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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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Omran SA, Ghani BA. Effect of fenugreek oil on healing of experimentally induced buccal mucosal ulcer by immunohistochemical evaluation of Ki-67 expression. Cell Biochem Biophys 2024:10.1007/s12013-024-01347-0. [PMID: 38869686 DOI: 10.1007/s12013-024-01347-0] [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: 06/01/2024] [Indexed: 06/14/2024]
Abstract
Wound healing involves multiple populations of cells, the extracellular matrix, and soluble mediators' actions like growth factors and cytokines. Wound care was the target of many research, utilizing new therapy techniques and the progression of acute and chronic wound treatments with techniques involving plants to improve healing and decrease the side effects of drugs. When fenugreek is applied to an ulcer, its anti-inflammatory components are released, reducing unnecessary inflammation and accelerating the healing process. Healing is controlled by growth factors that naturally activate and boost the proliferation of cells, such as Ki-67, which is associated with the growth fraction and represents the cell's ability to proliferate. The current study aims to assess the expression of Ki-67 in rat mucosal ulcers treated with fenugreek leave oil. Twenty-four male Wistar albino rats of 350-450 gm weight were used. The rats were grouped as follows; normal group (normal tissue without ulcer induction), control group (tissue with surgical ulcer induction on the right side), and study group (ulcer treated with fenugreek leave oil on the left side), and had been sacrificed at 3- and 7-day healing durations. Thereafter, the tissue specimens were used for immunohistochemical analysis of Ki-67. The obtained outcomes showed that expression of Ki-67 increased in groups where ulcers were induced, with significant differences between control and study groups on the 3rd day. It was concluded that the application of fenugreek oil had an accelerating effect on the healing process of mucosal ulcers, as indicated by the elevated expression level of Ki-67.
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Affiliation(s)
- Sarah A Omran
- Department of Oral Diagnostic Sciences, College of Dentistry, University of Baghdad, Baghdad, Iraq.
| | - Ban A Ghani
- Department of Oral Diagnostic Sciences, College of Dentistry, University of Baghdad, Baghdad, Iraq
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Zhang T, Di Carlo D, Lim CT, Zhou T, Tian G, Tang T, Shen AQ, Li W, Li M, Yang Y, Goda K, Yan R, Lei C, Hosokawa Y, Yalikun Y. Passive microfluidic devices for cell separation. Biotechnol Adv 2024; 71:108317. [PMID: 38220118 DOI: 10.1016/j.biotechadv.2024.108317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/27/2023] [Accepted: 01/06/2024] [Indexed: 01/16/2024]
Abstract
The separation of specific cell populations is instrumental in gaining insights into cellular processes, elucidating disease mechanisms, and advancing applications in tissue engineering, regenerative medicine, diagnostics, and cell therapies. Microfluidic methods for cell separation have propelled the field forward, benefitting from miniaturization, advanced fabrication technologies, a profound understanding of fluid dynamics governing particle separation mechanisms, and a surge in interdisciplinary investigations focused on diverse applications. Cell separation methodologies can be categorized according to their underlying separation mechanisms. Passive microfluidic separation systems rely on channel structures and fluidic rheology, obviating the necessity for external force fields to facilitate label-free cell separation. These passive approaches offer a compelling combination of cost-effectiveness and scalability when compared to active methods that depend on external fields to manipulate cells. This review delves into the extensive utilization of passive microfluidic techniques for cell separation, encompassing various strategies such as filtration, sedimentation, adhesion-based techniques, pinched flow fractionation (PFF), deterministic lateral displacement (DLD), inertial microfluidics, hydrophoresis, viscoelastic microfluidics, and hybrid microfluidics. Besides, the review provides an in-depth discussion concerning cell types, separation markers, and the commercialization of these technologies. Subsequently, it outlines the current challenges faced in the field and presents a forward-looking perspective on potential future developments. This work hopes to aid in facilitating the dissemination of knowledge in cell separation, guiding future research, and informing practical applications across diverse scientific disciplines.
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Affiliation(s)
- Tianlong Zhang
- College of Mechanical Engineering, Jiangsu University of Science and Technology, Zhenjiang 212100, China
| | - Dino Di Carlo
- Department of Bioengineering, University of California, Los Angeles, CA 90095, USA
| | - Chwee Teck Lim
- Department of Biomedical Engineering, National University of Singapore, Singapore 117583, Singapore
| | - Tianyuan Zhou
- College of Mechanical Engineering, Jiangsu University of Science and Technology, Zhenjiang 212100, China
| | - Guizhong Tian
- College of Mechanical Engineering, Jiangsu University of Science and Technology, Zhenjiang 212100, China.
| | - Tao Tang
- Department of Biomedical Engineering, National University of Singapore, Singapore 117583, Singapore
| | - Amy Q Shen
- Micro/Bio/Nanofluidics Unit, Okinawa Institute of Science and Technology Graduate University, Onna-son, Okinawa 904-0495, Japan
| | - Weihua Li
- School of Mechanical, Materials, Mechatronic and Biomedical Engineering, University of Wollongong, Wollongong, NSW 2522, Australia
| | - Ming Li
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, NSW 2052, Australia
| | - Yang Yang
- Institute of Deep-Sea Science and Engineering, Chinese Academy of Sciences, Sanya, Hainan 572000, China
| | - Keisuke Goda
- Department of Bioengineering, University of California, Los Angeles, CA 90095, USA; Department of Chemistry, University of Tokyo, Tokyo 113-0033, Japan; The Institute of Technological Sciences, Wuhan University, Wuhan 430072, China
| | - Ruopeng Yan
- The Institute of Technological Sciences, Wuhan University, Wuhan 430072, China
| | - Cheng Lei
- The Institute of Technological Sciences, Wuhan University, Wuhan 430072, China
| | - Yoichiroh Hosokawa
- Division of Materials Science, Nara Institute of Science and Technology, Nara 630-0192, Japan
| | - Yaxiaer Yalikun
- Division of Materials Science, Nara Institute of Science and Technology, Nara 630-0192, Japan.
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Ruiz-González N, Esporrín-Ubieto D, Hortelao AC, Fraire JC, Bakenecker AC, Guri-Canals M, Cugat R, Carrillo JM, Garcia-Batlletbó M, Laiz P, Patiño T, Sánchez S. Swarms of Enzyme-Powered Nanomotors Enhance the Diffusion of Macromolecules in Viscous Media. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2024; 20:e2309387. [PMID: 38200672 DOI: 10.1002/smll.202309387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Indexed: 01/12/2024]
Abstract
Over the past decades, the development of nanoparticles (NPs) to increase the efficiency of clinical treatments has been subject of intense research. Yet, most NPs have been reported to possess low efficacy as their actuation is hindered by biological barriers. For instance, synovial fluid (SF) present in the joints is mainly composed of hyaluronic acid (HA). These viscous media pose a challenge for many applications in nanomedicine, as passive NPs tend to become trapped in complex networks, which reduces their ability to reach the target location. This problem can be addressed by using active NPs (nanomotors, NMs) that are self-propelled by enzymatic reactions, although the development of enzyme-powered NMs, capable of navigating these viscous environments, remains a considerable challenge. Here, the synergistic effects of two NMs troops, namely hyaluronidase NMs (HyaNMs, Troop 1) and urease NMs (UrNMs, Troop 2) are demonstrated. Troop 1 interacts with the SF by reducing its viscosity, thus allowing Troop 2 to swim more easily through the SF. Through their collective motion, Troop 2 increases the diffusion of macromolecules. These results pave the way for more widespread use of enzyme-powered NMs, e.g., for treating joint injuries and improving therapeutic effectiveness compared with traditional methods.
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Affiliation(s)
- Noelia Ruiz-González
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), Baldiri i Reixac 10-12, Barcelona, 08028, Spain
| | - David Esporrín-Ubieto
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), Baldiri i Reixac 10-12, Barcelona, 08028, Spain
| | - Ana C Hortelao
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), Baldiri i Reixac 10-12, Barcelona, 08028, Spain
| | - Juan C Fraire
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), Baldiri i Reixac 10-12, Barcelona, 08028, Spain
| | - Anna C Bakenecker
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), Baldiri i Reixac 10-12, Barcelona, 08028, Spain
| | - Marta Guri-Canals
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), Baldiri i Reixac 10-12, Barcelona, 08028, Spain
| | - Ramón Cugat
- Mutualidad de Futbolistas - Delegación Catalana, Federación Española de Fútbol, Barcelona, 08010, Spain
- Instituto Cugat, Hospital Quironsalud Barcelona, Spain, Fundación García Cugat, Barcelona, 08023, Spain
| | - José María Carrillo
- Bioregenerative Medicine and Applied Surgery Research Group, Department of Animal Medicine and Surgery, CEU Cardenal Herrera University, CEU Universities, Valencia, Spain. García Cugat Foundation CEU-UCH Chair of Medicine and Regenerative Surgery, CEU Cardenal Herrera University, CEU Universities, Valencia, 46115, Spain
| | | | - Patricia Laiz
- Instituto Cugat, Hospital Quironsalud Barcelona, Spain, Fundación García Cugat, Barcelona, 08023, Spain
| | - Tania Patiño
- Department of Biomedical Engineering, Institute for Complex Molecular Systems (ICMS), Eindhoven University of Technology, Eindhoven, 5612 AZ, The Netherlands
| | - Samuel Sánchez
- Institute for Bioengineering of Catalonia (IBEC), Barcelona Institute of Science and Technology (BIST), Baldiri i Reixac 10-12, Barcelona, 08028, Spain
- Institució Catalana de Recerca i Estudies Avancats (ICREA), Passeig Lluís Companys 23, Barcelona, 08010, Spain
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Chen LS, Chen CK, Pang JHS, Lin LP, Yu TY, Tsai WC. Leukocyte-poor platelet-rich plasma and leukocyte-rich platelet-rich plasma promote myoblast proliferation through the upregulation of cyclin A, cdk1, and cdk2. J Orthop Res 2024; 42:32-42. [PMID: 37442643 DOI: 10.1002/jor.25666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/05/2023] [Accepted: 07/11/2023] [Indexed: 07/15/2023]
Abstract
Muscle injuries are common among athletes and often treated with platelet-rich plasma (PRP). However, whether the leukocyte concentration affects the efficacy of PRP in treating muscle injuries remains unclear. This study investigated the effects of leukocyte-poor platelet-rich plasma (LP-PRP) and leukocyte-rich platelet-rich plasma (LR-PRP) on myoblast proliferation and the molecular mechanisms underlying these effects. Myoblasts were treated with 0.5% LP-PRP, 0.5% LR-PRP, 1% LP-PRP, or 1% LR-PRP for 24 h. The gene expression of the LP-PRP- and LR-PRP-treated myoblasts was determined using RNA sequencing analysis. Cell proliferation was evaluated using an bromodeoxyuridine (BrdU) assay, and cell cycle progression was assessed through flow cytometry. The expression of cyclin A, cyclin-dependent kinase 1 (cdk1), and cdk2 was examined using Western blotting. The expression of myoblast determination protein 1 (MyoD1) was examined through Western blotting and immunofluorescence staining. The LP-PRP and LR-PRP both promoted the proliferation of myoblasts and increased differential gene expression of myoblasts. Moreover, the LP-PRP and LR-PRP substantially upregulated the expression of cyclin A, cdk1, and cdk2. MyoD1 expression was induced in the LP-PRP and LR-PRP-treated myoblasts. Our results corroborate the finding that LP-PRP and LR-PRP have similar positive effects on myoblast proliferation and MyoD1 expression.
