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no offense, but this is a position paper, not a study.

its a bunch of guys getting on their soapbox.

and btw,

"While this study is a step in the right direction, numerous other factors remain elusive and warrant comprehensive investigation. Different PRP compositions, absolute platelet counts as one important factor, and many other physiological and demographic variables will influence effectiveness.

Ultimately, the definition of PRP, whether leukocyte rich or poor, whether it should be activated or not, how often it should be injected, the ideal dose and how it should be prepared remains elusive. "
 
lobelsteve said:
Yet, aspects like the definition of PRP, whether activation is necessary, the frequency of injections, the optimal dosage, and the preparation method remain unclear.
Click to expand...

Ditto for steroids.
Ducttape said:
no offense, but this is a position paper, not a study.

its a bunch of guys getting on their soapbox.

and btw,

"While this study is a step in the right direction, numerous other factors remain elusive and warrant comprehensive investigation. Different PRP compositions, absolute platelet counts as one important factor, and many other physiological and demographic variables will influence effectiveness.

Ultimately, the definition of PRP, whether leukocyte rich or poor, whether it should be activated or not, how often it should be injected, the ideal dose and how it should be prepared remains elusive. "
Click to expand...

That's how science works. There is no Truth with a capital T. Just what we agree it is.
 
Any good training courses come up this year?
 
Agast said:
He’s a total hack!

Jk

What happened to the ARMI course? @oreosandsake
Click to expand...

re-structuring...

new teachers and leaders, also focus on traditional orthopedic surgery and the overlap between what we can do with our Interventional pain skillset. added some new talent to the leadership including Ariana DeMers the former IOF president
 
oreosandsake said:
re-structuring...

new teachers and leaders, also focus on traditional orthopedic surgery and the overlap between what we can do with our Interventional pain skillset. added some new talent to the leadership including Ariana DeMers the former IOF president
Click to expand...

DeMers is good.
 
Not sure if this was posted already……

www.mdpi.com

Angiogenesis and Tissue Repair Depend on Platelet Dosing and Bioformulation Strategies Following Orthobiological Platelet-Rich Plasma Procedures: A Narrative Review

Angiogenesis is the formation of new blood vessel from existing vessels and is a critical first step in tissue repair following chronic disturbances in healing and degenerative tissues. Chronic pathoanatomic tissues are characterized by a high number of inflammatory cells; an overexpression of...
www.mdpi.com www.mdpi.com
 
BMC Musculoskelet Disord. 2024 May 18;25(1):392.
doi: 10.1186/s12891-024-07519-6.

Percutaneous bone marrow concentrate and platelet products versus exercise therapy for the treatment of rotator cuff tears: a randomized controlled, crossover trial with 2-year follow-up​

Christopher J Centeno 1 2, Zachary Fausel 2, Ehren Dodson 3, Dustin R Berger 2, Neven J Steinmetz 2
Affiliations expand

Abstract​

Background: Surgical repair is recommended for the treatment of high-grade partial and full thickness rotator cuff tears, although evidence shows surgery is not necessarily superior to non-surgical therapy. The purpose of this study was to compare percutaneous orthobiologic treatment to a home exercise therapy program for supraspinatus tears.

Methods: In this randomized-controlled, crossover design, participants with a torn supraspinatus tendon received either 'BMC treatment', consisting of a combination of autologous bone marrow concentrate (BMC) and platelet products, or underwent a home exercise therapy program. After three months, patients randomized to exercise therapy could crossover to receive BMC treatment if not satisfied with shoulder progression. Patient-reported outcomes of Numeric Pain Scale (NPS), Disabilities of the Arm, Shoulder, and Hand, (DASH), and a modified Single Assessment Numeric Evaluation (SANE) were collected at 1, 3, 6, 12, and 24 months. Pre- and post-treatment MRI were assessed using the Snyder Classification system.

Results: Fifty-one patients were enrolled and randomized to the BMC treatment group (n = 34) or the exercise therapy group (n = 17). Significantly greater improvement in median ΔDASH, ΔNPS, and SANE scores were reported by the BMC treatment group compared to the exercise therapy group (-11.7 vs -3.8, P = 0.01; -2.0 vs 0.5, P = 0.004; and 50.0 vs 0.0, P < 0.001; respectively) after three months. Patient-reported outcomes continued to progress through the study's two-year follow-up period without a serious adverse event. Of patients with both pre- and post-treatment MRIs, a majority (73%) showed evidence of healing post-BMC treatment.

Conclusions: Patients reported significantly greater changes in function, pain, and overall improvement following BMC treatment compared to exercise therapy for high grade partial and full thickness supraspinatus tears.

Trial registration: This protocol was registered with www.

Clinicaltrials: gov (NCT01788683; 11/02/2013).

Keywords: Autologous orthobiologics; Bone marrow concentrate (BMC); Cell therapy; Exercise therapy; Musculoskeletal pain; Platelet-rich plasma (PRP); Rotator cuff tears; Shoulder.
© 2024. The Author(s).

1716219278304.png


  • BMC Treatment provided better outcomes compared to exercise therapy in terms of shoulder function, pain reduction, and overall improvement, especially at the 3-month follow-up.
  • Long-term Improvements: BMC treatment led to continued improvements in shoulder function and pain relief up to 24 months, while the exercise group did not show significant long-term benefits.
  • Statistical Significance: The improvements in the BMC group were statistically significant for all measured outcomes at the 3-month follow-up, highlighting BMC as a more effective treatment for shoulder injuries compared to exercise therapy.
 
Last edited:
Orthop J Sports Med. 2024 May 14;12(5):23259671241249123.
doi: 10.1177/23259671241249123. eCollection 2024 May.

Ultrasound-Guided Subfascial Platelet-Rich Plasma Injections Versus Enthesis Needling for Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial​

Leire Atilano 1 2, Nerea Martin 1 3, Jose Ignacio Martin 1 2, Gotzon Iglesias 1 2, Josu Mendiola 1 2, Paola Bully 4, Ayoola Aiyegbusi 5, Jose Manuel Rodriguez-Palomo 1 3, Isabel Andia 1
Affiliations expand

Abstract​

Background: Greater trochanteric pain syndrome (GTPS) is characterized by gluteal enthesopathy involving the peritrochanteric space and associated with chronic pain and functional impairment. A corticosteroid injection in the trochanteric bursa is the usual palliative treatment for pain. However, it is important to investigate treatment options that will relieve pain in the peritrochanteric space.

