Adding Regenerative medicine to your practice.

[cowboydoc]

this is why, to do a good study, you do a power analysis before you do the study.

which, to date, none of these retrospective PRP studies contain.

it is also why one cannot trust these retrospective studies - researchers will throw out data that is negative in order to obtain a positive result and post it so Centeno can congratulate them...

Getting a shout out on the socials beats actually doing good work (in any field).

---

Members don't see this ad.

 

[lobelsteve]

Lies, Damn Lies, and Statistics - Regenexx @Ducttape @lobelsteve

Will put the EBM courses from SIS ahead of Centeno diatribe.

 

[oreosandsake]

What does 3 consecutive times every 4 weeks mean? Did they get 3 injections in a day, 3 injections in 3 days. And every 4 weeks.

I ask because no protocol for treating anything is done in this manner.

you'll have to have some grace on the foreign authors. I'd imagine it means 3 injections, 4 weeks apart.

yes, things are done this way. when dosing of a therapy requires you to re- up it. chemo? radiation? monoclonal antibodies? botox?

the effects are biologic and should have downstream effects but I think they wanted to see if they could see a greater response.

that said, there is a famous doc that treats tendons series of 3 two weeks apart. the studies show us that response can take up to 12 weeks to fully manifest and have lasting effects for even weeks/months after that. so was it the first injection and he/she got paid for two more?

 

[bedrock]

1) celebrex doesn’t affect platelets

At all? I understand that it is cox 1 sparing but I’ve never read that it has no effect on platelets.

Can you share (DM is fine too) a reference on celecoxib and platelets?

If so would celecoxib be considered completely safe for elderly patients from a CV perspective?

 

[lobelsteve]

At all? I understand that it is cox 1 sparing but I’ve never read that it has no effect on platelets.

Can you share (DM is fine too) a reference on celecoxib and platelets?

If so would celecoxib be considered completely safe for elderly patients from a CV perspective?

Vioxx was Cox-2 as well.

And no.

 

[bedrock]

Vioxx was Cox-2 as well.

And no.

My understanding is that vioxx is more cox 1 sparing than celecoxib so vioxx has more CV effects than celecoxib, even while it is easier on the stomach.

Based on that, I would think that celecoxib would have more CV effect than an NSAID that blocks both cox enzymes a similar amount like ibuprofen.

 

[lobelsteve]

Risk of ischemic stroke and the use of individual non-steroidal anti-inflammatory drugs: A multi-country European database study within the SOS Project

Background and purpose A multi-country European study using data from six healthcare databases from four countries was performed to evaluate in a large study population (>32 million) the risk of ischemic stroke (IS) associated with individual NSAIDs and to assess the impact of risk factors of IS...

journals.plos.org

Risk of cardiovascular events and celecoxib: a systematic review and meta-analysis

Objectives: To examine whether the increased risk of cardiovascular events with rofecoxib represents a class effect of cyclooxygenase-2 (COX-2) specific inhibitors.Design: Systematic review and meta-analysis of randomized double-blind clinical trials ...

www.ncbi.nlm.nih.gov

Celebrex minimally increases risk of CVA, but significantly increases risk of MI.

 

[oreosandsake]

At all? I understand that it is cox 1 sparing but I’ve never read that it has no effect on platelets.

Can you share (DM is fine too) a reference on celecoxib and platelets?

If so would celecoxib be considered completely safe for elderly patients from a CV perspective?

Study Confirms Celebrex Does Not Interfere With Platelet Function

Normal platelet function is important for patients at risk of bleeding and for those who are already taking medications that increase the risk of bleeding.

www.medscape.com

 

[bedrock]

Study Confirms Celebrex Does Not Interfere With Platelet Function

Normal platelet function is important for patients at risk of bleeding and for those who are already taking medications that increase the risk of bleeding.

www.medscape.com

Thank you.

Do you not require patients on celecoxib to stop it for 4-6 weeks after a PRP injection?

Interesting study. Hard to mesh that with the one Steve posted about increased MI in patients on celecoxib.

 

[bedrock]

Risk of ischemic stroke and the use of individual non-steroidal anti-inflammatory drugs: A multi-country European database study within the SOS Project

Background and purpose A multi-country European study using data from six healthcare databases from four countries was performed to evaluate in a large study population (>32 million) the risk of ischemic stroke (IS) associated with individual NSAIDs and to assess the impact of risk factors of IS...

journals.plos.org

Risk of cardiovascular events and celecoxib: a systematic review and meta-analysis

Objectives: To examine whether the increased risk of cardiovascular events with rofecoxib represents a class effect of cyclooxygenase-2 (COX-2) specific inhibitors.Design: Systematic review and meta-analysis of randomized double-blind clinical trials ...

www.ncbi.nlm.nih.gov

Celebrex minimally increases risk of CVA, but significantly increases risk of MI.