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Affiliation(s)
- Li-Siou Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Kuang Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jong-Hwei Su Pang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Li-Ping Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Tung-Yang Yu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Wen-Chung Tsai
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Center of Comprehensive Sports Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Pérez Fraile A, González-Cubero E, Martínez-Flórez S, Olivera ER, Villar-Suárez V. Regenerative Medicine Applied to Musculoskeletal Diseases in Equines: A Systematic Review. Vet Sci 2023; 10:666. [PMID: 38133217 PMCID: PMC10748126 DOI: 10.3390/vetsci10120666] [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: 10/17/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
Musculoskeletal injuries in horses have a great economic impact, predominantly affecting tendons, ligaments, and cartilage, which have limited natural regeneration. Cell therapy, which uses mesenchymal stem cells due to their tissue differentiation properties and anti-inflammatory and immunoregulatory effects, aims to restore damaged tissue. In this manuscript, we performed a systematic review using the Parsifal tool, searching the PubMed and Web of Science databases for articles on regenerative medicine for equine musculoskeletal injuries. Our review covers 17 experimental clinical studies categorized by the therapeutic approach used: platelet-rich plasma, conditioned autologous serum, mesenchymal stem cells, and secretome. These therapies reduce healing time, promote regeneration of fibrocartilaginous tissue, improve cellular organization, and improve joint functionality and sustainability. In conclusion, regenerative therapies using platelet-rich plasma, conditioned autologous serum, equine mesenchymal stem cells, and the emerging field of the secretome represent a promising and highly effective approach for the treatment of joint pathologies in horses, implying a valuable advance in equine healthcare.
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Affiliation(s)
- Andrea Pérez Fraile
- Department of Anatomy, Veterinary Faculty, Campus de Vegazana, Universidad de León, 24007 León, Spain
| | - Elsa González-Cubero
- Department of Anatomy, Veterinary Faculty, Campus de Vegazana, Universidad de León, 24007 León, Spain
| | - Susana Martínez-Flórez
- Department of Anatomy, Veterinary Faculty, Campus de Vegazana, Universidad de León, 24007 León, Spain
- Institute of Biomedicine (IBIOMED), Veterinary Faculty, Campus de Vegazana, Universidad de León, 24007 León, Spain
| | - Elías R. Olivera
- Department of Molecular Biology, Veterinary Faculty, Campus de Vegazana, Universidad de León, 24007 León, Spain
| | - Vega Villar-Suárez
- Department of Anatomy, Veterinary Faculty, Campus de Vegazana, Universidad de León, 24007 León, Spain
- Institute of Biomedicine (IBIOMED), Veterinary Faculty, Campus de Vegazana, Universidad de León, 24007 León, Spain
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Poursalehian M, Lotfi M, Zafarmandi S, Arabzadeh Bahri R, Halabchi F. Hamstring Injury Treatments and Management in Athletes: A Systematic Review of the Current Literature. JBJS Rev 2023; 11:01874474-202311000-00007. [PMID: 37983561 DOI: 10.2106/jbjs.rvw.23.00161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023]
Abstract
BACKGROUND The field of sports medicine presents a varied landscape of research on hamstring injuries in athletes, characterized by inconclusive and sometimes conflicting findings on effective treatment and rehabilitation strategies. This discordance prompted the current systematic investigation. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed for conducting the systematic review. Multiple international bibliometric databases (Scopus, PubMed, Web of Science, and Embase) were searched to identify studies evaluating any treatment option for the management of hamstring injuries in athletes. Eligible studies were appraised for quality using Joanna Briggs Institute and Risk of Bias 2 tools. RESULTS A total of 30 studies with 1,195 participants were included. Of the reviewed studies, treatments varied from aggressive rehabilitation, platelet-rich plasma (PRP) injections, manual techniques, various exercise protocols to modalities like high-power laser and nonsteroidal anti-inflammatory drugs. Evidence suggested benefits from treatments like extensive muscle lengthening during eccentric actions, progressive agility, and trunk stabilization. PRP injections produced mixed results regarding return to sport and reinjury rates. Stretching exercises, sometimes combined with cryotherapy, showed benefits. CONCLUSION Treatments for hamstring injuries exhibit varied efficacy. Although rest, ice, compression, and elevation remains essential for acute management, rehabilitation focusing on muscle strengthening and flexibility is crucial. The potential benefits of PRP injections, especially for chronic cases, require more conclusive research. A comprehensive approach, combining evidence-based practices and patient-centric factors, is vital for effective management and recovery. LEVEL OF EVIDENCE Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Mohammad Poursalehian
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Sports and Exercise Medicine, Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohadeseh Lotfi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Sports and Exercise Medicine, Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Zafarmandi
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Sports and Exercise Medicine, Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Razman Arabzadeh Bahri
- Joint Reconstruction Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Sports and Exercise Medicine, Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzin Halabchi
- Sports and Exercise Medicine, Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Mavrogenis AF, Karampikas V, Zikopoulos A, Sioutis S, Mastrokalos D, Koulalis D, Scarlat MM, Hernigou P. Orthobiologics: a review. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05803-z. [PMID: 37071148 DOI: 10.1007/s00264-023-05803-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/30/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE The use of biologic materials in orthopaedics (orthobiologics) has gained significant attention over the past years. To enhance the body of the related literature, this review article is aimed at summarizing these novel biologic therapies in orthopaedics and at discussing their multiple clinical implementations and outcomes. METHODS This review of the literature presents the methods, clinical applications, impact, cost-effectiveness, and outcomes, as well as the current indications and future perspectives of orthobiologics, namely, platelet-rich plasma, mesenchymal stem cells, bone marrow aspirate concentrate, growth factors, and tissue engineering. RESULTS Currently available studies have used variable methods of research including biologic materials as well as patient populations and outcome measurements, therefore making comparison of studies difficult. Key features for the study and use of orthobiologics include minimal invasiveness, great healing potential, and reasonable cost as a nonoperative treatment option. Their clinical applications have been described for common orthopaedic pathologies such as osteoarthritis, articular cartilage defects, bone defects and fracture nonunions, ligament injuries, and tendinopathies. CONCLUSIONS Orthobiologics-based therapies have shown noticeable clinical results at the short- and mid-term. It is crucial that these therapies remain effective and stable in the long term. The optimal design for a successful scaffold remains to be further determined.
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Affiliation(s)
- Andreas F Mavrogenis
- First Department of OrthopaedicsNational and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
| | - Vasileios Karampikas
- First Department of OrthopaedicsNational and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Alexandros Zikopoulos
- First Department of OrthopaedicsNational and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Spyridon Sioutis
- First Department of OrthopaedicsNational and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitrios Mastrokalos
- First Department of OrthopaedicsNational and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitrios Koulalis
- First Department of OrthopaedicsNational and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Thermann H, Fischer R, Gougoulias N, Cipollaro L, Maffulli N. Endoscopic debridement for non-insertional Achilles tendinopathy with and without platelet-rich plasma. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:275-280. [PMID: 32619656 PMCID: PMC10105028 DOI: 10.1016/j.jshs.2020.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/01/2020] [Accepted: 06/08/2020] [Indexed: 06/01/2023]
Abstract
BACKGROUND When non-operative management fails to improve symptoms in patients with non-insertional Achilles tendinopathy, surgery may be required. Various open and endoscopic techniques have been proposed, and platelet-rich plasma (PRP) injections have been proposed as an adjunct to aid tendon healing. METHODS Thirty-six patients with mid-portion Achilles tendinopathy were randomized to undergo endoscopic debridement alone (n = 19) or in combination with intraoperative PRP application (n = 17). Clinical outcome measures included the Visual Analogue Scale for pain, function, and satisfaction and the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire. Patients were followed-up at 6 weeks, 3 months, 6 months, and 12 months after surgery. An MRI examination at 3 and 12 months was used to assess signal alterations within the tendon. RESULTS Both groups showed significant clinical improvement (p < 0.05) after surgery, with no difference between the 2 groups. Tendon diameter increased at 3 months and decreased at 12 months. The tendinopathy area increased at 3 months and decreased at 12 months below baseline level in both groups. There was no significant difference between the groups regarding the MRI parameters. Nodular thickening and MRI-detected signal alteration persisted after surgery, with no association between imaging and clinical outcome. Five minor complications were reported: 2 in the PRP group and 3 in the control group. CONCLUSION Endoscopic debridement of the Achilles tendon improved clinical outcomes in patients with mid-portion tendinopathy. The addition of PRP did not improve outcomes compared to debridement alone. MRI parameters showed no association with clinical outcomes.
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Affiliation(s)
- Hajo Thermann
- HKF-International Center for Hip, Foot and Knee Surgery, Bismarckstraße 9-15, 69115 Heidelberg, Germany
| | - Ralph Fischer
- HKF-International Center for Hip, Foot and Knee Surgery, Bismarckstraße 9-15, 69115 Heidelberg, Germany
| | | | - Lucio Cipollaro
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno 89100, Italy; Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, Salerno 89100, Italy; Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy; Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London E1 4DG, Queen Mary University of London, London, UK; School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent, ST4 7QB, UK.
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10
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Freitas NPP, Silva BDP, Bezerra MRL, Pescini LYG, Olinda RG, Salgueiro CCDM, Nunes JF, Martins JAM, Neto SG, Martins LT. Freeze-dried Platelet-rich Plasma and Stem Cell-conditioned Medium for Therapeutic Use in Horses. J Equine Vet Sci 2023; 121:104189. [PMID: 36464033 DOI: 10.1016/j.jevs.2022.104189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/19/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022]
Abstract
This study investigated platelet-rich plasma (PRP) and adipose stem cell-conditioned medium (ASC-CM) use as a strategy to accelerate tissue healing. Platelet-derived growth factor (PDGF) and vascular endothelial growth factor (VEGF) were quantified in fresh and freeze-dried PRP and ASC-CM, and a stability test was performed in the freeze-dried samples (90 and 180 days of storage). A cell proliferation test was performed using equine mesenchymal stem cell culture in reconstituted PRP gel mesh after freeze-drying. In vivo PRP, ASC-CM applications, or their association were performed in induced wounds at 15 and 9-day intervals, according to the treatments: saline solution (control), PRP, ASC-CM, or ASC-CM + PRP. Horses were monitored through photographs and wound area measurements on days 5, 7, 15, and 24 after lesion induction. Skin biopsies were obtained on days 15 and 24 of the experiment. PDGF and VEGF quantification did not differ between fresh or freeze-dried treatments, was similar after freeze-drying or 90 days of storage, but showed a significant reduction after 180 days of storage. Comparing all treatments, no differences were observed in the histopathological analyses. For inflammation, fibroplasia, and collagen formation, only the time effect between the first and second biopsies was significant. The cell proliferation test revealed intense multiplication in the PRP gel mesh. Healing time was similar among all treatments. In conclusion, our results showed the possibility to produce and maintain freeze-dried PRP and ASC-CM for 90 days. Further studies are needed to better explore the in vivo therapeutic PRP and ASC-CM effects.
