determine the Average Platelet and White Blood Cell Number and Its Correlation with Patient's Age, Weight, Breed and Gender: 92 Cases (2019-2020). Vet Sci 2021; 8:vetsci8110262. [PMID: 34822635 PMCID: PMC8625712 DOI: 10.3390/vetsci8110262] [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: 09/12/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 11/16/2022] Open
Abstract
Due to its easy preparation and that it is well tolerated, the use of autologous platelet-rich plasma (PRP) has become increasingly popular in regenerative medicine. However, there are still no clear guidelines on how it should be classified or whether the individual canine patient’s clinical status can influence its quality. Objective: This study aims to show if the weight, age, sex, neutered status or breed of canine patients have any correlation with the composition of PRP. Design: A blinded count of the platelets and white blood cells (WBC) was performed from 111 samples from 92 client owned dogs undergoing treatment for degenerative joint disease (DJD). The results were analysed using Pearson correlation test, ANOVA test or Student T-test. Results: There is a positive correlation between the number of platelets and WBC in canine patients of different breeds, but there was no significant difference on the platelet number and WBC number among the different breeds. The weight of the patient is also directly correlated to the platelet number (p = 0.003) but not WBC number. WBC number was negatively correlated to the weight of the patient. The sex and age of the patient did not affect platelets and WBC number, although WBC number is increased in non-neutered male population (p = 0.003). However, it would be interesting to investigate whether the growth factors released from the platelet granules are affected by patient variables in a canine population. Conclusions: Our results show that it is possible to obtain good quality autologous PRP, irrespective of age, sex, neutered status or weight of the patient, for PRP regenerative therapy.
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Affiliation(s)
- Isabel de Marcos Carpio
- Fitzpatrick Referrals, Surrey GU7 2QQ, UK; (M.A.S.); (A.J.); (N.F.)
- Correspondence: (I.d.M.C.); (A.S.-K.)
| | - Anita Sanghani-Kerai
- Fitzpatrick Referrals, Surrey GU7 2QQ, UK; (M.A.S.); (A.J.); (N.F.)
- Correspondence: (I.d.M.C.); (A.S.-K.)
| | - Miguel A. Solano
- Fitzpatrick Referrals, Surrey GU7 2QQ, UK; (M.A.S.); (A.J.); (N.F.)
| | - Gordon Blunn
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth PO1 2DT, UK;
| | | | - Noel Fitzpatrick
- Fitzpatrick Referrals, Surrey GU7 2QQ, UK; (M.A.S.); (A.J.); (N.F.)
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Padilla S, Nurden AT, Prado R, Nurden P, Anitua E. Healing through the lens of immunothrombosis: Biology-inspired, evolution-tailored, and human-engineered biomimetic therapies. Biomaterials 2021; 279:121205. [PMID: 34710794 DOI: 10.1016/j.biomaterials.2021.121205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/30/2021] [Accepted: 10/20/2021] [Indexed: 12/14/2022]
Abstract
Evolution, from invertebrates to mammals, has yielded and shaped immunoclotting as a defense and repair response against trauma and infection. This mosaic of immediate and local wound-sealing and pathogen-killing mechanisms results in survival, restoration of homeostasis, and tissue repair. In mammals, immunoclotting has been complemented with the neuroendocrine system, platelets, and contact system among other embellishments, adding layers of complexity through interconnecting blood-born proteolytic cascades, blood cells, and the neuroendocrine system. In doing so, immunothrombosis endows humans with survival advantages, but entails vulnerabilities in the current unprecedented and increasingly challenging environment. Immunothrombosis and tissue repair appear to go hand in hand with common mechanisms mediating both processes, a fact that is underlined by recent advances that are deciphering the mechanisms of the repair process and of the biochemical pathways that underpins coagulation, hemostasis and thrombosis. This review is intended to frame both the universal aspects of tissue repair and the therapeutic use of autologous fibrin matrix as a biology-as-a-drug approach in the context of the evolutionary changes in coagulation and hemostasis. In addition, we will try to shed some light on the molecular mechanisms underlying the use of the autologous fibrin matrix as a biology-inspired, evolution-tailored, and human-engineered biomimetic therapy.
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Affiliation(s)
- Sabino Padilla
- Eduardo Anitua Foundation for Biomedical Research, Vitoria, Spain; BTI-Biotechnology Institute ImasD, Vitoria, Spain; University Institute for Regenerative Medicine & Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain.
| | - Alan T Nurden
- Institut Hospitalo-Universitaire LIRYC, Hôpital Xavier Arnozan, Pessac, France
| | - Roberto Prado
- Eduardo Anitua Foundation for Biomedical Research, Vitoria, Spain; BTI-Biotechnology Institute ImasD, Vitoria, Spain; University Institute for Regenerative Medicine & Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain
| | - Paquita Nurden
- Institut Hospitalo-Universitaire LIRYC, Hôpital Xavier Arnozan, Pessac, France
| | - Eduardo Anitua
- Eduardo Anitua Foundation for Biomedical Research, Vitoria, Spain; BTI-Biotechnology Institute ImasD, Vitoria, Spain; University Institute for Regenerative Medicine & Oral Implantology - UIRMI (UPV/EHU-Fundación Eduardo Anitua), Vitoria, Spain.
