Adding Regenerative medicine to your practice.

[drusso]

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Members do not see this ad.

Fat injection into knee? Sure, why not. But why not choose a placebo arm or a visco arm or a steroid arm. You know, the stuff that is kind of standard of care treatment.

Fat injection into knee? Sure, why not. But why not choose a placebo arm or a visco arm or a steroid arm. You know, the stuff that is kind of standard of care treatment.

MFAT vs PRP for knee OA is the HF10 versus BurstDR of Regen. It’s Pepsi vs Coke. People die on those hills.

 

[Ducttape]

this study can only be used reliably to say that it doesnt make a difference between PRP and MFAT.

ie dont do MFART if you can do PRP - is correct.

you cannot conclude PRP is better than any other treatment because it was assumed that it was.

 

[drusso]

this study can only be used reliably to say that it doesnt make a difference between PRP and MFAT.

ie dont do MFART if you can do PRP - is correct.

you cannot conclude PRP is better than any other treatment because it was assumed that it was.

Which one will you offer your patients?

 

[lobelsteve]

Which one will you offer your patients?

Any risks of one over the other?
Any more4 difficult for the process?
Any more profitable choice?

If =, let patient choose.

 

[drusso]

Any risks of one over the other?
Any more4 difficult for the process?
Any more profitable choice?

If =, let patient choose.

MFAT requires mini liposuction. MFAT is more expensive.

 

[bedrock]

MFAT requires mini liposuction. MFAT is more expensive.

Exactly. PRP is the clear best choice between those two options

 

[Ducttape]

Which one will you offer your patients?

currently, i give referrals to patients to physicians who perform PRP only.

 

[Doctodd]

i didnt see anyone mention the recent court decision allowing for more manipulation than minimal, so expect to see lots more.

QC Kinetix is advertising everywhere....and they charge more than $10k i hear. From a NP.

 

[lobelsteve]

i didnt see the recent court decision allowing for more manipulation than minimal, so expect to see lots more.

QC Kinetix is advertising everywhere....and they charge more than $10k i hear. From a NP.

3 ads on radio over a 25 min drive. Great marketing for pure fluff.

 

[MitchLevi]

3 ads on radio over a 25 min drive. Great marketing for pure fluff.

Many questions from pts about these guys.

I've heard several thousand per shot, but that's from pts and they may be incorrect.

 

[drusso]

this study can only be used reliably to say that it doesnt make a difference between PRP and MFAT.

ie dont do MFART if you can do PRP - is correct.

you cannot conclude PRP is better than any other treatment because it was assumed that it was.

3 ads on radio over a 25 min drive. Great marketing for pure fluff.

https://www.bizjournals.com/portland/news/2017/11/20/patients-should-beware-of-stem-cell-quackery.html

 

[drusso]

J Shoulder Elbow Surg. 2022 Sep 29;S1058-2746(22)00727-3.

doi: 10.1016/j.jse.2022.08.017. Online ahead of print.

Plasma rich in growth factors (PRGF) versus corticosteroid injections for management of chronic rotator cuff tendinopathy: a prospective double-blind randomized controlled trial with 1-year of follow-up​

Víctor Vaquerizo 1, Marta García-López 2, Araceli Mena-Rosón 2, Roberto Prado 3, Sabino Padilla 3, Eduardo Anitua 3
Affiliations expand

• PMID: 36183895
• DOI: 10.1016/j.jse.2022.08.017

Abstract​

Background: Rotator cuff tendinopathy (RCT) is a painful and dysfunctional shoulder condition traditionally considered as a degenerative pathology. However, evidence is pointing to immunocompetent cells and activated stromal fibroblasts as the drivers of a non-resolved inflammatory condition in RCT. As potent anti-inflammatory agents, corticosteroid injections have been among the first-line and the most common therapeutic strategies. Recently, another adjuvant therapy to treat musculoskeletal inflammation-driven painful conditions, namely, platelet-rich plasma (PRP) is emerging as safe and effective. The aim of this study was to compare the clinical efficacy of intratendinous injections of plasma rich in growth factors (PRGF) with conventional intratendinous corticosteroid injections on patients with chronic RCT using patient-reported outcome (PRO) measures.
Methods: A total of 39 patients received PRGF treatment (3 infiltrations, one every other week) while 40 patients, as a control group, received corticosteroid (3 infiltrations, one every other week). Patients were evaluated before treatment, and at 3, 6, and 12 months as the end of follow-up using UCLA scale, QuickDASH, and Constant test. The primary outcome of the study was a 15% superior improvement of the PRGF group compared with the corticosteroid group in the UCLA scale and QuickDASH test at 6 month of follow-up, considering this difference to be clinically relevant.
Results: Both PRGF and corticosteroid groups showed significant clinical improvement in the three scores at all time points of the study compared with baseline. However, the PRGF group presented at 6 and 12 months of follow-up 22,13% and 21,15% for UCLA test, 14,33% and 13,49% for QuickDASH, and 16,42% and 20,18% for Constant-Murley test significantly superior percentage of improvement compared with the amelioration of corticosteroid group.
Conclusions: Three PRGF intratendinous injections every other week in patients with chronic rotator cuff tendinopathy shows significant superior and sustained pain-relieving and functional improvements compared with corticosteroid intratendinous injections assessed by three PRO scales at 6 and 12 months of follow-up.
Keywords: PRGF; corticosteriods; platelet-rich plasma; randomized controlled trial; rotator cuff; tendinopathy.
Copyright © 2022. Published by Elsevier Inc.

