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Thahir M, Misbah I, Bhaskaran J, Syed NH, Ashraf M, Balasubramanian N. Efficacy of Intraoperative Platelet-Rich Plasma After Meniscal Repair: Systematic Review and Meta-analysis. Indian J Orthop 2024; 58:845-857. [PMID: 38948373 PMCID: PMC11208355 DOI: 10.1007/s43465-024-01155-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/11/2024] [Indexed: 07/02/2024]
Abstract
Background Meniscal injuries frequently require surgical intervention to restore knee joint function and stability. Intraoperative platelet-rich plasma (PRP) injection has emerged as a potential adjunctive therapy to enhance tissue healing post-meniscal repair. This systematic review and meta-analysis aimed to evaluate the efficacy of PRP in terms of pain relief, functional recovery, and overall success rates in patients undergoing meniscal repair procedures. Methods A comprehensive search strategy was employed to identify relevant studies across Scopus, PubMed, Embase, and the Cochrane Library databases. The inclusion criteria encompassed human studies, including randomized controlled trials (RCTs), cohorts, and case-control studies, focusing on intraoperative platelet-rich plasma (PRP) use post-meniscal repair and reporting outcomes related to pain, functionality, and cure rates. Exclusion criteria comprised animal studies, non-English publications, studies lacking relevant outcome measures, and those with insufficient data. Two reviewers independently screened titles and abstracts, resolving disagreements through consensus or consultation with a third reviewer, followed by a full-text assessment for potentially eligible studies. Data extraction was conducted independently by two reviewers using a standardized form. The reliability of observational studies was evaluated using the Newcastle-Ottawa Scale. Subgroup analyses and pooled effect estimates for main outcomes were computed using RevMan 5.3, a meta-analysis tool. Results The demographic analysis revealed that the PRP group had an average age of 41.39 years, while the control group had an average age of 42.1 years. In terms of gender distribution, the PRP group consisted of 61 men and 29 women, while the control group had 62 men and 34 women. Pain ratings showed a preference for PRP with a mean difference of 4.83 (p = 0.13). However, there was no significant difference in Lysholm scores (mean difference: - 0.44, p = 0.91) or IKDC scores (mean difference: 2.80, p = 0.14) between the PRP and control groups. Similarly, ROM measures did not show a statistically significant difference, with a mean difference of 2.80 (p = 0.18). Additionally, there was no significant distinction in failure rates between the PRP and control groups, as indicated by a weighted mean difference of 0.71 (p = 0.52). These findings suggest that while PRP may offer some benefits in pain relief, its impact on functional recovery, range of motion, and failure rates following meniscal repair procedures is inconclusive. Conclusion The current evidence regarding the effect of intraoperative platelet-rich plasma (PRP) injection on patients undergoing meniscal repair remains inconclusive. While some studies suggest potential benefits in terms of pain relief and functional recovery, others show no significant differences compared to control groups. The impact of PRP therapy on overall success rates, including rates of re-tear and revision surgery, is also uncertain. Further well-designed randomized controlled trials with larger sample sizes are needed to provide more robust evidence and guide clinical practice in orthopedic surgery.
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Affiliation(s)
| | - Iffath Misbah
- Department of Radiodiagnosis, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Jagadeesh Bhaskaran
- Department of Orthopedics, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Nazmul Huda Syed
- Adjunct Faculty, Center for Global Health and Research, Saveetha Institute of Medical and Technical Sciences, Chennai, India
- School of Health Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan Malaysia
| | - Munis Ashraf
- Department of Orthopedics, Saveetha Institute of Medical and Technical Sciences, Chennai, India
| | - Navin Balasubramanian
- Department of Orthopedics, Saveetha Institute of Medical and Technical Sciences, Chennai, India
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Vale D, Pereira A, Andrade JP, Castro JP. The Role of Platelet-Rich Plasma Injection for Muscle Strains in Athletes. Cureus 2024; 16:e60585. [PMID: 38894806 PMCID: PMC11184543 DOI: 10.7759/cureus.60585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 06/21/2024] Open
Abstract
Muscle tears/strains are among the most common musculoskeletal injuries, posing a serious challenge for sports medicine. Aiming to reduce the time to return to play and the rate of reinjuries, apart from the traditional conservative treatments and rehabilitation protocols, new and innovative therapeutic options have emerged, particularly platelet-rich plasma (PRP). This study aims to present the available evidence regarding PRP injection for the treatment of muscle strains in athletes. Two databases were searched for articles published between January 2012 and December 2022 in Portuguese or English. The query used for the PubMed database was ("Muscles/injuries"[Mesh]) AND ("Athletes"[Mesh] OR "Athletic Injuries"[Mesh]) AND "Platelet-Rich Plasma"[Mesh], while for the Web of Science database the search was performed for "Platelet-rich plasma" AND "Muscle injuries" AND ("Athletes" OR "Athletic injuries"). Eleven studies involving athletes diagnosed with muscle injuries who received treatment with PRP injection alone, or in combination with traditional conservative treatment, compared to a control group, were included. Four randomized controlled trials, four systematic reviews/meta-analyses, two retrospective studies, and one comparative study were included. Current evidence from the highest-quality studies does not support the hypothesis of reduction of time to return to play and the rate of reinjuries after PRP injection, even though some studies reported positive results. However, the available evidence suggests that PRP might have a beneficial effect on the pain perceived by athletes following an acute muscle strain. It is challenging to arrive at definitive conclusions and translate these findings into a clinical context for treating muscle strains in athletes. The existing trials present several inconsistencies and limitations, with a heterogeneous set of patients and injuries, as well as the use of different and inconsistent methods for preparing, administering, and measuring the effects of PRP. To achieve consistent outcomes, standardizing PRP administration procedures is essential.
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Affiliation(s)
- David Vale
- Medical School, Faculty of Medicine, University of Porto, Porto, PRT
| | - Adriana Pereira
- Physical Medicine and Rehabilitation, Centro de Medicina de Reabilitação de Alcoitão, Alcoitão, PRT
| | - José Paulo Andrade
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, PRT
| | - João Paulo Castro
- Unit of Anatomy, Department of Biomedicine, Faculty of Medicine, University of Porto, Porto, PRT
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Baird HBG, Ashy CC, Kodali P, Myer GD, Murray IR, Pullen WM, Slone HS. Most Publications Regarding Platelet-Rich Plasma Use in the Knee Are From Asia, Investigate Injection for Osteoarthritis, and Show Outcome Improvement: A Scoping Review. Arthroscopy 2024:S0749-8063(24)00252-4. [PMID: 38537725 DOI: 10.1016/j.arthro.2024.03.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/12/2024] [Accepted: 03/17/2024] [Indexed: 04/23/2024]
Abstract
PURPOSE To evaluate and synthesize the available literature related to platelet-rich plasma (PRP) treatment of knee pathologies and to provide recommendations to inform future research in the field. METHODS PubMed, CINAHL, and Scopus databases were queried on October 6, 2023. All identified citations were collated and uploaded into Covidence for screening and data extraction. Studies were included if they were human studies published in English with adult cohorts that received PRP as a procedural injection or surgical augmentation for knee pathologies with patient-reported outcome measures (PROMs) and level of evidence Levels I-IV. RESULTS Our search yielded 2,615 studies, of which 155 studies from 2006 to 2023 met the inclusion criteria. Median follow-up was 9 months (±11.2 months). Most studies (75.5%) characterized the leukocyte content of PRP, although most studies (86%) did not use a comprehensive classification scheme. In addition, most studies were from Asia (50%) and Europe (32%) and were from a single center (96%). In terms of treatment, 74% of studies examined PRP as a procedural injection, whereas 26% examined PRP as an augmentation. Most studies (68%) examined treatment of knee osteoarthritis. Many studies (83%) documented significant improvements in PROMs, including 93% of Level III/IV evidence studies and 72% of Level I/II evidence studies, although most studies (70%) failed to include minimal clinically important difference values. The visual analog scale was the most-used PROM (58% of studies), whereas the Short Form Health Survey 36-item was the least-used PROM (5% of studies). CONCLUSIONS Most published investigations of knee PRP are performed in Asia, investigate procedural injection for osteoarthritis, and show significant outcome improvements. In addition, this review highlights the need for better classification of PRP formulations. LEVEL OF EVIDENCE Level IV, scoping Review of level I-IV studies.
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Affiliation(s)
- Henry B G Baird
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A..
| | - Cody C Ashy
- Department of Orthopedic Surgery and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Prudhvi Kodali
- College of Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Gregory D Myer
- Emory Sports Performance and Research Center (SPARC), Flowery Branch, Georgia, U.S.A.; Emory Sports Medicine Center, Atlanta, Georgia, U.S.A.; Department of Orthopaedics, Emory University School of Medicine, Atlanta, Georgia, U.S.A.; The Micheli Center for Sports Injury Prevention, Waltham, Massachusetts, U.S.A.; Youth Physical Development Centre, Cardiff Metropolitan University, Wales, United Kingdom
| | - Iain R Murray
- The University of Edinburgh, Edinburgh, United Kingdom
| | - W Michael Pullen
- Department of Orthopedic Surgery and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Harris S Slone
- Department of Orthopedic Surgery and Physical Medicine, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Maloney J, Strand N, Wie C, Pew S, Dawodu A, Dunn T, Johnson B, Eells A, Viswanath O, Freeman J, Covington S. Current Review of Regenerative Medicine Therapies for Spine-Related Pain. Curr Pain Headache Rep 2023:10.1007/s11916-023-01194-3. [PMID: 38112985 DOI: 10.1007/s11916-023-01194-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2023] [Indexed: 12/21/2023]
Abstract
PURPOSE OF REVIEW Persistent spinal pain syndromes are pervasive and lead to functional impairment, increased healthcare utilization, potential disability, and high societal costs. Spinal (cervical, thoracic, lumbar, and sacroiliac joint) pain includes mechanical, degenerative, inflammatory, oncologic, and infectious etiologies. Regenerative medicine is a novel biotechnology targeting mechanical, degenerative, and inflammatory conditions believed to cause pain. Preparations including platelet-rich plasma, mesenchymal stem cells (adipose tissue and bone marrow aspirate concentrates), and growth factors are derived from an autologous donor. The goal of intervention through guided injection of the regenerative media is to reduce inflammation and reverse the degenerative cascade in hopes of restoring normal cellular composition (physiologic homeostasis) and anatomical function to improve pain and function. The authors review limited research supporting the use of platelet-rich plasma injections for facet joint arthropathy and sacroiliac joint pain compared to traditional steroid treatments, as well as the use of platelet rich plasma or mesenchymal stem cells for lumbar discogenic and radicular pain. RECENT FINDINGS Current evidence to support regenerative medicine for spine-related pain is limited. Although several studies demonstrated a reduction in pain, many of these studies had a small number of participants and were case series or prospective trials. Regenerative medicine treatments lack evidence for the treatment of spine-related pain. Large randomized controlled trials are needed with consistent study protocols to make further recommendations.
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Affiliation(s)
- Jillian Maloney
- Mayo Clinic Arizona, Department of Anesthesiology, Division of Pain Medicine, Phoenix, AZ, USA.
| | - N Strand
- Mayo Clinic Arizona, Department of Anesthesiology, Division of Pain Medicine, Phoenix, AZ, USA
| | - C Wie
- Mayo Clinic Arizona, Department of Anesthesiology, Division of Pain Medicine, Phoenix, AZ, USA
| | - S Pew
- Mayo Clinic Arizona, Department of Anesthesiology, Division of Pain Medicine, Phoenix, AZ, USA
| | - A Dawodu
- Mayo Clinic Arizona, Department of Anesthesiology, Division of Pain Medicine, Phoenix, AZ, USA
| | - T Dunn
- Mayo Clinic Arizona, Department of Anesthesiology, Division of Pain Medicine, Phoenix, AZ, USA
| | - B Johnson
- Mayo Clinic Arizona, Department of Anesthesiology and Perioperative Medicine, Phoenix, AZ, USA
| | - A Eells
- Mayo Clinic Arizona, Department of Anesthesiology and Perioperative Medicine, Phoenix, AZ, USA
| | - O Viswanath
- Innovative Pain and Wellness, LSU Health Sciences Center School of Medicine, Creighton University School of Medicine, Phoenix, AZ, USA
| | - J Freeman
- Mayo Clinic Arizona, Department of Anesthesiology, Division of Pain Medicine, Phoenix, AZ, USA
| | - S Covington
- Mayo Clinic Arizona, Department of Anesthesiology, Division of Pain Medicine, Phoenix, AZ, USA
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Verron R, Zhang L, Bisseriex H, Grimandi R, Verrando A, Verdaguer C, Thomas M, Facione J, Borrini L. SAS-PRP Study: A Real-Life Satisfaction Assessment in Patients with Cartilage Lesions of the Knee Treated by Platelet-Rich Plasma. Bioengineering (Basel) 2023; 10:1276. [PMID: 38002400 PMCID: PMC10669872 DOI: 10.3390/bioengineering10111276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/27/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023] Open
Abstract
Platelet-rich plasma (PRP) is a rising therapy treating locomotor system lesions such as knee osteoarthritis. The objective of this study was to evaluate patients' satisfaction 6 to 12 months after a PRP injection for cartilage lesions of their knee under real-life conditions. Patients' satisfaction was assessed by a specific questionnaire named SATMED-Q©, which explores six different dimensions of a given treatment. In addition, pain and function were assessed thanks to VAS pain, WOMAC, and IKDC scores. Responders were identified through the OMERACT-OARSI criteria. We observed excellent satisfaction after a PRP injection with a SATMED-Q© score of 80.81% 6 to 12 months after the procedure. Even when there was no significant improvement in pain and function scores, 52% of the evaluated population fulfilled the OMERACT-OARSI criteria and were considered responders. According to the sub-group analysis, patients with less osteoarthritis damage (i.e., Kellgren-Lawrence grades 1-2) and older study subjects (i.e., >40 years old) with focal chondropathy had benefited most from their PRP injection. Thus, platelet-rich plasma seems to be a well-tolerated and efficient therapy for cartilage lesions of the knee.
