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Zhuang W, Li T, Li Y, Zhang Y, Gao J, Wang X, Ding Q, Li W. The varying clinical effectiveness of single, three and five intraarticular injections of platelet-rich plasma in knee osteoarthritis. J Orthop Surg Res 2024; 19:284. [PMID: 38720362 PMCID: PMC11077828 DOI: 10.1186/s13018-024-04736-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 04/13/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVE To investigate the variations in clinical effectiveness among patients diagnosed with knee osteoarthritis who underwent intra-articular administration of platelet-rich plasma using single, triple, or quintuple injections. METHODS One hundred twenty patients with grade I-III knee osteoarthritis were randomly assigned to three groups: PRP1 group, who received a single injection of platelet-rich plasma; PRP3 group, who received three PRP injections one week apart; PRP5 group, who received five PRP injections one week apart. The patients' conditions were evaluated using the Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index-VA3.1 version (WOMAC-VA3.1) at baseline and 6, 12, 24, and 52 weeks 52 weeks follow up. RESULTS Out of the total participants, 106 patients (30 males and 76 females) completed the study. The primary outcome measure, WOMAC pain score, registered significant improvements across all groups when compared to pre-treatment levels. However, the application of 3 and 5 injections of platelet-rich plasma was substantially more effective than that of a single injection in reducing knee pain and stiffness, as well as enhancing physical function in patients with knee osteoarthritis. No statistically discernable difference was observed between PRP3 and PRP5 at all follow-up intervals, and there was no discernable difference between 3 and 5 PRP injections either. Mild side effects occurred in all three groups. CONCLUSIONS The administration of three or five injections of platelet-rich plasma is safe, substantially more effective than single injections, and leads to remarkable clinical improvement by significantly reducing knee pain, improving joint stiffness, and enhancing physical function in patients with grade I-III knee osteoarthritis. Furthermore, no significant difference was observed in the efficacy of three or five injections. Therefore, we recommend using three injections of PRP in the treatment of patients with knee osteoarthritis of grade I-III.
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Affiliation(s)
- Weisheng Zhuang
- Department of Rehabilitation Medicine, Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Tianshu Li
- Department of Rehabilitation Medicine, Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University, Zhengzhou, Henan, 450003, China
- Department of Rehabilitation, The First People's Hospital of Zhengzhou, Zhengzhou, Henan, 450003, China
| | - Yuefang Li
- Department of Rehabilitation Medicine, Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Ying Zhang
- Department of Rehabilitation Medicine, Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Jiahuan Gao
- Department of Rehabilitation Medicine, Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University, Zhengzhou, Henan, 450003, China
| | - Xu Wang
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, 450003, China
| | - Qixin Ding
- School of Rehabilitation Medicine, Henan University of Chinese Medicine, Zhengzhou, 450003, China
| | - Wanyue Li
- Department of Rehabilitation Medicine, Henan Provincial People's Hospital, People's Hospital of Henan University, People's Hospital of Zhengzhou University, Zhengzhou, Henan, 450003, China.
- Department of Rehabilitation, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, 510000, China.
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Pai SN, Jeyaraman N, Venkatasalam R, Vr R, Ramasubramanian S, Balaji S, Nallakumarasamy A, Sharma S, Patro BP, Jeyaraman M. Standardized Informed Consent Form for Clinicians Administering Platelet-Rich Plasma. Cureus 2024; 16:e57565. [PMID: 38707034 PMCID: PMC11068980 DOI: 10.7759/cureus.57565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2024] [Indexed: 05/07/2024] Open
Abstract
Introduction When it comes to medico-legal malpractice suits, lawyers and insurers tend to focus on informed consent documentation. Unfortunately, there is no standard protocol for obtaining informed consent for the use of platelet-rich plasma (PRP) injections, which might cause problems. This study aimed to mitigate this concern through the development of a standardized informed consent document for PRP injections, grounded in evidence-based practices. Materials and methods An examination of databases was conducted to explore the medico-legal ramifications associated with PRP injections, as well as the broader topic of informed consent, with a particular focus on the context of PRP injections. Moreover, interviews were carried out with healthcare providers and individuals who had received PRP injections within the preceding year, utilizing a semi-structured methodology. Results We developed an evidence-based informed consent document tailored for PRP injections. To guarantee its legal validity, the document underwent review by a legal specialist. Subsequently, our institutions implemented the finalized form for PRP injection procedures over one year. Conclusion A legally valid and evidence-based informed consent form for PRP injections would ensure patient's rights, and encourage open communication and transparency between them and the doctor. Moreover, if a lawsuit were to arise, it would serve as a critical document in the doctor's defense and withstand scrutiny from lawyers and the judiciary.