Purpose: To compare the clinical efficacy of subfascial platelet-rich plasma (PRP) injection and enthesis needling for GTPS.

Study design: Randomized controlled trial; Level of evidence, 1

Methods: A total of 92 patients (90% women; mean age, 55 years old; mean body mass index, 25.3 kg/m2) were randomly divided into a subfascial PRP injection group and an enthesis needling group. Descriptive data and radiographic measurements of the pelvis-including leg-length difference, pelvic width difference, and pelvic trochanteric index-were recorded. The primary outcome measures were the Hip Outcome Score (HOS) activities of daily living (HOS-ADL) and sports-specific (HOS-SS) subscales and the visual analog scale for pain at 3, 6, and 12 months posttreatment. In addition, we evaluated the presence or absence of ultrasound characteristics (fascia nodules, trochanteric bursa distension, and calcium deposits) over time in response to treatment.

Results: Baseline demographic and radiological characteristics were similar between the groups. The PRP group saw significantly greater improvement from baseline to 12 months posttreatment on the HOS-SS subscore compared with the needling group (32.09 [95% CI, 28.99-40.20] vs 20.52 [95% CI, 11.99-29.05]; P = .048). At 3 months, 60% of patients in the PRP group versus 33.3% in the needling group had a reduction in pain compared with a baseline of >20% (P = .040). After subfascial PRP injection, fewer patients had a fascia nodule over the trochanter and/or bursa distension (P = .006 and P = .004, respectively). The pelvic trochanteric index was predictive of HOS-ADL and HOS-SS outcomes (P = .011 and P = .022, respectively). The interaction between treatment modality and fascia nodule influenced HOS-ADL and HOS-SS outcomes (P = .021 and P = .023) as well as the interactions of treatment modality, fascia nodules, and calcifications (P = .027).

Conclusion: Both subfascial PRP injection and enthesis needling resulted in clinical improvements, but the improvement in the HOS-SS was greater in the PRP group.

Registration: NCT04231357 (ClinicalTrials.gov identifier).

Keywords: enthesis needling; fascia; gluteal tendons; greater trochanteric pain syndrome; platelet-rich plasma; ultrasound.

1716224761432.png


  • PRP treatment generally led to better improvements in daily living activities and sports-specific functions compared to dry needling, especially noticeable at the 12-month mark.
  • Pain reduction was similar between both groups at 6 and 12 months, but PRP showed a greater reduction at the 3-month follow-up.
  • Significance: The improvements in the PRP group were statistically significant for the sports-specific function at 12 months, highlighting PRP as a more effective treatment in this area.
Overall, PRP treatment provided better outcomes in terms of function and pain reduction, particularly over a longer period (12 months).
 
drusso said:
Orthop J Sports Med. 2024 May 14;12(5):23259671241249123.
doi: 10.1177/23259671241249123. eCollection 2024 May.

Ultrasound-Guided Subfascial Platelet-Rich Plasma Injections Versus Enthesis Needling for Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial​

Leire Atilano 1 2, Nerea Martin 1 3, Jose Ignacio Martin 1 2, Gotzon Iglesias 1 2, Josu Mendiola 1 2, Paola Bully 4, Ayoola Aiyegbusi 5, Jose Manuel Rodriguez-Palomo 1 3, Isabel Andia 1
Affiliations expand

Abstract​

Background: Greater trochanteric pain syndrome (GTPS) is characterized by gluteal enthesopathy involving the peritrochanteric space and associated with chronic pain and functional impairment. A corticosteroid injection in the trochanteric bursa is the usual palliative treatment for pain. However, it is important to investigate treatment options that will relieve pain in the peritrochanteric space.

Purpose: To compare the clinical efficacy of subfascial platelet-rich plasma (PRP) injection and enthesis needling for GTPS.

Study design: Randomized controlled trial; Level of evidence, 1

Methods: A total of 92 patients (90% women; mean age, 55 years old; mean body mass index, 25.3 kg/m2) were randomly divided into a subfascial PRP injection group and an enthesis needling group. Descriptive data and radiographic measurements of the pelvis-including leg-length difference, pelvic width difference, and pelvic trochanteric index-were recorded. The primary outcome measures were the Hip Outcome Score (HOS) activities of daily living (HOS-ADL) and sports-specific (HOS-SS) subscales and the visual analog scale for pain at 3, 6, and 12 months posttreatment. In addition, we evaluated the presence or absence of ultrasound characteristics (fascia nodules, trochanteric bursa distension, and calcium deposits) over time in response to treatment.

Results: Baseline demographic and radiological characteristics were similar between the groups. The PRP group saw significantly greater improvement from baseline to 12 months posttreatment on the HOS-SS subscore compared with the needling group (32.09 [95% CI, 28.99-40.20] vs 20.52 [95% CI, 11.99-29.05]; P = .048). At 3 months, 60% of patients in the PRP group versus 33.3% in the needling group had a reduction in pain compared with a baseline of >20% (P = .040). After subfascial PRP injection, fewer patients had a fascia nodule over the trochanter and/or bursa distension (P = .006 and P = .004, respectively). The pelvic trochanteric index was predictive of HOS-ADL and HOS-SS outcomes (P = .011 and P = .022, respectively). The interaction between treatment modality and fascia nodule influenced HOS-ADL and HOS-SS outcomes (P = .021 and P = .023) as well as the interactions of treatment modality, fascia nodules, and calcifications (P = .027).

Conclusion: Both subfascial PRP injection and enthesis needling resulted in clinical improvements, but the improvement in the HOS-SS was greater in the PRP group.

Registration: NCT04231357 (ClinicalTrials.gov identifier).

Keywords: enthesis needling; fascia; gluteal tendons; greater trochanteric pain syndrome; platelet-rich plasma; ultrasound.

View attachment 386992

  • PRP treatment generally led to better improvements in daily living activities and sports-specific functions compared to dry needling, especially noticeable at the 12-month mark.
  • Pain reduction was similar between both groups at 6 and 12 months, but PRP showed a greater reduction at the 3-month follow-up.
  • Significance: The improvements in the PRP group were statistically significant for the sports-specific function at 12 months, highlighting PRP as a more effective treatment in this area.
Overall, PRP treatment provided better outcomes in terms of function and pain reduction, particularly over a longer period (12 months).
Click to expand...
Highlights failure to do better with VAS and HOS-ADL scores. But 1/3 ain't bad in baseball.
 
