Adding Regenerative medicine to your practice.

[drusso]

I would have to look it up, as I don't do a lot of knees, but I believe there may be some limitations to what you inject for Medicaid and medicare patients.

this is definitely the case for epidurals, facet joint injections or Si injections.

You do blood patches, right? Same, same.

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Members don't see this ad.

 

[bedrock]

I would have to look it up, as I don't do a lot of knees, but I believe there may be some limitations to what you inject for Medicaid and medicare patients.

this is definitely the case for epidurals, facet joint injections or Si injections.

If Medicare doesn’t cover it at all, I don’t believe they limit what you can inject, just like it’s not forbidden for Medicare patients to pay out of pocket for cosmetic surgery

 

[Ducttape]

You do blood patches, right? Same, same.

no, not same.

Evicore:

Non-Indications: ESI
 Both of the following are considered experimental, investigational, or unproven (EIU).

 Epidural steroid injection (ESI) performed with ultrasound guidance
 ESI for treatment of radicular pain or radiculopathy involving an injectate other than an anesthetic, corticosteroid, and/or contrast agent (e.g., biologics [platelet rich plasma, stem cells, amniotic fluid]

 

[drusso]

no, not same.

Evicore:

Non-Indications: ESI
 Both of the following are considered experimental, investigational, or unproven (EIU).

 Epidural steroid injection (ESI) performed with ultrasound guidance
 ESI for treatment of radicular pain or radiculopathy involving an injectate other than an anesthetic, corticosteroid, and/or contrast agent (e.g., biologics [platelet rich plasma, stem cells, amniotic fluid]

Don't let Evicore tell you how to practice medicine.

 

[Ferrismonk]

Don't let Evicore tell you how to practice medicine.

Ethically I agree, however "He who pays the piper calls the tune."

 

[Ducttape]

Don't let Evicore tell you how to practice medicine.

1. i want to practice best medicine. evidence based medicine.

2. i want to get paid for what i do.

3. i want to avoid getting audited.


im not convinced regenerative medicine for spine injection gets me the 1st, doesnt get me the 2nd, and may trigger the 3rd. Lose Lose Lose situation all the way around.

 

[drusso]

1. i want to practice best medicine. evidence based medicine.

2. i want to get paid for what i do.

3. i want to avoid getting audited.


im not convinced regenerative medicine for spine injection gets me the 1st, doesnt get me the 2nd, and may trigger the 3rd. Lose Lose Lose situation all the way around.

Who oversees Evicore? Trust no one but yourself. YOU'RE the doctor.

 

[drusso]

1. i want to practice best medicine. evidence based medicine.

2. i want to get paid for what i do.

3. i want to avoid getting audited.


im not convinced regenerative medicine for spine injection gets me the 1st, doesnt get me the 2nd, and may trigger the 3rd. Lose Lose Lose situation all the way around.

There used to be a pain doctor who was Medical Director for Evicore who would post here in the good old days. After a conference once, at the bar, he told me that the Evicore Doctors got bonused based upon the number of denials they made.

Since then, I just wipe my *** with their recommendations.

 

[Ducttape]

Who oversees Evicore? Trust no one but yourself. YOU'RE the doctor.

im sorry but that is utterly unrealistic. if you dont appreciate that term, then insert idealistic.




if this is how you approach your patients, then good luck with your Medicare audit.

 

[drusso]

im sorry but that is utterly unrealistic. if you dont appreciate that term, then insert idealistic.




if this is how you approach your patients, then good luck with your Medicare audit.

I tell patients all the time that Evicore is not a trusted partner in the care of patients. Just read their Better Business Bureau complaints and reviews from employees who have worked there. DO NOT INVOLVE THEM in how to formulate how you practice medicine.

eviCore healthcare | Complaints | Better Business Bureau® Profile

View customer complaints of eviCore healthcare, BBB helps resolve disputes with the services or products a business provides.

www.bbb.org

eviCore healthcare - DO NOT!!I REPEAT,DO NOT WORK HERE!!!

Friendly co-workers, decent pay, work from home, off every weekend.

www.glassdoor.com

 

[drusso]

@Ducttape

Stem Cells Dev
2021 Apr 24.
doi: 10.1089/scd.2021.0053. Online ahead of print.

