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drusso said:

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.


View attachment 390949

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.
Click to expand...
Either the graph is mislabeled or it shows that there was more improvement in VAS in the corticosteroid group…
 
the study seems relatively well done.

double blinded.

did use VAS but the other endpoints speak to better results with PRP.


but like lobel mentioned - steroids dont last for a year.

its kind of specious to state that ESI should be offered but hey they only last 3 months then turn around and say dont do steroid injections for tendinopathy because they only last 3 months.

i guess if the 28 year old were to only get 1 injection, then yes a PRP is the way to go.

now to find a way so they can afford the injection....
 
Ducttape said:
the study seems relatively well done.

double blinded.

did use VAS but the other endpoints speak to better results with PRP.


but like lobel mentioned - steroids dont last for a year.

its kind of specious to state that ESI should be offered but hey they only last 3 months then turn around and say dont do steroid injections for tendinopathy because they only last 3 months.

i guess if the 28 year old were to only get 1 injection, then yes a PRP is the way to go.

now to find a way so they can afford the injection....
Click to expand...
Vote Kamala: Then everything is free.
 
Ducttape said:
the study seems relatively well done.

double blinded.

did use VAS but the other endpoints speak to better results with PRP.


but like lobel mentioned - steroids dont last for a year.

its kind of specious to state that ESI should be offered but hey they only last 3 months then turn around and say dont do steroid injections for tendinopathy because they only last 3 months.

i guess if the 28 year old were to only get 1 injection, then yes a PRP is the way to go.

now to find a way so they can afford the injection....
Click to expand...

PRP is not that expensive. Plenty of docs outside of metro core do PRP for $700.

That’s $424 in 2004 dollars.

$700 just seems expensive because inflation is out of control due to democrat policies destroying the economy the past 4 years.

If someone really needs something they can get a weekend job for a couple weekends and then freaking pay for it themselves instead of whining that all of life should be free, and given to them with no effort on their part.

That is the key difference between liberals and conservatives.
 
Last edited:
Ducttape said:
its kind of specious to state that ESI should be offered but hey they only last 3 months then turn around and say dont do steroid injections for tendinopathy because they only last 3 months.
Click to expand...

I know you know the pathophysiology is different between the anatomical structures
 
bedrock said:
PRP is not that expensive. Plenty of docs outside of metro core do PRP for $700.

That’s $424 in 2004 dollars.

$700 just seems expensive because inflation is out of control due to democrat policies destroying the economy the past 4 years.
Click to expand...
ugh. you were doing so well until you added politics to this.


but if you want to phrase it that way, according to you, things were a lot worse during the trump era...

300 is really cheap for PRP. In LA most docs, particularly ortho charge $1200.

I’m the cheapest as I do I for $975
Click to expand...
July 21, 2020
forums.studentdoctor.net

Are you happy in pain?

Im a jr member of the evidence analysis committee. Studies are underway...lutz, wu, etc. Wu or Qu? Sent from my iPhone using SDN mobile
forums.studentdoctor.net forums.studentdoctor.net



If someone really needs something they can get a weekend job for a couple weekends and then freaking pay for it themselves instead of whining that all of life should be free, and given to them with no effort on their part.

That is the key difference between liberals and conservatives
Click to expand...
people cannot afford $700 or $800. asking them to work, on top of their full time job(s) 2 weekends - essentially no days off for 2 weeks probably at the job that is contributing to their pain is, well, perturbing...

you clearly do not know how 3/4 of america lives....
 
Ducttape said:
ugh. you were doing so well until you added politics to this.


but if you want to phrase it that way, according to you, things were a lot worse during the trump era...


July 21, 2020
forums.studentdoctor.net

Are you happy in pain?

Im a jr member of the evidence analysis committee. Studies are underway...lutz, wu, etc. Wu or Qu? Sent from my iPhone using SDN mobile
forums.studentdoctor.net forums.studentdoctor.net




people cannot afford $700 or $800. asking them to work, on top of their full time job(s) 2 weekends - essentially no days off for 2 weeks probably at the job that is contributing to their pain is, well, perturbing...

you clearly do not know how 3/4 of america lives....
Click to expand...
Porsche Syndrome: Cannot hear the problems of others at 8000rpm.
 
Ducttape said:
ugh. you were doing so well until you added politics to this.


but if you want to phrase it that way, according to you, things were a lot worse during the trump era...


people cannot afford $700 or $800. asking them to work, on top of their full time job(s) 2 weekends - essentially no days off for 2 weeks probably at the job that is contributing to their pain is, well, perturbing...

you clearly do not know how 3/4 of america lives....
Click to expand...

I know how 2/3 of america lives buddy. I grew up as very poor rural community. Started my first job when I was 13, getting up at dawn. You can stuff your simplistic, elitist views into a dark place

If you think the finances of the average american was on average better during the Trump years vs the Biden years, you are either illiterate or blind.

None of the people coddled by you Democrats are "working two jobs". They're not even working one job because they are living off the government. You liberals lack the cajones to even require part time work by people on medicaid and fight it at every turn, because you insist on treating a huge segment of the adult US population, like they are helpless children.

democrats-energycommerce.house.gov

House Democrats Oppose Unlawful Medicaid Work Requirements |

House Democrats sent a letter to Secretary of Health and Human Services Azar expressing their unified opposition to the Trump Administration’s actions that will allow, for the first time in the history of the Medicaid program, a work requirement as a condition of coverage.
democrats-energycommerce.house.gov democrats-energycommerce.house.gov
House Democrats Oppose Unlawful Medicaid Work Requirements |

A Snapshot of State Proposals to Implement Medicaid Work Requirements Nationwide - NASHP

Democrats are blocking at every turn, requiring any kind of personal responsibility or personal effort from our citizens. You'd prefer to burn large sums of government money, and create every program possible to to coddle the US population........"as long as they vote correctly"

Western liberals are actively doing their modern version of bread and circuses!
 
bedrock said:
I know how 2/3 of america lives buddy. I grew up as very poor rural community. Started my first job when I was 13, getting up at dawn. You can stuff your simplistic, elitist views into a dark place

If you think the finances of the average american was on average better during the Trump years vs the Biden years, you are either illiterate or blind.