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Affiliation(s)
- Satvik N Pai
- Orthopaedic Surgery, Hospital for Orthopedics, Sports Medicine, Arthritis & Trauma (HOSMAT) Hospital, Bangalore, IND
- Orthopaedic Surgery, Sri Ramachandra Institute of Higher Education and Research, Chennai, IND
| | - Naveen Jeyaraman
- Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, IND
| | | | - Ravi Vr
- Regenerative Medicine, Mothercell Regenerative Centre, Tiruchirappalli, IND
| | | | - Sangeetha Balaji
- Orthopaedics, Government Medical College, Omandurar Government Estate, Chennai, IND
| | - Arulkumar Nallakumarasamy
- Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER) - Karaikal, Karaikal, IND
| | - Shilpa Sharma
- Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, IND
| | - Bishnu P Patro
- Orthopaedics, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Madhan Jeyaraman
- Clinical Research, Viriginia Tech India, Dr MGR Educational and Research Institute, Chennai, IND
- Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, IND
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Gupta A, Migliorini F, Maffulli N. Management of rotator cuff injuries using allogenic platelet-rich plasma. J Orthop Surg Res 2024; 19:165. [PMID: 38438891 PMCID: PMC10913555 DOI: 10.1186/s13018-024-04657-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 03/02/2024] [Indexed: 03/06/2024] Open
Abstract
Rotator cuff injuries are a major cause of shoulder pain, affecting the quality of life and producing a significant burden on healthcare systems. Conservative management modalities are prioritized, resorting to surgery only when required. The field of regenerative medicine involving the use of biologics, such as platelet-rich plasma (PRP), has evolved and shown potential for managing rotator cuff injuries. Nonetheless, limitations including subpar outcomes have led clinicians to question the efficacy of autologous PRP. To circumvent this, the possibility of utilizing a standardized and well-characterized allogenic PRP for RCI has been explored. In this manuscript, we qualitatively present the evidence from in vitro, pre-clinical, clinical and ongoing studies investigating the applications of allogenic PRP in the context of rotator cuff disorders. Administration of allogenic PRP is safe and potentially efficacious to manage rotator cuff injuries, though more adequately powered randomized controlled trials with longer follow-ups are warranted to further establish the efficacy of allogenic PRP and justify its routine clinical use.
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Affiliation(s)
- Ashim Gupta
- Regenerative Orthopaedics, Noida, 201301, India
- Future Biologics, Lawrenceville, GA, 30043, USA
- South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX, 78045, USA
- BioIntegrate, Lawrenceville, GA, 30043, USA
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, London, E1 4DG, UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, ST5 5BG, UK
| | - Filippo Migliorini
- Future Biologics, Lawrenceville, GA, 30043, USA.
- South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX, 78045, USA.
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, 52074, Aachen, Germany.
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, London, E1 4DG, UK.
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, ST5 5BG, UK.