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Affiliation(s)
- Romain Verron
- Physical and Rehabilitation Department, HIA Percy, 92140 Clamart, France; (A.V.); (C.V.); (M.T.); (J.F.); (L.B.)
| | - Lucie Zhang
- Pneumology Department, HIA Clermont-Tonnerre, 29200 Brest, France;
| | - Hélène Bisseriex
- Physical and Rehabilitation Department, HIA Clermont-Tonnerre, 29200 Brest, France (R.G.)
| | - Ronan Grimandi
- Physical and Rehabilitation Department, HIA Clermont-Tonnerre, 29200 Brest, France (R.G.)
- ORPHY, EA4324, University of Brest, 29238 Brest, France
| | - Alix Verrando
- Physical and Rehabilitation Department, HIA Percy, 92140 Clamart, France; (A.V.); (C.V.); (M.T.); (J.F.); (L.B.)
| | - Claire Verdaguer
- Physical and Rehabilitation Department, HIA Percy, 92140 Clamart, France; (A.V.); (C.V.); (M.T.); (J.F.); (L.B.)
| | - Marie Thomas
- Physical and Rehabilitation Department, HIA Percy, 92140 Clamart, France; (A.V.); (C.V.); (M.T.); (J.F.); (L.B.)
| | - Julia Facione
- Physical and Rehabilitation Department, HIA Percy, 92140 Clamart, France; (A.V.); (C.V.); (M.T.); (J.F.); (L.B.)
| | - Leo Borrini
- Physical and Rehabilitation Department, HIA Percy, 92140 Clamart, France; (A.V.); (C.V.); (M.T.); (J.F.); (L.B.)
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Safarova S, Cevher Akdulum MF, Guler I, Bozkurt N, Erdem A, Karabacak RO. Does Platelet-Rich Plasma Treatment Increase In Vitro Fertilization (IVF) Success in the Infertile Population? Cureus 2023; 15:e47239. [PMID: 38021895 PMCID: PMC10654450 DOI: 10.7759/cureus.47239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVES Platelet-rich plasma (PRP) is obtained by centrifuging the platelet-rich portion of the patient's own blood. The objective of our study is to retrospectively examine the impact of intraovarian PRP injection on infertile women with diminished ovarian reserve, specifically focusing on the oocyte count, oocyte quality, and endometrial thinning. METHODS A retrospective assessment was conducted on cases who had intraovarian PRP injection at the in vitro fertilization (IVF) unit of the Obstetrics and Gynecology Department of Gazi University School of Medicine hospital. The review encompasses the period from 1 January 2015 to 30 June 2020. The endometrial thickness, follicle count of greater than 14 millimeters, estradiol levels, follicle-stimulating hormone (FSH) levels, and antral follicle count were assessed during the menstrual cycle both prior to and within a period of 1-6 months following the PRP procedure. Twenty nonpregnant patients who had IVF before and 4-6 months after PRP were admitted to the post-PRP IVF cycle. The quantification of oocytes and M2 oocytes was conducted both prior to and subsequent to PRP treatment. RESULTS Among 120 cases, only 60 cases who fulfilled inclusion criteria were analyzed. The basal endometrial thickness, basal follicle number (>14 mm), estradiol value, oocyte count, and M2 oocyte count exhibited a statistically significant increase following the administration of PRP injection (p<0.001). The basal FSH value exhibited a notable drop following the administration of PRP injection, with a statistically significant difference (p=0.002). In the pregnant group, the number of oocytes obtained with oocyte pick-up (OPU) increased by 300%, and in the nonpregnant group, the increase was 125% only. The number of M2 oocytes obtained with OPU increased by 250% in the pregnant group, while it was 93% in the nonpregnant group. CONCLUSION Ultimately, the affordability of PRP production and its considerable theoretical efficacy have the potential to substantially decrease the expenses associated with assisted reproductive technology procedures. In the present scenario, the administration of an intraovarian PRP injection may be contemplated as a therapeutic intervention for women exhibiting diminished ovarian reserve.
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Affiliation(s)
| | | | - Ismail Guler
- Obstetrics and Gynaecology, Gazi University, Ankara, TUR
| | - Nuray Bozkurt
- Obstetrics and Gynaecology, Gazi University, Ankara, TUR
| | - Ahmet Erdem
- Obstetrics and Gynaecology, Gazi University, Ankara, TUR
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Imam MS, Alotaibi AAS, Alotaibi NOM, Alosaimi NS, Alotaibi SGM, Abdelrahim MEA. Efficiency of platelet-rich plasma in the management of burn wounds: A meta-analysis. Int Wound J 2023; 21:e14419. [PMID: 37776166 PMCID: PMC10825070 DOI: 10.1111/iwj.14419] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 10/01/2023] Open
Abstract
The meta-analysis aimed to assess the efficiency of platelet-rich plasma (PRP) in the management of burn wounds (BWs). Using dichotomous or contentious random- or fixed-effects models, the outcomes of this meta-analysis were examined and the odds ratio (OR) and the mean difference (MD) with 95% confidence intervals (CIs) were computed. Thirteen examinations from 2009 to 2023 were enrolled for the present meta-analysis, including 808 individuals with BWs. PRP had significantly shorter healing time (MD, -5.80; 95% CI, -7.73 to -3.88, p < 0.001), higher healing rate (OR, 3.14; 95% CI, 2.05-4.80, p < 0.001), higher healed area percent (MD, 12.67; 95% CI, 9.79-15.55, p < 0.001) and higher graft take area percent (MD, 4.39; 95% CI, 1.51-7.26, p = 0.003) compared with standard therapy in patients with BW. However, no significant difference was found between PRP and standard therapy in graft take ratio (OR, 1.70; 95% CI, 0.86-3.34, p = 0.13) and infection rate (OR, 0.55; 95% CI, 0.20-1.47, p = 0.23) in patients with BW. The examined data revealed that PRP had a significantly shorter healing time, a higher healing rate, a higher healed area percent and a higher graft take area percent; however, no significant difference was found in graft take ratio or infection rate compared with standard therapy in patients with BW. Yet, attention should be paid to its values since all of the selected examinations had a low sample size and some comparisons had a low number of selected studies.
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Affiliation(s)
- Mohamed S. Imam
- Pharmacy Practice Department, College of PharmacyShaqra UniversityShaqraSaudi Arabia
- Clinical Pharmacy Department, National Cancer InstituteCairo UniversityCairoEgypt
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Lv M, Xu Q, He F, Guo J, Zheng Z, Xie J, Wang W. Transosseous-Equivalent/Suture Bridge Technique in Combination With Platelet-Rich Plasma Application Yield Optimal Clinical Outcomes in Arthroscopic Rotator Cuff Repair: A Bayesian Network Analysis of Randomized Controlled Trials. Arthroscopy 2023; 39:425-437.e1. [PMID: 36343767 DOI: 10.1016/j.arthro.2022.10.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 10/22/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
PURPOSE To assess the clinical evidence defining the optimal combination of arthroscopic suture technique and platelet-rich products (PRP), and application for arthroscopic rotator cuff repair (ARCR). METHODS All level of evidence (LOE) I randomized controlled trials (RCT) focusing on arthroscopic suture technique and/or PRP application in ARCR were included. The exclusion criteria were LOE II or worse, studies with other interventions, studies reported none of the predetermined clinical outcomes; studies unable to extract any precise data; studies from the same patient group of included studies. A pair-wise meta-analysis and Bayesian network analysis were performed on each comparison. The intervention options were ranked by Bayesian network analysis. RESULTS 27 studies comprising 1,947 individuals met the inclusion criteria. The application of transosseous equivalent/suture bridge repair (SB) with PRP (SB+PRP) significantly reduced retear rate (risk ratio [RR], 0.29; 95% confidence interval [CI], [0.15, 0.55].) and increased Constant-Murley score (mean difference, 1.90; 95% CI, [0.14, 3.74]), compared to SB repair. Single-row repair (SR) with PRP usage (SR+PRP) significantly reduced retear rate (RR, 0.27; 95% CI, [0.12, 0.55]) and pain visual analog scale (VAS) (mean difference: -0.84; 95% CI [-1.39, -0.46].), increased University of California, Los Angeles (UCLA) shoulder score (mean difference: 1.48; 95% CI [0.50, 2.58]) and Constant-Murley score (mean difference: 4.53; 95% CI [2.65, 6.38]), compared to SR repair. The ranking for outcomes demonstrated SB+PRP resulted in the best retear rate, UCLA shoulder score, with the second-best postoperative pain, Constant-Murley score, while SR+PRP resulted in the best postoperative pain, Constant-Murley score, with the second-best retear rate and UCLA score. CONCLUSION Arthroscopic rotator cuff repair utilizing SB+PRP yields optimal retear rate and UCLA shoulder score, with the second-best postoperative pain and Constant-Murley shoulder outcome score, while SR+PRP yields the best in these two parameters. LEVEL OF EVIDENCE Level I, Bayesian network analysis of level I RCT.
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Affiliation(s)
- Minchao Lv
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
| | - Qingxin Xu
- Clinical and Translational Research Center, Shanghai First Maternity and Infant Hospital, Tongji University School of Medicine, Shanghai, China
| | - Feixiong He
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
| | - Jinku Guo
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
| | - Zhenxin Zheng
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
| | - Jun Xie
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China
| | - Wei Wang
- Department of Orthopedics, The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital, Quzhou, Zhejiang Province, China.
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Sato K, Funayama T, Noguchi H, Asada T, Kono M, Eto F, Shibao Y, Miura K, Kikuchi N, Yoshioka T, Takahashi H, Koda M, Yamazaki M. Efficacy of platelet-rich plasma impregnation for unidirectional porous β-tricalcium phosphate in lateral lumbar interbody fusion: study protocol for a prospective controlled trial. Trials 2022; 23:908. [PMID: 36303197 PMCID: PMC9615172 DOI: 10.1186/s13063-022-06857-x] [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: 06/27/2021] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The use of platelet-rich plasma has been increasing in spinal fusion surgery. However, the efficacy of platelet-rich plasma in lateral lumbar interbody fusion is unclear. In Japan, Affinos,® (Kuraray Co., Tokyo, Japan), a β-tricalcium phosphate artificial bone, has been increasingly used for spinal fusion. The purpose of this trial is to demonstrate whether Affinos® impregnated with platelet-rich plasma can achieve a higher fusion rate and better clinical outcomes than Affinos® alone. METHODS The current study is a prospective randomized controlled trial. This trial will include consecutive patients scheduled for lateral lumbar interbody fusion. An intervertebral cage for lateral lumbar interbody fusion has two spaces for bone grafts. As a consequence, two bone grafts are inserted at each intervertebral level. In this study, an artificial bone with platelet-rich plasma will be inserted into one space, and an artificial bone without platelet-rich plasma will be inserted into the other space. We will compare the fusion rates between the bone grafts with and without platelet-rich plasma. Our primary endpoint will be the interbody fusion rate at 1 year after surgery. DISCUSSION This trial will verify the efficacy of platelet-rich plasma with Affinos® for bony fusion in lateral lumbar interbody fusion. It will also provide substantial evidence for the effectiveness and safety of platelet-rich plasma in spinal fusion surgery. TRIAL REGISTRATION Japan Registry of Clinical Trials (jRCT) jRCTb032200199 . First registered on 13 November 2020. jRCT is approved as a member of the Primary Registry Network of WHO ICTRP.