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Affiliation(s)
- Natália P P Freitas
- Department of Veterinary Medicine, Graduate Program, Rede Nordeste de Biotecnologia (Renorbio), State University of Ceará (UECE), Fortaleza, Ceará, Brazil.
| | - Beatriz D'Almeida P Silva
- Department of Veterinary Medicine, Experimental Biology Unit (Nubex), University of Fortaleza (Unifor), Fortaleza, Ceará, Brazil
| | - Marcus R L Bezerra
- Department of Biotechnology, Graduate Program, Federal University of Ceará (UFC), Fortaleza, Ceará, Brazil
| | - Laura Y G Pescini
- Department of Veterinary Medicine, Experimental Biology Unit (Nubex), University of Fortaleza (Unifor), Fortaleza, Ceará, Brazil
| | - Roberio G Olinda
- Department of Pathology, Vetlab Veterinary Laboratory, Fortaleza, Ceará, Brazil
| | | | - José F Nunes
- Department of Veterinary Medicine, Faculty of Veterinary Medicine, State University of Ceará (UECE), Fortaleza, Ceará, Brazil
| | - Jorge A M Martins
- Department of Veterinary Medicine, Federal University of Cariri (UFCA), Crato, Ceará, Brazil
| | - Saul G Neto
- Department of Veterinary Medicine, Experimental Biology Unit (Nubex), University of Fortaleza (Unifor), Fortaleza, Ceará, Brazil
| | - Leonardo T Martins
- Department of Veterinary Medicine, Experimental Biology Unit (Nubex), University of Fortaleza (Unifor), Fortaleza, Ceará, Brazil
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11
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Efficacy of Platelet-Rich Plasma Versus Placebo in the Treatment of Tendinopathy: A Meta-analysis of Randomized Controlled Trials. Clin J Sport Med 2023; 33:69-77. [PMID: 34342296 DOI: 10.1097/jsm.0000000000000961] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 06/28/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the efficacy of platelet-rich plasma (PRP) injections versus placebo in the treatment of tendinopathy. DATA SOURCES We performed a systematic literature search in MEDLINE, Embase, Scopus, CINAHL, Cochrane Library, and ClinicalTrials.gov through November 2020 to identify randomized controlled trials (RCTs) that evaluated the clinical efficacy of PRP versus placebo for the treatment of tendinopathy. Outcomes were analyzed on an intention-to-treat basis with random-effects models. MAIN RESULTS A total of 13 RCTs were included in this meta-analysis. The pooled analysis showed no significant difference in pain relief at 4 to 6 weeks (standard mean difference [SMD]: -0.18, 95% confidence intervals [CI]: -0.62 to 0.26), 12 weeks (SMD: -0.14, 95% CI: -0.55 to 0.26), and ≥24 weeks (SMD: -0.56, 95% CI: -1.16 to 0.05) or function improvement at 4 to 6 weeks (SMD: 0.11, 95% CI: -0.13 to 0.35), 12 weeks (SMD: 0.18, 95% CI: -0.13 to 0.49), and ≥24 weeks (SMD: 0.26, 95% CI: -0.14 to 0.66) for PRP compared with placebo in the treatment of tendinopathy. The sensitivity analysis indicated no significant difference in pain relief or function improvement at 12 weeks between PRP and placebo for different types of tendinopathies, treatment regimens, leukocyte concentrations, or cointerventions. CONCLUSIONS Platelet-rich plasma injection was not found to be superior to placebo in the treatment of tendinopathy, as measured by pain relief and functional improvement at 4 to 6, 12, and ≥24 weeks.
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12
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Aguilar-García D, Fernández-Sarmiento JA, del Mar Granados Machuca M, Rodríguez JM, Rascón PM, Calvo RN, Ruiz YM, Poveda JMC, Castañeda JM, Bertomeu RC, Domínguez Pérez JM. Histological and biochemical evaluation of plasma rich in growth factors treatment for grade II muscle injuries in sheep. BMC Vet Res 2022; 18:400. [DOI: 10.1186/s12917-022-03491-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/09/2022] [Accepted: 10/17/2022] [Indexed: 11/15/2022] Open
Abstract
AbstractThe purpose of this study was to perform a histological and biochemical evaluation of the influence of plasma rich in growth factors (PRGF) on muscle regeneration process after a surgically induced grade II muscle laceration. A randomized, single blind, controlled experimental research was conducted including twenty-one adult healthy sheep, randomly divided in three groups (n = 7). A grade II surgical section was performed in the biceps femoris muscle of both hindlimbs. After two days (basal time), intralesional infiltration of autologous PRGF or Saline solution was randomly administered in both hindlimbs. Treatment was repeated once a week. Animal groups were euthanized at 1 (T1), 2 (T2) or 4 (T4) weeks. Histological assessment showed that PRGF intralesional injection induced a significant decrease of inflammatory cells density, significant higher centrally nucleated fibers percentage and significantly smaller fibrotic areas compared to Saline-treated muscles at T1, T2 and T4. Also, lower vascular density, with lower capillaries cross-sectional area, in PRGF group compared to Saline was observed. Biochemical analysis revealed a significant higher expression level of MYOD1, MYF5 and MYOG genes in PRGF groups at T1 compared to Saline treated muscles. At ultrastructural level, PRGF groups presented scarce edema and loss of connective tissue structure, as well as higher mitochondrial density adequately associated to the sarcomere unit in contrast to the Saline group. In conclusion, histological, biochemical, and ultrastructural results showed that PRGF treatment improved muscle regeneration process leading to more mature histological aspect in newly formed muscle tissue after a surgically induced grade II muscle injury.
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13
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Creating an Optimal In Vivo Environment to Enhance Outcomes Using Cell Therapy to Repair/Regenerate Injured Tissues of the Musculoskeletal System. Biomedicines 2022; 10:biomedicines10071570. [PMID: 35884875 PMCID: PMC9313221 DOI: 10.3390/biomedicines10071570] [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] [Received: 03/24/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Following most injuries to a musculoskeletal tissue which function in unique mechanical environments, an inflammatory response occurs to facilitate endogenous repair. This is a process that usually yields functionally inferior scar tissue. In the case of such injuries occurring in adults, the injury environment no longer expresses the anabolic processes that contributed to growth and maturation. An injury can also contribute to the development of a degenerative process, such as osteoarthritis. Over the past several years, researchers have attempted to use cellular therapies to enhance the repair and regeneration of injured tissues, including Platelet-rich Plasma and mesenchymal stem/medicinal signaling cells (MSC) from a variety of tissue sources, either as free MSC or incorporated into tissue engineered constructs, to facilitate regeneration of such damaged tissues. The use of free MSC can sometimes affect pain symptoms associated with conditions such as OA, but regeneration of damaged tissues has been challenging, particularly as some of these tissues have very complex structures. Therefore, implanting MSC or engineered constructs into an inflammatory environment in an adult may compromise the potential of the cells to facilitate regeneration, and neutralizing the inflammatory environment and enhancing the anabolic environment may be required for MSC-based interventions to fulfill their potential. Thus, success may depend on first eliminating negative influences (e.g., inflammation) in an environment, and secondly, implanting optimally cultured MSC or tissue engineered constructs into an anabolic environment to achieve the best outcomes. Furthermore, such interventions should be considered early rather than later on in a disease process, at a time when sufficient endogenous cells remain to serve as a template for repair and regeneration. This review discusses how the interface between inflammation and cell-based regeneration of damaged tissues may be at odds, and outlines approaches to improve outcomes. In addition, other variables that could contribute to the success of cell therapies are discussed. Thus, there may be a need to adopt a Precision Medicine approach to optimize tissue repair and regeneration following injury to these important tissues.
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14
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Kerzner B, Fortier LM, Swindell HW, McCormick JR, Kasson LB, Hevesi M, LaPrade RF, Mandelbaum BR, Chahla J. An Update on the Use of Orthobiologics Combined with Corrective Osteotomies for Osteoarthritis: Osteotomy Site and Intra-Articular Efficacy. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150933] [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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15
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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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16
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Khan M, Shanmugaraj A, Prada C, Patel A, Babins E, Bhandari M. The Role of Hyaluronic Acid for Soft Tissue Indications: A Systematic Review and Meta-Analysis. Sports Health 2022; 15:86-96. [PMID: 35114853 PMCID: PMC9808833 DOI: 10.1177/19417381211073316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
CONTEXT Soft tissue injuries are often treated with injectables such as corticosteroids and platelet-rich plasma (PRP) to reduce inflammation and promote healing. There is increasing evidence examining the use of hyaluronic acid (HA) for the management of soft tissue injuries. OBJECTIVE To evaluate the treatment effect and role of HA for available soft tissue indications. DATA SOURCES A search of PubMed, MEDLINE, EMBASE, and CENTRAL from the inception date of each database through February 24, 2021, was conducted for all randomized controlled trials (RCTs) involving the use of HA for soft tissue indications. Two reviewers independently screened articles for eligibility and extracted data from included studies for analysis. We assessed risk of bias for all included studies and pooled outcomes using a fixed-effects model. Outcomes (ie, function and pain relief) were categorized to short-term (<6 weeks, 6-12 weeks) and mid-term (>12 weeks) data. We present effect estimates as mean differences (MDs) and standardized mean differences (SMDs) and present the estimate of effect of HA for available indications in relation to available comparators. STUDY DESIGN Meta-analysis of RCTs. LEVEL OF EVIDENCE Level 1. RESULTS Of the 6930 articles screened, 19 RCTs (n = 1629 patients) were eligible and included in this review. HA was evaluated across a variety of soft tissue indications including rotator cuff disease, elbow pain, ankle sprains, Achilles tendinopathy, patellar tendinopathy, and trigger finger. Of the 19 RCTs, 11 were placebo-controlled and 9 used active comparators (PRP, cortisone, prolotherapy, or extracorporeal shockwave therapy). The pooled treatment effect of HA across most soft indications against placebo and active comparators demonstrated benefit in short-term pain <6 weeks (MD visual analogue scale [VAS] 2.48, 95% CI 2.31-2.65) and 6 to 12 weeks (MD VAS 2.03, 95% CI 1.86-2.20). Mid-term pain relief also favored HA over comparators across indications >12 weeks from administration (MD VAS 3.57, 95% CI 3.35-3.78). High heterogeneity was present with rotator cuff (10 trials, I2 = 94%), and elbow tendinopathy (2 trials, I2 = 99%). We identified uncertain benefit for trigger finger (2 trials, I2 = 67%). Heterogeneity for ankle sprains, patellar tendinopathy and Achilles tendinopathy could not be assessed as they only had 1 trial each. CONCLUSION This systematic review and meta-analysis support HA's efficacy in the treatment of a variety of soft tissue indications. Understanding the relative effects of HA to other injectable modalities requires additional, large trials.
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Affiliation(s)
- Moin Khan
- Division of Orthopaedic Surgery,
Department of Surgery, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods,
Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada,Moin Khan, MD, MSc, FRCSC,
McMaster University, St Joseph’s Healthcare Hamilton, 50 Charlton Avenue East,
Mary Grace Wing, Room G807, Hamilton, Ontario, L8N 4A6, Canada (
) (Twitter: @moinkhan_md)
| | - Ajaykumar Shanmugaraj
- Division of Orthopaedic Surgery,
Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Carlos Prada
- Division of Orthopaedic Surgery,
Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ashaka Patel
- Schulich School of Medicine, Western
University, London, Ontario
| | - Eric Babins
- University of Calgary, Calgary,
Alberta, Canada
| | - Mohit Bhandari
- Division of Orthopaedic Surgery,
Department of Surgery, McMaster University, Hamilton, Ontario, Canada,Department of Health Research Methods,
Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
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17
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Tan Q, Li J, Liu Y, Zhu X, Shao W. Feasibility of Growth Factor Agent Therapy in Repairing Motor Injury. Front Pharmacol 2022; 13:842775. [PMID: 35145420 PMCID: PMC8821907 DOI: 10.3389/fphar.2022.842775] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/05/2022] [Indexed: 01/10/2023] Open
Abstract
Growth factors (GF), with the activity of stimulating cell growth, play a significant role in biology, medicine, and exercise physiology. In the process of exercise, human tissues are impacted, making cells suffer damage. Growth factor can accelerate the repair of damaged cells and regulate the synthesis of protein, so biological preparations of growth factors can be added to traditional therapies. A combination of growth factor biologics and conventional therapies may improve the efficiency of injury repair, but growth factor biologics may not produce any results. The feasibility of growth factor biologics in the treatment of motor injury was discussed. The research have shown that: 1) GF biological agent therapy is a very promising treatment for motor injury, which is based on the power of autologous growth factor (GFs) to accelerate tissue healing, promote muscle regeneration, increase angiogenesis, reduce fibrosis, and make the muscle injury rapid recovery. 2) There are various methods for delivering the higher dose of GF to the injured tissue, but most of them depend on the platelet release of GF. At the site of injury, there are several ways to deliver higher doses of GF to the injured tissue. 3) At present, the inhibition of GF is mainly through signal transduction inhibitors and inhibition of transcription factor production. 4) Pattern of GF during wound repair: GF directly regulates many key steps of normal wound repair, including inflammatory cell chemotaxis, division and proliferation of fibroblasts, keratinocytes and vascular endothelial cells, formation of new blood vessels, and synthesis and degradation of intercellular substances. 5) When GF promotes chronic wound healing, in most cases, certain GF can be used targeted only when in vivo regulation still cannot meet the need for repair.