Any good studies that directly compare celecoxib to regular NSAID MI risk stratified by age?

 

[oreosandsake]

Thank you.

Do you not require patients on celecoxib to stop it for 4-6 weeks after a PRP injection?

Interesting study. Hard to mesh that with the one Steve posted about increased MI in patients on celecoxib.

This med isn’t meant for life saving purposes so holding it isn’t an issue. But 2-3 weeks prob more than enough

 

[oreosandsake]

August 2022 – Nashville Regenerative Biologics – ARMI | Advanced Regenerative Medicine Institute

advancedregenmedinstitute.com

 

[drusso]

J Clin Med. 2022 Jun 6;11(11):3241.
doi: 10.3390/jcm11113241.

Efficacy of a Novel Intra-Articular Administration of Platelet-Rich Plasma One-Week Prior to Hyaluronic Acid versus Platelet-Rich Plasma Alone in Knee Osteoarthritis: A Prospective, Randomized, Double-Blind, Controlled Trial​

Yung-Tsan Wu 1 2 3, Tsung-Ying Li 1 2, Kuei-Chen Lee 1 4, King Hei Stanley Lam 5 6 7 8, Chih-Ya Chang 1 9, Cheng-Kuang Chang 10, Liang-Cheng Chen 1
Affiliations expand

Free PMC article

Abstract​

Recent studies have suggested that the combined injection of platelet-rich plasma (PRP) and hyaluronic acid (HA) may have additive benefits for knee osteoarthritis over PRP alone, but there is insufficient evidence to support this combined injection. Moreover, the simultaneous injection of PRP and HA may offset the combined effect. Hence, the aim of this prospective, randomized, double-blind study was to assess their combined efficacy with a novel injection protocol. Forty-six study subjects with unilateral knee osteoarthritis were randomized to receive either a single-dose injection of HA (intervention group) or normal saline (control group) 1 week after a single-dose injection of leukocyte-poor PRP. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and static balance and the risk of falls measured by Biodex Balance System were, respectively, the primary and secondary outcome measures. Evaluations were performed at baseline, 1 month, 3 months, 6 months, and 12 months post-injection. The intervention group exhibited significant declines in WOMAC pain, stiffness, and total scores, as well as static balance, compared to the control group (p < 0.05). These randomized double-blind control trials, with novel protocol of intra-articular injection of PRP 1-week prior to HA, provide greater symptom relief and improve static balance compared to PRP alone in patients with knee osteoarthritis.
Keywords: balance; hyaluronic acid; knee; osteoarthritis; platelet-rich plasma.

 

[oreosandsake]

J Clin Med. 2022 Jun 6;11(11):3241.
doi: 10.3390/jcm11113241.

Efficacy of a Novel Intra-Articular Administration of Platelet-Rich Plasma One-Week Prior to Hyaluronic Acid versus Platelet-Rich Plasma Alone in Knee Osteoarthritis: A Prospective, Randomized, Double-Blind, Controlled Trial​

Yung-Tsan Wu 1 2 3, Tsung-Ying Li 1 2, Kuei-Chen Lee 1 4, King Hei Stanley Lam 5 6 7 8, Chih-Ya Chang 1 9, Cheng-Kuang Chang 10, Liang-Cheng Chen 1
Affiliations expand

Free PMC article

Abstract​

Recent studies have suggested that the combined injection of platelet-rich plasma (PRP) and hyaluronic acid (HA) may have additive benefits for knee osteoarthritis over PRP alone, but there is insufficient evidence to support this combined injection. Moreover, the simultaneous injection of PRP and HA may offset the combined effect. Hence, the aim of this prospective, randomized, double-blind study was to assess their combined efficacy with a novel injection protocol. Forty-six study subjects with unilateral knee osteoarthritis were randomized to receive either a single-dose injection of HA (intervention group) or normal saline (control group) 1 week after a single-dose injection of leukocyte-poor PRP. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and static balance and the risk of falls measured by Biodex Balance System were, respectively, the primary and secondary outcome measures. Evaluations were performed at baseline, 1 month, 3 months, 6 months, and 12 months post-injection. The intervention group exhibited significant declines in WOMAC pain, stiffness, and total scores, as well as static balance, compared to the control group (p < 0.05). These randomized double-blind control trials, with novel protocol of intra-articular injection of PRP 1-week prior to HA, provide greater symptom relief and improve static balance compared to PRP alone in patients with knee osteoarthritis.
Keywords: balance; hyaluronic acid; knee; osteoarthritis; platelet-rich plasma.

