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El-Sherif SM, Abdel-Hamid MM, Noureldin JMAM, Fahmy HM, Abdel-Naby HMA. Effectiveness of lyophilized growth factors injection for subacromial impingement syndrome: a prospective randomized double-blind placebo-controlled study. J Orthop Surg Res 2023; 18:78. [PMID: 36721157 PMCID: PMC9887845 DOI: 10.1186/s13018-023-03548-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 01/17/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Platelet-derived lyophilized growth factors (L-GFs) use a standardized number of allogenic pathogen-free platelets instead of autologous platelets used in PRP as a source of growth factors. This study aimed to evaluate the efficacy of L-GF injection versus placebo in subacromial impingement (SIS) treatment. METHODS The current randomized double-blind placebo-controlled study included sixty patients (40 females and 20 males, aged between 24 and 75 years) diagnosed with SIS (both clinically and sonographically). Patients were randomly assigned to two equal groups. Under ultrasound guidance, group 1 received subacromial saline injection, and group 2 received L-GF injection. Clinical examination, pain visual analogue scale (VAS), shoulder pain and disability index (SPADI) and shoulder ultrasound were performed before and at the 8th week after injection. RESULTS Follow-up assessment showed statistically significant improvement in the L-GF group regarding active flexion, active and passive internal rotation and extension, SPADI-disability scale, VAS and thickness of the supraspinatus tendon by US. Regression analysis showed that group 1 was approximately 30 times more likely than the L-GF group to experience painful arc at follow-up. Both groups showed statistically significant improvement in SPADI-pain scale and SPADI-total, flexion and abduction (still the mean value of abduction was significantly higher in the L-GF group). CONCLUSIONS L-GF injection resulted in clinically significant reductions in pain and functional disability outcomes in patients with SIS. An objective significant reduction in the thickness of the supraspinatus tendon, measured by ultrasound, in the L-GF group hopefully encourages proper healing and functioning in SIS. TRIAL REGISTRATION The identification number is NCT04330027, date of first registration (01/04/2020). Unique on 21/11/2019, Protocol ID: 0106178.
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Affiliation(s)
- Sherine Mahmoud El-Sherif
- Present Address: Department Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Medaan El-Khartoom Square, Al-Azaritah, Alexandria, Egypt
| | - Mowaffak Moustafa Abdel-Hamid
- Present Address: Department Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Medaan El-Khartoom Square, Al-Azaritah, Alexandria, Egypt
| | - Jailan Mohamed Ashraf Mohamed Noureldin
- Present Address: Department Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Medaan El-Khartoom Square, Al-Azaritah, Alexandria, Egypt
| | | | - Hoda Mohamed Aly Abdel-Naby
- Present Address: Department Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Alexandria University, Medaan El-Khartoom Square, Al-Azaritah, Alexandria, Egypt
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Guimarães JDS, Arcanjo FL, Leporace G, Metsavaht LF, Conceição CS, Moreno MVMG, Vieira TEM, Moraes CC, Gomes Neto M. Effects of therapeutic interventions on pain due to plantar fasciitis: A systematic review and meta-analysis. Clin Rehabil 2022; 37:727-746. [PMID: 36571559 DOI: 10.1177/02692155221143865] [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: 12/27/2022]
Abstract
OBJECTIVE To determine the effects of different therapeutic interventions that have ever been evaluated in randomized controlled trials on pain due to plantar fasciitis. METHODS We searched different electronic databases until September 2022. Mean differences (MDs) and 95% confidence intervals (CIs) were calculated. The Grading of Recommendations Assessment, Development and Evaluation was used to evaluate the overall certainty evidence. RESULTS A total of 236 studies met the study criteria, including 15,401 patients. Botulinum toxin MD -2.14 (CI: -4.15, -0.14), micronized dehydrated human amnion/chorion membrane injection MD -3.31 (CI: -5.54, -1.08), dry needling MD -2.34 (CI: -4.64, -0.04), low-dye taping MD -3.60 (CI: -4.16, -3.03), low-level laser therapy MD -2.09 (CI: -2.28, -1.90), myofascial releases MD -1.79 (CI: -2.63, -0.94), platelet-rich plasma MD -2.40 (CI: -4.16, -0.63), radiofrequency MD -2.47 (CI: -4.65, -0.29), and stretching MD -1.14 (CI: -2.02, -0.26) resulted in being effective treatments for pain when compared to the control in the short term. In the medium and long term, only extracorporeal shock wave therapy MD -0.97 (CI: -1.13, -0.81)/MD -2.49 (CI: -3.17, -1.82) was effective for improving pain when compared to the control. CONCLUSIONS Considering the available studies, this systematic review and meta-analysis showed that different therapeutic interventions seem to be useful strategies for improving pain in patients with plantar fasciitis. In the medium and long term, only extracorporeal shock wave therapy was effective in improving pain when compared to the control.