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Affiliation(s)
- Qiaoyin Tan
- College of Teacher Education, Zhejiang Normal University, Jinhua, China
| | - Jiayu Li
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
| | - Yuwen Liu
- Department of General Surgery, The First Affiliated Hospital of Jiangxi Medical College, Shangrao, China
| | - Xiaojuan Zhu
- College of Teacher Education, Zhejiang Normal University, Jinhua, China
| | - Weide Shao
- College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua, China
- *Correspondence: Weide Shao,
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18
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Danieli MV, Guerreiro JPF, Vimercati TA, Mendes PHF, Miyazaki PRTK, Cataneo DC. Platelet-Rich Plasma Versus Hyaluronic Acid for Knee Chondral Injuries In Young Patients. Rev Bras Ortop 2021; 56:634-640. [PMID: 34733436 PMCID: PMC8558929 DOI: 10.1055/s-0041-1724075] [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: 04/13/2020] [Accepted: 09/17/2020] [Indexed: 11/09/2022] Open
Abstract
Objective
The present study aimed to compare the clinical and functional outcomes of hyaluronic acid (HA) or platelet-rich plasma (PRP) applications to treat young patients with knee chondral lesions with no arthrosis.
Methods
Prospective clinical and functional evaluation of 30 young adult patients with knee chondral lesions submitted to conservative treatment with HA or PRP for a minimum follow-up time of 12 months. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) and visual analog scale (VAS) were used for the evaluation.
Results
According to the WOMAC score, the PRP group showed significant improvement in all evaluated points, whereas the HA group presented no score improvement. In the VAS, the PRP group showed improvement in all evaluated points, and the HA group presented improvement at 6 and 12 months. Compared to the HA group, the PRP group presented better WOMAC scores at all evaluated points and better VAS scores up to 6 months after treatment.
Conclusion
Platelet-rich plasma application resulted in better clinical and functional outcomes at both the WOMAC and VAS scores when applied to knees from young patients with chondral lesions, but no arthrosis. These outcomes were sustained for up to 12 months.
Level of evidence
Randomized clinical trial (Type 2B)
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Affiliation(s)
- Marcus Vinicius Danieli
- Grupo de Cirurgia do Joelho, Uniorte Hospital de Ortopedia, Londrina, PR, Brasil.,Hospital Evangélico de Londrina, Londrina, PR, Brasil
| | - João Paulo Fernandes Guerreiro
- Grupo de Cirurgia do Joelho, Uniorte Hospital de Ortopedia, Londrina, PR, Brasil.,Hospital Evangélico de Londrina, Londrina, PR, Brasil
| | | | | | | | - Daniele Cristina Cataneo
- Departamento de Cirurgia, Universidade Estadual Paulista (UNESP), Faculdade de Medicina, Botucatu, Botucatu, SP, Brasil
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19
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Parker BJ, Rhodes DI, O'Brien CM, Rodda AE, Cameron NR. Nerve guidance conduit development for primary treatment of peripheral nerve transection injuries: A commercial perspective. Acta Biomater 2021; 135:64-86. [PMID: 34492374 DOI: 10.1016/j.actbio.2021.08.052] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/19/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022]
Abstract
Commercial nerve guidance conduits (NGCs) for repair of peripheral nerve discontinuities are of little use in gaps larger than 30 mm, and for smaller gaps they often fail to compete with the autografts that they are designed to replace. While recent research to develop new technologies for use in NGCs has produced many advanced designs with seemingly positive functional outcomes in animal models, these advances have not been translated into viable clinical products. While there have been many detailed reviews of the technologies available for creating NGCs, none of these have focussed on the requirements of the commercialisation process which are vital to ensure the translation of a technology from bench to clinic. Consideration of the factors essential for commercial viability, including regulatory clearance, reimbursement processes, manufacturability and scale up, and quality management early in the design process is vital in giving new technologies the best chance at achieving real-world impact. Here we have attempted to summarise the major components to consider during the development of emerging NGC technologies as a guide for those looking to develop new technology in this domain. We also examine a selection of the latest academic developments from the viewpoint of clinical translation, and discuss areas where we believe further work would be most likely to bring new NGC technologies to the clinic. STATEMENT OF SIGNIFICANCE: NGCs for peripheral nerve repairs represent an adaptable foundation with potential to incorporate modifications to improve nerve regeneration outcomes. In this review we outline the regulatory processes that functionally distinct NGCs may need to address and explore new modifications and the complications that may need to be addressed during the translation process from bench to clinic.
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Affiliation(s)
- Bradyn J Parker
- Department of Materials Science and Engineering, Monash University, 22 Alliance Lane, Clayton, Victoria 3800, Australia; Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing, Research Way, Clayton, Victoria 3168, Australia
| | - David I Rhodes
- Department of Materials Science and Engineering, Monash University, 22 Alliance Lane, Clayton, Victoria 3800, Australia; ReNerve Pty. Ltd., Brunswick East 3057, Australia
| | - Carmel M O'Brien
- Commonwealth Scientific and Industrial Research Organisation (CSIRO) Manufacturing, Research Way, Clayton, Victoria 3168, Australia; Australian Regenerative Medicine Institute, Science, Technology, Research and innovation Precinct (STRIP), Monash University, Wellington Road, Clayton, Victoria 3800, Australia
| | - Andrew E Rodda
- Department of Materials Science and Engineering, Monash University, 22 Alliance Lane, Clayton, Victoria 3800, Australia
| | - Neil R Cameron
- Department of Materials Science and Engineering, Monash University, 22 Alliance Lane, Clayton, Victoria 3800, Australia; School of Engineering, University of Warwick, Coventry CV4 7AL, United Kingdom.
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20
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O'Sullivan L, Ní Ríordáin R. Autologous platelet concentrates in oral surgery: protocols, properties, and clinical applications. Oral Surg Oral Med Oral Pathol Oral Radiol 2021; 133:156-164. [PMID: 34518138 DOI: 10.1016/j.oooo.2021.05.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/19/2021] [Accepted: 05/27/2021] [Indexed: 12/31/2022]
Abstract
Autologous platelet concentrates (APCs) are a relatively new phenomenon, with initial reports of their regenerative potential published as recently as 1998. Despite their relative infancy, a huge body of evidence exists in support of their capacity to promote osseous and soft tissue regeneration through the physiologic processes of platelet activation and subsequent growth factor release. APCs have transformed many areas of healthcare and are now considered an essential component of the surgical milieu. In this narrative review, we explore the evolution of autologous platelet therapies with a particular emphasis on their contemporary applications in oral surgery, which rather fittingly was the first specialty to report the regenerative potential of APCs.
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Affiliation(s)
- Laura O'Sullivan
- Specialty trainee, Oral Surgery, Cork University Dental School and Hospital, University College Cork, Cork, Ireland.
| | - Rícheal Ní Ríordáin
- Consultant/Senior Lecturer, Oral Medicine, Cork University Dental School and Hospital, University College Cork, Cork, Ireland; Honorary Associate Professor, Oral Medicine, University College London, London Eastman Dental Institute, London, United Kingdom
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21
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Tsai WC, Yu TY, Chang GJ, Chang HN, Lin LP, Lin MS, Pang JHS. Use of Platelet-Rich Plasma Plus Suramin, an Antifibrotic Agent, to Improve Muscle Healing After Injuries. Am J Sports Med 2021; 49:3102-3112. [PMID: 34351815 DOI: 10.1177/03635465211030295] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The increasing use of platelet-rich plasma (PRP) to treat muscle injuries raises concerns because transforming growth factor-beta (TGF-β) in PRP may promote fibrosis in the injured muscle and thus impair muscle regeneration. PURPOSE To investigate whether suramin (a TGF-β inhibitor) can reduce muscle fibrosis to improve healing of the injured muscle after PRP treatment and identify the underlying molecular mechanism. STUDY DESIGN Controlled laboratory study. METHODS Myoblasts isolated from the gastrocnemius muscle of Sprague Dawley rats were treated with PRP or PRP plus suramin. MTT assays were performed to evaluate cell viability. The expression of fibrosis-associated proteins (such as type I collagen and fibronectin), Smad2, and phosphorylated Smad2 was determined using Western blot analysis and immunofluorescent staining. An anti-TGF-β antibody was employed to verify the role of TGF-β in fibronectin expression. Gastrocnemius muscles were injured through a partial transverse incision and then treated using PRP or PRP plus suramin. Hematoxylin and eosin staining was conducted to evaluate the healing process 7 days after the injury. Immunofluorescent staining was performed to evaluate fibronectin expression. Muscle contractile properties-fast-twitch and tetanic strength-were evaluated through electric stimulation. RESULTS PRP plus 25 μg/mL of suramin promoted myoblast proliferation. PRP induced fibronectin expression in myoblasts, but suramin reduced this upregulation. The anti-TGF-β antibody also reduced the upregulation of fibronectin expression in the presence of PRP. The upregulation of phosphorylated Smad2 by PRP was reduced by either the anti-TGF-β antibody or suramin. In the animal study, no significant difference was discovered in muscle healing between the PRP versus PRP plus suramin groups. However, the PRP plus suramin group had reduced fibronectin expression at the injury site. Fast-twitch strength and tetanic strength were significantly higher in the injured muscle treated using PRP or PRP plus suramin. CONCLUSION Simultaneous PRP and suramin use reduced fibrosis in the injured muscle and promoted healing without negatively affecting the muscle's contractile properties. The underlying molecular mechanism may be associated with the phosphorylated Smad2 pathway. CLINICAL RELEVANCE Simultaneous PRP and suramin use may reduce muscle fibrosis without compromising muscle contractile properties and thus improve muscle healing.
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Affiliation(s)
- Wen-Chung Tsai
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Tung-Yang Yu
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan
| | - Gwo-Jyh Chang
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan
| | - Hsiang-Ning Chang
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Li-Ping Lin
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan
| | - Miao-Sui Lin
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Jong-Hwei S Pang
- Department of Physical Medicine and Rehabilitation, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan
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Perego R, Spada E, Moneta E, Baggiani L, Proverbio D. Use of Autologous Leucocyte- and Platelet-Rich Plasma (L-PRP) in the Treatment of Aural Hematoma in Dogs. Vet Sci 2021; 8:vetsci8090172. [PMID: 34564566 PMCID: PMC8473142 DOI: 10.3390/vetsci8090172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 01/03/2023] Open
Abstract
Leukocyte- and platelet-rich plasma (L-PRP) can accelerate the healing process by providing increased concentrations of platelet-derived growth factors. The objective of this study was to evaluate the clinical effect of L-PRP in the treatment of canine aural hematomas associated with otitis externa. Twenty mL of citrated whole blood was collected from each of the 17 dogs included and autologous L-PRP was produced. The aural hematoma was drained and 0.5–1 mL of L-PRP was injected. The dogs were examined weekly until 7 days after complete clinical healing. A final clinical follow-up was performed 6 weeks after the first treatment with L-PRP. If there was recurrence of the aural hematoma at the first follow-up, the treatment was repeated. In total, 2/17 cases were lost after the first follow-up. In 5/17 dogs, a short-term recurrence occurred. In 12/15 cases, complete clinical resolution was achieved with a single L-PRP application (Group A1) and in 3/15 with two treatments (Group A2). The mean time to complete clinical resolution was 16 ± 8.7 days (A1) and 23.3 ± 4 days (A2), respectively. No side effects were reported. The in situ administration of autologous L-PRP resulted in a complete resolution of the aural hematoma in all dogs that completed the clinical trial.
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Affiliation(s)
- Roberta Perego
- Veterinary Transfusion Research Laboratory (REVLab), Department of Veterinary Medicine (DIMEVET), University of Milan, Via dell’Università 6, 26900 Lodi, LO, Italy; (L.B.); (D.P.)
- Correspondence: (R.P.); (E.S.)
| | - Eva Spada
- Veterinary Transfusion Research Laboratory (REVLab), Department of Veterinary Medicine (DIMEVET), University of Milan, Via dell’Università 6, 26900 Lodi, LO, Italy; (L.B.); (D.P.)
- Correspondence: (R.P.); (E.S.)
| | - Elena Moneta
- Clinica Veterinaria Lainate, Via Nerviano 2, 20045 Lainate, MI, Italy;
| | - Luciana Baggiani
- Veterinary Transfusion Research Laboratory (REVLab), Department of Veterinary Medicine (DIMEVET), University of Milan, Via dell’Università 6, 26900 Lodi, LO, Italy; (L.B.); (D.P.)
| | - Daniela Proverbio
- Veterinary Transfusion Research Laboratory (REVLab), Department of Veterinary Medicine (DIMEVET), University of Milan, Via dell’Università 6, 26900 Lodi, LO, Italy; (L.B.); (D.P.)