 

[Ducttape]

study looks pretty decent. both groups got improvement and the PRP got 15% more by 6 months. odd that there is no specific comment about the % superior improvement at 12 months.

i dont see the details in the study, however. given that it was double blinded, the groups should be similar in composition.


edit: i downloaded the submitted pdf. of note:

The effect of both treatments, expressed in absolute values (Figure 3), in the UCLA 187 score, QuickDASH test and Constant-Murley test showed significant clinical and 188 functional improvements at all time points of the study compared with baselines scores 189 as indicated in the Table 2. However, when compared the improvement among the 190 different time points of follow-up (3 months - 6 months, 3 months -12 months, and 6 191 months -12 months), the corticosteroid group did not manifest significant improvements 192 whereas the PRGF group revealed significant steady improvements in Constant-Murley 193 test among the different time points of follow-up but only significant improvements in 194 UCLA score between 3 months - 6 months and in QuickDASH score between 3 months 195 -12 months (Table 2).

so steroids kick in early but no real change after 3 months, PRP may not kick in as early, but change in the tests after 3 months. improvement of PRP over baseline at all time points.


there was no funding but the researchers did note that 3 of them are part of the BTI Biotechnology Institute,
"a biomedical company that investigates in the fields of regenerative medicine and PRGF-Endoret technology".


complete tears (obviously) and calcific tendonitis was not included.

 

[lobelsteve]

study looks pretty decent. both groups got improvement and the PRP got 15% more by 6 months. odd that there is no specific comment about the % superior improvement at 12 months.

i dont see the details in the study, however. given that it was double blinded, the groups should be similar in composition.


edit: i downloaded the submitted pdf. of note:

so steroids kick in early but no real change after 3 months, PRP may not kick in as early, but change in the tests after 3 months. improvement of PRP over baseline at all time points.


there was no funding but the researchers did note that 3 of them are part of the BTI Biotechnology Institute,
"a biomedical company that investigates in the fields of regenerative medicine and PRGF-Endoret technology".


complete tears (obviously) and calcific tendonitis was not included.

Who does 3 steroid injections to the shoulder in a month?

 

[drusso]

study looks pretty decent. both groups got improvement and the PRP got 15% more by 6 months. odd that there is no specific comment about the % superior improvement at 12 months.

i dont see the details in the study, however. given that it was double blinded, the groups should be similar in composition.


edit: i downloaded the submitted pdf. of note:

so steroids kick in early but no real change after 3 months, PRP may not kick in as early, but change in the tests after 3 months. improvement of PRP over baseline at all time points.


there was no funding but the researchers did note that 3 of them are part of the BTI Biotechnology Institute,
"a biomedical company that investigates in the fields of regenerative medicine and PRGF-Endoret technology".


complete tears (obviously) and calcific tendonitis was not included.

You can't Jedi mind trick platelet cytokines. Cytokines don't care what you believe about them.

 

[Ducttape]

you can Jedi Mind trick yourself in to believing that cytokines really are helping when they may not be significantly different. especially if you are an employee of the company that is profitting off of them.

 

[drusso]

you can Jedi Mind trick yourself in to believing that cytokines really are helping when they may not be significantly different. especially if you are an employee of the company that is profitting off of them.

You can't fool cells in a dish...

Int J Implant Dent
. 2022 Oct 3;8(1):39.
doi: 10.1186/s40729-022-00440-4.

Plasma rich in growth factors (PRGF) and leukocyte-platelet rich fibrin (L-PRF): comparative release of growth factors and biological effect on osteoblasts​

Laura Baca-Gonzalez 1, Rebeca Serrano Zamora 2, Lisa Rancan 3, Francisco González Fernández-Tresguerres 2, Isabel Fernández-Tresguerres 2, Rosa M López-Pintor 2, Juan López-Quiles 2, Isabel Leco 2, Jesús Torres 2
Affiliations expand

