Apr 4, 2013 | Elbow, Journal Studies, PRP, Research, Staff Articles
Commentary on Platelet Rich Plasma, Stem Cells and Regenerative Medicine
84% of patients with chronic tennis elbow who had failed other non-operative treatments were successfully treated using platelet-rich plasma (PRP) in a large randomized trial. The results were presented at the American Academy of Orthopedic Surgery Meeting in Chicago.
The study was a randomized, double-blind, multi-center controlled trial of 230 patients. Patients received needling of their elbow tendons with and without PRP. At 24 weeks the PRP patients reports a 71.5% improvement in their pain compared to 56.1 in the control group. (P = 0.027) Patients treated with PRP also had less elbow tenderness at each follow up point. (See Graph Below) Overall, 84% of the PRP patients were successfully treated compared to 68.3% of the control group. (P = 0.012)
This is the largest study done to date using PRP. There are now over 340 patients who have been treated with the same system (Biomet GPS PRP) and techniques confirming the value of PRP as a treatment for chronic tennis elbow. Importantly, there is also a decade long experience using PRP with an excellent safety profile. PRP with this newly released data can now be confidently used for chronic tennis elbow patients prior to considering surgical intervention.
Source: http://bit.ly/17f91ZA
Apr 1, 2013 | PRP, Research, Shoulder / Rotator Cuff
Platelet Rich Plasma Prolotherapy For Rotator Cuff Tears
Physicians should consider platelet rich plasma prolotherapy for patients with tendinopathies or rotator cuff tears before any surgical interventions.
History: A 40 year old woman presents with a 3 year history of right shoulder pain which began during a kickboxing workout. She pushed past the pain on three subsequent workouts until she could no longer lift her arm or continue her work as a hairdresser.
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Mar 28, 2013 | Blog, Research
PRP is an autologous blood therapy that stimulates your body’s natural healing process through the injection of its own growth factors into injured areas. Research and clinical data show that PRP injections are extremely safe, with minimal risk for any adverse reaction or complication. Because PRP is produced from your own blood, there is no concern for rejection or disease transmission. There is a small risk of infection from any injection into the body, but this is rare. Some research suggests that PRP may have an anti-bacterial property which protects against possible infection.
Your body naturally recruits platelets and white blood cells from the blood to initiate a healing response. Under normal conditions, platelets store numerous growth factors which are released in response to signals from the injured tissue. Special PRP devices concentrate platelets from whole blood. When the PRP is injected into the damaged tissue growth factor release is enhanced so that natural healing is accelerated. Desired results include by enhancing the body’s natural healing capacity, and a more rapid, more efficient, more thorough restoration of tissue to a healthy state.
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Mar 15, 2013 | PRP, Research
Abstract
In recent years there have been rapid developments in the use of growth factors for accelerated healing of injury. Growth factors have been used in Maxillo-facial and Plastic Surgery with success and the technology is now being developed for Orthopaedics and Sports Medicine applications. Growth factors mediate the biological processes necessary for repair of soft tissues such has muscle, tendon and ligament following acute traumatic, or overuse injury, and animal studies have demonstrated clear benefits in terms of accelerated healing. There are various ways of delivering higher doses of growth factors to injured tissue, but each has in common, a reliance on release of growth factors from blood platelets. Platelets contain growth factors in their -granules (IGF-1, bFGF, PDGF, EGF, VEGF, TGF-
1) and these are released upon injection at the site of an injury. Three commonly utilised techniques are known as Platelet-rich plasma, autologous blood injections, and autologous conditioned serum. Each of these techniques have been studied clinically in humans to a very limited degree so far, but results are promising in terms of earlier return to play following muscle and particularly tendon injury. The use of growth factors in Sports Medicine is restricted under the terms of the WADA anti-doping code, particularly because of concerns regarding the IGF-1 content of such preparations, and the potential for abuse as performance-enhancing agents. We review the basic science and clinical trials related to the technology, and discuss the use of such agents in relation to the WADA code.
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Mar 10, 2013 | PRP, Research
NEW YORK (Reuters Health), Nov 6
A promising treatment for chronic Achilles tendon injuries may beon the horizon, researchers report. A pilot study of ultrasound-guided dextrose injections for the treatment of painful, often debilitating Achilles tendinosis was conducted by researchers at St. Paul’s Hospital, Vancouver, British Columbia.They noted a “significant reduction in tendon pain at rest and during/after activity,” lead investigator Dr. Norman J. Maxwell told Reuters Health.