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Affiliation(s)
- Kosuke Sato
- grid.20515.330000 0001 2369 4728Department of Orthopedic Surgery, University of Tsukuba, 2-1-1 Amakubo, Tsukuba City, Ibaraki, Japan
| | - Toru Funayama
- grid.20515.330000 0001 2369 4728Department of Orthopedic Surgery, University of Tsukuba, 2-1-1 Amakubo, Tsukuba City, Ibaraki, Japan
| | - Hiroshi Noguchi
- grid.20515.330000 0001 2369 4728Department of Orthopedic Surgery, University of Tsukuba, 2-1-1 Amakubo, Tsukuba City, Ibaraki, Japan
| | - Tomoyuki Asada
- grid.20515.330000 0001 2369 4728Department of Orthopedic Surgery, University of Tsukuba, 2-1-1 Amakubo, Tsukuba City, Ibaraki, Japan
| | - Mamoru Kono
- grid.20515.330000 0001 2369 4728Department of Orthopedic Surgery, University of Tsukuba, 2-1-1 Amakubo, Tsukuba City, Ibaraki, Japan
| | - Fumihiko Eto
- grid.20515.330000 0001 2369 4728Department of Orthopedic Surgery, University of Tsukuba, 2-1-1 Amakubo, Tsukuba City, Ibaraki, Japan
| | - Yosuke Shibao
- grid.20515.330000 0001 2369 4728Department of Orthopedic Surgery, University of Tsukuba, 2-1-1 Amakubo, Tsukuba City, Ibaraki, Japan
| | - Kosei Miura
- grid.20515.330000 0001 2369 4728Department of Orthopedic Surgery, University of Tsukuba, 2-1-1 Amakubo, Tsukuba City, Ibaraki, Japan
| | - Naoya Kikuchi
- grid.20515.330000 0001 2369 4728Department of Orthopedic Surgery, University of Tsukuba, 2-1-1 Amakubo, Tsukuba City, Ibaraki, Japan
| | - Tomokazu Yoshioka
- grid.20515.330000 0001 2369 4728Department of Orthopedic Surgery, University of Tsukuba, 2-1-1 Amakubo, Tsukuba City, Ibaraki, Japan
| | - Hiroshi Takahashi
- grid.20515.330000 0001 2369 4728Department of Orthopedic Surgery, University of Tsukuba, 2-1-1 Amakubo, Tsukuba City, Ibaraki, Japan
| | - Masao Koda
- grid.20515.330000 0001 2369 4728Department of Orthopedic Surgery, University of Tsukuba, 2-1-1 Amakubo, Tsukuba City, Ibaraki, Japan
| | - Masashi Yamazaki
- grid.20515.330000 0001 2369 4728Department of Orthopedic Surgery, University of Tsukuba, 2-1-1 Amakubo, Tsukuba City, Ibaraki, Japan
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Bugarin A, Schroeder G, Shi BY, Jones KJ, Kremen TJ. Assessment of Characteristics and Methodological Quality of the Top 50 Most Cited Articles on Platelet-Rich Plasma in Musculoskeletal Medicine. Orthop J Sports Med 2022; 10:23259671221093074. [PMID: 35656192 PMCID: PMC9152206 DOI: 10.1177/23259671221093074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 01/21/2022] [Indexed: 12/18/2022] Open
Abstract
Background: The wide range of clinical applications and controversial scientific evidence associated with platelet-rich plasma (PRP) therapy in musculoskeletal medicine requires an examination of the most commonly cited studies within this field. Purpose: To identify the 50 most cited articles on PRP, assess their study design, and determine any correlations between the number of citations and level of evidence (LoE) or methodological quality. Study Design: Cross-sectional study. Methods: The Web of Science database was queried to identify the top 50 most cited articles on PRP in orthopaedic surgery. Bibliometric characteristics, number of citations, and LoE were recorded. Methodological quality was evaluated using the Modified Coleman Methodology Score (MCMS), Methodological Index for Non-randomized Studies (MINORS), and Minimum Information for Studies Evaluating Biologics in Orthopaedics (MIBO). The Pearson correlation coefficient and Spearman correlation coefficient (rS) were used to determine the degree of correlation between the number of citations or citation density and LoE, MCMS, MINORS score, and MIBO score. Student t tests were performed for 2-group comparisons. Results: The top 50 articles were published between 2005 and 2016 in 21 journals. The mean number of citations and citation density were 241 ± 94 (range, 151-625) and 23 ± 8, respectively, and the mean LoE was 2.44 ± 1.67, with 15 studies classified as LoE 1. The mean MCMS, MINORS score, and MIBO score were 66.9 ± 12.6, 16 ± 4.7, and 12.4 ± 3.7, respectively. No correlation was observed between the number of citations or citation density and LoE, MCMS, MINORS score, and MIBO score. A significant difference (P = .02) was noted in LoE in articles from the United States (3.56 ± 1.7) versus outside the United States (2 ± 1.5). Seven of the 8 in vivo studies were published between 2005 and 2010, whereas 19 of the 25 clinical outcome investigations were published between 2011 and 2016. Studies that were published more recently were found to significantly correlate with number of citations (rS = –0.38; P = .01), citation density (rS = 0.36; P = .01), and higher LoE (rS = 0.47; P = .01). Conclusion: The top 50 most cited articles on PRP consisted of high LoE and fair methodological quality. There was a temporal shift in research from in vivo animal studies toward investigations focused on clinical outcomes.
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Affiliation(s)
- Amador Bugarin
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Grant Schroeder
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Brendan Y. Shi
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Kristofer J. Jones
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
| | - Thomas J. Kremen
- Department of Orthopaedic Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California, USA
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Von der Grundlagenforschung zur täglichen Praxis: „Platelet-rich plasma“ in der Orthopädie/Unfallchirurgie. ARTHROSKOPIE 2022. [DOI: 10.1007/s00142-022-00541-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Oeding JF, Lansdown DA, Leucht P, Bosco JA, Konopka J, Lajam CM. Influential Studies in Orthopaedic Platelet-Rich Plasma Research Are Recent and Consist of High Levels of Evidence: A Review of the Top 50 Most Cited Publications. J Knee Surg 2022. [PMID: 35272369 DOI: 10.1055/s-0042-1744223] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Platelet-rich plasma (PRP) has garnered widespread and increasing attention in recent years. We aimed to characterize the most influential articles in PRP research while clarifying controversies surrounding its use and clinical efficacy and identifying important areas on which to focus future research efforts. The Science Citation Index Expanded subsection of the Web of Science Core Collection was systematically searched to identify the top 50 cited publications on orthopedic PRP research. Publication and study characteristics were extracted, and Spearman's correlations were calculated to assess the relationship between citation data and level of evidence. The top 50 articles were published between the years 2005 and 2016, with 68% published in the year 2010 or later. Of the 33 studies for which level of evidence was assessed, the majority were of level I or II (18, 54.5%). Seventeen articles (34%) were classified as basic science. All clinical studies were prospective, and most (12 studies, 60%) included a high number of metrics related to the PRP preparation protocol and composition. Knee osteoarthritis was the most common topic among clinical studies in the top 50 cited articles (11 studies, 34%). More recent articles were associated with higher citation rates (ρ = 0.46, p < 0.001). The most influential articles on orthopaedic PRP research are recent and consist of high-level of evidence studies mostly. Randomized controlled trials were the most common study type, while basic science articles were relatively less common. The most influential clinical studies reported a high number of metrics related to their PRP preparation protocol and the final PRP composition. These results suggest a rapidly evolving field with the potential to better explain inconsistent clinical results with improved understanding and documentation of basic science concepts such as PRP composition, preparation, and combination techniques.
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Affiliation(s)
- Jacob F Oeding
- School of Medicine, New York University Grossman School of Medicine, New York, New York
| | - Drew A Lansdown
- Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California
| | - Philipp Leucht
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Joseph A Bosco
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Jaclyn Konopka
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
| | - Claudette M Lajam
- Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York
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Paramanantham M, Seenappa H, Venkataraman S, Shanthappa AH. Functional Outcome of Platelet-Rich Plasma (PRP) Intra-lesional Injection for Tennis Elbow – A Prospective Cohort Study. Cureus 2022; 14:e22974. [PMID: 35415041 PMCID: PMC8990042 DOI: 10.7759/cureus.22974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Platelet-Rich Plasma (PRP) is an autologous human plasma preparation with a higher platelet concentration. Injection of PRP were, found to be effective in treating tendinopathy and arthritis. A few studies only focused in using PRP injection in patients with tennis elbow. This study was conducted to access the functional outcome of PRP injection in tennis elbow patients. Methodology A prospective study was done from June 2020 to June 2021, at R. L. Jalappa Hospital, Kolar, India among 80 individuals diagnosed with tennis elbow. All individuals aged between 18 to 65 years of either gender and the pain symptoms not subsided with oral analgesics or physiotherapy were included in this study. We analysed all the patients with a MAYO elbow performance score and Visual Analogue Pain Scale (VAS) during the follow-up period. Results In total, 80 individuals participated in our study, of which the mean age of the participants was 45.54. There is statistical significance in the difference of means of pain score obtained using both VAS and MAYO score at 12 weeks and 24 weeks. There is high significant positive correlation of age with the pain scores at 12th week and 24th week after the procedure. Conclusion In tennis elbow patients, PRP injection shows an effective reduction in pain according to VAS and MAYO score and especially, younger age patients have shown more benefit in terms of pain reduction with PRP treatment.
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Nowaczyk A, Szwedowski D, Dallo I, Nowaczyk J. Overview of First-Line and Second-Line Pharmacotherapies for Osteoarthritis with Special Focus on Intra-Articular Treatment. Int J Mol Sci 2022; 23:ijms23031566. [PMID: 35163488 PMCID: PMC8835883 DOI: 10.3390/ijms23031566] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/19/2022] [Accepted: 01/27/2022] [Indexed: 02/07/2023] Open
Abstract
Osteoarthritis (OA) can be defined as the result of pathological processes of various etiologies leading to damage to the articular structures. Although the mechanism of degenerative changes has become better understood due to the plethora of biochemical and genetic studies, the drug that could stop the degenerative cascade is still unknown. All available forms of OA therapy are based on symptomatic treatment. According to actual guidelines, comprehensive treatment of OA should always include a combination of various therapeutic options aimed at common goals, which are pain relief in the first place, and then the improvement of function. Local treatment has become more common practice, which takes place between rehabilitation and pharmacological treatment in the hierarchy of procedures. Only in the case of no improvement and the presence of advanced lesions visible in imaging tests, should surgery be considered. Currently, an increasing number of studies are being published suggesting that intra-articular injections may be as effective or even more effective than non-steroidal anti-inflammatory drugs (NSAIDs) and result in fewer systemic adverse events. The most commonly used preparations are hyaluronic acid (HA), glucocorticosteroids (GS), and also platelet-rich plasma (PRP) in recent years. This review aims to present the mechanism of action and clinical effectiveness of different pharmacological options in relieving pain and improving functions in OA as well as the emerging approach in intra-articular treatment with PRP.
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Affiliation(s)
- Alicja Nowaczyk
- Department of Organic Chemistry, Faculty of Pharmacy, LudwikRydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 2 dr. A. Jurasza St., 85-094 Bydgoszcz, Poland
- Correspondence: (A.N.); (J.N.); Tel.: +48-52-585-3904 (A.N.); +48-56-6114838 (J.N.)
| | - Dawid Szwedowski
- Department of Orthopaedics and Trauma Surgery, Provincial Polyclinical Hospital, 87-100 Toruń, Poland;
- Orthopedic Arthroscopic Surgery International (O.A.S.I.) Bioresearch Foundation, Gobbi N.P.O., 20133 Milan, Italy
| | - Ignacio Dallo
- Unit of Biological Therapies, SportMe Medical Center, Department of Orthopaedic Surgery and Sports Medicine, 41013 Seville, Spain;
| | - Jacek Nowaczyk
- Department of Physical Chemistry and Physicochemistry of Polymers, Faculty of Chemistry, Nicolaus Copernicus University, 7 Gagarina St., 87-100 Toruń, Poland
- Correspondence: (A.N.); (J.N.); Tel.: +48-52-585-3904 (A.N.); +48-56-6114838 (J.N.)
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15
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Yang H, Shao GX, Du ZW, Li ZW. Treatment for subtrochanteric fracture and subsequent nonunion in an adult patient with osteopetrosis: A case report and review of the literature. World J Clin Cases 2021; 9:11007-11015. [PMID: 35047611 PMCID: PMC8678881 DOI: 10.12998/wjcc.v9.i35.11007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/04/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND As a congenital metabolic bone disease caused by defective osteoclastic resorption of immature bone, osteopetrosis is characterized by diffused sclerosis of bones, brittle bones, easy fracturing, narrow medullary canals, and a weak fracture healing ability. At present, clear standards and principles for the treatment of fractures in patients with osteopetrosis are lacking. Non-operative treatment can prevent fracture hematoma and preserve the blood supply to the bone fragments, while being associated with frequent failures and higher mortality rates. Meanwhile, closed reduction and internal fixation with intramedullary nail (CRIF + IMN) approaches can also protect blood supply to the fracture site. However, IMN cannot be used for the vast majority of patients with osteopetrosis due to the narrowing of medullary canals. Thus, open reduction and internal fixation with plate remains the most appropriate surgical method for treating fractures in patients with osteopetrosis, but this approach is complicated by the lack of intramedullary hematopoiesis in such patients. Fracture healing primarily depends on the blood supply to the external periosteum. Open reduction can also easily destroy the periosteum and cause delayed fracture healing or even nonunion; however, CRIF may be the most practical approach. As a result, it would be prudent to solve the difficulty of drilling during the operation and the problem of postoperative nonunion.
CASE SUMMARY In 2018, we treated an adult patient with osteopetrosis presenting with a subtrochanteric fracture. The fracture was fixed using a femoral locking compression plate. Because of delayed consolidation, at 12 mo postoperatively the patient was further treated with platelet-rich plasma (PRP) combined with radial extracorporeal shock wave therapy (rESWT). Antero-posterior and lateral radiographs obtained at the latest follow-up (10 mo) showed that the callus had grown at the original fracture site, and the medial fracture line almost disappeared.
CONCLUSION Osteosynthesis remains the first choice of treatment approach for fractures in patients with osteopetrosis, especially peritrochanteric fractures. Preoperative preparation is necessary to avoid risks such as drill bit breakage and iatrogenic fracture during the operation. Moreover, fractures in a patient with osteopetrosis present with a high risk of delayed union and nonunion, which can be potentially cured with PRP + rESWT.