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23
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Cole BJ, Gilat R, DiFiori J, Rodeo SA, Bedi A. The 2020 NBA Orthobiologics Consensus Statement. Orthop J Sports Med 2021; 9:23259671211002296. [PMID: 34017878 PMCID: PMC8114275 DOI: 10.1177/23259671211002296] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 12/14/2020] [Indexed: 12/26/2022] Open
Abstract
This 2020 NBA Orthobiologics Consensus Statement provides a concise summary of available literature and practical clinical guidelines for team physicians and players. We recognize that orthobiologic injections are a generally safe treatment modality with a significant potential to reduce pain and expedite early return to play in specific musculoskeletal injuries. The use of orthobiologics in sports medicine to safely reduce time loss and reinjury is of considerable interest, especially as it relates to the potential effect on a professional athlete. While these novel substances have potential to enhance healing and regeneration of injured tissues, there is a lack of robust data to support their regular use at this time. There are no absolutes when considering the implementation of orthobiologics, and unbiased clinical judgment with an emphasis on player safety should always prevail. Current best evidence supports the following: Key Points There is support for the use of leukocyte-poor platelet-rich plasma in the treatment of knee osteoarthritis. There is support for consideration of using leukocyte-rich platelet-rich plasma for patellar tendinopathy. The efficacy of using mesenchymal stromal cell injections in the management of joint and soft tissue injuries remains unproven at this time. There are very few data to suggest that current cell therapy treatments lead to any true functional tissue regeneration. Meticulous and sterile preparation guidelines must be followed to minimize the risk for infection and adverse events if these treatments are pursued.Given the high variability in orthobiologic formulations, team physicians must stay up-to-date with the most recent peer-reviewed literature and orthobiologic preparation protocols for specific injuries.Evidence-based treatment algorithms are necessary to identify the optimal orthobiologic formulations for specific tissues and injuries in athletes.Changes in the regulatory environment and improved standardization are required given the exponential increase in utilization as novel techniques and substances are introduced into clinical practice.
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Affiliation(s)
- Brian J Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA
| | - Ron Gilat
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, USA.,Department of Orthopaedic Surgery, Shamir Medical Center and Tel Aviv University, Tel Aviv, Israel
| | - John DiFiori
- Hospital for Special Surgery, New York, New York, USA
| | - Scott A Rodeo
- Hospital for Special Surgery, New York, New York, USA
| | - Asheesh Bedi
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Platelet-Rich Plasma Applications for Achilles Tendon Repair: A Bridge between Biology and Surgery. Int J Mol Sci 2021; 22:ijms22020824. [PMID: 33467646 PMCID: PMC7830415 DOI: 10.3390/ijms22020824] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/08/2021] [Accepted: 01/10/2021] [Indexed: 12/15/2022] Open
Abstract
Achilles tendon ruptures are very common tendon ruptures and their incidence is increasing in modern society, resulting in work incapacity and months off sport, which generate a need for accelerated and successful therapeutic repair strategy. Platelet-rich plasma (PRP) is emerging as adjuvant human blood-derived constructs to assist Achilles tendon rupture treatment. However, myriad PRP preparation methods in conjunction with poor standardization in the modalities of their applications impinge on the consistent effectiveness of clinical and structural outcomes regarding their therapeutic efficacy. The purpose of this review is to provide some light on the application of PRP for Achilles tendon ruptures. PRP has many characteristics that make it an attractive treatment. Elements such as the inclusion of leukocytes and erythrocytes within PRP, the absence of activation and activation ex vivo or in vivo, the modality of application, and the adjustment of PRP pH can influence the biology of the applied product and result in misleading therapeutic conclusions. The weakest points in demonstrating their consistent effectiveness are primarily the result of myriad PRP preparation methods and the poor standardization of modalities for their application. Selecting the right biological scaffold and applying it correctly to restitutio ad integrum of ruptured Achilles tendons remains a daunting and complex task.
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25
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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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26
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Zhou M, Wang N, Wang G, Jia Z, Qi X. Parecoxib alleviates the inflammatory effect of leukocyte-rich platelet-rich plasma in normal rabbit tendons. BMC Musculoskelet Disord 2020; 21:831. [PMID: 33302906 PMCID: PMC7731558 DOI: 10.1186/s12891-020-03793-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 11/12/2020] [Indexed: 01/08/2023] Open
Abstract
Background Platelet-rich plasma (PRP) is widely used to treat tendon injuries. Its therapeutic effect varies depending on the different cell components, and white blood cells (WBCs) may play an important role in this phenomenon. The purpose of this study was to evaluate how PRP with different concentrations of WBCs affect normal rabbit tendon and assess whether non-steroidal anti-inflammatory drugs (NSAIDs) can suppress the catabolic effects of WBCs. Methods Sixteen adult New Zealand White rabbits were used. Blood samples were collected from each rabbit, and PRP was extracted following two different protocols to obtain leukocyte-poor PRP (LP-PRP) and leukocyte-rich PRP (LR-PRP). LP-PRP or LR-PRP was injected into the patellar tendon of each rabbit, while normal saline (NS) was injected as control. In LR-PRP + NSAID group, Parecoxib was administered after LR-PRP injection. For each group, 2 rabbits were euthanatized at day 5 and 14. The patellar tendons were collected and stained with hematoxylin and eosin. A semi-quantitative approach was used to assess the inflammatory response and tendon destruction based on the evaluation of the WBCs, vascularization, fiber structure, and fibrosis. Results The LR-PRP group exhibited a higher total tendon score than the LP-PRP group at day 5 after PRP injection, but there was no significant difference between the two groups at day 14. For the NSAID group, the tendon score was lower than that of the LR-PRP group both at day 5 and 14. Conclusion LR-PRP can promote a higher inflammatory response than LP-PRP in the normal rabbit patellar tendon, and this effect can be suppressed by NSAIDs.
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Affiliation(s)
- Ming Zhou
- Department of Rehabilitation Medicine, First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Ning Wang
- Department of Rehabilitation Medicine, First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China.
| | - Gang Wang
- Department of Rehabilitation Medicine, First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Zishan Jia
- Department of Rehabilitation Medicine, First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China
| | - Xiaolei Qi
- Department of Rehabilitation Medicine, First Medical Center of Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, People's Republic of China
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Alian SM, Zaghlol RS, Khalil SS. Platelet rich plasma versus extracorporeal shock wave therapy in patients with non-calcific supraspinatous tears. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2020. [DOI: 10.1186/s43166-020-00020-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To compare the clinical efficacy of platelet rich plasma (PRP) subacromial injection and extracorporeal shock wave therapy (ESWT) on refractory non-calcific partial thickness supraspinatous tendon tear.
Results
Significant improvement in all outcome measures achieved in both groups at 4 weeks follow-up period (the end of treatment course) (P< 0.05). At 12 weeks follow-up period, group I, showed significant improvement in all outcome measures compared to baseline and group II; however, in group II, there was no significant difference compared to baseline; moreover, deterioration in the previous improvement was noticed.
Conclusion
Both PRP (group I) and ESWT (group II) are effective therapeutic methods in the management of refractory non-calcific partial thickness supraspinatous tendon tear; however, PRP (group I) has better long-term effects on both pain and function.
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28
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Khurana A, Dhankhar V, Goel N, Gupta R, Goyal A. Comparison of midterm results of Platelet Rich Plasma (PRP) versus Steroid for plantar fasciitis: A randomized control trial of 118 patients. J Clin Orthop Trauma 2020; 13:9-14. [PMID: 33717869 PMCID: PMC7920137 DOI: 10.1016/j.jcot.2020.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/14/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Plantar fasciitis, which is a common cause of heel pain, often results in significant morbidity. In cases who are not responsive to initial conservative treatment, invasive procedures, often in the form of local infiltration of steroid are required. These procedures are associated with significant complications. Local Platelet Rich Plasma (PRP) infiltration is an emerging addition to these treatments. However, whether it is more effective in reducing pain and improving function than other treatments (such as steroid injections or whole blood) remains controversial. METHODS Skeletally mature patients with plantar fasciitis who had failed conservative therapy were randomized using envelope method into 2 groups: PRP and Steroid group. The participants were assessed for pain using Visual Analog Scale on the day of presentation, and then after therapy at 2 weeks, 4 weeks, 3 months, and 6 months. They were additionally assessed on final follow-up using AOFAS hind-foot Score. RESULTS 118 patients were randomized into 2 groups: 58 patients to the PRP group and 60 to the Steroid group. PRP was associated with greater improvement in VAS score and resulted in superior AOFAS score at 6 months as compared to steroid injection. The authors did not find any local or systemic complications in any of the groups. The result and difference were more pronounced as the time from injection increased and maximal benefit was observed at 6 months follow-up. None of the patients needed a repeat injection at 6 months. CONCLUSION Our study expands on the previous studies to provide a better evidence for superiority of PRP over local injection of steroid in plantar fasciitis, and the authors conclude that PRP provides better pain relief and function as compared to steroid injection. LEVEL OF EVIDENCE Level 1 Prospective Randomized Control Trial (RCT).
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Affiliation(s)
- Ankit Khurana
- Department of Orthopaedics, Dr BSA Medical College and Hospital, Delhi, India,Corresponding author. Department of Orthopaedics, Dr BSA Medical college and Hospital, Rohini Sector 6, Delhi, 110085, India.
| | - Vaneet Dhankhar
- Department of Orthopaedics, Dr BSA Medical College and Hospital, Delhi, India
| | - Navneet Goel
- Department of Orthopaedics, Dr BSA Medical College and Hospital, Delhi, India
| | - Rishi Gupta
- Department of Biostatistics, Manokalp Clinic, Delhi, India
| | - Ashish Goyal
- Department of Orthopaedics, Dr BSA Medical College and Hospital, Delhi, India
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29
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Bi J, Intriago MFB, Koivisto L, Jiang G, Häkkinen L, Larjava H. Leucocyte‐ and platelet‐rich fibrin regulates expression of genes related to early wound healing in human gingival fibroblasts. J Clin Periodontol 2020; 47:851-862. [DOI: 10.1111/jcpe.13293] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/03/2020] [Accepted: 04/11/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Jiarui Bi
- Faculty of Dentistry Department of Oral Biological and Medical Sciences University of British Columbia Vancouver BC Canada
| | - Maria Fernanda Barona Intriago
- Faculty of Dentistry Department of Oral Biological and Medical Sciences University of British Columbia Vancouver BC Canada
| | - Leeni Koivisto
- Faculty of Dentistry Department of Oral Biological and Medical Sciences University of British Columbia Vancouver BC Canada
| | - Guoqiao Jiang
- Faculty of Dentistry Department of Oral Biological and Medical Sciences University of British Columbia Vancouver BC Canada
| | - Lari Häkkinen
- Faculty of Dentistry Department of Oral Biological and Medical Sciences University of British Columbia Vancouver BC Canada
| | - Hannu Larjava
- Faculty of Dentistry Department of Oral Biological and Medical Sciences University of British Columbia Vancouver BC Canada
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30
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Yausep OE, Madhi I, Trigkilidas D. Platelet rich plasma for treatment of osteochondral lesions of the talus: A systematic review of clinical trials. J Orthop 2020; 18:218-225. [PMID: 32071508 PMCID: PMC7013135 DOI: 10.1016/j.jor.2020.01.046] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/26/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The ankle is the second most frequent site, following the knee, that requires cartilage repair. Osteochondral lesion of the talus (OLT) is common among athletes and is a result of talar cartilage detachment with or without subchondral bone fragmentation after a traumatic event. Treatment strategies for OLT can be classified as reparative or replacement interventions, with the former taking precedence. Recent studies show that the growth factors and bioactive components in platelet rich plasma (PRP) could improve cartilage regeneration. The prospect of using autologous blood to obtain a product that could enhance regeneration in damaged cartilage has been regarded as innovative, as it could circumvent the need for a replacement, and potentially join the ranks of first line reparative interventions against cartilage diseases. METHODS Literature searches were performed across seven search engines for randomized controlled trials using PRP to treat patients with OLT. Outcomes extracted included ankle function and pain measures. Level of evidence and methodological quality were evaluated using relevant guidelines. RESULTS Four studies met the eligibility criteria and were systematically appraised. Two studies scored Level 1 and 2 scored Level 2 based on the LOE assessment. MQOE evaluation revealed one study with excellent quality, and three with good quality. Overall results showed that PRP, as an adjunct to microfracture surgery, significantly improved function and reduced pain compared to microfracture surgery alone. Intra-articular PRP injection also demonstrated significantly enhanced recovery of function, and decreased pain scores compared to HA. CONCLUSION PRP improves joint function, and reduces pain in patients with OLT regardless of the method of implementation. In addition, inter-study comparison demonstrated that patients that received surgery along with PRP injections improved more than those that received PRP only. The studies that corroborate this conclusion have high levels of evidence with satisfactory methodological quality. LEVEL OF EVIDENCE Level 2, systematic review of Level 1 and 2 studies.
