Adding Regenerative medicine to your practice.

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(no, that's not the actual meaning of their name, but I couldn't help it...)
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bedrock said:
Similar to the ones that blinded patients in Florida???
Click to expand...
we still dont know how many patients benefited from the procedure....we only hear about the 3 cases that had poor results and the subsequent pile-on, and they were done by Nurse Practitioners

health.wusf.usf.edu

Florida Stem Cell Treatment Leaves 3 Blind

Three patients at a Florida clinic went blind after receiving eye injections of stem cells derived from their own abdominal fat, according to a report…
health.wusf.usf.edu
 
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Two-year clinical outcomes of autologous microfragmented adipose tissue in elderly patients with knee osteoarthritis: a multi-centric, international study​

International Orthopaedics (2021)Cite this article

Abstract

Purpose​

The aim of this study is to evaluate the outcomes of autologous microfragmented adipose tissue (MFAT) injection in elderly patients with knee osteoarthritis (OA). We hypothesized that MFAT knee infiltration for the treatment of knee OA would yield good clinical results out to two years follow-up.

Methods​

Multi-centric, international, open-label study conducted by orthopedic surgery, and/or regenerative medicine facilities utilizing patient registries. Subjects recruited for eligibility. The primary outcome measure was Knee Injury and Osteoarthritis Outcome Score (KOOS). Outcomes and patient factors were compared to baseline, at six, 12, and 24 months. Statistical models were used to assess KOOS subscores and probability of exceeding the Minimally Clinically Important Difference (MCID) or Patient Acceptable Symptom State (PASS), and to assess the effect of the treatment variables on KOOS - Pain.

Results​

Seventy-five patients, 120 primary treatments, mean age 69.6 years, (95%CI 68.3–70.9), BMI 28.4 (95%CI 27.3–29.6), with KL grade 2 to 4 knee OA treated with a single MFAT injection. KL grades 2 (15.1%), 3 (56.3%), and 4 (28.6%), with 20.8% of knees having previously undergone surgery. Patients with KL grade 2 disease had the best results in KOOS - Pain (P = 0.001), at six, 12, and 24 months. Including advanced KL grade 3 and 4 osteoarthritis patients, significant functional and quality of life success was seen in 106/120 treatments (88.3%, 66 patients) at all follow-up time points. Fourteen treatments (11.7%, 9 patients) failed prior to the study endpoint.

Conclusion​

This study shows that a single-dose MFAT injection leads to clinical, functional, and quality of life improvement at two years in elderly patients, in KL grades 2 to 4 of knee osteoarthritis. These findings provide evidence that this treatment modality could be a safe and effective option to other commonly available treatments in carefully selected patients.
 
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drusso said:
I can't think of a placebo that lasts 2 years...
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then genicular RFA.

data that it is superior to standard of care at 6 months:

pubmed.ncbi.nlm.nih.gov

A Randomized Controlled Pilot Study Comparing the Efficacy of Pulsed Radiofrequency Combined With Exercise Versus Exercise Alone in Pain Relief and Functional Improvement for Chronic Knee Osteoarthritis - PubMed

The improvement in pain relief and knee function might be associated with restoration of muscle strength after PRF-PS exercise by overcoming muscle inhibition.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

and this

pubmed.ncbi.nlm.nih.gov

Results of genicular nerve ablation by radiofrequency in osteoarthritis-related chronic refractory knee pain - PubMed

In chronic refractory knee pain due to OA, the application of RF ablation to the genicular nerve is an effective and safe treatment option in the medium to long term.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
 
Ducttape said:
then genicular RFA.

data that it is superior to standard of care at 6 months:

pubmed.ncbi.nlm.nih.gov

A Randomized Controlled Pilot Study Comparing the Efficacy of Pulsed Radiofrequency Combined With Exercise Versus Exercise Alone in Pain Relief and Functional Improvement for Chronic Knee Osteoarthritis - PubMed

The improvement in pain relief and knee function might be associated with restoration of muscle strength after PRF-PS exercise by overcoming muscle inhibition.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

and this

pubmed.ncbi.nlm.nih.gov

Results of genicular nerve ablation by radiofrequency in osteoarthritis-related chronic refractory knee pain - PubMed

In chronic refractory knee pain due to OA, the application of RF ablation to the genicular nerve is an effective and safe treatment option in the medium to long term.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov
Click to expand...

