Adding Regenerative medicine to your practice.

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Interesting study.
Besides the usual questions (small pt size, was it double blinded), 2 pop up for me.

1. was it the PRP or the BMAC that was therapeutic?
2. Would one ever expect a study in which the first author is the biggest proponent for regenerative medicine not have positive results?

has Deer ever had a study that did not show benefit from ITP, bogduk for RFA, manchikanti from any interventional spine procedure?
 
Ducttape said:
Interesting study.
Besides the usual questions (small pt size, was it double blinded), 2 pop up for me.

1. was it the PRP or the BMAC that was therapeutic?
2. Would one ever expect a study in which the first author is the biggest proponent for regenerative medicine not have positive results?

has Deer ever had a study that did not show benefit from ITP, bogduk for RFA, manchikanti from any interventional spine procedure?
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How much more proof do you need that it's a bad idea to inject steroids into torn tendons?

Why such a high bar for such a benign intervention--especially when government payers have no "skin in the game." I would never tell anyone else how to spend their own money on their own health needs.
 
drusso said:
How much more proof do you need that it's a bad idea to inject steroids into torn tendons?

Why such a high bar for such a benign intervention--especially when government payers have no "skin in the game." I would never tell anyone else how to spend their own money on their own health needs.
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not recommending steroids into tendons.
You: buy my magic beans.
 
drusso said:
How much more proof do you need that it's a bad idea to inject steroids into torn tendons?

Why such a high bar for such a benign intervention--especially when government payers have no "skin in the game." I would never tell anyone else how to spend their own money on their own health needs.
Click to expand...
I too don't inject steroids in torn tendons.

out of curiosity, for males, what is latest literature on sperm for stem cells? seems like it would be a lot easier to harvest in 1/2 the population...
 
Ducttape said:
I too don't inject steroids in torn tendons.

out of curiosity, for males, what is latest literature on sperm for stem cells? seems like it would be a lot easier to harvest in 1/2 the population...
Click to expand...

Oh goodness...
 
I apologize for any sexist innuendo, but if the purpose of BMAC is to inject cells that can differentiate in to mature cells in that environment, would not these cells be most likely to differentiate?
 
Honestly, if you follow the literature, there is better evidence for Menstrual blood derived stem cells. Although I'm an autologous-only believer when it comes to cellular therapy.
 
Ferrismonk said:
Honestly, if you follow the literature, there is better evidence for Menstrual blood derived stem cells. Although I'm an autologous-only believer when it comes to cellular therapy.
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There it is! I was waiting for this one. The circle is now complete!
 
Ducttape said:
I apologize for any sexist innuendo, but if the purpose of BMAC is to inject cells that can differentiate in to mature cells in that environment, would not these cells be most likely to differentiate?
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...or maybe they modify the local tissue milieu to facilitate healing through cellular signaling pathways...aka paracrine effects...maybe the regenerative aspect of regenerative medicine is not the primary mechanism of action...

Medicinal signalling cells: they work, so use them

Discover the world’s best science and medicine | Nature.com
www.nature.com www.nature.com
 
Ducttape said:
I apologize for any sexist innuendo, but if the purpose of BMAC is to inject cells that can differentiate in to mature cells in that environment, would not these cells be most likely to differentiate?
Click to expand...

i can pretty much guarantee that sperm cells never "mature". i still watch 3 stooges on a semi-regular basis.
 
lobelsteve said:
n=trillion
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J Pain Res. 2020 Jan 10;13:65-73. doi: 10.2147/JPR.S204788. eCollection 2020.
MRI Changes After Platelet Rich Plasma Injection in Knee Osteoarthritis (Randomized Clinical Trial).
Raeissadat SA1, Ghorbani E2, Sanei Taheri M3, Soleimani R3, Rayegani SM2, Babaee M2, Payami S4.
Author information