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Affiliation(s)
- Hao Yang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Guo-Xi Shao
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Zhen-Wu Du
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
| | - Zheng-Wei Li
- Departments of Orthopedics, The Second Hospital of Jilin University, Changchun 130041, Jilin Province, China
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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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17
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Barman A, Mishra A, Maiti R, Sahoo J, Thakur KB, Sasidharan SK. Can platelet-rich plasma injections provide better pain relief and functional outcomes in persons with common shoulder diseases: a meta-analysis of randomized controlled trials. Clin Shoulder Elb 2021; 25:73-89. [PMID: 34823313 PMCID: PMC8907495 DOI: 10.5397/cise.2021.00353] [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: 06/02/2021] [Accepted: 07/26/2021] [Indexed: 11/26/2022] Open
Abstract
Background To evaluate the efficacy of autologous platelet-rich plasma (PRP) injections in the treatment of common shoulder diseases. Methods The PubMed, Medline, and Central databases and trial registries were searched from their inception to October 2020 for randomized controlled trials of autologous PRP injections for shoulder diseases versus placebo or any control intervention. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed in the selection, analysis, and reporting of findings. The primary outcome was pain intensity (visual analog scale), and secondary outcomes were changes in function and quality of life (QoL). Results A total of 17 randomized controlled trials of PRP versus control were analyzed. From 8–12 weeks to ≥1 year, PRP injections were associated with better pain relief and functional outcomes than control interventions. PRP injections were also associated with greater QoL, with an effect size of 2.61 (95% confidence interval, 2.01–14.17) at medium-term follow-up. Compared with placebo and corticosteroid injections, PRP injections provided better pain relief and functional improvement. In subgroup analyses, trials in which PRP was prepared by the double centrifugation technique, the platelet concentration in the PRP was enriched ≥5 times, leucocyte-rich PRP was used, or an activating agent was used before application reported the most effective pain relief at 6–7 months. Conclusions PRP injections could provide better pain relief and functional outcomes than other treatments for persons presenting with common shoulder diseases. PRP injections have a greater capacity to improve shoulder-related QoL than other interventions.
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Affiliation(s)
- Apurba Barman
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Archana Mishra
- Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India
| | - Rituparna Maiti
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Jagannatha Sahoo
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Kaustav Basu Thakur
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Sreeja Kamala Sasidharan
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Bhubaneswar, India
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18
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Ryan JM, Imbergamo C, Sudah S, Kirchner G, Greenberg P, Monica J, Gatt C. Platelet-Rich Product Supplementation in Rotator Cuff Repair Reduces Retear Rates and Improves Clinical Outcomes: A Meta-analysis of Randomized Controlled Trials. Arthroscopy 2021; 37:2608-2624. [PMID: 33744318 PMCID: PMC8349828 DOI: 10.1016/j.arthro.2021.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 03/01/2021] [Accepted: 03/05/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to conduct a comprehensive systematic review and meta-analysis to investigate the clinical and imaging outcomes of all 4 types of platelet-rich therapies (pure platelet-rich plasma [P-PRP], leukocyte and platelet-rich plasma, pure platelet-rich fibrin, and leukocyte and platelet-rich fibrin) in rotator cuff repairs. METHODS A systematic literature search was performed to identify rotator cuff tears comparing any of the 4 types of platelet-rich products (PRP) to a control in rotator cuff repair. Data extracted from the studies included retear rates diagnosed with imaging studies, as well as outcome scores such as Constant, American Shoulder and Elbow Surgeons (ASES), University of California Los Angeles (UCLA), Simple Shoulder Test (SST), and visual analog scale (VAS). Meta-analyses compared postoperative outcome scores and retear rates between the control and study groups. RESULTS Seventeen studies were included in the meta-analysis. When pooling data from all studies, retear rate for the treatment group was 19.3%, compared to 25.4% for the control group (odds ratio [OR] 0.59, P = .0037). When stratified based on PRP type, only P-PRP resulted in a significant reduction in retear rate (OR 0.26, P = .0005). Overall, treatment with PRP significantly improved Constant scores when compared to controls (mean difference [MD] 2.41, P =.0027), as well as VAS scores (MD -0.12, P = .0014), and SST scores (MD 0.41, P = .0126). There was no significant difference in ASES scores (MD 0.37, P = .7762) or UCLA scores (MD 0.76, P =0.2447) between treatment and controls when pooling data from all studies. CONCLUSIONS This analysis demonstrates significant reductions in retear rates when rotator cuff repair is augmented with PRP. P-PRP appears to be the most effective formulation, resulting in significantly improved retear rates and clinical outcome scores when compared with controls.
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Affiliation(s)
- James M Ryan
- Rutgers Robert Wood Johnson Medical School, New Brunswick,
NJ
| | - Casey Imbergamo
- Rutgers Robert Wood Johnson Medical School, New Brunswick,
NJ
| | | | | | | | - James Monica
- Rutgers Robert Wood Johnson Medical School, New Brunswick,
NJ
| | - Charles Gatt
- Rutgers Robert Wood Johnson Medical School, New Brunswick,
NJ
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Jiang P, Mao L, Qiao L, Lei X, Zheng Q, Li D. Efficacy and safety of mesenchymal stem cell injections for patients with osteoarthritis: a meta-analysis and review of RCTs. Arch Orthop Trauma Surg 2021; 141:1241-1251. [PMID: 33507375 DOI: 10.1007/s00402-020-03703-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/03/2020] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Osteoarthritis (OA), which has a high incidence in the elderly, brings a huge economic burden to society. MSCs (Mesenchymal Stem Cells) have shown great multidirectional differentiation potential which are expected to treat OA, and numerous clinical trials have been conducted. However, the efficacy and safety of the MSCs still need to be further integrated and analyzed. MATERIALS AND METHODS We searched several databases (PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, Ovid, and ScienceDirect) for assessing eligible trials that randomized controlled trials, hyaluronic acid as control, and MSCs injection to treat OA. Vitro studies and animal studies were excluded. Search terms were: "cartilage," "clinical trial," "mesenchymal," "stromal" and "stem cell", "osteoarthritis". The preliminary guidelines and study protocol were published online at PROSPERO. RESULTS Many assessment scales could not be improved significantly after 6 months. However, most of the scales were significantly improved after 12 months, indicating that compared with hyaluronic acid, stem cells could relieve OA symptoms significantly. No serious adverse effect was found. CONCLUSION There are significant therapeutic effects on joint function, symptoms, and no permanent adverse effect has been found after stem cell treatment. It is promising to apply intro-articular injection of stem cells for OA to clinical application. More researches are needed to supplement present deficiencies.
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Affiliation(s)
- Pan Jiang
- Affiliated Hospital of Jiangsu University, No.438, Jiefang road, Zhenjiang, 212000, China
| | - Lianghao Mao
- Affiliated Hospital of Jiangsu University, No.438, Jiefang road, Zhenjiang, 212000, China
| | - Longwei Qiao
- The Affiliated Suzhou Hospital of Nanjing Medical University, Nanjing, China
| | - Xuan Lei
- Affiliated Hospital of Jiangsu University, No.438, Jiefang road, Zhenjiang, 212000, China
| | - Qiping Zheng
- School of Medicine, Jiangsu University, Zhenjiang, China
| | - Dapeng Li
- Affiliated Hospital of Jiangsu University, No.438, Jiefang road, Zhenjiang, 212000, China.
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Trevisson B, Becerro-de-Bengoa-Vallejo R, Sevillano D, González N, Losa-Iglesias M, López-López D, Alou L. Age-based inter-subject variability in platelet and white blood cell concentrations of platelet-rich plasma prepared using a new application to blood separation system. Int Wound J 2021; 19:362-369. [PMID: 34114747 PMCID: PMC8762541 DOI: 10.1111/iwj.13636] [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: 05/14/2021] [Revised: 05/25/2021] [Accepted: 05/26/2021] [Indexed: 12/20/2022] Open
Abstract
The benefit of autologous platelet‐rich plasma (PRP) treatment is still under discussion. Variations in PRP products, consequence of the lack of a standardised protocol for the multitude of commercially available blood separation systems and the lack of knowledge of the optimal composition of PRP or its suitability for the proposed indication are some of the reasons behind clinical inconsistencies. The impact of inter‐subject variability in PRP has received less attention in comparison. The purpose of this study was to determine the inter‐subject variability, based on age, in the concentrates prepared by a new blood concentration system. Twenty‐six healthy volunteers of both genders (29‐93 years) were enrolled. Whole blood (WB) was collected from each participant to prepare PRP using the Easy PRP kit. Platelets and white blood cells (WBC) from WB and PRP were analysed after split population by age; patients younger than 65 years (n = 13) and patients ≥65 years old (n = 13). Among the demographic characteristics tested, only age was significantly different between the groups. Cell capture efficiency of the system was specific for each type of blood cell and identical for both age groups. Platelets and WBC in PRP were higher than in WB (P < .001). In WB, platelets and WBC concentrations were significantly lower in older group (P ≤ .035). These differences persisted in the prepared PRP (P ≤ .004). The ageing of population has a strong influence on the haematocrit and therefore on the composition of PRP. Because the efficiency of blood separator system seems to be constant across individuals, the inter‐subject haematocrit variability based on age could be used as a predictor of resulting PRP. The clinical application of PRP should be restricted to the specific cell capture capacity of the different commercial devices.
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Affiliation(s)
- Bibiana Trevisson
- SALBIS Research Group, Nursing Department, Faculty of Health Sciences, Universidad de León, León, Spain
| | | | - David Sevillano
- Microbiology Section, Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Natalia González
- Microbiology Section, Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Marta Losa-Iglesias
- Nursing and Stomatology Department, Faculty of Health Science, Universidad Rey Juan Carlos, Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, Ferrol, Spain
| | - Luis Alou
- Microbiology Section, Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Gentile P, Alves R, Cole JP, Andjelkov K, Van Helmelryck T, Fernandez J, Trivisonno A, Guillaume L, Verpaele A, Tonnard P, Magalon J, Magalon G, Menkes S. AIRMESS - Academy of International Regenerative Medicine & Surgery Societies: recommendations in the use of platelet-rich plasma (PRP), autologous stem cell-based therapy (ASC-BT) in androgenetic alopecia and wound healing. Expert Opin Biol Ther 2021; 21:1443-1449. [PMID: 33769906 DOI: 10.1080/14712598.2021.1908995] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Many investigations showed that platelet-rich plasma (PRP), human follicles stem cells (HFSCs), and adipose-derived stem cells (ASCs), considered autologous stem cell-based therapy (ASC-BT), are effective for hair regrowth (HR) in patients affected by androgenetic alopecia and for wound healing (WH). The aim of this article is to analyze the in vitro and in vivo impact of different PRP, HFSCs, and ASCs preparation methods on HR and in WH. AREAS COVERED The analyzed data intended to clarify the molecular mechanism in which PRP, HFSCs, and ASCs are involved, the clinical use and related indications, fully respecting the European rules. Comparative studies between different systems of PRP, HFSCs, and ASCs preparation revealed differences in terms of HR and WH. EXPERT OPINION Despite a lack of standardized protocols, there is convincing evidence with objective measurement modalities that display positive outcomes of ASC-BT in HR and WH.
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Affiliation(s)
- Pietro Gentile
- Plastic and Reconstructive Surgery, Surgical Science Department, University of Rome "Tor Vergata", Rome, Italy.,Scientific Director of AIRMESS, Academy of International Regenerative Medicine & Surgery Societies, Geneva, Switzerland
| | - Rubina Alves
- Dermatology Department, Hospital Central Do Funchal, Funchal, Portugal.,Treasurer of AIRMESS, Academy of International Regenerative Medicine & Surgery Societies, Geneva, Switzerland
| | - John P Cole
- Cole Hair Transplant Group, Alpharetta, GA, USA.,Vice President of AIRMESS, Academy of International Regenerative Medicine & Surgery Societies, Geneva, Switzerland
| | - Katarina Andjelkov
- Research Associate, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Secretary of AIRMESS, Academy of International Regenerative Medicine & Surgery Societies, Geneva, Switzerland
| | | | - Jonathan Fernandez
- Plastic-Reconstructive and Hand Surgery Unit, University Hospital of Nice, Nice, France
| | - Angelo Trivisonno
- Department of Surgical Science, University of Rome "La Sapienza", Rome, Italy
| | | | - Alexis Verpaele
- Plastic Surgery Unit, Coupure Center for Plastic Surgery, Ghent, Belgium
| | - Patrick Tonnard
- Founder of Coupure Center for Plastic Surgery, Ghent, Belgium
| | - Jeremy Magalon
- Aix Marseille University, INSERM, INRAE, C2VN, Marseille, France
| | - Guy Magalon
- Plastic Surgeon, Plastic Surgery Department, Assistance Publique Hôpitaux De Marseille (APHM), Aix Marseille University, Marseille, France.,Honorary President of AIRMESS, Academy of International Regenerative Medicine & Surgery Societies, Geneva, Switzerland
| | - Sophie Menkes
- Forever Institute, Geneva, Switzerland.,President of AIRMESS, Academy of International Regenerative Medicine & Surgery Societies, Geneva, Switzerland
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The Use of Platelet-Rich Plasma for Treatment of Tenodesmic Lesions in Horses: A Systematic Review and Meta-Analysis of Clinical and Experimental Data. Animals (Basel) 2021; 11:ani11030793. [PMID: 33809227 PMCID: PMC7998797 DOI: 10.3390/ani11030793] [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: 02/08/2021] [Revised: 03/01/2021] [Accepted: 03/09/2021] [Indexed: 11/23/2022] Open
Abstract
Simple Summary Tenodesmic injuries are key problems for sport horses. Several therapies have been developed over the years, including platelet-rich plasma (PRP), an autologous product that should stimulate tissue regeneration with its high concentration of growth factors. Nowadays, there are conflicting reports concerning the effect of PRP in tenodesmic lesions. The aim of our systematic review was to determine the effect of PRP on tendons and ligaments healing through a meta-analysis, a process to determine consensus from across published studies. The meta-analysis is the quantitative component of a systematic review, a statistical synthesis of the published data about a topic. We selected studies that evaluate PRP therapy in vitro or in vivo, most of which had a high risk of bias. The results found there is no evidence that PRP enhances the healing of tendon and ligament injuries. In the future, further unbiased, blinded, and controlled studies are needed to clarify the efficacy of this platelet concentrate in the treatment of equine tendon and ligament injuries. Abstract The use of platelet-rich plasma (PRP) to enhance tenodesmic lesion healing has been questioned over the years. The aim of this study was to evaluate current literature to establish the effectiveness of PRP for treating tenodesmic lesions through a systematic review, in accordance with the PRISMA guidelines, and a meta-analysis. Studies comparing PRP with placebo or other treatments for horses with tenodesmic injuries or evaluated PRP effect on tendon and ligament explants were included. Outcomes were clinical, ultrasound, histologic, molecular evaluation, and adverse effects. Two authors independently extracted data and assessed each study’s risk of bias. Treatment effects were evaluated using risk ratios for dichotomous data, together with 95% CI. Data were pooled using the random-effects model. The quality of the evidence for each outcome was assessed using GRADE criteria. Twenty-four trials met inclusion criteria for systematic review, while fifteen studies were included in the meta-analysis. Results showed no significant differences in the outcomes between PRP and control groups. Finally, there is no definitive evidence that PRP enhances tendons and ligaments healing. Therefore, there is a need for more controlled trials to draw a firmer conclusion about the efficacy of PRP as a treatment for tenodesmic lesions in the horse.