Cash/out of pocket SOS facility fee for genicular RFA/Coollief is $2500
 
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decent study.

small group. i assume they assessed group size for power.

interestingly, the group to surgery was faster with PRP than with HA. but the total numbers were better with PRP (ie not going to surgery). but sample might have been too small...
 
Have a friend with a subchondral fx of lateral trochlea, cartilage looks fine. 7 months of symptoms. Would any of you rec PRP in a case like this? IA or subchondral. Has a 4x11mm defect and surround bony edema.
 
drusso said:
View attachment 332549
Click to expand...


strange choice. most studies for Knee show that HMW HA superior. and one reason why HA not FDA approved for hips is that it's been shown not to be effective in hips. (otherwise, it's a huge indication to get FDA and thus coverage for)

24 week follow up is nice.

benefits demonstrated based on abstract to 6 months.

does LP-PRP prevent THA? what a pity it's such a small sample size
 
Arthroscopy

. 2021 Feb;37(2):510-517.
doi: 10.1016/j.arthro.2020.10.037. Epub 2020 Oct 28.

Platelet-Rich Plasma in Patients With Partial-Thickness Rotator Cuff Tears or Tendinopathy Leads to Significantly Improved Short-Term Pain Relief and Function Compared With Corticosteroid Injection: A Double-Blind Randomized Controlled Trial​

Cory A Kwong 1, Jarret M Woodmass 2, Eva M Gusnowski 3, Aaron J Bois 4, Justin Leblanc 4, Kristie D More 5, Ian K Y Lo 4
Affiliations expand

Abstract​

Purpose: To perform a randomized controlled trial comparing platelet-rich plasma (PRP) with standard corticosteroid (CS) injection in providing pain relief and improved function in patients with rotator cuff tendinopathy and partial-thickness rotator cuff tears (PTRCTs).
Methods: This double-blind randomized controlled trial enrolled patients with ultrasound-proven or magnetic resonance imaging-proven PTRCTs who received either an ultrasound-guided PRP or CS injection. Patients completed patient-reported outcome assessments at baseline and at 6 weeks, 3 months, and 12 months after injection. The primary outcome was improvement in the visual analog scale (VAS) score for pain. Secondary outcomes included changes in American Shoulder and Elbow Surgeons (ASES) and Western Ontario Rotator Cuff Index (WORC) scores. Treatment failure was defined as subsequent injection, consent to undergo surgery, or operative intervention.
Results: We followed up 99 patients (47 in the PRP group and 52 in the CS group) until 12 months after injection. There were no differences in baseline patient demographic characteristics including age, sex, or duration of symptoms. Despite randomization, patients in the PRP group had worse baseline VAS (46.0 vs 34.7, P = .01), ASES (53.9 vs 61.8, P = .02), and WORC (42.2 vs 49.5, P = .03) scores. At 3 months after injection, the PRP group had superior improvement in VAS (-13.6 vs 0.4, P = .03), ASES (13.0 vs 2.9, P = .02), and WORC (16.8 vs 5.8, P = .03) scores. There were no differences in patient-reported outcomes at 6 weeks or 12 months. There was no difference in the rate of failure (P = .31) or conversion to surgery (P = .83) between groups.
Conclusions: Patients with PTRCTs or tendinopathy experienced clinical improvement in pain and patient-reported outcome scores after both ultrasound-guided CS and PRP injections. Patients who received PRP obtained superior improvement in pain and function at short-term follow-up (3 months). There was no sustained benefit of PRP over CS at longer-term follow-up (12 months).
Level of evidence: Level I, randomized controlled trial.
Copyright © 2020 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.
 