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Affiliation(s)
- Janice de S Guimarães
- Postgraduate Program in Medicine and Health at the Federal University of Bahia (UFBA), Salvador, Bahia, Brazil.,Foot and Ankle Medicine and Surgery Department, 534569Cardiopulmonar Hospital, Salvador, Bahia, Brazil
| | - Fabio L Arcanjo
- Postgraduate Program in Medicine and Health at the Federal University of Bahia (UFBA), Salvador, Bahia, Brazil.,Physiotherapy Research Group, 28111Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Gustavo Leporace
- Physiotherapy Research Group, 28111Federal University of Bahia (UFBA), Salvador, Bahia, Brazil.,Biocinética, Rua Visconde de Pirajá, Rio de Janeiro, Brazil
| | | | - Cristiano Sena Conceição
- Postgraduate Program in Medicine and Health at the Federal University of Bahia (UFBA), Salvador, Bahia, Brazil.,Physiotherapy Research Group, 28111Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
| | - Marcus V M G Moreno
- Foot and Ankle Medicine and Surgery Department, 534569Cardiopulmonar Hospital, Salvador, Bahia, Brazil
| | - Tulio E Marçal Vieira
- Foot and Ankle Medicine and Surgery Department, 534569Cardiopulmonar Hospital, Salvador, Bahia, Brazil
| | - Carolina Cunha Moraes
- Foot and Ankle Medicine and Surgery Department, Portuguese Hospital of Bahia, Salvador, Bahia, Brazil
| | - Mansueto Gomes Neto
- Postgraduate Program in Medicine and Health at the Federal University of Bahia (UFBA), Salvador, Bahia, Brazil.,Physiotherapy Research Group, 28111Federal University of Bahia (UFBA), Salvador, Bahia, Brazil.,Physiotherapy Department, Physiotherapy course, 28111Federal University of Bahia (UFBA), Salvador, Bahia, Brazil
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Peña-Martínez VM, Acosta-Olivo C, Tamez-Mata Y, Simental-Mendía LE, Blázquez-Saldaña J, Vilchez-Cavazos F, Simental-Mendía M. Normal saline injection produces a therapeutic effect in patients with plantar fasciitis: A systematic review and meta-analysis of randomized controlled trials. Foot Ankle Surg 2022; 28:1129-1138. [PMID: 35637108 DOI: 10.1016/j.fas.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/15/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Injectable therapies have been increasingly investigated to treat plantar fasciitis in randomized controlled trials (RCT) where normal saline injections are frequently used as placebo. The purpose was to quantify the effect of saline injections and compared against available minimal clinically important difference (MCID) criteria specific for plantar fasciitis to assess if changes were clinically meaningful. METHODS RCT including a placebo group (normal saline) and reporting changes in pain and functional outcomes in plantar fasciitis were identified through a search in MEDLINE, Embase, Web of Science, and Scopus to February 2022. PRISMA guidelines and a registered protocol (PROSPERO: CRD42020214035) were followed to conduct the study. RESULTS Pooled analysis of 13 RCT (379 subjects) included for analysis revealed a significant improvement on pain (P < .00001) and functional scores (P < .00001) after normal saline injections. These changes exceeded the established MCID criteria. CONCLUSIONS Normal saline injections in plantar fasciitis showed a therapeutic effect with statistically and clinically meaningful improvement when administered in the setting of an RCT for up to 12 months. The control of potential confounders influencing the effect of saline injections is required for future research.
