Abstract
BackgroundThe use of autologous platelet gel in orthopedics is effective in accelerating the healing process of osteochondral, muscle, tendon and ligament lesions. The aim of our study was to verify whether the variability in response to infiltration with platelet gel was dependent on the underlying disease treated, sex and age of the patients. During four years, 140 patients have been treated for musculoskeletal injuries by infiltration of gel platelet and lysate platelet obtained from autologous thrombin, with echo-ultrasound guided. The response to treatment was assessed at different time points T0, T1, T2 with respect to pain estimation (VAS), joint mobility (ROM scale) and echo-ultrasound evaluation. This data collection has allowed classifying the response to treated lesions in three categories: NR (no response), PR (partial response), CR (complete response).ResultsThe data here reported showed that the ability to physical recovery response is evident in tendon injuries, while the large joints injuries gave a poor response. Almost all patients showed a significant pain relief after the first infiltration, but in terms of echo-ultrasound evaluation and tissue repair, only the muscle and tendon injuries showed hyperechoic areas, signs or evidences of repair. Concerning the correlation between response to infiltration with platelet gel and gender/age of the patients, the clinical results appear not influenced by the age and the gender of the patient.DiscussionOur data indicate that, pain relief and ability to physical recovery of muscles, tendons and ligaments depend on tissue repair clearly visible by echo ultrasound evaluation. On the other hand tissue repair seems not occur in the large joints (hip and knee) where arthritis and /or corrosion of articular cartilage cannot be repaired and the only relief is exclusively linked to the reduction of periarticular inflammation (reduction of the inflammatory leakage and signs).
Highlights
The use of autologous platelet gel in orthopedics is effective in accelerating the healing process of osteochondral, muscle, tendon and ligament lesions
From a first glance of the sample population, the pathologies mostly treated with platelet gel are injuries of the supraspinatus tendon, the gonarthritis and injuries of the Achilles tendon (Figure 1)
There are differences in diseases distribution especially concerning gender: the female population seems more affected by lesions of the large joints and the supraspinatus tendon while other clinical conditions seems to affect more the male population (Figure 2)
Summary
The use of autologous platelet gel in orthopedics is effective in accelerating the healing process of osteochondral, muscle, tendon and ligament lesions. Platelet are the protagonists of the haemostatic process, but plays a key role in the inflammatory process (due to high concentrations of proinflammatory and immune-modulatory cytokines), in the antimicrobial defence (since the α- granules are rich in “protein microbicide platelet”, chemokines -CXCL4, thymosin-β4, derivatives of CXCL7- PBP, CTAP - III, NAP- 2 and CCL5 -6 and complement proteins), in cell replication (mitogenesis), in angiogenesis and, last but not least, actively modulate tissue regeneration These activities are possible because platelet precursors, megakaryocytes, actively produce growth factors (VEGF, PDGF, FGF, EGF, HGF, IGF) responsible for endothelial and fibroblasts cells permeability, recruitment and proliferation [2,3,4,5,6]. Several studies show that in reconstructive orthopaedic surgery, the application of platelet gel combined with the bone matrix apposition, confirmed the ability of platelet growth factors to determine bone regeneration, and provide the regenerative stimulus to autologous bone used as a filler and source of osteoblasts [7,8,9]
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