Medicina (Kaunas). 2024 Jun 13;60(6):977.
doi: 10.3390/medicina60060977.

Effectiveness and Complications of Bone Marrow Aspirate Concentrate in Patients with Knee Osteoarthritis of Kellgren-Lawrence Grades II-III​

Ji-Hoon Baek 1, Su Chan Lee 1, Dong Nyoung Lee 1, Hye Sun Ahn 1, Chang Hyun Nam 1
Affiliations expand
Free article

Abstract​

Background: This study aimed to identify the effectiveness and potential complications on the harvest site and knee of bone marrow aspirate concentrate (BMAC) treatment of patients with Kellgren-Lawrence (K-L) grades II-III knee osteoarthritis (OA) over a minimum follow-up period of 6 months.

Methods: This study retrospectively evaluated data from 231 patients (285 knees) with knee OA treated with BMAC articular injection at a single center from August 2023 to October 2023. The inclusion criteria were a longstanding knee pain unresponsive to conservative treatments for at least 6 weeks with K-L grades II-III OA. The exclusion criteria were age of <40 years or >80 years, previous knee surgery, rheumatological or other systemic disease, malignancy, uncontrolled diabetes mellitus, or infections. Bone marrow was aspirated from the anterior iliac crest and concentrated by the single-spin centrifugation technique. The visual analog scale (VAS) pain score and Knee Society Score were used to evaluate the clinical outcomes and complications associated with harvest and injection sites were evaluated.

Results: The mean follow-up period was 7.2 months (range: 6-8 months). The pretreatment VAS pain score decreased from 4.3 to 0.4 points at the final follow-up (p < 0.05). Pretreatment Knee Society knee and function scores were improved from 86.9 to 98.1 (p < 0.05) and from 68.4 to 83.3 points (p < 0.05), respectively. A total of 15 complications (5.3%, 15/285) were observed, including 3 hematomas, 2 numbness, 2 contact dermatitis, and 1 superficial infection in the harvest site and 4 mild and moderate swelling and 3 severe swelling and pain in the injection site.

Conclusion: BMAC is a reliable and effective treatment for patients with K-L grades II-III knee OA, but the orthopedic surgeon should consider that bleeding tendency by heparin causes severe joint swelling and pain after intra-articular knee injection.

Keywords: bone marrow aspirate concentrate; complications; effectiveness.

1719669967464.png


Time series: Pre-treatment, 1-month, 3-month, 6-month follow-up intervals.
 
drusso said:
Medicina (Kaunas). 2024 Jun 13;60(6):977.
doi: 10.3390/medicina60060977.

Effectiveness and Complications of Bone Marrow Aspirate Concentrate in Patients with Knee Osteoarthritis of Kellgren-Lawrence Grades II-III​

Ji-Hoon Baek 1, Su Chan Lee 1, Dong Nyoung Lee 1, Hye Sun Ahn 1, Chang Hyun Nam 1
Affiliations expand
Free article

Abstract​

Background: This study aimed to identify the effectiveness and potential complications on the harvest site and knee of bone marrow aspirate concentrate (BMAC) treatment of patients with Kellgren-Lawrence (K-L) grades II-III knee osteoarthritis (OA) over a minimum follow-up period of 6 months.

Methods: This study retrospectively evaluated data from 231 patients (285 knees) with knee OA treated with BMAC articular injection at a single center from August 2023 to October 2023. The inclusion criteria were a longstanding knee pain unresponsive to conservative treatments for at least 6 weeks with K-L grades II-III OA. The exclusion criteria were age of <40 years or >80 years, previous knee surgery, rheumatological or other systemic disease, malignancy, uncontrolled diabetes mellitus, or infections. Bone marrow was aspirated from the anterior iliac crest and concentrated by the single-spin centrifugation technique. The visual analog scale (VAS) pain score and Knee Society Score were used to evaluate the clinical outcomes and complications associated with harvest and injection sites were evaluated.

Results: The mean follow-up period was 7.2 months (range: 6-8 months). The pretreatment VAS pain score decreased from 4.3 to 0.4 points at the final follow-up (p < 0.05). Pretreatment Knee Society knee and function scores were improved from 86.9 to 98.1 (p < 0.05) and from 68.4 to 83.3 points (p < 0.05), respectively. A total of 15 complications (5.3%, 15/285) were observed, including 3 hematomas, 2 numbness, 2 contact dermatitis, and 1 superficial infection in the harvest site and 4 mild and moderate swelling and 3 severe swelling and pain in the injection site.

Conclusion: BMAC is a reliable and effective treatment for patients with K-L grades II-III knee OA, but the orthopedic surgeon should consider that bleeding tendency by heparin causes severe joint swelling and pain after intra-articular knee injection.

Keywords: bone marrow aspirate concentrate; complications; effectiveness.

View attachment 388621

Time series: Pre-treatment, 1-month, 3-month, 6-month follow-up intervals.
Click to expand...
What’s with the complications and frequency thereof?
 
cowboydoc said:
What’s with the complications and frequency thereof?
Click to expand...
I hold blood thinners for this procedure if safe to do so. Weird cuz I’ve never had most of those complications. Only pain and swelling from overfilling the joint…..KNOCK ON WOOD
 
lobelsteve said:
That was not science as much as Tooth Fairy science.
Click to expand...

Science begins with systematic observations and builds to a consensus of evidence.

"Evidence based medicine is not "cookbook" medicine. Because it requires a bottom up approach that integrates the best external evidence with individual clinical expertise and patients' choice, it cannot result in slavish, cookbook approaches to individual patient care. External clinical evidence can inform, but can never replace, individual clinical expertise, and it is this expertise that decides whether the external evidence applies to the individual patient at all and, if so, how it should be integrated into a clinical decision. Similarly, any external guideline must be integrated with individual clinical expertise in deciding whether and how it matches the patient's clinical state, predicament, and preferences, and thus whether it should be applied. Clinicians who fear top down cookbooks will find the advocates of evidence based medicine joining them at the barricades."

