Autologous Platelet-rich Plasma Research Articles

Regenerative endodontic treatment with autologous platelet-rich plasma

Regenerative endodontic treatment with autologous platelet-rich plasma

Innovative approaches to feline mandibular lip avulsion: Integrating autologous platelet rich plasma with surgical management

Innovative approaches to feline mandibular lip avulsion: Integrating autologous platelet rich plasma with surgical management

Comparative efficacy of autologous platelet rich plasma and conventional dressing in the management of chronic ulcers

Background: Chronic ulcers pose a major global healthcare challenge. The use of platelet-rich plasma (PRP) for treating these wounds has garnered interest because of its potential healing benefits. Objective were to determine the effect of autologous PRP therapy on the percentage of surface area reduction/healing in chronic ulcers. Methods: This randomized controlled trial was conducted at the department of general surgery of M.M. institute of medical sciences and research (M.M.I.M.S.R.) Mullana, Ambala from May 1, 2023, to April 30, 2024. Patients aged 18-80 years of either gender with chronic ulcers were enrolled. Patients were randomly allocated to the PRP group and control group. PRP group was administered autologous PRP once in two weeks for 6 weeks after debridement, while for the control group conventional saline dressings were done after debridement. Final assessment was done at 8 weeks. Results: Of the 60 patients, the mean age was 53.90±11.23 years. There were 49 (82%) males and 11 (18%) females. At 8 weeks, the PRP group achieved 83.78% (SD=2.99) reduction in surface area of ulcers, whereas the control group had a 57.78% (SD=1.32) reduction in surface area of ulcers, with a p=0.0000 indicating a significant difference. The small sample size and 56-day follow-up period are insufficient to assess long-term treatment effects. Conclusions: A better outcome of PRP was observed compared to conventional dressing in patients with chronic non-healing ulcers.

Blood Products and Stem Cells in Osteoarthritis Therapy

The principle of regenerative medicine in the treatment of osteoarthritis pursues a functional restoration of cartilage tissue instead of just repairing cartilage defects. The use of blood products is intended to inhibit chronic inflammatory processes and promote tissue regeneration. Intraarticular injection of autologous platelet-rich plasma (PRP) is a prominent procedure. Clinical evidence supports PRP injection over hyaluronic acid or glucocorticoid injection. Comparability of studies is difficult due to missing standardisation of production procedures, dosing and donor variability. In particular, whether presence of residual leukocytes is required or should be avoided is an open debate. In contrast, stem cell therapies in osteoarthritis therapy are often based on mesenchymal stem cells (MSC) from adipose tissue or bone marrow aspirate. Different sources of MSC might render the cells more suitable for application in a given context. Nevertheless, it became evident that their secretome rather than the cells themselves are responsible for observed regenerative processes. Research on the mechanisms of action have focused on growth factors. However, an overlooked component of blood products called extracellular vesicles (EV) came to the center of attention, which are also released by MSC as intercellular signal carriers. EV cargo molecules such as miRNAs open up new dimensions in the investigation and explanation of clinically observed anti-inflammatory and regenerative effects.

A Prospective, Interventional, Comparative Study to Evaluate the Efficacy of Using Combined Platelet-Rich Plasma and Platelet-Rich Fibrin Over Standard Cleaning and Dressing in Chronic Wounds.

Chronic wounds are defined as wounds that have failed to proceed through the orderly process that produces satisfactory anatomic and functional integrity or that have proceeded through the repair process without producing an adequate anatomic and functional result. The majority of wounds that have not healed in three months are considered chronic, although a duration as low as four weeks has been used to indicate chronicity.Our study aimed to compare the efficacy of autologous platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) versus standard cleaning and dressing as a regenerative medicine strategy to promote healing in chronic wounds. A prospective randomized controlled trial was undertaken to test the efficacy of autologous PRPand PRFin the healing of chronic wounds. A series of 60 cases was compiled from patients attending the outpatient department regularly for the management of chronic wounds. A total of 30 cases were randomly chosen for study with autologous PRP and PRF and 30 cases received conventional dressing. The average healing duration in the study was significantly shorter for the PRP & PRF group. The mean healing time for this group was 4.45 weeks (31.2 ± 3.07 days) compared to 9.61 weeks (67.27 ± 9.19 days) for the conventional dressing group. PRP and PRF belong to a new generation of platelet concentrates that help efficaciously for enhanced healing and functional recovery, safely and cost-effectively. They help by shortening the recovery period overall, improving the quality of life of patients, and altogether eliminating the additional morbidity of operative procedures.