• PMID: 36184700
• DOI: 10.1186/s40729-022-00440-4

Abstract​

Purpose: To compare the release of platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), insulin-like growth factor (IGF-I) and interleukin 1β (IL-1β) of plasma rich in growth factors (PRGF) and leucocyte platelet-rich fibrin (L-PRF) and to evaluate their biological implication in osteoblasts.
Methods: Blood from 3 healthy volunteers was processed into PRGF, immediate L-PRF (L-PRF 0') and L-PRF 30 min after collection (L-PRF-30') and a control group. Growth factors release were analyzed at 7 times by ELISA. Cell proliferation, collagen-I synthesis and alkaline phosphatase activity were assessed in primary cultures of human osteoblasts.
Results: A slower controlled release of IGF-I, VEGF and PDGF was observed in the PRGF group at day 14. A higher synthesis of type I collagen was also quantified in PRGF. L-PRF released significantly higher amounts of IL-1β, that was almost absent in the PRGF.
Conclusions: The addition of leukocytes dramatically increases the secretion of proinflammatory cytokines, which are likely to negatively influence the synthesis of type I collagen and alkaline phosphatase (ALP) by osteoblasts.

Keywords: Bone regeneration; IGF-I; IL-1 β; PDGF-AB; PRGF; Platelet; Platelet-rich fibrin; Platelet-rich plasma; VEGF; Wound healing.
© 2022. The Author(s).

 

[Tboned]

Who does 3 steroid injections to the shoulder in a month?

Intratendinous CSI no less

 

[drusso]

J Orthop Res. 2022 Oct 17.
doi: 10.1002/jor.25463. Online ahead of print.

Platelet-Rich Plasma versus Corticosteroid Injections in the Management of Patients with Rotator Cuff Disease: A Systematic Review and Meta-Analysis​

Maamoun Adra 1 2, Nour El Ghazal 1 2, Hayato Nakanishi 1 2, Karen Smayra 1 2, Sam S Hong 1 2, Shahid Miangul 1 2, Reem H Matar 1 2 3, Christian A Than 1 2 4, Duncan Tennent 5
Affiliations expand

• PMID: 36250611
• DOI: 10.1002/jor.25463

Abstract​

Platelet-rich plasma (PRP) is an alternative to corticosteroid (CS) injections in managing rotator cuff disease. This meta-analysis investigated differences between PRP and CS for function and pain scores in significance and minimal clinical important difference (MCID). A literature search of Ovid Cochrane Library, Medline, Embase, Epub, and Scopus was conducted from inception to October 28, 2021. Eligible studies reported patients older than 18 years with a diagnosis of rotator cuff disease. This review was registered in PROSPERO (ID: CRD42021278740). Twelve studies met eligibility criteria (n=639) of patients receiving either PRP or CS. At short-term follow-up, a difference favored CS compared to PRP in baseline change for Disability of Arm, Shoulder and Hand (DASH) score (MD= -5.08, 95% CI: -8.00, -2.15; P= 0.0007; I2 = 0%) and Simple Shoulder Test (SST) (MD= 1.25, 95% CI: 0.33, 2.18; P= 0.008; I2 = 0%). At intermediate follow-up, a difference favored PRP to CS baseline change of the DASH score (MD= 3.41, 95% CI: 0.67, 6.15; P= 0.01; I2 = 0%). At medium-term, a difference favored PRP to CS baseline change of the American Shoulder and Elbow Surgeons Shoulder (ASES) score (MD= -4.42, 95% CI: -8.16, -0.67; P= 0.02; I2 = 0%). Both treatments achieved individual MCID for each score. Despite favoring CS at short-term follow-up and PRP at intermediate- and medium-term follow-up, functional and pain scores did not demonstrate any clinical difference between the two treatment modalities in management of rotator cuff disease at all follow-up periods. This article is protected by copyright. All rights reserved.
Keywords: Corticosteroid; Injection; Meta-analysis; Platelet-rich; Rotator cuff.

 

[Ducttape]

meta-analysis. GIGO.

and let me reiterate what the final conclusion is, as i suspect some people did not read the article:


Despite favoring CS at short-term follow-up and PRP at intermediate- and medium-term follow-up, functional and pain scores did not demonstrate any clinical difference between the two treatment modalities in management of rotator cuff disease at all follow-up periods.

 

[drusso]

meta-analysis. GIGO.

and let me reiterate what the final conclusion is, as i suspect some people did not read the article:


Despite favoring CS at short-term follow-up and PRP at intermediate- and medium-term follow-up, functional and pain scores did not demonstrate any clinical difference between the two treatment modalities in management of rotator cuff disease at all follow-up periods.

Non-inferior.

 

[oreosandsake]

Is GIGO now the response to every SR?

They are technically supposed to be the highest grade of evidence as there is a systematic evaluation of the studies to prevent Garbage in as part of the methodology… at least a few authors typically will use validated tools to determine risk for bias etc

Going through to do it by Cochrane or the other methods is a big PITA

 

[Ducttape]

If you do not screen out poor studies for your meta-analysis, you get garbage.

Validating it makes it smell better. Like multiple analogies - if the supports are rotten, the structure won't stand.