| | - Nicola Maffulli
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, 52074, Aachen, Germany
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy
- Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University La Sapienza, Rome, Italy
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Queen Mary University of London, London, E1 4DG, UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, ST5 5BG, UK
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Yang K, Ding Y, Xu H, Lai M, Xu X, Yu X, Deng Q, Jiang L. Efficacy and safety of platelet-rich plasma combined with Tai Chi for knee osteoarthritis: study protocol for a placebo-controlled randomized trial. J Orthop Surg Res 2023; 18:885. [PMID: 37990325 PMCID: PMC10662628 DOI: 10.1186/s13018-023-04372-6] [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: 10/01/2023] [Accepted: 11/14/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND No definitive treatment methods of curative for knee osteoarthritis (KOA). The combined therapies that into account both the biochemical and biomechanical may provide potential opportunities for treat KOA, and previous studies have demonstrated that the platelet-rich plasma of intra-articular injection (IAI-PRP) and exercise treatments afford more benefits than do their corresponding monotherapies. The absence of a specific exercise plan and detailed explanation renders the aforementioned study results questionable. Furthermore, Tai Chi (TC) with moderate-intensity, whole body movements and good adherence may prove to be more effective for treating KOA. However, few studies examined the effectiveness and safety of combined IAI-PRP and TC for KOA. METHODS This study protocol will be a placebo-controlled, assessor-blinded randomized trial involving 12-week intervention and 1-year follow-up. The stratified randomization will be used to randomly assign the 212 participants to four groups: group A (placebo IAI); group B (PRP IAI); group C (TC and placebo IAI); group D (TC and PRP IAI). Injection will be performed once a week, three consecutive times as a course, after a week of rest to continue the next course, a total of 3 courses (12 week). Additionally, the TC interventions will be carried out 3 days per week for a total of 12 weeks. The primary outcome measures will include the efficacy (Western Ontario and McMaster Universities Osteoarthritis Index), acceptability and safety of these interventions. The secondary outcome measures will include physical function (Timed Up and Go test), walking function (Gait Analysis), inflammatory factor levels (e.g., Interleukin-1 β, interleukin-6, vascular endothelial growth factor), quality of life (36-Item Short Form Health Survey), volume of patellofemoral cartilage and effusion-synovitis (MRI). Two-way of variance with repeated measures will be applied to examine the main effects of the group and the time factor and group-time interaction effects for all outcome measures. DISCUSSION This trial will be first one to propose an integrated scheme combing IAI-PRP and TC for treatment of KOA, based on the consideration of the biochemical and biomechanical pathogenesis of KOA. These results of the study will provide evidence with high quality for integrated IAI-PRP and TC to treatment KOA. Trial Registration Chinese Clinical Trial Registry ChiCTR2300067559. Registered on 11 January 2023.
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Affiliation(s)
- Kun Yang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuwu Ding
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Haichen Xu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Minghui Lai
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xueping Xu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiaoming Yu
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Qian Deng
- School of Health and Nursing, Wuxi Taihu University, Wuxi, China
| | - Liming Jiang
- Department of Rehabilitation, Seventh People's Hospital of Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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Gupta A. StemOne TM/Stempeucel ®: CDSCO Approved, Adult Human Bone Marrow-Derived, Cultured, Pooled, Allogenic Mesenchymal Stem Cells for Knee Osteoarthritis. Biomedicines 2023; 11:2894. [PMID: 38001895 PMCID: PMC10669254 DOI: 10.3390/biomedicines11112894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 11/26/2023] Open
Abstract
The knee, the most likely joint to present osteoarthritis (OA), is accountable for approximately 80% of the global burden of the OA [...].
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Affiliation(s)
- Ashim Gupta
- Regenerative Orthopaedics, Noida 201301, India;
- Future Biologics, Lawrenceville, GA 30043, USA
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Huang J, Lian SL, Han JH, Lu ZC, Ding Y. Pure platelet-rich plasma promotes semaphorin-3A expression: a novel insight to ameliorate intervertebral disk degeneration in vitro. J Orthop Surg Res 2023; 18:789. [PMID: 37864189 PMCID: PMC10588088 DOI: 10.1186/s13018-023-04290-7] [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: 08/05/2023] [Accepted: 10/15/2023] [Indexed: 10/22/2023] Open
Abstract
INTRODUCTION Intervertebral disk degeneration (IVDD) can be effectively treated using platelet-rich plasma (PRP). While the exact process is fully understood, it is believed that using pure PRP (P-PRP) without leukocytes is a better option for preventing IVDD. Semaphorin-3A (Sema3A), an inhibitor of angiogenesis and innervation, is essential for preserving IVDD's homeostasis. Whether PRP prevents IVDD by modifying Sema3A has yet to receive much research. This work aims to clarify how P-PRP affects Sema3A when IVDD develops in vitro. METHODS Nucleus pulposus cells (NPCs) isolated from 8-week-old male Sprague-Dawley rats were exposed to 10 ng/ml IL-1β and then treated with P-PRP or leukocyte platelet-rich plasma (L-PRP) in vitro, followed by measuring cell proliferation, apoptosis and microstructures, inflammatory gene and Sema3A expression, as well as anabolic and catabolic protein expression by immunostaining, quantitative real-time polymerase chain reaction (qPCR), western blot, and enzyme-linked immunosorbent assay (ELISA). RESULTS In comparison with L-PRP, P-PRP had a higher concentration of growth factors but a lower concentration of inflammatory substances. P-PRP increased the proliferation of NPCs, while IL-1 relieved the amount of apoptosis due to its intervention. Anabolic genes, aggrecan, and collagen II had higher expression levels. MMP-3 and ADAMTS-4, two catabolic or inflammatory genes, showed lower expression levels. Sema3A activity was enhanced after P-PRP injection, whereas CD31 and NF200 expression levels were suppressed. CONCLUSIONS P-PRP enhanced the performance of NPCs in IVDD by modifying the NF-κB signaling pathway and encouraging Sema3A expression, which may offer new therapy options for IVDD. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE The findings provide a new therapeutic target for the treatment of IVDD and show a novel light on the probable mechanism of PRP and the function of Sema3A in the progression of IVDD.