The effect of intratesticular autologous platelet-rich plasma injection on sperm retrieval rates and in vitro fertilization outcomes in couples with non-obstructive azoospermia.

To assess the efficacy of intratesticular injection of autologous platelet-rich plasma (PRP) in men with non-obstructive azoospermia (NOA) and a history of failed microdissection-testicular sperm extraction (mTESE) procedures. A prospective case series of a cohort study was conducted involving couples diagnosed with NOA. Patients with at least one failed mTESE procedure were included. Intratesticular PRP injection was performed using a standardized protocol. Follow-up assessments included sperm analysis, hormonal evaluation, and in vitro fertilization (IVF) outcomes. Data from 177 men with NOA were analyzed, with 135 patients meeting eligibility criteria. PRP treatment resulted in positive sperm retrieval rates of 27.5% in patients with one prior failed mTESE procedure and 16.4% in patients with two or more failed attempts. IVF outcomes showed fertilization rates of 86.4% and 100.0% in respective groups, with pregnancy rates of 36.8% and 22.2% per embryo transfer. Histopathological examination post-mTESE revealed varied patterns, including Sertoli cell-only syndrome and maturation arrest. Intratesticular PRP injection shows promise as a potential therapeutic approach for NOA patients with prior failed mTESE procedures, demonstrating improved sperm retrieval rates and favorable IVF outcomes. Further randomized controlled trials are warranted to validate these findings and refine the technique's efficacy in male infertility management to answer the question of whether PRP could significantly improve the second attempt retrieval rate.

Effect of extracorporeal shock wave combined with autologous platelet-rich plasma injection on rotator cuff calcific tendinitis: study protocol for a randomized controlled trial

BackgroundRotator cuff calcific tendinitis (RCCT) is a common shoulder disease whose main symptoms include shoulder pain, limited mobility, and calcification deposits in the shoulder. Traditional treatment methods have certain limitations, so finding new treatment methods has become the focus of research. Extracorporeal shock wave (ESW) and platelet-rich plasma (PRP) treatments have attracted much attention due to their non-invasive and tissue repair-promoting properties; however, the efficacy of their combined treatment in RCCT remains unclear.MethodsThis study is designed as a single-center, assessment-blind, randomized controlled clinical trial with three parallel groups. Sixty subjects will be recruited and randomly divided into the ESW group, PRP group, and ESW combined with PRP group, in a 1:1:1 ratio. The entire intervention period is 4 weeks, and the follow-up period is 4 weeks. Outcomes will be measured at baseline (T0), after 1 week of intervention (T1), after 2 weeks of intervention (T2), after 4 weeks of intervention (T3), and after an additional 4 weeks of follow-up period (T4). The primary endpoint is the VAS score. Secondary endpoints are ASES, CMS, UCLA, and the location and size of calcified areas.DiscussionThis study aims to evaluate the efficacy of ESW therapy combined with PRP in treating RCCT. We compare the effects of single and combined treatments to explore their impact on disease symptoms, functional improvement, and calcification regression. This provides a scientific basis for identifying more effective treatment options.Trial registrationClinicalTrials.gov NCT06372600. Registered on April 17, 2024; version 1.

Role of Platelet-Rich Plasma in the Management of Non-obstructive Azoospermia.

Non-obstructive azoospermia (NOA) is a common cause of infertility in males, which is characterized by the absence of sperm in the ejaculate, resulting from impaired spermatogenesis. The primary therapeutic approaches for the management of NOA include testicular sperm extraction, varicocelectomy in case of clinical varicoceles, and hormonal manipulation. While traditional treatments are found to have a limited role in the management of NOA, recent studies have explored the potential of platelet-rich plasma (PRP) as a safer and promising therapeutic option. Autologous PRP preparations are derived from the patient's blood and comprise growth factors and cytokines, promoting tissue repair and regeneration. PRP has a wide range of applications in the medical field, including managing infertility in males and females. This literature review aimed to evaluate the existing evidence on the efficacy and safety of PRP in the management of NOA. After a thorough review of relevant data from observational and experimental studies, the findings of this study suggested that PRP may positively influence spermatogenesis, sperm quality, DNA integrity, and sperm retrieval during assisted reproductive procedures. Further research is needed to establish the optimal PRP preparation, administration method, and long-term benefits. The newer studies shall include a diverse patient population and employ long-term follow-up to assess the durability of any positive effects of PRP treatment. The growing body of evidence regarding the therapeutic potential for NOA in humans offers greater opportunities for men seeking fertility treatment, informing clinical practice, and optimizing the use of PRP.