A prospective study comparing leukocyte-poor platelet-rich plasma combined with hyaluronic acid and autologous microfragmented adipose tissue in patients with early knee osteoarthritis​

Ignacio Dallo 1, Dawid Szwedowski 2, Ali Mobasheri 3 4 5 6, Eleonora Irlandini 7, Alberto Gobbi 8
Affiliations expand

• PMID: 33899526
• DOI: 10.1089/scd.2021.0053

Abstract​

The objective of this study was to compare the clinical efficacy of repeated doses of leucocyte-poor platelet-rich plasma (LP-PRP) plus hyaluronic acid (HA) to a single dose of autologous microfragmented adipose tissue (AMAT) injections in patients with early osteoarthritis (OA) symptoms. Eighty knees in fifty patients (mean age: 61.3 years) were randomly allocated into two equal groups in a non-blinded design and prospectively followed for 12 months. Group 1 received three intra-articular injections (1 month apart) using autologous LP-PRP+HA. Group 2 received a single dose of AMAT injection. Outcomes were measured by PROMs Tegner, Marx, VAS, and KOOS at 6 and 12 months. Both groups had significant clinical and functional improvement at 6 and 12 months. The differences between groups were statistically significant in Tegner score and KOOS symptoms (both p < 0.05) at 6 months in group 2. The test with statistically significant differences (p<0.05) at 12 months was Tegner (p<0.001), with group 2 having a higher median than group 1. LP-PRP+HA and AMAT lead to clinical and functional improvement at 6 and 12 months. AMAT showed better clinical results in Tegner and KOOS Symptoms at 6 months and Tegner at 12 months. Understanding which therapy offers the most benefits with the least risk can significantly improve the quality of life for millions of people affected by OA. Long-term randomized controlled studies are needed to verify differences in efficacy.

 

[oreosandsake]

In 7 days there will be a virtual conference on regenerative medicine
There’s a good representation of physicians from around the world.

Some of the topics are a little further out from the EBM base but represent what attendees are interested in hearing about

APEX Biologix

Dedicated to the science and research of regenerative medicine.

www.apexbiologix.com

 

[drusso]

Anecdotes does not equal anecdata.

#Gamechanger #Showmethedata #Youaskedforit #RIPCorticosteroid

Arch Phys Med Rehabil.
2021 May;102(5):951-958. doi: 10.1016/j.apmr.2020.12.025. Epub 2021 Feb 3.

One-Year Efficacy of Platelet-Rich Plasma for Moderate-to-Severe Carpal Tunnel Syndrome: A Prospective, Randomized, Double-Blind, Controlled Trial

Si-Ru Chen 1, Yu-Ping Shen 1, Tsung-Yen Ho 2, Tsung-Ying Li 3, Yu-Chi Su 1, Yu-Ching Chou 4, Liang-Cheng Chen 1, Yung-Tsan Wu 5
Affiliations expand

PMID: 33548206 DOI: 10.1016/j.apmr.2020.12.025

Abstract
Objective: To assess the therapeutic effect of platelet-rich plasma (PRP) for moderate-to-severe carpal tunnel syndrome (CTS).

Design: A prospective, randomized, double-blinded, controlled trial (1-year follow-up).

Setting: Outpatient of local medical center settings.

Participants: Patients (N=26) who were diagnosed with bilateral moderate-to-severe CTS (total 52 wrists) were included. For each patient, one wrist was randomized into either the PRP or control group and the contralateral wrist of the same patient was allocated to another group. Twenty-four patients were included in the final data analysis.

Interventions: The wrists in the PRP group received a single ultrasound-guided dose of PRP injection (3.5mL), and the control group received a single ultrasound-guided injection with normal saline (3.5mL).

Main outcome measures: The Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores were used as the primary outcome. Secondary outcomes encompassed the cross-sectional area of the median nerve and electrophysiological study. Assessments were conducted prior to injection and 1, 3, 6, and 12 months postinjection.

Results: Compared to the control group, the PRP group exhibited significant improvements in BCTQ severity scores at all time points, BCTQ functional scores at the sixth month, and cross-sectional area at the 12th month postinjection (P<.0125).