David Sackett, MD
 
please continue posting new studies - particularly prospective blinded studies - regarding bone marrow for knee pain that are advancing the science.



this particular study isnt really doing that. just a retread..
 
Knee Surg Sports Traumatol Arthrosc. 2024 Jul 4.
doi: 10.1002/ksa.12320. Online ahead of print.

Platelet-rich plasma injections for the management of knee osteoarthritis: The ESSKA-ICRS consensus. Recommendations using the RAND/UCLA appropriateness method for different clinical scenarios​

Elizaveta Kon 1 2, Laura de Girolamo 3, Lior Laver 4 5 6, Luca Andriolo 7, Isabel Andia 8, Ricardo Bastos 9 10, Philippe Beaufils 11, Leela Biant 12 13, Berte Bøe 14, Angelo Boffa 7, Ramon Cugat 15 16 17, Alessandro Di Martino 7, Christoph Erggelet 18, Michael Iosifidis 19 20, Baris Kocaoglu 21, Jérémy Magalon 22 23 24, Rodica Marinescu 25, Stefan Nehrer 26 27, Philipp Niemeyer 28, Marko Ostojić 29, Tomasz Piontek 30, Mikel Sánchez 31 32, Kristof Sas 33 34, Georges Skarpas 35 36 37, Thomas Tischer 38, Lucienne Vonk 39 40, Giuseppe Filardo 41 42 43
Affiliations expand

Abstract​

Purpose: The aim of this consensus was to develop evidence- and expert-based patient-focused recommendations on the appropriateness of intra-articular platelet-rich plasma (PRP) injections in different clinical scenarios of patients with knee osteoarthritis (OA).
Methods: The RAND/UCLA Appropriateness Method was used by the European Society of Sports Traumatology, Knee Surgery, and Arthroscopy (ESSKA), as well as the International Cartilage Regeneration and Joint Preservation Society (ICRS) to reach a consensus and produce recommendations for specific patient categories combining best available scientific evidence with the collective judgement of a panel of experts.
Results: Scenarios were defined based on first treatment vs first injective treatment vs second injective treatment, age (<50/50-65/66-80/>80), tibiofemoral vs patellofemoral involvement, OA level (Kellgren-Lawrence/KL 0-I/II-III/IV), and joint effusion (dry knee, minor-mild or major effusion). Out of 216 scenarios, in 84 (38.9%) the indication was considered appropriate, in 9 (4.2%) inappropriate and in 123 (56.9%) uncertain. The parameters associated with the highest consensus were PRP use after failed injective treatments (62.5%), followed by PRP after failed conservative treatments and KL 0-III scenarios (58.3%), while the highest uncertainty was found for PRP use as first treatment and KL IV OA (91.7% and 87.5% of uncertain scenarios, respectively).
Conclusion: This ESSKA-ICRS consensus established recommendations on the appropriateness or inappropriateness of PRP injections for the treatment of knee OA, providing a useful reference for clinical practice. PRP injections are considered appropriate in patients aged ≤80 years with knee KL 0-III OA grade after failed conservative non-injective or injective treatments, while they are not considered appropriate as first treatment nor in KL IV OA grade.
Level of evidence: Level I.
Keywords: OA; consensus; knee; osteoarthritis; platelet‐rich plasma.


The ESSKA-ICRS consensus provides guidelines on when to use platelet-rich plasma (PRP) injections for treating knee osteoarthritis (OA).
  1. When PRP is Appropriate:
    • Failed Treatments: PRP is suitable for patients aged 80 or younger who have knee OA and have not found relief from other treatments like physical therapy or steroid injections.
    • OA Severity: It works best for those with early to moderate OA (classified as KL 0-III).
    • Effusion Level: It can be used regardless of whether the knee has mild swelling or no swelling.
  2. When PRP is Not Appropriate:
    • First Treatment: PRP should not be the first treatment option. Patients should try other methods like exercise or weight management first.
    • Severe OA: It’s not recommended for severe OA (KL IV), as it’s less effective.
    • Age Over 80: PRP is generally not advised for patients older than 80.
  3. Uncertain Cases:
    • The use of PRP as the first treatment and for severe OA (KL IV) are areas with the most uncertainty, meaning experts aren't sure if it's effective or not in these situations.

Key Points:​

  • PRP injections are a second-line treatment, meaning they are used after other treatments have failed.
  • Age and OA Severity are important factors. PRP is more appropriate for younger patients and those with less severe OA.
  • Joint Swelling: It can be used whether there's mild swelling or no swelling, but not for major swelling cases.
  • Keep a registry and track your outcomes: Do not experiment on humans.
 
drusso said:
144 studies on PRP. "Show me the data..."

regenexx.com

My 2024 PRP RCT Infographic - Regenexx

Regenexx offers non-surgical, regenerative orthopedic treatment options for pain related to osteoarthritis, joint injuries, overuse conditions, spine pain, and common sports injuries.
regenexx.com regenexx.com
Click to expand...
Sorry, you meant show me good data. This is just an ad.
 
Asian Spine J. 2024 Feb;18(1):58-65.
doi: 10.31616/asj.2023.0115. Epub 2024 Feb 26.

Lumbar Transforaminal Injection of Steroids versus Platelet-Rich Plasma for Prolapse Lumbar Intervertebral Disc with Radiculopathy: A Randomized Double-Blind Controlled Pilot Study​

Anuj Gupta 1, Harvinder Singh Chhabra 2, Vishwajeet Singh 3, Daram Nagarjuna 4
Affiliations expand