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Everts PA, van Erp A, DeSimone A, Cohen DS, Gardner RD. Platelet Rich Plasma in Orthopedic Surgical Medicine. Platelets 2021; 32:163-174. [PMID: 33400591 DOI: 10.1080/09537104.2020.1869717] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
There is a global interest in optimizing post-surgical tissue repair strategies, leading to better patient outcomes and fewer complications, most ideally with reduced overall cost. In this regard, in recent years, the interest in autologous biological treatments in orthopedic surgery and sports medicine has increased greatly, and the addition of platelet-rich plasma (PRP) to the surgical armamentarium is of particular note. Unfortunately, the number of PRP preparation devices has also grown immensely over the recent decades, raising meaningful concern for the considerable variation in the qualities of currently available PRP preparations. The lack of consensus on the standardization of PRP preparation and of agreement on condition specific PRP formulations is largely responsible for the sometimes contradictory outcomes in the literature. Furthermore, the full potential of PRP technology, the concept of individualized treatment protocols based on bioformulation options, and platelet dosing, angiogenesis, and antimicrobial and painkilling effects of PRP relevant to orthopedic surgery have rarely been addressed. In this review, we will discuss recent developments regarding PRP preparations and potential therapeutic effects. Additionally, we present a synopsis of several published data regarding PRP applications in orthopedic surgery for treating tendon injuries, inducing bone repair, strengthening spinal fusion outcomes, and supporting major joint replacements.
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Affiliation(s)
- Peter A Everts
- Science and Research Department, Gulf Coast Biologics, Fort Myers, FL, USA
| | | | | | - Dan S Cohen
- Spine Care Institute of Miami Beach, Mt. Sinai Medical Center, Miami Beach, FL, USA
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El Gharbawy NH, Labib HS. Role of Platelet Rich Plasma (PRP) injection in treatment of rotator cuff tear. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2020. [DOI: 10.1186/s43166-020-00032-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Abstract
Background
One of the commonest causes of shoulder pain and disability is partial thickness tear of the rotator cuff. Platelet-rich plasma (PRP) therapy is a volume of the plasma fraction of autologous blood that has platelet concentration above the baseline. It is theorized that PRP may help stimulate the development of normal-appearing histologic tissue characteristics at the repair site and improve clinical outcomes. Our purpose is to assess the efficacy of PRP therapy in treatment of rotator cuff tear. This prospective single-center study involved 30 patients (aged 31.7 ± 7.7 years, 63.3% males) complaining of symptomatic rotator cuff tear. Platelet-rich plasma (PRP) injection was done to all patients. Before and after injection of PRP, scoring was done using visual analog score, Shoulder Pain and Disability Index (SPADI), and musculoskeletal ultrasound scoring of the tear. Reassessment was done 4 weeks after the injections.
Results
The pre-injection VAS pain score was 7.1 ± 0.99 after injection, and it became 3.7 ± 1.09. Also, SPADI score decreased from 78.03 ± 8.25 pre-injection to 42.1 ± 13.97 post-injection. There was a highly statistically significant difference in VAS pain score and SPADI score before and after PRP injection (p < 0.001). There was highly statistically significant positive correlation between the improvement of US grading score change and the improvement of VAS score change, and between it and SPADI improvement change (r = 0.695, p < 0.001 and r = 0.693, p < 0.001, respectively). There was a highly statistically significant difference between US grading score before and after PRP injection (p < 0.001).
Conclusion
PRP can be considered an effective method for treatment of rotator cuff tear and less invasive compared to surgical treatment. It improves the pain, shoulder function, and tear size.
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Bilal Ö, Topak D, Kınaş M, Kurutaş EB, Kızıldağ B, Bahar AY. Epidermal growth factor or platelet-rich plasma combined with induced membrane technique in the treatment of segmental femur defects: an experimental study. J Orthop Surg Res 2020; 15:601. [PMID: 33308245 PMCID: PMC7730740 DOI: 10.1186/s13018-020-02142-2] [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: 09/23/2020] [Accepted: 11/30/2020] [Indexed: 02/15/2023] Open
Abstract
Objective Extensive bone defects remain a therapeutic challenge necessitating alternative surgical approaches with better outcomes. Can increase the effectiveness of PRP or EGF treatment in surgical treatment of large bone defects with Masquelet technique? Aim of this study examined potential therapeutic benefits of the Masquelet technique with induced membranes in combination with platelet-rich plasma (PRP) or epidermal growth factor (EGF) in a rat model of segmental femur defect. Methods Three groups each consisting of 20 Sprague-Dawley rats were defined as follows: EGF group, PRP group, and control group. A femoral bone defect was created and filled with antibiotic embedded polymethyl methacrylate. Half of the animals in each group were sacrificed at week 6 and the pseudo-membranes formed were analyzed. In the remaining half, the cement was removed and the space was filled with autograft. After another 6 weeks, the structures formed were examined radiologically, histologically, and biochemically. Results At week 6, both PRP and EGF groups had significantly higher membrane CD31, TGF-beta, and VEGF levels than controls. At week 12, when compared to controls, PRP and EGF groups had significantly higher membrane CD31 levels and the PRP group had significantly higher membrane TGF levels. Regarding bone tissue levels, PRP and EGF groups had significantly higher VEGF levels and the EGF group had significantly higher BMP levels. In addition, PRP and EGF groups had higher radiological scores than controls. However, the two experimental groups did not differ with respect to any parameter tested in this study. Conclusion Both PRP and EGF seem to be associated with histological, biochemical, and radiological improvements in experimental rat model of Masquelet technique, warranting in further clinical studies. Level of evidence Level 5
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Affiliation(s)
- Ökkeş Bilal
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Duran Topak
- Department of Orthopaedic and Traumatology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.
| | | | - Ergül Belge Kurutaş
- Department of Biochemistry, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Betül Kızıldağ
- Department of Radiology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Abdulkadir Yasir Bahar
- Department of Pathology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
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26
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Fernandez-Moure JS, Van Eps JL, Scherba JC, Yazdi IK, Robbins A, Cabrera F, Vatsaas CJ, Moreno M, Weiner BK, Tasciotti E. Addition of platelet-rich plasma supports immune modulation and improved mechanical integrity in Alloderm mesh for ventral hernia repair in a rat model. J Tissue Eng Regen Med 2020; 15:3-13. [PMID: 33197147 DOI: 10.1002/term.3156] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/22/2020] [Accepted: 10/10/2020] [Indexed: 01/08/2023]
Abstract
The recurrence of ventral hernias continues to be a problem faced by surgeons, in spite of efforts toward implementing novel repair techniques and utilizing different materials to promote healing. Cadaveric acellular dermal matrices (Alloderm) have shown some promise in numerous surgical subspecialties, but these meshes still suffer from subsequent failure and necessitation of re-intervention. Here, it is demonstrated that the addition of platelet rich plasma to Alloderm meshes temporally modulates both the innate and cytotoxic inflammatory responses to the implanted material. This results in decreased inflammatory cytokine production at early time points, decreased matrix metalloproteinase expression, and decreased CD8+ T cell infiltration. Collectively, these immune effects result in a healing phenotype that is free from mesh thinning and characterized by increased material stiffness.
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Affiliation(s)
| | - Jeffrey L Van Eps
- Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA.,Department of Nanomedicine, Surgical Advanced Technologies Lab, Houston Methodist Research Institute, Houston, Texas, USA
| | - Jacob C Scherba
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Iman K Yazdi
- Department of Nanomedicine, Surgical Advanced Technologies Lab, Houston Methodist Research Institute, Houston, Texas, USA.,Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Robbins
- Department of Orthopedic Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | | | - Cory J Vatsaas
- Department of Surgery, Duke University School of Medicine, Houston, Texas, USA
| | | | - Bradley K Weiner
- Department of Nanomedicine, Surgical Advanced Technologies Lab, Houston Methodist Research Institute, Houston, Texas, USA.,Department of Orthopedic Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Ennio Tasciotti
- Department of Nanomedicine, Surgical Advanced Technologies Lab, Houston Methodist Research Institute, Houston, Texas, USA
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27
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Cai YF, Tian TZ, Chen LY, Liu BX, Zhou JP, Shi M, Liang HD. The effect of platelet-rich plasma on the fusion rate and clinical outcome of spinal fusion surgery: A systematic review and meta-analysis. PLoS One 2020; 15:e0243204. [PMID: 33270711 PMCID: PMC7714170 DOI: 10.1371/journal.pone.0243204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 11/17/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Platelet-rich plasma (PRP) is widely used in many orthopedic surgeries and spinal disease treatments; however, the effect of PRP on spinal fusion remains controversial. QUESTIONS/PURPOSES To assess the fusion rate and clinical results of PRP compared with non-PRP administration in the treatment of spinal fusion with regard to decreasing pain and improving healing and function. PATIENTS AND METHODS Studies comparing PRP to non-PRP treatment with respect to the fusion rate and clinical outcome in patients who underwent spinal fusion surgery were included. RESULT Three randomized controlled trials (RCTs) and 7 prospective cohort studies were identified. The spinal fusion rate was not significantly different between the groups in all RCTs or cohort studies at the final follow-up. In comparison, PRP significantly reduced pain after surgery as evaluated in the RCT analysis and the complication rate did not differ significantly between the two groups. CONCLUSION According to the available studies, PRP does not contribute to the union rate, relieve pain or increase the complication rate in spinal fusion surgery. As clinical heterogeneity exists in these studies, further large, well-designed RCTs that focus on the standard assessment of PRP are needed.
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Affiliation(s)
- Ying-feng Cai
- Department of Orthopaedics, The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Tian-Zhao Tian
- Department of Orthopaedics, The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Li-Ye Chen
- Department of Orthopaedics, The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Bao-Xin Liu
- Department of Orthopaedics, The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Jian-Peng Zhou
- Department of Orthopaedics, The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Min Shi
- Department of Orthopaedics, The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Hao-Dong Liang
- Department of Orthopaedics, The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
- * E-mail:
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Xu PC, Xuan M, Cheng B. Effects and mechanism of platelet-rich plasma on military drill injury: a review. Mil Med Res 2020; 7:56. [PMID: 33220706 PMCID: PMC7680596 DOI: 10.1186/s40779-020-00285-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 11/04/2020] [Indexed: 02/07/2023] Open
Abstract
Military drill injury is a significant part of military medical research. The increase of training intensity and changes in training methods lead to differences in injury types. The ideal therapeutic modality should allow rapid healing at a reasonable cost and minimize impact on patients' life. Platelet -rich plasma (PRP), a platelet concentrate, is rich in a variety of growth factors and widely used clinically as a minimally invasive treatment. It plays an important role in injury repair and rehabilitation. In this article, we review the therapeutic role of PRP in military drill injury and its possible underlying mechanisms, with a focus on plantar fasciitis, stress fractures and other common injuries, in order to provide basic support for military reserve.
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Affiliation(s)
- Peng-Cheng Xu
- Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command of Chinese PLA, No. 111 Liuhua Road, Yuexiu District, Guangzhou, 510010, Guangdong Province, China
| | - Min Xuan
- Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command of Chinese PLA, No. 111 Liuhua Road, Yuexiu District, Guangzhou, 510010, Guangdong Province, China
| | - Biao Cheng
- Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command of Chinese PLA, No. 111 Liuhua Road, Yuexiu District, Guangzhou, 510010, Guangdong Province, China.