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Affiliation(s)
- Víctor Manuel Peña-Martínez
- Universidad Autonoma de Nuevo Leon, Orthopedics and Traumatology Service, "Dr. José Eleuterio González" University Hospital, Monterrey, Mexico
| | - Carlos Acosta-Olivo
- Universidad Autonoma de Nuevo Leon, Orthopedics and Traumatology Service, "Dr. José Eleuterio González" University Hospital, Monterrey, Mexico
| | - Yadira Tamez-Mata
- Universidad Autonoma de Nuevo Leon, Orthopedics and Traumatology Service, "Dr. José Eleuterio González" University Hospital, Monterrey, Mexico
| | - Luis E Simental-Mendía
- Instituto Mexicano del Seguro Social, Biomedical Research Unit, Delegación Durango, Durango, Mexico
| | - Jaime Blázquez-Saldaña
- Universidad Autonoma de Nuevo Leon, Orthopedics and Traumatology Service, "Dr. José Eleuterio González" University Hospital, Monterrey, Mexico
| | - Félix Vilchez-Cavazos
- Universidad Autonoma de Nuevo Leon, Orthopedics and Traumatology Service, "Dr. José Eleuterio González" University Hospital, Monterrey, Mexico
| | - Mario Simental-Mendía
- Universidad Autonoma de Nuevo Leon, Orthopedics and Traumatology Service, "Dr. José Eleuterio González" University Hospital, Monterrey, Mexico.
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Bildik C, Kaya O. Platelet-Rich Plasma vs Autologous Blood Injection to Treat Plantar Fasciitis: A Prospective Randomized, Double-Blinded, Controlled Trial. Foot Ankle Int 2022; 43:1211-1218. [PMID: 35975719 DOI: 10.1177/10711007221114122] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Plantar fasciitis (PF) is the most common cause of heel pain. Previous work has shown promising results regarding platelet-rich plasma (PRP) injections for the treatment of PF. The aim of this study is to prospectively compare the efficacy of PRP and autologous blood injections in a randomized anonymized patient group to treat PF. METHODS PF patients who failed at least 6 weeks of noninvasive conservative treatment aged between 40 and 65 years were recruited to be in the study. Patients were randomly assigned into group A (PRP) or group B (autologous blood). Injections were performed under ultrasonographic guidance in a double-anonymized manner. The groups were compared according to preinjection and postinjection health-related quality of life (HRQoL) scores measured with Foot and Ankle Disability Index (FADI) and visual analog scale (VAS). Intragroup comparative analysis was also performed at different time points. Independent t tests and repeated measures analyses of variance were used for statistical analysis, with P <.05 set for statistical significance. RESULTS Group A (PRP) included 30 (19 female, 11 male) patients with mean age 52.2 ±6.3; group B (ABI) included 30 (20 female, 10 male) patients with mean age 52.7 ± 6.5. Both groups had similar body mass index (P = .719). No injection-related complications were recorded. After treatment, both groups had improved FADI and VAS scores compared to the baseline. Although the mean HRQoL scores were higher in the PRP group, there was no significant difference between the 2 groups (PVAS = .589; PFADI = .742). CONCLUSION Participants with plantar fasciitis improved statistically significantly after either PRP or ABI injections compared with baseline HRQoL scores, with no significant differences seen between the groups. LEVEL OF EVIDENCE Level I, prospective randomized double-anonymized clinical comparative study.