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Affiliation(s)
- Jie Huang
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, 100048, China
- Department of Orthopedics, School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Shi-Lin Lian
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, 100048, China
| | - Jia-Heng Han
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, 100048, China
- Department of Orthopedics, School of Medicine, South China University of Technology, Guangzhou, 510006, China
| | - Zheng-Cao Lu
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, 100048, China
- Department of Orthopedics, School of Medicine, Jinzhou Medical University, Jinzhou, 121001, China
| | - Yu Ding
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, Beijing, 100048, China.
- Department of Orthopedics, School of Medicine, South China University of Technology, Guangzhou, 510006, China.
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Gupta A, Sharma SP, Potty AG. Combination of Platelet-Rich Plasma and Hyaluronic Acid vs. Platelet-Rich Plasma Alone for Treatment of Knee Osteoarthritis. Biomedicines 2023; 11:2759. [PMID: 37893132 PMCID: PMC10604546 DOI: 10.3390/biomedicines11102759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Knee osteoarthritis (OA) is the most documented form of OA and is accountable for about 80% of total OA cases worldwide [...].
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Affiliation(s)
- Ashim Gupta
- Regenerative Orthopaedics, Noida 201301, India
- Future Biologics, Lawrenceville, GA 30043, USA
- BioIntegrate, Lawrenceville, GA 30043, USA
- South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX 78045, USA;
| | | | - Anish G. Potty
- South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX 78045, USA;
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Gupta A, Aratikatla A, Martin SM. Allogenic Platelet-Rich Plasma for the Treatment of Adhesive Capsulitis. Cureus 2023; 15:e47491. [PMID: 38022351 PMCID: PMC10663409 DOI: 10.7759/cureus.47491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2023] [Indexed: 12/01/2023] Open
Abstract
Adhesive capsulitis (AC) is a common shoulder disorder leading to pain and restricted range of motion (ROM) and affects the patient's activities of daily living (ADL) and overall quality of life (QoL). Conservative therapies are prioritized, resorting to surgical intervention only when necessary. Unfortunately, these modalities have limitations and do not address the underlying pathological cause of AC. The use of autologous biologics, such as platelet-rich plasma (PRP), has evolved and shown promise for managing musculoskeletal (MSK) injuries, including AC. However, subpar functional outcomes have led clinicians to question the long-term efficacy of autologous PRP. To circumvent this, the possibility of utilizing a standardized and well-characterized allogenic PRP for AC has been explored. In this manuscript, we qualitatively present in vitro, pre-clinical, clinical, and ongoing studies investigating the varied applications of allogenic PRP for the management of AC. The results demonstrated that allogenic PRP acts in a pleiotropic manner and decreases pro-inflammatory cytokines only in the inflammatory condition. In addition, the administration of allogenic PRP is safe and potentially efficacious, in terms of reducing pain and improving range of motion, shoulder strength, and function, in non-surgical management of AC. Nonetheless, more pre-clinical studies and adequately powered, multicenter, prospective, non-randomized, and randomized controlled trials with longer follow-up are warranted to further establish the safety and efficacy of allogenic PRP and justify its routine clinical use.