None of the people coddled by you Democrats are "working two jobs". They're not even working one job because they are living off the government. You liberals lack the cajones to even require part time work by people on medicaid and fight it at every turn, because you insist on treating a huge segment of the adult US population, like they are helpless children.

democrats-energycommerce.house.gov

House Democrats Oppose Unlawful Medicaid Work Requirements |

House Democrats sent a letter to Secretary of Health and Human Services Azar expressing their unified opposition to the Trump Administration’s actions that will allow, for the first time in the history of the Medicaid program, a work requirement as a condition of coverage.
democrats-energycommerce.house.gov democrats-energycommerce.house.gov
House Democrats Oppose Unlawful Medicaid Work Requirements |

A Snapshot of State Proposals to Implement Medicaid Work Requirements Nationwide - NASHP

Democrats are blocking at every turn, requiring any kind of personal responsibility or personal effort from our citizens. You'd prefer to burn large sums of government money, and create every program possible to to coddle the US population........"as long as they vote correctly"

Western liberals are actively doing their modern version of bread and circuses!
Click to expand...
if you dont think that "people coddled by you democrats" dont work, you again demonstrate you do not know how 2/3 of america lives.


42% of Medicaid recipients report that they are working, and 23% report that they have a disability. the majority of the remainder are caretakers of dependent children.



and once and for all, i am not democrat, have never been a registered democrat.

your post was just political biased mumbo jumbo that has been rehashed on multiple political threads. this one is on regenerative medicine. drusso needs his forum thread...
 
Ducttape said:
if you dont think that "people coddled by you democrats" dont work, you again demonstrate you do not know how 2/3 of america lives.


42% of Medicaid recipients report that they are working, and 23% report that they have a disability. the majority of the remainder are caretakers of dependent children.



and once and for all, i am not democrat, have never been a registered democrat.

your post was just political biased mumbo jumbo that has been rehashed on multiple political threads. this one is on regenerative medicine. drusso needs his forum thread...
Click to expand...


"This study will provide the first scientifically based data on whether health disparities exist among patients seeking next-generation regenerative interventions such as platelet-rich plasma," says Dr. Master. "The results will give us the unique opportunity to identify factors that are creating barriers to regenerative care and proactively address ways to overcome them."

Here's a summary of the differences in costs:

  1. ACL Reconstruction:
    • The study on pediatric ACL reconstruction found significant cost variability, with prices ranging from approximately $25,207 to $41,812. The average cost was $29,590, with top-ranked hospitals generally charging more than non-top-ranked hospitals. Additionally, obtaining price estimates was challenging, with only 30.3% of hospitals providing complete price information. Self-pay discounts were available in some cases, potentially reducing costs significantly.
  2. Knee Arthroplasty:
    • The study analyzing total joint arthroplasty (including knee arthroplasty) revealed a wide range of costs. The median price for a major hip or knee arthroplasty without complications was $68,016, with a range from $39,927 to $195,264. Revision procedures were even more expensive, with a median cost of $90,966 and a range from $58,967 to $247,715. The study found little correlation between procedure pricing and the cost of living or median income in the hospital's location.
  3. PRP Injections:
    • PRP injections for knee osteoarthritis also showed substantial cost variability. The cost ranged from $350 to $2,815 per injection, with a median price of $800. The highest prices were found in the Northeast, and there was significant price variation even within metropolitan areas.

Clin Orthop Relat Res. 2024 Apr 1;482(4):675-684.
doi: 10.1097/CORR.0000000000002864. Epub 2023 Oct 9.

There Is Wide Variation in Platelet-rich Plasma Injection Pricing: A United States Nationwide Study of Top Orthopaedic Hospitals​

Justin Tiao 1, Kevin Wang 1, Michael Herrera 1, Renee Ren 1, Ashley M Rosenberg 1, Richawna Cassie 1, Jashvant Poeran 1 2
Affiliations Expand

Abstract​

Background: Demand for platelet-rich plasma (PRP) injections for osteoarthritis has dramatically increased in recent years despite conflicting evidence regarding its efficacy and highly variable pricing in the top orthopaedic centers in the United States, because PRP is typically not covered by insurance. A previous study investigating the mean price of PRP injections obtained information only from centers advertising online the availability of PRP injections. Thus, there is a need for further clarification of the overall availability and variability in cost of PRP injections in the orthopaedic community as well as an analysis of relevant regional demographic and hospital characteristics that could be associated with PRP pricing.
Questions/purposes: Our study purposes were to (1) report the availability and price variation of knee PRP injections at top-ranked United States orthopaedic centers, (2) characterize the availability of pricing information for a PRP injection over the telephone, (3) determine whether hospital characteristics (Orthopaedic Score [ U . S. News & World Report measure of hospital orthopaedic department performance], size, teaching status, and rural-urban status) were associated with PRP injection availability and pricing, and (4) characterize the price variation, if it exists, of PRP injections in three metropolitan areas and individual institutions.
Methods: In this prospective study, a scripted telephone call to publicly listed clinic telephone numbers was used to determine the availability and price estimate (amount to be paid by the patient) of a PRP injection for knee osteoarthritis from the top 25 hospitals from each United States Census region selected from the U.S. News & World Report ranking of best hospitals for orthopaedics. Univariable analyses examined factors associated with PRP injection availability and willingness to disclose pricing, differences across regions, and the association between hospital characteristics (Orthopaedic Score, size, teaching status, and rural-urban status) and pricing. The Orthopaedic Score is a score assigned to each hospital by U . S. News & World Report as a measure of hospital performance based partly on patient outcomes, with higher scores indicating better outcomes.
Results: Overall, 87% (87 of 100) of respondents stated they offered PRP injections. Pricing ranged from USD 350 to USD 2815 (median USD 800) per injection, with the highest prices in the Northeast. The largest price range was in the Midwest, where more than two-thirds of PRP injections given at hospitals that disclosed pricing cost USD 500 to USD 1000. Of the hospitals that offered PRP injections, 68% (59 of 87) were willing to disclose price information over the telephone. PRP injection pricing was inversely correlated with hospital Orthopaedic Score (-3% price change [95% CI -5% to -1%]; p = 0.01) and not associated with any of the other hospital characteristics that were studied, such as patient population median income and total hospital expenses. An intracity analysis revealed wide variations in PRP pricing in all metropolitan areas that were analyzed, ranging from a minimum of USD 300 within 10 miles of metropolitan area B to a maximum of USD 1269 within 20 miles of metropolitan area C.
Conclusion: We found that although PRP injections are widely available, pricing continues to be a substantial financial burden on patients, with large price variability among institutions. We also found that if patients are willing to shop around in a metropolitan area, there is potential to save a meaningful amount of money.
Clinical relevance: As public interest in biologics in orthopaedic surgery increases, knowledge of its pricing should be clarified to consumers. The debated efficacy of PRP injections, combined with our findings that it is an expensive out-of-pocket procedure, suggests that PRP has limited cost-effectiveness, with variable, discrete pricing. As such, the price of PRP injections should be clearly disclosed to patients so they can make informed healthcare decisions.
Copyright © 2023 by the Association of Bone and Joint Surgeons.