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Danieli MV, Guerreiro JPF, Queiroz AO, da Rosa Pereira H, Cataneo DC. Leucocyte-poor-platelet-rich plasma intra-operative injection in chondral knee injuries improve patients outcomes. A prospective randomized trial. INTERNATIONAL ORTHOPAEDICS 2020; 45:463-471. [PMID: 32990794 DOI: 10.1007/s00264-020-04830-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 09/22/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE Evaluate the effects of intra-operative leucocyte-poor-platelet-rich plasma (PRP) (type P3-Bβ with endogenous activation) injection in International Cartilage Repair Society (ICRS) grade III knee chondral injuries treated by chondroplasties, to increase and ameliorate the repair tissue. METHODS Patients were divided into two groups. Group A (control) consisted of 31 patients and Group B (PRP) 33 patients, totaling 64 patients analyzed. Patients also could had associated injuries (meniscal and/or ACL) being equally divided between both groups to avoid bias. PRP was injected at the end of surgery in group B. The patient outcomes were assessed using subjective International Knee Documentation Committee (IKDC) form, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Tegner activity forms, prior to the surgery and three, six, 12, and 24 months after surgery (medium-term follow up). RESULTS IKDC and KOOS scores showed increase at each evaluation time points after surgery in both groups, but the treated Group (B) showed a higher increase with statistically significant difference. The Tegner activity scores were higher for the treated group only at six and 12 months. CONCLUSION Based on the subjective IKDC, KOOS, and Tegner scores, those patients affected by ICRS grade III chondral injuries undergoing arthroscopic chondroplasty who were also treated with PRP showed better and faster outcomes than the control group. Independently from the associated injury (meniscal or ACL). This difference could be measured for up to two years.
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Affiliation(s)
| | | | | | - Hamilton da Rosa Pereira
- Departamento de Cirurgia, Faculdade de Medicina, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
| | - Daniele Cristina Cataneo
- Departamento de Cirurgia, Faculdade de Medicina, Universidade Estadual Paulista (UNESP), Botucatu, SP, Brazil
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Improved outcomes after mesenchymal stem cells injections for knee osteoarthritis: results at 12-months follow-up: a systematic review of the literature. Arch Orthop Trauma Surg 2020; 140:853-868. [PMID: 31456015 DOI: 10.1007/s00402-019-03267-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Indexed: 12/26/2022]
Abstract
PURPOSE According to the World Health organization (WHO), more than 10% in people older than 60 years suffer from osteoarthritis (OA). Over the last years, there has been an increased interest around regenerative medicine, especially regarding stem cell treatments and related applications. We hypothesize that stem cell therapies can represent a feasible option for idiopathic knee OA, delaying or even avoiding the joint replacement. To emphasize the potential of percutaneous injections of mesenchymal stem cells for knee OA, a comprehensive systematic review of the literature was conducted. MATERIAL AND METHODS Two independent authors (FM, GC) performed the literature search. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). The main databases were accessed: Pubmed, Embase, Google Scholar, Cochrane Systematic Reviews, Scopus, AMED. For this systematic review, all articles treating percutaneous injections of mesenchymal stem cells for knee OA were considered. Because of the rapid advancements promoted by the scientific progress on stem cell expansion and processing, only articles published within the last five years were included. Solely articles reporting the outcomes of interest across 6- and 12-month follow-up were recruited for eligibility. We included only studies reporting quantitative data under the outcomes of interest. We referred for the quality assessment to the Coleman Methodology Score (CMS). The statistical analysis was performed with Review Manager Software 5.3 (The Nordic Cochrane Centre, Copenhagen). RESULTS A total of 18 studies were enrolled in the present study, comprising 1069 treated knees. The mean age of the samples was 57.39 ± 7.37 years. 72% of the included studies harvested the stem cells from the iliac crest (bone marrow-derived MSCs), the remaining 28% from the adipose tissue (adipose-derived MSCs). The mean visual analogic scale improved from 18.37 to 30.98 and 36.91 at 6- and 12-month follow-up, respectively. The mean WOMAC score improved from 25.66 to 25.23 and 15.60 at 6- and 12-month follow-up, respectively. The mean walking distance improved from 71.90 to 152.22 and 316.72 at 6- and 12-month follow-up, respectively. The mean Lequesne scale improved from 33.76 to 12.90 at 12-month follow-up. The KOOS score improved from 41.07 to 8.47% and 18.94 at 6- and 12-month follow-up. All the KOOS subscales improved significantly from the baseline. A total of 136 (12.7%) local complications were detected. CONCLUSION According to the current evidences and the main findings of this systematic review, we reported that MSC infiltrations for knee OA can represent a feasible option, leading to an overall remarkable improvement of all clinical and functional considered outcomes, regardless of the cell source. Patients treated at earlier-degeneration stages reported statistically significant greater outcomes. The pain and function scores were improved considerably, thus, leading to a significant improvement of patient participation in recreational activities and quality of life.
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Rasheed N, Hafeez K, Zaidi IH, Askari R, Rasheed N, Khani GMK. Role of platelet-rich plasma in early osteoarthritis of knee joint: Experience from a tertiary care center in Pakistan. J Orthop Surg (Hong Kong) 2020; 27:2309499019853953. [PMID: 31177908 DOI: 10.1177/2309499019853953] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Osteoarthritis is the most common articular disease. The aim of this study was to observe the outcome after intra-articular platelet-rich plasma (PRP) injection in our patients presenting with knee osteoarthritis. METHODS This study was conducted in Dow University of Health Sciences, Karachi, Pakistan, from December 2014 to December 2015. All patients between 35 years and 60 years of age diagnosed with grade I and II arthritis were included in the study. Three PRP injections were injected in the knees at 4-week interval. Patients were followed up in outpatient department (OPD) and were assessed for pain and physical activity associated with arthritis using the Western Ontario and McMaster University Arthritis Index (WOMAC) score at the time of induction in the study and at 6 months interval. RESULTS Two hundred fourteen patients with the mean age of 55.15 (±6.93) years were studied. Female to male ratio was 3:1. One hundred fifty-five patients were classified as having Kellgren-Lawrence grade 1 osteoarthritis, while 59 were grade 2. One hundred eighty-nine patients had clinical symptoms for less than 2 years and 25 for more than 2 years. Mean WOMAC score before the start of treatment was 83.05, and after 6 months, it was reduced to 38.84 which was statistically significant ( p = 0.000). WOMAC score was improved more in the subgroup with patients having symptoms less than 2 years ( p = 0.005). Three patients developed minor hyperemia which was managed conservatively with activity limitation and ice application, but none of the patient developed gross infection. CONCLUSION The sequential use of PRP injection for the treatment of early osteoarthritis proved to be effective in our study.
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Affiliation(s)
- Nusrat Rasheed
- 1 Department of Orthopedics, Dow University of Health Sciences, Dow International Medical College, Karachi, Pakistan
| | - Kamran Hafeez
- 2 Department of Orthopedics, Buraidah Central Hospital, Al Qassim, Saudi Arabia
| | - Itat Hussain Zaidi
- 1 Department of Orthopedics, Dow University of Health Sciences, Dow International Medical College, Karachi, Pakistan
| | - Raza Askari
- 1 Department of Orthopedics, Dow University of Health Sciences, Dow International Medical College, Karachi, Pakistan
| | - Naseem Rasheed
- 3 Department of Gynecology and Obstetrics, Sindh Government Hospital, Karachi, Pakistan
| | - Ghulam Mustafa Kaim Khani
- 1 Department of Orthopedics, Dow University of Health Sciences, Dow International Medical College, Karachi, Pakistan
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Baig MZ, Abdullah UEH, Muhammad A, Aziz A, Syed MJ, Darbar A. Use of Platelet-Rich Plasma in Treating Low Back Pain: A Review of the Current Literature. Asian Spine J 2020; 15:117-126. [PMID: 32160728 PMCID: PMC7904486 DOI: 10.31616/asj.2019.0161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/21/2019] [Indexed: 11/23/2022] Open
Abstract
Low back pain (LBP) is a common problem encountered by physicians. It is a considerable cause of morbidity and socioeconomic loss and is one of the most expensive musculoskeletal disorders. Conventional treatments include bed rest, analgesics, therapeutic exercises, lumbar or caudal epidural corticosteroids, and surgery. Several new biological therapies are being investigated for use in LBP and one of these is platelet-rich plasma (PRP). In this article, we summarize the current literature published on PRP concerning its composition, classification, and application in LBP. We believe our review will prove useful to clinicians and academics alike, interested in new developing therapies for LBP.
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Affiliation(s)
- Mirza Zain Baig
- Department of Surgical Oncology, Dyson Cancer Center, Health Quest Health Systems/Nuvance Health, Poughkeepsie, NY, USA
| | - Umm E Hani Abdullah
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA
| | - Aun Muhammad
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Abeer Aziz
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Maryam Jamil Syed
- Department of Neurology, Aga Khan University Hospital, Karachi, Pakistan
| | - Aneela Darbar
- Department of Neurosurgery, Aga Khan University Hospital, Karachi, Pakistan
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Atwan Y, Schemitsch EH. The top three unanswered questions in the management of open fractures. OTA Int 2020; 3:e072. [PMID: 33937691 PMCID: PMC8081489 DOI: 10.1097/oi9.0000000000000072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 12/23/2019] [Indexed: 11/26/2022]
Abstract
Despite improvements in treatment strategies and emphasis on preventative measures, the management of open fractures continues to be a challenging endeavor for orthopaedic surgeons. Deep infections, delayed healing, and nonunion continue to be problematic complications associated with these devastating injuries. There remain many unanswered clinical questions regarding the management of these injuries and how the various aspects of care can be further optimized. There continues to be a paucity of evidence regarding how infection can best be treated and prevented, how to reliability predict bone healing/nonunion, and how bone healing can be best augmented in the setting of open fractures and their potential nonunions. This review aims to assess the current literature on these top unanswered questions and discuss the gaps in evidence that may be filled with future studies.
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Affiliation(s)
- Yousif Atwan
- Division of Orthopaedic Surgery, Western University, London, ON, Canada
| | - Emil H Schemitsch
- Division of Orthopaedic Surgery, Western University, London, ON, Canada
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Twomey-Kozak J, Jayasuriya CT. Meniscus Repair and Regeneration: A Systematic Review from a Basic and Translational Science Perspective. Clin Sports Med 2020; 39:125-163. [PMID: 31767102 DOI: 10.1016/j.csm.2019.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Meniscus injuries are among the most common athletic injuries and result in functional impairment in the knee. Repair is crucial for pain relief and prevention of degenerative joint diseases like osteoarthritis. Current treatments, however, do not produce long-term improvements. Thus, recent research has been investigating new therapeutic options for regenerating injured meniscal tissue. This review comprehensively details the current methodologies being explored in the basic sciences to stimulate better meniscus injury repair. Furthermore, it describes how these preclinical strategies may improve current paradigms of how meniscal injuries are clinically treated through a unique and alternative perspective to traditional clinical methodology.
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Affiliation(s)
- John Twomey-Kozak
- Department of Orthopaedics, Brown University/Rhode Island Hospital, Box G-A1, Providence, RI 02912, USA
| | - Chathuraka T Jayasuriya
- Department of Orthopaedics, Brown University/Rhode Island Hospital, Box G-A1, Providence, RI 02912, USA.
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Zheng W, Zhao DL, Zhao YQ, Li ZY. Effectiveness of platelet rich plasma in burn wound healing: a systematic review and meta-analysis. J DERMATOL TREAT 2020; 33:131-137. [PMID: 32048887 DOI: 10.1080/09546634.2020.1729949] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Wang Zheng
- Department of Burns, The Fifth Hospital of Harbin, Harbin, China
| | - De-lai Zhao
- Orthopaedic Ward, The Fifth Hospital of Harbin, Harbin, China
| | - Yan-qiu Zhao
- Department of Hemato-Oncology, The First Affiliated Hospital Harbin, Harbin Medical University, Harbin, China
| | - Zong-yu Li
- Department of Burns, The Fifth Hospital of Harbin, Harbin, China
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Ozcan P, Takmaz T, Tok OE, Islek S, Yigit EN, Ficicioglu C. The protective effect of platelet-rich plasma administrated on ovarian function in female rats with Cy-induced ovarian damage. J Assist Reprod Genet 2020; 37:865-873. [PMID: 32020412 DOI: 10.1007/s10815-020-01689-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/03/2020] [Indexed: 12/31/2022] Open
Abstract
PURPOSE We evaluated the protective effect of PRP on ovarian function in female rats with cyclophosphamide (Cy)-induced ovarian damage. METHODS Thirty-two adult female Sprague-Dawley rats were randomly divided into four groups. Group 1 (control-sodium chloride 0.9%; 1 mL/kg, single-dose ip injection), group 2 (Cy); 75 mg/kg, single-dose ip injection and sodium chloride 0.9% (1 mL/kg, single-dose ip injection), group 3 Cy plus PRP, Cy (75 mg/kg, single-dose and PRP (200 μl, single-dose) ip injection), group 4 (PRP, 200 μl, single-dose ip injection). Primordial, antral, and atretic follicle counts; serum anti-Müllerian hormone (AMH) levels; AMH-positive granulosa cells; and gene expression analysis of Ddx4 were assessed. RESULTS Serum AMH levels were significantly lower in group 2 compared to groups 1, 3, and 4 (p < 0.01, p < 0.01, and p = 0.04, respectively). A significant difference was found in the primordial, primary, secondary, antral, and atretic follicle counts between all groups (p < 0.01). There was a statistically significant difference in AMH-positive staining primary, secondary, and antral follicles count between the groups (p < 0.01). There was a statistically significant difference in primary, secondary, and antral AMH positive staining follicle intensity score between the groups (p < 0.01). Ddx4 expression in group 4 was highest compared to other groups. CONCLUSION Our study may provide evidence that PRP could protect ovarian function against ovarian damage induced by Cy. It could lead to improved primordial, primary, secondary, and antral follicle numbers.