Conclusions: A single dose of ultrasound-guided perineural PRP injection can provide a therapeutic effect for 1 year postinjection.

Keywords: Carpal tunnel syndrome; Platelet-rich plasma; Rehabilitation.

 

[lobelsteve]

Fun study, low N, and used same patient for each treatment. Not enough N for accounting for severity (patients are not always symmetric in symptoms or severity). Would like to see DBRCT set up same way but only allow one wrist per patient.

 

[drusso]

Fun study, low N, and used same patient for each treatment. Not enough N for accounting for severity (patients are not always symmetric in symptoms or severity). Would like to see DBRCT set up same way but only allow one wrist per patient.

 

[Ducttape]

however... very small sample size.

shows benefit over saline.

Discussion​

To our knowledge, this was the first prospective, randomized, double-blind study to explore the long-term efficacy of single-dose ultrasound-guided perineural injection with PRP in patients with moderate-to-severe CTS. The PRP group was observed to have a notably better decline in pain and disability accompanied with improved CSA of the median nerve until 1 year postintervention compared to the control group. However, the intergroup difference of SSS and FSS was not greater than the MCID value. Although more marked differences in improvements in the FSS scores, CSA, and electrophysiological measurements with longer follow-up were observed (PRP>control group), significant differences were only seen in the FSS scores at the 6-month follow-up and in the CSA at the 12-month follow-up. Thus, their clinical significance remains uncertain. Further studies with larger sample size are therefore needed to obtain conclusive results.

carpal tunnel and epicondylitis both appear to be prime target sites to advance regenerative medicine.

 

[Nodolor]

Carpal tunnel release surgery is extremely effective and safe, why dick around injecting it?

 

[oreosandsake]

Carpal tunnel release surgery is extremely effective and safe, why dick around injecting it?

big fat ugly scar.
sometimes the surgery doesn't fix it then you still need to treat it
patient with A1c in the teens

 

[Taus]

big fat ugly scar.
sometimes the surgery doesn't fix it then you still need to treat it
patient with A1c in the teens

I’ve had it. Bilateral. Mini open technique under local. Took maybe 5 mins. <1cm long <1mm wide scar. Did left on a Friday and worked Monday. Did right the day before a weeklong vacation. Problem solved. Never looked back.

when you work with your hands and watch your median motor latency prolong and amplitude decrease IMO it’s no time to f around.

 

[lobelsteve]

big fat ugly scar.
sometimes the surgery doesn't fix it then you still need to treat it
patient with A1c in the teens

So it controls their DM too? Amazeballs.

 

[sloh]

big fat ugly scar.
sometimes the surgery doesn't fix it then you still need to treat it
patient with A1c in the teens

Carpal tunnel release is one of the most effective ortho procedures. The patients that benefit the most from carpal tunnel release are those in the moderate-severe category. It doesn't seem prudent to even suggest PRP based off that low sample size study when putting off surgery and letting the condition progress further can lead to irreversible nerve damage that won't benefit as much from surgery.

 

[drusso]

Carpal tunnel release is one of the most effective ortho procedures. The patients that benefit the most from carpal tunnel release are those in the moderate-severe category. It doesn't seem prudent to even suggest PRP based off that low sample size study when putting off surgery and letting the condition progress further can lead to irreversible nerve damage that won't benefit as much from surgery.

Here's a larger trial.

Clin Rheumatol
2019 Dec;38(12):3643-3654.
doi: 10.1007/s10067-019-04719-7. Epub 2019 Aug 16.

Platelet-rich plasma in treatment of patients with idiopathic carpal tunnel syndrome​