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study seems pretty well done.

interestingly, no long term difference in pain or outcome measures (at 12 months) between the 2 modalities.
 
Ducttape said:
study seems pretty well done.

interestingly, no long term difference in pain or outcome measures (at 12 months) between the 2 modalities.
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Not only that:

There were no differences in patient-reported outcomes at 6 weeks or 12 months.

Drusso: Explain why the conclusion doesnt state the above. And how that happened.
 
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lobelsteve said:
I agree stem cell therapy holds lots of promise. And should be the future of interventional care. But without reliable harvest, concentration, injection techniques and outcome studies validating primary endpoints in large RCTs, our cart is finished the race and our horse is still in the barn.
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And what about cymerus and the sculptor trial? Do you think they have a chance ?
 
www.cvent.com

Advanced Regenerative Spine Intradiscal, Facet SI, and Spine Ligaments

<p style="box-sizing: border-box; margin: 0px 0px 1em; padding: 0px; border: 0px; outline: 0px; background-image: initial; background-position: 0px 0px; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial...
www.cvent.com

It's $2,500 o_O is it worth it to go? No travel costs for me...

Advanced Regenerative Spine Intradiscal, Facet SI, and Spine Ligaments
Click to expand...

Here is what you will learn:

Advanced Regenerative Intradiscal, Facet, SI, and Spine Ligaments

  • Intradiscal using PRP for facets and SI joint
  • Using platelet products epidural
Spinal ligaments with ultrasound and fluoroscopy

  • Multifidus
  • Supraspinous-Interspinous Ligments
  • Iliolumbar ligaments
  • SI Joint/Ligaments
Click to expand...
 
Agast said:
www.cvent.com

Advanced Regenerative Spine Intradiscal, Facet SI, and Spine Ligaments

<p style="box-sizing: border-box; margin: 0px 0px 1em; padding: 0px; border: 0px; outline: 0px; background-image: initial; background-position: 0px 0px; background-size: initial; background-repeat: initial; background-attachment: initial; background-origin: initial; background-clip: initial...
www.cvent.com

It's $2,500 o_O is it worth it to go? No travel costs for me...
Click to expand...
Advanced Regenerative Intradiscal, Facet, SI, and Spine Ligaments
  • Intradiscal using PRP for facets and SI joint
  • Using platelet products epidural
Spinal ligaments with ultrasound and fluoroscopy
  • Multifidus
  • Supraspinous-Interspinous Ligments
  • Iliolumbar ligaments
  • SI Joint/Ligaments
You will also receive procedure-specific instructional videos that you can pull up at any time to review the procedure before treating a patient!

General Prerequisites​


MD or DO with a musculoskeletal specialty:
  • Physical Medicine and Rehabilitation
  • Family Practice with the completion of a Sports Fellowship
  • Interventional Spine (Anesthesiology or PMR)
  • Orthopedic Surgery
  • Interventional Radiology accepted only with significant hands on examination experience.



Just send your local FP-Sports guy. Burn the money. It would be more useful then supporting this BS.
 
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That's actually a pretty good deal if you're interested. It's IOF and they seem to be simplifying the process to complete in one day.
 
Ferrismonk said:
That's actually a pretty good deal if you're interested. It's IOF and they seem to be simplifying the process to complete in one day.
Click to expand...
Do you think these modalities are helpful to patients?

Sometimes I feel it's like joining a cult.
 
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Agast said:
Do you think these modalities are helpful to patients?