View attachment 356291

First sentence already says it.


And most studies that compare prp to HA show that prp >> HA

 

[oreosandsake]

First sentence already says it.


And most studies that compare prp to HA show that prp >> HA

Recent studies have suggested that the combined injection of platelet-rich plasma (PRP) and hyaluronic acid (HA) may have additive benefits for knee osteoarthritis over PRP alone, but there is insufficient evidence to support this combined injection.

Moreover, the simultaneous injection of PRP and HA may offset the combined effect.

Not sure if this line of reasoning really follows the first statement.


All basic science studies show that 1 + 1 here is more than 2

 

[oreosandsake]

First sentence already says it.


And most studies that compare prp to HA show that prp >> HA

Recent studies have suggested that the combined injection of platelet-rich plasma (PRP) and hyaluronic acid (HA) may have additive benefits for knee osteoarthritis over PRP alone, but there is insufficient evidence to support this combined injection.

Moreover, the simultaneous injection of PRP and HA may offset the combined effect.

Not sure if this line of reasoning really follows the first statement.


All basic science studies show that 1 + 1 here is more than 2

 

[Ducttape]

overall a decent study, but its important to determine exactly what was being studied.


this study really is to show whether hyaluronidase before PRP is more beneficial than saline before PRP and to suggest that hyaluronidase adds something to benefit from PRP injections.

you cannot make any inferences of whether PRP is better than hyaluronidase based on this study.

---
they are postulating that the 2 "drugs" combined at the same time may interact with each other to negate each other.

they didnt really test this - if they wanted to test this potential interaction, then they should have had a study where 1 group got PRP mixed with saline and 1 group got PRP mixed with hyaluronidase.

 

[cowboydoc]

J Clin Med. 2022 Jun 6;11(11):3241.
doi: 10.3390/jcm11113241.

Efficacy of a Novel Intra-Articular Administration of Platelet-Rich Plasma One-Week Prior to Hyaluronic Acid versus Platelet-Rich Plasma Alone in Knee Osteoarthritis: A Prospective, Randomized, Double-Blind, Controlled Trial​

Yung-Tsan Wu 1 2 3, Tsung-Ying Li 1 2, Kuei-Chen Lee 1 4, King Hei Stanley Lam 5 6 7 8, Chih-Ya Chang 1 9, Cheng-Kuang Chang 10, Liang-Cheng Chen 1
Affiliations expand

Free PMC article

Abstract​

Recent studies have suggested that the combined injection of platelet-rich plasma (PRP) and hyaluronic acid (HA) may have additive benefits for knee osteoarthritis over PRP alone, but there is insufficient evidence to support this combined injection. Moreover, the simultaneous injection of PRP and HA may offset the combined effect. Hence, the aim of this prospective, randomized, double-blind study was to assess their combined efficacy with a novel injection protocol. Forty-six study subjects with unilateral knee osteoarthritis were randomized to receive either a single-dose injection of HA (intervention group) or normal saline (control group) 1 week after a single-dose injection of leukocyte-poor PRP. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and static balance and the risk of falls measured by Biodex Balance System were, respectively, the primary and secondary outcome measures. Evaluations were performed at baseline, 1 month, 3 months, 6 months, and 12 months post-injection. The intervention group exhibited significant declines in WOMAC pain, stiffness, and total scores, as well as static balance, compared to the control group (p < 0.05). These randomized double-blind control trials, with novel protocol of intra-articular injection of PRP 1-week prior to HA, provide greater symptom relief and improve static balance compared to PRP alone in patients with knee osteoarthritis.
Keywords: balance; hyaluronic acid; knee; osteoarthritis; platelet-rich plasma.

View attachment 356291

I saw this have a pretty remarkable effect during my residency on aging future HoF NBA players. I have no idea how to translate that into my fat old population now, but this guy went from crawlin to ballin!

 

[MitchLevi]

I saw this have a pretty remarkable effect during my residency on aging future HoF NBA players. I have no idea how to translate that into my fat old population now, but this guy went from crawlin to ballin!