Sports Health. 2020 Jan/Feb;12(1):94-98.
doi: 10.1177/1941738119880256. Epub 2019 Oct 30.

The Cost Variability of Orthobiologics​

Amit Mukesh Momaya 1, Andrew Sullivan McGee 1, Alexander R Dombrowsky 1, Alan Joshua Wild 2, Naqeeb M Faroqui 3, Raymond P Waldrop 1, Jun Kit He 1, Eugene W Brabston 1, Brent Andrew Ponce 1
Affiliations Expand

Abstract​

Background: Mixed results exist regarding the benefit of orthobiologic injections. The purpose of this study was to assess the variability in costs for platelet-rich plasma (PRP) and stem cell (SC) injections and evaluate for variables that influence pricing.
Hypothesis: There will be significant variability in the cost of PRP and SC injections throughout the United States.
Study design: Descriptive epidemiology study.
Level of evidence: Level 3.
Methods: Calls were made to 1345 orthopaedic sports medicine practices across the United States inquiring into the availability of PRP or SC knee injections and associated costs. In addition to pricing, the practice type, number of providers, and population and income demographics were recorded. Univariate statistical analyses were used to identify differences in availability and cost between variables.
Results: Of the contacted offices that provided information on both PRP and SC availability (n = 1325), 268 (20.2%) offered both treatments, 550 (41.5%) offered only PRP injections, 20 (1.5%) offered only SC injections, and 487 (36.8%) did not offer either treatment. The mean ± SD cost of a PRP injection was $707 ± $388 (range, $175-$4973), and the mean cost of an SC injection was $2728 ± $1584 (range, $300-$12,000). Practices offering PRP and SC injections tended to be larger (PRP, 12.0 physicians per practice vs. 8.1 [P < 0.001]; SC, 13.6 vs 9.7 [P < 0.001]). Practices that offered PRP injections were located in areas with higher median household income (P = 0.047). Variables associated with higher cost of PRP injections included city population (P < 0.001) and median income of residents (P < 0.001).
Conclusion: While the majority of sports medicine practices across the United States offer some type of orthobiologic injection, there exists significant variability in the cost of these injections.
Clinical relevance: This study demonstrates the significant variability in costs of orthobiologic injections throughout the country, which will allow sports medicine physicians to appreciate the value of these injections when counseling patients on available treatment options.
Keywords: cost; injections; orthobiologics; platelet-rich plasma; variability.

J Pediatr Orthop. 2022 Nov-Dec;42(10):614-620.
doi: 10.1097/BPO.0000000000002254. Epub 2022 Aug 25.

How Much Will My Child's ACL Reconstruction Cost? Availability and Variability of Price Estimates for Anterior Cruciate Ligament Reconstruction in the United States​

Julianna Lee 1, Ryan H Guzek, Neal S Shah, J Todd R Lawrence, Theodore J Ganley, Apurva S Shah
Affiliations Expand

Abstract​

Background: Despite recent policy efforts to increase price transparency, obtaining estimated prices for surgery remains difficult for most patients and families.
Purpose: Assess availability and variability of cost and self-pay discounts for pediatric anterior cruciate ligament (ACL) reconstruction in the United States.
Methods: This was a prospective study using scripted telephone calls to obtain price estimates and self-pay discounts for pediatric ACL reconstruction. From July to August 2020, investigators called 102 hospitals, 51 "top-ranked" pediatric orthopaedic hospitals and 51 "non-top ranked" hospitals randomly selected, to impersonate the parent of an uninsured child with a torn ACL. Hospital, surgeon, and anesthesia price estimates, availability of a self-pay discount, and number of calls and days required to obtain price estimates were recorded for each hospital. Hospitals were compared on the basis of ranking, teaching status, and region.
Results: Only 31/102 (30.3%) hospitals provided a complete price estimate. Overall, 52.9% of top-ranked hospitals were unable to provide any price information versus 31.4% of non-top-ranked hospitals ( P =0.027). There was a 6.1-fold difference between the lowest and highest complete price estimates (mean estimate $29,590, SD $14,975). The mean complete price estimate for top-ranked hospitals was higher than for non-top-ranked hospitals ($34,901 vs. $25,207; P =0.07). The mean complete price estimate varied significantly across US region ( P =0.014), with the greatest mean complete price in the Northeast ($41,812). Altogether, 38.2% hospitals specified a self-pay discount, but only a fraction disclosed exact dollar or percentage discounts. The mean self-pay discount from top-ranked hospitals was larger than that of non-top-ranked hospitals ($18,305 vs. $9902; P =0.011). An average of 3.1 calls (range 1.0 to 12.0) over 5 days (range 1 to 23) were needed to obtain price estimates.
Conclusion: Price estimates for pediatric sports medicine procedures can be challenging to obtain, even for the educated consumer. Top-ranked hospitals and hospitals in the Northeast region may charge more than their counterparts. In all areas, self-pay discounts can be substantial if they can be identified but they potentially create an information disadvantage for unaware patients needing to pay out-of-pocket.
Study design: Economic; Level of Evidence II.

J Am Acad Orthop Surg Glob Res Rev. 2023 Sep 7;7(9):e23.00052.
doi: 10.5435/JAAOSGlobal-D-23-00052. eCollection 2023 Sep 1.