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28
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Ruan D, Fei Y, Qian S, Huang Z, Chen W, Tang C, Xiang X, Xu J, Yin Z, Chen X, Heng BC, Liu W, Shen W, Ouyang H. Early-Stage Primary Anti-inflammatory Therapy Enhances the Regenerative Efficacy of Platelet-Rich Plasma in a Rabbit Achilles Tendinopathy Model. Am J Sports Med 2021; 49:3357-3371. [PMID: 34549620 DOI: 10.1177/03635465211037354] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tendinopathy is a pervasive clinical problem that afflicts both athletes and the general public. Although the inflammatory changes in tendinopathy are well characterized, how the therapeutic effects of platelet-rich plasma (PRP) on tendinopathy are being modulated by the inflammatory environment is not well defined. PURPOSE/HYPOTHESIS In this study, we aimed to compare the therapeutic effects of PRP alone versus a combination of PRP with a primary glucocorticoid (GC) injection at the early stage of tendinopathy. We hypothesized that PRP treatment could promote better tendon regeneration through the suppression of inflammation with GC. STUDY DESIGN Controlled laboratory study. METHODS The gene expression profile of tendon stem/progenitor cells (TSPCs) cultured with PRP was analyzed with RNA sequencing. To evaluate the cell viability, senescence, and apoptosis of TSPCs under different conditions, TSPCs were treated with 0.1 mg/mL triamcinolone acetonide (TA) and/or 10% PRP in an IL1B-induced inflammatory environment. To further verify the effects of the sequential therapy of GCs and PRP, an early tendinopathy animal model was established through a local injection of collagenase in the rabbit Achilles tendon. The tendinopathy model was then treated with isopycnic normal saline (NS group), TA (TA group), PRP (PRP group), or TA and PRP successively (TA+PRP group). At 8 weeks after treatment, the tendons were assessed with magnetic resonance imaging (MRI), histological examination, transmission electron microscopy (TEM), and mechanical testing. RESULTS Gene Ontology enrichment analysis indicated that PRP treatment of TPSCs induced an inflammatory response, regulated cell migration, and remodeled the extracellular matrix. Compared with the sole use of PRP, successive treatment with TA followed by PRP yielded similar results in cell viability and senescence but less cell apoptosis in vitro. In vivo experiments demonstrated that the TA+PRP group achieved significantly better tendon regeneration, as confirmed by MRI, histological examination, TEM, and mechanical testing. CONCLUSION This study showed that the primary use of GCs did not exert any obvious deleterious side effects on the treated tendon but instead enhanced the regenerative effects of PRP in early inflammatory tendinopathy. CLINICAL RELEVANCE The sequential therapy of GCs followed by PRP provides a promising treatment strategy for tendinopathy in clinical practice. PRP combined with the primary use of GCs appears to promote tendon regeneration in early inflammatory tendinopathy.
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Affiliation(s)
- Dengfeng Ruan
- Department of Orthopedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Orthopedics Research Institute, Zhejiang University, Hangzhou, China; Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China; Institute of Sports Medicine, Zhejiang University, Hangzhou, China; China Orthopedic Regenerative Medicine Group, Hangzhou, China
| | | | | | | | - Weishan Chen
- Department of Orthopedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Orthopedics Research Institute, Zhejiang University, Hangzhou, China; Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China; Institute of Sports Medicine, Zhejiang University, Hangzhou, China
| | - Chenqi Tang
- Department of Orthopedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Orthopedics Research Institute, Zhejiang University, Hangzhou, China; Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China; Institute of Sports Medicine, Zhejiang University, Hangzhou, China; Dr Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China
| | - Xinyu Xiang
- Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China
| | - Jialu Xu
- Department of Infectious Diseases, First Affiliated Hospital, Wenzhou Medical University, Wenzhou, China; Hepatology Institute, Wenzhou Medical University, Wenzhou, China; Key Laboratory of Hepatology, Wenzhou Medical University, Wenzhou, China
| | - Zi Yin
- Dr Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China; Department of Orthopedic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China; China Orthopedic Regenerative Medicine Group, Hangzhou, China
| | - Xiao Chen
- Dr Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China; Department of Orthopedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China; China Orthopedic Regenerative Medicine Group, Hangzhou, China
| | | | - Wanlu Liu
- Department of Orthopedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China; Dr Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Weiliang Shen
- Department of Orthopedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Orthopedics Research Institute, Zhejiang University, Hangzhou, China; Key Laboratory of Motor System Disease Research and Precision Therapy of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China; Institute of Sports Medicine, Zhejiang University, Hangzhou, China; Dr Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China; Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China; China Orthopedic Regenerative Medicine Group, Hangzhou, China; Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Hongwei Ouyang
- Dr Li Dak Sum & Yip Yio Chin Center for Stem Cells and Regenerative Medicine, Zhejiang University School of Medicine, Hangzhou, China; Department of Orthopedic Surgery, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China; Zhejiang University-University of Edinburgh Institute, Zhejiang University School of Medicine, Haining, China; Key Laboratory of Tissue Engineering and Regenerative Medicine of Zhejiang Province, Zhejiang University School of Medicine, Hangzhou, China; Department of Sports Medicine, Zhejiang University School of Medicine, Hangzhou, China; China Orthopedic Regenerative Medicine Group, Hangzhou, China.,Investigation performed at the Department of Orthopedic Surgery, Second Affiliated Hospital; Zhejiang University-University of Edinburgh Institute; and School of Basic Medical Sciences; Zhejiang University School of Medicine, Hangzhou, China
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29
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Negrini F, De Lucia F, Negrini S, Tornese D, Facchini F, Vecchio M, de Girolamo L. Case Report: Rehabilitation After Platelet-Rich Growth Factors' Intra-Articular Injections for Knee Osteoarthritis: Two Case Reports of a Home-Based Protocol. Front Pharmacol 2021; 12:718060. [PMID: 34497519 PMCID: PMC8419220 DOI: 10.3389/fphar.2021.718060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 07/05/2021] [Indexed: 12/24/2022] Open
Abstract
Knee osteoarthritis (KOA) is a chronic progressive disease that can cause pain, functional impairment, and ultimately disability. A novel and promising therapeutic approach to KOA is the so-called regenerative medicine, a set of procedures designed to harness tissue regenerative capacity and optimize functional recovery. Increasing evidence points out that platelet-rich plasma (PRP) intra-articular injections can decrease pain and improve functional abilities in KOA patients. In the present case reports, we analyze two patients who were treated with PRP injections coupled with a posttreatment home-based rehabilitation program. The two patients were selected to represent two different populations: patient 1 was an 85-year-old with severe impairment of functional abilities, while patient 2 was a younger (59 years old) and more active patient. The protocol consisted in a series of exercise to be performed at home, during the five days following PRP injection for two consecutive weeks (10 days in total). The exercises were designed to reduce the inflammation after the injection, enhance the proprioceptive control of the treated lower limb, and strengthen hip and knee flexors and extensors, mainly by isometric work. Results were evaluated at two time points: before and 2 months after the first PRP injection. The outcomes considered were as follows: visual analog scale for pain, EuroQol 5 dimensions questionnaire, Tegner Activity Scale for functioning, and Knee Injury and Osteoarthritis Outcome Score (KOOS). Both patients did not report any side effects from the treatment. Improvement in patient 1 was drastic at the two months follow-up as far as pain and functional abilities are concerned. Patient 2’s improvement was less evident, probably due to the higher starting point in both pain and functionality. Overall, the developed program seemed safe and was tolerated by the patients analyzed in the study, who performed it with good compliance.