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Affiliation(s)
- Celaleddin Bildik
- Orthopedics and Traumatology, Istanbul Atasehir Florence Nightingale, Atasehir, Istanbul, Turkey.,Faculty of Health Sciences, Istanbul Yeni Yüzyil University, Istanbul, Turkey
| | - Ozcan Kaya
- SBU Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
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Allogeneic platelet-derived growth factors local injection in treatment of tennis elbow: a prospective randomized controlled study. INTERNATIONAL ORTHOPAEDICS 2022; 46:581-588. [PMID: 35020026 PMCID: PMC8840929 DOI: 10.1007/s00264-022-05300-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/30/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE The purpose of this study aimed to evaluate the efficacy of local injection of allogeneic platelet-derived growth factors in treatment of patients with tennis elbow. PATIENTS AND METHODS This study included 120 tennis elbow patients randomly divided into two groups. The patients were locally injected with allogeneic growth factors (treatment group) or with normal saline (control group). The outcomes were assessed using Patient-Related Tennis Elbow Evaluation (PRTEE) and quick Disabilities of the Arm, Shoulder and Hand (qDASH) scales. The clinical outcomes were accordingly classified as excellent, good and poor. The patient's satisfaction and adverse effects were also recorded. RESULTS There was no statistically significant difference between the two groups regarding the age, gender, dominant arm or the pre-injection scores. At three month follow-up, the reductions in the mean PRTEE and qDASH scores were 88.7% and 70.6% in the treatment group versus 21.8% and 14.9% in the control group, respectively. At the last follow-up, the outcomes in the treatment group were excellent in 85% of patients and good in 15%, versus 8% and 32% in the control group. Overall, 95% were satisfied in the treatment group compared to 25% in control group. Forty patients in the treatment group experienced mild transient post-injection pain. CONCLUSION This study strongly suggests that local injection of allogeneic platelet-derived growth factors could be a promising safe treatment option for tennis elbow with significant pain relief, functional improvement and patient's satisfaction. Yet, additional larger studies are needed to assess the durability of these outcomes.
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Andia I, Atilano L, Maffulli N. Moving toward targeting the right phenotype with the right platelet-rich plasma (PRP) formulation for knee osteoarthritis. Ther Adv Musculoskelet Dis 2021; 13:1759720X211004336. [PMID: 33854574 PMCID: PMC8010808 DOI: 10.1177/1759720x211004336] [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] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 03/03/2021] [Indexed: 12/14/2022] Open
Abstract
Intra-articular injections of platelet-rich plasma (PRP) and other novel blood-derived products developed specifically for osteoarthritis (OA) can provide pain relief and potential benefits in disease progression. Meta-analyses show the clinical superiority of PRP compared with other intra-articular injections, but results are modest and the effect sizes are small. PRP injections in knee OA are performed indiscriminately, but the clinical response varies enormously between patients because of an array of mixed OA phenotypes. Subgroup analyses are scarce; some studies stratify patients according to radiographic severity and found better results in early OA, without consensus for more advanced stages of the condition. Parallel identification of soluble and imaging biomarkers is essential to personalise and leverage PRP therapies. The inflammatory phenotype is most interesting from the PRP perspective because PRPs modulate inflammation by releasing a large pool of chemokines and cytokines, which interact with synovial fibroblasts and macrophages; in addition, they can modulate the innate immune response. No soluble biomarkers have been discovered that have implications for OA research and PRP interventions. Clinical examination of patients based on their inflammatory phenotype and imaging identification of pain sources and structural alterations could help discern who will respond to PRP. Synovial inflammation and bone marrow lesions are sources of pain, and intra-articular injections of PRP combined with subchondral bone injection can enhance clinical outcomes. Further refining ultrasound phenotypes may aid in personalising PRP therapies. Intra-articular delivery combined with injections in altered ligamentous structures, medial and coronal ligaments or premeniscal pes anserinus showed positive clinical outcomes. Although the evidence supporting these approaches are weak, they merit further consideration to refine PRP protocols and target the right OA phenotypes.