We should be striving for more prospective randomized studies. There aren't enough. And the end points for these studies are generally vague and poorly defined.

The main problem I see with pain medicine is that these high quality studies are not being done. Compared to internal medicine, cardiology, anesthesiology based studies, pain medicine studies are as a whole more poorly designed and implemented.

 

[Ducttape]

Non-inferior.

Not a good result if we are going to convince CMS and private insurances to cover PRP.....

 

[drusso]

Not a good result if we are going to convince CMS and private insurances to cover PRP.....

That would be terrible. Can you think of one pain treatment where CMS/Insurance improved reimbursement?

 

[Ducttape]

over no coverage at all, for those who are not independently wealthy in the US?

epidurals
median branch blocks
RFAs
kyphoplasty
SCS
etc.

 

[MitchLevi]

I've had a few pts with no insurance with failed back and severe, unilateral radicular pain. Great candidates for SCS, but can't do it bc uninsured. Kills me.

 

[Doctodd]

Not a good result if we are going to convince CMS and private insurances to cover PRP.....

I’m fine with CMS not regulating…..I mean not covering it

 

[drusso]

over no coverage at all, for those who are not independently wealthy in the US?

epidurals
median branch blocks
RFAs
kyphoplasty
SCS
etc.

Prove me wrong. Name one procedure that INCREASED reimbursement, or even kept pace with inflation/practice expense/cost of living, following CMS coverage (do not include SOS/facility fee arbitrage).

 

[lobelsteve]

I've had a few pts with no insurance with failed back and severe, unilateral radicular pain. Great candidates for SCS, but can't do it bc uninsured. Kills me.

Get wealthier patients. Have done 2 self pay. They get a huge discount on everything. $75k OTD pricing from hospital. Maybe even cheaper. Probably posted this on here years ago.

 

[Ducttape]

physician reimbursement is not my primary concern. yes, it is a concern. just not #1 or #2.

theres a reason i did not choose to go in to either of the 2 private practices i was offered a job.

quality care of patients and providing safe effective care for all patients is a far greater concern for me.

 

[drusso]

physician reimbursement is not my primary concern. yes, it is a concern. just not #1 or #2.

theres a reason i did not choose to go in to either of the 2 private practices i was offered a job.

quality care of patients and providing safe effective care for all patients is a far greater concern for me.

How will you be sustainable if you can't make any money? No one wants to work for free.

 

[Ducttape]

and things tend to take care of themselves...

 

[Doctodd]

View attachment 360882

This is a simpletons argument…..one that your staff won’t agree with when it comes time to their salary.

 

[Ducttape]

no offense, but is this false dilemma argument the best retort out there?

kinda sad.

 

[drusso]

Intradiscal Autologous Platelet-Rich Plasma Injection for Discogenic Low Back Pain: A Clinical Trial - PMC

Platelet-rich plasma (PRP) contains high concentrations of growth factors and cytokines and may promote healing and tissue formation and exert anti-inflammatory effects. PRP has been shown to improve intervertebral disc degeneration in vivo and in ...

www.ncbi.nlm.nih.gov

Intradiscal Autologous Platelet-Rich Plasma Injection for Discogenic Low Back Pain: A Clinical Trial

Jianbo Zhang 1, Dongyang Liu 1, Qingjuan Gong 1, Jinsheng Chen 1, Li Wan 1

Affiliations collapse
Affiliation
1Department of Pain Management, The State Key Clinical Specialty for Pain Medicine, Guangzhou Medical University Second Affiliated Hospital, Guangzhou, China.
PMID: 36262971 PMCID: PMC9576382 DOI: 10.1155/2022/9563693
Free PMC article

Abstract
Background: Platelet-rich plasma (PRP) contains high concentrations of growth factors and cytokines and may promote healing and tissue formation and exert anti-inflammatory effects. PRP has been shown to improve intervertebral disc degeneration in vivo and in vitro. This study is aimed at evaluating the effectiveness of autologous PRP on discogenic low back pain (DLBP) at 48 weeks postinjection in patients who received a single intradiscal injection.

Methods: All patients received a single intradiscal injection of PRP in a prospective trial. The pain scores, lumbar function, and adverse events were assessed at 1 week, 4 weeks, 8 weeks, 12 weeks, 24 weeks, and 48 weeks postinjection and compared to the preinjection values (0 weeks).

Results: Data were analysed from 31 patients with a 94% follow-up rate. Compared to preinjection, pain and lumbar function were significantly improved, and there were significant differences (P < 0.05) over the 48-week follow-up. Twenty-two (71%) patients were classified as successes after the intradiscal injection of PRP. One patient received surgery at two weeks postinjection due to intervertebral discitis.

Conclusions: Intradiscal injection of PRP can significantly relieve pain sensation and improve lumbar function in patients with DLBP over a 48-week follow-up period. Further randomized controlled clinical trials are needed to assess the effects of this injection therapy.