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Affiliation(s)
| | - Francesco De Lucia
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Stefano Negrini
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Department of Biomedical, Surgical, and Dental Sciences, University La Statale, Milan, Italy
| | | | | | - Michele Vecchio
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy.,Rehabilitation Unit, A.O.U. Policlinico S. Marco, Catania, Italy
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Muthu S, Patel S, Selvaraj P, Jeyaraman M. Comparative analysis of leucocyte poor vs leucocyte rich platelet-rich plasma in the management of lateral epicondylitis: Systematic review & meta-analysis of randomised controlled trials. J Clin Orthop Trauma 2021; 19:96-107. [PMID: 34046304 PMCID: PMC8144683 DOI: 10.1016/j.jcot.2021.05.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 02/08/2023] Open
Abstract
STUDY DESIGN Systematic Review & Meta-analysis. OBJECTIVES We aim to comparatively analyse the efficacy and safety of using leucocyte-poor platelet rich plasma (LP-PRP) against leucocyte-rich platelet rich plasma (LR-PRP) in the management of lateral epicondylitis. MATERIALS AND METHODS We conducted independent and duplicate electronic database searches including PubMed, Embase, Web of Science and Cochrane Library till September 2020 for randomised controlled trials analyzing the efficacy and safety of LP-PRP and LR-PRP in the management of lateral epicondylitis. Visual Analog Score(VAS) for pain, Disabilities of the Arm, Shoulder and Hand (DASH) Score, Patient Reported Tennis-Elbow Evaluation (PRETEE) Score, Mayo Elbow Performance Score(MEPS) and adverse events were the outcomes analyzed. Analysis was performed in R-platform using OpenMeta[Analyst] software. RESULTS We performed a single arm meta-analysis of 26 studies involving 2034 patients. On analysis it was noted that significant improvement was noted in the VAS for pain (p < 0.001), DASH score (p < 0.001), PRETEE score (p < 0.001) and MEPS (p < 0.027) compared to their pre-operative state. No significant increase in adverse events were noted compared to the control group (p = 0.170). While stratifying the results based on the type of PRP used, no significant difference was noted between the use of LP-PRP or LR-PRP in any of the above-mentioned outcome measures. CONCLUSION PRP is a safe and effective treatment option for lateral epicondylitis with clinical improvements in pain and functional scores and both types of PRP (LR-PRP & LP-PRP) offer similar results.
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Affiliation(s)
- Sathish Muthu
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
| | - Sandeep Patel
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Preethi Selvaraj
- Department of Community Medicine, SRM Medical College Hospital and Research Centre, SRM University Chennai, Tamil Nadu, India
| | - Madhan Jeyaraman
- Department of Orthopaedics, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
- Corresponding author.
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Wang C, Zhang Y, Zhang G, Yu W, He Y. Adipose Stem Cell-Derived Exosomes Ameliorate Chronic Rotator Cuff Tendinopathy by Regulating Macrophage Polarization: From a Mouse Model to a Study in Human Tissue. Am J Sports Med 2021; 49:2321-2331. [PMID: 34259608 DOI: 10.1177/03635465211020010] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Chronic rotator cuff (RC) tendinopathy is one of the most prevalent causes of shoulder pain. Growing evidence suggests that macrophages play a significant role in the proinflammatory response, resolution of inflammation, and tissue healing of tendinopathy. In particular, enhancement of M2 macrophage (M2φ) activity contributes to the accelerated healing of tendinopathy. Therefore, a treatment that enhances M2φ polarization would be useful for patients with this common musculoskeletal disorder. PURPOSE To investigate whether adipose stem cell-derived exosomes (ASC-Exos) enhance M2φ polarization and ameliorate chronic RC tendinopathy. STUDY DESIGN Controlled laboratory study. METHODS First, we compared the effects of ASC-Exos on polarization of mouse bone marrow-derived macrophages between a classically activated phenotype (M1φ) and an alternatively activated phenotype (M2φ) in vitro. In total, 72 C57BL/6 mice were assigned to normal cage activity (n = 24) or 5 weeks of treadmill overuse (n = 48). The supraspinatus tendon of each treadmill overuse mouse was treated with ASC-Exos (n = 24) or saline (n = 24). Histological and biomechanical outcomes were assessed 4 weeks after treatment. Finally, tissue samples from human patients with RC tendinopathy were obtained to assay the effect of ASC-Exos on the M1φ/M2φ balance in tissue-resident macrophages. RESULTS ASC-Exos inhibited M1φ polarization and augmented M2φ polarization in vitro and in vivo. Mice in the ASC-Exos group showed less severe pathological changes than those in the saline group, including less cellular infiltration, disorganization of collagen, and ground substance deposition. The modified Bonar score of the ASC-Exos group (mean ± SD, 7.68 ± 1.03) was significantly lower than that of the saline group (9.81 ± 0.96; P < .05). Furthermore, the maximum failure load was significantly higher in the ASC-Exos group than in the saline group (4.23 ± 0.66 N vs 3.86 ± 0.65 N; P < .05), as was stiffness (3.38 ± 0.34 N/m vs 2.68 ± 0.49 N/m; P < .05). CONCLUSION ASC-Exos-mediated polarization balance of M1φ/M2φ contributes to the amelioration of chronic RC tendinopathy. Regulation of the M1φ/M2φ balance could be a new target for the treatment of chronic RC tendinopathy. CLINICAL RELEVANCE Administration of ASC-Exos is a cell-free approach that may become a novel treatment option for chronic RC tendinopathy and should be explored further.