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Affiliation(s)
- Isabel Andia
- Regenerative Therapies, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Plaza Cruces 12, Barakaldo, Bizkaia, 48903, Spain
| | - Leire Atilano
- Regenerative Therapies, Biocruces Bizkaia Health Research Institute, Interventionist Radiology Unit, Department of Radiology, Cruces University Hospital, Barakaldo, Bizkaia, 48903, Spain
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Dentristry, Salerno, Italy
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK
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El-Gohary R, Diab A, El-Gendy H, Fahmy H, Gado KH. Using intra-articular allogenic lyophilized growth factors in primary knee osteoarthritis: a randomized pilot study. Regen Med 2021; 16:113-115. [PMID: 33754800 DOI: 10.2217/rme-2020-0104] [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
Objective: Investigating the safety in addition to clinical and structural efficacy of allogenic lyophilized growth factors (L-GFs) in patients with symptomatic primary knee osteoarthritis. Design: A prospective, open-label pilot study. A total of 31-patients randomized into non-intervention and intervention groups. Materials & methods: The intervention group received two intra-articular doses at baseline and after 2-months. Post-injection complications were documented, and the efficacy was assessed by Western Ontario and McMaster Universities Osteoarthritis Index scores and ultrasonography. Results: One dropout from the intervention group. The percentage of improvement of mean Western Ontario and McMaster Universities Osteoarthritis Index-scores and ultrasonography-detected effusion were statistically significant in the intervention group compared with the non-intervention. A brief, mild, post-injection pain was reported by all intervention group. Conclusion: This study provides the safety of intra-articular injection of allogenic L-GFs in knee osteoarthritis. The conclusion of efficacy was limited by small sample size and lack of control injection. Clinical trial registration: NCT04331327 (ClinicalTrials.gov, retrospectively registered).
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Affiliation(s)
- Rasmia El-Gohary
- Department of Internal Medicine, Faculty of Medicine, Clinical Immunology & Rheumatology Unit, Cairo University, Cairo 11562, Egypt
| | - Amany Diab
- Department of Internal Medicine, Faculty of Medicine, Clinical Immunology & Rheumatology Unit, Cairo University, Cairo 11562, Egypt
| | - Hala El-Gendy
- Department of Internal Medicine, Faculty of Medicine, Clinical Immunology & Rheumatology Unit, Cairo University, Cairo 11562, Egypt
| | - Hossam Fahmy
- Department of Clinical Pathology, Faculty of Medicine, Ain Shams University, Cairo 11566, Egypt
| | - Kamel Heshmat Gado
- Department of Internal Medicine, Faculty of Medicine, Clinical Immunology & Rheumatology Unit, Cairo University, Cairo 11562, Egypt
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Andia I, Perez-Valle A, Del Amo C, Maffulli N. Freeze-Drying of Platelet-Rich Plasma: The Quest for Standardization. Int J Mol Sci 2020; 21:ijms21186904. [PMID: 32962283 PMCID: PMC7555364 DOI: 10.3390/ijms21186904] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/14/2020] [Accepted: 09/18/2020] [Indexed: 02/06/2023] Open
Abstract
The complex biology of platelets and their involvement in tissue repair and inflammation have inspired the development of platelet-rich plasma (PRP) therapies for a broad array of medical needs. However, clinical advances are hampered by the fact that PRP products, doses and treatment protocols are far from being standardized. Freeze-drying PRP (FD-PRP) preserves platelet function, cytokine concentration and functionality, and has been proposed as a consistent method for product standardization and fabrication of an off-the-shelf product with improved stability and readiness for future uses. Here, we present the current state of experimental and clinical FD-PRP research in the different medical areas in which PRP has potential to meet prevailing medical needs. A systematic search, according to PRISMA (Preferred Reported Items for Systematic Reviews and Meta-Analyses) guidelines, showed that research is mostly focused on wound healing, i.e., developing combination products for ulcer management. Injectable hydrogels are investigated for lumbar fusion and knee conditions. In dentistry, combination products permit slow kinetics of growth factor release and functionalized membranes for guided bone regeneration.
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Affiliation(s)
- Isabel Andia
- Bioprinting Laboratory, Regenerative Therapies, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Plaza Cruces 12, 48903 Barakaldo, Bizkaia, Spain; (A.P.-V.); (C.D.A.)
- Correspondence: ; Tel.: +34-609419897 or +34-946007964
| | - Arantza Perez-Valle
- Bioprinting Laboratory, Regenerative Therapies, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Plaza Cruces 12, 48903 Barakaldo, Bizkaia, Spain; (A.P.-V.); (C.D.A.)
| | - Cristina Del Amo
- Bioprinting Laboratory, Regenerative Therapies, Biocruces Bizkaia Health Research Institute, Cruces University Hospital, Plaza Cruces 12, 48903 Barakaldo, Bizkaia, Spain; (A.P.-V.); (C.D.A.)
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Dentristry, 84084 Salerno, Italy;
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London E1 4DG, UK
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