Effects of intrauterine infusion of autologous platelet-rich plasma gel on endometrial thickness and outcomes of frozen-thawed embryo transfer in women with thin endometrium.

The purpose of this study is to determine whether intrauterine infusion of autologous platelet-rich plasma (PRP) gel increases endometrial thickness (EMT) and improves the outcomes of frozen-thawed embryo transfer (FET) in women with thin endometrium. This study included 111 women (aged 25-44years) who had thin endometrium. All patients had at least one previous cycle canceled because of thin endometrium or previous embryo transfer cycles and an EMT < 7mm. Forty-seven women underwent intrauterine infusion of autologous PRP gel on three occasions during endometrial preparation and the remaining women served as controls. The final EMT was measured by ultrasound before the start of the luteal phase, and FET-related outcome parameters were monitored. Mean EMT was greater in women who received PRP gel than in those who did not (6.7mm vs. 6.3mm, respectively, p < 0.05). FET was attempted in all women. The 47 women who underwent infusion of PRP had a significantly higher pregnancy rate (18 pregnancies (38.3%), with 17 (36.2%) ongoing) compared with 64 control women (ten pregnancies (18.5%), nine (16.7%) ongoing). However, there was no significant reduction in the miscarriage rate. Intrauterine infusion of autologous PRP gel during endometrial preparation for FET cycles can improve the EMT, clinical pregnancy rate, and ongoing pregnancy rate in women with thin endometrium.

Enhancing wound healing in cattle through the application of vitreous humour fluid and platelet-rich plasma

The aim of this work: to examine the impact of applying vitreous humour fluid as well as platelet-rich plasma (PRP) on cattle's wound healing. Twelve dairy cows, randomly divided into three groups, constituted the subjects for this research. Those cows consumed standard quantities—grains; alfalfa; straw—with ad libitum clean water. We collected Vitreous humour fluid from slaughtered cows, storing it at 4°C. Through withdrawing blood from the same cows and separating PRP from plasma, we prepared Autologous PRP. Furthermore, we prepared a mixture of PRP with vitreous humour fluid which has been subsequently applied to wound site. At 7, 14, and 21 weeks, we performed biopsies on the cows for histopathological examination. On day 7, the histopathological examination revealed improved tissue reorganization and proliferation in wounds treated with PRP and vitreous humour fluid. Furthermore, in comparison with the control group--at this same time point--collagen organization has been notably superior. Moving onto day 14: a complete or partial union of wound margins manifested in the two groups treated with PRP and vitreous humour fluid; also, better granulation tissue formation stood out significantly—an indicator that healing progress had been robustly effective. By day 21; complete epithelialization—alongside dense collagen bundles filling the wound site—signified successful healing of wounds treated specifically with the use of vitreous humor fluid. The findings of the presented work indicate that the utilization of vitreous humour fluid and PRP could facilitate the process of wound healing in cattle. Improvements in tissue reorganization, proliferation, and collagen organization were all found. In the process of developing wound healing therapies for cattle, such findings offer useful insights that can be further developed.

Intraovarian Platelet-Rich Plasma Administration for Anovulatory Infertility: Preliminary Findings of a Prospective Cohort Study.