Copyright © 2022 Jianbo Zhang et al.

Conflict of interest statement
No potential conflict of interest relevant to this article was reported.

 

[lobelsteve]

Discograms on normal discs. VAS 7ish to 5ish might not be clinically significant. No mention of length of time pain present or prior treatments. No demographics.

 

[Taus]

another intradiscal regen trial…. Another discitis case despite being a small trial. Big risk for questionable benefit. I’ve been on the fence re offering it for years… still a no

 

[MitchLevi]

Intradiscal Autologous Platelet-Rich Plasma Injection for Discogenic Low Back Pain: A Clinical Trial - PMC

Platelet-rich plasma (PRP) contains high concentrations of growth factors and cytokines and may promote healing and tissue formation and exert anti-inflammatory effects. PRP has been shown to improve intervertebral disc degeneration in vivo and in ...

www.ncbi.nlm.nih.gov

Intradiscal Autologous Platelet-Rich Plasma Injection for Discogenic Low Back Pain: A Clinical Trial

Jianbo Zhang 1, Dongyang Liu 1, Qingjuan Gong 1, Jinsheng Chen 1, Li Wan 1

Affiliations collapse
Affiliation
1Department of Pain Management, The State Key Clinical Specialty for Pain Medicine, Guangzhou Medical University Second Affiliated Hospital, Guangzhou, China.
PMID: 36262971 PMCID: PMC9576382 DOI: 10.1155/2022/9563693
Free PMC article

Abstract
Background: Platelet-rich plasma (PRP) contains high concentrations of growth factors and cytokines and may promote healing and tissue formation and exert anti-inflammatory effects. PRP has been shown to improve intervertebral disc degeneration in vivo and in vitro. This study is aimed at evaluating the effectiveness of autologous PRP on discogenic low back pain (DLBP) at 48 weeks postinjection in patients who received a single intradiscal injection.

Methods: All patients received a single intradiscal injection of PRP in a prospective trial. The pain scores, lumbar function, and adverse events were assessed at 1 week, 4 weeks, 8 weeks, 12 weeks, 24 weeks, and 48 weeks postinjection and compared to the preinjection values (0 weeks).

Results: Data were analysed from 31 patients with a 94% follow-up rate. Compared to preinjection, pain and lumbar function were significantly improved, and there were significant differences (P < 0.05) over the 48-week follow-up. Twenty-two (71%) patients were classified as successes after the intradiscal injection of PRP. One patient received surgery at two weeks postinjection due to intervertebral discitis.

Conclusions: Intradiscal injection of PRP can significantly relieve pain sensation and improve lumbar function in patients with DLBP over a 48-week follow-up period. Further randomized controlled clinical trials are needed to assess the effects of this injection therapy.

Copyright © 2022 Jianbo Zhang et al.

Conflict of interest statement
No potential conflict of interest relevant to this article was reported.

Discitis 1/31 cases for a procedure that doesn't appear to have done a whole lot.

 

[cowboydoc]

Intradiscal Autologous Platelet-Rich Plasma Injection for Discogenic Low Back Pain: A Clinical Trial - PMC

Platelet-rich plasma (PRP) contains high concentrations of growth factors and cytokines and may promote healing and tissue formation and exert anti-inflammatory effects. PRP has been shown to improve intervertebral disc degeneration in vivo and in ...

www.ncbi.nlm.nih.gov

Intradiscal Autologous Platelet-Rich Plasma Injection for Discogenic Low Back Pain: A Clinical Trial

Jianbo Zhang 1, Dongyang Liu 1, Qingjuan Gong 1, Jinsheng Chen 1, Li Wan 1

Affiliations collapse
Affiliation
1Department of Pain Management, The State Key Clinical Specialty for Pain Medicine, Guangzhou Medical University Second Affiliated Hospital, Guangzhou, China.
PMID: 36262971 PMCID: PMC9576382 DOI: 10.1155/2022/9563693
Free PMC article

Abstract
Background: Platelet-rich plasma (PRP) contains high concentrations of growth factors and cytokines and may promote healing and tissue formation and exert anti-inflammatory effects. PRP has been shown to improve intervertebral disc degeneration in vivo and in vitro. This study is aimed at evaluating the effectiveness of autologous PRP on discogenic low back pain (DLBP) at 48 weeks postinjection in patients who received a single intradiscal injection.

Methods: All patients received a single intradiscal injection of PRP in a prospective trial. The pain scores, lumbar function, and adverse events were assessed at 1 week, 4 weeks, 8 weeks, 12 weeks, 24 weeks, and 48 weeks postinjection and compared to the preinjection values (0 weeks).