Abstract​

Study design: Double-blind randomized controlled pilot study.
Purpose: The purpose of this study was to compare outcomes of steroids with autologous platelet-rich plasma (PRP) administered by lumbar transforaminal injection (LTI) in patients with lumbar radiculopathy.
Overview of literature: Degenerative disc disease of the lumbar spine is one of the most common conditions managed by spine surgeons in routine practice. Once conservative management fails, LTI is diagnostic and often therapeutic. Steroids are the gold standard drug used for LTI but have limitations and side effects.
Methods: In this single-center double-blind randomized controlled pilot study, 46 patients were recruited and randomized by the lottery method. The Visual Analog Scale (VAS) for leg pain, modified Oswestry Disability Index (mODI), and Short-Form 12 (SF-12) were assessed at 1 week, 3 weeks, 6 weeks, 6 months, and 1 year.
Results: Both groups were comparable in terms of demographics, preprocedure VAS scores, mODI, and SF-12 scores (p=0.52). At the 1-week follow-up, the steroid group had significantly better improvement than the PRP group (p=0.0001). At the 3-week follow-up, both groups showed comparable outcomes; however, the PRP group had better symptom improvement. At 6 weeks and 6 months, the PRP group had better outcomes (VAS, p<0.0001; ODI, p=0.02; SF-12, p=0.002). Moreover, 17 and 16 patients in the steroid and PRP groups underwent repeat LTI with steroids or surgery because of pain recurrence during follow-up. At 1 year, no difference in outcomes was observed.
Conclusions: PRP may be a useful alternative to steroids for LTI in lumbar radiculopathy. Although improvement was delayed and 1-year outcomes were comparable, the 6-week and 6-month outcomes were better with PRP than with LTI. Multiple PRP injections may be beneficial because of its autologous nature. However, further studies with a larger number of participants, longer follow-up, and repeat LTIs are warranted to draw definite conclusions.
Keywords: Intervertebral disc herniation; Lumbar transforaminal injection; Platelet-rich plasma; Radiculopathy; Steroids.

1721781916004.png
 
Decent study.

Blinded.

No comparison after 6 weeks because of the high rate of additional procedures.

Of interest:
1. No placebo control. You can allude the likelihood of benefit with historical data but a saline injection could show difference. Perhaps short term the irrigation is more important than the substance injected.....
2. there were different volumes - PRP got 3 ml vs 2 ml for steroid injection. This should have been standardized...
3. Note that it was a small group.
4. 1 more person in PRP group ended up getting surgery than non PRP group, while 1 more steroid patient got other injection than PRP. Fairly high rate of other procedures.
 
drusso said:
Asian Spine J. 2024 Feb;18(1):58-65.
doi: 10.31616/asj.2023.0115. Epub 2024 Feb 26.

Lumbar Transforaminal Injection of Steroids versus Platelet-Rich Plasma for Prolapse Lumbar Intervertebral Disc with Radiculopathy: A Randomized Double-Blind Controlled Pilot Study​

Anuj Gupta 1, Harvinder Singh Chhabra 2, Vishwajeet Singh 3, Daram Nagarjuna 4
Affiliations expand

Abstract​

Study design: Double-blind randomized controlled pilot study.
Purpose: The purpose of this study was to compare outcomes of steroids with autologous platelet-rich plasma (PRP) administered by lumbar transforaminal injection (LTI) in patients with lumbar radiculopathy.
Overview of literature: Degenerative disc disease of the lumbar spine is one of the most common conditions managed by spine surgeons in routine practice. Once conservative management fails, LTI is diagnostic and often therapeutic. Steroids are the gold standard drug used for LTI but have limitations and side effects.
Methods: In this single-center double-blind randomized controlled pilot study, 46 patients were recruited and randomized by the lottery method. The Visual Analog Scale (VAS) for leg pain, modified Oswestry Disability Index (mODI), and Short-Form 12 (SF-12) were assessed at 1 week, 3 weeks, 6 weeks, 6 months, and 1 year.
Results: Both groups were comparable in terms of demographics, preprocedure VAS scores, mODI, and SF-12 scores (p=0.52). At the 1-week follow-up, the steroid group had significantly better improvement than the PRP group (p=0.0001). At the 3-week follow-up, both groups showed comparable outcomes; however, the PRP group had better symptom improvement. At 6 weeks and 6 months, the PRP group had better outcomes (VAS, p<0.0001; ODI, p=0.02; SF-12, p=0.002). Moreover, 17 and 16 patients in the steroid and PRP groups underwent repeat LTI with steroids or surgery because of pain recurrence during follow-up. At 1 year, no difference in outcomes was observed.
Conclusions: PRP may be a useful alternative to steroids for LTI in lumbar radiculopathy. Although improvement was delayed and 1-year outcomes were comparable, the 6-week and 6-month outcomes were better with PRP than with LTI. Multiple PRP injections may be beneficial because of its autologous nature. However, further studies with a larger number of participants, longer follow-up, and repeat LTIs are warranted to draw definite conclusions.
Keywords: Intervertebral disc herniation; Lumbar transforaminal injection; Platelet-rich plasma; Radiculopathy; Steroids.

View attachment 389816
Click to expand...

Looks intriguing. I have a few patients very opposed to steroids with good results after TFESI with PRP.
 
Ducttape said:
Decent study.

Blinded.

No comparison after 6 weeks because of the high rate of additional procedures.

Of interest:
1. No placebo control. You can allude the likelihood of benefit with historical data but a saline injection could show difference. Perhaps short term the irrigation is more important than the substance injected.....
2. there were different volumes - PRP got 3 ml vs 2 ml for steroid injection. This should have been standardized...
3. Note that it was a small group.
4. 1 more person in PRP group ended up getting surgery than non PRP group, while 1 more steroid patient got other injection than PRP. Fairly high rate of other procedures.
Click to expand...

A placebo is useless. There is no placebo platelet. Actually...

www.wired.com

These Artificial Blood Platelets Could One Day Save Lives

Platelets help blood clot, but they have a short shelf life. With blood in short supply, synthetic platelets could help meet demand.
www.wired.com www.wired.com
 
J Orthop Surg Res.
2024 Jul 23;19(1):426.
doi: 10.1186/s13018-024-04917-3.