Abstract
PURPOSE:
Few papers have studied the objective effects of PRP on cartilage. In this study, we investigated the effect of PRP on cartilage characteristics by special MRI sequencing in knee osteoarthritis (IRCT registration number: 2014020413442N6).
PATIENTS AND METHODS:
In this double blind randomized clinical trial, patients with bilateral knees osteoarthritis-grade 1, 2, and 3 were included in the study. Each patient's knees were randomly allocated to either control or treatment groups. PRP was injected in two sessions with 4 week intervals in PRP group. The VAS (visual analog scale) and WOMAC (Western Ontario and McMaster Universities Arthritis Index) were utilized and MRI was performed for all patients, before, and 8 months after treatment. The MRI sequences taken were transverse 3D TRUFISP and coronal and sagittal fat saturated proton-density. Imaging was scored according to four cartilage characteristics.
RESULTS:
46 knees (from 23 patients) were included in this study. 23 knees in the case group and 23 knees in control group were studied. All patients were female with mean age of 57.57±5.9 years. Mean total WOMAC and VAS changes before and after treatment in control group were 11.61±8.5 and 1.3±1.1 respectively. In PRP group, mean total WOMAC and VAS changes showed better improvement with 20±12.3 and 3.2±1.6 respectively (P-value <0.05). In PRP group, all of the radiologic variables (patellofemoral cartilage volume, synovitis and medial and lateral meniscal disintegrity), with the exception of subarticular bone marrow abnormality, had significant improvement (P-value <0.05). In a comparison between the two groups, patellofemoral cartilage volume and synovitis had significantly changed in the PRP group (P-value <0.05).
CONCLUSION:
In this study, in addition to the effect of PRP on VAS and WOMAC, there was a significant effect on radiologic characteristics (patellofemoral cartilage volume and synovitis). For further evaluation, a longer study with a larger sample size is recommended.
© 2020 Raeissadat et al.
KEYWORDS:
MRI; PRP; cartilage; knee; magnetic resonance imaging; osteoarthritis; platelet rich plasma
 
Is anyone here doing this? I've done median nerve hydro dissection with platelet lysate but haven't tried PRP post-op. I have a couple of hand surgeons I know would probably like the idea...

Sci Rep. 2020 Feb 7;10(1):2085. doi: 10.1038/s41598-020-59113-0.
Efficacy of platelet-rich plasma as an adjuvant to surgical carpal ligament release: a prospective, randomized controlled clinical trial.
Trull-Ahuir C1, Sala D2, Chismol-Abad J2, Vila-Caballer M3, Lisón JF4,5.
Author information

Abstract
The purpose of this study is to evaluate the efficiency of local platelet-rich plasma (PRP) injection as an adjuvant treatment after carpal ligament release. We conducted a prospective randomized, triple-blinded, controlled trial. Fifty participants with mild to extreme carpal tunnel syndrome (CTS) were randomly assigned either to the PRP (n = 25) or the platelet-poor plasma (PPP, n = 25) group. After performing open surgical release of the carpal ligament, the inside of the carpal tunnel was irrigated with 3 mL of PRP or PPP according to each participant's group allocation. The primary outcome was hand grip strength (HGS). Secondary outcomes were the time taken off work after surgery (in days) and scores on the Wong-Baker Faces Scale, Boston Carpal Tunnel Questionnaire, and Southampton Wound Assessment Scale. We evaluated patients before treatment and at 6-weeks. As expected, the pain levels, symptom severity, and functional status improved in all the patients after surgery. However, intragroup analysis revealed that only the participants in the PRP group had regained their pre-operative HGS levels at 6-weeks follow-up. These findings indicate that PRP is an effective adjuvant treatment in patients with mild to severe CTS who require surgery.
 

Attachments

wow.

talk about trying to make a mountain out of a molehill.