Large Variation in Listed Chargemaster Price for Total Joint Arthroplasty Among Top Orthopaedic Hospitals in the United States​

Jordan R Pollock 1, Matthew K Doan, M Lane Moore, Jack M Haglin, Jaymeson R Arthur, David G Deckey, Karan A Patel, Joshua S Bingham
Affiliations Expand

Abstract​

Background: Chargemasters are lists of all services offered by a hospital and their associated cost. This study analyzes chargemaster data to determine price differences among different hospitals for total joint arthroplasty.
Methods: In May 2020, the chargemaster data for highly rated orthopaedic hospitals were accessed, and the diagnostic-related group (DRG) codes related to primary and revision total joint arthroplasty were analyzed (DRGs 466, 467, 468, 469, and 470). The prices listed for each hospital were averaged, and descriptive statistics were calculated. Furthermore, Medicare reimbursement was collected. A subanalysis was performed to determine relationships between geographic and demographic information.
Results: The median price for a major hip or knee joint arthroplasty without complications was $68,016 (range: $39,927 to $195,264). The median price of a revision of hip or knee arthroplasty without complications was $90,966 (range: $58,967 to $247,715). The cost of living in the city in which the hospitals are located was weakly correlated with procedure pricing, whereas the median income had no notable relationship to chargemaster pricing.
Conclusion: The published cost of DRG codes in arthroplasty is widely variable among the top 20 US orthopaedic hospitals, with little correlation to the cost of living or median income of the area.
 
Conclusion: We found that although PRP injections are widely available, pricing continues to be a substantial financial burden on patients, with large price variability among institutions. We also found that if patients are willing to shop around in a metropolitan area, there is potential to save a meaningful amount of money.


the high cost of surgery is not to be ignored, but insurance may cover a significant portion of surgery where orthobiologics thus far are rarely covered. none of these studies really compare out of pocket cost to the patient between the various interventions.

and if someone told me, back in the day, that a PRP injection would repair my completely torn ACL, i would have doubts about his claim...
 
Ducttape said:
Conclusion: We found that although PRP injections are widely available, pricing continues to be a substantial financial burden on patients, with large price variability among institutions. We also found that if patients are willing to shop around in a metropolitan area, there is potential to save a meaningful amount of money.


the high cost of surgery is not to be ignored, but insurance may cover a significant portion of surgery where orthobiologics thus far are rarely covered. none of these studies really compare out of pocket cost to the patient between the various interventions.

and if someone told me, back in the day, that a PRP injection would repair my completely torn ACL, i would have doubts about his claim...
Click to expand...

www.ncbi.nlm.nih.gov

Nanosurgical and Bioengineering Treatment of Human Anterior Cruciate Ligament Tears with Ultrasound-Guided Injection of Modified Platelet-Rich Plasma Using Human Cell Memory Based on Clinical, Ultrasound, MRI, and Nanoscope Analyses: A Double-Blind R

Background: Anterior cruciate ligament (ACL) tears account for 40% to 50% of all ligamentous knee injuries. Most patients with ACL ruptures undergo surgical treatment. There is currently no objective, well-documented, repeatable, and standardized nonsurgical ...
www.ncbi.nlm.nih.gov www.ncbi.nlm.nih.gov
 
read it another way - PRP by itself doesnt work. need the nanobots i mean nanosurgery cells.

in truth, basically PRP with growth hormone added in to the mix but injected specifically in to the remnants of the ACL.


concerns:

very small group size.

these were all slender patients with BMIs of 23 and 24.

Based on the literature, a PRP injection inside the joint capsule has no effect on ACL healing [16,17,18].
Click to expand...

primarily 12 week follow up.

however, "nanoscopy" suggests that these ACLs healed.


This study has a limitation. Although the follow-up in the study group was 54.5 months, we did not compare the treatment group to a patient group that underwent ACL reconstructive surgery, but this is a reason to undertake another study. Another limitation is the lack of stratification based on sex and age. Nonetheless, the surgical treatment outcomes remain consistent across sexes and among patients aged 17 to 40 years.
Click to expand...

it also needs a bit more research. N=17. a good preliminary study that should be confirmed.
 

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lobelsteve said:
With the KOLs as authors, it loses its luster on the face of it. 3-4 guys on there that cannot be trusted.
God I miss Nik.
Click to expand...

Do you know what we need? We need a "regen" procedure for VCF. Something where we put the bone back into the bone. Imagine like "anal beads for your back."

That would be cool...
 
Neuromodulation. 2021 Dec;24(8):1451-1457. doi: 10.1111/ner.13105. Epub 2020 Feb 6.

Pulsed Radiofrequency Neuromodulation Contributes to Activation of Platelet-Rich Plasma in In Vitro Conditions

Anna Michno 1, Zbigniew Kirkor 2, Ewelina Gojtowska 1, Marek Suchorzewski 3, Irmina Śmietańska 3, Bartosz Baścik 4
Affiliations Expand
PMID: 32027438 DOI: 10.1111/ner.13105

Abstract
Objectives: Recent years have brought new developments in interventional chronic pain management, namely regenerative orthopedics utilizing platelet-rich plasma (PRP) as well as further evolution of pulsed radiofrequency neuromodulation (PRF). Both methods have been used separately. Here, we investigated whether PRF may potentiate the activation of platelets in PRP samples when both these techniques are combined together in in vitro conditions.

Materials and methods: Studies were performed on concentrated PRP samples (PRPs) obtained from acid citrate dextrose-treated blood taken from 11 healthy volunteers. PRPs were divided into four groups: 1) nonactivated PRP; 2) thrombin-activated PRP as a positive control for maximal platelets activation; 3) PRF-treated PRP exposed for 20 min to PRF energy generated by neurotherm radio frequency generator at 500 kHz, with a voltage of 40 V and maximal temperature of 42°C; and 4) a combination of groups 2 and 3.

Results: PRF-induced platelet activation measured by platelet factor 4 (PF4) and ATP release from PRPs was significantly higher compared to nonactivated PRPs, and similar to PF4 and ATP release from thrombin-activated PRPs. Thrombin activation did not potentiate PF4 release in PRF samples and even reduced ATP level. Additionally, PRF neither induced any platelet membrane damage measured by lactic dehydrogenase release from PRP nor modified any platelets viability or metabolism measured by MTT.

Conclusions: We confirmed that PRF may activate PRP without additional platelet activators. So, a combination of both methods PRF and PRP application may provide a more effective opportunity for tissue regeneration in dentistry, surgery, dermatology, or in orthopedics.

Keywords: Chronic pain; platelet activation; platelet-rich plasma; pulsed radiofrequency neuromodulation; regenerative treatment.
 
What really gets me is that his chief complaint from his CIDP neuropathy was not pain, but weakness in his legs. And no one thought to tell him to get a stationary bike and start building his muscle with exercise and protein.
 
Agast said:
My patient paid $42,500 for someone in California to administer 96 stem cell injections into his arms and legs. It did not work. I think he could technically afford it…
Click to expand...
Was not me
 
drusso said:
Neuromodulation. 2021 Dec;24(8):1451-1457. doi: 10.1111/ner.13105. Epub 2020 Feb 6.