Comparative efficacy of platelet-rich plasma (PRP) injection versus PRP combined with vitamin C injection for partial-thickness rotator cuff tears: a randomized controlled trial​

Fatemeh Mohammadivahedi 1 2, Amirreza Sadeghifar 3, Alireza Farsinejad 4, Sara Jambarsang 5, Hamid Mirhosseini 6 7
Affiliations expand

Abstract​

Background: The optimal approach for managing partial-thickness rotator cuff tears (PTRCT) remains controversial. Recent studies related to PTRCTs have shown that platelet-rich plasma (PRP) injection might be an effective treatment option. Despite the role of vitamin C in collagen synthesis and its antioxidant properties, the effects of combined PRP and vitamin C treatment on rotator cuff repair are not well understood. This study investigated the effect of combined treatment of PRP and vitamin C treatment on PTRCTs.
Methods: One hundred-ten patients with PTRCTs were randomly allocated to two groups and underwent subacromial injections of either (A) normal saline and platelet-rich plasma or (B) vitamin C and platelet-rich plasma. The Constant score, American Shoulder and Elbow Surgeons (ASES) score, and visual analog scale were used to evaluate the outcomes before, 1 month after, and 3 months after injection.
Results: At the 3-month follow-up, no statistically significant differences were observed between the two groups in terms of ASES and Constant scores. Although a slight difference favoring group B was noted in functional scores and pain reduction, this difference was not statistically significant. However, both groups demonstrated significant pain reduction over time (p-value < 0.001). Additionally, the enhancement of ASES and Constant scores in both groups was statistically significant (p-value < 0.001).
Conclusions: In conclusion, both PRP injection alone and PRP combined with vitamin C led to significant reductions in pain and enhancements in function scores over time (p < 0.001), suggesting the effectiveness of PRP as a non-surgical treatment for PTRCTs within 3 months. While PRP alone showed significant benefits, further research is required to ascertain if the combination therapy offers statistically significant advantages over PRP alone.
Trial registration: Clinical trial registration code: IRCT20230821059205N1.
Keywords: Ascorbic acid; PRP; Partial-thickness rotator cuff tears; Platelet-rich plasma; Rotator cuff tears; Ultrasound guided injection; Vitamin C.

1722119330958.png


1722119350159.png



The graphs illustrating the changes in Constant scores, ASES scores, and VAS scores over time for both groups (Group A: PRP alone, Group B: PRP with Vitamin C). The scores demonstrate significant improvements over the 3 months, with Group B showing slightly better outcomes in all measures, although the differences are not statistically significant.

  • Constant Scores: Both groups show significant improvement from baseline to 3 months.
  • ASES Scores: Similar significant improvement in both groups over time.
  • VAS Scores: Significant reduction in pain for both groups, with Group B showing a slightly better outcome.



Int J Mol Sci.
2024 Jul 21;25(14):7957.
doi: 10.3390/ijms25147957.

The Biological Effect of Platelet-Rich Plasma on Rotator Cuff Tears: A Prospective Randomized In Vivo Study​

Charalampos Pitsilos 1, Sofia Karachrysafi 2 3, Aikaterini Fragou 4, Ioannis Gigis 1, Pericles Papadopoulos 1, Byron Chalidis 5
Affiliations expand

Abstract​

The positive effect of platelet-rich plasma (PRP) on tendon metabolism has been extensively investigated and proven in vitro. Additionally, in vivo animal studies have correlated the application of PRP with the enhancement of tenocyte anabolic activity in the setting of tendon degeneration. However, less is known about its in vivo effect on human tendon biology. The purpose of the current prospective randomized comparative study was to evaluate the effect of PRP on torn human supraspinatus tendon. Twenty consecutive eligible patients with painful and magnetic resonance imaging (MRI)-confirmed degenerative supraspinatus tendon tears were randomized in a one-to-one ratio into two groups. The patients in the experimental group (n = 10) underwent an ultrasound-guided autologous PRP injection in the subacromial space 6 weeks before the scheduled operation. In the control group (n = 10), no injection was made prior to surgery. Supraspinatus tendon specimens were harvested from the lateral end of the torn tendon during shoulder arthroscopy and were evaluated under optical and electron microscopy. In the control group, a mixed cell population of oval and rounded tenocytes within disorganized collagen and sites of accumulated inflammatory cells was detected. In contrast, the experimental group yielded abundant oval-shaped cells with multiple cytoplasmic processes within mainly parallel collagen fibers and less marked inflammation, simulating the intact tendon structure. These findings indicate that PRP can induce microscopic changes in the ruptured tendon by stimulating the healing process and can facilitate a more effective recovery.
Keywords: collagen; fibroblast; histology; microscopy; platelet-rich plasma; rotator cuff; tendon.

1722120021003.png

Here are the bar graphs illustrating the VAS scores before and after PRP treatment and the Bonar scores for the control and PRP groups:

  • VAS Scores: The first and third graphs show the initial and final VAS scores, with a significant reduction in the PRP group from 6.6 to 1.4, while the control group's score remains at 6.6.
  • Bonar Scores: The second graph shows the Bonar scores, with the PRP group having a much lower score (0.4) compared to the control group (3), indicating better tendon health and less inflammation.
These visualizations highlight the effectiveness of PRP treatment in reducing pain and improving tendon structure.

1722120160468.png
 
Last edited:
Cureus. 2024 Mar 5;16(3):e55609.
doi: 10.7759/cureus.55609. eCollection 2024 Mar.

Platelet-Rich Plasma in the Management of Temporomandibular Joint Pain in Young Adults With Temporomandibular Disorder​

Santosh Kumar Mathpati 1, Gourav Jain 2, Vijay Mishra 2, Atul K Singh 2, Rahul Mishra 3, Bipin K Yadav 4
Affiliations expand

Abstract​

Background: Temporomandibular disorder (TMD) encompasses a range of conditions affecting the temporomandibular joint (TMJ) and associated structures, with TMJ pain being a prevalent symptom. Conventional management strategies have limitations, which require the exploration of innovative interventions. Platelet-rich plasma (PRP), known for its regenerative properties, presents a potential therapeutic avenue. This study aims to investigate the effectiveness of PRP in reducing the pain associated with mild TMJ in young adults.
Methodology: Participants (n = 128) aged 18 to 35 years with mild TMD were evenly randomized into PRP treatment and placebo control groups. PRP was prepared using a standardized protocol, and intra-articular injections were administered. Placebo injections mimic PRP. Follow-up evaluations were carried out at four and eight weeks after the intervention.
Results: The study successfully randomized comparable groups, and the PRP treatment group experienced a significant reduction in TMJ pain (visual analog scale [VAS] score: 6.8 ± 1.2 to 2.1 ± 1.0 at eight weeks, P < 0.001). The PRP treatment also increased the largest opening of the mouth (from 38.2 ± 2.5 to 43.5 ± 3.1, P < 0.001) and the number of lateral movements (12.3 ± 1.5 to 14.9 ± 2.0, P < 0.001), while the placebo group had very few changes. Positive patient-reported outcomes on daily activities were observed, with no serious complications reported in either group.
Conclusions: This study provides evidence supporting the efficacy of PRP in reducing TMJ pain, improving jaw function, and improving quality of life in young adults with mild TMD. The results underscore the potential of PRP as a minimally invasive intervention for TMJ disorders.
Keywords: dentistry; pain; platelet-rich plasma; regenerative medicine; temporomandibular disorder; tmj pain.