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Affiliation(s)
- Chongyang Wang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yao Zhang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Guangcheng Zhang
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weilin Yu
- Department of Sports Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yaohua He
- Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China
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Hurley ET, Colasanti CA, Anil U, Luthringer TA, Alaia MJ, Campbell KA, Jazrawi LM, Strauss EJ. The Effect of Platelet-Rich Plasma Leukocyte Concentration on Arthroscopic Rotator Cuff Repair: A Network Meta-analysis of Randomized Controlled Trials. Am J Sports Med 2021; 49:2528-2535. [PMID: 33332160 DOI: 10.1177/0363546520975435] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND It is unclear whether leukocyte-poor (LP) or leukocyte-rich (LR) varieties of platelet-rich plasma (PRP) as an adjuvant to arthroscopic rotator cuff repair (ARCR) result in improved tendon healing rates. PURPOSE To perform a network meta-analysis of the randomized controlled trials in the literature to ascertain whether there is evidence to support the use of LP- or LR-PRP as an adjunct to ARCR. METHODS The literature search was based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Randomized controlled trials comparing LP- or LR-PRP with a control alongside ARCR were included. Clinical outcomes, including retears and functional outcomes, were compared using a frequentist approach to network meta-analysis, with statistical analysis performed using R. The treatment options were ranked using the P-score. RESULTS There were 13 studies (868 patients) included, with 9 studies comparing LP-PRP with a control and 4 studies comparing LR-PRP with a control. LP-PRP was found to significantly reduce the rate of retear and/or incomplete tendon healing after fixation, even among medium-large tears; it also improved outcomes on the visual analog scale for pain, Constant score, and University of California Los Angeles score. LP-PRP had the highest P-score for all treatment groups. LR-PRP did not result in any significant improvements over the control group, except for visual analog scale score for pain. However, post hoc analysis revealed that LP-PRP did not lead to significant improvements over LR-PRP in any category. CONCLUSION The current study demonstrates that LP-PRP reduces the rate of retear and/or incomplete tendon healing after ARCR and improves patient-reported outcomes as compared with a control. However, it is still unclear whether LP-PRP improves the tendon healing rate when compared with LR-PRP.
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Affiliation(s)
| | | | - Utkarsh Anil
- New York University Langone Health, New York, New York, USA
| | | | | | | | | | - Eric J Strauss
- New York University Langone Health, New York, New York, USA
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Yu S, Su H, Lu J, Zhao F, Jiang F. Combined T2 Mapping and Diffusion Tensor Imaging: A Sensitive Tool to Assess Myofascial Trigger Points in a Rat Model. J Pain Res 2021; 14:1721-1731. [PMID: 34163230 PMCID: PMC8214538 DOI: 10.2147/jpr.s313966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/20/2021] [Indexed: 11/23/2022] Open
Abstract
Background Myofascial trigger points (MTrPs) are defined as very small and hypersensitive points in skeletal muscle that are palpable, and produce localized pain on compression. The aim of this study was to explore the feasibility of combining T2 mapping with diffusion tensor imaging (DTI) for assessing MTrPs in a rat model and to investigate properties of the pathophysiological mechanisms. Methods Twenty-four Sprague-Dawley rats (model group, n = 14; control group, n = 10) underwent a magnetic resonance imaging (MRI) examination on a 3 T-MRI-scanner with a protocol consisting of T2 mapping and DTI. The MTrPs were established by blunt strike in combination with eccentric exercise. Enzyme-linked immunosorbent assays (ELISAs) were used to detect the levels of interleukin-1ß (IL-1ß) and interleukin-2 (IL-2) and their results were correlated with T2 values. Parameters from MRI including T2 values, fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) were compared between the two groups. Histological analysis was applied to provide an additional supply for MRI findings. Results The MTrPs of rats displayed significantly increased T2 values and FA (= 0.000) compared with normal controls, whereas MD and RD values were significantly lower (P= 0.031, = 0.000, respectively). There was no statistically significant difference in AD between the two groups (P= 0.400). These differences were accompanied by elevated levels of IL-1ß and interleukin-2 IL-2 in the MTrP group compared with controls. T2 values were positively correlated with elevated IL-1ß levels (r = 0.543, P < 0.05) but were not correlated with IL-2 levels (P > 0.05). Conclusion Combining T2 and DTI sequences creates a sensitive tool to assess MTrPs in a rat model. These data clarify a hypothesis that a trigger point is a chronic and mild muscle injury with inflammation.
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Affiliation(s)
- Shuangcheng Yu
- Department of Radiology, Minzu Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530001, People's Republic of China
| | - Haiqing Su
- Department of Medical Ultrasound, Minzu Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530001, People's Republic of China
| | - Jianchang Lu
- Department of Radiology, Minzu Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530001, People's Republic of China
| | - Fanyu Zhao
- Department of Radiology, Minzu Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530001, People's Republic of China
| | - Fangyan Jiang
- Department of Medical Ultrasound, Minzu Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530001, People's Republic of China
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Zhang C, Wu J, Li X, Wang Z, Lu WW, Wong TM. Current Biological Strategies to Enhance Surgical Treatment for Rotator Cuff Repair. Front Bioeng Biotechnol 2021; 9:657584. [PMID: 34178957 PMCID: PMC8226184 DOI: 10.3389/fbioe.2021.657584] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/07/2021] [Indexed: 01/08/2023] Open
Abstract
Rotator cuff tear is one of the most common shoulder problems encountered by orthopedic surgeons. Due to the slow healing process and high retear rate, rotator cuff tear has distressed millions of people all around the world every year, especially for the elderly and active athletes. This disease significantly impairs patients' motor ability and reduces their quality of life. Besides conservative treatment, open and arthroscopic surgery contributes a lot to accelerate the healing process of rotator cuff tear. Currently, there are many emerging novel treatment methods to promote rotator cuff repair. A variety of biological stimulus has been utilized in clinical practice. Among them, platelet-rich plasma, growth factors, stem cells, and exosomes are the most popular biologics in laboratory research and clinical trials. This review will focus on the biologics of bioaugmentation methods for rotator cuff repair and tendon healing, including platelet-rich plasma, growth factors, exosomes and stem cells, etc. Relevant studies are summarized in this review and future research perspectives are introduced.
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Affiliation(s)
- Cheng Zhang
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jun Wu
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xiang Li
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zejin Wang
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Weijia William Lu
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Center for Human Tissues and Organs Degeneration, Shenzhen Institutes of Advanced Technology (CAS), Shenzhen, China
| | - Tak-Man Wong
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Liu X, Zhang R, Zhu B, Li Y, Liu X, Guo S, Wang C, Wang D, Li S. Effects of leukocyte- and platelet-rich plasma on tendon disorders based on in vitro and in vivo studies (Review). Exp Ther Med 2021; 21:639. [PMID: 33968170 PMCID: PMC8097231 DOI: 10.3892/etm.2021.10071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/22/2021] [Indexed: 12/21/2022] Open
Abstract
Tendon-related disorders are common musculoskeletal system disorders in clinical practice, accounting for 30-50% of all sports-related injuries, and they are difficult to treat due to the hypovascular structure of the tendons. Platelet-rich plasma (PRP), including pure PRP and leukocyte- and platelet-rich plasma (L-PRP), has been attracting increasing attention, as it may stimulate tissue regeneration through the release of growth factors and cytokines. The aim of the present review was to provide a summary of the effects of L-PRP on tendon disorders and the underlying mechanisms through a comprehensive examination of the published literature, including in vitro, animal and clinical studies. It has been demonstrated that L-PRP results in comparatively greater pain relief and improved function in patients suffering from tendon disorders. Furthermore, L-PRP may exert its effects through a diverse range of mechanisms, such as neovascularization, cell proliferation and differentiation of tendon/progenitor stem cells into tenocytes, as well as extracellular matrix reorganization by transforming type III to type I collagen fibers. It has also been indicated that the effects of leukocytes in L-PRP depend on the biological state of the injured tissue and its surrounding microenvironment. L-PRP is beneficial and promotes tendon healing at the early stage, whereas it is likely detrimental to the repair of tendon at a later stage because of the risk of excessive catabolic and inflammatory responses. Overall, the application of L-PRP in tendon disorders appears to be a promising field that is worthy of further research.