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Affiliation(s)
| | - Imad Madhi
- Orthopedic Division, South Tyneside District Hospital, South Shields, United Kingdom
| | - Dionysios Trigkilidas
- Orthopedic Division, South Tyneside District Hospital, South Shields, United Kingdom
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YALÇIN Ü. Plantar Fasiit Tedavisinde Trombosit Zengin Plazma ve Ekstrakorporeal Şok Dalga Tedavisinin Etkinliğinin Karşılaştırılması. ACTA MEDICA ALANYA 2020. [DOI: 10.30565/medalanya.566188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Beyzadeoglu T, Pehlivanoglu T, Yildirim K, Buldu H, Tandogan R, Tuzun U. Does the Application of Platelet-Rich Fibrin in Anterior Cruciate Ligament Reconstruction Enhance Graft Healing and Maturation? A Comparative MRI Study of 44 Cases. Orthop J Sports Med 2020; 8:2325967120902013. [PMID: 32128315 PMCID: PMC7036517 DOI: 10.1177/2325967120902013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/28/2019] [Indexed: 01/03/2023] Open
Abstract
Background: Anterior cruciate ligament (ACL) reconstruction performed with growth factors
and activated platelets has been suggested to accelerate tendon
ligamentization, leading to earlier return to daily activities and
sports. Hypotheses: Platelet-rich fibrin (PRF) will result in improved graft maturation and
healing as evaluated by magnetic resonance imaging (MRI) in patients
undergoing hamstring ACL reconstruction. Hemostatic and analgesic properties
of PRF will lead to less postoperative blood loss and pain. Study Design: Cohort study; Level of evidence, 3. Methods: A total of 44 patients with isolated ACL injuries who underwent arthroscopic
all-inside anatomic single-bundle ACL reconstruction with semitendinosus
tendon graft were enrolled. Group 1 included 23 patients who had PRF sprayed
to the surface of the graft; group 2 included 21 patients for whom no PRF
was used. Patients were discharged after 24 hours and examined for
hemarthrosis that needed to be aspirated. MRI was performed at the fifth
postoperative month. A blinded radiologist evaluated graft maturation
according to its signal intensity and the presence of synovial fluid at the
tunnel-graft interface. Results: PRF-treated grafts demonstrated lower MRI signal intensity and less fluid in
the graft-tunnel interface as compared with controls for the entire length
of the graft. The mean full-length MRI signal intensities were 9.19 versus
16.59 (P = .047) for groups 1 and 2, respectively. Subgroup
analysis of the semitendinosus grafts demonstrated a signal intensity of
11.57 versus 23.98 (P = .044) for the proximal third, 9.53
versus 13.83 (P = .237) for the midbody, and 6.48 versus
11.98 (P = .087) for the distal third. Synovial fluid at
the graft-tunnel interface was detected in 1 patient in group 1 (4.3%) and 3
patients in group 2 (14.3%; P < .001). Patients in group
1 had significantly less hemarthrosis that needed to be aspirated
(P = .003), while postoperative analgesia requirements
were similar in both groups (P = .08). No clinical benefit
of PRF could be demonstrated in clinical outcomes. Conclusion: Application of PRF led to superior graft integration and maturation in the
proximal third of the ACL graft. There was no significant difference in MRI
signal intensity in the midbody or distal tibial graft. Application of PRF
also resulted in significantly lower rates of postoperative hemarthrosis
that needed to be aspirated.
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Affiliation(s)
- Tahsin Beyzadeoglu
- Beyzadeoglu Clinic, Department of Orthopaedics and Traumatology, Istanbul, Turkey.,Department of Sports Medicine, Faculty of Health Sciences, Halic University, Istanbul, Turkey
| | - Tuna Pehlivanoglu
- Department of Orthopaedic Surgery and Traumatology, Istanbul Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Kerem Yildirim
- Beyzadeoglu Clinic, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Halil Buldu
- Beyzadeoglu Clinic, Department of Orthopaedics and Traumatology, Istanbul, Turkey.,Department of Sports Medicine, Faculty of Health Sciences, Halic University, Istanbul, Turkey
| | - Reha Tandogan
- Cankaya Ortopedi, Department of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Umit Tuzun
- Department of Radiology, Sonomed Imaging Center, Istanbul, Turkey
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Lee HW, Choi KH, Kim JY, Kim KO, Haotian B, Yuxuan L, Noh KC. Proteomic Classification and Identification of Proteins Related to Tissue Healing of Platelet-Rich Plasma. Clin Orthop Surg 2020; 12:120-129. [PMID: 32117548 PMCID: PMC7031431 DOI: 10.4055/cios.2020.12.1.120] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 08/02/2019] [Indexed: 12/21/2022] Open
Abstract
Background Platelet-rich plasma (PRP) is a plasma component of autologous blood containing a high concentration of platelets. PRP is used to promote healing of damaged tissues. However, there are not many studies on the composition and expression patterns of active proteins in PRP. The purpose of this study was to identify unknown factors that contribute to tissue healing by proteomic analysis of proteins in PRP. Methods Three men in their 30s with no basal disease participated in this study. All identified proteins were classified for tissue healing-related functions on the basis of the gene ontology analysis of adhesion molecule with Ig-like domain 2 (AmiGO2). PRP was prepared by using the ACP kit and GPS III kit. Results We identified a total of 125 proteins related to wound healing, along with three proteins for angiogenesis involved in wound healing, two proteins for fibroblast migration, four proteins for collagen biosynthesis process, two proteins for glycosaminoglycan biosynthesis process, and 13 proteins for glycosaminoglycan binding. So, in addition to the growth factors that have been already known to be involved in tissue healing, 25 new proteins were identified. Conclusions We identified the unknown proteins associated with tissue healing in PRP. Our findings may serve as a foundation for the establishment of basic medical evidence for PRP applications.
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Affiliation(s)
- Ho Won Lee
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Kyung-Ho Choi
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jung-Youn Kim
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Kyung-Ok Kim
- Gachon Medical Research Institute, Gil Medical Center, Gachon University, Incheon, Korea
| | - Bai Haotian
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.,Department of Orthopaedic Surgery, The Second Hospital of Jilin University, Changchun, China
| | - Liu Yuxuan
- Department of Orthopaedic Surgery, The Second Hospital of Jilin University, Changchun, China.,Department of Radiology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Kyu-Cheol Noh
- Department of Orthopaedic Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Rogulska O, Tykhvynska O, Revenko O, Grischuk V, Mazur S, Volkova N, Vasyliev R, Petrenko A, Petrenko Y. Novel Cryopreservation Approach Providing Off-the-Shelf Availability of Human Multipotent Mesenchymal Stromal Cells for Clinical Applications. Stem Cells Int 2019; 2019:4150690. [PMID: 31885604 PMCID: PMC6907044 DOI: 10.1155/2019/4150690] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 09/21/2019] [Accepted: 10/14/2019] [Indexed: 12/19/2022] Open
Abstract
Cryopreservation is the only established method to provide long-term storage and fast availability of cellular product for therapeutic applications. The overwhelming majority of cryopreservation media contain toxic concentrations of dimethyl sulfoxide (DMSO) limiting the possibility for the direct administration of cryopreserved cells to the patients. Here, we propose a novel approach for nontoxic xeno-free cryopreservation of human multipotent mesenchymal stromal cells (MSCs) aimed at ensuring high viability, ready-to-use availability, and localized delivery of the cell-based graft into damaged tissues. For MSC cryopreservation, we applied sucrose pretreatment procedure and xeno-free cryoprotective medium containing human platelet-poor blood plasma (PPP), sucrose, and nontoxic concentration of DMSO. Using the combination of PPP, 0.2 M sucrose, and 1% DMSO, the recovery rate of cryopreserved MSCs reached 73% of the values obtained for noncryopreserved cells. Moreover, the presence of PPP in the cryoprotective medium provided the possibility to create a ready-to-use 3D hydrogel for the localized delivery and additional support of MSCs in vivo. In a proof-of-concept study, we assessed the regenerative capacity of cryopreserved MSCs in a full-thickness wound model in mice. The positive impact of MSCs within 3D gel on wound healing rates was confirmed by morphometric and histological examinations. Our results demonstrate the possibility to apply cryopreserved cells immediately after thawing using a cryoprotective medium as the vehicle solution.
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Affiliation(s)
- Olena Rogulska
- Department of Biochemistry, Institute for Problems of Cryobiology and Cryomedicine, National Academy of Sciences of Ukraine, Pereyaslavska 23, 61015 Kharkiv, Ukraine
| | - Olga Tykhvynska
- Department of Biochemistry, Institute for Problems of Cryobiology and Cryomedicine, National Academy of Sciences of Ukraine, Pereyaslavska 23, 61015 Kharkiv, Ukraine
| | - Olena Revenko
- Department of Biochemistry, Institute for Problems of Cryobiology and Cryomedicine, National Academy of Sciences of Ukraine, Pereyaslavska 23, 61015 Kharkiv, Ukraine
| | - Viktor Grischuk
- Department of Biochemistry, Institute for Problems of Cryobiology and Cryomedicine, National Academy of Sciences of Ukraine, Pereyaslavska 23, 61015 Kharkiv, Ukraine
| | - Svitlana Mazur
- Department of Biochemistry, Institute for Problems of Cryobiology and Cryomedicine, National Academy of Sciences of Ukraine, Pereyaslavska 23, 61015 Kharkiv, Ukraine
| | - Natalia Volkova
- Department of Biochemistry, Institute for Problems of Cryobiology and Cryomedicine, National Academy of Sciences of Ukraine, Pereyaslavska 23, 61015 Kharkiv, Ukraine
| | - Roman Vasyliev
- State Institute of Genetic and Regenerative Medicine, National Academy of Medical Sciences of Ukraine, Kiev 04114, Ukraine
| | - Alexander Petrenko
- Department of Biochemistry, Institute for Problems of Cryobiology and Cryomedicine, National Academy of Sciences of Ukraine, Pereyaslavska 23, 61015 Kharkiv, Ukraine
| | - Yuriy Petrenko
- Department of Biochemistry, Institute for Problems of Cryobiology and Cryomedicine, National Academy of Sciences of Ukraine, Pereyaslavska 23, 61015 Kharkiv, Ukraine
- Department of Biomaterials and Biophysical Methods, Institute of Experimental Medicine AS CR v.v.i, Videnska 1083, 14220 Prague, Czech Republic
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McNamee MJ, Coveney CM, Faulkner A, Gabe J. Ethics, Evidence Based Sports Medicine, and the Use of Platelet Rich Plasma in the English Premier League. HEALTH CARE ANALYSIS 2018; 26:344-361. [PMID: 28756518 PMCID: PMC6208980 DOI: 10.1007/s10728-017-0345-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The use of platelet rich plasma (PRP) as a novel treatment is discussed in the context of a qualitative research study comprising 38 interviews with sports medicine practitioners and other stakeholders working within the English Premier League during the 2013-16 seasons. Analysis of the data produced several overarching themes: conservatism versus experimentalism in medical attitudes; therapy perspectives divergence; conflicting versions of appropriate evidence; subcultures; community beliefs/practices; and negotiation of medical decision-making. The contested evidence base for the efficacy of PRP is presented in the context of a broader professional shift towards evidence based medicine within sports medicine. Many of the participants while accepting this shift are still committed to casuistic practices where clinical judgment is flexible and does not recognize a context-free hierarchy of evidentiary standards to ethically justifiable practice. We also discuss a tendency in the data collected to consider the use of deceptive, placebo-like, practices among the clinician participants that challenge dominant understandings of informed consent in medical ethics. We conclude that the complex relation between evidence and ethics requires greater critical scrutiny for this emerging specialism within the medical community.