Crawlin to ballin!


Those who do HA + PRP. How costly is that? The pt buys both obviously, but I can't imagine that's affordable. If I have knee OA, I'd try that combo shot but I'm a full baller who makes it rain.

 

[drusso]

Crawlin to ballin!


Those who do HA + PRP. How costly is that? The pt buys both obviously, but I can't imagine that's affordable. If I have knee OA, I'd try that combo shot but I'm a full baller who makes it rain.

I charge 2/3 of a local HOPD facility fee and it's a fraction of the cost of an arthroplasty. If your patient has a high deductible health plan they won't know the difference.

 

[cowboydoc]

Crawlin to ballin!


Those who do HA + PRP. How costly is that? The pt buys both obviously, but I can't imagine that's affordable. If I have knee OA, I'd try that combo shot but I'm a full baller who makes it rain.

Office visit and HA covered by ins. ~$750 for PRP seems reasonable even for a cheap @$$, half balla like me.

 

[oreosandsake]

Office visit and HA covered by ins. ~$750 for PRP seems reasonable even for a cheap @$$, half balla like me.

There is issue with combining cash and at least Medicare covered services

 

[MitchLevi]

I charge 2/3 of a local HOPD facility fee and it's a fraction of the cost of an arthroplasty. If your patient has a high deductible health plan they won't know the difference.

What's the actual number?

 

[cowboydoc]

There is issue with combining cash and at least Medicare covered services

I don’t do this (yet). Isn’t the purpose of an ABN to make a cash agreement for non-covered service?

To be more clear, I was suggesting to do the HA and PRP injections separately.

 

[oreosandsake]

I don’t do this (yet). Isn’t the purpose of an ABN to make a cash agreement for non-covered service?

To be more clear, I was suggesting to do the HA and PRP injections separately.

Yes but I think billing Medicare or prob commercial at the same time you are doing a cash based procedure in combination is an issue

there is a non paid for code for prp so you can’t bill 20611 joint injection and ask for cash for the prp if the intent was to do prp

 

[bedrock]

Yes but I think billing Medicare or prob commercial at the same time you are doing a cash based procedure in combination is an issue

there is a non paid for code for prp so you can’t bill 20611 joint injection and ask for cash for the prp if the intent was to do prp

I've been wondering about this. I know it is a no no for medicare patients, likely not allowed by some commercials.

I have been billing the procedure code for some WC patients though

 

[drusso]

More evidence for the massive brainwashing effect on patients of placebo injections...

Ther Adv Musculoskelet Dis. 2022 Jun 14;14:1759720X221100304. doi: 10.1177/1759720X221100304. eCollection 2022.

Real-world evidence to assess the effectiveness of platelet-rich plasma in the treatment of knee degenerative pathology: a prospective observational study

Mikel Sánchez 1, Cristina Jorquera 2, Leonor López de Dicastillo 1, Nicolás Fiz 1, Jorge Knörr 1, Maider Beitia 2, Beatriz Aizpurua 1, Juan Azofra 1, Diego Delgado 3
Affiliations expand
PMID: 35721321 PMCID: PMC9201351 DOI: 10.1177/1759720X221100304

Abstract
Objective: The present work aims to analyse the effectiveness of platelet-rich plasma (PRP) in degenerative knee pathology based on real-world data and to evaluate possible factors influencing the response to treatment.

Methods: In total, 531 cases were analysed collecting data on gender, age, body mass index, pathology location, severity, number of cycles and route of administration. Clinical outcome was evaluated at 6 and 15 months after treatment, using the Knee injury and Osteoarthritis Outcome Score (KOOS) and obtaining percentages of Minimal Clinically Important Improvement (MCII). Blood and PRP samples were randomly tested as a quality control measure to ensure the correct properties. Comparative statistical tests and multivariate regression were performed for the analysis of the variables.

Results: The PRP applied had a platelet concentration factor of 1.67, with no leukocytes or erythrocytes. The percentage of patients with MCII at 6 and 15 months after PRP application was 59.32% and 70.62%, respectively. Patients with MCII were younger (p = 0.0246) and with lower body mass index (p = 0.0450). The treatment had a better response in mild/moderate cases than in severe cases (p = 0.0002). Intraosseous PRP application in severe cases improved the effect of intraarticular PRP (p = 0.0358). The application of a second cycle of PRP only improved the response in patients without MCII at 6 months (p = 0.0029), especially in mild/moderate cases (p = 0.0357).