Sometimes I feel it's like joining a cult.
Click to expand...

for the appendicular skeleton? yes.

for the spine? we arent there yet. PRP for supraspinous ligament? multifidi? c'mon.

we have good treatments for facets. im not ready to put PRP in the epidural space or disc
 
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SSdoc33 said:
for the appendicular skeleton? yes.

for the spine? we arent there yet. PRP for supraspinous ligament? multifidi? c'mon.

we have good treatments for facets. im not ready to put PRP in the epidural space or disc
Click to expand...
Prp in facets ok?
 
lobelsteve said:
Advanced Regenerative Intradiscal, Facet, SI, and Spine Ligaments
  • Intradiscal using PRP for facets and SI joint
  • Using platelet products epidural
Spinal ligaments with ultrasound and fluoroscopy
  • Multifidus
  • Supraspinous-Interspinous Ligments
  • Iliolumbar ligaments
  • SI Joint/Ligaments
You will also receive procedure-specific instructional videos that you can pull up at any time to review the procedure before treating a patient!

General Prerequisites​


MD or DO with a musculoskeletal specialty:
  • Physical Medicine and Rehabilitation
  • Family Practice with the completion of a Sports Fellowship
  • Interventional Spine (Anesthesiology or PMR)
  • Orthopedic Surgery
  • Interventional Radiology accepted only with significant hands on examination experience.



Just send your local FP-Sports guy. Burn the money. It would be more useful then supporting this BS.
Click to expand...

I've had it done on myself and it works great!
 
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SSdoc33 said:
intra-articular is fine in younger patients. i guess. probably wont work as well or as long as RF, but it isnt destructive
Click to expand...

Don't ever do PRP in facets. Facet capsules communicate with the epidural space. Do platelet lysate instead. Slowly degranulating inflammatory goop in the epidural space results in bad, bad Yelp reviews...
 
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I'm hesitant about injecting discs because of iatrogenic discitis, but other than that I think it's good medicine. I've done several SI PRP and everyone has been a slam dunk.
 
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Agast said:
Do you think these modalities are helpful to patients?

Sometimes I feel it's like joining a cult.
Click to expand...

Just walked out of a room after seeing a 55-year-old mountain biker with bad 1st CMC OA and a bad thumb strain after doing an Endo on his bike. 4 weeks after PRP into the joint and ligaments he's 90% improved. The hand surgeon wanted to fuse his CMC. #healthcareheros.
 
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Ferrismonk said:
I'm hesitant about injecting discs because of iatrogenic discitis, but other than that I think it's good medicine. I've done several SI PRP and everyone has been a slam dunk.
Click to expand...
hmmmmmmmmm.....
 
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drusso said:
Just walked out of a room after seeing a 55-year-old mountain biker with bad 1st CMC OA and a bad thumb strain after doing an Endo on his bike. 4 weeks after PRP into the joint and ligaments he's 90% improved. The hand surgeon wanted to fuse his CMC. #healthcareheros.
Click to expand...
How much for your magic beans?

I just a 40 y/o to ortho for prp of cmc. Hand surgeon said too young for surgery. Same group, different doc.
 
drusso said:
Don't ever do PRP in facets. Facet capsules communicate with the epidural space. Do platelet lysate instead. Slowly degranulating inflammatory goop in the epidural space results in bad, bad Yelp reviews...
Click to expand...
Yes lysate works very well
 
drusso said:
Have you spoken to a patient with a high deductible health plan? Not everyone has your kind of insurance. For a lot of people, it's all cash on the barrel.
Click to expand...
a very small minority. this tells me that you see very little medicare/caid and are milking commercial insurances and cash pay patients.

i understand your "i hate SOS" philosophy, but the science has to back up your schemes. example: charging patient cash for intra-articular or tendon PRP is kosher. random goop stem cells or PRP in a disc is not, IMHO
 
SSdoc33 said:
a very small minority. this tells me that you see very little medicare/caid and are milking commercial insurances and cash pay patients.

i understand your "i hate SOS" philosophy, but the science has to back up your schemes. example: charging patient cash for intra-articular or tendon PRP is kosher. random goop stem cells or PRP in a disc is not, IMHO
Click to expand...
Science ...

Science is a methodology for structured skepticism

Science is NOT a collection of irrefutable facts.

Scientific is not dogma. Scientific findings can be improved, updated, and disproved. And... They can and will disprove medical dogma on a regular basis.
 
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