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Affiliation(s)
- M J McNamee
- College of Engineering, Swansea University, Swansea, UK.
| | | | | | - J Gabe
- Royal Holloway, University of London, Egham, UK
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Abstract
In the last few decades, several techniques have been used to optimize tendon, ligament, and musculoskeletal healing. The evidence in favor of these techniques is still not proven, and level I studies are lacking. We performed an analysis of the therapeutic strategies and tissue engineering projects recently published in this field. Here, we try to give an insight into the current status of cell therapies and the latest techniques of bioengineering applied to the field of orthopedic surgery. The future areas for research in the management of musculoskeletal injuries are outlined. There are emerging technologies developing into substantial clinical treatment options that need to be critically evaluated. Mechanical stimulation of the constructs reproduces a more propitious environment for effective healing.
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Chahla J, Cinque ME, Mandelbaum BR. Biologically Augmented Quadriceps Tendon Autograft With Platelet-Rich Plasma for Anterior Cruciate Ligament Reconstruction. Arthrosc Tech 2018; 7:e1063-e1069. [PMID: 30533350 PMCID: PMC6261920 DOI: 10.1016/j.eats.2018.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/26/2018] [Indexed: 02/03/2023] Open
Abstract
Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures studied in the orthopaedic literature. In this regard, graft preparation is a key factor for successful outcomes. Although current methods to reconstruct the ACL are generally perceived to be successful, recent studies indicate that normal structure and function of the knee are fully restored in less than half of the patients. Therefore, biologically augmenting these scaffolds could provide a potential solution for improving healing times and biomechanical properties of the graft. The purpose of this Technical Note is to describe our preferred technique for an ACL graft preparation (quadriceps tendon) augmented with platelet-rich plasma.
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Affiliation(s)
- Jorge Chahla
- Cedars Sinai Kerlan Jobe Institute, Santa Monica, California, U.S.A.,Address correspondence to Jorge Chahla, M.D., Ph.D., 2020 Santa Monica Blvd, Ste 400, Santa Monica, CA 90404, U.S.A.
| | - Mark E. Cinque
- Steadman Philippon Research Institute, Vail, Colorado, U.S.A
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Ling Y, Wang S. Effects of platelet-rich plasma in the treatment of plantar fasciitis: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2018; 97:e12110. [PMID: 30212938 PMCID: PMC6156022 DOI: 10.1097/md.0000000000012110] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Plantar fasciitis is a common cause of heel pain, which often results in significant morbidity. There have been several treatment options that are used for plantar fasciitis, including nonsteroidal anti-inflammatory drugs, orthoses, physical therapy, and steroid injections. OBJECTIVES The aim of this meta-analysis was to compare the effects of platelet-rich plasma (PRP) and other treatments in patients with plantar fasciitis. SEARCH METHODS Medline, Web of Science, and Embase were systematically searched to identify relevant trials. SELECTION CRITERIA Randomized controlled trials (RCTs) that compared the effects of PRP and other treatments on plantar fasciitis were included. DATA COLLECTION AND ANALYSIS The main outcomes included changes from baseline in visual analog scale (VAS) score, American Orthopaedic Foot and Ankle Society Score (AOFAS), and Roles-Maudsley score (RMS). Results were expressed as weight mean difference (WMD) with 95% confidence interval (95% CI). The meta-analysis was performed using a fixed-effects or random-effects model according to heterogeneity. MAIN RESULTS Ten RCTs involving a total of 445 patients with plantar fasciitis were included. Among these studies, 9 compared PRP with steroid, and 1 compared PRP with whole blood.Four studies were categorized as being at low risk of bias, and the remaining 6 as being at unclear risk of bias.Pooled estimates suggested that PRP had greater changes in VAS and AOFAS scores than other treatments. However, it had no benefit effect in the RMS.Subgroup analysis for VAS and AOFAS showed that PRP had superior effect than other treatments at 12 months, but not at the 1, 3, 6 months.Subgroup analysis based on treatment regimens demonstrated that PRP was more effective than steroid in the change from baseline in AOFAS, but not in VAS and RMS scores. AUTHORS' CONCLUSION PRP was as effective as other treatments in reducing pain and improving function in patients with plantar fasciitis. Subgroup analysis indicated that PRP had better effect than steroid in AOFAS Score and its effect was durable in a long term. However, considering the potential limitations in this study, more large-scale RCTs are needed to confirm the current findings.
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Affiliation(s)
- Yan Ling
- Department of Rehabilitation, Research Center of Sports Rehabilitation of Shandong
| | - Shu Wang
- Department of Rehabilitation, Shandong Sports Hospital, Jinan, China
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Incorporating platelet-rich plasma into coaxial electrospun nanofibers for bone tissue engineering. Int J Pharm 2018; 547:656-666. [DOI: 10.1016/j.ijpharm.2018.06.020] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/15/2018] [Accepted: 06/06/2018] [Indexed: 12/11/2022]
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McClure MJ, Clark NM, Schwartz Z, Boyan BD. Platelet-rich plasma and alignment enhance myogenin via ERK mitogen activated protein kinase signaling. ACTA ACUST UNITED AC 2018; 13:055009. [PMID: 29967311 DOI: 10.1088/1748-605x/aad0a7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Volumetric muscle loss is debilitating and involves extensive rehabilitation. One approach to accelerate healing, rehabilitation, and muscle function is to repair damaged skeletal muscle using regenerative medicine strategies. In sports medicine and orthopedics, a common clinical approach is to treat minor to severe musculoskeletal injuries with platelet-rich plasma (PRP) injections. While these types of treatments have become commonplace, there are limited data demonstrating their effectiveness. The goal of this study was to determine the effect of PRP on myoblast gene expression and protein production when incorporated into a polymer fiber. To test this, we generated extracellular matrix mimicking scaffolds using aligned polydioxanone (PDO) fibers containing lyophilized PRP (SmartPReP® 2, Harvest Technologies Corporation, Plymouth, MA). Scaffolds with PRP caused a dose-dependent increase in myogenin and myosin heavy chain but did not affect myogenic differentiation factor-1 (MyoD). Integrin α7β1D decreased and α5β1A did not change in response to PRP scaffolds. ERK inhibition decreased myogenin and increased Myod on the PDO-PRP scaffolds. Taken together, these data suggest that alignment and PRP produce a substrate-dependent, ERK-dependent, and dose-dependent effect on myogenic differentiation.
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Affiliation(s)
- Michael J McClure
- Physical Medicine and Rehabilitation Service, Hunter Holmes McGuire VA Medical Center, Richmond, VA, United States of America. Department of Biomedical Engineering, Virginia Commonwealth University, College of Engineering, Richmond, VA, United States of America
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41
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Rehabilitation of hamstring strains: does a single injection of platelet-rich plasma improve outcomes? (Clinical study). SPORT SCIENCES FOR HEALTH 2018. [DOI: 10.1007/s11332-018-0474-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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42
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Gasparro R, Qorri E, Valletta A, Masucci M, Sammartino P, Amato A, Marenzi G. Non-Transfusional Hemocomponents: From Biology to the Clinic-A Literature Review. Bioengineering (Basel) 2018; 5:bioengineering5020027. [PMID: 29614717 PMCID: PMC6027172 DOI: 10.3390/bioengineering5020027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 03/23/2018] [Accepted: 03/29/2018] [Indexed: 12/17/2022] Open
Abstract
Non-transfusional hemocomponents for surgical use are autogenous products prepared through the centrifugation of a blood sample from a patient. Their potential beneficial outcomes include hard and soft tissue regeneration, local hemostasis, and the acceleration of wound healing. Therefore, they are suitable for application in different medical fields as therapeutic options and in surgical practices that require tissue regeneration.
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Affiliation(s)
- Roberta Gasparro
- Department of Neuroscience, Reproductive Science and Dental Science, University of Naples Federico II, 80131 Naples, Italy.
| | - Erda Qorri
- Division of Oral and Maxillofacial Surgery, Department of Dentistry, Albanian University, 1000 Tirana, Albania.
| | - Alessandra Valletta
- Department of Neuroscience, Reproductive Science and Dental Science, University of Naples Federico II, 80131 Naples, Italy.
| | - Michele Masucci
- Department of Neuroscience, Reproductive Science and Dental Science, University of Naples Federico II, 80131 Naples, Italy.
| | - Pasquale Sammartino
- Multidisciplinary Department of medical-Surgical and Dental Specialities, University of Naples "Luigi Vanvitelli", 80136 Italy.
| | - Alessandra Amato
- Department of Neuroscience, Reproductive Science and Dental Science, University of Naples Federico II, 80131 Naples, Italy.
| | - Gaetano Marenzi
- Department of Neuroscience, Reproductive Science and Dental Science, University of Naples Federico II, 80131 Naples, Italy.
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Lim W, Park SH, Kim B, Kang SW, Lee JW, Moon YL. Relationship of cytokine levels and clinical effect on platelet-rich plasma-treated lateral epicondylitis. J Orthop Res 2018; 36:913-920. [PMID: 28851099 DOI: 10.1002/jor.23714] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 08/19/2017] [Indexed: 02/04/2023]
Abstract
Lateral epicondylitis (LE) is difficult to manage and can result in significant patient morbidity. Currently, the clinical use of platelet-rich plasma (PRP) for painful tendons has received attention, but its efficacy remains controversial. This study aimed to investigate the clinical effects of PRP and its biological components. A total of 156 patients with LE were randomly divided into group 1, treated with a single injection of 2-ml autologous PRP, and group 2, treated with a control received only physical therapy without injection. Both groups used a tennis elbow strap and performed stretching and strengthening exercises during 24 weeks' follow-up. Pain and functional improvements were assessed using the visual analog scale (VAS), Modified Mayo Clinic Performance Index for the elbow, and magnetic resonance imaging (MRI). White blood cell count, platelet count, and levels of platelet-derived growth factor-AB (PDGF-AB), PDGF-BB, transforming growth factor-β (TGF-β), vascular endothelial growth factor, epithelial growth factor, and interleukin-1 β in PRP were measured and investigated for statistical correlation with the clinical score. At 24 weeks, all pain and functional variables, including VAS score, Mayo Clinic performance scores, and MRI grade, improved significantly in group 1 (p < 0.05). PDGF-AB, PDGF-BB, and TGF-β levels were more significantly increased in PRP than in whole blood. TGF-β level significantly correlated with Mayo Clinic performance score and MRI grade improvement. Thus, TGF-β level in PRP is considered to play a pivotal role in tendon healing. These results may contribute to identifying the best protocol for PRP application in tendinopathies. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:913-920, 2018.