Results: Data were analysed from 31 patients with a 94% follow-up rate. Compared to preinjection, pain and lumbar function were significantly improved, and there were significant differences (P < 0.05) over the 48-week follow-up. Twenty-two (71%) patients were classified as successes after the intradiscal injection of PRP. One patient received surgery at two weeks postinjection due to intervertebral discitis.

Conclusions: Intradiscal injection of PRP can significantly relieve pain sensation and improve lumbar function in patients with DLBP over a 48-week follow-up period. Further randomized controlled clinical trials are needed to assess the effects of this injection therapy.

Copyright © 2022 Jianbo Zhang et al.

Conflict of interest statement
No potential conflict of interest relevant to this article was reported.

View attachment 360954
View attachment 360955

Congrats, they found it!

 

[lobelsteve]

Congrats, they found it!

View attachment 361030

 

[Doctodd]

bummer....but it's china

 

[Ducttape]

comparing it to pre injection. so no control per se. ie no placebo group.

not blinded.

no discussion on concomitant treatments or whether they were offered or not. for example, doing the injection and giving a month or two supply of vicodin may skew the results.

they do note further randomized control studies need to be done.

bummer....but it's china

what does china have to do with the results?

 

[drusso]

Another example of the powerful effect that "wishful thinking" and placebo have on cytokines. Cytokines don't lie...

Biomed Res Int

. 2022 Oct 10;2022:4496949.
doi: 10.1155/2022/4496949. eCollection 2022.

PRP from Personal Blood Relieves Joint Fluid-Inducing Synovial Injury through NF- κ B Pathway and Mitochondrial Apoptosis in Human Synovial Fibroblast Cells​

Li Xie 1 2 3, Wanchang Lin 4, Lingqi Zhu 1 2, Liang Zhou 1 2, Dasheng Lin 1 2, Lianshui Huang 1 2, Wei Xie 1 2, Wenliang Zhai 1 2
Affiliations expand

• PMID: 36262969
• PMCID: PMC9576388
• DOI: 10.1155/2022/4496949

Free PMC article

Abstract​

Background: Platelet-rich plasma (PRP) therapy is a new kind of biological therapy to retune the plasma concentrator into the patient's body for the treatment of osteoarthritis diseases. The present research aims to confirm the treatment effects of PRP against osteoarthritis injury and elucidate its potential mechanism via constructing a kind of cellular injury model of human synovial fibroblast cells (HSF cells) induced by synovial fluid from osteoarthritis patients.
Materials and methods: HSF cells were firstly treated with different doses of synovial fluid from osteoarthritis patients, and evaluated for cellular injury via cell morphology and MTT assay. And then, the protective effect of PRP against cellular injury was examined by cell morphology and MTT assay. Flow cytometry and western blot assay were employed to evaluate the effect of PRP on mitochondrial apoptosis. Finally, the effect of PRP on NF-κB pathway-associated inflammation were examined by Elisa ELISA assay and western blot.
Results: The dilution ratio 1 : 5 of synovial fluid displayed an excellent injury effect against HSF cells and was selected as the model condition. The data from cellular image and MTT assay showed that PRP with the doses 1 : 5 and 1 : 10 could alleviate the cellular mounts decrease in the damaged HSF cells. Flow cytometry, western blot, and Elisa ELISA assay displayed that PRP could relieve the cellular mitochondrial apoptosis and NF-κB pathway-associated inflammation in the damaged HSF cells.
Conclusion: PRP might relieve HSF cells injury induced by synovial fluid from osteoarthritis patients by alleviating the mitochondrial apoptosis and NF-κB pathway-associated inflammation.

Copyright © 2022 Li Xie et al.

 

[drusso]

More cytokine-induced placebo effects (even across different body parts) on medically-desperate patients. #ThePowerOfWishfulThinking

World J Orthop. 2022 Oct 18;13(10):911-920. doi: 10.5312/wjo.v13.i10.911.

Adjunctive platelet-rich plasma and hyaluronic acid injection after arthroscopic debridement in Kellgren-Lawrence grade 3 and 4 knee osteoarthritis

Henry Tirtosuharto 1, I Gede Eka Wiratnaya 2, Putu Astawa 1
Affiliations expand
PMID: 36312525 PMCID: PMC9610867 DOI: 10.5312/wjo.v13.i10.911

Abstract
Background: Osteoarthritis (OA) is the most common cause of pain and disability, predominantly affecting the knee. The current management of knee OA falls short of completely stopping disease progression, particularly in Kellgren-Lawrence (KL) grade 3 and 4 knee OA. As such, joint replacement is often recommended, although only 15%-33% of candidates accept it. Alternative therapeutic options are still needed to prevent the progression of joint damage and delay the need for knee arthroplasty.

Aim: To investigate the effect of adjunctive platelet rich plasma (PRP) and hyaluronic acid (HA) after arthroscopic debridement in KL grade 3 and 4 knee OA.