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Affiliation(s)
- Ashim Gupta
- Regenerative Medicine, Regenerative Orthopaedics, Noida, IND
- Regenerative Medicine, Future Biologics, Lawrenceville, USA
- Regenerative Medicine, BioIntegrate, Lawrenceville, USA
- Orthopaedics, South Texas Orthopaedic Research Institute, Laredo, USA
| | | | - Scott M Martin
- Medical Aesthetics, Elite Medical Aesthetics, Las Vegas, USA
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Wang Z, Zhu P, Liao B, You H, Cai Y. Effects and action mechanisms of individual cytokines contained in PRP on osteoarthritis. J Orthop Surg Res 2023; 18:713. [PMID: 37735688 PMCID: PMC10515001 DOI: 10.1186/s13018-023-04119-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
Osteoarthritis (OA) is defined as a degenerative joint disease that can affect all tissues of the joint, including the articular cartilage, subchondral bone, ligaments capsule, and synovial membrane. The conventional nonoperative treatments are ineffective for cartilage repair and induce only symptomatic relief. Platelet-rich plasma (PRP) is a platelet concentrate derived from autologous whole blood with a high concentration of platelets, which can exert anti-inflammatory and regenerative effects by releasing multiple growth factors and cytokines. Recent studies have shown that PRP exhibits clinical benefits in patients with OA. However, high operational and equipment requirements greatly limit the application of PRP to OA treatment. Past studies have indicated that high-concentration PRP growth factors and cytokines may be applied as a commercial replacement for PRP. We reviewed the relevant articles to summarize the feasibility and mechanisms of PRP-based growth factors in OA. The available evidence suggests that transforming growth factor-α and β, platelet-derived growth factors, epidermal growth factor, insulin-like growth factor-1, and connective tissue growth factors might benefit OA, while vascular endothelial growth factor, tumor necrosis factor-α, angiopoietin-1, and stromal cell derived factor-1α might induce negative effects on OA. The effects of fibroblast growth factor, hepatocyte growth factor, platelet factor 4, and keratinocyte growth factor on OA remain uncertain. Thus, it can be concluded that not all cytokines released by PRP are beneficial, although the therapeutic action of PRP has a valuable potential to improve.
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Affiliation(s)
- Zhengchao Wang
- Department of Orthopedics, Wuhan Fourth Hospital, Wuhan, China
| | - Pengfei Zhu
- Department of Cardiovascular, Wuhan Fourth Hospital, Wuhan, China
- Department of Cardiovascular, Fujian Medical University Union Hospital, Fuzhou, China
| | - Bokai Liao
- School of Chemistry and Chemical Engineering, Guangzhou University, Guangzhou, China
| | - Hongbo You
- Department of Orthopedics, Tongji Hospital, Tongji Medical College, Huazhong University and Technology, Jiefang Avenue No.1095, Qiaokou District, Wuhan, 430030, Hubei Province, China.
| | - Yu Cai
- Department of Rehabilitation, Wuhan Fourth Hospital, Hanzheng Street No.473, Qiaokou District, Wuhan, 430000, Hubei Province, China.
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Prognostic Factors Related to Clinical Response in 210 Knees Treated by Platelet-Rich Plasma for Osteoarthritis. Diagnostics (Basel) 2023; 13:diagnostics13040760. [PMID: 36832248 PMCID: PMC9956000 DOI: 10.3390/diagnostics13040760] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 01/27/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
Many studies have shown the effectiveness of platelet-rich plasma (PRP) in the treatment of knee osteoarthritis. We aimed to determine the factors associated with good or poor response to PRP injections in knee osteoarthritis. This was a prospective observational study. Patients with knee osteoarthritis were recruited from a university hospital. PRP was injected twice at a one-month interval. Pain was assessed on a visual analog scale (VAS) and function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Radiographic stage was collected and defined according to the Kellgren-Lawrence classification. Patients were classified as responders if they met the OMERACT-OARSI criteria at 7 months. We included 210 knees. At 7 months, 43.8% were classified as responders. Total WOMAC and VAS were significantly improved between M0 and M7. Physical therapy and a heel-buttock distance >35 cm were the two criteria associated with poor response at M7 by multivariate analysis. Pain VAS at M7 appeared to be lower in patients with osteoarthritis for less than 24 months. No adverse effects were reported. PRP treatment in knee osteoarthritis appears to be well-tolerated and effective, even in patients who reacted poorly to hyaluronic acid. Response was not associated with radiographic stage.