Output image



  1. VAS Scores for TMJ Pain Reduction:
    • PRP treatment group showed a significant reduction in pain over time.
    • Placebo group showed minimal changes.
  2. Maximum Mouth Opening:
    • PRP treatment group demonstrated a notable increase in mouth opening.
    • Placebo group showed no significant changes.
  3. Lateral Excursions:
    • PRP treatment group had significant improvements in lateral excursions.
    • Placebo group had minimal changes.
  4. Eating and Chewing Scores:
    • PRP treatment group reported significant improvements in eating and chewing ability.
    • Placebo group showed minimal changes.
 
drusso said:
J Orthop Surg Res.
2024 Jul 23;19(1):426.
doi: 10.1186/s13018-024-04917-3.

Comparative efficacy of platelet-rich plasma (PRP) injection versus PRP combined with vitamin C injection for partial-thickness rotator cuff tears: a randomized controlled trial​

Fatemeh Mohammadivahedi 1 2, Amirreza Sadeghifar 3, Alireza Farsinejad 4, Sara Jambarsang 5, Hamid Mirhosseini 6 7
Affiliations expand
Click to expand...
only conclusion you can possibly make is that vitamin c didnt help. they go too far in concluding it was prp that helped, when prp was used on all patients.

drusso said:

The Biological Effect of Platelet-Rich Plasma on Rotator Cuff Tears: A Prospective Randomized In Vivo Study​

Charalampos Pitsilos 1, Sofia Karachrysafi 2 3, Aikaterini Fragou 4, Ioannis Gigis 1, Pericles Papadopoulos 1, Byron Chalidis 5
Affiliations expand

Abstract​

Click to expand...
this wasnt really a study at all. some dudes looked under a slide and saw what they wanted to see.

drusso said:
Cureus. 2024 Mar 5;16(3):e55609.
doi: 10.7759/cureus.55609. eCollection 2024 Mar.

Platelet-Rich Plasma in the Management of Temporomandibular Joint Pain in Young Adults With Temporomandibular Disorder​

Santosh Kumar Mathpati 1, Gourav Jain 2, Vijay Mishra 2, Atul K Singh 2, Rahul Mishra 3, Bipin K Yadav 4
Affiliations expand
Click to expand...
now this is a good study.

with only 1 major concern - it does not state that the control group did get blood drawn to mimic the PRP process. it seems logical to assume that they did, but i did not find a specific statement that this was the case.....
 
Ducttape said:
only conclusion you can possibly make is that vitamin c didnt help. they go too far in concluding it was prp that helped, when prp was used on all patients.


this wasnt really a study at all. some dudes looked under a slide and saw what they wanted to see.


now this is a good study.

with only 1 major concern - it does not state that the control group did get blood drawn to mimic the PRP process. it seems logical to assume that they did, but i did not find a specific statement that this was the case.....
Click to expand...

Looking under a microscope and telling you what they see is how most cellular science gets accomplished.
 
Leucocyte-Rich Platelet-Rich Plasma Treatment of Gluteus Medius and Minimus Tendinopathy: A Double-Blind Randomized Controlled Trial With 2-Year Follow-up

Jane Fitzpatrick et al. Am J Sports Med. 2019 Apr.

Purpose: This follow-up study was conducted to determine whether there would be a sustained long-term difference in the modified Harris Hip Score (mHHS) at 2 years for a leucocyte-rich PRP (LR-PRP) injection in the treatment of chronic gluteal tendinopathy.

Study design: Randomized controlled trial; Level of evidence, 1.

Methods: This trial included 80 patients randomized 1:1 to receive LR-PRP or CSI intratendinously under ultrasound guidance. Patients had a mean age of 60 years, a 9:1 ratio of women to men, a mean body mass index of 27, and a mean length of symptoms >15 months. No patients had full-thickness tears of the gluteal tendons. An open-labeled extension allowed patients to receive crossover treatment after 3 months. The main outcome measure was the mHHS.

Results: The mean mHHS improved significantly at 12 weeks in the PRP group (74.05; SD, 13.92) as compared with the CSI group (67.13; SD, 16.04) ( P = .048). At 24 weeks, the LR-PRP group (77.60; SD, 11.88) improved further than the CSI group (65.72; SD, 15.28; P = .0003). Twenty-seven patients were deemed to have failed the CSI treatment at 16 to 24 weeks, with an exit score of 59.22 (SD, 11.54), and then had treatment with LR-PRP. The crossover group improved with the LR-PRP: from 59.22 (SD, 11.22) at baseline to 75.55 (SD, 16.05) at 12 weeks, 77.69 (SD, 15.30) at 24 weeks, and 77.53 (SD, 14.54) at 104 weeks. The LR-PRP group retained 38 of 39 patients to 52 weeks and continued to improve. Their baseline scores of 53.77 (SD, 12.08) improved to 82.59 (SD, 9.71) at 104 weeks ( P < .0001).

Conclusion: Among patients with chronic gluteal tendinopathy and a length of symptoms >15 months, a single intratendinous LR-PRP injection performed under ultrasound guidance results in greater improvement in pain and function than a single CSI. The improvement after LR-PRP injection is sustained at 2 years, whereas the improvement from a CSI is maximal at 6 weeks and not maintained beyond 24 weeks.
 
nerve zapper said:
Leucocyte-Rich Platelet-Rich Plasma Treatment of Gluteus Medius and Minimus Tendinopathy: A Double-Blind Randomized Controlled Trial With 2-Year Follow-up

Jane Fitzpatrick et al. Am J Sports Med. 2019 Apr.

Purpose: This follow-up study was conducted to determine whether there would be a sustained long-term difference in the modified Harris Hip Score (mHHS) at 2 years for a leucocyte-rich PRP (LR-PRP) injection in the treatment of chronic gluteal tendinopathy.

Study design: Randomized controlled trial; Level of evidence, 1.