Conclusion: The applications of PRP in degenerative knee pathologies is an effective treatment, but this effectiveness nonetheless depends on several variables. Real-world data can complement that from clinical trials to provide valuable information.

Keywords: intraarticular; intraosseous; knee joint degeneration; platelet-rich plasma; real-world evidence.

 

[Ducttape]

someone told me that a study like this was garbage in, garbage out.

i forget who said this so eloquently...


im sorry, but why did you comment about placebos? placebo injections were not used in this study.

this was a "prospective" observational study with no placebo, no randomization.



the main problem with the study is, while the numbers look good, they are incomplete. 1336 people were enrolled in the study. 605 were lost to follow up by 12 months. this means that maybe as much as 45% of the patients failed to return and one can surmise that a significant portion of this population did not return because it didnt work...

 

[lobelsteve]

someone told me that a study like this was garbage in, garbage out.

i forget who said this so eloquently...


im sorry, but why did you comment about placebos? placebo injections were not used in this study.

this was a "prospective" observational study with no placebo, no randomization.



the main problem with the study is, while the numbers look good, they are incomplete. 1336 people were enrolled in the study. 605 were lost to follow up by 12 months. this means that maybe as much as 45% of the patients failed to return and one can surmise that a significant portion of this population did not return because it didnt work...

Or they did not come back because they did so well. 110% relief. They can now reflect 10% of pain back on others.

 

[oreosandsake]

play at 1.5x

can skip to about 8 min to start

 

[drusso]

play at 1.5x

can skip to about 8 min to start

A testament to the profound brainwashing effects that placebo injections cause in the minds of patients...

 

[lobelsteve]

Primers on Placebo.

Time to revisit science:

Quackcast.

RSS Feed: http://www.quackcast.com/spodcasts/files/mp3rss.xml

Standard Podcasts (mp3) | The QuackCast. Revenant Edition

A review of SCAM. Supplements, Complementary and Alternative Medicne.

www.quackcast.com

#34,71,76,82,123,152


Some are tangential to placebo. All are entertaining.

 

[cowboydoc]

play at 1.5x

can skip to about 8 min to start

Iovera brought that guy in for training about 5 years ago. He was talking about his "surface EMG" practice where he was diagnosing CTS with a Magic glove. He's like the Chiro's equivalent of an NP.

 

[oreosandsake]

Iovera brought that guy in for training about 5 years ago. He was talking about his "surface EMG" practice where he was diagnosing CTS with a Magic glove. He's like the Chiro's equivalent of an NP.

his Msk US skills are solid. They don’t know the management of Msk Neuro issues like a doc and shouldn’t get their knowledge base confused with medical training

 

[Ducttape]

where is Wisonic Dandelion College?

tells me that wisonic.com is not secure. dont proceed (on office computer).



oh wait, Wisonic is a chinese ultrasound company... no conflict of interest here...

 

[drusso]

Excellent topical review on A2M and neuropathic pain!

https://www.futuremedicine.com/doi/10.2217/pmt-2022-0006?fbclid=IwAR2KpQj9zz6m4E-vY60kfP5JAxNR3x7bVlTCK1zlIT0ANBCuc_IKnGK4W-M

 

[Ducttape]

Review.

as you noted: GIGO.



please re read the last line of your post.

 

[oreosandsake]

Review.

as you noted: GIGO.



please re read the last line of your post.

fwiw, review of literature isn't the same as a systematic review


it all starts somewhere...

 

[plasma.]

Guys - any more information on why not to use kits? The couple people I've spoken with who do PRP are new to it and using kits. Do they discuss the use of kits vs alternative in the above listed Orthobiologics Courses?

 

[Doctodd]

Guys - any more information on why not to use kits? The couple people I've spoken with who do PRP are new to it and using kits. Do they discuss the use of kits vs alternative in the above listed Orthobiologics Courses?

using a kit is fine if just starting. They may discuss it if sponsored or attended by the company vs manual.

 

[drusso]

Dick Doctors say Placebos Injections can Impact the Angle of the Dangle...

Prog Urol. 2022 Jun 28;S1166-7087(22)00132-4. doi: 10.1016/j.purol.2022.05.004. Online ahead of print.

Tolerance and efficacy of platelet-rich plasma injections in Peyronie's disease: Pilot study

A Schirmann 1, E Boutin 2, A Faix 3, R Yiou 4
Affiliations expand
PMID: 35778315 DOI: 10.1016/j.purol.2022.05.004
Abstract
Introduction: Platelet-rich plasma (PRP) injections are increasingly proposed for the treatment of Peyronie's disease since the discontinuation of Xiapex® despite poorly understood results.