Mohammad K Senna 1, Reham M Shaat 2, Alaa Ali Awad Ali 1
Affiliations expand

• PMID: 31420812
• DOI: 10.1007/s10067-019-04719-7

Abstract​

Background: Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the upper extremity. Treatments for CTS alternate from conservative strategies to surgical decompression of median nerve. Few studies have applied platelet-rich plasma (PRP) for treating idiopathic CTS, with acceptable success rates. Further studies are needed to reach concrete conclusion.
Objective: To study the effect of PRP injection in treatment of mild to moderate idiopathic CTS.
Methods: This is a randomized controlled trial in a cohort of Egyptian patients suffered from mild to moderate CTS. They were randomly divided into two groups. Group 1: patients received ultrasound guided PRP injection and group 2 patients received ultrasound guided corticosteroid injection. The outcome measures were assessed via Visual Analog Scale, the Boston Carpal Tunnel Syndrome Questionnaire, electrophysiological findings in sensory and motor functions of median nerve and morphological changes of median nerve detected by ultrasound.
Results: This study included 150 patients suffered from mild to moderate idiopathic CTS 15 did not provide the written consent and 37 participants were excluded from the study based on the exclusion criteria leaving only 98 patients to participate in the study they were divided into two groups PRP Injection Group (PRP-inj-G) - this group included 49 patients (40 females and 9 males) steroid injection Group (St-inj-G) - included 49 patients (41 females and 8 males). At the beginning of study there was no significant difference between both groups in all parameters. (a) PRP injection had significantly improved the clinical manifestations, the electrodiagnostic examination (EDX) parameters of the median nerve (MN), and the median nerve cross sectional area (m-CSA) at 1 month and 3 months post-injection evaluation in comparison to baseline recordings; (b) local steroid injection had significantly improved the clinical manifestations, the EDX parameters of the MN, and the m-CSA at 1 month and 3 months post-injection evaluation in comparison to baseline recordings and (c) PRP injection was superior to the local steroid injection in the improvement of clinical manifestations as well as the MN motor conduction velocity along the wrist-elbow segment, the sensory latency (SL) and the MN sensory conduction, this superiority was observed in third month follow-up suggesting better outcomes in long-term follow-up.
Conclusion: Platelet-rich plasma could be effective treatment of mild to moderate idiopathic CTS and superior to corticosteroid in improving pain, function, and distal sensory latency of median nerve.
Trial registration: Clinical Trials.gov Identifier: NCT03863873Key Points:• PRP is effective treatment of mild to moderate CTS.• PRP is superior to corticosteroids in improving pain and function in CTS.
Keywords: Carpal tunnel syndrome; Corticosteroids; Platelet rich plasma.

 

[Nodolor]

Sorry if I am uninformed to all the properties of this " magic elixir' , but how does it help decompress the nerve?

 

[Doctodd]

Sorry if I am uninformed to all the properties of this " magic elixir' , but how does it help decompress the nerve?

it helps the nerve tolerate the compression by improving the environment around it, just like in joints.....arthritic joints are hostile environments

 

[Nodolor]

it helps the nerve tolerate the compression by improving the environment around it, just like in joints.....arthritic joints are hostile environments

 

[oreosandsake]

Carpal tunnel release is one of the most effective ortho procedures. The patients that benefit the most from carpal tunnel release are those in the moderate-severe category. It doesn't seem prudent to even suggest PRP based off that low sample size study when putting off surgery and letting the condition progress further can lead to irreversible nerve damage that won't benefit as much from surgery.

if you're a surgical candidate you're a surgical candidate. a lot of people do not want surgery.

 

[oreosandsake]

 

[oreosandsake]

So it controls their DM too? Amazeballs.

lot of hand surgeons dont want to touch patients with A1c that can legally buy cigarettes.

 

[Nodolor]

if you're a surgical candidate you're a surgical candidate. a lot of people do not want surgery.

If 20 years of practice I can count on one hand the number of patients who didn't want carpal tunnel release and were surgical candidates

 

[sloh]

If 20 years of practice I can count on one hand the number of patients who didn't want carpal tunnel release and were surgical candidates

Lol that's exactly what I thought. Pretty much every patient I've seen with moderate-severe carpal tunnel syndrome is on board with surgery once the benefits and risks are discussed.

 

[cowboydoc]

I like injecting about anything (except feet). I like thinking I can help people avoid surgery sometimes. Yet, for significant CTS, I have to be coaxed to inject it. I usually encourage them to go get the 5 minute surgery and fix the issue. Our hand guy does an direct visualization "open" technique that avoids the pitfalls of endoscopic, has a 1 cm incision, wide awake, local block, 5 minutes in OR...SLICK!

This really seems like a solution looking for a problem. Do you think any of the SI fusion companies are looking for a way to fuse the wrist to treat CTS?