In the intra-group analysis after 6-weeks, only the patients in the PPP group showed significant differences in HGS (P = 0.016; Table 2). Thus, patients treated with PRP regained their pre-surgery HGS significantly earlier than those in the PPP group, although no differences were found in the between-group analysis at 6-weeks follow-up.
There were no statistically significant differences between groups for the SWAS scores at the 6-weeks follow-up (P = 0.609, Z = −0.969). Moreover, the median and interquartile range for this variable at 6 weeks was 0 in both cases, indicating that the wound healing was normal in both groups. In addition, both groups also took a similar amount of leave from work after their surgery, although there was a non-statistical significant trend towards a faster return to work by the PRP group compared to the PPP group (110 ± 70 vs. 124 ± 111 days, respectively). Finally, no surgical complications were reported at the 6-weeks follow-up in either the PRP or PPP groups.
Click to expand...
and your question cant be answered, drusso, because there was no placebo control to compare it to.
 
Doctodd said:
jsaul probably has.
Click to expand...

I have done hundreds of median nerve hydrodissection with ultrasound with NS and then injected steroid

I have done probably about 20 PRP carpal tunnel injections mainly because of patient request

I would say at about 9 of those 20 were very satisfied
 
drusso said:
J Pain Res. 2020 Jan 10;13:65-73. doi: 10.2147/JPR.S204788. eCollection 2020.
MRI Changes After Platelet Rich Plasma Injection in Knee Osteoarthritis (Randomized Clinical Trial).
Raeissadat SA1, Ghorbani E2, Sanei Taheri M3, Soleimani R3, Rayegani SM2, Babaee M2, Payami S4.
Author information

Abstract
PURPOSE:
Few papers have studied the objective effects of PRP on cartilage. In this study, we investigated the effect of PRP on cartilage characteristics by special MRI sequencing in knee osteoarthritis (IRCT registration number: 2014020413442N6).
PATIENTS AND METHODS:
In this double blind randomized clinical trial, patients with bilateral knees osteoarthritis-grade 1, 2, and 3 were included in the study. Each patient's knees were randomly allocated to either control or treatment groups. PRP was injected in two sessions with 4 week intervals in PRP group. The VAS (visual analog scale) and WOMAC (Western Ontario and McMaster Universities Arthritis Index) were utilized and MRI was performed for all patients, before, and 8 months after treatment. The MRI sequences taken were transverse 3D TRUFISP and coronal and sagittal fat saturated proton-density. Imaging was scored according to four cartilage characteristics.
RESULTS:
46 knees (from 23 patients) were included in this study. 23 knees in the case group and 23 knees in control group were studied. All patients were female with mean age of 57.57±5.9 years. Mean total WOMAC and VAS changes before and after treatment in control group were 11.61±8.5 and 1.3±1.1 respectively. In PRP group, mean total WOMAC and VAS changes showed better improvement with 20±12.3 and 3.2±1.6 respectively (P-value <0.05). In PRP group, all of the radiologic variables (patellofemoral cartilage volume, synovitis and medial and lateral meniscal disintegrity), with the exception of subarticular bone marrow abnormality, had significant improvement (P-value <0.05). In a comparison between the two groups, patellofemoral cartilage volume and synovitis had significantly changed in the PRP group (P-value <0.05).
CONCLUSION:
In this study, in addition to the effect of PRP on VAS and WOMAC, there was a significant effect on radiologic characteristics (patellofemoral cartilage volume and synovitis). For further evaluation, a longer study with a larger sample size is recommended.
© 2020 Raeissadat et al.
KEYWORDS:
MRI; PRP; cartilage; knee; magnetic resonance imaging; osteoarthritis; platelet rich plasma
Click to expand...

Make Iran great again lol
 
Ducttape said:
I’d say possible active comparator. You can’t tell, as there is no control group...

Jeez doctodd stop with the politics please...
Click to expand...

Platelet Poor Plasma is not a Placebo...