Objectives: Evaluation of the tolerance and efficacy of intra-plate PRP injections in patients with Peyronie's disease.

Methods: Three intra-plate injections of PRP were performed 15 days apart in 17 patients with Peyronie's disease. The Peyronie's Disease Questionnaire (PDQ) and the measurement of the angle of curvature of the erect penis were assessed before treatment and then 1, 3 and 6 months after treatment. Erectile function was assessed by different questionnaires (IIEF-EF, EHS, SEP, sexual discomfort score).

Results: No side effects were noted during the study period. Three months after treatment, all three PDQ domains were significantly improved (P=0.002; P=0.015; P=0.017 respectively). The angle of curvature of the penis was significantly decreased by 11.8° with a mean angle of 40.4° before treatment and 28.6° after (P=0.007). The IIEF-EF score was significantly improved after treatment (mean preoperative value: 10.67) with a gain of 5 points at months 1 and 6 (P=0.01 and P=0.036 respectively) and 7 points at month 3 (P=0.04).

Conclusion: Our initial experience suggests that PRP injections for Peyronie's disease are safe. Although the limited data is suggestive of efficacy, a placebo control will be required for confirmation.

Keywords: Dysfonction érectile; Erectile dysfunction; Maladie de Lapeyronie; Peyronie's disease; Plasma riche en plaquettes; Platelet-rich plasma.

Copyright © 2022. Published by Elsevier Masson SAS.

 

[oreosandsake]

search

academic.oup.com

search

academic.oup.com

Pain Medicine journal

commentary
SIJ pain isn't a joint problem in most non AS patients.
IA and PA same outcomes. that said, it's a tough thing to treat. despite what others have experienced I don't think lumbosacral spine related pain does great with regen

 

[drusso]

Cureus. 2022 May 31;14(5):e25523.

doi: 10.7759/cureus.25523. eCollection 2022 May.

A Prospective Study Comparing the Efficacy of Local Injection of Platelet-Rich Plasma (PRP) vs Methylprednisolone in Plantar Fasciitis​

Kishore Vellingiri 1, Nagakumar J S 1, Manohar P V 1, Joe P Lourdu 2, Meenakshi S Andra Suryanarayana 3
Affiliations expand

• PMID: 35800843
• PMCID: PMC9246436
• DOI: 10.7759/cureus.25523

Free PMC article

Abstract​

Introduction: Plantar fasciitis is a common musculoskeletal problem in Orthopaedic practice. Heel pain caused due to plantar fasciitis, if persistent, can cause distress to the patient, so the correct intervention at the right time is needed. Plantar fasciitis is also common in the rural population.

Objectives: To compare the efficacy of local injection of platelet-rich plasma (PRP) and corticosteroid (CS) (methylprednisolone) in patients with chronic plantar fasciitis, and to evaluate the safety, side effect and complications of two different modalities of treatment.

Materials and methods: The study period was between August 2018 and September 2020. After obtaining proper written consent, 110 patients, who were above the age of 18 years and suffering from plantar fasciitis for more than three months, were included in the study. The patient characteristics including gender, age, weight, history of heel pain, duration of symptoms and types of prior treatment were noted. All the 110 patients were subjected to four parameter assessments before administration of the PRP/CS injections.

Results: Out of the 110 patients, 55 patients received PRP injection and 55 received CS - 2 ml (40 mg) methylprednisolone with 2 ml of sterile water injections. Post administration of injections, the patients' clinical, radiological, subjective and functional outcomes were assessed at the first, third and sixth month by using the Visual Analog Scale (VAS), Foot and Ankle Outcome Instrument Core Scale (FAI), Roles and Maudsley Scores (RMS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot scale and ultrasonogram of plantar fascia thickness. Discussion In this study, 110 patients were screened and evaluated. Out of these 110 patients, five patients who received PRP and five who received CS were lost for follow-up. Out of the 110 patients, 59 were females and 41 were males. The majority of the patients were in the BMI range of 18.5 to 24.9, with a mean BMI of 23.6. Comparing the results in both the groups reflected an improvement in the group of patients who received PRP injections. Two patients had post-operative complications (superficial infection) in the PRP injection group, while 10 patients had post-procedure complications (five patients developed superficial infections, three patients developed skin depigmentation, and two patients had atrophy of fat pad) in the corticosteroid injections (CSI) group. Infections subsided in all the patients as observed during subsequent follow-up.