 

[oreosandsake]

If 20 years of practice I can count on one hand the number of patients who didn't want carpal tunnel release and were surgical candidates

I have one guy who only had one hand. He lost the other one and is scared to have someone touch his only remaining hand. But he’s been happy having me inject it even though I’ve told him he’s a surgical candidate.
The plastics guy who works with me sends me a lot of his patients for an injection first to see if they can avoid surgery. He also sends them to me when they continue to have median neuropathy after release. I’ve seen many patients with bilateral symptoms and refuse surgery after the first side is done citing the scar as one of the issues. I’m not here fighting for regen of carpal tunnel either so this doesn’t need to be drawn out. The topic thread is on regen.

 

[drusso]

Great supplement from the International Journal of Spine Surgery dedicated to Regen Med in the Spine.

International Journal of Spine Surgery: 15 (s1)

www.ijssurgery.com

 

[lobelsteve]

Great supplement from the International Journal of Spine Surgery dedicated to Regen Med in the Spine.

International Journal of Spine Surgery: 15 (s1)

www.ijssurgery.com

SIS Annual Meeting. Washington DC.


Thursday, August 19

---

Continental Breakfast in Exhibit Hall
8:00-8:40 a.m

---

Welcome Remarks Annual Meeting Committee Chair: Scott Naftulin, DO
8:40-8:45 a.m.

---

Orthobiologics for the Treatment of Spine Pain Moderator: Byron J. Schneider, MD

8:45-9:05 a.m. - SIS Systematic Review on Intradiscal Biologic Treatments for Discogenic Pain - Byron J. Schneider, MD
9:05-9:12 a.m. - Intradiscal Biologics: Pro - David Levi, MD
9:12-9:19 a.m. - Intradiscal Biologics: Con - D. Scott Kreiner, MD
9:19-9:29 a.m. - Discussion
9:29-9:39 a.m. - Biologics for Epidural Use - Christine Hunt, DO, MS
9:39-9:49 a.m. - Biologics for Zygapophysial Joint Pain - Nathaniel M. Schuster, MD
9:49-9:55 a.m. - Discussion

Meetup thread needed.

 

[drusso]

SIS Annual Meeting. Washington DC.


Thursday, August 19

---

Continental Breakfast in Exhibit Hall
8:00-8:40 a.m

---

Welcome Remarks Annual Meeting Committee Chair: Scott Naftulin, DO
8:40-8:45 a.m.

---

Orthobiologics for the Treatment of Spine Pain Moderator: Byron J. Schneider, MD

8:45-9:05 a.m. - SIS Systematic Review on Intradiscal Biologic Treatments for Discogenic Pain - Byron J. Schneider, MD
9:05-9:12 a.m. - Intradiscal Biologics: Pro - David Levi, MD
9:12-9:19 a.m. - Intradiscal Biologics: Con - D. Scott Kreiner, MD
9:19-9:29 a.m. - Discussion
9:29-9:39 a.m. - Biologics for Epidural Use - Christine Hunt, DO, MS
9:39-9:49 a.m. - Biologics for Zygapophysial Joint Pain - Nathaniel M. Schuster, MD
9:49-9:55 a.m. - Discussion

Meetup thread needed.

I'm going to try to make it. I have a HPC meeting, but I also need to work...

 

[lobelsteve]

I'm going to try to make it. I have a HPC meeting, but I also need to work...

This is more important. And I will treat you to dinner at whatever replaced Zentan. Sad that it closed in 2018.

 

[drusso]

This is more important. And I will treat you to dinner at whatever replaced Zentan. Sad that it closed in 2018.

I'll ask the wife. I guess I could visit my Congressman when I'm there...

 

[Taus]

I have one guy who only had one hand. He lost the other one and is scared to have someone touch his only remaining hand. But he’s been happy having me inject it even though I’ve told him he’s a surgical candidate.
The plastics guy who works with me sends me a lot of his patients for an injection first to see if they can avoid surgery. He also sends them to me when they continue to have median neuropathy after release. I’ve seen many patients with bilateral symptoms and refuse surgery after the first side is done citing the scar as one of the issues. I’m not here fighting for regen of carpal tunnel either so this doesn’t need to be drawn out. The topic thread is on regen.

But drawing it out is fun...

if he’s got lots w painful scars and residual cts I think a new hand surgeon to refer them to is in order.