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Affiliation(s)
- Pinar Ozcan
- Department of Obstetrics and Gynecology, Bezmialem University Faculty of Medicine, İskender Paşa Mh Adnan Menderes Bulvarı, Vatan Cad, 34093, Fatih/İstanbul, Turkey. .,Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Bezmialem University Faculty of Medicine, İstanbul, Turkey.
| | - Taha Takmaz
- Department of Obstetrics and Gynecology, Bezmialem University Faculty of Medicine, İskender Paşa Mh Adnan Menderes Bulvarı, Vatan Cad, 34093, Fatih/İstanbul, Turkey
| | - Olgu Enis Tok
- Department of Histology and Embryology, Faculty of Medicine, Istanbul Medipol University, İstanbul, Turkey
| | - Sevde Islek
- Department of Obstetrics and Gynecology, Bezmialem University Faculty of Medicine, İskender Paşa Mh Adnan Menderes Bulvarı, Vatan Cad, 34093, Fatih/İstanbul, Turkey
| | - Esra Nur Yigit
- Institute of Biotechnology, Gebze Technical University, Kocaeli, Turkey
| | - Cem Ficicioglu
- Department of Obstetrics and Gynecology, Acibadem Health Group, Istanbul, Turkey
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Figueroa D, Calvo R, Vaisman A, Arellano S, Figueroa F, Donoso R, Bernal N, O'Connell LA. Arthroscopic Intercondylar Notch Bone Marrow Aspiration During Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2019; 8:e1437-e1441. [PMID: 31890519 PMCID: PMC6928362 DOI: 10.1016/j.eats.2019.07.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 07/20/2019] [Indexed: 02/03/2023] Open
Abstract
The anterior cruciate ligament is the most commonly injured ligament, with up to 10% of surgery failure. Atraumatic instability in the early postoperative period (<6 months) occurs as the result of poor surgical technique, failure of graft integration, or early mechanical overload during rehabilitation. Engineered cell therapy is a developing resource designed to increase the rate of tendon-to-bone interface healing. We describe a simple and safe technique to harvest mesenchymal stem cells by arthroscopic bone marrow aspiration from the intercondylar notch.
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Affiliation(s)
| | | | | | | | | | | | | | - Luis A. O'Connell
- Address correspondence to Luis A. O'Connell, M.D., Servicio de Traumatología y Ortopedia de Adultos, Clínica Alemana de Santiago-Universidad del Desarrollo, Av Manquhue Norte 1410, Vitacura, Santiago, Chile.
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Pachito DV, Latorraca CDOC, Riera R. Efficacy of platelet-rich plasma for non-transfusion use: Overview of systematic reviews. Int J Clin Pract 2019; 73:e13402. [PMID: 31408240 DOI: 10.1111/ijcp.13402] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Platelet-rich plasma (PRP) is a blood component therapy with a supraphysiological concentration of platelets derived from allogenic or, more commonly, autologous blood. PRP has been used in different non-transfusion indications because of its role in the promotion of tissue repair and healing, in fields such as Traumatology, Dermatology and Dentistry. OBJECTIVE To provide a synthesis of the efficacy of PRP for different clinical situations. METHODS Systematic searches were carried out in MEDLINE, Embase, Cochrane Library and LILACS in July 2018 to identify systematic reviews (SRs) of randomized clinical trials (RCTs) focusing on PRP for non-transfusion use. Two authors independently screened all retrieved references in two stages (titles and abstracts at a first stage and full texts at a second stage). The methodological quality of SRs that met the eligibility criteria was appraised by AMSTAR 2. Conclusions were based on the most recent SRs with highest quality. RESULTS One thousand two hundred and forty references were retrieved. After checking the inclusion criteria, 29 SRs of RCTs related to three different fields (wound care, Orthopedics and Dentistry) were included. The results suggest the benefit of PRP for different clinical situations, such as diabetic wounds, acute lesions of musculoskeletal system, rotator cuff lesions, tendinopathies, knee and hip osteoarthritis, total knee arthroplasty, allogenic bone graft for dental implants and periodontal intrabony defects. CONCLUSION There is low to moderate quality evidence supporting the efficacy of PRP for specific clinical situations. The low quality of the evidence limits the certainty of these findings. Well-planned and well-conducted RCTs are still needed to further assess the efficacy of PRP.
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Affiliation(s)
- Daniela Vianna Pachito
- Hospital Sírio-Libanês, Núcleo de Avaliação de Tecnologias de Saúde, São Paulo, Brazil
- Disciplina de Economia e Gestão da Saúde, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Rachel Riera
- Hospital Sírio-Libanês, Núcleo de Avaliação de Tecnologias de Saúde, São Paulo, Brazil
- Evidence Based Health Program, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
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Park MS, Moon SH, Kim TH, Oh JK, Yoon WY, Chang HG. Platelet-rich plasma for the spinal fusion. J Orthop Surg (Hong Kong) 2019; 26:2309499018755772. [PMID: 29415616 DOI: 10.1177/2309499018755772] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
There has been a wide interest in using platelet-rich plasma (PRP) as a therapeutic agent to enhance spinal fusion. There are two review articles based only on clinical studies regarding the effect of PRP on spinal fusion. However, with regard to both animal model studies and clinical studies, there is no review studies regarding its effect on spinal fusion and no review studies focusing on the platelet count and the concentration of the growth factor in the PRP. The purpose is to review the literatures about the effect of PRP on spinal fusion according to the animal model studies and clinical studies, focusing on the effect of the platelet count and the concentration of the growth factor in the PRP. A PubMed search was performed for English-language articles. We identified 20 articles regarding the effect of PRP on fusion in animal model studies and clinical studies, of which 16 articles met the study criteria of case-control studies or prospective randomized studies for the spinal fusion. The articles were categorized into small-sized animal model, middle-sized animal model, and clinical studies. Studies have shown both beneficial and inhibitory effects. The conclusion that PRP has the stimulating effect on spinal fusion was not reached. However, PRP might promote the human spinal fusion if the platelet count or the concentration of growth factors in the PRP increases.
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Affiliation(s)
- Moon Soo Park
- 1 Department of Orthopaedic Surgery, Medical College of Hallym University, Gyeonggi-do, Republic of Korea
| | - Seong-Hwan Moon
- 2 Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hwan Kim
- 1 Department of Orthopaedic Surgery, Medical College of Hallym University, Gyeonggi-do, Republic of Korea
| | - Jae Keun Oh
- 3 Department of Neurosurgery, Medical College of Hallym University, Gyeonggi-do, Republic of Korea
| | - Won Yong Yoon
- 1 Department of Orthopaedic Surgery, Medical College of Hallym University, Gyeonggi-do, Republic of Korea
| | - Ho Guen Chang
- 1 Department of Orthopaedic Surgery, Medical College of Hallym University, Gyeonggi-do, Republic of Korea
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Ocak S, Buk OF, Genc B, Avcı B, Uzuner HO, Gundogdu SB. The effects of platelet-rich-plasma gel application to the colonic anastomosis in hyperthermic intraperitoneal chemotherapy: An experimental rat model. Int Wound J 2019; 16:1426-1432. [PMID: 31448554 DOI: 10.1111/iwj.13207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/05/2019] [Accepted: 08/11/2019] [Indexed: 12/14/2022] Open
Abstract
Hyperthermic intraperitoneal chemotherapy (HIPEC) has cytotoxic effects on tumour cells but also negative impacts on anastomotic healing. Platelet-rich-plasma (PRP) is used for wound care but data about effects on gastrointestinal anastomosis are limited. In this experimental study, we aimed to investigate the effects of PRP application on colon anastomosis in rats those received HIPEC with cisplatin. Five rats were sacrificed to obtain PRP gel. Thirty rats were divided into three groups; Group 1: control group, Group 2: colon anastomosis and HIPEC with cisplatin, and Group 3: colon anastomosis enhanced by PRP and HIPEC with cisplatin. The rats were re-operated on postoperative day seven and anastomotic bursting pressure (ABP) was recorded. Also, tissue samples were taken for hydroxyproline assessment and histopathological examination. There were significant differences in ABP between Groups 2 and 3, and also those groups had lower ABP compared with the control group. Group 3 had significantly higher hydroxyproline levels and had better histopathological findings than group 2. According to our findings, we suggest that PRP application improves the anastomotic healing by increasing anastomotic bursting pressure, hydroxyproline levels, and decreasing inflammatory response. Further clinical studies are needed to prove our hypothesis.
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Affiliation(s)
- Sonmez Ocak
- Department of General Surgery, University of Health Sciences, Samsun Research and Training Hospital, Samsun, Turkey
| | - Omer F Buk
- Department of General Surgery, University of Health Sciences, Samsun Research and Training Hospital, Samsun, Turkey
| | - Bugra Genc
- Department of Animal Nutrition and Nutritional Diseases, Faculty of Veterinary Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Bahattin Avcı
- Department of Biochemistry, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Hatice O Uzuner
- Department of Pathology, University of Health Sciences, Samsun Research and Training Hospital, Samsun, Turkey
| | - Salih B Gundogdu
- Department of Gastroenterological Surgery, University of Health Sciences, Turkiye Yuksek Ihtisas Research and Training Hospital Ankara, Turkey
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El Rayes J, Bou Sader R, Moutran M, Rassi S, Boueri W. Biologically Enhanced Hamstring Tendon Transfer for Treatment of Acute Rupture of Posterior Tibialis Tendon in an Athlete: Case Report. J Foot Ankle Surg 2019; 58:647-652. [PMID: 30448181 DOI: 10.1053/j.jfas.2018.07.014] [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: 07/17/2017] [Indexed: 02/03/2023]
Abstract
We report the case of a 32-year-old basketball player who presented with an acute flatfoot deformity after performing a unipodal power jump. Rupture of the posterior tibial tendon within the foot was diagnosed and then treated by hamstring tendon transfer combined with application of autologous biologic preparations. The functional outcome at 18 months was good. To our knowledge, this is the first reported case of posterior tibial tendon rupture treated by hamstring tendon transfer.
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Affiliation(s)
- Johnny El Rayes
- Surgeon, Department of Orthopedic Surgery, Bellevue University Medical Center, Mansourieh, Lebanon.
| | - Roula Bou Sader
- Radiologist, Department of Radiology, Bellevue University Medical Center, Mansourieh, Lebanon
| | - Michel Moutran
- Surgeon, Department of Plastic Surgery, Bellevue University Medical Center, Mansourieh, Lebanon
| | - Sahar Rassi
- Pathologist, Institut National de Parthologie INP, Hadeth, Lebanon
| | - Wissam Boueri
- Surgeon, Department of Orthopedic Surgery, Sports Medicine, Bellevue University Medical Center, Mansourieh, Lebanon
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Ajrawat P, Dwyer T, Chahal J. Autologous Interleukin 1 Receptor Antagonist Blood-Derived Products for Knee Osteoarthritis: A Systematic Review. Arthroscopy 2019; 35:2211-2221. [PMID: 31272643 DOI: 10.1016/j.arthro.2018.12.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/06/2018] [Accepted: 12/22/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To systematically review the available clinical data regarding the use of autologous IL-1 receptor antagonist blood products (AILBPs) and their validity as an alternative intra-articular (IA) therapy for symptomatic knee osteoarthritis (OA). METHODS The PubMed, MEDLINE, Embase, and Cochrane Library databases were searched from inception to June 2018. All randomized controlled trials (RCTs) and noncomparative studies that evaluated the clinical efficacy of AILBPs (i.e., autologous protein solution and autologous conditioned serum) for knee OA were included. The primary outcome measure was the Western Ontario and McMaster Universities Osteoarthritis Index. The secondary outcomes measured were the Knee Injury and Osteoarthritis Outcome Score, visual analog scale score, Short Form 36 (SF-36) score, radiographic scores, and adverse events, which were qualitatively analyzed. RESULTS We included 8 studies, comprising 3 RCTs (Level II) and 5 noncomparative studies (Level IV), with a total of 592 patients (mean age, 56.4 years; 49.7% male patients). The RCTs represented high methodologic quality, whereas the noncomparative studies represented moderate to good quality. With AILBPs, 2 of 4 studies (50%) showed improvements in the Knee Injury and Osteoarthritis Outcome Score symptom and sport subscales, 5 of 7 studies (71%) achieved improvements in the Western Ontario and McMaster Universities Osteoarthritis Index score, and 4 of 5 studies (80%) attained improvements in the visual analog scale pain score from baseline to final follow-up. Most adverse events associated with AILBPs were mild to moderate in severity and were primarily localized to the injection site. CONCLUSIONS Limited evidence substantiates that AILBPs are a safe and tolerable IA injection therapy that may improve pain parameters and functionality for mild to moderate knee OA patients and may be an effective adjunct for those unresponsive to traditional IA therapies. LEVEL OF EVIDENCE Level IV, systematic review of Level II through IV studies.
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Affiliation(s)
- Prabjit Ajrawat
- University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Tim Dwyer
- University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, Toronto, Ontario, Canada
| | - Jaskarndip Chahal
- University of Toronto Orthopaedic Sports Medicine, Women's College Hospital, Toronto, Ontario, Canada.