J Oral Maxillofac Surg. 2018 Oct;76(10):2097-2102. doi: 10.1016/j.joms.2018.06.024. Epub 2018 Jun 27.
Influence of Platelet-Poor Plasma on Angiogenesis and Maintenance of Volume in Autogenous Bone Grafts.
Batista JD1, Justino Oliveira Limirio PH2, Rocha FS1, Gomes Moura CC3, Zanetta-Barbosa D1, Dechichi P4.
Author information

Abstract
PURPOSE:
The aim of this study was to evaluate the effect of different storage media on angiogenesis and maintaining autogenous bone graft volume in rabbits.
MATERIAL AND METHODS:
Two grafts were removed bilaterally from the calvaria of 18 rabbits. One graft was removed and immediately fixed in the right mandibular angle (control group). The other graft was stored for 30 minutes in 1 of the following storage media (n = 6): saline solution (saline group), air exposure (dry group), or platelet-poor plasma (PPP group) and then retained by a screw in the right mandibular angle in the same animal. Four weeks later the animals were euthanized, and the grafted areas were harvested, fixed in 10% phosphate buffered formaldehyde solution, and embedded in paraffin. The 5-μm semi-serial sections were stained in hematoxylin and eosin and Mallory trichrome.
RESULTS:
Histologic analysis of all groups showed the bone graft was vascularized and well incorporated into the recipient site. The number of blood vessels decreased in the saline and dry groups compared with the control group (P < .03); in contrast, the number of blood vessels increased in the PPP group (P < .05). There were fewer osteoclasts in the saline group compared with the control group (P < .05). Furthermore, the saline group showed larger numbers of blood vessels than the dry group (P < .01). The PPP group showed larger bone graft volumes compared with the dry and saline groups (P < .01). In addition, the saline group showed larger bone graft volumes than the dry group (P < .01).
CONCLUSIONS:
PPP improved angiogenesis, maintained the volume of the autogenous bone graft, and was a better storage medium during the trans-surgical period than the dry and saline media.
Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.
PMID: 30009789 DOI: 10.1016/j.joms.2018.06.024
 
Ducttape said:
I’d say possible active comparator. You can’t tell, as there is no control group...

Jeez doctodd stop with the politics please...
Click to expand...

it wasnt about politics....it was a joke about that study being from iran (of all places) and one of the authors last name was same as a recent terrorist killed....just pointing out something most may have missed
 
lobelsteve said:

Rogue stem cell clinics | Bone & Joint

Rogue stem cell clinics
online.boneandjoint.org.uk online.boneandjoint.org.uk
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1581822369318.png
 
lobelsteve said:

Rogue stem cell clinics | Bone & Joint

Rogue stem cell clinics
online.boneandjoint.org.uk online.boneandjoint.org.uk
Click to expand...

Eur J Orthop Surg Traumatol. 2020 Feb 14. doi: 10.1007/s00590-020-02623-4. [Epub ahead of print]
Is platelet-rich plasma effective for the treatment of knee osteoarthritis? A systematic review and meta-analysis of level 1 and 2 randomized controlled trials.
Hohmann E1,2, Tetsworth K3,4,5,6, Glatt V6,7.
Author information