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Gupta A, Jeyaraman M, Potty AG. Leukocyte-Rich vs. Leukocyte-Poor Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis. Biomedicines 2023; 11:biomedicines11010141. [PMID: 36672650 PMCID: PMC9856144 DOI: 10.3390/biomedicines11010141] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023] Open
Abstract
Knee osteoarthritis (OA) is a well-established form of OA and accounts for nearly 4/5 of global OA burden […].
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Affiliation(s)
- Ashim Gupta
- Regenerative Orthopaedics, Noida 201301, UP, India
- Future Biologics, Lawrenceville, GA 30043, USA
- BioIntegrate, Lawrenceville, GA 30043, USA
- South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX 78045, USA
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow 226010, UP, India
- Correspondence:
| | - Madhan Jeyaraman
- South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX 78045, USA
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow 226010, UP, India
- Department of Orthopaedics, Faculty of Medicine, Sri Lalithambigai Medical College and Hospital, Dr. MGR Educational and Research Institute, Chennai 600095, TN, India
| | - Anish G. Potty
- South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX 78045, USA
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Allogenic Perinatal Tissue for Musculoskeletal Regenerative Medicine Applications: A Systematic Review. Biomedicines 2022; 10:biomedicines10123173. [PMID: 36551929 PMCID: PMC9775213 DOI: 10.3390/biomedicines10123173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/26/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Producing tremendous amounts of stress and financial burden on the global patient population and healthcare systems around the world, most current modalities of treatment for musculoskeletal ailments often do not address the etiopathogenetic causes of these disorders. Regenerative medicine for musculoskeletal disorders relies on orthobiologics derived from either allogenic or autologous sources. Multiple drawbacks are associated with autologous sources, including donor-site morbidity, a dearth of studies, and variability in both patient reported and clinical/functional outcomes. On the other hand, allogenic sources address several of these concerns, and continue to be a suitable source of mesenchymal stem cells (MSCs). This review qualitatively reports both the preclinical and clinical outcomes of publications studying the applications of umbilical cord (-derived Wharton's jelly), amniotic suspension allograft, amniotic membrane, and amniotic fluid in musculoskeletal medicine. A systematic review was conducted utilizing the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines on studies published between January 2010 and October 2022 that used allogeneic perinatal tissues. Further randomized controlled clinical studies are necessary to properly evaluate the safety and efficacy of these tissues in orthopedic surgery.
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Deng Z, Long ZS, Gong FP, Chen G. The efficacy and safety of platelet-rich plasma in the tendon-exposed wounds: a preliminary study. J Orthop Surg Res 2022; 17:497. [PMCID: PMC9675281 DOI: 10.1186/s13018-022-03401-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 11/11/2022] [Indexed: 11/21/2022] Open
Abstract
Objective Currently, among wounds with large skin tissue defects caused by various reasons, the treatment of refractory wounds is still a major clinical problem. This study is aimed to preliminarily assess the therapeutic potentials of platelet-rich plasma (PRP) in refractory wounds with exposed tendons, as well as corresponding efficacy and safety. Methods A total of 12 patients (5 males and 7 females) with refractory wounds and exposed tendons who were admitted to our hospital from June 2018 to December 2020 were included in this study. After the preparation of PRP, the included patients underwent the PRP injection after the debridement of wounds, and the efficacy and prognosis were assessed by the same group of senior surgeons. Results The average age of included patients was 42.7 ± 12.9 years, and the causes of injury included traffic accidents (3 cases), contusion (2 cases), burns (2 cases), diabetes complications (4 cases), and melanoma complications (1 cases). The average healing time was 23.0 ± 5.0 days, and the mean size of the wound was 3.1 × 5.1 cm2. During the whole treatment process, Vancouver Scar Scale (VSS) decreased from 7.4 ± 1.6 before PRP treatment to 3.6 ± 0.9 after treatment (P < 0.001), Manchester Scar Scale (MSS) decreased from 12.3 ± 4.5 before PRP treatment to 5.4 ± 1.2 after treatment (P < 0.001), and no redness and swelling were observed around wounds, the size and degree of wounds gradually reduced, the coverage rate of granulation tissue was acceptable, overall quality of scar was relatively good, skin sensitivity around wounds was normal, there was no local wounds secretion, and postoperative patient's satisfaction was relatively good during follow-up. Conclusions Our study has preliminarily indicated that PRP can promote the wounds healing, reduce the inflammation around wounds, and improve the granulation tissue and angiogenesis, thereby effectively polishing up the safety and efficacy.