Methods: This retrospective cohort study used the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score and WOMAC sub-scores (pain, stiffness, and function) to assess 21 patients, grouped according to medical record data of treatment received: Arthroscopic debridement (n = 7); arthroscopic debridement with PRP (n = 7); or arthroscopic debridement with HA (n = 7). WOMAC scores and sub-scores at baseline and at 3 mo and 5 mo posttreatment were recorded. The three-group data were statistically analyzed using the tests of paired t, one-way analysis of variance, and post hoc least significant difference.

Results: All three treatment groups showed significant improvements in WOMAC score and sub-scores from before treatment to 3 mo and 5 mo after treatment. However, the arthroscopic debridement with PRP treatment group, in particular, showed a significantly lower WOMAC pain score than the group who received arthroscopic debridement alone at 5 mo after the procedure (P = 0.03).

Conclusion: Compared to arthroscopic debridement alone, adjunctive PRP after arthroscopic debridement significantly lessened the patients' pain symptom.

Keywords: Arthroscopic debridement; Hyaluronic acid; Osteoarthritis; Platelet-rich plasma; WOMAC score; Western Ontario and McMaster Universities Osteoarthritis Index.

©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.


Arthrosc Sports Med Rehabil. 2022 Sep 6;4(5):e1739-e1746. doi: 10.1016/j.asmr.2022.06.021. eCollection 2022 Oct.

Clinical Outcomes of Pectoralis Major Tendon Repair with and without Platelet-Rich Plasma

Jared A Hanson 1, Marilee P Horan 1, Michael J Foster 1 2, Kaitlyn E Whitney 1, Justin J Ernat 1 3, Dylan R Rakowski 1, Annalise M Peebles 1, Johnny Huard 1, Matthew T Provencher 1 2, Peter J Millett 1 2
Affiliations expand
PMID: 36312699 PMCID: PMC9596906 DOI: 10.1016/j.asmr.2022.06.021

Abstract
Purpose: To assess clinical outcomes following pectoralis major tendon (PMT) repairs and to compare outcomes of PMT repairs augmented with and without leukocyte-poor platelet-rich plasma (LP-PRP).

Methods: A retrospective review of prospectively collected data was performed of patients who underwent a PMT repair from May 2007 to June 2019 with a minimum of 2-year follow-up. Exclusion criteria included revision PMT repair, PMT reconstruction, and concomitant repair of another glenohumeral tendon/ligament. LP-PRP was injected surrounding the PMT repair before wound closure. Patient-reported outcome (PRO) data were collected preoperatively and evaluated at final follow-up using the American Shoulder and Elbow Surgeons Score (ASES), Single Assessment Numeric Evaluation Score (SANE), Quick Disabilities of the Arm, Shoulder and Hand Score (QuickDASH), and Short Form 12 physical component summary (SF-12 PCS), patient satisfaction with outcomes.

Results: Twenty-three men (mean age, 38.6 years; range, 20.5-64.3 years) were included in the final analysis. Mean time from injury to surgery was 30 days (range, 3-123 days). Follow-up was obtained for 16 of 23 patients (70%) at a mean of 5.1 years (range 2.0-13.0 years). Significant improvement in PROs was observed (ASES: 59.0 → 92.4, P = .008; SANE: 44.4 → 85.9, P = .018; QuickDASH: 44.4 → 8.5, P = .018; and SF-12 PCS: 42.5 → 52.6, P = .008). Median satisfaction was 9 of 10 (range, 6-10). Patients receiving LP-PRP had superior ASES (99.6 vs 83.0, P = .001), SANE (94.8 vs 74.6, P = .005), QuickDASH (0.24 vs 19.1, P = .001), and patient satisfaction (10 vs 9, P = .037) scores compared with those without PRP. PROs were unchanged based on chronicity, mechanism of injury, or tear location. One patient had revision surgery at 3.4 years due to adhesions.

Conclusions: PMT repair produces improved PROs at final follow-up when compared with preoperative values.

Level of evidence: Level III, retrospective comparative therapeutic trial.

 

[Ducttape]

both studies are very small, retrospective study - prone to bias.
neither are blinded, of course.




first study is interesting, because there are studies that suggest arthroscopic debridement does not help long term - but in this study's case - this study does show benefit.



for study #2: only 23 patients. some important differences in the groups.

Mean follow-up in those treated with LP-PRP was 2.6 years (range, 2.0-2.9 years) versus 8.5 years (range, 4.1-13.0 years) (P = .001) in those without. There were 8 tears at the musculotendinous junction (type III-C) in the LP-PRP cohort and 3 in the group without PRP group (P = .007).

they make a big point about how satisfaction was significantly better in the PRP group - but the satisfaction rate for the non- PRP group was 9 out of 10 vs 10 out of 10.