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Han C, Na Y, Zhu Y, Kong L, Eerdun T, Yang X, Ren Y. Is platelet-rich plasma an ideal biomaterial for arthroscopic rotator cuff repair? A systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res 2019; 14:183. [PMID: 31221198 PMCID: PMC6585122 DOI: 10.1186/s13018-019-1207-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/20/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Recently, many authors have reported the effects of platelet-rich plasma (PRP) on rotator cuff repair. Whether PRP treatment during arthroscopic rotator cuff repair improves tendon healing rates or restores full function remains unknown. The purpose of this meta-analysis was to evaluate the clinical improvement and radiological outcomes of PRP treatment in patients undergoing arthroscopic rotator cuff repair. METHODS PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched. The study included only level 1 or 2 randomized controlled trials (RCTs) that compared the injection of platelet-rich plasma or platelet-rich fibrin matrix. The methodological quality of the trials was assessed using the Cochrane Handbook for Systematic Reviews of Interventions, 5.3. Continuous variables were analysed using the weighted mean difference, and categorical variables were assessed using relative risks. P < 0.05 was considered statistically significant. RESULTS The meta-analysis revealed a lower retear rate following PRP treatment than that following the control method (mean difference, 1.10; 95% CI, 1.03 to 1.18; P = 0.004). Constant shoulder scores improved with PRP (mean difference, 2.31; 95% CI, 1.02 to 3.61; P = 0.0005). PRP treatment also resulted in higher UCLA scores (mean difference, 0.98; 95% CI, 0.27 to 1.69; P = 0.007), and simple shoulder test scores were improved (mean difference, 0.43; 95% CI, 0.11 to 0.75; P = 0.008). Finally, lower visual analogue scale scores were observed with PRP augmentation (mean difference, - 0.35; 95% CI, - 0.57 to - 0.13; P = 0.002). CONCLUSIONS The current systematic review and meta-analysis reveals that PRP treatment with arthroscopic repair of rotator cuff tears decreases the retear rate and improves the clinical outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016048416.
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Affiliation(s)
- Changxu Han
- Department of Arthroscopy and Sports Medicine, The Second Affiliated Hospital of Inner Mongolia Medical University, No. 1 Yingfang Street, Huimin District, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Yuyan Na
- Department of Arthroscopy and Sports Medicine, The Second Affiliated Hospital of Inner Mongolia Medical University, No. 1 Yingfang Street, Huimin District, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Yong Zhu
- Department of Spinal Surgery, The Second Hospital of Inner Mongolia Medical University, No. 1 Yingfang Street, Huimin District, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Lingyue Kong
- Department of Arthroscopy and Sports Medicine, The Second Affiliated Hospital of Inner Mongolia Medical University, No. 1 Yingfang Street, Huimin District, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Tu Eerdun
- Department of Arthroscopy and Sports Medicine, The Second Affiliated Hospital of Inner Mongolia Medical University, No. 1 Yingfang Street, Huimin District, Hohhot, 010000, Inner Mongolia Autonomous Region, China
| | - Xuejun Yang
- Department of Spinal Surgery, The Second Hospital of Inner Mongolia Medical University, No. 1 Yingfang Street, Huimin District, Hohhot, 010000, Inner Mongolia Autonomous Region, China.
| | - Yizhong Ren
- Department of Arthroscopy and Sports Medicine, The Second Affiliated Hospital of Inner Mongolia Medical University, No. 1 Yingfang Street, Huimin District, Hohhot, 010000, Inner Mongolia Autonomous Region, China.
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Johal H, Khan M, Yung SHP, Dhillon MS, Fu FH, Bedi A, Bhandari M. Impact of Platelet-Rich Plasma Use on Pain in Orthopaedic Surgery: A Systematic Review and Meta-analysis. Sports Health 2019; 11:355-366. [PMID: 31136726 DOI: 10.1177/1941738119834972] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
CONTEXT Amid extensive debate, evidence surrounding the use of platelet-rich plasma (PRP) for musculoskeletal injuries has rapidly proliferated, and an overall assessment of efficacy of PRP across orthopaedic indications is required. OBJECTIVES (1) Does PRP improve patient-reported pain in musculoskeletal conditions? and (2) Do PRP characteristics influence its treatment effect? DATA SOURCES MEDLINE, EMBASE, Cochrane, CINAHL, SPORTDiscus, and Web of Science libraries were searched through February 8, 2017. Additional studies were identified from reviews, trial registries, and recent conferences. STUDY SELECTION All English-language randomized trials comparing platelet-rich therapy with a control in patients 18 years or older with musculoskeletal bone, cartilage, or soft tissue injuries treated either conservatively or surgically were included. Substudies of previously reported trials or abstracts and conference proceedings that lacked sufficient information to generate estimates of effect for the primary outcome were excluded. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 1. DATA EXTRACTION All data were reviewed and extracted independently by 3 reviewers. Agreement was high between reviewers with regard to included studies. RESULTS A total of 78 randomized controlled trials (5308 patients) were included. A standardized mean difference (SMD) of 0.5 was established as the minimum for a clinically significant reduction in pain. A reduction in pain was associated with PRP at 3 months (SMD, -0.34; 95% CI, -0.48 to -0.20) and sustained until 1 year (SMD, -0.60; 95% CI, -0.81 to -0.39). Low- to moderate-quality evidence supports a reduction in pain for lateral epicondylitis (SMD, -0.69; 95% CI, -1.15 to -0.23) and knee osteoarthritis (SMD, -0.91; 95% CI, -1.41 to -0.41) at 1 year. PRP characteristics did not influence results. CONCLUSION PRP leads to a reduction in pain; however, evidence for clinically significant efficacy is limited. Available evidence supports the use of PRP in the management of lateral epicondylitis as well as knee osteoarthritis.
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Affiliation(s)
- Herman Johal
- Center for Evidence-Based Orthopaedics, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Moin Khan
- Center for Evidence-Based Orthopaedics, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Shu-Hang Patrick Yung
- Hong Kong Centre for Sports Medicine and Sports Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, People's Republic of China
| | - Mandeep S Dhillon
- Department of Orthopaedics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh Schools of the Health Sciences, UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Mohit Bhandari
- Center for Evidence-Based Orthopaedics, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
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Smit Y, Marais HJ, Thompson PN, Mahne AT, Goddard A. Clinical findings, synovial fluid cytology and growth factor concentrations after intra-articular use of a platelet-rich product in horses with osteoarthritis. J S Afr Vet Assoc 2019; 90:e1-e9. [PMID: 31170778 PMCID: PMC6556911 DOI: 10.4102/jsava.v90i0.1721] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 02/04/2019] [Accepted: 02/19/2019] [Indexed: 01/06/2023] Open
Abstract
Osteoarthritis is a common cause of lameness in horses, resulting in poor performance. Intra-articular platelet-rich plasma can deliver a collection of bioactive molecules, such as autologous growth factors and proteins involved in the quality of tissue repair. Horses (n=5) with osteoarthritis affecting antebrachiocarpal, middle carpal or metacarpophalangeal joints, and horses (n=5) without osteoarthritis of the corresponding joints (radiographically free of osteoarthritis), were used for the production of platelet-rich plasma which was subsequently injected into selected joints. Clinical and synovial fluid changes after intra-articular injection of platelet-rich plasma as well as synovial platelet-derived growth factor-BB and transforming growth factor-beta 1 concentration changes were evaluated in these joints and compared between normal joints and joints with osteoarthritis. A gravity filtration system produced a moderately concentrated platelet-rich plasma, representing a 4.7-fold increase in baseline platelet concentration. The synovial effusion score was significantly different between the control joints and joints with osteoarthritis on Day 0 with a higher score in the group with osteoarthritis. Within the control group, the synovial effusion score was significantly higher on Days 1 and 2 compared to Day 0. For both groups, the synovial fluid nucleated cell count, predominantly intact neutrophils, was significantly increased on Days 1 and 2, with no significant difference between groups. The mean synovial platelet-derived growth factor-BB and transforming growth factor-beta 1 concentrations were increased for both groups but significantly lowered in the group with osteoarthritis on Day 1 compared to normal joints. Concentrations for platelet-derived growth factor-BB remained unchanged on Day 5, compared to Day 1, with no significant difference between groups. In conclusion, intra-articular treatment with platelet-rich plasma resulted in increased synovial growth factor concentrations in joints but with lower concentrations in joints with osteoarthritis. A transient inflammatory reaction was seen both clinically as an increase in synovial effusion and cytologically in both normal joints and joints with osteoarthritis.
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Affiliation(s)
- Yolandi Smit
- Department of Companion Animal Clinical Studies, University of Pretoria, Onderstepoort.
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Johnson-Lynn S, Cooney A, Ferguson D, Bunn D, Gray W, Coorsh J, Kakwani R, Townshend D. A Feasibility Study Comparing Platelet-Rich Plasma Injection With Saline for the Treatment of Plantar Fasciitis Using a Prospective, Randomized Trial Design. Foot Ankle Spec 2019; 12:153-158. [PMID: 29779399 DOI: 10.1177/1938640018776065] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Platelet-rich plasma (PRP) has been advocated for treatment of plantar fasciitis but there are few good-quality clinical trials to support its use. We conducted a feasibility study of PRP versus saline for treatment of plantar fasciitis. Patients with 6 months or more of magnetic resonance imaging-proven plantar fasciitis, who had failed conservative treatment were invited to participate in the study. Patients were block randomized to either PRP or an equivalent volume of saline. The techniques used for injection and rehabilitation were standardized for both groups. The patient and assessor were blinded. Visual analogue scale (VAS) for pain and painDETECT score were recorded preoperatively and at 6 months follow-up. From 35 patients approached, 28 (19 female, mean age 50 years) were recruited, with 14 randomized to each arm. At 6 months, 8 patients (28.6%) were lost to follow-up. There was a significant change in VAS score from baseline to follow-up in both intervention (mean change 37.2, P = .008) and control (mean change 42.2, P = .003) groups. There was no correlation between preoperative painDETECT score and change in VAS. Recruitment and loss to follow-up rates were relatively high. Both treatments resulted in a similar, significant, improvement in symptoms. Levels of Evidence: Level II.
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Affiliation(s)
- Sarah Johnson-Lynn
- Trauma and Orthopaedics, North Tyneside General Hospital, Tyne and Wear, UK
| | - Alan Cooney
- Trauma and Orthopaedics, North Tyneside General Hospital, Tyne and Wear, UK
| | - Diarmaid Ferguson
- Trauma and Orthopaedics, North Tyneside General Hospital, Tyne and Wear, UK
| | - Deborah Bunn
- Trauma and Orthopaedics, North Tyneside General Hospital, Tyne and Wear, UK
| | - William Gray
- Trauma and Orthopaedics, North Tyneside General Hospital, Tyne and Wear, UK
| | - Jonathan Coorsh
- Trauma and Orthopaedics, North Tyneside General Hospital, Tyne and Wear, UK
| | - Rajesh Kakwani
- Trauma and Orthopaedics, North Tyneside General Hospital, Tyne and Wear, UK
| | - David Townshend
- Trauma and Orthopaedics, North Tyneside General Hospital, Tyne and Wear, UK
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Alsousou J, Harrison P. Therapeutic Platelet-Rich Plasma in Wound Healing. Platelets 2019. [DOI: 10.1016/b978-0-12-813456-6.00065-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
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Murphy CP, Sanchez A, Peebles LA, Provencher MT. Incorporating Ortho-Biologics into Your Clinical Practice. Clin Sports Med 2019; 38:163-168. [DOI: 10.1016/j.csm.2018.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Verma R, Negi G, Kandwal A, Chandra H, Gaur DS, Harsh M. Effect of autologous PRP on wound healing in dental regenerative surgeries and its correlation with PDGF levels. Asian J Transfus Sci 2019; 13:47-53. [PMID: 31360011 PMCID: PMC6580828 DOI: 10.4103/ajts.ajts_25_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION: Autologous platelet-rich plasma (PRP) is the fraction of blood plasma, with increased concentration of platelets, from baseline serum level. Growth factors (GFs) in PRP expedite the soft tissue and bony healing. However, estimation of their levels and role in healing had not been studied extensively. This study gives an insight to the quantification of platelet-derived GF-BB (PDGF-BB) present in PRP and its correlation with the clinical wound healing and bone regeneration. AIMS: This study aims to quantify PDGF-BB levels in PRP with its subsequent correlation with healing in dental regenerative surgeries. SETTINGS AND DESIGN: This was an experimental study including patients undergoing various dental regenerative surgeries. SUBJECTS AND METHODS: Autologous thrombin-activated PRP in the form of PRP gel was used in study group (n = 39) whereas no such intervention was given in control group (n = 30). PDGF-BB quantification was done in PRP samples using enzyme-linked immunosorbent assay. Clinicoradiological evaluation of healing was done in both the groups. STATISTICAL ANALYSIS USED: Descriptive analysis, independent Z-test, Correlation regression analysis, and ANOVA. RESULTS: Mean platelet concentration achieved in PRP was 5.79 times the baseline count. Mean PDGF-BB concentration in PRP was 31.92 ± 10.47 ng/ml which significantly correlated (P < 0.05) with the PRP platelet count. Study group showed significant healing clinically (P < 0.05). Significant bone fill observed in study group at 3 and 6 months when compared to the baseline as well as control group. Furthermore, bone fill at 6 months showed linear correlation with PGDF-BB levels (r = 0. 80). CONCLUSIONS: PRP led to enhanced bone regeneration and soft-tissue healing with former being directly related to higher concentration of PDGF-BB.
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Affiliation(s)
- Rahul Verma
- Department of Pathology, Swami Rama Himalayan Institute, Dehradun, Uttarakhand, India
| | - Gita Negi
- Department of Pathology, Swami Rama Himalayan Institute, Dehradun, Uttarakhand, India
| | - Abhishek Kandwal
- Department of Dentistry, Swami Rama Himalayan Institute, Dehradun, Uttarakhand, India
| | - Harish Chandra
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Dushyant Singh Gaur
- Department of Pathology, Swami Rama Himalayan Institute, Dehradun, Uttarakhand, India
| | - Meena Harsh
- Department of Pathology, Swami Rama Himalayan Institute, Dehradun, Uttarakhand, India
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