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Affiliation(s)
- Zhuan Deng
- grid.415002.20000 0004 1757 8108Department of Orthopedics, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006 Jiangxi China ,grid.260463.50000 0001 2182 8825Medical College, Nanchang University, Nanchang, 330006 Jiangxi China
| | - Zhi-Sheng Long
- grid.415002.20000 0004 1757 8108Department of Orthopedics, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006 Jiangxi China ,grid.260463.50000 0001 2182 8825Medical College, Nanchang University, Nanchang, 330006 Jiangxi China
| | - Fei-Peng Gong
- grid.415002.20000 0004 1757 8108Department of Orthopedics, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006 Jiangxi China
| | - Gang Chen
- grid.415002.20000 0004 1757 8108Department of Orthopedics, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006 Jiangxi China
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Mochizuki T, Ushiki T, Watanabe S, Omori G, Kawase T. The levels of TGFβ1, VEGF, PDGF-BB, and PF4 in platelet-rich plasma of professional soccer players: a cross-sectional pilot study. J Orthop Surg Res 2022; 17:465. [PMID: 36303196 PMCID: PMC9615199 DOI: 10.1186/s13018-022-03362-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 10/20/2022] [Indexed: 11/10/2022] Open
Abstract
Background Regenerative therapy using platelet-rich plasma (PRP), a rich source of growth factors, has become popular in orthopedic sports medicine. Elite athletes prefer PRP therapy for their injured muscles and tendons primarily to avoid the possible risks of surgical treatment. However, the clinical effectiveness of PRP therapy in elite athletes compared to that in non-athletes remains unknown. Therefore, to investigate the effectiveness of PRP therapy in professional athletes (pro-athletes), we focused on the quality of PRP preparations and compared the levels of bioactive molecules between pro-athletes and non-athletes.
Methods PRP was prepared from healthy, non-smoking male professional soccer players (pro-athletes) (n = 22) and non-athletes (VEGF: n = 34, others: n = 38). The levels of TGFβ1, PDGF-BB, VEGF, and PF4 were determined using ELISA kits. Polyphosphate was probed with 4’,6-diamidino-2-phenylindole and monitored using a fluorometer. The body composition of the donors was determined using a bathroom weighing scale. Results The levels of TGFβ1 and VEGF were significantly lower in pro-athletes than in non-athletes, whereas PF4 levels were significantly higher in pro-athletes. No significant difference was found in PDGF-BB levels between these groups. Biomolecule levels were not correlated with polyphosphate levels. Conclusion TGFβ1, VEGF, and PDGF-BB levels in pro-athletes were not higher than those in non-athletes. These findings suggest that growth factor levels in PRP may not be a predominant determinant of the clinical effectiveness of PRP therapy in pro-athletes. Increased PF4 levels in pro-athletes suggest an immunological function of PRP that may positively influence tissue regeneration.
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Affiliation(s)
- Tomoharu Mochizuki
- Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Takashi Ushiki
- Division of Hematology and Oncology, Graduate School of Health Sciences, Niigata University, Niigata, Japan.,Department of Transfusion Medicine, Cell Therapy and Regenerative Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan.,Department of Hematology, Endocrinology and Metabolism, Faculty of Medicine, Niigata University, Niigata, Japan
| | - Satoshi Watanabe
- Department of Orthopaedic Surgery, Niigata Medical Center, Niigata, Japan
| | - Go Omori
- Department of Health and Sports, Faculty of Health Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Tomoyuki Kawase
- Division of Oral Bioengineering, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan.
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