Conclusion: This study shows that PRP administration is a good method of managing patients suffering from chronic plantar fasciitis, presenting with some discomfort following activity, with more than three months of symptoms and with a VAS score of more than 6 and plantar fascia thickness of 5 mm and failed conservative management. This is evidenced by a comparison of AOFAS, FAI score and thickness of plantar fascia using an ultrasonogram before and after the procedure. This study reflects better treatment outcomes with PRP injection compared to local steroid infiltration. This is the largest series of cases studied compared to other previously available studies in the literature. PRP injections may thus be used as a superior alternative to the already available treatments for chronic heel pain.

Keywords: local injection; methyl prednisolone; plantar fasciitis; platelet-rich plasma; prospective study.
Copyright © 2022, Vellingiri et al.

 

[cowboydoc]

Cureus. 2022 May 31;14(5):e25523.

doi: 10.7759/cureus.25523. eCollection 2022 May.

A Prospective Study Comparing the Efficacy of Local Injection of Platelet-Rich Plasma (PRP) vs Methylprednisolone in Plantar Fasciitis​

Kishore Vellingiri 1, Nagakumar J S 1, Manohar P V 1, Joe P Lourdu 2, Meenakshi S Andra Suryanarayana 3
Affiliations expand

• PMID: 35800843
• PMCID: PMC9246436
• DOI: 10.7759/cureus.25523

Free PMC article

Abstract​

Introduction: Plantar fasciitis is a common musculoskeletal problem in Orthopaedic practice. Heel pain caused due to plantar fasciitis, if persistent, can cause distress to the patient, so the correct intervention at the right time is needed. Plantar fasciitis is also common in the rural population.

Objectives: To compare the efficacy of local injection of platelet-rich plasma (PRP) and corticosteroid (CS) (methylprednisolone) in patients with chronic plantar fasciitis, and to evaluate the safety, side effect and complications of two different modalities of treatment.

Materials and methods: The study period was between August 2018 and September 2020. After obtaining proper written consent, 110 patients, who were above the age of 18 years and suffering from plantar fasciitis for more than three months, were included in the study. The patient characteristics including gender, age, weight, history of heel pain, duration of symptoms and types of prior treatment were noted. All the 110 patients were subjected to four parameter assessments before administration of the PRP/CS injections.

Results: Out of the 110 patients, 55 patients received PRP injection and 55 received CS - 2 ml (40 mg) methylprednisolone with 2 ml of sterile water injections. Post administration of injections, the patients' clinical, radiological, subjective and functional outcomes were assessed at the first, third and sixth month by using the Visual Analog Scale (VAS), Foot and Ankle Outcome Instrument Core Scale (FAI), Roles and Maudsley Scores (RMS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot scale and ultrasonogram of plantar fascia thickness. Discussion In this study, 110 patients were screened and evaluated. Out of these 110 patients, five patients who received PRP and five who received CS were lost for follow-up. Out of the 110 patients, 59 were females and 41 were males. The majority of the patients were in the BMI range of 18.5 to 24.9, with a mean BMI of 23.6. Comparing the results in both the groups reflected an improvement in the group of patients who received PRP injections. Two patients had post-operative complications (superficial infection) in the PRP injection group, while 10 patients had post-procedure complications (five patients developed superficial infections, three patients developed skin depigmentation, and two patients had atrophy of fat pad) in the corticosteroid injections (CSI) group. Infections subsided in all the patients as observed during subsequent follow-up.

Conclusion: This study shows that PRP administration is a good method of managing patients suffering from chronic plantar fasciitis, presenting with some discomfort following activity, with more than three months of symptoms and with a VAS score of more than 6 and plantar fascia thickness of 5 mm and failed conservative management. This is evidenced by a comparison of AOFAS, FAI score and thickness of plantar fascia using an ultrasonogram before and after the procedure. This study reflects better treatment outcomes with PRP injection compared to local steroid infiltration. This is the largest series of cases studied compared to other previously available studies in the literature. PRP injections may thus be used as a superior alternative to the already available treatments for chronic heel pain.

Keywords: local injection; methyl prednisolone; plantar fasciitis; platelet-rich plasma; prospective study.
Copyright © 2022, Vellingiri et al.

6.3% of the study subjects got an infection from the injection??? I’m not sure if that reflects more poorly on the study administration or the patient population.

 

[drusso]

American Academy of Orthopedic Surgeons technology review for PRP and BMAC for knee OA.