Pulsed Radiofrequency Neuromodulation Contributes to Activation of Platelet-Rich Plasma in In Vitro Conditions

Anna Michno 1, Zbigniew Kirkor 2, Ewelina Gojtowska 1, Marek Suchorzewski 3, Irmina Śmietańska 3, Bartosz Baścik 4
Affiliations Expand
PMID: 32027438 DOI: 10.1111/ner.13105

Abstract
Objectives: Recent years have brought new developments in interventional chronic pain management, namely regenerative orthopedics utilizing platelet-rich plasma (PRP) as well as further evolution of pulsed radiofrequency neuromodulation (PRF). Both methods have been used separately. Here, we investigated whether PRF may potentiate the activation of platelets in PRP samples when both these techniques are combined together in in vitro conditions.

Materials and methods: Studies were performed on concentrated PRP samples (PRPs) obtained from acid citrate dextrose-treated blood taken from 11 healthy volunteers. PRPs were divided into four groups: 1) nonactivated PRP; 2) thrombin-activated PRP as a positive control for maximal platelets activation; 3) PRF-treated PRP exposed for 20 min to PRF energy generated by neurotherm radio frequency generator at 500 kHz, with a voltage of 40 V and maximal temperature of 42°C; and 4) a combination of groups 2 and 3.

Results: PRF-induced platelet activation measured by platelet factor 4 (PF4) and ATP release from PRPs was significantly higher compared to nonactivated PRPs, and similar to PF4 and ATP release from thrombin-activated PRPs. Thrombin activation did not potentiate PF4 release in PRF samples and even reduced ATP level. Additionally, PRF neither induced any platelet membrane damage measured by lactic dehydrogenase release from PRP nor modified any platelets viability or metabolism measured by MTT.

Conclusions: We confirmed that PRF may activate PRP without additional platelet activators. So, a combination of both methods PRF and PRP application may provide a more effective opportunity for tissue regeneration in dentistry, surgery, dermatology, or in orthopedics.

Keywords: Chronic pain; platelet activation; platelet-rich plasma; pulsed radiofrequency neuromodulation; regenerative treatment.
Click to expand...
Platelets naturally activate too…
 
www.nature.com

Stem cells reverse woman’s diabetes — a world first

Patient is the first person with type 1 diabetes to receive this kind of transplant.
www.nature.com www.nature.com

"In June 2023, in an operation that lasted less than half an hour, they injected the equivalent of roughly 1.5 million islets into the woman’s abdominal muscles — a new site for islet transplants. Most islet transplants are injected into the liver, where the cells cannot be observed. But by placing them in the abdomen, the researchers could monitor the cells using magnetic resonance imaging, and potentially remove them if needed."
 
drusso said:
www.nature.com

Stem cells reverse woman’s diabetes — a world first

Patient is the first person with type 1 diabetes to receive this kind of transplant.
www.nature.com www.nature.com

"In June 2023, in an operation that lasted less than half an hour, they injected the equivalent of roughly 1.5 million islets into the woman’s abdominal muscles — a new site for islet transplants. Most islet transplants are injected into the liver, where the cells cannot be observed. But by placing them in the abdomen, the researchers could monitor the cells using magnetic resonance imaging, and potentially remove them if needed."
Click to expand...
 
Dose matters...Just say "no" to weak sauce, ghetto juice PRP.

pubmed.ncbi.nlm.nih.gov

The Effect of Platelet Dose on Outcomes after Platelet Rich Plasma Injections for Musculoskeletal Conditions: A Systematic Review and Meta-Analysis - PubMed

Notable heterogeneity exists in the literature regarding platelet dosage. Clinical studies indicate that a higher dosage may lead to improved outcomes concerning pain relief, functional improvement, and chondroprotection in knee osteoarthritis (OA). However, the impact of dosing on other...
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

Curr Rev Musculoskelet Med. 2024 Sep 27.
doi: 10.1007/s12178-024-09922-x. Online ahead of print.

The Effect of Platelet Dose on Outcomes after Platelet Rich Plasma Injections for Musculoskeletal Conditions: A Systematic Review and Meta-Analysis​

William Berrigan 1, Frances Tao 2 3, Joel Kopcow 4, Anna L Park 4, Isabel Allen 5, Peggy Tahir 4, Aakash Reddy 6, Zachary Bailowitz 2 7 8
Affiliations Expand

Abstract​

Purpose of review: This study aims to systematically review platelet dosage in platelet rich plasma (PRP) injections for common musculoskeletal conditions.
Recent findings: Notable heterogeneity exists in the literature regarding platelet dosage. Clinical studies indicate that a higher dosage may lead to improved outcomes concerning pain relief, functional improvement, and chondroprotection in knee osteoarthritis (OA). However, the impact of dosing on other musculoskeletal pathologies remains uncertain. Our investigation identifies a potential dose-response relationship between platelet dose and PRP effectiveness for knee OA treatment, pinpointing an optimal threshold of greater than 10 billion platelets for favorable clinical outcomes. Notably, this effect appears more pronounced for functional outcomes than for pain relief. For other conditions, a lower dosage may suffice, although the existing literature lacks clarity on this matter. PRP dosage may significantly influence treatmentoutcomes, particularly in knee OA. Further research is warranted to elucidate optimal dosages for varying conditions.
Keywords: Osteoarthritis (OA); Platelet dosage; Platelet dosing; Platelet rich plasma (PRP); Tendinopathy.
 

Microfragmented Adipose Tissue Injection Reduced Pain Compared With a Saline Control Among Patients With Symptomatic Osteoarthritis of the Knee During 1-Year Follow-Up: A Randomized Controlled Trial​

Author links open overlay panelDustin L. Richter M.D. a, Joshua L. Harrison M.D. b, Lauren Faber M.D. c, Samuel Schrader M.D. d, Yiliang Zhu Ph.D. e, Carina Pierce a, Leorrie Watson a, Anil K. Shetty M.D. b, Robert C. Schenck Jr. M.D. a
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Purpose​

To evaluate the effectiveness of microfragmented adipose tissue (MFAT) for pain relief and improved joint functionality in osteoarthritis (OA) of the knee in a randomized controlled clinical trial with 1-year follow-up.