 

[drusso]

J Orthop Surg Res

. 2021 May 21;16(1):333.
doi: 10.1186/s13018-021-02470-x.

Corticosteroids or platelet-rich plasma injections for rotator cuff tendinopathy: a randomized clinical trial study​

Haleh Dadgostar 1, Farinaz Fahimipour 2, Alireza Pahlevan Sabagh 3, Peyman Arasteh 4, Mohammad Razi 3
Affiliations expand

• PMID: 34020672
• PMCID: PMC8139041
• DOI: 10.1186/s13018-021-02470-x

Free PMC article

Abstract​

Background: Studies evaluating the role of both corticosteroids and platelet-rich plasma (PRP) in the treatment of rotator cuff (RC) tendinopathies have been contradicting. We compared structural and clinical changes in RC muscles after corticosteroids and PRP injections.
Methods: This is a randomized double-blind clinical trial. All individuals with diagnosis of RC tendinitis during 2014-2017 were considered. Individuals were randomly allocated to either receive PRP or corticosteroids. Overall, 3cc of PRP was injected within the subacromial joint and another 3cc was injected at the site of the tendon tear, under the guide of sonography. For the corticosteroid group, 1cc of Depo-medrol 40mg and 1cc of lidocaine (2%) was injected within the subacromial joint.
Results: Overall, 58 patients entered the study. Comparison of pain, range of motion (ROM), Western Ontario RC (WORC), Disability of Arm-Hand-Shoulder (DASH) scores, and supraspinatus thickness showed significant improvement during follow-ups in both groups (p<0.05). During 3 months of follow-up, pain improvement was significantly better within the PRP group during (from 6.66±2.26 to 3.08±2.14 and 5.53±1.80 to 3.88±1.99, respectively; p=0.023). Regarding ROM, the PRP group had significant improvement in adduction (20.50°±8.23° to 28°±3.61° and 23.21°±7.09° to 28.46°±4.18° for the PRP and corticosteroid groups, respectively; p=0.011) and external rotation (59.66°±23.81° to 76.66°±18.30° and 57.14°±24.69° to 65.57°±26.39°, for the PRP and corticosteroid groups, respectively; p=0.036) compared to the corticosteroid group.
Conclusion: We found that PRP renders similar results to that of corticosteroids in most clinical aspects among patients with RC tendinopathies; however, pain and ROM may show more significant improvement with the use of PRP. Considering that the use of corticosteroids may be contraindicated in some patients and may be associated with the risk of tendon rupture, we suggest the use of PRP in place of corticosteroid-based injections among patients with RC tendinopathy.
Trial registration: Clinical trial registration code: IRCT201302174251N9.
Keywords: Corticosteroid; Platelet-rich plasma; Rotator cuff; Supraspinatus; Tendinopathy.

 

[lobelsteve]

J Orthop Surg Res

. 2021 May 21;16(1):333.
doi: 10.1186/s13018-021-02470-x.

Corticosteroids or platelet-rich plasma injections for rotator cuff tendinopathy: a randomized clinical trial study​

Haleh Dadgostar 1, Farinaz Fahimipour 2, Alireza Pahlevan Sabagh 3, Peyman Arasteh 4, Mohammad Razi 3
Affiliations expand