Abstract
INTRODUCTION:
The purpose of this study was to perform a systematic review and meta-analysis comparing intra-articular knee injection of PRP and hyaluronic acid and investigate clinical outcomes and pain at both 6 and 12 months.
METHODS:
A systematic review of Medline, Embase, Scopus, and Google Scholar was performed in the English and German literature reporting on intra-articular knee injections for knee osteoarthritis. All level 1 and 2 studies with a minimum of 6-month follow-up in patients with knee osteoarthritis from 2010 to 2019 were included. Clinical outcome was assessed by WOMAC and IKDC scores and pain by VAS and WOMAC pain scores. Subgroup analysis for autologous platelet-rich plasma (ACP) was performed. Publication bias and risk of bias were assessed using the Cochrane Collaboration's tools. The GRADE system was used to assess the quality of the body of evidence. Heterogeneity was assessed using χ2 and I2 statistics.
RESULTS:
Twelve studies (1,248 cases; 636 PRP, 612 HA) met the eligibility criteria. The pooled estimate demonstrated non-significant differences between PRP and HA for clinical outcomes at 6 months (p = 0.069) and at 12 months (p = 0.188). However, the pooled estimate for pain did demonstrate significant differences in favour of PRP at 6 months (p = 0.001) and 12 months (p = 0.001). For the ACP subgroup (249 cases), the pooled estimate for these studies demonstrated significant differences in favour of PRP (p < 0.0001) at 6 months.
CONCLUSION:
The results of this systematic review and meta-analysis suggest that PRP is superior to HA for symptomatic knee pain at 6 and 12 months. ACP appears to be clearly superior over HA for pain at both 6 and 12 months. There were no advantages of PRP over HA for clinical outcomes at both 6 and 12 months.
LEVEL OF EVIDENCE:
Level 2; systematic review and meta-analysis.
KEYWORDS:
Autologous conditioned plasma (ACP); Hyaluronic acid; Knee osteoarthritis; Knee pain; Meta-analysis; PRP; Platelet-rich plasma; Systematic review
PMID: 32060630 DOI: 10.1007/s00590-020-02623-4
 
The pooled estimate demonstrated non-significant differences between PRP and HA for clinical outcomes at 6 months (p = 0.069) and at 12 months (p = 0.188).

And I am more a fan of Mark Knopfler.
 
lobelsteve said:
The pooled estimate demonstrated non-significant differences between PRP and HA for clinical outcomes at 6 months (p = 0.069) and at 12 months (p = 0.188).

And I am more a fan of Mark Knopfler.
Click to expand...

I wonder if Paul Knoepfler has competing commitments and how trustworthy/knowledgable he is when it comes to orthobiologics for MSK conditions. I'm always wary of people with axes to grind.
 
Last edited:
drusso said:
I wonder if Paul Knoepfler has competing commitments and how trustworthy/knowledgable he is when it comes to orthobiologics for MSK conditions. I'm always wary of people with axes to grind.
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Who is Paul Knoepfler?
I first met Paul a little more than a decade ago when we were embroiled in trying to establish what the FDA regulations should be around autologous stem cell use. Paul approached me a bit like a journalist with questions to answer about what was happening. Over the last decade, I’ve had countless interactions with Paul over email and have been featured in one way or another in his blog many times.

Paul is a university bench scientist who works at UC Davis in the Cell Biology department and who has a primary research interest in brain development and childhood cancers. I know that Paul is a prostate cancer survivor because he has written about this several times. Meaning, like the rest of us, he is very human.

As a scientist, you can see Paul is different just from reading the publication list on his lab’s website. Since about 2013, while the requisite publish or perish papers are there in his field of expertise, there is also a large chunk of the papers or opinion pieces he’s written about the out of control commercial stem cell space. In addition, for as long as I can remember, Paul has maintained a blog that is mostly about that one topic.



Looks more honest than the $tem$ell$ale$men
 
lobelsteve said:
Who is Paul Knoepfler?
I first met Paul a little more than a decade ago when we were embroiled in trying to establish what the FDA regulations should be around autologous stem cell use. Paul approached me a bit like a journalist with questions to answer about what was happening. Over the last decade, I’ve had countless interactions with Paul over email and have been featured in one way or another in his blog many times.

Paul is a university bench scientist who works at UC Davis in the Cell Biology department and who has a primary research interest in brain development and childhood cancers. I know that Paul is a prostate cancer survivor because he has written about this several times. Meaning, like the rest of us, he is very human.

As a scientist, you can see Paul is different just from reading the publication list on his lab’s website. Since about 2013, while the requisite publish or perish papers are there in his field of expertise, there is also a large chunk of the papers or opinion pieces he’s written about the out of control commercial stem cell space. In addition, for as long as I can remember, Paul has maintained a blog that is mostly about that one topic.