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Affiliation(s)
- Xueli Liu
- Department of Physical Education, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China.,Department of Rehabilitation, Sichuan Vocational College of Health and Rehabilitation, Zigong, Sichuan 643000, P.R. China
| | - Rong Zhang
- Department of Rehabilitation, Sichuan Vocational College of Health and Rehabilitation, Zigong, Sichuan 643000, P.R. China
| | - Bin Zhu
- Department of Physical Education, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Yujie Li
- Department of Physical Education, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Xinyue Liu
- Department of Physical Education, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Sheng Guo
- Spinal Surgery Department, Hospital (Traditional Chinese Medicine) Affiliated to Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Chenglong Wang
- Spinal Surgery Department, Hospital (Traditional Chinese Medicine) Affiliated to Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Dingxuan Wang
- Department of Physical Education, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
| | - Sen Li
- Department of Physical Education, Southwest Medical University, Luzhou, Sichuan 646000, P.R. China.,Spinal Surgery Department, Hospital (Traditional Chinese Medicine) Affiliated to Southwest Medical University, Luzhou, Sichuan 646000, P.R. China
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Abstract
CONTEXT Injections are commonly used by health care practitioners to treat foot and ankle injuries in athletes despite ongoing questions regarding efficacy and safety. EVIDENCE ACQUISITION An extensive literature review was performed through MEDLINE, Google Scholar, and EBSCOhost from database inception to 2021. Keywords searched were injections, athletes, sports, foot and ankle, corticosteroids, platelet-rich plasma, and placental tissue. Search results included articles written in the English language and encompassed reviews, case series, empirical studies, and basic science articles. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Corticosteroids, platelet-rich plasma/autologous blood, anesthetic, and placental tissue injections are commonly used in the treatment of foot and ankle injuries. Primary indications for injections in athletes include plantar fasciitis, Achilles tendinosis, isolated syndesmotic injury, and ankle impingement with varying clinical results. CONCLUSIONS Despite promising results from limited case series and comparative studies, the data for safety and efficacy of injections for foot and ankle injuries in athletes remain inconclusive.
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Affiliation(s)
- Jonathan K Ochoa
- Department of Orthopaedic Surgery, University of California-Irvine, Orange, California
| | - Christopher E Gross
- Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina
| | - Robert B Anderson
- Bellin Health Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin
| | - Andrew R Hsu
- Department of Orthopaedic Surgery, University of California-Irvine, Orange, California
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Nie LY, Zhao K, Ruan J, Xue J. Effectiveness of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Meta-analysis of Randomized Controlled Clinical Trials. Orthop J Sports Med 2021; 9:2325967120973284. [PMID: 33718505 PMCID: PMC7930657 DOI: 10.1177/2325967120973284] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: The effectiveness of platelet-rich plasma (PRP) injections for knee osteoarthritis and the effects of leukocyte-poor PRP (LP-PRP) versus leukocyte-rich PRP (LR-PRP) are still controversial. Purpose: To assess the effectiveness of different PRP injections through a direct and indirect meta-analysis of randomized controlled trials. Study Design: Systematic review; Level of evidence, 1. Methods: A systematic literature search of electronic databases (PubMed, Cochrane Library, and EMBASE) was performed to locate randomized controlled trials published through March 2019 that compared PRP with control treatment. A random-effects meta-analysis was conducted to synthesize the evidence, and meta-regression analyses were conducted to determine the influence of trial characteristics. An indirect comparison was performed to assess the effects of LP-PRP and LR-PRP compared with hyaluronic acid (HA). Results: A total of 21 trials were included. A clinically important benefit for pain relief was seen for intra-articular PRP compared with intra-articular saline (standardized mean difference [SMD] = –1.38 [95% CI, –2.07 to –0.70]; P < .0001; I2 = 37%) and corticosteroid solution injection (SMD = –2.47 [95% CI, –3.34 to –1.61]; P < .00001; I2 = 47%). As a result of heterogeneity (I2 = 89%), there was no conclusive effect compared with HA, even though the pooling effect provided clinically relevant pain relief (SMD = –0.59 [95% CI, –0.97 to –0.21]; P = .003). Indirect meta-analysis showed that there was no significant difference between LR-PRP and LP-PRP. Conclusion: PRP injections are beneficial for pain relief and functional improvement in knee osteoarthritis. Larger, randomized high-quality studies are needed to compare the effects of LP-PRP and LR-PRP.
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Affiliation(s)
- Liu-Yan Nie
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China
| | - Kun Zhao
- School of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Jiaqi Ruan
- School of Medicine, Zhejiang University, Hangzhou, P.R. China
| | - Jing Xue
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, P.R. China
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Platelet-Rich Plasma Applications for Achilles Tendon Repair: A Bridge between Biology and Surgery. Int J Mol Sci 2021; 22:ijms22020824. [PMID: 33467646 PMCID: PMC7830415 DOI: 10.3390/ijms22020824] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/08/2021] [Accepted: 01/10/2021] [Indexed: 12/15/2022] Open
Abstract
Achilles tendon ruptures are very common tendon ruptures and their incidence is increasing in modern society, resulting in work incapacity and months off sport, which generate a need for accelerated and successful therapeutic repair strategy. Platelet-rich plasma (PRP) is emerging as adjuvant human blood-derived constructs to assist Achilles tendon rupture treatment. However, myriad PRP preparation methods in conjunction with poor standardization in the modalities of their applications impinge on the consistent effectiveness of clinical and structural outcomes regarding their therapeutic efficacy. The purpose of this review is to provide some light on the application of PRP for Achilles tendon ruptures. PRP has many characteristics that make it an attractive treatment. Elements such as the inclusion of leukocytes and erythrocytes within PRP, the absence of activation and activation ex vivo or in vivo, the modality of application, and the adjustment of PRP pH can influence the biology of the applied product and result in misleading therapeutic conclusions. The weakest points in demonstrating their consistent effectiveness are primarily the result of myriad PRP preparation methods and the poor standardization of modalities for their application. Selecting the right biological scaffold and applying it correctly to restitutio ad integrum of ruptured Achilles tendons remains a daunting and complex task.