Methods: This trial included 80 patients randomized 1:1 to receive LR-PRP or CSI intratendinously under ultrasound guidance. Patients had a mean age of 60 years, a 9:1 ratio of women to men, a mean body mass index of 27, and a mean length of symptoms >15 months. No patients had full-thickness tears of the gluteal tendons. An open-labeled extension allowed patients to receive crossover treatment after 3 months. The main outcome measure was the mHHS.

Results: The mean mHHS improved significantly at 12 weeks in the PRP group (74.05; SD, 13.92) as compared with the CSI group (67.13; SD, 16.04) ( P = .048). At 24 weeks, the LR-PRP group (77.60; SD, 11.88) improved further than the CSI group (65.72; SD, 15.28; P = .0003). Twenty-seven patients were deemed to have failed the CSI treatment at 16 to 24 weeks, with an exit score of 59.22 (SD, 11.54), and then had treatment with LR-PRP. The crossover group improved with the LR-PRP: from 59.22 (SD, 11.22) at baseline to 75.55 (SD, 16.05) at 12 weeks, 77.69 (SD, 15.30) at 24 weeks, and 77.53 (SD, 14.54) at 104 weeks. The LR-PRP group retained 38 of 39 patients to 52 weeks and continued to improve. Their baseline scores of 53.77 (SD, 12.08) improved to 82.59 (SD, 9.71) at 104 weeks ( P < .0001).

Conclusion: Among patients with chronic gluteal tendinopathy and a length of symptoms >15 months, a single intratendinous LR-PRP injection performed under ultrasound guidance results in greater improvement in pain and function than a single CSI. The improvement after LR-PRP injection is sustained at 2 years, whereas the improvement from a CSI is maximal at 6 weeks and not maintained beyond 24 weeks.
Click to expand...

A very strong placebo effect lasting years...if you told me that my platelets' alpha granules contained placebos, I'd be pissed.


Output image

Interactive
 
drusso said:
How do you know anyone's biases?
Click to expand...
i expect scientists who are not pain $hill$ to have some ethical standing in reporting the data.

a lot of your regen studies are made up by re$earcher$ that pocket the money they garner from the injection$ they are doing. they profit from studies that show that what they are selling is supposed to work.

when something is too good to be true - it probably is. and someone is grifting.
 
Ducttape said:
i expect scientists who are not pain $hill$ to have some ethical standing in reporting the data.

a lot of your regen studies are made up by re$earcher$ that pocket the money they garner from the injection$ they are doing. they profit from studies that show that what they are selling is supposed to work.

when something is too good to be true - it probably is. and someone is grifting.
Click to expand...

Prove it!
 

Ethics Statement and Conflict of Interest Disclosures​

Human subjects: Consent was obtained or waived by all participants in this study. Uttar Pradesh University of Medical Sciences issued approval IEC/UPUMS/2021/IR/23. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.



i added underlining.

btw thats from your TMJ study.
 
Ducttape said:

Ethics Statement and Conflict of Interest Disclosures​

Human subjects: Consent was obtained or waived by all participants in this study. Uttar Pradesh University of Medical Sciences issued approval IEC/UPUMS/2021/IR/23. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.



i added underlining.

btw thats from your TMJ study.
Click to expand...

I don't see the conflict.
 

Subacromial injection of Platelet Rich Plasma Provides Greater Improvement in Pain and Functional Outcomes Compared to Corticosteroids at 1 Year Follow- Up​

Author links open overlay panelLuciano Andrés Rossi MD, PhD 1, Rodrigo Brandariz MD 1, Tomás Gorodischer MD 1, Pablo Camino MD 2, Nicolás Piuzzi MD 3, Ignacio Tanoira MD PhD 1, Maximiliano Ranalletta MD PhD 1

Redirecting

Abstract​

Background​

Studies evaluating the results of platelet-rich plasma (PRP) for the treatment of rotator cuff tendinopathy (RCT) have demonstrated conflicting results and have been confounded by small patient samples, the absence of a control group, the combined analysis of isolated tendinopathies and rotator cuff tears, insufficient reporting of PRP preparations, The purpose of this study was to perform a randomized controlled trial comparing platelet-rich plasma (PRP) with standard corticosteroid (CS) injections in providing pain relief and improved function in patients with rotator cuff tendinopathy.

Methods​

This was a double-blind RCT at a single center. We evaluated patients between 18 and 50 years old who had both a clinical and magnetic resonance (MRI) diagnosis of supraspinatus tendinopathy refractory to conservative treatment. A total of 50 patients received PRP treatment, whereas 50 patients received a corticosteroid, as a control group. Patients completed patient-reported outcome assessments at baseline and at 1, 3, 6 and 12 months after injection. The primary outcome was improvement in the VAS score for pain. Secondary outcomes included changes in ASES score, SANE score and the Pittsburgh Sleep Quality Index (PSQI). Treatment failure was defined as persistent pain at 3 months which required a subsequent injection.

Results​

The mean age was 27.7 (±7.4). All the patients completed 12 months clinical follow-up. At 12 months, patients in the PRP group showed a significantly greater improvement in the VAS than patients in the CS group 1.68(0.6) vs 2.3(1.0) (p<0.001). As well, at 12 months follow-up, the 3 scores evaluated were significantly higher in patients treated with PRP than in patients treated with CS ASES 89.8 (6.3) vs 78.0 (8.6) (p<.001); SANE 89.2 (6.3) vs 80.5 (9.6) (p< .001) and PSQI 2.72 (0.6) vs 4.02 (1.7) (p< .001). The overall failure rate, was significantly higher in the CS group (30%) than in the PRP group (12%) (p<0.01)

Conclusion​

One subacromial PRP injection in patients with rotator cuff tendinopathy showed significantly superior and sustained pain-relieving and functional improvements compared with one corticosteroid subacromial injection assessed by 4 patient-reported outcome scales at 12 months of follow-up. Moreover, the overall failure rate, was significantly higher in the CS group than in the PRP group.


1724022276637.png


The bar graph illustrates the differences between the two groups in pain relief (VAS Score), functional improvement (ASES and SANE Scores), sleep quality (PSQI Score), and failure rate.
  • PRP Group shows better outcomes across all measures than the Corticosteroid group, including lower failure rates.
  • CS Group has higher VAS scores (indicating more pain), lower functional scores, poorer sleep quality, and a higher failure rate.
 
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