Background/Objectives: Infertility constitutes a significant challenge for couples around the world. Ovarian dysfunction, a major cause of infertility, can manifest with anovulatory cycles, elevated follicle-stimulating hormone levels, and diminished ovarian reserve markers such as anti-Müllerian hormone (AMH) levels or the Antral Follicle Count (AFC). Blood-derived therapies including platelet-rich plasma (PRP) have been used in fertility treatments in women with low ovarian reserve or premature ovarian insufficiency. This prospective clinical cohort study aims to assess the effects of intraovarian PRP therapy on ovarian function in women diagnosed with anovulatory cycles. Methods: The preliminary findings of this prospective cohort study are based on the first 32 patients enrolled. In this study, patients over 40 years old with anovulatory infertility were included. Venous blood samples were collected from each participant for the preparation of autologous platelet-rich plasma (PRP). Each participant received two courses of intraovarian PRP injections using a transvaginal ultrasound-guided approach. Serum levels of reproductive hormones before and after PRP intervention were measured. Results: This study's results demonstrate a significant improvement in ovarian physiology following transvaginal ultrasound-guided PRP infusion. A 75% increase in Antral Follicle Count (AFC) was observed, which was statistically significant. Furthermore, statistically significant reductions in follicle-stimulating hormone (FSH), luteinizing hormone (LH), and prolactin levels were observed. Serum Vitamin D 1-25 levels were substantially increased after the injection. Conclusions: These findings highlight the beneficial impact of intraovarian PRP injection in optimizing ovarian function and other metabolic parameters. However, the published literature on this subject is limited and further clinical studies should be conducted to confirm the role of intraovarian PRP in fertility treatments.

Angiogenic factor-driven improvement of refractory thin endometrium with autologous platelet-rich plasma intrauterine infusion in frozen embryo transfer cycles.

A beneficial effect on endometrial thickness (EMT) and improvement of pregnancy outcome after intrauterine infusion of platelet-rich plasma (PRP) has been suggested. This study assessed the effect of intrauterine PRP infusion on live birth rate and obstetrical outcomes and analyzed cytokines that can potentially improve pregnancy outcomes through PRP. This study was a prospective cohort study conducted in a university hospital fertility center. The study included ninety-one patients who had a history of two or more failed in vitro fertilization (IVF) attempts and refractory thin endometrium that remained unresponsive after at least two conventional treatments for thin endometrium. Patients were treated with an intrauterine infusion of autologous PRP between days 7 and 14 of their hormone replacement therapy-frozen embryo transfer (HRT-FET) cycle. PRP was administered at 3-day intervals until their EMT reached 7mm. After a maximum of three PRP administrations, embryo transfer (ET) was performed. The primary outcome was the live birth rate. Secondary outcomes included the implantation rate and increase in EMT compared to the previous cycle. We compared the cytokines related to angiogenesis in a patient's whole blood (WB) and PRP by utilizing a commercial screening kit. The live birth rate in the PRP treatment cycle was 20.9% (19 of 91 patients), significantly superior to the previous cycle without PRP infusion (p < 0.001). The implantation rate was also significantly higher during the PRP treatment cycle (16.4%) compared to the previous cycle (3.1%) (p < 0.001). The mean EMT post-PRP treatment was 6.1 mm, showing a significant increase of 0.8 mm (p < 0.001). Nonetheless, an increase in EMT was also observed in the non-pregnancy group. No adverse effects were reported by patients treated with autologous PRP. Cytokine array analysis confirmed marked increases in well-known pro-angiogenic factors such as Ang-1, EGF, LAP (TGF-b1), MMP-8, PDGF-AA, and PDGF-AB/PDGF-BB. Intrauterine PRP infusion offers a safe and effective treatment for patients with refractory thin endometrium and implantation failures. The angiogenic cytokines present in PRP are the primary drivers of this improvement.

Platelet-rich Plasma as an Adjuvant Therapy to Crystallized Phenol in the Treatment of Pediatric Pilonidal Sinus Disease: A Prospective Randomized Controlled Trial

ObjectiveThis study aims to evaluate the safety and efficacy of platelet-rich plasma (PRP) as an adjuvant to crystallized phenol (CP) in treating pediatric pilonidal sinus disease (PSD). MethodsA single-center randomized controlled trial was conducted at Istanbul Esenyurt Hospital. Eighty-seven patients aged 0–18 were randomly assigned to two groups: the CP group (n = 42) and the CP + PRP group (n = 45). Upon arrival at the clinic, patients began a regimen of manual shaving and, if necessary, laser epilation every 6–8 weeks. For those with pilonidal abscesses, incision, drainage, and antibiotics were given. The treatment area was sterilized and numbed with local anesthesia. Hair removal and curettage were performed, followed by the application of crystallized phenol. In CP + PRP group, PRP injections were also administered. The procedure concluded with wound dressing and thorough disinfection. The study was registered https://clinicaltrials.gov/ (NCT06324656). ResultsThe CP + PRP group demonstrated significantly shorter healing times (19.4 ± 7.88 days) compared to the CP group (30.7 ± 12.9 days) (p < 0.001). The cosmetic score was higher in the CP + PRP group (7.42 ± 1.61) than in the CP group (6.11 ± 1.88, p = 0.001). CP + PRP group had lower VAS scores at measured all-time points after applications (p < 0.05 for each). Complications were comparable between the groups, with no significant differences in bleeding, infections, or skin burns (p > 0.05 for each comparison). No difference was found between groups in terms of total complication rate (p = 0.398). The success rate was higher in CP + PRP group (98%; n = 44) compared to CP group (86%; n = 36) (p = 0.039). Recurrence rates were lower in CP + PRP group (2%; n = 1) than CP group (14%; n = 6) (p = 0.039). ConclusionThe autologous PRP injection in pediatric PSD is safe. The addition of PRP to CP treatment for pediatric PSD significantly improves healing time, cosmetic outcomes, and overall success rates without increasing complication rates. This combined approach offers a promising alternative for effective and efficient treatment of PSD in children. Type of the studyRandomized controlled trial. Level of evidenceLevel I