• PMID: 34020672
• PMCID: PMC8139041
• DOI: 10.1186/s13018-021-02470-x

Free PMC article

Abstract​

Background: Studies evaluating the role of both corticosteroids and platelet-rich plasma (PRP) in the treatment of rotator cuff (RC) tendinopathies have been contradicting. We compared structural and clinical changes in RC muscles after corticosteroids and PRP injections.
Methods: This is a randomized double-blind clinical trial. All individuals with diagnosis of RC tendinitis during 2014-2017 were considered. Individuals were randomly allocated to either receive PRP or corticosteroids. Overall, 3cc of PRP was injected within the subacromial joint and another 3cc was injected at the site of the tendon tear, under the guide of sonography. For the corticosteroid group, 1cc of Depo-medrol 40mg and 1cc of lidocaine (2%) was injected within the subacromial joint.
Results: Overall, 58 patients entered the study. Comparison of pain, range of motion (ROM), Western Ontario RC (WORC), Disability of Arm-Hand-Shoulder (DASH) scores, and supraspinatus thickness showed significant improvement during follow-ups in both groups (p<0.05). During 3 months of follow-up, pain improvement was significantly better within the PRP group during (from 6.66±2.26 to 3.08±2.14 and 5.53±1.80 to 3.88±1.99, respectively; p=0.023). Regarding ROM, the PRP group had significant improvement in adduction (20.50°±8.23° to 28°±3.61° and 23.21°±7.09° to 28.46°±4.18° for the PRP and corticosteroid groups, respectively; p=0.011) and external rotation (59.66°±23.81° to 76.66°±18.30° and 57.14°±24.69° to 65.57°±26.39°, for the PRP and corticosteroid groups, respectively; p=0.036) compared to the corticosteroid group.
Conclusion: We found that PRP renders similar results to that of corticosteroids in most clinical aspects among patients with RC tendinopathies; however, pain and ROM may show more significant improvement with the use of PRP. Considering that the use of corticosteroids may be contraindicated in some patients and may be associated with the risk of tendon rupture, we suggest the use of PRP in place of corticosteroid-based injections among patients with RC tendinopathy.
Trial registration: Clinical trial registration code: IRCT201302174251N9.
Keywords: Corticosteroid; Platelet-rich plasma; Rotator cuff; Supraspinatus; Tendinopathy.

SO no difference. What is the cost difference? 2cc vs 6cc injected might make a difference.
Otherwise looks promising, if you can do it for price of steroids.

 

[drusso]

SO no difference. What is the cost difference? 2cc vs 6cc injected might make a difference.
Otherwise looks promising, if you can do it for price of steroids.

Show me where you see the no difference.

 

[lobelsteve]

Show me where you see the no difference.

found that PRP renders similar results to that of corticosteroids in most clinical aspects among patients with RC tendinopathies;

MAY.

 

[drusso]

found that PRP renders similar results to that of corticosteroids in most clinical aspects among patients with RC tendinopathies;

MAY.

If you said, "I'm going to stick this steroid in your tendon and make you feel better," I would get up and leave your exam room...Now, if you're the non-op MSK partner in an ortho group, I could understand your interests.

 

[Ducttape]

If you said, "I'm going to stick this steroid in your tendon and make you feel better," I would get up and leave your exam room...Now, if you're the non-op MSK partner in an ortho group, I could understand your interests.

technically, the study showed that both groups did get better in terms of reduction in pain. and both groups did get better in terms of their other scores. so you may be inappropriately denying yourself benefit by walking out of the room.



study overall looks promising.

one issue - the difference in protocol. 2 injections were done in the PRP group, and only 1 in the steroid group, into subacromial injection. also, Ultrasound was utilized for those who got PRP injection in to the site of the tear. in addition, volume of injection was twice that in PRP group (2 injections of 3 ml each).

this may have influenced not only the proceduralist but also the patient. I am not advocating that steroids should have been injected in to the site of the tear - far from it. but this is a fundamental difference in protocol that may alter results.

 

[drusso]

Arch Orthop Trauma Surg

. 2021 Jun 11.
doi: 10.1007/s00402-021-03979-w. Online ahead of print.

Patients with stage II of the knee osteoarthritis most likely benefit from the intra-articular injections of autologous adipose tissue-from 2 years of follow-up studies​

Paweł Bąkowski # 1, Jakub Kaszyński # 2, Cezary Baka 2, Tomasz Kaczmarek 2, Kinga Ciemniewska-Gorzela 2, Kamilla Bąkowska-Żywicka 3, Tomasz Piontek 4 5
Affiliations expand