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Neph A, Schroeder A, Enseki KR, Everts PA, Wang JHC, Onishi K. Role of Mechanical Loading for Platelet-Rich Plasma-Treated Achilles Tendinopathy. Curr Sports Med Rep 2020; 19:209-216. [PMID: 32516191 DOI: 10.1249/jsr.0000000000000719] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
There is no consensus on the optimal rehabilitation protocol after platelet-rich plasma (PRP) treatment for tendinopathy despite basic science studies showing the critical role of mechanical loading in the restoration of tendon structure and function posttreatment. In this article, we will review tendon mechanobiology, platelet biology, and review levels I and II Achilles tendon clinical studies paying particular attention to the role of mechanical loading in rehabilitation of injured tendons. Animal studies emphasize the synergistic effect of mechanical tendon loading and PRP to treat tendon injury while clinical studies described minimal details on loading protocols.
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Affiliation(s)
- Alyssa Neph
- Department of Physical Medicine and Rehabilitation at University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Allison Schroeder
- Department of Physical Medicine and Rehabilitation at University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Keelen R Enseki
- University of Pittsburgh Medical Center Centers for Rehab Services, Pittsburgh, PA
| | - Peter A Everts
- Scientific and Research Department at Gulf Coast Biologics, Fort Myers, FL
| | - James H-C Wang
- Department of Orthopedic Surgery at University of Pittsburgh School of Medicine, Pittsburgh, PA
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Tenforde A, Robinson D, Borg‐Stein J, Borgstrom H, Singh JR. Extracorporeal Shockwave Therapy Versus Platelet‐rich Plasma for Achilles Tendinopathy. PM R 2020; 12:1169-1176. [DOI: 10.1002/pmrj.12498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Adam Tenforde
- Department of Physical Medicine and Rehabilitation Harvard Medical School Cambridge MA
- Spaulding National Running Center, Spaulding Hospital Spaulding Rehabilitation Hospital Charlestown MA
| | - David Robinson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School Spaulding Rehabilitation Hospital Charlestown MA
| | - Joanne Borg‐Stein
- Department of Physical Medicine and Rehabilitation, Harvard Medical School Spaulding Rehabilitation Hospital Charlestown MA
| | - Haylee Borgstrom
- Department of Physical Medicine and Rehabilitation, Harvard Medical School Spaulding Rehabilitation Hospital Charlestown MA
| | - Jaspal Ricky Singh
- Weill Cornell Center for Comprehensive Spine Care Weill Cornell Medicine Department of Rehabilitation Medicine New York NY
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Biological strategies for osteoarthritis: from early diagnosis to treatment. INTERNATIONAL ORTHOPAEDICS 2020; 45:335-344. [PMID: 33078204 DOI: 10.1007/s00264-020-04838-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 09/28/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE To provide an updated review of the literature on the use of orthobiologics as a potential treatment option to alleviate symptoms associated with osteoarthritis (OA), slow the progression of the disease, and aid in cartilage regeneration. METHODS A comprehensive review of the literature was performed to identify basic science and clinical studies examining the role of orthobiologics in the diagnosis and management of osteoarthritis. RESULTS Certain molecules (such as interleukin-6 (IL-6), interleukin-8 (IL-8), matrix metalloproteinase (MMPs), cartilage oligomeric matrix protein (COMP), and tumor necrosis factor (TNF), microRNAs, growth differentiation factor 11 (GDF-11)) have been recognized as biomarkers that are implicated in the pathogenesis and progression of degenerative joint disease (DJD). These biomarkers have been used to develop newer diagnostic applications and targeted biologic therapies for DJD. Local injection therapy with biologic agents such as platelet-rich plasma or stem cell-based preparations has been associated with significant improvement in joint pain and function in patients with OA and has increased in popularity during the last decade. The combination of PRP with kartogenin or TGF-b3 may also enhance its biologic effect. The mesenchymal stem cell secretome has been recognized as a potential target for the development of OA therapies due to its role in mediating the chondroprotective effects of these cells. Recent experiments have also suggested the modification of gut microbiome as a newer method to prevent OA or alter the progression of the disease. CONCLUSIONS The application of orthobiologics for the diagnosis and treatment of DJD is a rapidly evolving field that will continue to expand. The identification of OA-specific and joint-specific biomarker molecules for early diagnosis of OA would be extremely useful for the development of preventive and therapeutic protocols. Local injection therapies with HA, PRP, BMAC, and other stem cell-based preparations are currently being used to improve pain and function in patients with early OA or those with progressed disease who are not surgical candidates. Although the clinical outcomes of these therapies seem to be promising in clinical studies, future research will determine the true role of orthobiologic applications in the field of DJS.
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Do patients benefit from platelet-rich plasma? Jt Dis Relat Surg 2020; 31:409-410. [PMID: 32962568 PMCID: PMC7607936 DOI: 10.5606/ehc.2020.57895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Darrieutort-Laffite C, Soslowsky LJ, Le Goff B. Molecular and Structural Effects of Percutaneous Interventions in Chronic Achilles Tendinopathy. Int J Mol Sci 2020; 21:ijms21197000. [PMID: 32977533 PMCID: PMC7582801 DOI: 10.3390/ijms21197000] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/08/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022] Open
Abstract
Achilles tendinopathy (AT) is a common problem, especially in people of working age, as well as in the elderly. Although the pathogenesis of tendinopathy is better known, therapeutic management of AT remains challenging. Various percutaneous treatments have been applied to tendon lesions: e.g., injectable treatments, platelet-rich plasma (PRP), corticosteroids, stem cells, MMP inhibitors, and anti-angiogenic agents), as well as percutaneous procedures without any injection (percutaneous soft tissue release and dry needling). In this review, we will describe and comment on data about the molecular and structural effects of these treatments obtained in vitro and in vivo and report their efficacy in clinical trials. Local treatments have some impact on neovascularization, inflammation or tissue remodeling in animal models, but evidence from clinical trials remains too weak to establish an accurate management plan, and further studies will be necessary to evaluate their value.