Efficacy of platelet-rich plasma in the treatment of thin endometrium: a meta-analysis of randomized controlled trials

BackgroundThin endometrium (TE) is a common cause of female infertility in clinical practice. Platelet-rich Plasma (PRP) therapy becomes a novel treatment for thin endometrium; however, its clinical application remains controversial. This meta-analysis aims to evaluate the therapeutic effects of intrauterine autologous PRP infusion in women with thin endometrium through relevant randomized controlled trials (RCTs).MethodsWe systematically searched studies published in English from inception until June 2024 in databases such as PubMed, The Cochrane Library, Embase, Web of Science, and MEDLINE. Search terms included “Platelet-Rich Plasma,” “thin endometrium,” “endometrial thickness,” “infertility,” “pregnancy,” “reproduction,” and “adverse reactions”. RCTs identified through the search were subjected to systematic review and meta-analysis, and data were analyzed using fixed-effects or random-effects models based on heterogeneity.ResultsEight RCTs involving 678 patients with thin endometrium were included. Patients receiving PRP infusion demonstrated significantly superior outcomes compared to the control group in endometrial thickness (MD: 1.23, 95%CI: 0.87 to 1.59, P = 0.000), clinical pregnancy rate (RR: 2.04, 95%CI: 1.52 to 2.76, P = 0.000), live birth rate (RR: 2.46; 95%CI: 1.57 to 3.85, P = 0.000), cycle cancellation rate (RR: 0.46, 95%CI: 0.23 to 0.93, P = 0.000), and embryo implantation rate (RR: 2.71; 95%CI: 1.91 to 3.84, P = 0.000). There were no statistically significance in spontaneous abortion rate (RR: 0.85, 95%CI: 0.40 to 1.78, P = 0.659), chemical pregnancy rate (RR: 1.84, 95%CI: 0.72 to 4.72, P = 0.204) and endometrial vascular improvement rate (RR: 1.10; 95%CI: 0.89 to 1.38, P = 0.367) between the two groups. The limitations of this study includes that, we only included single lauguage for literature research, the sample size and heterogeneity which could cause criteria bias.ConclusionIntrauterine PRP infusion may be an effective and safe treatment for women with thin endometrium. Further high-quality, large-sample, randomized controlled trials are needed to validate the reliability of our results.Trial registrationThe review protocol is registered on PROSPERO with registration number CRD42023490421, and no modifications were made to the information provided at registration.

The growth factor content as an indicator of platelet counts in platelet-rich plasma

BackgroundPlatelet contains growth factors that enhance tissue repair mechanisms, including epidermal growth factor (EGF), platelet-derived growth factor (PDGF-AA and −AB), and transforming growth factor (TGF)-β. Autologous platelet-rich plasma (PRP) has been shown to significantly improve the treatment of tendon injuries compared with hyaluronic acid and placebo. The topic of agreement between platelet concentrations and growth factors has been covered in some previous studies, but growth factor levels did not correlate well with platelet concentrations. MethodIn this study, autologous PRP was prepared by concentrating platelets through a J6-MI centrifuge. The automatic hematology analyzer Sysmex XN-20 was used to analyze the platelet concentration in PRP, and the PRP growth factors were determined by ELISA, including PDGF, transforming growth factor- β1 (TGF-β1), and EGF. Statistical analysis was conducted on data from 107 patients who received autologous PRP using Pearson correlation analysis. ResultsPearson correlation analysis revealed PDGF, TGF, and EGF had a strong positive correlation with the platelet concentration of the final PRP product (r = 0.697, p < 0.0001; r = 0.488, p < 0.0001; r = 0.572, p < 0.0001, respectively) ConclusionsThere was a strong positive correlation between the concentration of platelets in the final PRP product and the levels of PDGF-AB, TGF-β, and EGF. These results suggested straightforward and cost-effective growth factor tests can provide valuable information about platelet content in PRP.