Methods​

Seventy-five patients were stratified by baseline pain level and randomized to 1 of 3 treatment groups: MFAT, corticosteroid (CS), or saline control (C) injection. Patients 18 years of age or older, diagnosed with symptomatic OA of the knee, with radiographic evidence of OA of the knee and a visual analog pain scale score of 3 of 10 or greater were included. Patients were excluded if they had any previous intra-articular knee injection, current knee ligamentous instability, or an allergy to lidocaine/corticosteroid. The visual analog pain scale, Western Ontario and McMaster Universities Osteoarthritis Index, and the Knee Injury and Osteoarthritis Outcome score (KOOS) were recorded preprocedure and at 2 weeks, 6 weeks, 3 and 6 months, and 1-year follow-up.

Results​

MFAT demonstrated consistent and statistically significant improvements across all primary outcome measures for joint pain and functionality compared with C. For MFAT, there was a significant improvement over baseline at each follow-up, with median (95% confidence interval) KOOS Pain score changes of 18.1 (11.1-26.4) at week 2 to 27.8 (19.4-37.5) at 1 year. For CS, the median KOOS pain score reached a maximum of 22.2 (15.3-30.6) at week 2, only to level off to 13.9 (–2.8 to 29.2), a level not statistically different from baseline, at 1 year. The median changes for C hovered around 6 to 11 points, with statistically significant improvements over baseline indicating a placebo effect. Similar trends were seen for the Western Ontario and McMaster Universities Osteoarthritis Index Pain score and VAS Pain score.

Conclusions​

In this study, MFAT demonstrated a clinically significant improvement in primary outcome scores compared with the C group, whereas the CS group only showed statistically significant improvement compared with the C group at 2 and 6 weeks. This finding indicates that MFAT may be a viable alternative treatment for patients with OA of the knee who fall into the orthopaedic treatment gap.

Level of Evidence​

Level II, partially blinded, randomized controlled clinical trial.
 
Randomized Controlled Trial

Bull Hosp Jt Dis (2013). 2024 Dec;82(4):245-256.

The Effectiveness of Alpha-2-Macroglobulin Injections for Osteoarthritis of the Knee​

Kamali Thompson, Dhruv S Shankar, Shengnan Huang, Thorsten Kirsch, Kirk A Campbell, Guillem Gonzalez-Lomas, Michael J Alaia, Eric J Strauss, Laith M Jazrawi

  • PMID: 39259950

Abstract​

Background: Intra-articular (IA) injections of plateletrich plasma (PRP) have been increasingly used in the nonoperative treatment of knee osteoarthritis (OA) but have considerable heterogeneity in both formulation and clinical results. Alpha-2-macroglobulin (A2M) is a large plasma protein found in PRP that inhibits cartilage-degrading enzymes and could be an efficacious OA treatment independently. The purpose of this study was to compare the short-term clinical efficacy of IA injection of A2M-rich PRP concentrate to conventionally prepared PRP and corticosteroids in the management of symptomatic knee OA.
Methods: This double-blinded, randomized, controlled clinical trial was conducted at a single medical center with enrollment from June 2018 to May 2019. Subjects with symptomatic Kellgren-Lawrence (KL) grade 2 or 3 knee OA were randomized to IA injection with A2M, PRP, or methylprednisolone (MP) and followed for 12 weeks post-injection. Knee pain and function were assessed at pre-treatment baseline and at 6-week and 12-week followup with patient-reported outcome (PRO) surveys including the visual analog scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, and Tegner score.
Results: Seventy-five subjects were enrolled in the trial, of whom 68 (90.7%) completed the 12-week follow-up. The majority of subjects (73%) were female with a mean age of 59 years (range: 37 to 75 years). There were no significant differences in age (p = 0.30), sex (p = 0.44), or KL grade (p = 0.73) between treatment groups. By 12 weeks postinjection, the A2M group showed significant improvement in VAS, WOMAC, KOOS, and Tegner (p < 0.05), the PRP group showed no significant improvement in any PROs (p > 0.05), and the MP group showed significant improvement in Lysholm only (p = 0.01). However, the changes in PRO scores between baseline and 12-week follow-up did not significantly differ between the three groups (p > 0.05).
Conclusions: Alpha-2-macroglobulin IA injection shows comparable efficacy to PRP and corticosteroids in the treatment of mild-to-moderate knee OA. Alpha-2-macroglobulin treatment resulted in modest improvement in knee pain and function at 6-week follow-up, albeit inconsistently across PRO measures and to a similar degree as PRP and corticosteroids. Given its non-superior short-term efficacy compared to established IA injections, as well as its increased cost of preparation, A2M may not be a justifiable option for routine treatment of knee OA.
 
J Shoulder Elbow Surg. 2024 Aug 3:S1058-2746(24)00544-5.
doi: 10.1016/j.jse.2024.06.012. Online ahead of print.

Subacromial injection of platelet-rich plasma provides greater improvement in pain and functional outcomes compared to corticosteroids at 1-year follow-up: a double-blinded randomized controlled trial​

Luciano Andrés Rossi 1, Rodrigo Brandariz 2, Tomás Gorodischer 2, Pablo Camino 3, Nicolás Piuzzi 4, Ignacio Tanoira 2, Maximiliano Ranalletta 2
Affiliations Expand

Abstract​

Background: Studies evaluating the results of platelet-rich plasma (PRP) for the treatment of rotator cuff tendinopathy 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, and insufficient reporting of PRP preparations. The purpose of this study was to perform a randomized controlled trial (RCT) comparing PRP with standard corticosteroid 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 imaging 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 visual analog scale (VAS) score for pain. Secondary outcomes included changes in American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, Single Assessment Numeric Evaluation (SANE) score, and the Pittsburgh Sleep Quality Index (PSQI). Treatment failure was defined as persistent pain at 3 months that required a subsequent injection.
Results: The mean age was 27.7 years (±7.4). All the patients completed 12 months of clinical follow-up. At 12 months, patients in the PRP group showed a significantly greater improvement in the VAS score than patients in the corticosteroid group: 1.68 (0.6) vs. 2.3 (1.0) (P < .001). As well, at the 12-month follow-up, the 3 scores evaluated were significantly higher in patients treated with PRP than in patients treated with corticosteroid: 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 corticosteroid group (30%) than in the PRP group (12%) (P < .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 the 12-month follow-up. Moreover, the overall failure rate was significantly higher in the corticosteroid group than in the PRP group.
Keywords: Rotator cuff tendinopathy; corticosteroids; image guided; platelet rich plasma; randomized controlled trial; subacromial injections.
Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.
 
drusso said:
Randomized Controlled Trial

Bull Hosp Jt Dis (2013). 2024 Dec;82(4):245-256.