Maxwell, currently affiliated with the University of Pittsburgh Medical Center, Pennsylvania, and colleagues used ultrasound to identify the injured areas of the Achilles tendon in 25 men and 11 women, between 23 and 82 years. All of the subjects had chronic Achilles tendon pain for more than three months.
Pain in the tendon connecting the calf muscle and the heel bone is frequently caused by repetitive ankle or foot stress from standing, walking, or running.
The researchers used ultrasound to guide injections of a small amount of hyperosmolar dextrose solution to the sites of these repetitive injuries to “induce a localized inflammatory process in order to initiate a normal wound healing cascade,” Maxwell told Reuters Health.
Treatment may require several injections, usually every four to six weeks depending on the severity of the chronic tendinosis, and may take six months or longer, Maxwell said.
“We ask the patients to refrain from taking any anti-inflammatory medications during the treatment periodand not to perform any strenuous exercise on the Achilles tendon for two weeks following each injection,” Maxwell said.
Over an average of four sessions, 33 tendons in 32patients were successfully treated. Three patients with minimal response discontinued treatment, while one patient, with a large Achilles tendon tear, was referred for surgical consultation, the researchers report in the American Journal of Roentgenology.
Overall, after treatment pain scores for tendon pain at rest decreased by 88%; while tendon pain during normal daily activity decreased by 84%; and tendon pain during or after participation in sports or other physical activity fell by 78%, the researchers report.
Of the 30 patients contacted by telephone one year after treatment, 20 had no return of symptoms, nine had mild symptoms, and one patient had moderate symptoms of Achilles tendinosis.
“We are very encouraged with our progress to date,” Maxwell said, but further studies are required to validate the effectiveness of this treatment and to compare this treatment to others for Achilles tendinosis.
By Joene Hendry
Last Updated: 2007-11-05 13:00:54 -0400 (Reuters Health)
SOURCE: American Journal of Roentgenology, October 2007
Mar 1, 2013 | Research, Stem Cell Procedures
Safety and complications reporting update on the re-implantation of culture-expanded mesenchymal stem cells using autologous platelet lysate technique.
Abstract
Mesenchymal stem cells (MSCs) hold great promise as therapeutic agents in regenerative medicine. Numerous animal studies have documented the multipotency of MSCs, showing their capabilities for differentiating into orthopedic tissues such as muscle, bone, cartilage, and tendon. However, the safety of culture expanded MSC’s for human use has only just begun to be reported.
METHODS: Between 2006 and 2010, two groups of patients were treated for various orthopedic conditions with culture-expanded, autologous, bone marrow-derived MSCs (group 1: n=50; group 2: n=290-one patient in both groups). Cells were cultured in monolayer culture flasks using an autologous platelet lysate technique and re-injected into peripheral joints or into intervertebral discs with use of c-arm fluoroscopy. While both groups had prospective surveillance for complications, Group 1 additionally underwent 3.0T MRI tracking of the re-implant sites.
RESULTS: The mean age of patients treated was 53 +/- 13.85 years; 214 were males and 125 females with mean follow-up time from any procedure being 435 days +/- 261 days. Number of contacts initiated based on time from first procedure was 482 at 3 months, 433 at 6 months, 316 contacts at 12 months, 110 contacts at 24 months, and 22 contacts at 36 months. For Group 1, 50 patients underwent 210 MRI surveillance procedures at 3 months, 6 months, 1, 2, and 3 years which failed to demonstrate any tumor formation at the re-implant sites. Formal disease surveillance for adverse events based on HHS criteria documented significantly less morbidity than is commonly reported for more invasive surgical procedures, all of which were either self-limited or were remedied with therapeutic measures. Two patients were diagnosed with cancer out of 339 patients treated since study inception; however, this was almost certainly unrelated to the MSC therapy and the neoplasm rate in similar to that seen in the U.S. Caucasian population. Knee outcome data was collected on a subset of patients. Here, > 75% improvement was reported in 41.4% while decreasing the improvement threshold to > 50% improvement, 63.2% reported an improvement. At an average reporting time of 11.3 months from first procedure average reported relief in the knee sample equaled 53.1% (n=133 reporting).
CONCLUSIONS: Using both intensive high field MRI tracking and complications surveillance in 339 patients, no neoplastic complications were detected at any stem cell re-implantation site. These findings are consistent with our prior publication and other published reports that also show no evidence of malignant transformation in vivo, following implantation of MSCs for orthopedic use.
Source:http://www.ncbi.nlm.nih.gov/pubmed/22023622