Comparison of the Effectiveness of Injection Laryngoplasty Using Autologous Platelet-Rich Plasma or Autologous Fat With Platelet-Rich Fibrin for the Treatment of Patients With Unilateral Vocal Fold Paralysis

ObjectivesUnilateral vocal fold paralysis (UVFP) can be idiopathic or a result of surgery, cancer or neurological disease. The most common presentation is dysphonia, which causes problems with communication, and can lead to anxiety and depression. Injection laryngoplasty (IL) is a current means of treatment, but there have been few studies to determine the optimal material to use. Therefore, we aimed to compare the use of autologous platelet-rich plasma and autologous fat with platelet-rich fibrin for injection laryngoplasty under local anesthesia and general anesthesia respectively. Study designA prospective randomized controlled study was conducted at the Otolaryngology-Head and Neck Surgery Department, Ramathibodi Hospital, Faculty of Medicine, Mahidol University. MethodsThirty-four patients with UVFP were recruited. All met the inclusion criteria and were randomized to two groups, to be treated using autologous platelet-rich plasma under local anesthesia or autologous fat with platelet-rich fibrin under general anesthesia. The primary outcome was the mean difference in the Voice Handicap Index (VHI) between the groups at 1- and 6-months post. The secondary outcomes were the mean differences in voice acoustic parameters [maximum phonation time (MPT), jitter, shimmer, and harmonic to noise ratio (HNR)] between the groups at these time points. ResultsAt the measured time points, there were no significant differences in the mean VHIs (P=0.462), MPT (P=0.79), jitter (P=0.234), shimmer (P=0.863), or HNR (P=0.096) between the groups. Few people who underwent the procedure under local anesthesia developed laryngospasm while some of those in the fat with platelet-rich fibrin developed postoperative abdominal contusion or hematoma which resolved spontaneously. ConclusionsWe have found no difference in the effectiveness of IL using autologous platelet-rich plasma under local anesthesia or autologous fat with platelet-rich fibrin performed under general anesthesia in patients with UVFP. No serious or life-threatening complications were found in both groups.

Platelet-rich Plasma as a Treatment Modality for Wound Healing: An Open Randomized Controlled Trial.

Unlike conventional management protocols, like dressings, wound debridement, and skin grafting that do not facilitate healing, platelet-rich plasma (PRP) directly feeds growth factors to enhance wound healing. An open randomized controlled trial with a sample size of 60 was carried out on patients with a wound surface area ≤10 × 10 cm2 with 30 participants in each. The PRP group (PRPG) was given autologous PRP using the infiltration technique, and the control group (CG) was treated using conventional dressings. The PRPG showed a reduction from 1421 to 661 mm2, whereas the CG showed a decrease from 1710 to 1478 mm2 on day 30. The PRP group had a decreased hospital stay (n = 14) in comparison to the CG (n = 17.5 days). The rate of epithelization (mean) is 11.12 mm2/day in the CG and 34.026 mm2/day in the PRPG. Platelet-rich plasma (PRP) can be considered a primary modality for wound management because of decreased length of hospital stay, analgesic effects, fastened rate of healing, and absence of adverse reactions.

Augmentation of Autologous Platelet-Rich Plasma in Hip Salvage in Stages I and II of Avascular Necrosis: Randomized Blinded Trial Comparing 3 Surgical Techniques in 82 Patients.