The Effectiveness of Alpha-2-Macroglobulin Injections for Osteoarthritis of the Knee​

Kamali Thompson, Dhruv S Shankar, Shengnan Huang, Thorsten Kirsch, Kirk A Campbell, Guillem Gonzalez-Lomas, Michael J Alaia, Eric J Strauss, Laith M Jazrawi

  • PMID: 39259950

Abstract​

Background: Intra-articular (IA) injections of plateletrich plasma (PRP) have been increasingly used in the nonoperative treatment of knee osteoarthritis (OA) but have considerable heterogeneity in both formulation and clinical results. Alpha-2-macroglobulin (A2M) is a large plasma protein found in PRP that inhibits cartilage-degrading enzymes and could be an efficacious OA treatment independently. The purpose of this study was to compare the short-term clinical efficacy of IA injection of A2M-rich PRP concentrate to conventionally prepared PRP and corticosteroids in the management of symptomatic knee OA.
Methods: This double-blinded, randomized, controlled clinical trial was conducted at a single medical center with enrollment from June 2018 to May 2019. Subjects with symptomatic Kellgren-Lawrence (KL) grade 2 or 3 knee OA were randomized to IA injection with A2M, PRP, or methylprednisolone (MP) and followed for 12 weeks post-injection. Knee pain and function were assessed at pre-treatment baseline and at 6-week and 12-week followup with patient-reported outcome (PRO) surveys including the visual analog scale (VAS) for pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm score, and Tegner score.
Results: Seventy-five subjects were enrolled in the trial, of whom 68 (90.7%) completed the 12-week follow-up. The majority of subjects (73%) were female with a mean age of 59 years (range: 37 to 75 years). There were no significant differences in age (p = 0.30), sex (p = 0.44), or KL grade (p = 0.73) between treatment groups. By 12 weeks postinjection, the A2M group showed significant improvement in VAS, WOMAC, KOOS, and Tegner (p < 0.05), the PRP group showed no significant improvement in any PROs (p > 0.05), and the MP group showed significant improvement in Lysholm only (p = 0.01). However, the changes in PRO scores between baseline and 12-week follow-up did not significantly differ between the three groups (p > 0.05).
Conclusions: Alpha-2-macroglobulin IA injection shows comparable efficacy to PRP and corticosteroids in the treatment of mild-to-moderate knee OA. Alpha-2-macroglobulin treatment resulted in modest improvement in knee pain and function at 6-week follow-up, albeit inconsistently across PRO measures and to a similar degree as PRP and corticosteroids. Given its non-superior short-term efficacy compared to established IA injections, as well as its increased cost of preparation, A2M may not be a justifiable option for routine treatment of knee OA.
Click to expand...
interesting study.

small group. blinded. i find it most interesting that they did find improvement in VAS, WOMAC etc at 12 weeks, yet didnt go blaring that as the final conclusion, but did exhibit extraordinary scientific integrity in deciding that A2M "may not be a justifiable option for routine treatment".
 
Dose matters...

Am J Sports Med. 2024 Nov;52(13):3223-3231.doi: 10.1177/03635465241283463. Epub 2024 Oct 14.

Influence of Platelet Concentration on the Clinical Outcome of Platelet-Rich Plasma Injections in Knee Osteoarthritis​

Angelo Boffa 1, Luca De Marziani 1, Luca Andriolo 1, Alessandro Di Martino 1, Iacopo Romandini 1, Stefano Zaffagnini 1, Giuseppe Filardo 2 3
Affiliations Expand

Abstract​

Background: Platelet-rich plasma (PRP) is one of the most frequently used orthobiologic products for the injection treatment of patients affected by knee osteoarthritis (OA). Some preliminary evidence supports the influence of platelet concentration on patients' clinical outcomes.
Purpose: To analyze if platelet concentration can influence the safety and clinical efficacy of PRP injections for the treatment of patients with knee OA.
Study design: Cohort study; Level of evidence, 3.
Methods: This study consisted of 253 patients with knee OA (142 men, 111 women; mean ± SD age, 54.8 ± 11.4 years; Kellgren-Lawrence grades 1-3) who were treated with 3 intra-articular injections of 5 mL of autologous leukocyte-rich or leukocyte-poor PRP. All patients were prospectively evaluated at baseline and at 2, 6, and 12 months. Patients were clinically assessed thorough the Knee injury and Osteoarthritis Outcome Score (KOOS) subscales and the International Knee Documentation Committee (IKDC) Subjective score. Platelet concentration was correlated with clinical outcome. Further analysis was performed by stratifying patients into 3 groups (homogeneous for OA severity) based on platelet concentration (high, medium, and low). All complications and adverse events were reported, as well as failures.
Results: An overall statistically significant improvement in all clinical scores was documented from baseline to each follow-up evaluation. Platelet concentration positively correlated with clinical outcome. KOOS Pain improved more with higher platelet concentration at 2 months (P = .036; rho = 0.132), 6 months (P = .009; rho = 0.165), and 12 months (P = .014; rho = 0.155). The same trend was shown by the other KOOS subscales and by the IKDC Subjective score, as well as by the comparison of the groups of high-, medium-, and low-platelet PRP. The highest failure rate (15.0%) was found in the low-platelet group as compared with the medium-platelet group (3.3%) and the high-platelet group (3.3%). No differences were observed among the 3 groups in terms of adverse events.
Conclusion: This study demonstrated that platelet concentration influences the clinical outcome of PRP injections in knee OA treatment. PRP with a higher platelet concentration provides a lower failure rate and higher clinical improvement as compared with PRP with a lower platelet concentration, with overall better results up to 12 months of follow-up in patients with knee OA.
Keywords: PRP; concentration; knee; osteoarthritis; platelets.
 
#gamechanger


Am J Sports Med. 2024 Nov;52(13):3212-3222.
doi: 10.1177/03635465241283500. Epub 2024 Oct 12.