AAOS Biologics Technology Overviews

www.aaos.org

 

[Ducttape]

1. randomized not blinded.
2. no control.
3. CSI patients more actually did better month 1 after injection than PRP. by month 3, PRP did better.
4. no placebo control. the 2nd big mistake of the study.
5. most importantly, the article states that 90% of patients do better with conservative therapy.
6. they had no patients with BMI >30. so this study did not take place in the US.

having had steroid injections for plantar fasciitis, i do not advocate for steroid injections. PRP does seem promising, but again, conservative treatment is beneficial 90% of the time per the authors.

oh and not sure if it would be as effective for a US population that is significantly heavier.

 

[drusso]

1. randomized not blinded.
2. no control.
3. CSI patients more actually did better month 1 after injection than PRP. by month 3, PRP did better.
4. no placebo control. the 2nd big mistake of the study.
5. most importantly, the article states that 90% of patients do better with conservative therapy.
6. they had no patients with BMI >30. so this study did not take place in the US.

having had steroid injections for plantar fasciitis, i do not advocate for steroid injections. PRP does seem promising, but again, conservative treatment is beneficial 90% of the time per the authors.

oh and not sure if it would be as effective for a US population that is significantly heavier.

PRP always takes longer because of tissue healing effects.
What's a placebo for growth factors? If you told me my heel pain was all in my head, I'd be pissed.

 

[Ducttape]

you are presupposing that growth factors really work.

the problem with PRP data is that that is an implicit assumption. we need to prove it first.

in my experience, it seems every time we do a study that does not use a placebo, the authors tout such great evidence of benefit (not just with PRP) that magically vanishes when placebo and/or double blinding is incorporated in to the study design

 

[drusso]

you are presupposing that growth factors really work.

the problem with PRP data is that that is an implicit assumption. we need to prove it first.

in my experience, it seems every time we do a study that does not use a placebo, the authors tout such great evidence of benefit (not just with PRP) that magically vanishes when placebo and/or double blinding is incorporated in to the study design

Wait...you dispute platelet growth factors are bioactive??? How do you think you stop bleeding? Why do epidural blood patches work?

If I were a molecular biologist and you told me that platelet growth factors don't work, I'd be pissed...

Cells. 2022 Jun 30;11(13):2089.
doi: 10.3390/cells11132089.

In Vitro and Ex Vivo Kinetic Release Profile of Growth Factors and Cytokines from Leucocyte- and Platelet-Rich Fibrin (L-PRF) Preparations​

Xuzhu Wang 1, Melissa R Fok 1, George Pelekos 1, Lijian Jin 1, Maurizio S Tonetti 1 2 3 4

Abstract​

L-PRF is an autologous blood-derived biomaterial (ABDB) capable of releasing biologically active agents to promote healing. Little is known about its release profile of growth factors (GFs), cytokines, and MMPs. This study reported the in vitro and ex vivo release kinetics of GFs, cytokines, and MMPs from L-PRF at 6, 24, 72, and 168 h. The in vitro release rates of PDGF, TGF-β1, EGF, FGF-2, VEGF, and MMPs decreased over time with different rates, while those of IL-1β, IL-6, TNF-α, IL-8, and IL-10 were low at 6 h and then increased rapidly for up to 24 h and subsequently decreased. Of note, the release rates of the GFs followed first-order kinetics both in vitro and ex vivo. Higher rates of release were found ex vivo, suggesting that significant amounts of GFs were produced by the local cells within the wound. In addition, the half-life times of GFs locally produced in the wound, including PDGF-AA, PDGF-AB/BB, and VEGF, were significantly extended (p < 0.05). This work demonstrates that L-PRF can sustain the release of GFs and cytokines for up to 7 days, and it shows that the former can activate cells to produce additional mediators and amplify the communication network for optimizing the wound environment, thereby enhancing healing.
Keywords: L-PRF; ex vivo; first-order kinetics; growth factors; in vitro; release.

 

[Doctodd]

sounds like study was in India...no wonder so many had infections. And who uses 40mg near a fascia/tendon sheath?!? Im surprised more didnt have fat atrophy or even a rupture.

ducttape.....As for the VAS at 1 month, that is useless for PRP cuz most patients are sore for the first week. And we all know CS is great initially, but worse later. Long term is all that matters. Yes 90% of PF patients get better with conservative treatment.....im assuming these 110 patients already failed that because it says they suffered for more than 3 months. I dont have access to full study.