Regenerative Injectable Therapies: Current Evidence

Effectiveness of sub-acromial injections in rotator cuff injuries: A systematic review and meta-analysis

BACKGROUND

Sub-acromial injections are a therapeutic option for rotator cuff injuries; however, evidence regarding the most effective drug in this context is unclear, which needs to be investigated.

AIM

To evaluate the effectiveness of various sub-acromial injections for rotator cuff injuries.

METHODS

We conducted a systematic review and pair-wise and network meta-analyses of randomized clinical trials (RCTs) comparing sub-acromial injections for rotator cuff injuries. The interventions evaluated were hyaluronic acid (HA), platelet-rich plasma (PRP), prolotherapy, and corticosteroids. The outcomes of interest were pain and functional improvement, which were evaluated with standardized scores. The Risk of Bias 2 tool and the Grading of Recommendations, Assessment, Development and Evaluation methodology were used to assess data quality.

RESULTS

Twenty RCTs, comprising 1479 participants, were included. In the short term, HA achieved the best outcomes [pain mean difference (MD) = -1.48, 95% confidence interval (CI) -2.37 to -0.59; function MD = 10.18, 95%CI: 4.96-15.41]. In the medium term, HA, PRP, HA + PRP, and corticosteroids were not superior to placebo in improving pain. Based on function, HA + PRP was superior to placebo, corticosteroids, and PRP (MD = 26.72; 95%CI: 8.02-45.41). In the long term, HA, PRP, and corticosteroids were not superior to placebo in reducing pain. However, based on function, HA + PRP, PRP, and HA were superior to placebo, and HA + PRP had the best result (MD = 36.64; 95%CI: 31.66-33.62).

CONCLUSION

HA provides satisfactory short-term results, while HA with PRP demonstrates functional improvement in the medium and long terms. However, no intervention maintained the pain-relief effect on > 3-month follow-up.

The Outcomes at 3 Years in 82 Knees with Kellgren and Lawrence 2-3 Osteoarthritis Treated with an Autologous Protein Fluid Concentrate Produced with a Fluid Volume Reducer

INTRODUCTION

Knee osteoarthritis (OA) is a highly prevalent and debilitating condition with significant emotional and economic impacts. Current treatment options may only provide temporary pain relief and are not regenerative, thus the progression of knee OA is not deterred and total knee arthroplasty is inevitable. Injection therapies with orthobiologics possess regenerative potential and are an emerging treatment option. We present a prospective study aimed at examining patients with knee OA who had received an autologous platelet concentrate fluid (APCF) injection produced through a fluid volume reducer.

METHODS

This was an observational review of the results following an APCF injection in a cohort of patients at a single site. Patients were included in the study if they were diagnosed with K/L grade 2-3 knee OA and treated with an APCF knee injection. Patients were excluded if they had obtained an orthobiologic injection in the three months prior to study enrollment or if baseline data were unavailable. Knee score and function score were used to assess patients at the baseline and post-injection follow-ups.

RESULTS

Improvements for knee score were statistically significant for the follow-ups at three months, six months, one year, and three years. Function score improved, with statistically significant changes for the three month and three year follow-ups.

CONCLUSIONS

Our study demonstrates that there is some utility in using APCF injection for knee OA, with improvements that may be sustained up to three years in some patients.

Acute and chronic pain management in sport medicine: an expert opinion looking at an alternative mechanism-based approach to the pharmacological treatment

In the last decades there has been a huge increase in people who practice sports requesting an increase of the performance. Consequently, also incidence of acute and chronic pain is highly increased in this population of "healthy" people. Pain represents not only a signal of a lesion occurred during the sportive activity, but also (and almost) an unbalance of posture or an overuse of specific articulations or muscles, that has to be resolved not only with a correct physiotherapeutic approach, but also with a careful diagnosis of the complex mechanisms that sustain the pain. Furthermore, many drugs, commonly used in patients with acute pain, can cause side effects in people who practice sports, or they cannot be used as classified in the doping list. Hence, the pain therapist assumes a pivotal role in the management of pain in people who practice sports, for his skills in pain diagnosis, and for the possibility to introduce new mechanism-based therapies. In the last decade, these new therapies, such as regenerative medicine and peripheral neuromodulation, have demonstrated their effectiveness not only to reduce pain, but also to facilitate the healing process and the faster return to the sportive activity. In this expert opinion we summarize the most recent data to support this approach, focalizing not only on how to treat specific pain syndromes but also on how pain therapist could drive, through a careful diagnosis of the pain mechanism, to a new simultaneous mechanism-based disease modifying approach in people with pain practicing sport.

Dextrose Prolotherapy to Treat Pain, Improve Activities of Daily Living, and Improve Quality of Life in an Ewing's Sarcoma Patient Following Radiation and Chemotherapy Treatment

Advances in the treatment and survival of Ewing’s sarcoma patients create a need to treat underlying symptoms that limit activities of daily living and quality of life. This case describes the treatment of pain in a 25-year-old female pediatric nurse with Ewing’s sarcoma of the pelvis that was in remission following radiation and chemotherapy. She reported medication side effects and limitations in her activities of daily living and quality of life with the chronic use of topical and oral pain medications. A dextrose prolotherapy approach was used to treat her pain, which allowed her to discontinue her pain medication regimen, resulting in an improvement in her activities of daily living and quality of life. The improvement was sustained at the three-year follow-up after the last procedure.

Recommended Musculoskeletal and Sports Medicine Curriculum for Internal Medicine Residency Training

ABSTRACT

Patients present to primary care physicians with musculoskeletal complaints more often than they do for upper respiratory infections, hypertension, or diabetes. Despite this, instruction in musculoskeletal medicine for internal medicine residents represents less than 1% of their total didactic and clinical education time. We recognize the immense breadth of knowledge and skill required to train residents in the practice of internal medicine. This curriculum guideline defines a recommended training strategy, and supplies relevant resources, to improve musculoskeletal education among internal medicine residents to optimize patient care. This curriculum guideline was created by internists who are sports medicine specialists. Sports medicine physicians promote overall health and well-being while providing expertise in acute and chronic musculoskeletal conditions, as well as how disease affects exercise and using exercise as medicine for people with chronic disease.