As discussed, our study is not without limitations. One major limitation of our study is the difference in follow-up duration between the cohort receiving PRP versus those who did not, which is a result of the limited duration of use of PRP. The small cohort sizes compounded by the loss to follow-up rate in our study is also a limiting factor that is not unique to our retrospective study design. In addition, the use of available PROs rather than the Bak criteria17 reduces the ability to compare the results of our study with published outcomes; however, we believe the inclusion of baseline patient scores outweighs this disadvantage.

all that being said, if i had a pec tear that required surgery, i would like them to use PRP.

 

[drusso]

Randomized Controlled Trial BMC Musculoskelet Disord. 2022 Nov 4;23(1):954. doi: 10.1186/s12891-022-05906-5.

Comparing efficacy of a single intraarticular injection of platelet-rich plasma (PRP) combined with different hyaluronans for knee osteoarthritis: a randomized-controlled clinical trial

Hung-Ya Huang 1 2, Chien-Wei Hsu 3 4, Guan-Chyun Lin 5, Huey-Shyan Lin 6, Yi-Jiun Chou 7, I-Hsiu Liou 1, Shu-Fen Sun 8 9
Affiliations expand
PMID: 36329428 PMCID: PMC9635114 DOI: 10.1186/s12891-022-05906-5
Free PMC article

Abstract
Background: Intraarticular plasma-rich platelet (PRP) and hyaluronic acid (HA) have each been shown to be effective for treating knee osteoarthritis (OA). Evidence supporting the combination therapy is controversial. This study aimed to investigate the efficacy of a single intraarticular PRP injection combined with different HAs in patients with knee OA.

Methods: In this prospective randomized-controlled trial, 99 patients with Kellgren-Lawrence grade 2 knee OA with average knee pain ≥ 30 mm on a 0-100 mm pain visual analog scale (VAS) were randomized into two groups. The PRP + Artz group received a single intraarticular HA (Artz, 2.5 ml, 10 mg/ml) followed by 3 ml PRP (n = 50). The PRP + HYAJOINT Plus group received a single intraarticular cross-linked HA (HYAJOINT Plus, 3 ml, 20 mg/ml) followed by 3 ml PRP (n = 49). All patients were evaluated before and at 1, 3 and 6 months after injections. The primary outcome was the VAS pain reduction from baseline at 6 months. Secondary outcome measures included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Lequesne index, single leg stance (SLS) test and patient satisfaction.

Results: Ninety-five patients were analyzed by intention-to-treat analysis. Both groups improved significantly in VAS pain, WOMAC, Lequesne index and SLS at 1, 3 and 6 months post intervention (p < 0.05). Between-group comparisons showed no significant differences at most follow-up time points, except better improvements in Lequesne index at 1 month (p = 0.003) and WOMAC-stiffness score at 6 months (p = 0.020) in the PRP + Artz group, and superiority in SLS at 1, 3 and 6 months in the PRP+ HYAJOINT Plus group (p < 0.001, p = 0.003 and p = 0.004). Additional Johnson-Neyman analyses showed that among the patients with baseline WOMAC-pain score > 8.5, WOMAC-function score > 21.7 and WOMAC-total score > 32.0, respectively, those treated with PRP + HYAJOINT Plus injections had better effects in WOMAC-pain, WOMAC-function and WOMAC-total scores than those treated with PRP + Artz at 3 months postinjection (p < 0.05). Both groups reported high satisfaction. No serious adverse events occurred during the study.

Conclusions: A single PRP injection combined with Artz or HYAJOINT Plus is effective and safe for 6 months in patients with knee OA. Both injection regimens are potential treatment options for knee OA. Further studies are needed to confirm these results.

Trial registration: The study was registered at ClinicalTrials.gov (NCT04931719), retrospectively. Date of registration 18/6/2021.

Name of trial registry: Comparing efficacy of single PRP combined with different hyaluronans for knee osteoarthritis.

Level of evidence: Therapeutic Level 1.

Keywords: Hyaluronic acid; Intraarticular injection; Knee osteoarthritis; Platelet-rich plasma.

 

[Ducttape]

So... what exactly does this study show?


was it the PRP, the type of hyaluronidase, or the injection itself, or some other factor that made these ppl feel better for 3 to 6 months after injection?

All you can say is that the 2 protocols give similar results.

 

[drusso]

So... what exactly does this study show?


was it the PRP, the type of hyaluronidase, or the injection itself, or some other factor that made these ppl feel better for 3 to 6 months after injection?

All you can say is that the 2 protocols give similar results.

The benefit of adding HA to PRP is disputed. But clinically, I see better results. Some people think that certain brands of HA are better than others. Some people think certain kinds of PRP are better than others. Your mileage may vary. It's personalized care.

Science advances slowly in the absence of Big Pharma and Industry sponsored studies.

 

[Ducttape]

you cannot make an assessment of whether hyaluronidase helps the PRP with this study.

you can say that it seems that the kind may not make a great deal of difference.