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Affiliation(s)
- Christelle Darrieutort-Laffite
- Rheumatology Department, Nantes University Hospital, 44000 Nantes, France;
- INSERM UMR1238, Bone Sarcoma and Remodeling of Calcified Tissue, Nantes University, 44000 Nantes, France
- Correspondence: ; Tel.: +33-2-40-08-48-01
| | - Louis J. Soslowsky
- McKay Orthopaedic Research Laboratory, University of Pennsylvania, Philadelphia, PA 19401-6081, USA;
| | - Benoit Le Goff
- Rheumatology Department, Nantes University Hospital, 44000 Nantes, France;
- INSERM UMR1238, Bone Sarcoma and Remodeling of Calcified Tissue, Nantes University, 44000 Nantes, France
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D'Hooghe P, Vinagre G. In Adults with Acute Achilles Tendon Rupture, a Single Platelet-Rich Plasma Injection Did Not Improve Muscle-Tendon Function at 24 Weeks. J Bone Joint Surg Am 2020; 102:1466. [PMID: 32590399 DOI: 10.2106/jbjs.20.00993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Pieter D'Hooghe
- Department of Orthopaedic Surgery, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
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Abstract
Tendon injuries or tendinopathy is a common painful and disabling conditions resulting from overuse and aging. Tendinopathy remains a challenging clinical problem because response to different treatment modalities is usually unsatisfactory and recovery is slow. We performed an extensive literature review focusing on nonsurgical treatment options for tendinopathies, including nonsteroidal anti-inflammatory drugs, corticosteroid, eccentric exercise, extracorporeal shock wave therapy, therapeutic ultrasound, hyaluronic acid, platelet-rich plasma, prolotherapy, polydeoxyribonucleotide, and stem cells, aimed at providing the most updated evidence as a guideline for caregivers.
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Ali M, Benjamin B, Jain N, Malviya A. Does Platelet-rich Plasma Augmentation Following Hip Arthroscopy Improve Outcomes: A Systematic Review. Hip Pelvis 2020; 32:70-77. [PMID: 32566537 PMCID: PMC7295617 DOI: 10.5371/hp.2020.32.2.70] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 02/07/2023] Open
Abstract
Platelet-rich plasma (PRP) has gathered widespread acceptance among orthopaedic surgeons because of its multimodal effects on tissue healing. Varying results have been reported when PRP injections are combined with hip arthroscopic surgery. To evaluate the influence of PRP on clinical outcomes following hip arthroscopy. We hypothesized that patients treated with PRP would have improved postoperative outcome scores. A search of the National Institute for Health and Care Excellence (NICE) healthcare database advanced search (HDAS) via Athens (PubMed, MEDLINE, CINAHL, EMBASE, and AMED databases) was conducted from their years of inception to May 2018 with the keywords: "Hip Arthroscopy" and "Platelet-Rich Plasma". A quality assessment was performed based on the Cochrane risk of bias tool. Three studies were included for analysis; two of which had low risk of bias. The studies included 363 hips, of which 141 were randomised for PRP treatment. The mean age of all patients was 35 years and the follow-up ranged from 18.5 to 36 months. Authors used different PRP systems and preparations. Modified Harris hip score was reported in all three studies with two studies favouring the use of PRP. The use of PRP following hip arthroscopy did not lead to significantly improved postoperative pain or functional outcomes when compared to control groups in the studies included in this review.
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Affiliation(s)
- Mohammed Ali
- Department of Trauma and Orthopaedics, Raigmore Hospital, UK
| | - Biju Benjamin
- Department of Trauma and Orthopaedics, Raigmore Hospital, UK
| | - Nimesh Jain
- North Cumbria NHS Foundation Trust, Carlisle, UK
| | - Ajay Malviya
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
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Hurley ET, Shimozono Y, Hannon CP, Smyth NA, Murawski CD, Kennedy JG. Platelet-Rich Plasma Versus Corticosteroids for Plantar Fasciitis: A Systematic Review of Randomized Controlled Trials. Orthop J Sports Med 2020; 8:2325967120915704. [PMID: 32426407 PMCID: PMC7222276 DOI: 10.1177/2325967120915704] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/17/2019] [Indexed: 01/08/2023] Open
Abstract
Background: Plantar fasciitis is the most common cause of plantar heel pain. Several
recent randomized control trials (RCTs) have been published comparing the
use of platelet-rich plasma (PRP) and corticosteroids (CSs) for the
treatment of plantar fasciitis. Purpose: To perform a systematic review of RCTs to compare whether PRP or CS
injections result in decreased pain levels and improved patient outcomes in
the treatment of plantar fasciitis. Study Design: Systematic review; Level of evidence, 1. Methods: Medline, EMBASE, and the Cochrane Library were screened according to the
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)
guidelines to identify RCTs comparing PRP and CS injections for plantar
fasciitis. The visual analog scale (VAS) pain scores and the American
Orthopaedic Foot and Ankle Society (AOFAS) scores were compared between
groups at 1, 1.5, 3, 6, and 12 months, where possible. Statistical analysis
was performed using RevMan, and P < .05 was considered
to be statistically significant. Results: A total of 9 RCTs were identified comparing 239 patients with PRP with 240
patients with CS injections. At the follow-up time points, including 1-1.5,
3, 6, and 12 months, there were statistically significant differences in VAS
scores in favor of PRP (P = .004, P <
.00001, P < .00001, and P < .00001,
respectively). At 1 and 3 months, there was no difference in AOFAS scores
(P = .76 and P = .35, respectively).
However, at 6 and 12 months, there was a difference in AOFAS scores in favor
of PRP (P < .00001 and P < .00001,
respectively). Conclusion: In patients with chronic plantar fasciitis, the current clinical evidence
suggests that PRP may lead to a greater improvement in pain and functional
outcome over CS injections.