Leukocytes Do Not Influence the Safety and Efficacy of Platelet-Rich Plasma Injections for the Treatment of Knee Osteoarthritis: A Double-Blind Randomized Controlled Trial​

Iacopo Romandini 1, Angelo Boffa 1, Alessandro Di Martino 1, Luca Andriolo 1, Annarita Cenacchi 2, Elena Sangiorgi 2, Simone Orazi 1, Valeria Pizzuti 1, Stefano Zaffagnini 1, Giuseppe Filardo 3 4
Affiliations Expand

Abstract​

Background: Platelet-rich plasma (PRP) is increasingly used for the injection treatment of knee osteoarthritis (OA). However, the role of leukocytes contained in PRP is controversial, with some preclinical studies suggesting detrimental effects and others emphasizing their contribution in secreting bioactive molecules.
Purpose: To compare the safety and effectiveness of leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP) for the treatment of knee OA.
Hypothesis: That leukocytes could influence results both in terms of adverse events and clinical outcomes.
Study design: Randomized controlled trial; Level of evidence, 1.
Methods: This double-blind randomized controlled trial included 132 patients with Kellgren-Lawrence grade 1-3 knee OA who were randomized to a 3-injection cycle of either LR-PRP or LP-PRP. Patients were prospectively assessed at baseline and at 2, 6, and 12 months with subjective evaluations comprising the International Knee Documentation Committee (IKDC) subjective score, the KOOS (Knee injury and Osteoarthritis Outcome Score), the WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index), the visual analog scale for pain, the EuroQol-visual analog scale, the EuroQol-5 dimensions, and the Tegner activity scale. Objective evaluations consisted of the IKDC objective score, active/passive range of motion, and circumference of the index and contralateral knees. Patient judgment of the treatment was recorded as well as adverse reactions and failures.
Results: An overall improvement in subjective and objective outcomes was documented, with no differences between the 2 groups, except for the improvement in the IKDC subjective score at 2 months, which was greater for the LR-PRP group compared with the LP-PRP group (14.8 ± 14.8 vs 8.6 ± 13.3, respectively; P = .046), as well as for active (P = .021) and passive (P = .040) ROM of the index knee at 6 months, showing statistically significant higher values in the LP-PRP group; and for quadriceps circumference of the index (P = .042) and contralateral (P = .045) knees at 12 months, which were significantly greater in the LR-PRP group. The IKDC subjective score improved from 42.5 ± 17.6 at baseline to 55.6 ± 21.4 at 12 months for the LR-PRP group (P < .0005) and from 45.7 ± 16.4 to 55.3 ± 20.4 for the LP-PRP group (P = .001). No differences in terms of patient treatment judgment were observed at all follow-up time points. No severe adverse events related to the treatment were reported, but some mild adverse events related to the treatment were observed: 16 in the LR-PRP group and 17 in the LP-PRP group. Treatment failed in 5 patients in the LR-PRP group and 2 in the LP-PRP group.
Conclusion: This double-blind randomized controlled trial demonstrated that leukocytes did not affect the safety and efficacy of intra-articular PRP injections for the treatment of patients with knee OA. Both LR-PRP and LP-PRP demonstrated comparable clinical outcomes at all follow-up time points, without showing differences in subjective and objective outcomes or in adverse events and treatment failures.
Registration: NCT04187183 (ClinicalTrials.gov).
Keywords: injection; intra-articular; knee; leukocytes; osteoarthritis; platelet-rich plasma (PRP).
 
What volumes of PRP do you use for common indications?

1- large joint -knee shoulder hip
2- single tendon- unilateral tennis elbow
3- SIJ
4- glut med/supraspinatus
5- epidural
 
bedrock said:
What volumes of PRP do you use for common indications?

1- large joint -knee shoulder hip
2- single tendon- unilateral tennis elbow
3- SIJ
4- glut med/supraspinatus
5- epidural
Click to expand...

I have a small kit and a large kit, yielding 3.25cc and 7cc.

I mix 0.5-1cc ropivacaine into my PRP, so I have around 4cc and 8cc of injectate.

Shoulders get the whole 8cc, and I usually split 5 glenohumeral, 2 subacromial and 1 either biceps tendon or AC.

Hips usually get 6cc intra articular and 2 at the greater trochanter.

Knee and elbow are 4cc.

SIJ is 2 in the joint and the rest I pepper around the joint.

Greater trochanter 4, and never tried an ESI with PRP and I don’t see why anyone would do that.

Rotator cuff 4.
 
MitchLevi said:
I have a small kit and a large kit, yielding 3.25cc and 7cc.

I mix 0.5-1cc ropivacaine into my PRP, so I have around 4cc and 8cc of injectate.

Shoulders get the whole 8cc, and I usually split 5 glenohumeral, 2 subacromial and 1 either biceps tendon or AC.

Hips usually get 6cc intra articular and 2 at the greater trochanter.

Knee and elbow are 4cc.

SIJ is 2 in the joint and the rest I pepper around the joint.

Greater trochanter 4, and never tried an ESI with PRP and I don’t see why anyone would do that.

Rotator cuff 4.
Click to expand...

We use the same kit.

Question is there no issue with PRP efficacy if mixed with a local anesthetic?

Regarding PRP epidurals-
I just cured a guy last week who had epidural fibrosis with years of chronic radicular pain. He failed 10 different ESI by other docs. He is now 98% better six weeks after a single PRP epidural, and thrilled with his new life.
As I’ve posted previously I’ve also had good success treating symptomatic annular tears with PRP. Only provides a sustained benefit in 70% of patients but those 70% of patients are damn happy.
 
bedrock said:
We use the same kit.

Question is there no issue with PRP efficacy if mixed with a local anesthetic?

Regarding PRP epidurals-
I just cured a guy last week who had epidural fibrosis with years of chronic radicular pain. He failed 10 different ESI by other docs. He is now 98% better six weeks after a single PRP epidural, and thrilled with his new life.
As I’ve posted previously I’ve also had good success treating symptomatic annular tears with PRP. Only provides a sustained benefit in 70% of patients but those 70% of patients are damn happy.
Click to expand...
Ropi (to my knowledge) is fine.

How painful is a PRP ESI?
 
bedrock said:
We use the same kit.

Question is there no issue with PRP efficacy if mixed with a local anesthetic?

Regarding PRP epidurals-
I just cured a guy last week who had epidural fibrosis with years of chronic radicular pain. He failed 10 different ESI by other docs. He is now 98% better six weeks after a single PRP epidural, and thrilled with his new life.
As I’ve posted previously I’ve also had good success treating symptomatic annular tears with PRP. Only provides a sustained benefit in 70% of patients but those 70% of patients are damn happy.
Click to expand...
I can cure cancer with PRP. Step up your game.
 
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