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Affiliation(s)
- Wonbong Lim
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju, 61453, South Korea.,Laboratory of Orthopedic Research, Department of Orthopedic Surgery, Chosun University Hospital, Gwangju, 61453, South Korea.,Department of Premedical Program, School of Medicine, Chosun University, Gwangju, 61452, South Korea
| | - Sang H Park
- Run Orthopedic Hospital, Nam-gu, Gwangju, South Korea
| | - Bora Kim
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju, 61453, South Korea.,Laboratory of Orthopedic Research, Department of Orthopedic Surgery, Chosun University Hospital, Gwangju, 61453, South Korea
| | - Sin W Kang
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju, 61453, South Korea.,Laboratory of Orthopedic Research, Department of Orthopedic Surgery, Chosun University Hospital, Gwangju, 61453, South Korea
| | - Jung W Lee
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju, 61453, South Korea.,Laboratory of Orthopedic Research, Department of Orthopedic Surgery, Chosun University Hospital, Gwangju, 61453, South Korea
| | - Young L Moon
- Department of Orthopedic Surgery, Chosun University Hospital, Gwangju, 61453, South Korea.,Laboratory of Orthopedic Research, Department of Orthopedic Surgery, Chosun University Hospital, Gwangju, 61453, South Korea
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44
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Epicondylosis. Integr Med (Encinitas) 2018. [DOI: 10.1016/b978-0-323-35868-2.00071-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Evaluation of a filter-prepared platelet concentrate for the treatment of suspensory branch injuries in horses. Vet Comp Orthop Traumatol 2017; 24:363-9. [DOI: 10.3415/vcot-11-01-0001] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 05/09/2011] [Indexed: 02/06/2023]
Abstract
SummaryObjectives: Platelet preparations have become a treatment for soft tissue injuries in horses. This study evaluated a novel filter-based system to concentrate platelets and assesses its value in the treatment of suspensory ligament branch desmitis.Methods: Filtered platelet concentrate was prepared from 55 ml of venous blood obtained from 21 normal horses. Platelets and white blood cells in whole blood and filtered platelet concentrate were measured, as was platelet activating factor (PAF)–induced platelet-derived growth factor-BB (PDGF-BB) release. Eleven horses with 18 focal acute suspensory ligament branch injuries were treated intra-lesionally with autologous filtered platelet concentrate and evaluated clinically and ultrasonographically for one to three years.Results: The increase in concentration of platelets in the filtered concentrate in comparison with whole blood (6.9 ± 1.9-fold) was significantly greater than the increase in white blood cells (3.8 ± 0.8-fold) (p <0.0001). There was no effect of sex or breed on platelet concentration. Platelets were responsive to PAF with >100-fold higher levels of PDGF release over basal levels. All hypoechoic lesions re-evaluated within three months had resolved. Five of the 11 horses returned to their previous level of work, one was exercising at a lower level, three were retired, one died for unrelated reasons, and one was still convalescing.Clinical significance: Filtered platelet concentrate was easily and reliably prepared and injected into suspensory ligament branch injuries without short-term complications. This treatment was associated with rapid resolution of ultrasonographic lesions and lameness. Filtered platelet concentrate represents a convenient alternative for the treatment of suspensory ligament branch injuries.
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Nurden A. Platelets, inflammation and tissue regeneration. Thromb Haemost 2017; 105 Suppl 1:S13-33. [DOI: 10.1160/ths10-11-0720] [Citation(s) in RCA: 469] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Accepted: 02/04/2011] [Indexed: 12/20/2022]
Abstract
SummaryBlood platelets have long been recognised to bring about primary haemostasis with deficiencies in platelet production and function manifesting in bleeding while upregulated function favourises arterial thrombosis. Yet increasing evidence indicates that platelets fulfil a much wider role in health and disease. First, they store and release a wide range of biologically active substances including the panoply of growth factors, chemokines and cytokines released from α-granules. Membrane budding gives rise to microparticles (MPs), another active participant within the blood stream. Platelets are essential for the innate immune response and combat infection (viruses, bacteria, micro-organisms). They help maintain and modulate inflammation and are a major source of pro-inflammatory molecules (e.g. P-selectin, tissue factor, CD40L, metalloproteinases). As well as promoting coagulation, they are active in fibrinolysis; wound healing, angiogenesis and bone formation as well as in maternal tissue and foetal vascular remodelling. Activated platelets and MPs intervene in the propagation of major diseases. They are major players in atherosclerosis and related diseases, pathologies of the central nervous system (Alzheimers disease, multiple sclerosis), cancer and tumour growth. They participate in other tissue-related acquired pathologies such as skin diseases and allergy, rheumatoid arthritis, liver disease; while, paradoxically, autologous platelet-rich plasma and platelet releasate are being used as an aid to promote tissue repair and cellular growth. The above mentioned roles of platelets are now discussed.
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Unlu MC, Kivrak A, Kayaalp ME, Birsel O, Akgun I. Peritendinous injection of platelet-rich plasma to treat tendinopathy: A retrospective review. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2017; 51:482-487. [PMID: 29108884 PMCID: PMC6197157 DOI: 10.1016/j.aott.2017.10.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/18/2017] [Accepted: 10/12/2017] [Indexed: 12/29/2022]
Abstract
Objective The aim of this study was to determine factors associated with the likelihood of a better clinical outcome after the peritendinous injection of PRP for the treatment of chronic tendinopathy and identify whether PRP represents an effective treatment option for chronic tendinopathies. Methods The study included 214 patients (86 males and 128 females; mean age: 39.3 (18–75) years) who received PRP injections for tendinopathy refractory to conventional treatments. The mean duration of symptoms at the moment of the PRP treatment was 8.3 months. Primary outcome measurement was perceived improvement in symptoms for each anatomic compartment for upper and lower limbs at 6 months after treatment. Also, a visual analog scale (VAS) score (pain intensity on a 0–10 scale) was used for pain scoring questionnaire before treatment, 6 weeks and 6 months following the PRP injection(s). To identify factors associated with the likelihood of a better clinical outcome, patients were categorized on the basis of their perceived improvement in symptoms 6 months after the PRP injection(s)—that is, as lower (less than 50% global improvement) or higher (more than 50% global improvement). Results A visual analogue scale score and perceived improvement in symptoms were significantly lower after peritendinous injection in 6-week and 6-month follow-ups compared with the baseline (P < 0.001) except for peroneal and Achilles tendons. Overall, 83% of patients indicated moderate to complete improvement in symptoms. The most common injection sites were the lateral epicondyle, Achilles, and patellar tendons. Furthermore, 30% of patients received only 1 injection, 30% received 2 injections, and 40% received 3 or more injections. A total of 85% of patients were satisfied (more than 50% global improvement) with the procedure. In addition, upper limb tendons, increase in the age, and female gender were associated with a higher likelihood of perceived improvement in symptoms. Conclusions In the present retrospective study assessing PRP injections in the treatment of chronic tendinopathy, a moderate improvement (>50%) in pain symptoms was observed in most of the patients. Our research found that results were most promising with patellar and lateral epicondylar tendinopathy in the short to medium term. Female patients, patients with upper extremity tendinopathy and older patients appeared to benefit more from PRP injection. Level of evidence Level IV, Therapeutic study.
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Affiliation(s)
- Mehmet Can Unlu
- Istanbul University, Cerrahpasa Medical Faculty, Department of Orthopedics and Traumatology, Istanbul, Turkey.
| | - Aybars Kivrak
- Istanbul University, Cerrahpasa Medical Faculty, Department of Orthopedics and Traumatology, Istanbul, Turkey.
| | - Mahmut Enes Kayaalp
- Istanbul University, Cerrahpasa Medical Faculty, Department of Orthopedics and Traumatology, Istanbul, Turkey.
| | - Olgar Birsel
- Koc University Hospital, Department of Orthopedics and Traumatology, Istanbul, Turkey.
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Deal JB, Smith E, Heard W, O'Brien MJ, Savoie FH. Platelet-Rich Plasma for Primary Treatment of Partial Ulnar Collateral Ligament Tears: MRI Correlation With Results. Orthop J Sports Med 2017; 5:2325967117738238. [PMID: 29164165 PMCID: PMC5686880 DOI: 10.1177/2325967117738238] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Jobe revolutionized the treatment of medial ulnar collateral ligament (MUCL) tears with his reconstruction technique. However, not all MUCL injuries require operative management; Rettig showed that 42% of MUCL injuries respond to conservative management. This was improved by Podesta, who showed that augmentation of nonoperative management with platelet-rich plasma (PRP) and magnetic resonance imaging (MRI) for detecting partial MUCL tears resulted in significantly higher success rates. Their series used a single injection of leukocyte-rich PRP. However, to our knowledge, no study has established optimal dosing and composition of PRP for augmentation of soft tissue healing. We present a series of patients with partial MUCL tears of the elbow treated with a series of 2 leukocyte-rich PRP injections, bracing, physical therapy, and a structured return-to-throwing protocol. Hypothesis: Nonoperative management of acute or subacute partial MUCL tears of the elbow with a formal treatment protocol will allow the injured ligament to heal without surgery and will permit a rapid return to sport. Study Design: Case series; Level of evidence, 4. Methods: Patients with symptomatic MUCL instability and magnetic resonance arthrography demonstrating grade 2 MUCL tears at the proximal or distal aspect were treated with varus-loading elbow bracing, activity restriction, and physical therapy, supplemented by 2 injections of PRP. The injections were separated by 2 weeks. Two weeks after the second injection, a repeat examination and magnetic resonance arthrogram were obtained to evaluate the response to treatment. Results: A total of 25 athletes (23 baseball athletes, 2 softball athletes [1 participant also danced]) underwent PRP injections and guided rehabilitation. Of these patients, 23 were diagnosed with primary grade 2 injuries of the MUCL; 22 patients with primary injuries (96%) demonstrated stability of the MUCL after treatment and returned to play at the same or higher level of competition without further intervention. Repeat MRI demonstrated reconstitution of the ligament in all patients, although 2 patients demonstrated only partial reconstitution. Patients were released to play at 6 weeks; due to vagaries of sports seasons, the mean time to return to competitive play was 82 days. Two of the 25 patients had undergone prior surgery (1 MUCL reconstruction and 1 repair). These patients remained unstable and symptomatic on examination after this treatment regimen, did not show complete reconstitution of the ligament on subsequent MRI, and required MUCL reconstruction. Conclusion: Ouf of 23 primary injury patients who received PRP injections and nonoperative measures, 22 (96%) were able to return to play and demonstrated reconstitution of the MUCL on MRI. Two of the 3 patients for whom PRP therapy failed had undergone previous MUCL surgery. We conclude that a 2-injection regimen of leukocyte-rich PRP is a safe and effective treatment for partial MUCL tears, but it appears to be less effective in patients with previous surgery for MUCL repair or reconstruction.
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Affiliation(s)
| | - Ed Smith
- Tulane University, New Orleans, Louisiana, USA
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Tsai WC, Yu TY, Lin LP, Lin MS, Tsai TT, Pang JHS. Platelet rich plasma promotes skeletal muscle cell migration in association with up-regulation of FAK, paxillin, and F-Actin formation. J Orthop Res 2017; 35:2506-2512. [PMID: 28233384 DOI: 10.1002/jor.23547] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 02/10/2017] [Indexed: 02/04/2023]
Abstract
Platelet rich plasma (PRP) contains various cytokines and growth factors which may be beneficial to the healing process of injured muscle. The aim of this study was to investigate the effect and molecular mechanism of PRP on migration of skeletal muscle cells. Skeletal muscle cells intrinsic to Sprague-Dawley rats were treated with PRP. The cell migration was evaluated by transwell filter migration assay and electric cell-substrate impedance sensing. The spreading of cells was evaluated microscopically. The formation of filamentous actin (F-actin) cytoskeleton was assessed by immunofluorescence staining. The protein expressions of paxillin and focal adhesion kinase (FAK) were assessed by Western blot analysis. Transfection of paxillin small-interfering RNA (siRNAs) to muscle cells was performed to validate the role of paxillin in PRP-mediated promotion of cell migration. Dose-dependently PRP promotes migration of and spreading and muscle cells. Protein expressions of paxillin and FAK were up-regulated dose-dependently. F-actin formation was also enhanced by PRP treatment. Furthermore, the knockdown of paxillin expression impaired the effect of PRP to promote cell migration. It was concluded that PRP promoting migration of muscle cells is associated with up-regulation of proteins expression of paxillin and FAK as well as increasing F-actin formation. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2506-2512, 2017.
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Affiliation(s)
- Wen-Chung Tsai
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Tung-Yang Yu
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan
| | - Li-Ping Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan
| | - Mioa-Sui Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan
| | - Ting-Ta Tsai
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan
| | - Jong-Hwei S Pang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Linkou, Taoyuan City, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan City, Taiwan
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