Avascular necrosis of the femoral head is common in routine orthopedic clinics. The challenge arises in managing early stages (I and II) without obvious radiological evidence. Authors explore this naïve research area by comparing surgical procedures in early AVN patients. A prospective multicentric study was performed from November 2020 to February 2023 on 82 patients treated with surgical decompression and adjuvants, concerning the defined inclusion and exclusion criteria. Radiopacity and intraosseous edema resolution and THA conversion rates were assessed. Hip pain VAS, groin/thigh pain, difficulty in sitting cross-legged incidence, pain-free walking distance, Harris hip scores, 30-s chair test, and complications were noted. Among 82 patients, the mean age was 28.46years. Male:female ratio of 3.9:1. 8.5% had bilateral affection and 48.78% had a positive family history. 93.90% presented with groin pain and difficulty in sitting cross-legged, restricted hip movements in 85.3%, and thigh pain in 54.87%. Harris hip scored worst in Group 3 followed by Group 2 and Group 1. 63.41% and 36.58% of patients had Grades 1 and 2 AVN, respectively. At 1week post-operatively, 96.3% and 93.9% of patients were relieved from groin and thigh pain, respectively (p < 0.001); the trend being Group 3 > Group 2 > Group 1. Hip pain VAS followed a similar trend. At 4weeks, Harris hip scores improved in Group 3 > Group 2 > Group 1. At 6months, the trend was Group 2 > Group 3 > Group 1. Group 3 had better 30-s chair test results, pain-free walking distance, and longer cross-legged sitting time. Complication rate of 3.6%. 6.09% of patients underwent THA later. Sclerotic patch and marrow edema resolution early in Group 3, i.e., 46 and 31days respectively, followed by Group 2 and Group 1. In Stages I and II AVN, biplanar core decompression (double) and intraosseous PRP injection is a promising salvage option; patients have better early hip scores (4weeks), and early groin and thigh pain recovery. Patients treated early have better clinical and radiological recovery.

Association Between Spinopelvic Parameters and Clinical Outcomes of Patients Treated With Transforaminal Platelet-Rich Plasma Injections for Lumbar Disc Prolapse.

Introduction Lumbar disc prolapse mainly occurs in the regions involving the L4-L5 and L5-S1 vertebrae. In this context, the significance of spinopelvic parameters becomes notably prominent. Non-invasive management of lumbar disc prolapse encompasses medicinal therapy, physical therapy, exercise, and epidural injections. Because of its autologous blood origin, platelet-rich plasma (PRP) therapy has minimal risks associated with immunogenic reactions and side consequences. We evaluated the extent of pain reduction and improvement of functional outcomes in patients having discogenic low back pain with modified spinopelvic parameters before and after undergoing transforaminal autologous PRP injection interventions. Methodology An observational study was conducted between September 2022 and August 2023 on 100 patients with low back pain for six months.The study populationcomprised patients whodid not respond to conservative treatment; they were recruited from the orthopaedicward of the emergency medicine department and outpatient department at the RLJalappa Hospital and Research Centre affiliated with Sri Devaraj Urs Medical College in Kolar, India. Every patient received a thorough evaluation that comprised an extensive medical history, a clinical examination, and imaging of the lumbosacral spine from both the front and side views. After obtaining the patient's consent and confirming their readiness for surgery, a PRPinjection was administered. The injection technique followed the standardized protocol and was performed by an experienced spine surgeon in collaboration with orthopaedic residents. Pain evaluations utilizing the Visual Analog Scale (VAS) and assessment of functional outcomes using the Oswestry Disability Index (ODI) scale were conducted before and after PRPinjections at the one- and six-month follow-ups. Results The average age of the study participants was 41.82 ± 5.0 years, with 55% of them being male. A total of 39% of study samples exhibited an increased angle in spinopelvic parameters. The independent t-test revealed a statistically significant difference in the mean score of back pain, limb pain, and ODI score between patients with increased and decreased angles of spinopelvic parameters before and after injection (p=0.0001). The severity of back pain, leg pain, and functional disability was significantly reduced in patients with increased angles of spinopelvic parameters following PRP injections at the one-month follow-up (p=0.0001). However, at the six-month follow-up, patients encountered recurring symptoms and worsening back pain, leg pain, and functional disability compared to the one-month follow-up. Conversely, the severity of back pain, leg pain, and functional disability has been markedly reduced in the patients with lower spinopelvic parameter angles following PRP injections at one month (p=0.0001) and six months (p=0.0001) compared to pre-injections. Conclusion During the long-term follow-up, subjects with elevated spinopelvic parameter angles reported a lower level of improvement in functional outcome, leg pain, and back pain. The impact of spinopelvic parameterson back pain severity and functional disability is substantial, significantly affecting the functional outcome of patients with lumbar disc prolapse.

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

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