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Affiliation(s)
- Eoghan T Hurley
- NYU Langone Health, New York, New York, USA.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Yoshiharu Shimozono
- NYU Langone Health, New York, New York, USA.,Kyoto University Graduate School of Medicine, Department of Orthopaedic Surgery, Kyoto, Japan
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Jiang G, Wu Y, Meng J, Wu F, Li S, Lin M, Gao X, Hong J, Chen W, Yan S, Yan R, Feng G, Cheng Z. Comparison of Leukocyte-Rich Platelet-Rich Plasma and Leukocyte-Poor Platelet-Rich Plasma on Achilles Tendinopathy at an Early Stage in a Rabbit Model. Am J Sports Med 2020; 48:1189-1199. [PMID: 32134682 DOI: 10.1177/0363546520906142] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Tendinopathy is still a great challenge in clinical practice, and the role of platelet-rich plasma (PRP) is controversial. The influence of leukocytes on tendinopathy at an early stage has not been defined so far. PURPOSE To compare the effects of leukocyte-rich PRP (Lr-PRP) and leukocyte-poor PRP (Lp-PRP) on Achilles tendinopathy when applied at an early stage. STUDY DESIGN Controlled laboratory study. METHODS A rabbit Achilles tendinopathy model was induced by a collagenase injection. A week later, treatments were applied randomly on local Achilles tendon lesions: (1) 200 μL of Lr-PRP (16 legs), (2) 200 μL of Lp-PRP (16 legs), and (3) 200 μL of saline (16 legs). At 3 and 6 weeks after the collagenase injection, outcomes were evaluated by histology, magnetic resonance imaging (MRI), real-time polymerase chain reaction analysis, immunohistochemistry, and transmission electron microscopy (TEM). RESULTS The Lr-PRP group had a lower T2 signal intensity (P = .0377) and smaller diameter (P = .0193) and cross-sectional area (P = .0194) than the Lp-PRP group on MRI. Histologically, the Lr-PRP group had better scores than the Lp-PRP group (P = .0284 and P = .0188, respectively). Compared with the Lp-PRP group, higher gene expression and more protein synthesis of collagen I (P = .0160 and P = .0309, respectively) and CD163 (P < .0001 and P = .0411, respectively) were found in the Lr-PRP group. Considering TEM and biomechanical testing, the Lr-PRP group demonstrated more mature collagen fibers (P < .0001), a larger fiber diameter (P = .0005), a higher failure load (P = .00417), and higher tensile stress (P < .0001) than the Lp-PRP group. CONCLUSION Lr-PRP had more beneficial effects than Lp-PRP when delivered at an early stage during tendon repair. CLINICAL RELEVANCE Here, we showed that tendinopathy influenced the curative effects of PRP in vivo. An early-stage application of Lr-PRP had more benefits for the repair of tendinopathy than Lp-PRP in a rabbit model, which will supplement guidelines of PRP treatment on tendinopathy clinically.
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Affiliation(s)
- Guangyao Jiang
- Investigation performed at the Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yifan Wu
- Investigation performed at the Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiahong Meng
- Investigation performed at the Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fengfeng Wu
- Investigation performed at the Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Sihao Li
- Investigation performed at the Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Mu Lin
- Investigation performed at the Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xin Gao
- Investigation performed at the Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jianqiao Hong
- Investigation performed at the Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Weishan Chen
- Investigation performed at the Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Shigui Yan
- Investigation performed at the Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Ruijian Yan
- Investigation performed at the Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Gang Feng
- Investigation performed at the Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhiyuan Cheng
- Investigation performed at the Department of Orthopedic Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Li S, Wu Y, Jiang G, Tian X, Hong J, Chen S, Yan R, Feng G, Cheng Z. Intratendon delivery of leukocyte-rich platelet-rich plasma at early stage promotes tendon repair in a rabbit Achilles tendinopathy model. J Tissue Eng Regen Med 2019; 14:452-463. [PMID: 31840415 DOI: 10.1002/term.3006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 10/30/2019] [Accepted: 11/24/2019] [Indexed: 12/12/2022]
Abstract
Tendinopathy is a great obstacle in clinical practice due to its poor regenerative capacity. The influence of different stages of tendinopathy on effects of leukocyte-rich platelet-rich plasma (Lr-PRP) has not been elucidated. The aim of this study is to investigate the optimal time point for delivery of Lr-PRP on tendinopathy. A tendinopathy model was established by local collagenase injection on the rabbit Achilles tendon. Then after collagenase induction, following treatments were applied randomly on the lesion: (a) 200 μl of Lr-PRP at 1 week (PRP-1 group), (b) 200 μl of saline at 1 week (Saline-1 group), (c) 200 μl of Lr-PRP at 4 weeks (PRP-2 group), and (d) 200 μl of saline at 4 weeks (Saline-2 group). Six weeks after collagenase induction, outcomes were assessed by magnetic resonance imaging, cytokine quantification, gene expression, histology, and transmission electron microscopy. Our results demonstrated that PRP-1 group had the least cross-sectional area and lesion percent of the involved tendon, as well as the lowest signal intensity in magnetic resonance imaging among all groups. However, the PRP-2 group showed larger cross-sectional area than saline groups. Enzyme-linked immunosorbent assay indicated that PRP-1 group had a higher level of interleukin-10 but lower level of interleukin-6 when compared with PRP-2 and saline groups. Meanwhile, the highest expression of collagen (Col) 1 in PRP-1 and Col 3, matrix metalloproteinase (MMP)-1, and MMP-3 in PRP-2 was found. Histologically, the PRP-1 showed better general scores than PRP-2, and no significant difference was found between the PRP-2 and saline groups. For transmission electron microscopy, PRP-1 had the largest mean collagen fibril diameter, and the PRP-2 group showed even smaller mean collagen fibril diameter than saline groups. In conclusion, intratendon delivery of Lr-PRP at early stage showed beneficial effect for repair of tendinopathy but not at late stage. For translation of our results to clinical circumstances, further studies are still needed.
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Affiliation(s)
- Sihao Li
- Department of Orthopedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Yifan Wu
- Department of Surgery, Zhejiang University Hospital, Zhejiang University, Hangzhou, China
| | - Guangyao Jiang
- Department of Orthopedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Xiulian Tian
- Department of Neurology, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Jianqiao Hong
- Department of Orthopedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Shiming Chen
- Department of Surgery, Shaoxing Second Hospital, Shaoxing, China
| | - Ruijian Yan
- Department of Orthopedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Gang Feng
- Department of Orthopedic Surgery, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang, China
| | - Zhiyuan Cheng
- Institute of Microelectronics and Nanoelectronics, Key Lab. of Advanced Micro/Nano Electronics Devices & Smart Systems of Zhejiang, College of Information Science & Electronic Engineering, Zhejiang University, Hangzhou, China
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Mehrabani D, Seghatchian J, Acker JP. Platelet rich plasma in treatment of musculoskeletal pathologies. Transfus Apher Sci 2019; 58:102675. [DOI: 10.1016/j.transci.2019.102675] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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