Looks more honest than the $tem$ell$ale$men
Click to expand...

Bottom line: When it comes to listening about which medical treatments "work" and "don't work," I prefer to take advice from people who actually treat patients for a living. Are you going to take Kypho advice from a PhD material scientist who wrote a dissertation on polymethyl methacrylate chemistry or Doug Beall, MD?

Maybe you should listen to Jason Dragoo, MD...

 
drusso said:
Bottom line: When it comes to listening about which medical treatments "work" and "don't work," I prefer to take advice from people who actually treat patients for a living. Are you going to take Kypho advice from a PhD material scientist who wrote a dissertation on polymethyl methacrylate chemistry or Doug Beall, MD?

Maybe you should listen to Jason Dragoo, MD...

Click to expand...

From your link:

Platelet-rich plasma (PRP) is a promising treatment for musculoskeletal maladies and clinical data to date have shown that PRP is safe. However, evidence of its efficacy has been mixed and highly variable depending on the specific indication. Additional future high-quality large clinical trials will be critical in shaping our perspective of this treatment option. The heterogeneity of PRP preparations, both presently and historically, leads sweeping recommendations about its utility impossible to make. This heterogeneity has also made interpreting existing literature more complicated.


SO this looks promising, but the data is not there yet. And the treatment is sullied from snake oil salesman posing as docs and chiros.
 
I get SOOO many patients dropping $5k on these stem cell therapies. I try to talk them out of it.

Ive thought of doing them for much less and telling patients they are unproven, hoping that they will either not do it, or at least if they do I save them money and I make some money. Not sure how I feel about this ethically. I would be completely honest with the patients. Plus I bet patient will prefer to pay 2x+ has much to someone who lies to them vs the person that is honest and saves them money (human psychology is so weird).
 
mid|ine said:
I get SOOO many patients dropping $5k on these stem cell therapies. I try to talk them out of it.

Ive thought of doing them for much less and telling patients they are unproven, hoping that they will either not do it, or at least if they do I save them money and I make some money. Not sure how I feel about this ethically. I would be completely honest with the patients. Plus I bet patient will prefer to pay 2x+ has much to someone who lies to them vs the person that is honest and saves them money (human psychology is so weird).
Click to expand...

Chiropractors are MASTER snake oil salesmen. I see a new chiropractic practice offering this every week. I would not be surprised if one day those idiots convince a state board to allow them to perform surgery.


Sent from my iPhone using Tapatalk
 
Still waiting on a chiro to explain to me what it means for a hip to be "out." SIJ can apparently be "out," as well as the piriformis.
 
The main guy in our area is a board certified MD. Procedure is $5k. He uses bone marrow cells and is doing intradiscal and facets I think.
 
A new patient yesterday told me something very revealing about Chiros. She said: “ I’m really upset and disappointed with my chiropractor. He assured me over an over again that he could fix this problem and that no other treatment was necessary. I really believed in him. Last week when I complained that I was getting worse he responded ‘ What do you want? There is only so much I can do.’” In order to sell lots of these services (decompression, stem cells, etc) I think you need to be able to feel comfortable essentially guaranteeing results and then saying - oops my bad, I was wrong - when nothing happens.


Sent from my iPhone using Tapatalk
 
Please read notes from chiropractors. If I see a WC patient that has chiropractor notes I always read them and I'm stunned at the fact they're considered medical professionals.
 
SommeRiver said:
Please read notes from chiropractors. If I see a WC patient that has chiropractor notes I always read them and I'm stunned at the fact they're considered medical professionals.
Click to expand...
Medical professionals with ever increasing scope of practice. The fact that chiropractors can do ANYTHING beyond some modalities and a spinal manipulation presents a greater risk to public safety than anything else I know.
 
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