• PMID: 34117558
• DOI: 10.1007/s00402-021-03979-w

Abstract​

Background: Knee osteoarthritis (OA) is a common, chronic, progressive and degenerative disease which affects patients' quality of life and may cause disability and social isolation. OA is a huge economic burden for the patient and a large strain for the whole healthcare system. Articular cartilage has a small potential to repair, with progressively more clinicians emphasizing cellular therapy. Subcutaneous fat tissue in human body is a large reservoir of mesenchymal stem cells (MSCs) and is been harvested in minimally invasive, simple procedure. The purpose of this study was to define a specific group of patients with knee osteoarthritis, who are the most likely to benefit from the treatment with intra-articular injection of an autologous adipose tissue (AAT).
Methods: From 2016 to 2018, 59 symptomatic bilateral and unilateral knee OA patients were treated with a single intra-articular (IA) injection of an autologous adipose tissue (AAT). Before the treatment and at the follow-up, the participant was asked to fulfill the Knee Injury and Osteoarthritis Outcome Score (KOOS), the International Knee Documentation Committee 2000 (IKDC 2000), The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Health Questionnaire EQ-5D-5L and to quantify the pain in the affected joint with a Numeric Rating Scale (NRS). Moreover, the patients were asked to: (i) assess their satisfaction with the effects of the conducted treatment: from 0 (unsatisfied) to 10 (very satisfied), (ii) describe the rehabilitation, if it was performed (supervised or individual and duration in weeks) and (iii) indicate any additional treatment applied, like IA injections of hyaluronic acid (HA) or platelet-rich plasma (PRP), knee arthroscopy, partial or total knee arthroplasty (TKA) at the follow-up.
Results: The mean age of 37 participants (16 males and 21 females) included into statistical analysis was 57.78 ± 7.39 years, the mean BMI was 31.30 ± 7.51. The questionnaires were fulfilled after the average follow-up time of 27 ± 6.5 months. A significant difference (p < 0.05) compared with the baseline, was observed in pain [NRS], WOMAC, KOOS index, pain, symptoms, ADL, Sport and Rec, QoL, EQ-5D-5L index. The satisfaction in the whole group was 6.16 ± 3.07. There was no significant difference between satisfied and unsatisfied patients in BMI and pain [NRS] at the baseline. 6 out of 7 patients with stage IV in K-L were unsatisfied with the effects of the treatment with AAT.
Discussion: The main conclusion of this study is that the patients with stage II of the knee OA with normal BMI are were most likely to benefit from IA injection of AAT, in contrast to the patients with stage IV, who will not beware not satisfied with the effectiveness of this kind of treatment. There were no adverse events reported at the donor site as well as in the treated knee joints.
Keywords: Autologous subcutaneous adipose tissue; Intra-articular injection; Knee OA; Platelet-rich plasma.

 

[lobelsteve]

N of 59 down to 37.

They only found this many knees to inject in 2 years? Shady.

 

[drusso]

N of 59 down to 37.

They only found this many knees to inject in 2 years? Shady.

The thing about Regen studies is that there is no industry money to hire research coordinators, advertisement, etc. So, everything is mom-and-pop labor of love. What would be the COI?

 

[Ducttape]

The thing about Regen studies is that there is no industry money to hire research coordinators, advertisement, etc. So, everything is mom-and-pop labor of love. What would be the COI?

oh gosh. let me see. for this study?

marketing of the treatment.

marketing of the practice.

marketing of the individual physician.

as a quick example, an academic physician would put together this simple study with the data from initial intake. he would tell the PT to call these people up (during a specific time period, irrespective of how long since the previous injection, apparently) to ask the questions again. his research assistant then spent the weekend finding something to report, they published, and the professors with little work would use this to advance to tenure.

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this was a nonrandom or blinded study asking patients if the injection the doctor did helped. no comparison or control group.

they eliminated 10 out of the 59 patients because they had a second/different procedure, and 2 "communication from coexisting mental illness". so 20% were taken out of data. (one possibility - the injection didnt work, the patient swore at the caller and hung up.)



ultimately, they basically parsed all the data out to find something positive to report. at least they were honest about that.

When we have analyzed the data for the whole treatment group, that is all 37 cases, without categorization according to the OA progression stage, there was were no clinically significant improvements observed at the follow-up, although the results achieved the level of statistical significance.

one can consider that their conclusion worded a different way: only those with Stage II possibly can get benefit.

 

[lobelsteve]

I think @drusso posts these so we can pick them apart. I did not even read past the recruitment to know it was worthless.

 

[SSdoc33]

If you said, "I'm going to stick this steroid in your tendon and make you feel better," I would get up and leave your exam room...Now, if you're the non-op MSK partner in an ortho group, I could understand your interests.

nobody said anything about INTRA-tendon steroid injection.